![]() Considering the large caliber of the right system, a 1.75mm Rota burr (Boston Scientific) was advanced and multiple runs were performed with a speed of 170,000 rpm. The authors parked an Apex OTW balloon (Boston Scientific) tip of the lesion and exchanged the BMW wire (Abbott Vascular) with Rota wire (Boston Scientific). As the calcified lesion was angiographically evident, it was decided to proceed with RA for lesion modification. It was not possible to cross the lesion with 1.5mm x 15mm Tazuna Balloon (Terumo). The right coronary artery (RCA) (Figure 1) ostium was successfully intubated with 7.5F JR4 sheathless guide (Asahi Intecc) then 0.014-inch BMW wire (Abbott Vascular) crossed the PDA lesion and was parked distally. A right radial approach was followed, and the angiogram showed heavily calcified multiple vessel disease with a significant lesion in the posterior descending artery (PDA) (Figure 1) and an intervention to the PDA lesion was planned. Anti-ischemic measures were followed, and the patient was taken for coronary angiogram (CAG) (Figure 1). There were non-specific changes on electrocardiogram. Case presentationĪ 71-year-old male smoker with type II diabetes mellitus, dyslipidemia, hypertension, and renal impairment on medical therapy was diagnosed with a non-ST elevation myocardial infarction and transferred for a percutaneous coronary intervention (PCI). Moreover, the authors elaborate on other techniques that were reported to overcome this complication safely. In this case report, child-in-a-mother technique (Cunnington M, 2012) utilizing a guideliner was used to retrieve the burr percutaneously. The factors leading to such a complication is variable while techniques of percutaneous retrieval of the entrapped burr have been widely developed leading to avoidance of emergency surgery. Encountering such complications is possible as the number of cases of complex and high-risk coronary interventions that use RA is increasing. Keywords: Coronary Angiography, Atherectomy, Coronary, Coronary Artery Disease, Cardiovascular Diseases, Percutaneous Coronary Intervention, Drug-Eluting Stents, Coronary Restenosis, Coronary Artery BypassĮntrapped burr is a rare complication of rotational atherectomy (RA) known as Kokeshi phenomenon. The authors report a rare complication of RA, Kokeshi phenomenon, where the stuck burr was successfully retrieved percutaneously. Entrapped burr can lead to devastating complications, where it may end up by emergency surgery. Similar to other invasive procedures, RA carries variable risks such as perforation, entrapped burr, slow-flow and dissection. It is evident that RA has benefits primarily in treating calcific coronary artery lesions predominantly lesion modification. Besides conventional therapies to treat coronary artery disease, which ranges from preventative measures to invasive intervention, complex percutaneous coronary intervention techniques have been developed that yield several techniques including rotational atherectomy (RA). Cardiovascular disease remains the leading cause of death worldwide. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |