# Guide Tip Damage Due to Rotablation

## TL;DR

A rare complication of guide tip damage during a heart procedure is reported, with suggestions to prevent future issues.

## Contribution

The paper identifies potential causes of guide tip damage during rotablation and suggests a preventive measure.

## Key findings

- A 77-year-old patient experienced partial loss of a guide tip during a coronary procedure.
- Insufficient coaxiality and force application may contribute to guide tip damage.
- Positioning the burr outside the guide may prevent similar complications.

## Abstract

The rotational atherectomy system can effectively debulk calcified coronary lesions. However, rare complications specific to that system have been reported.

A 77-year-old man with a heavily calcified lesion in the right coronary artery (RCA) ostium underwent percutaneous coronary intervention in an 8-F system. During the procedure, rotablation with a 2.25-mm burr was required. After the percutaneous coronary intervention, partial loss of the tip of the guide was observed. He had no clinical sequelae despite the presumed retained catheter material in his body.

Although insufficient guide coaxiality has been suggested as the primary cause of guide tip fracture during RCA ostial ablation, other factors may have contributed: the application of force to the tip and a small difference in size between the guide and the burr.

When ablating RCA ostial lesions, positioning the burr platform outside the guide may help prevent similar complications in future cases.