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Rotational Atherectomy Burr Entrapment: Its Mechanism and its Management

Andreas Y Andreou1, Efstratios Trogkanis1

  • 1Department of Cardiology, Limassol General Hospital, Limassol, Cyprus; Department of Basic and Clinical Sciences, University of Nicosia Medical School, Nicosia, Cyprus.

JACC. Case Reports
|April 18, 2025
PubMed

Insights

Rotational atherectomy can cause burr entrapment, a serious complication. This case report details successfully treating this issue during a percutaneous coronary intervention for complex bifurcation stenosis.

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.

Keywords:
burr entrapmentcalciumcomplicationsintravascular ultrasoundpercutaneous coronary interventionrotational atherectomy

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