Work

Transcatheter Mechanical Aspiration of a Large Right Ventricle Lead Vegetation

Year: 2025

Type: article

Abstract: BACKGROUND: Large lead-associated vegetations carry a significant risk of pulmonary embolism with hemodynamic instability when transvenous lead extraction is attempted. We describe a percutaneous approach using the FlowTriever thrombectomy system to remove large lead vegetation before transvenous lead extraction. CASE SUMMARY: We present a 54-year-old male who came to the hospital with fever and dyspnea. He was found to have methicillin-sensitive Staphylococcus aureus bacteremia and a large right ventricular lead vegetation on echo. He had multiple comorbidities and was a high-risk surgical candidate. He underwent successful vegetation aspiration using the FlowTriever system, followed by endovascular lead extraction. DISCUSSION: The key to managing device-related endocarditis is device removal. The 2020 European Heart Rhythm Association consensus document on cardiac device infection recognizes percutaneous aspiration of vegetations that are >20 mm before or during lead extraction and open heart surgery as an alternative. TAKE-HOME MESSAGE: Percutaneous removal of large vegetation should be considered, especially in patients with high surgical risk.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2025.103695

Authors: Emmanuel Daniel, Keerthi Sajja, Mohammed El-Nayir, Tanmay Swadia

Institutions: Trinity Health Michigan, Trinity Health Ann Arbor Hospital, Des Moines University

Language: English

Topic: Infective Endocarditis Diagnosis and Management

Subfield: Epidemiology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $850