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. 2013 Sep;10(3):230-4.
doi: 10.3969/j.issn.1671-5411.2013.03.013.

Mechanism and management of burr entrapment: A nightmare of interventional cardiologists

Chia-Pin Lin  1 , Ji-Hung Wang, Wen-Ling Lee, Po-Ming Ku, Wei-Hsian Yin, Ten-Ping Tsao, Chi-Jen Chang
Affiliations

Mechanism and management of burr entrapment: A nightmare of interventional cardiologists

Chia-Pin Lin et al. J Geriatr Cardiol. 2013 Sep.

Abstract

Entrapment of the burr within calcified lesion is an uncommon, but serious complication during rotational atherectomy and usually needs surgical retrieval. We report a case series of this complication and also review the possible mechanisms, such as kokesi phenomenon or insufficient pecking motion with decreased rotational speed. We also review the potential techniques ever proposed to rescue this complication percutaneously, including simple manual traction, balloon dilation to release the trap, snaring the burr as distal as possible for forceful local traction and wedging the burr with a child catheter to facilitate retrieval. Gentle pecking motion of the burr for sufficient ablation and shortening the run less than 15 s may avoid such complications. Interventional cardiologists using the rotablator should be familiar with the tips and tricks to avoid and rescue this complication.

Keywords: Complication; Percutaneous coronary intervention; Rotational atherectomy.

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Figures

Figure 1.
Figure 1.. Heavily calcified left anterior descending artery (arrows) (A) with entrapped burr at middle to distal LAD (B).
Figure 2.
Figure 2.. Heavily calcified left anterior descending artery (arrows) with entrapped burr at distal.
Figure 3.
Figure 3.. Long and angulated left anterior descending artery with calcification (arrows) and an entrapped burr after the angulation.
Figure 4.
Figure 4.. Entrapped burr at distal left anterior descending artery and rescued by balloon inflation (arrow) at the proximal stenotic lesion.
Figure 5.
Figure 5.. The left circumflex artery was heavily calcified (arrows) and the burr was entrapped at middle part.
See this image and copyright information in PMC

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