Kokeshi phenomenon: stuck rotablator burr
Kokeshi phenomenon is a stuck rotablator burr in a heavily calcified coronary artery during attempted rotablation. Though it is a rare complication, it is a potentially serious one as it can cause coronary occlusion and necessitate emergency surgery. Different methods have been described for retrieval of the stuck burr. Mechery A and associates noted that deep engagement of the guiding catheter and manual traction is a safe method for retrieval of the burr .
Tanaka Y et al used a modified STAR (subintimal tracking and re-entry) technique using a 3 g tapered tip hydrophilic wire to remove the burr . Successful removal using a Kiwami straight catheter (4F) has also been reported .
Kokeshi are Japanese dolls handmade from wood, with an enlarged head and no limbs attached to the trunk . These are Japanese dolls for children, crafted for over 150 years, originally from the northeastern region.
- Mechery A, Jordan PJ, Doshi SN, Khan SQ. Retrieval of a stuck Rotablator burr (“Kokeshi phenomenon”) and successful percutaneous coronary intervention. Journal of Cardiology Cases. 2016; 13:90-92.
- Tanaka Y, Saito S. Successful retrieval of a firmly stuck rotablator burr by using a modified STAR technique. Catheter Cardiovasc Interv. 2016;87:749-756.