Retrieval of entrapped Rotablator burr in coronary stent using guide extension catheter and RotaWire spring-tip

概要

Kobe University Repository : Kernel
PDF issue: 2024-05-08

Retrieval of entrapped Rotablator burr in
coronary stent using guide extension catheter
and RotaWire spring-tip

Toba, Takayoshi ; Hamana, Tomoyo ; Kawamori, Hiroyuki ; Torii, Sho ;
Nakazawa, Gaku ; Otake, Hiromasa
(Citation)
Cardiovascular Intervention and Therapeutics,38(4):431-433

(Issue Date)
2023-10

(Resource Type)
journal article

(Version)
Version of Record

(Rights)
© The Author(s) 2023
This article is licensed under a Creative Commons Attribution 4.0 International
License, which permits use, sharing, adaptation, distribution and reproduction in any
medium or format, as long as you give appropriate credit to the original author(s) a…
the
source, provide a link to the Creative Commons licence, and indicate if changes
(URL)
were made. The images or other third party material in this article are included in
https://hdl.handle.net/20.500.14094/0100483166
the article's Creative Commons licence, unless indicated otherwise in a credit line to
the material. If material is not included in the article's Creative Commons licence
and your intended use is not permitted by statutory regulation or exceeds the
permitted use, you will need to obtain permission directly from the copyright holder.

Cardiovascular Intervention and Therapeutics (2023) 38:431–433
https://doi.org/10.1007/s12928-023-00939-6

IMAGES IN CARDIOVASCULAR INTERVENTION

Retrieval of entrapped Rotablator burr in coronary stent using guide
extension catheter and RotaWire spring‑tip
Takayoshi Toba1   · Tomoyo Hamana1 · Hiroyuki Kawamori1 · Sho Torii2 · Gaku Nakazawa3 · Hiromasa Otake1
Received: 24 April 2023 / Accepted: 10 May 2023 / Published online: 30 May 2023
© The Author(s) 2023

Case presentation
A 78-year-old man underwent coronary angiography due
to medically refractory effort angina. He previously underwent multiple percutaneous coronary interventions (PCIs),
without debulking devices, for in-stent restenosis (ISR) of
the right coronary artery (RCA). Angiography revealed ISR
in the middle RCA (Fig. 1A). Optical coherence tomography (OCT) showed stent underexpansion with stent fracture,
which mainly caused ISR (Fig. 1G). Rotational atherectomy (RA) was performed with 7-French guiding catheter
and RotaWire Extra Support (Boston Scientific Corporation, Natick, MA, USA) via femoral approach. When the
1.75-mm Rotablator burr (Boston Scientific Corporation)
was advanced toward the proximal portion of the lesion,
the burr was entrapped, followed by its disconnection
from the driveshaft (Fig. 1B, C, Supplementary Movie 1).
Using the double-guiding catheter technique, balloon on
another guidewire crossing via the second guiding catheter
was dilated beside the entrapped burr (Fig. 1D). Finally,
RotaWire, the distal enlarged spring-tip of which was united
by the burr, was pulled as the guide extension catheter over
the driveshaft was pushed forward, and then the burr was
successfully retrieved (Fig.  1E, Supplementary Movie
2). Final OCT findings demonstrated that the stent struts

covered with neointima had resected (Fig. 1H). The target
lesion was treated with drug-coated balloon without any
complications (Fig. 1F). Macroscopic examination of the
retrieved burr showed that the metallic stent, to which neointimal tissue was attached, was clinging to the driveshaft and
the disconnected burr (Fig. 1I). Pathological examination
revealed collagen-rich neointimal tissue without calcified
or lipid components (Fig. 1J, K).
RA is a feasible treatment option for ISR lesions due to
stent underexpansion and fracture [1]. However, our case
implies that indication of RA should be decided carefully,
especially in those with severe tortuosity. Depending on
cases, we should prioritize medical titration and avoid
debulking device including RA. In the present case, we
decided to use RA because of medically refractory symptom
and a history of repeated PCI without debulking devices.
The macroscopic findings showed that the burr entangled
in stent struts is the main mechanism of burr entrapment
in ISR. The RotaWire was pulled tightly, generating the
strong pulling force of the Rotablator burr entangled in stent
struts. Moreover, pushing force with guide extension catheter supported to remove the entrapped burr successfully.
This technique might be a reasonable strategy to retrieve the
entrapped burr in ISR lesions, although we should consider

* Takayoshi Toba
taka02222003@gmail.com
1



Division of Cardiovascular Medicine, Department
of Internal Medicine, Kobe University Graduate School
of Medicine, 7‑5‑2, Kusunoki‑cho, Chuo‑ku, Kobe 6500017,
Japan

2



Department of Cardiology, Tokai University School
of Medicine, Isehara, Japan

3

Division of Cardiology, Department of Internal Medicine,
Kinki University School of Medicine, Osaka, Japan



13

Vol.:(0123456789)


432

T. Toba et al.

Fig. 1  HYPERLINK "sps:id::fig1||locator::gr1||MediaObject::0" A–
F Coronary angiographic findings. A Initial, B Burr entrapment, C
Burr disconnection from driveshaft, D Balloon dilatation beside the
entrapped burr, E Retrieval of the entrapped burr, F Final. G, H Optical coherence tomography findings before (G) and after percutaneous

coronary intervention (H) I Macroscopic findings of the retrieved
Rotablator burr. J, K Microscopic findings of the neointima attached
to the stent strut. J Hematoxylin and eosin staining, K Movat Pentachrome staining

the potential risk of coronary rupture. PCI operators using
RA should be aware of this bailout technique.

adaptation, distribution and reproduction in any medium or format,
as long as you give appropriate credit to the original author(s) and the
source, provide a link to the Creative Commons licence, and indicate
if changes were made. The images or other third party material in this
article are included in the article's Creative Commons licence, unless
indicated otherwise in a credit line to the material. If material is not
included in the article's Creative Commons licence and your intended
use is not permitted by statutory regulation or exceeds the permitted
use, you will need to obtain permission directly from the copyright
holder. To view a copy of this licence, visit http://​creat​iveco​mmons.​
org/​licen​ses/​by/4.​0/.

Supplementary Information  The online version contains supplementary material available at https://d​ oi.o​ rg/1​ 0.1​ 007/s​ 12928-0​ 23-0​ 0939-6.
Funding None.
Data availability  Data sharing is not applicable to this article as no new
data were analyzed in this study.

Declarations 
Conflict of interest  None to be declared.

Reference

Open Access  This article is licensed under a Creative Commons
Attribution 4.0 International License, which permits use, sharing,

1. Sakakura K, Ito Y, Shibata Y, Okamura A, Kashima Y, Nakamura
S, Hamazaki Y, Ako J, Yokoi H, Kobayashi Y, Ikari Y. Clinical

13

Retrieval of entrapped Rotablator burr in coronary stent using guide extension catheter and…

433

expert consensus document on rotational atherectomy from the
Japanese association of cardiovascular intervention and therapeutics. Cardiovasc Interv Ther. 2021;36(1):1–18.
Publisher's Note Springer Nature remains neutral with regard to
jurisdictional claims in published maps and institutional affiliations. ...

この論文で使われている画像