Mechanism and management of burr entrapment: A nightmare of interventional cardiologists
Case 1 was a 60-year-old lady with lupus nephritis complicated with end stage renal disease under regular hemodialysis for decades. Rotablation for the heavily calcified left anterior decending artery (LAD) () was performed by 1.5 mm rotablator burr initially and followed by another 1.75 mm one. During the pecking motion of the 1.75 mm burr at 160,000 r/min, it was suddenly stuck at the distal LAD and could not be activated even after intracoronary nitroglycerin injection (). A hydrophilic Fielder FC wire (Asahi Intech, Japan) and a stiff Conquest wire (Asahi Intech, Japan) were tried to pass the entrapped burr for dilation of the segment that entrapped it, but both failed. The burr was re-activated after increased the speed up to 180,000 r/min and could be advanced distally followed by successful retrieval.