Successful retrieval of a firmly stuck rotablator burr by using a modified STAR technique

Rotablator burr entrapment occurring during rotational atherectomy is a rare but serious complication that can lead to coronary occlusion and require emergency cardiac surgery. Although several bailout techniques for stuck burrs have been proposed, no definitive methods for removal have been established. We report here a difficult case of a stuck rotablator burr, in which various techniques failed to retrieve the burr. It was ultimately removed using the subintimal tracking and reentry (STAR) technique with a 3-g tapered tip hydrophilic wire. This modified STAR technique, which was originally developed for percutaneous coronary intervention for chronic total occlusion, may be useful as a bailout technique in patients with a firmly stuck rotablator burr that cannot be removed by using standard procedures.