Imaging findings associated with costoclavicular intervention during lead extraction.

BACKGROUND: Binding sites in the costoclavicular space are commonly encountered during transvenous lead extraction. Severe adhesions may warrant use of more aggressive rotational cutting tools or surgical intervention. It is not known whether preprocedural multidetector computed tomography (MDCT) can provide information about the likelihood that a patient will require costoclavicular intervention. OBJECTIVE: The purpose of this study was to determine whether there are preprocedural MDCT findings associated with need for intervention in the costoclavicular space during lead extraction. METHODS: Patients who underwent lead extraction and required use of stiffer rotational cutting tools (TightRail Sub-C) or surgical intervention in the costoclavicular space as well as age- and sex-matched controls who did not require intervention were included. Preprocedural MDCT was evaluated for patterns of lead tethering to bone and adjacent calcification. RESULTS: Overall, 56 patients were included (n = 20 Sub-C only, n = 8 surgical intervention, and n = 28 matched controls). The mean patient age of interventional cases was 65.0 ± 14.7 years, 18% were female, and the mean lead age was 12.3 ± 6.2 years. Four major patterns were identified on imaging: lead surrounded 360° by fat (intervention rate, 5/24 patients); lead tethered to bone by <180° (11/19); no tethering of lead but with associated calcifications (3/4); and lead tethered to bone by >180° (9/9). Tethering of at least 1 lead to bone by >180° was associated with a 100% rate of costoclavicular intervention and the highest rate of surgical intervention (56%). Absence of any degree of bone tethering was associated with a 0% rate of surgical intervention. CONCLUSION: Computed tomography captures details of costoclavicular binding that appear to correlate with the need for adjunctive extraction techniques, including surgical intervention. Computed tomography may be useful in preprocedural planning for adhesions in the costoclavicular space.

Duke Scholars

Author Donald Dale Hegland Medicine, Cardiology

Author Adam Richard Williams Surgery, Cardiovascular and Thoracic Surgery

Author Jeffrey Giles Gaca Surgery, Cardiovascular and Thoracic Surgery

Author Robert Kenneth Lewis Medicine, Cardiology

Author Sean Pokorney Medicine, Cardiology

Author Jonathan Paul Piccini Sr. Medicine, Cardiology