Novel technique for resolving a stuck rotational atherectomy device in a peripheral artery: a case report

Rotational atherectomy device entrapment is a rare but challenging complication of peripheral vascular interventions. This case report details a novel dual-access endovascular technique for retrieving an entrapped atherectomy burr from the posterior tibial artery of a 70-year-old man with severe peripheral arterial and chronic kidney disease. When conventional retrieval methods failed, retrograde posterior tibial access was established as an adjunct to the existing femoral access, enabling sequential balloon angioplasty with progressively larger balloons (1.5-2.5 mm) around the entrapped device. This dual-access approach successfully liberated the burr without requiring surgical extraction or arteriotomy. Following device retrieval, definitive treatment with balloon angioplasty and stent placement was completed immediately, achieving excellent restoration of flow. This minimally invasive technique offers several advantages over traditional surgical approaches, including vessel patency preservation, reduced procedural morbidity, avoidance of general anesthesia, and protection of potential future bypass targets. The described methodology expands the endovascular options for managing complex device-related complications and demonstrates particular value in high-risk patients with significant comorbidities.