E1194. Cardiac Implantable Electronic Device Lead Extraction: Preprocedural Imaging
University of California, San Diego
Increased prevalence of cardiac implantable electronic devices (CIEDs) including pacemakers and defibrillators has led to an increased demand for lead and device removal for complications such as lead malfunction, infection, or thrombosis. Percutaneous laser lead extraction uses a catheter-guided laser to deliver pulsed energy, which cuts through fibrotic tissue around transvenous leads, permitting removal. Preprocedural CT is increasingly being used to assist cardiologists and surgeons in anticipating potential procedural complications related to lead extraction such as vessel perforation, myocardial injury, or lead fracture.
Educational Goals / Teaching Points
The goals of this exhibit are as follows: describe institutional experience with a tailored, cardiac-gated full-chest CT venogram protocol for evaluation of patients prior to lead extraction;review current literature on frequency of imaging findings with corresponding prognostic value and risk for complications; provide a number of case examples that illustrate the imaging findings that cardiologists and surgeons want to know prior to lead extraction including device pocket collections/calcifications, central vein patency/anatomy, lead fracture, lead adhesions, lead thrombi/calcifications, vascular wall embedment, and lead perforation; and review basic terminology related to CIEDs and lead extraction that the reading radiologist should know.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Cardiac-gated CT helps characterize lead motion, and contrast injection protocol should be tailored for optimum venous opacification. Be aware of potential pitfalls related to metal and motion artifact.
CT is increasingly being used to evaluate patients prior to CIED and lead extraction. Radiologists should be aware of the preprocedural imaging findings that may portend increased risk for complication.