Rotational Atherectomy Burr Entrapment: Its Mechanism and its Management

This report illustrates a rare, but serious, complication of rotational atherectomy, that is, burr entrapment, in an older patient with a severely calcified, proximal left anterior descending coronary artery/diagonal artery bifurcation stenosis and a background of aortic valve stenosis scheduled for percutaneous treatment. A series of events made us select a 1.25-mm burr, which became entrapped immediately distal to the stenosis. The complication was ascribed to the Kokeshi phenomenon and was successfully tackled percutaneously.