Rotational Atherectomy Burr Entrapment: Its Mechanism and its Management

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Surgery

Background:

• Rotational atherectomy is a common procedure for treating calcified coronary lesions.
• Burr entrapment is a rare but serious complication of rotational atherectomy.
• Bifurcation lesions, especially in the left anterior descending coronary artery, pose significant challenges in percutaneous coronary intervention.

Purpose of the Study:

• To illustrate a rare complication of rotational atherectomy: burr entrapment.
• To describe the management of burr entrapment in a complex coronary bifurcation lesion.
• To highlight the Kokeshi phenomenon as a potential cause of burr entrapment.

Main Methods:

• A case report of an elderly patient with severe calcified left anterior descending coronary artery/diagonal artery bifurcation stenosis and aortic valve stenosis.
• Percutaneous coronary intervention using rotational atherectomy with a 1.25-mm burr.
• Management of immediate burr entrapment distal to the stenosis.

Main Results:

• Successful percutaneous treatment of burr entrapment.
• The complication was attributed to the Kokeshi phenomenon.
• The patient underwent successful percutaneous coronary intervention despite the complication.

Conclusions:

• Burr entrapment is a serious complication of rotational atherectomy that can occur in complex calcified lesions.
• The Kokeshi phenomenon may contribute to burr entrapment.
• Percutaneous techniques can be employed to successfully manage burr entrapment.