# The Safety and Efficacy of Resolving Burr Entrapment by the Ping-Pong and Mother-in-Child Techniques

## TL;DR

This paper presents two effective techniques for safely retrieving a stuck burr during a heart procedure.

## Contribution

The ping-pong and mother-in-child techniques are introduced as secure methods for resolving burr entrapment.

## Key findings

- The ping-pong technique uses two guide catheters to retrieve the entrapped burr.
- The mother-in-child technique involves deep engagement of a guide extension catheter for manual traction.
- Both methods are shown to be highly effective and safe in resolving burr entrapment.

## Abstract

Burr entrapment is a serious risk when performing rotational atherectomy on specific anatomical features of lesions such as tortuosity, calcification, and acute angulation. This occurrence, known as the Kokeshi phenomenon in Japanese, is caused by the burr’s proximal section being unable to ablate while pulling back the burr, leaving the distal end of the burr covered in diamond crumbs capable of lesion ablation following rotation. There are reports of different approaches used to retrieve an entrapped rotablator burr. In this case, we demonstrate that the ping-pong and mother-in-child techniques, which use separate guide catheters to engage the same coronary artery wiring across the lesion afterward and deep engagement of guide extension catheter manual traction, are highly effective and secure methods for retrieval.