Here is my algorithm: 1) Vasodilator therapy (if hemodynamic allow and pull) 2) Pull Rotawire. This works very effectively, 90% of times. It is frequently overlooked. The 0.014 tip works as a great way to bring back the stuck burr. Make sure wire is free with brake off for maximal efficiency. Pulling the driveshaft is less effective, as it is made of 3 coiled wires which gives some elasticity to the driveshaft. 3) If burr is free beyond lesion, can use short dynaglide runs and then pull. Prinicple is that dynamic friction is lower. Don’t overdo this and also with skipping rope technique, there is risk of driveshaft breakage and burr loss due to torsional forces with a fix s immobile burr! 4) Cut driveshaft and remove teflon sheath 5) Deliver GE over driveshaft to the burr and pull. 6) Intimal/subintimal wire and ballooning to dislodge burr and pull. 7) Re-deliver GE over driveshaft and pull. 8) Obtain second access and adding a ping-pong guide. Remember a ping-pong guide is not required in most cases. Once Teflon sheath is removed, a 6F guide can accommodate: Driveshaft + coronary wire, Driveshaft + Caravel microcatheter, Driveshaft + Corsair/Turnpike LP microcatheters, Driveshaft + 2.5-4mm balloons 9) Combine subintimal ballooning and GE over driveshaft and pull. Only these maneuvers requires ping-pong guides. 10) Call surgeons.