Fracture of Rotational Atherectomy Burr: Pre-Fracture Signs, Mechanisms, and Management Strategies.

IF 2.1 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Catheterization and Cardiovascular Interventions Pub Date : 2025-03-17 DOI:10.1002/ccd.31496

Umihiko Kaneko, Yoshifumi Kashima, Takuro Sugie, Shoichi Kuramitsu, Yutaka Tadano, Tsuyoshi Takeuchi, Ken Kobayashi, Daitaro Kanno, Tsutomu Fujita

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引用次数: 0

Abstract

Background: Burr fracture during rotational atherectomy (RA) is a rare but potentially devastating complication. Due to its infrequency, comprehensive data on its incidence, mechanisms, and management are lacking. This study aimed to investigate the incidence, contributing factors, and management strategies for burr fractures during RA procedures.

Methods: This retrospective analysis included all patients who underwent PCI with RA at a single center between January 2013 and October 2024. Data were collected from a prospective registry.

Results: Among 3738 patients, three cases of burr fracture without entrapment were identified (incidence: 0.08%). Burr fractures occurred at the burr-driveshaft junction (tip fracture) in two cases and at the driveshaft in one case. Pre-fracture warning signs included incoherent burr-advancer knob movement, fluoroscopic translucency, and frequent driveshaft prolapse. Significant proximal tortuosity or enlargement and non-coaxiality between the RA device and the coronary artery were identified as potential contributing factors. In two cases involving tip fractures, simple manual traction removed the fractured burr. In the third case involving driveshaft fracture, coronary rupture necessitated covered stent implantation and urgent surgery.

Conclusion: Burr fractures during RA are rare but potentially serious complications. Significant proximal tortuosity or enlargement and non-coaxiality between the RA device and the coronary artery may increase the risk of burr fracture. Recognizing pre-fracture warning signs and understanding the underlying mechanisms are crucial for minimizing complications and optimizing procedural safety.

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来源期刊

Catheterization and Cardiovascular Interventions 医学-心血管系统

CiteScore

5.40

自引率

8.70%

发文量

419

审稿时长

2 months

期刊介绍： Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.