From Failure to Success: Lithotripsy Transforms Lead Extraction in a Same-Patient Case.

Introduction: Cardiac implantable electronic device infections often necessitate extraction, which can be complicated by calcified adhesions, leading to increased procedural risk and reduced efficacy. Given these challenges, intravascular lithotripsy (IVL) has been proposed as a tool for lead extraction to aid in overcoming calcification. This report presents the first reported case where shockwave IVL was successfully employed to extract a severely calcified lead system after an initial extraction attempt failed due to extensive calcification.

Clinical background: A 58-year-old woman with a dual-chamber pacemaker and recurrent MSSA bacteremia was found to have extensive calcification around her leads. An initial TLE attempt failed due to extensive calcifications.

Intervention: Three months later, given ongoing bacteremia, IVL was used during a repeat percutaneous extraction attempt. Lithotripsy pulses were applied via balloon catheter to disrupt calcified adhesions, enabling sheath advancement and lead mobilization.

Results: Both atrial and ventricular leads were successfully extracted without major complications. The use of IVL directly enabled success where prior methods had failed.

Conclusion: This is the first reported case of successful CIED lead extraction using IVL following a failed initial attempt due to severe calcification. This case illustrates IVL's potential in overcoming specific high-risk anatomic challenges.