Coronary stuck burr (in or beyond the stenosis): Kokeshi phenomenon
Coronary Rotablator complications
Burr entrapment is a rare and challenging complication of rotablation. This section looks at several techniques employed today to retrieve an entrapped burr including a retrieval method involving a guide extension catheter combined with a snare which could be used to successfully respond to this complication.
Table of content
- Introduction
- Management overview
- Additional links
- Case library
Introduction
Burr entrapment is seen to occur for several reasons: if a burr slips across the lesion without the burring (the coefficient of friction is less at high speed than at the rest), the ledge of the calcium behind the elliptical burr causes a Kokeshi phenomenon, or the burr may get entrapped in the tortuous segment of the lesion. While a surgeon should be called immediately, several approaches are available. A guide extension catheter can be passed over the shaft of the entrapped burr, a second guidewire and balloon can be used to attempt to release the burr.
Management overview
- Balloon trapping technique: One of some techniques is to use a 2nd wire and to inflate a balloon.
- Snare technique: There are several techniques typically employed to retrieve a stuck rotablator burr. The snare can be be attempted but not in first attention.
- Mini star technique: The mini-STAR technique is a promising bailout strategy for the management of entrapped burr in the event of complications, achieving a high procedural success rate and low occurrence of procedural adverse events.
Additional links
References - Rotational atherectomy complications
Case library
Case study on the knuckle wire technique by Benjamin Faurie: Stuck Rota burr
Consult this step-by-step algorithm for the management of an entrapped rotablation burr from the EuroIntervention Journal: Stuck rotablator
More 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.
