Key result
Percutaneous mechanical aspiration using the FlowTriever system successfully removed a large right ventricular lead vegetation prior to endovascular lead extraction without complications.
Why the study?
Large lead-associated vegetations pose a significant risk of pulmonary embolism with hemodynamic instability during transvenous lead extraction.
Case Report (n=1)
No
Percutaneous mechanical aspiration using the FlowTriever system is a feasible approach for removing large cardiac device lead vegetations prior to endovascular lead extraction in high-surgical-risk patients.
Supports feasibility of pre-extraction thrombectomy in select infected leads; leaves open safety and efficacy in prospective studies.
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.
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Daniel et al. (2025) conducted a case report in Device-related infective endocarditis with large right ventricular lead vegetation (n=1). Percutaneous mechanical aspiration using the FlowTriever thrombectomy system was evaluated on Successful vegetation aspiration and lead extraction. Percutaneous mechanical aspiration using the FlowTriever system successfully removed a large right ventricular lead vegetation prior to endovascular lead extraction without complications.
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