Abstract
The patient was an 84-year-old Chinese male, with a significant history of diabetes mellitus, hypertension, hyperlipidemia, and previous stroke. He had a recent admission for non-ST-elevation myocardial infarction (NSTEMI) for which an angiogram showed calcified triple vessel disease and significant left main (LM) disease (Figs. 24.1 and 24.2, Videos 24.1 and 24.2). He was offered coronary angiography bypass grafting at that time but declined. Currently, he was readmitted for recurrent NSTEMI and acute pulmonary edema requiring intubation. Due to hemodynamic instability, a multidisciplinary team decision was made for urgent revascularization by percutaneous coronary intervention.
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Calcified left main bifurcation and LCX disease (MP4 2831 kb)
Calcified left main bifurcation and diffuse LAD disease (MP4 3712 kb)
Initial burring with 1.25 mm burr (MP4 11416 kb)
Separated and dislodged rotaburr in LM (MP4 1149 kb)
Initial attempt at removal of rotablation assembly. Note the driveshaft being pulled back in the guide catheter (MP4 11419 kb)
Removal of entire rotablation assembly. Observe the rotaburr coming back into the guide together with the wire. Substantial force had to be applied. There is risk of ostial LM dissection with the force required to pull the burr out. Fortunately, this did not occur (MP4 9996 kb)
Successful repeat rotablation with new 1.25 mm burr (MP4 11453 kb)
Successful repeat rotablation with new 1.25 mm burr (MP4 11405 kb)
Angiogram after rotablation (MP4 2623 kb)
Final angiograms showing satisfactory results (MP4 3912 kb)
Final angiograms showing satisfactory results (MP4 4439 kb)
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Yap, J., Yeo, K.K. (2018). Complication: Dislodged Burr. In: Low, R., Yeo, K. (eds) Clinical Cases in Coronary Rotational Atherectomy. Clinical Cases in Interventional Cardiology. Springer, Cham. https://doi.org/10.1007/978-3-319-60490-9_24
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DOI: https://doi.org/10.1007/978-3-319-60490-9_24
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