Transcatheter Mechanical Aspiration of a Large Right Ventricle Lead Vegetation

Large lead-associated vegetations carry a significant risk of pulmonary embolism with hemodynamic instability when transvenous lead extraction is attempted. We describe a percutaneous approach using the FlowTriever thrombectomy system to remove large lead vegetation before transvenous lead extraction.

We present a 54-year-old male who came to the hospital with fever and dyspnea. He was found to have methicillin-sensitive Staphylococcus aureus bacteremia and a large right ventricular lead vegetation on echo. He had multiple comorbidities and was a high-risk surgical candidate. He underwent successful vegetation aspiration using the FlowTriever system, followed by endovascular lead extraction.

The key to managing device-related endocarditis is device removal. The 2020 European Heart Rhythm Association consensus document on cardiac device infection recognizes percutaneous aspiration of vegetations that are >20 mm before or during lead extraction and open heart surgery as an alternative.

Percutaneous removal of large vegetation should be considered, especially in patients with high surgical risk.