Coronary rota burr / shaft disconnection
Coronary Rotablator complications
Despite the mechanical complexity of the Rotablator system, device failure is a rare event. However certain complications may occur during the rotational atherectomy (RA) procedure including slow or no reflow, coronary spasm, distal embolisation, coronary dissection, coronary perforation, guidewire (GW) fracture, or the disconnection of the drive shaft and entrapment of burr. As the majority of device failure cases are due to the use of this device outside standard procedures, the goal of this section is to increase awareness of the proper clinical approach to RA and thus be able to quickly identify the origin of the complication and be prepared for treating it.
Table of content
- Introduction
- Management overview
- Additional links
Introduction
In the case of rota burr or shaft disconnection, the burr has become stuck and when an attempt is made to take it out, the broken shaft could be either within or outside the guiding catheter.
The first step in dealing with this complication consists of inspecting the shaft using panning fluoroscopy to determine where the disconnect has occurred. Next, depending on what is found, several techniques may be employed including a balloon trapping technique if the break is within the guiding catheter or, if the break is outside the guiding catheter, the snaring technique could be appropriate. Learn which tools have proven useful in either event, and be aware of the danger inherent in snaring, where fracture can occur.
A conservative approach is not recommended, and we should always be aware that surgery might be necessary.
Management overview
- Balloon trapping technique: Balloon trapping technique, which can be challenging is explained here.
- Snare technique - Trifold: The snare technique is often used for the retrieval in cases of rota shaft fracture, but involves several decisions and technical steps. Discover more about this technique here.
- Snare technique: GooseNeck: The snare technique is often used for the retrieval in cases of balloon shaft fracture, but involves several decisions and technical steps. Find out more about this technique here.
Additional links
References - Rotational atherectomy complications
Clinical cases will become available shortly!
Disclaimer
This case report does not reflect the opinion of PCR or PCRonline, nor does it engage their responsibility.
