Maznyczka Annette, Mozid Abdul
Swiss Cardiovascular Center, Bern University Hospital, Freiburgstrasse 18, Bern CH-3010, Switzerland.
Leeds General Infirmary, Leeds, UK.
Eur Heart J Case Rep. 2024 Jan 25;8(2):ytae044. doi: 10.1093/ehjcr/ytae044. eCollection 2024 Feb.
Burr entrapment is a rare, but potentially serious complication of rotablation. This report describes the percutaneous options available for Rota burr retrieval.
A 62-year-old Caucasian man with stable angina presented for percutaneous coronary intervention. Attempted rotablation with a 1.75 mm burr resulted in Rota burr entrapment, in the heavily calcified proximal right coronary artery. A chronic total occlusion angioplasty technique (limited antegrade subintimal tracking) was successfully used to remove the trapped Rota burr, by enabling subintimal dilatation to externally crush plaque and dislodge the burr. The angioplasty procedure was then completed using the wire that had a short subintimal passage, before re-entering the true lumen.
The mechanism for Rota burr entrapment, in this case, was initiating rotablation on the heavily calcified lesion and not more proximal to allow a pecking motion. The learning points are (i) to start the rotablator several millimetres proximal to the actual lesion, and (ii) if unable to wire alongside a trapped Rota burr in the true lumen, then subintimal crossing and balloon dilatation in the subintimal space may work to dislodge the burr.
旋磨头嵌顿是旋磨术一种罕见但可能严重的并发症。本报告描述了可用于取出旋磨头的经皮操作方法。
一名62岁患有稳定型心绞痛的白种男性接受经皮冠状动脉介入治疗。使用1.75毫米旋磨头进行旋磨时，旋磨头在严重钙化的右冠状动脉近端发生嵌顿。一种慢性完全闭塞血管成形术技术（有限的正向内膜下跟踪）成功用于取出被困的旋磨头，通过内膜下扩张从外部挤压斑块并使旋磨头移位。然后使用在短暂内膜下穿行后重新进入真腔的导丝完成血管成形术。
在这种情况下，旋磨头嵌顿的机制是在严重钙化病变上开始旋磨，而不是在更靠近近端处以允许啄击动作。经验教训是：（i）在实际病变近端几毫米处启动旋磨器；（ii）如果无法在真腔内沿着被困旋磨头置入导丝，那么在内膜下空间进行内膜下穿行和球囊扩张可能有助于使旋磨头移位。
