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旋磨钻断开连接与间隙预测器

Rotablator Burr Disconnection and a Gap Predictor.

作者信息

Yamaji Kazunori, Tanaka Kota, Yamasaki Tomohiro, Sudo Kiwamu, Kinoshita Yasusuke, Sumiyoshi Akinori, Watanabe Satoshi, Iwamoto Mutsumi, Watanabe Heitaro, Okamura Atsunori

机构信息

Cardiovascular Center, Sakurabashi Watanabe Advanced Healthcare Hospital, Osaka, Japan.

Cardiovascular Center, Sakurabashi Watanabe Advanced Healthcare Hospital, Osaka, Japan.

出版信息

JACC Case Rep. 2025 Aug 27;30(25):104403. doi: 10.1016/j.jaccas.2025.104403. Epub 2025 Jul 18.

DOI:10.1016/j.jaccas.2025.104403
PMID:40682583
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12402349/
Abstract

Disconnection of the rotational atherectomy (Rotablator) burr during rotational atherectomy is an extremely rare complication, the precise etiology of which remains unclear. At our institution, we have encountered 6 cases of burr disconnection over a period of 16 years. The target vessels were the right coronary artery in 4 cases and the left circumflex artery in the remaining 2 cases. Burr disconnection occurred within a stent in 4 of these cases. Two cases were accompanied by guidewire fracture, necessitating emergency surgical intervention, whereas the guidewire remained intact in the remaining 4 cases, allowing successful retrieval of the burr by pulling the guidewire. Immediately before burr disconnection, a gap between the burr and the drive shaft was occasionally observed, which we termed the "blank sign." This phenomenon may indicate increased risk of burr disconnection, warranting immediate cessation of the procedure and thorough inspection of the device.

摘要

旋磨术（Rotablator）过程中旋磨头断开是一种极其罕见的并发症，其确切病因尚不清楚。在我们机构，16年间我们遇到了6例旋磨头断开的病例。目标血管为4例右冠状动脉和其余2例左旋支动脉。其中4例旋磨头断开发生在支架内。2例伴有导丝断裂，需要紧急手术干预，而其余4例导丝保持完整，通过拉动导丝成功取出旋磨头。就在旋磨头断开之前，偶尔会观察到旋磨头与驱动轴之间有间隙，我们称之为“空白征”。这种现象可能表明旋磨头断开风险增加，应立即停止操作并对设备进行彻底检查。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e0e3/12402349/7b5115192c3a/gr8.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e0e3/12402349/bfb01be8562d/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e0e3/12402349/90d1a78bd781/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e0e3/12402349/7df863555d67/gr6.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e0e3/12402349/7b5115192c3a/gr8.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e0e3/12402349/0c51e875b94f/ga1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e0e3/12402349/c961cdc826ea/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e0e3/12402349/d5e56c423a7a/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e0e3/12402349/be8ad244615a/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e0e3/12402349/bfb01be8562d/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e0e3/12402349/90d1a78bd781/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e0e3/12402349/7df863555d67/gr6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e0e3/12402349/f91760a69f7e/gr7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e0e3/12402349/7b5115192c3a/gr8.jpg

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引用本文的文献

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本文引用的文献

1
Clinical expert consensus document on rotational atherectomy from the Japanese association of cardiovascular intervention and therapeutics: update 2023.日本心血管介入治疗学会旋磨术临床专家共识文件：2023 年更新版。
Cardiovasc Interv Ther. 2023 Apr;38(2):141-162. doi: 10.1007/s12928-022-00906-7. Epub 2023 Jan 16.
2
A rare case of Rotablator driveshaft fracture and successful percutaneous retrieval of a trapped burr using a balloon and GuideLiner.一例罕见的旋磨器驱动轴断裂及使用球囊和引导鞘成功经皮取出嵌顿毛刺的病例。
Cardiovasc Interv Ther. 2017 Jul;32(3):294-298. doi: 10.1007/s12928-016-0423-z. Epub 2016 Aug 31.
3
Emergent coronary artery bypass grafting after a broken Rotablator drive-shaft.
Interact Cardiovasc Thorac Surg. 2010 Nov;11(5):614-6. doi: 10.1510/icvts.2010.238055. Epub 2010 Aug 4.