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Rotablator Burr Disconnection and a Gap Predictor.

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Rotational atherectomy (Rotablator) burr disconnection is a rare complication. Observing a "blank sign" gap before disconnection may signal a need to stop the procedure and inspect the device.

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Area of Science:

  • Cardiovascular Interventions
  • Medical Device Complications
  • Interventional Cardiology

Background:

  • Rotational atherectomy is a key procedure for treating complex coronary artery disease.
  • Burr disconnection from the drive shaft is an exceptionally rare but serious complication.
  • Understanding the causes and predictors of burr disconnection is crucial for patient safety.

Observation:

  • Six cases of rotational atherectomy burr disconnection were identified over 16 years.
  • Disconnections occurred in the right coronary artery (4 cases) and left circumflex artery (2 cases).
  • In 4 cases, burr disconnection happened within a previously placed stent.

Findings:

  • A "blank sign" (gap between burr and drive shaft) was observed preceding disconnection in some cases.
  • Guidewire fracture occurred in 2 cases, requiring emergency surgery.
  • In 4 cases, the guidewire remained intact, allowing successful burr retrieval.

Implications:

  • The "blank sign" may serve as an early warning for impending burr disconnection.
  • Immediate procedural cessation and device inspection are recommended upon observing the "blank sign".
  • This finding can help refine safety protocols for rotational atherectomy procedures.