Dataset Information
Computed Tomography-Guided Risk Assessment in Percutaneous Lead Extraction.
Ontology highlight
ABSTRACT:
Background: Unpredictable lead adhesions can make lead extraction complicated. Adhesions are known to affect leads with longer indwelling time but can unpredictably affect newer leads.
Methods: Consecutive patients who had CTs performed ?90 days before their planned lead extraction (LE) were included. CTs were reviewed blinded to outcome according to a preset checklist. The outcome was a combined endpoint of procedural complexity and major complications.
Results: Between January 1, 2015 and July 1, 2018, 143 patients underwent CT and LE. Median age was 68 years (interquartile range [IQR]: 54.4 to 76.5), and 35% were female. Median age of extracted leads was 111 months, and 126 (43%) were >10 years. CT detected lead perforation ?5 mm (n = 13), <5 mm (n = 55), severe lead adhesions (n = 65), leads touching vessel wall >1 cm (n = 102), lead fracture (n = 8), and severe ipsilateral venous stenosis/occlusion (n = 36). The procedure was complex in 63 cases. There were 2 deaths, and 6 major complications. Patients with severe lead adhesions had more complex procedures (n = 36 vs 29; p = 0.04), whereas none of the other findings on CT were significantly associated with worse outcome. In patients with leads that had an indwelling time <10 years (n = 72), severe lead adhesions on CT was associated with worse outcome in multivariable analysis (odds ratio: 6.4; 95% confidence interval: 1.4 to 30.2; p = 0.02).
Conclusions: Pre-procedural CT can be used to locate severe lead adhesions in patients planned for lead extraction. In patients with indwelling leads <10 years, pre-procedural CT aids in identifying patients prone to complex extractions.
SUBMITTER: Svennberg E
PROVIDER: S-EPMC7718020 | biostudies-literature | 2019 Dec
REPOSITORIES: biostudies-literature
Publications
Computed Tomography-Guided Risk Assessment in Percutaneous Lead Extraction.
JACC. Clinical electrophysiology 20191127 12
<h4>Objectives</h4>The aim of this study was to assess if pre-procedural computed tomography (CT) could identify high-risk operative features and predict increased procedural complexity.<h4>Background</h4>Unpredictable lead adhesions can make lead extraction complicated. Adhesions are known to affect leads with longer indwelling time but can unpredictably affect newer leads.<h4>Methods</h4>Consecutive patients who had CTs performed ≤90 days before their planned lead extraction (LE) were included ...[more]