Author + information
- Received September 6, 2017
- Accepted September 26, 2017
- Published online December 18, 2017.
- Kenichi Sakakura, MD∗ (, )
- Yousuke Taniguchi, MD,
- Takunori Tsukui, MD,
- Kei Yamamoto, MD,
- Shin-ichi Momomura, MD and
- Hideo Fujita, MD
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
- ↵∗Address for correspondence:
Dr. Kenichi Sakakura, Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-city, Saitama 330-8503, Japan.
A 75-year-old man underwent rotational atherectomy (RA) to left anterior descending artery (Figures 1A and 1B). When the 1.25-mm burr jumped beyond the circumferential calcification, it became entrapped (Figure 1C). We tried a novel bailout method using a soft guide extension catheter. We cut the drive shaft sheath, drive shaft and RotaWire (Boston Scientific, Natick, Massachusetts) together, and then pulled out the drive shaft sheath (1). We advanced a Guideplus catheter (Nipro, Osaka, Japan) until it reached the tail of the burr (Figures 1D and 1E), and then pulled out the drive shaft, RotaWire, and Guideplus together (Figure 1F). A drug-eluting stent was deployed following a 2.0-mm burr RA (Figures 1G to 1I). The details of the procedure are described in Figure 2. A flexible shaft and hydrophilic coating make it easy to advance the Guideplus to the tail of the entrapped burr. Because the mechanism and severity of burr entrapment would vary depending upon clinical situations (1), knowledge of several bailout procedures would enhance the safety of percutaneous coronary intervention of severely calcified lesions.
The authors acknowledge all staff in the catheter laboratory in Saitama Medical Center, Jichi Medical University, for their technical support in this study.
This work was supported by a Grant-in-Aid for Scientific Research (KAKENHI) grant number 17K09521 from the Japan Society for the Promotion of Science (Dr. Sakakura). Dr. Sakakura has received speaking honoraria from Abbott Vascular, Boston Scientific, Medtronic Cardiovascular, Terumo, OrbusNeich, and Nipro; has served as a proctor for Rotablator for Boston Scientific; and has served as a consultant for Abbott Vascular and Boston Scientific. Dr. Fujita has served as a consultant for Mehergen.
- Received September 6, 2017.
- Accepted September 26, 2017.
- 2017 American College of Cardiology Foundation