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Case Reports
. 2024 Jul 11;8(7):ytae332.
doi: 10.1093/ehjcr/ytae332. eCollection 2024 Jul.

X marks the spot: catheter aspiration using the Inari FlowTriever device to debulk defibrillator lead vegetations prior to transvenous lead extraction-a case report

James Clark  1 , Abbas Zaidi  1 , Peter O'Callaghan  1 , Ulrich von Oppell  2 , Andrew S P Sharp  3
Affiliations
Case Reports

X marks the spot: catheter aspiration using the Inari FlowTriever device to debulk defibrillator lead vegetations prior to transvenous lead extraction-a case report

James Clark et al. Eur Heart J Case Rep. .

Abstract

Background: When cardiac implantable electronic device infection occurs, standard therapy is usually total system extraction. Transvenous lead extraction is preferable to open heart surgical extraction, unless contraindicated because of the presence of very large vegetations on the intravenous leads according to the European Society of Cardiology guidelines. Extraction of transvenous leads with vegetations risks distal embolism resulting in obstruction and/or infection in the pulmonary arteries. Catheter aspiration of vegetations or thrombi has been performed prior to transvenous lead extraction using a partial veno-venous extracorporeal bypass circuit. We report the use of a single-access aspiration system using the Inari FlowTriever 24 French system to debulk a defibrillator lead before percutaneous extraction.

Case summary: A 79-year-old male presented with fever 18 years after his first implantable cardioverter defibrillator implant and 9 years after his most recent pulse generator change. Two large vegetations were identified on his transvenous defibrillator lead on the atrial aspect, near the tricuspid annulus, which were aspirated using the Inari Medical 24Fr FlowTriever aspiration catheter. We describe anatomical considerations during the approach and a technique to localize the vegetations based on a combination of fluoroscopy and transoesophageal echocardiogram guidance.

Discussion: This case demonstrates the safe and effective use of the Inari Medical 24Fr FlowTriever aspiration catheter in debulking a defibrillator lead before transvenous lead extraction. This method uses a single venous puncture and is not dependent on extracorporeal bypass. Apart from reducing complexity, this technique may be advantageous in patients where anticoagulation needs to be minimised.

Keywords: Aspiration; CIED; Case report; Defibrillator; Endocarditis; Vegetation.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
The dimensions of both mobile masses adhered to the defibrillator lead at the level of the tricuspid annulus. (A) 15 mm, (B) 17 mm, (C) 16 mm, and (D) 14 mm.
Figure 2
Figure 2
(A) Antero-posterior projection of the aspiration catheter in the first position (mid right atrium). (B) The aspiration catheter in the same view, at the point of successful aspiration where the wire marks the point where the lead crosses the tricuspid annulus.
Figure 3
Figure 3
The material aspirated by the Inari Medical FlowTriever system and recovered from the aspiration container.
Figure 4
Figure 4
The defibrillator lead has been successfully debulked by removing the two mobile masses.
None
See this image and copyright information in PMC

References

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