Percutaneous Vegetation Debulking Without Lead Extraction in Enterococcal Endocarditis Related to Cardiac Implantable Electronic Device

BACKGROUND: The AngioVac cannula with snare (AngioDynamics) was originally designed to percutaneously remove intravascular thrombi, with expanded roles including adjunctive therapy during cardiac implantable electronic device lead extraction procedures. We describe using this tool in a high-risk case without concomitant lead extraction. CASE SUMMARY: A 70-year-old man presented to our institution with Enterococcus faecalis sepsis. He had a history of non-ST-segment elevation myocardial infarction complicated by ventricular tachycardia and Mobitz type II atrioventricular block, and he had undergone implantable cardioverter-defibrillator implantation. Two intravascular implantable cardioverter-defibrillator leads were present: a 26-year-old dual coil and a 4-year-old single coil. Given the high extraction risk profile, vegetation aspiration alone was performed without concomitant lead extraction. The patient's subsequent clinical course was excellent. DISCUSSION: Cardiac implantable electronic device extraction is the standard of care after device-related endocarditis, but unique circumstances may necessitate a nonconventional approach. TAKE-HOME MESSAGE: This case report raises the possibility that vegetation debulking alone may be an option in high-risk extraction cases.