Wire-entanglement retrieval of a detached rotational atherectomy burr after complete wire disengagement: a case report

Background Rotational atherectomy is crucial for heavily calcified coronary lesions, but complications like burr entrapment, though rare, can be fatal. Case Summary A 55-year-old man with diffuse coronary stenosis underwent rotational atherectomy for a left circumflex artery lesion. During the procedure, the rotational atherectomy burr disconnected from the guidewire, and the wire subsequently disengaged entirely from the burr, leaving the burr retained. A novel wire-entanglement technique was successfully employed by advancing a Fielder XT-A guidewire through the burr's lumen and intentionally knuckling a Sion guidewire to intertwine with it. This maneuver loosened and dislodged the burr, allowing for controlled proximal migration and retrieval into the guiding catheter. Discussion This case presents a rare scenario of complete rotational atherectomy guidewire disengagement from the burr. The successful retrieval using a wire-entanglement technique offers a valuable percutaneous bailout strategy for similar challenging situations where traditional retrieval methods may fail.