Campens Laurence, Schmidt Michael Rahbek, Philbert Berit T, Vinther Michael
Congenital Interventional Cardiology, Cardiology Department, Rigshospitalet, Copenhagen, Denmark.
Congenital Interventional Cardiology, Cardiology Department, Rigshospitalet, Copenhagen, Denmark.
JACC Case Rep. 2025 Apr 2;30(7):103374. doi: 10.1016/j.jaccas.2025.103374.
This report discusses the challenges and strategies involved in managing venous stenosis secondary to pacing or defibrillator leads, focusing on endovascular treatment options and procedural considerations.
Crucial steps of the procedure include thorough preprocedural planning, obtaining multisite venous access for optimal angiographic visualization, wiring through the stent using a percutaneous coronary intervention wire supported by a microcatheter and guiding catheter, confirming true lumen and intraluminal wire passage, and progressive ballooning using high-pressure balloons and kissing balloon technique.
Procedural complications include crushing of the pacing leads within the stent, incomplete stent expansion, and aggravation of existing stenosis. Ensuring correct wire trajectory and using multiple imaging modalities are critical to avoiding these issues.
TAKE-HOME MESSAGE: Venous stenosis related to pacing leads requires a multidisciplinary approach, with careful preprocedural planning and meticulous technique.
本报告讨论了处理起搏或除颤器导线继发的静脉狭窄所涉及的挑战和策略，重点关注血管内治疗选择和操作注意事项。
该操作的关键步骤包括全面的术前规划、获得多部位静脉通路以实现最佳血管造影可视化、使用由微导管和引导导管支撑的经皮冠状动脉介入导丝穿过支架、确认真腔和腔内导丝通过，以及使用高压球囊和双球囊技术进行逐步球囊扩张。
操作并发症包括支架内起搏导线受压、支架扩张不完全以及现有狭窄加重。确保正确的导丝轨迹并使用多种成像方式对于避免这些问题至关重要。
与起搏导线相关的静脉狭窄需要多学科方法，术前仔细规划并采用细致的技术。
