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 [1].

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 [2]. Successful removal using a  Kiwami straight catheter (4F) has also been reported [3].

Kokeshi are japanese dolls handmade from wood, with an enlarged head and no limbs attached to the trunk [4].


  1. 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.
  2. 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.
  3. https://en.wikipedia.org/wiki/Kokeshi