Percutaneous extraction of leads from coronary sinus vein and branch by modified techniques  

作　　者：CHU Xian-ming LI Xue-bin ZHANG Ping, WANG Long LI Ding LI Bing AN Yi LENG Min DUAN Jiang-bo GUO Ji-hong 

机构地区：[1]Department of Cardiac Electrophysiology,Peking University People's Hospital,Beijing 100044,China [2]Department of Cardiology,Affiliated Hospital of Medical College,Qingdao University,Qingdao,Shandong 266100,China [3]Department of Biology,Medical College of Qingdao University,Qingdao,Shandong 266021,China

出　　处：《Chinese Medical Journal》2012年第20期3707-3711,共5页中华医学杂志（英文版）

基　　金：This work was supported by grants from the National Natural Science Foundation of China （No. 81001346, 81071246）, Medical Health Science and Technology Development Plan Project of Shandong Province, China （No. 2011HZ023）, and Capital Clinical Project （No. Z121107001012016）.

摘　　要：Background Cardiac resynchronization therapy （CRT） device and coronary sinus （CS） lead extraction are required due to the occurrence of systemic infection, malfunction, or upgrade. Relevant research of CS lead extraction is rare, especially in developing countries because of the high cost and lack of specialized tools. We aimed to evaluate percutaneous extraction of CS leads by modified conventional techniques. Methods Of 200 patients referred for lead extraction from January 2007 to June 2011, 24 （12.0%） involved CS leads （24 CS leads）. We prospectively analyzed clinical characteristics, optimized extraction techniques and feasibility of extraction. Results Complete procedural success was achieved in 23 patients （95.8%）, and the clinical success in 24 patients （100.0%）. The leading indication for CS lead extraction was infection （66.7%）. Mean implant duration was （29.5±20.2） months （range, 3-78 months）. Sixteen CS leads （66.6%） were removed with locking stylets plus manual traction by superior transvenous approach. Mechanical dilatation and counter-traction was required to free fibrotic adhesions and extract 4 CS leads （16.7%）, which had longer implant duration than other leads （（62.5±12.3） vs. （22.9±14.1） months, P〈0.05）. Another 4 CS （16.7%） leads were removed by modified and innovative snare techniques from femoral vein approach. Median extraction time was 11 minutes （range, 3-61 minutes） per CS lead, which had significant correlation with implant duration （r = 0.8, P 〈0.001）. Sixteen patients （66.6%） were reimplanted with new devices at a median of 7.5 days after extraction. Median followed-up was 23.5 months （range, 8-61 months）, three patients died due to sudden cardiac death （26 months）, heart failure （45 and 57 months, respectively）. Conclusion The modified procedure was proved to be practical for percutaneous extraction of CS leads, especially in developing countries lacking expensive powered sheaths.Background Cardiac resynchronization therapy （CRT） device and coronary sinus （CS） lead extraction are required due to the occurrence of systemic infection, malfunction, or upgrade. Relevant research of CS lead extraction is rare, especially in developing countries because of the high cost and lack of specialized tools. We aimed to evaluate percutaneous extraction of CS leads by modified conventional techniques. Methods Of 200 patients referred for lead extraction from January 2007 to June 2011, 24 （12.0%） involved CS leads （24 CS leads）. We prospectively analyzed clinical characteristics, optimized extraction techniques and feasibility of extraction. Results Complete procedural success was achieved in 23 patients （95.8%）, and the clinical success in 24 patients （100.0%）. The leading indication for CS lead extraction was infection （66.7%）. Mean implant duration was （29.5±20.2） months （range, 3-78 months）. Sixteen CS leads （66.6%） were removed with locking stylets plus manual traction by superior transvenous approach. Mechanical dilatation and counter-traction was required to free fibrotic adhesions and extract 4 CS leads （16.7%）, which had longer implant duration than other leads （（62.5±12.3） vs. （22.9±14.1） months, P〈0.05）. Another 4 CS （16.7%） leads were removed by modified and innovative snare techniques from femoral vein approach. Median extraction time was 11 minutes （range, 3-61 minutes） per CS lead, which had significant correlation with implant duration （r = 0.8, P 〈0.001）. Sixteen patients （66.6%） were reimplanted with new devices at a median of 7.5 days after extraction. Median followed-up was 23.5 months （range, 8-61 months）, three patients died due to sudden cardiac death （26 months）, heart failure （45 and 57 months, respectively）. Conclusion The modified procedure was proved to be practical for percutaneous extraction of CS leads, especially in developing countries lacking expensive powered sheaths.

关 键 词：LEAD ＂ extraction ＂ cardiac resynchronization therapy ＂ coronary vessels ＂ infection 

分 类 号：I[文学]