Key result
Rotational atherectomy using a 1.25-mm burr resulted in burr entrapment (Kokeshi phenomenon) in an older patient with severely calcified coronary stenosis, which was successfully managed percutaneously.
Case Report (n=1)
This case report highlights the risk of burr entrapment (Kokeshi phenomenon) during rotational atherectomy in severely calcified lesions and demonstrates successful percutaneous retrieval.
Raises caution for burr entrapment during rotational atherectomy of calcified bifurcations; leaves optimal prevention and bailout strategies open.
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.
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Andreou et al. (2025) conducted a case report in Severely calcified, proximal left anterior descending coronary artery/diagonal artery bifurcation stenosis and aortic valve stenosis (n=1). Rotational atherectomy was evaluated on Burr entrapment. Rotational atherectomy using a 1.25-mm burr resulted in burr entrapment (Kokeshi phenomenon) in an older patient with severely calcified coronary stenosis, which was successfully managed percutaneously.
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