Single-Access Retrieval of an Entrapped Rotational Atherectomy Burr Using Parallel-Wire STAR Technique

Rotational atherectomy facilitates percutaneous coronary intervention in heavily calcified coronary lesions. Burr entrapment occurs in <1% of procedures, but it may cause vessel occlusion and myocardial ischemia. An 81-year-old woman with recurrent angina underwent rotational atherectomy-assisted percutaneous coronary intervention to a heavily calcified right coronary artery. The 1.5-mm burr became entrapped, resulting in inferior ST-segment elevation myocardial infarction. Successful retrieval of the burr was achieved via a single 7-F access by cutting the burr and extracting the drive shaft sheath, followed by subintimal tracking and re-entry (STAR) with a parallel wire, then external crushing to modify the calcified plaque. This case demonstrates parallel-wire balloon-assisted plaque modification as an effective percutaneous bailout strategy for an entrapped rotablation burr. Subintimal tracking and re-entry (STAR) with a parallel wire and external plaque crushing by a balloon is feasible from a single 7-F sheath by cutting the burr and extracting the drive-shaft sheath.