Innovative Approach to Transvenous Lead Extraction: Bioptome and Snare Technique Without Additional Venous Access

BACKGROUND: Transvenous lead extraction (TLE) is recognized as an effective method of lead extraction, but can be challenging with old and tined pacemaker leads. CASE SUMMARY: We present the case of a 44-year-old male with cardiovascular implantable electronic device (CIED) infection who underwent TLE of his 15-year-old tined pacemaker leads using a novel approach. A carotid shuttle sheath with the tip fashioned into a bevel shape was used as a makeshift dilator to dissect and free the leads from adhesions. A bioptome, introduced through the TightRail sheath, was employed to dislodge the right ventricular (RV) lead tip, while a snare introduced subsequently through the same access was used to grip the distal end of the RV lead. The lead was extracted using the snare without the need for additional femoral or jugular access. CONCLUSION: To the best of our knowledge, the use of this bioptome and snare technique, through the TightRail sheath, without employing femoral or jugular access for lead extraction, has not been previously reported. This case highlights the importance of innovative techniques in successfully addressing challenging TLE cases.