Background
Transvenous lead extraction (TLE)
is essential in the long-term management of cardiac implantable
electronic devices. TLE is necessary in cases of lead infection, lead
damage, lead extraction for transplant, or lead
replacement.1 Superior lead extraction is frequently
used as the primary approach for TLE.2 In some cases,
using both the superior and femoral approaches for lead extraction may
be necessary to achieve successful lead removal.3 The
femoral approach can be useful in a situation where there is limited
space between the lead and the superior vena cava. In this situation,
creating sufficient separation to allow for the safe and effective
removal of the lead using only the superior approach is difficult. The
femoral approach may be necessary to facilitate the advancement of a
powered sheath via the superior approach. Grasping a lead without a free
end is difficult. The Needle’s
eye snare (NES) (Cook Medical Inc., Bloomington, IN, USA) is an
effective tool to grasp a lead without a free end.3However, the size of its loop cannot be changed and the threader is
rigid. Therefore, there are instances where the loop fails to grasp a
lead, leading to unsuccessful procedures and complications, such as
cardiac tamponade and atrial septal perforation.4In this report, we propose a
faster and easier method of successfully grasping a lead without a free
end named the “Wire ThRoUgh Snare Twice” (Wire TRUST) technique.