Imaging findings associated with costoclavicular intervention during lead extraction

Area of Science:

• Cardiology
• Radiology
• Medical Devices

Background:

• Transvenous lead extraction often involves the costoclavicular space, where adhesions can complicate procedures.
• Severe adhesions may necessitate advanced tools or surgical intervention.
• The utility of preprocedural multidetector computed tomography (MDCT) in predicting the need for costoclavicular intervention is unclear.

Purpose of the Study:

• To investigate preprocedural MDCT findings associated with the requirement for intervention in the costoclavicular space during lead extraction.
• To determine if MDCT can predict the need for specialized tools or surgery.

Main Methods:

• Retrospective analysis of patients undergoing lead extraction with costoclavicular intervention (rotational cutting tools or surgery) and matched controls.
• Evaluation of preprocedural MDCT for patterns of lead tethering to bone and calcification in the costoclavicular region.

Main Results:

• Of 56 patients, 28 required intervention. Four imaging patterns were identified: fat encapsulation, <180° bone tethering, calcification without tethering, and >180° bone tethering.
• Lead tethering to bone by >180° was associated with 100% costoclavicular intervention and 56% surgical intervention.
• Absence of bone tethering correlated with a 0% surgical intervention rate.

Conclusions:

• MDCT effectively visualizes costoclavicular adhesions and their severity.
• Preprocedural MDCT findings correlate with the need for adjunctive extraction techniques and surgical intervention.
• MDCT may aid in preprocedural planning for lead extraction complicated by costoclavicular space adhesions.