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Intravascular lead extraction using locking stylets and sheaths.

C L Byrd, S J Schwartz, N B Hedin

    Pacing and Clinical Electrophysiology : PACE
    |December 1, 1990
    PubMed
    Summary
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    This study shows that intravascular countertraction techniques are safe and effective for chronic transvenous lead extraction. These methods successfully removed various lead models in patients needing lead removal due to complications.

    Area of Science:

    • Cardiology
    • Interventional Cardiology
    • Medical Device Extraction

    Background:

    • Chronic transvenous leads pose removal challenges.
    • Over 65 lead models were included, encompassing passive and active fixation devices.
    • Lead extraction is necessary for complications like infection, erosion, and thrombosis.

    Purpose of the Study:

    • To evaluate the safety and efficacy of intravascular countertraction techniques for chronic transvenous lead extraction.
    • To assess the success rates of superior vena cava (SVC) and inferior vena cava (IVC) approaches.

    Main Methods:

    • Utilized intravascular countertraction with telescoping sheaths for SVC approach.
    • Employed a femoral vein approach with a sheath workstation, deflection catheter, and snare for IVC approach.

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  • Applied traction on the lead and countertraction with sheaths for removal.

    • Main Results:

    • Successful extraction of 115 leads in 62 patients (mean age 65 years).
    • SVC approach was successful in 71% of attempts (82/101 leads).
    • IVC approach was required for 12% of leads inaccessible to SVC and 29% of SVC failures.

    Conclusions:

    • Intravascular countertraction techniques are safe and effective for chronic transvenous lead extraction.
    • Both SVC and IVC approaches demonstrate utility in complex lead removal cases.
    • Experienced operators can achieve high success rates with these methods.