An intra-aortic balloon pump was inserted via left femoral access for circulatory support for this high-risk coronary intervention. Noting the degree of calcification, the decision was made for rotablation to prepare the lesion. The Finecross microcatheter initially had difficulty crossing the lesion. The left circumflex was pre-dilated sequentially with a compliant 1.0 mm and 1.5 mm balloon, to facilitate passage of the Finecross to allow for exchange for the extra-support rotawire. Initial rotablation was performed with a 1.25 mm burr (Fig. 24.3, Video 24.3). However, during the process, the burr was dislodged from the shaft and was trapped on the rotawire in the proximal LCX (Fig. 24.4, Video 24.4). During the initial attempt at removal, the drive shaft can be seen to be withdrawn without removal of the burr (Video 24.5). Subsequently, the dislodged rotaburr was successfully removed by pulling out the rotablation assembly as a whole unit (Video 24.6). The LCX was rewired and repeat rotablation was performed with a new 1.25 mm burr without any complications (Figs. 24.5, 24.6, and 24.7, Videos 24.7, 24.8, and 24.9). A decision was made not to rotablate the LAD. After balloon angioplasty, the mid-LAD was stented with a 2.25 mm drug-eluting stent (DES), and the LM bifurcation was treated with the Coulotte technique with a 2.5 mm DES in the LM-LCX and a 2.75 mm DES in the LM-LAD (Figs. 24.8 and 24.9, Videos 24.10 and 24.11). Figure 24.10 shows the dislodged rotaburr on the rotawire after extraction.