case_images: PMC11196185_01
case_images: (a) Baseline coronary angiogram. (b) The driveshaft is separated from the burr (the red arrow indicates the edge of the driveshaft).
case_images: CRIC2024-5482922.001.jpg
case_images: PMC11196185_01_CRIC2024-5482922.001.jpg
case_images: fig1
case_images: Coronary angiography revealed a bent moderately stenotic calcified lesion in the proximal right coronary artery (RCA), along with a severely stenotic lesion in the middle section of the RCA with severe calcification (Figure 1(a)). However, we observed that the burr detached from the driveshaft as it advanced into the distal RCA despite the driveshaft being pulled (Figures 1(b) and 2(b), Videos 2 and 3).
case_images: (a) Final angiogram. (b) Separated burr and edge of the driveshaft (red arrow). (c) The distal tip and body of Rotawire Floppy.
case_images: CRIC2024-5482922.002.jpg
case_images: PMC11196185_01_CRIC2024-5482922.002.jpg
case_images: fig2
case_images: IL, USA) was implanted in the mid-RCA and the proximal part was dilated with a drug-coated balloon (SeQuent Please 3.5/20 mm; B BRAUN, Frankfurt, Germany) to complete the treatment (Figure 2(a)). It took about 80 minutes to extract the burr from the fracture.
case_images: (a) The burr was observed using intravascular ultrasound (IVUS). The burr was not entrapped at this site. (b) Inflated 2.5 mm balloon next to the entrapped burr. The inner side of the proximal lesion of the bending RCA was observed by IVUS to be ablated.
case_images: CRIC2024-5482922.003.jpg
case_images: PMC11196185_01_CRIC2024-5482922.003.jpg
case_images: fig3
case_images: Notably, the burr was not entrapped at this site (Figure 3(a)). Therefore, we dilate the proximal part of the RCA using a 2.5 mm balloon (NEON NC PRO 2.5/10 mm, 20 atm; Cordis, FL, USA) through the second guide catheter, followed by dilation at the site of the burr (Figure 3(b)).
case_images: (a) Advancement of GUIDEPLUS until contact with the burr. GUIDEPLUS and burr were then pulled together. (b) Successful extraction of the burr into the guide catheter.
case_images: CRIC2024-5482922.004.jpg
case_images: PMC11196185_01_CRIC2024-5482922.004.jpg
case_images: fig4
case_images: We then advanced the guide extension catheter until it was in contact with the burr and pulled them together (Figure 4(a)), successfully extracting the burr (Figure 4(b)).