Key result
Coaxial steerable sheath and internal snare enables bailout of entrapped cutting sheaths during TLE.
Why the study?
Mechanical entrapment of the TightRail rotating dilator sheath during transvenous lead extraction is a distinctive failure mode with limited published procedural bailout details.
Case Report
Provides procedural details for a bailout technique to manage mechanical sheath entrapment during transvenous lead extraction.
Answers are grounded in this paper and cite their sources.
Offers bailout option for entrapped cutting sheaths in lead extraction; extends technical options for complex transvenous procedures.
Transvenous lead extraction is established for chronic leads with malfunction or infection, with class I and IIa indications defined in the 2017 Heart Rhythm Society expert consensus statement.1 The TightRail rotating dilator sheath (Philips/Spectranetics, Colorado Springs, CO) employs a bidirectional crown-type rotating blade shielded within a flexible polymer shaft, with reported clinical success rates of 89–97%.2-5 A distinctive failure mode — mechanical entrapment of the cutting edge onto the lead body, in which the sheath becomes immobile in both directions and the sheath and lead can only be moved as a single complex — has been reported in the FDA Manufacturer and User Facility Device Experience (MAUDE) database6 and as a recent abstract,7 but published procedural detail on bailout remains limited.
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Mohamed Shokr (2026) conducted a case report in Mechanical sheath entrapment during transvenous lead extraction. Staged bailout with coaxial steerable sheath-through-laser-through-an outer sheath construct and internal snare was evaluated. A staged bailout technique using a coaxial steerable sheath construct and internal snare is presented for managing mechanical entrapment of a cutting sheath during transvenous lead extraction.
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