title: Mechanism and management of burr entrapment: A nightmare of interventional cardiologists.
abstract: Entrapment of the burr within calcified lesion is an uncommon, but serious complication during rotational atherectomy and usually needs surgical retrieval. We report a case series of this complication and also review the possible mechanisms, such as kokesi phenomenon or insufficient pecking motion with decreased rotational speed. We also review the potential techniques ever proposed to rescue this complication percutaneously, including simple manual traction, balloon dilation to release the trap, snaring the burr as distal as possible for forceful local traction and wedging the burr with a child catheter to facilitate retrieval. Gentle pecking motion of the burr for sufficient ablation and shortening the run less than 15 s may avoid such complications. Interventional cardiologists using the rotablator should be familiar with the tips and tricks to avoid and rescue this complication.
authors.affiliation: The First Cardiovascular Division, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, No. 199, Tung-Hwa North Road, Taipei, Taiwan, China.
authors.forename: Chia-Pin
authors.initials: CP
authors.lastname: Lin
authors.forename: Ji-Hung
authors.initials: JH
authors.lastname: Wang
authors.forename: Wen-Ling
authors.initials: WL
authors.lastname: Lee
authors.forename: Po-Ming
authors.initials: PM
authors.lastname: Ku
authors.forename: Wei-Hsian
authors.initials: WH
authors.lastname: Yin
authors.forename: Ten-Ping
authors.initials: TP
authors.lastname: Tsao
authors.forename: Chi-Jen
authors.initials: CJ
authors.lastname: Chang
keywords: Complication; Percutaneous coronary intervention; Rotational atherectomy