Vacuum-Assisted Percutaneous Management of Cardiac Implantable Electronic Device Lead Endocarditis

Background and Clinical Significance: Infective endocarditis is a disease of the endocardial surface of the heart, most often affecting heart valves (native or prosthetic) or intracardiac device. Although relatively rare, it carries high embolic risk of complications and mortality. Complete device extraction is recommended; however, conventional surgery may be prohibitive in frail patients with multiple comorbidities. Case presentation: We present a case of a 74-year-old male with implantable cardioverter-defibrillator (ICD)-related infective endocarditis and large lead-associated vegetation measuring approximately 3 cm in size. Due to a high operative risk assessed by Euro SCORE II, a minimally invasive percutaneous approach using the Penumbra vacuum-assisted aspiration system was selected. The procedure enabled successful debulking of the vegetation, followed by complete device removal and targeted antibiotic therapy. The patient's clinical condition improved, with normalization of inflammatory markers and no recurrence of infection, and a new ICD was safely reimplanted after recovery. Conclusions: This case highlights the potential role of percutaneous vacuum-assisted aspiration as an effective and less invasive therapeutic option in high-risk patients with CIED-related infective endocarditis, particularly when conventional surgical management is contraindicated or requires bridging therapy until the patient's status is stabilized.