Successful retrieval of a stuck rotablator burr and PTCA by using a guideliner catheter at complex LAD lesion: A case report

Background: An entrapped rotablator burr is a rare but severe complication of Rotational Atherectomy (RA), and surgical removal is invasive and takes several hours. Therefore, a less invasive measure is necessary for this complication. Case summary: A 54-year-old man with Diabetes Mellitus (DM) and hypertension revealed chronic total occlusion in the proximal LAD In-Stent Restenosis (ISR). The left coronary ostium was engaged with 7Fr EBU. A Runthrough was inserted into D1, and the XTR guidewire was inserted into distal LAD using Guideliner catheter. Because of the severe angulated calcified lesion at the proximal LAD, the 1.0 balloon could not pass the lesion, so we performed rotablation. The burr suddenly became trapped within the calcified lesion at the distal angulated edge. We performed a gentle manual retraction of the rota and attempted to insert another guidewire to alongside the burr for balloon dilation to free the burr, but wiring failed. Then, we cut off the drive sheath of the rota, inserted a 5.5 Fr Guideliner catheter through the remaining system and fixed the catheter tip near the entrapped rotablator burr by pushing and pulling the rotablator at the same time. Finally the rota system was removed successfully, but the burr was nearly detached from the rota wire during retraction. Discussion: We might get an information of the degree of fibrous and angulated calcification by MDCT before PCI and this will be helpful to predict the possibility of bur stuck. A large size sheath and femoral approach may be preferable.