Starfix lead extraction: Clinical experience and technical issues

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• 作者：Pier Giorgio Golzio ; MD ; FESC ; FACC ; ^{pg.golzio@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; ^{pgolzio@cittadellasalute.to.it" class="auth_mail" title="E-mail the corresponding author} ; ^{piergiorgio.golzio@unito.it" class="auth_mail" title="E-mail the corresponding author} ; Ilaria Meynet ; MD ; Fulvio Orzan ; MD ; Elisa Pellissero ; MD ; Davide Castagno ; MD ; Federico Ferraris ; MD ; Fiorenzo Gaita ; MD
• 关键词：Lead extraction ; Coronary sinus ; Starfix lead ; Active-fixation leads ; Infection
• 刊名：Journal of Cardiology Cases
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：13
• 期：1
• 页码：25-30
• 全文大小：1783 K

文摘

Transvenous lead extraction (TLE) of the Starfix coronary sinus (CS) active-fixation lead may be challenging, due to undeployment of fixation lobes and venous occlusion. We report our experience in Starfix TLE, in comparison with previous data.

A 78-year-old male, implanted in 2009 with Starfix lead, was referred to our institution for TLE, due to infective endocarditis with lead-associated vegetations. The tip of Starfix lead was located in distant, anterior position, in the great cardiac vein, close to patent left internal mammary artery-to-left anterior descending artery anastomosis, and first-choice surgical removal had a prohibitive operative risk.

Conventional dilatation beyond CS ostium, as well as the use of a standard delivery catheter, was ineffective. An off-label modification of the delivery, by cutting the distal soft tip, was successful. However, the tip of the lead fragmented and was trapped in the innominate vein. Then a gooseneck snare grasped the fragment, allowing complete retrieval.

TLE of Starfix leads may be particularly challenging, especially when its tip is located in a distant anterior location. In these cases, important help may be obtained by dilatation within the CS, by means of conventional or modified delivery catheters. Only experienced operators, sometimes with non-conventional techniques, should perform TLE of Starfix leads.

<Learning objective: TLE of Starfix leads may be challenging, particularly when the tip is located in a distant anterior position. Dilatation with conventional tools may be precluded. In these cases modifications of the delivery catheters may be useful. Surgery should be avoided as first-choice procedure; only experienced operators, sometimes with non-conventional techniques, should perform TLE of Starfix leads.>