Use of Preprocedural MDCT for Cardiac Implantable Electric Device Lead Extraction: Frequency of Findings That Change Management
| Autor: | Daniel T. Boll, Robert K. Lewis, Wendy L. Ehieli, Daniele Marin, Jonathan P. Piccini, Lynne M. Hurwitz |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Pacemaker Artificial Percutaneous 030204 cardiovascular system & hematology Preoperative care Risk Assessment 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Postoperative Complications Multidetector Computed Tomography Preoperative Care medicine North Carolina Prevalence Humans Radiology Nuclear Medicine and imaging Thrombus Vein Lead (electronics) Device Removal Aged Retrospective Studies Aged 80 and over business.industry Patient Selection Retrospective cohort study Heart General Medicine Middle Aged medicine.disease Prognosis Defibrillators Implantable Electrodes Implanted Patient Care Management Stenosis medicine.anatomical_structure Female Radiology business Lead extraction |
| Zdroj: | AJR. American journal of roentgenology. 208(4) |
| ISSN: | 1546-3141 |
| Popis: | Five percent of cardiac implantable electric devices (CIEDs) are removed each year. Percutaneous extraction is preferred but can be complicated if the leads adhere to the vasculature or perforate. The goal of this study is to assess the frequency of findings on dedicated MDCT that alter preprocedural planning for percutaneous CIED extraction.One hundred patients with CIEDs who underwent MDCT before percutaneous lead extraction were analyzed. Major findings that could preclude percutaneous removal, including lead course and termination, were distinguished from moderately significant findings that could alter but not preclude percutaneous removal, including endofibrosis of leads to the vasculature, lead termination abnormalities, central vein stenosis, or thrombus. Incidental findings were characterized separately. Findings were correlated with preprocedural decisions, the extraction procedure performed, and procedural outcomes.Twenty-six women and 74 men with 125 right ventricular leads, 84 right atrial leads, and 26 coronary venous leads were evaluated. Major findings were present in 7% of patients, including six patients with lead perforation and one with a lead coursing outside a tricuspid annuloplasty ring. Moderately significant findings of endothelial fibrosis were found in 78% of patients. The central veins were narrowed or occluded in 42% of patients, and thrombus was present in 2% of patients. Thirty-six percent of patients had incidental findings, and 4% of patients had unexpected findings requiring immediate inpatient attention.MDCT performed before CIED lead extraction is able to identify major and moderately significant findings that can alter either percutaneous extraction or preprocedural planning. The use of dedicated preprocedural MDCT can help to stratify patient risk, guide decision making by the proceduralist, and identify non-catheter-related findings that affect patient management. |
| Databáze: | OpenAIRE |
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