Ehieli Wendy L, Boll Daniel T, Marin Daniele, Lewis Robert, Piccini Jonathan P, Hurwitz Lynne M
1 Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710.
2 Department of Radiology, University Hospital Basel, Basel, Switzerland.
AJR Am J Roentgenol. 2017 Apr;208(4):770-776. doi: 10.2214/AJR.16.16897. Epub 2017 Jan 11.
Five percent of cardiac implantable electric devices (CIEDs) are removed each year. Percutaneous extraction is preferred but can be complicated if the leads adhere to the vasculature or perforate. The goal of this study is to assess the frequency of findings on dedicated MDCT that alter preprocedural planning for percutaneous CIED extraction.
One hundred patients with CIEDs who underwent MDCT before percutaneous lead extraction were analyzed. Major findings that could preclude percutaneous removal, including lead course and termination, were distinguished from moderately significant findings that could alter but not preclude percutaneous removal, including endofibrosis of leads to the vasculature, lead termination abnormalities, central vein stenosis, or thrombus. Incidental findings were characterized separately. Findings were correlated with preprocedural decisions, the extraction procedure performed, and procedural outcomes.
Twenty-six women and 74 men with 125 right ventricular leads, 84 right atrial leads, and 26 coronary venous leads were evaluated. Major findings were present in 7% of patients, including six patients with lead perforation and one with a lead coursing outside a tricuspid annuloplasty ring. Moderately significant findings of endothelial fibrosis were found in 78% of patients. The central veins were narrowed or occluded in 42% of patients, and thrombus was present in 2% of patients. Thirty-six percent of patients had incidental findings, and 4% of patients had unexpected findings requiring immediate inpatient attention.
MDCT performed before CIED lead extraction is able to identify major and moderately significant findings that can alter either percutaneous extraction or preprocedural planning. The use of dedicated preprocedural MDCT can help to stratify patient risk, guide decision making by the proceduralist, and identify non-catheter-related findings that affect patient management.
每年有5%的心脏植入式电子设备（CIED）被移除。经皮拔除是首选方法，但如果导线与血管系统粘连或穿孔则可能出现并发症。本研究的目的是评估专用MDCT检查结果改变经皮CIED拔除术前规划的频率。
分析100例在经皮导线拔除术前接受MDCT检查的CIED患者。将可能排除经皮拔除的主要发现，包括导线走行和终止情况，与可能改变但不排除经皮拔除的中度显著发现区分开来，后者包括导线与血管系统的纤维组织增生、导线终止异常、中心静脉狭窄或血栓形成。偶然发现则单独分类。将检查结果与术前决策、所进行的拔除手术以及手术结果进行关联分析。
评估了26名女性和74名男性，共有125根右心室导线、84根右心房导线和26根冠状静脉导线。7%的患者存在主要发现，包括6例导线穿孔患者和1例导线走行于三尖瓣成形环外的患者。78%的患者发现了中度显著的内皮纤维化表现。42%的患者中心静脉狭窄或闭塞，2%的患者存在血栓。36%的患者有偶然发现，4%的患者有需要立即住院治疗的意外发现。
CIED导线拔除术前进行的MDCT能够识别可改变经皮拔除或术前规划的主要和中度显著发现。使用专用的术前MDCT有助于对患者风险进行分层，指导手术医生进行决策，并识别影响患者管理的非导管相关发现。
