Rotablator Burr Disconnection and a Gap Predictor

Disconnection of the rotational atherectomy (Rotablator) burr during rotational atherectomy is an extremely rare complication, the precise etiology of which remains unclear. At our institution, we have encountered 6 cases of burr disconnection over a period of 16 years. The target vessels were the right coronary artery in 4 cases and the left circumflex artery in the remaining 2 cases. Burr disconnection occurred within a stent in 4 of these cases. Two cases were accompanied by guidewire fracture, necessitating emergency surgical intervention, whereas the guidewire remained intact in the remaining 4 cases, allowing successful retrieval of the burr by pulling the guidewire. Immediately before burr disconnection, a gap between the burr and the drive shaft was occasionally observed, which we termed the "blank sign." This phenomenon may indicate increased risk of burr disconnection, warranting immediate cessation of the procedure and thorough inspection of the device.