Rotational Atherectomy as Endovascular Haute Couture: A Road Map of Tools and Techniques for the Interventional Management of Burr Entrapment

Abstract

Rotational atherectomy (RA) is used as a debulking technique prior to stenting in some specialized cardiac centers for calcified coronary lesions amenable to percutaneous coronary intervention (PCI). A specific possible complication, burr entrapment, is unusual but carries serious risks and may sometimes necessitate surgery as a rescue procedure. However, different modalities using a percutaneous approach were proposed as a bail-out. We aim to propose a framework for possible management for trapped RA burr. A literature review of the most relevant cases of entrapped burr during PCI was performed. Twelve cases were reported and different solutions were discussed. Surgery was needed in only 1 patient to retrieve the trapped burr, and in all the other cases, different percutaneous solutions were successful to retract the trapped device. These cases illustrate that burr entrapment during RA, albeit rare, may occur and may transform a relatively simple PCI to a procedure failure. Although prevention is better than treatment, the operators should be aware of such serious complication and they should keep in mind that various possible percutaneous solutions may be successful to retrieve the burr and to avoid surgery.