# The limited antegrade subintimal tracking technique to retrieve a trapped rotablator burr: a case report

## TL;DR

This case report describes a successful method to retrieve a trapped rotablator burr during a heart procedure using a specialized angioplasty technique.

## Contribution

The paper introduces a practical, percutaneous technique for retrieving a trapped Rota burr using limited antegrade subintimal tracking.

## Key findings

- Limited antegrade subintimal tracking enabled successful retrieval of a trapped Rota burr in a calcified coronary artery.
- Subintimal dilatation helped dislodge the burr by crushing plaque externally.
- The case highlights the importance of starting rotablation proximal to the lesion to avoid entrapment.

## Abstract

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.