Successful Retrieval of a Stalled Rotational Atherectomy Burr.
DOI:
https://doi.org/10.58889/PJCVI.5.39.45Keywords:
Percutaneous Coronary Intervention, Rotational Atherectomy, Drug Eluting Stent, Stalled Burr, Calcified LesionAbstract
Background: Rotational atherectomy (Rotablation, RA) is a well-established and time-tested technique to treat calcified coronary arteries through plaque modification. This can be achieved by using Rota burrs of different sizes revolving at speeds in excess of 150,000 revolutions per minute (rpm). A stalled burr is perhaps the most feared complication of this technique.
Case Presentation: We present the case of a 63-year old patient who presented with unstable angina. His right coronary artery was severely calcified with two severe discrete stenosis in the proximal and distal vessel respectively. The left coronary vessels were unobstructed.
Results: We elected to perform up-front RA using a 1.25 mm burr at 180,000 rpm. However, after the first pass across the proximal lesion, the burr came to an abrupt halt. Initially, the burr was pulled manually which proved futile. We then cut the burr shaft and rota wire simultaneously near the advancer hub and stripped off the outer plastic coating. Subsequently, another wire was introduced into the same guide catheter and a 2.0 x 15 mm balloon was inflated across the stalled burr which was successfully released and retrieved. The case was successfully completed with the implantation of two drug eluting stents.
Conclusion: We have described a case report of a stalled burr which was retrieved through the same guide catheter by cutting through and stripping off the outer coating of a burr shaft. To the best of our knowledge, we believe this to be the first described case report from Pakistan describing this novel technique to successfully retrieve a stalled burr percutaneously.
