Laser sheaths extracted old leads with similar success, shorter procedure times vs. femoral approach

Bordachar P. Circ Arrhythm Electrophysiol. 2010;3:319-323.

Issue: November 2010

Patients undergoing extraction of old transvenous leads via laser sheaths experienced similar success and complication rates, and shorter procedure times vs. femoral snare extraction, new study data suggested.

This prospective study compared the safety and efficacy of laser sheaths (CVX-300 Excimer Laser System, Spectranetics Corp.) with femoral snare extractions in single-center and multicenter trials.

The single-center trial was composed of 101 patients referred for unequivocal indications to extractat least one transvenous lead. Patients were 4 years or older and were randomly assigned to either groups (laser sheaths, n=50; femoral approach, n=51). The multicenter trial (n=356 patients) also evaluated extraction methods but was designed to compare the experience of six medical centers with expertise in the femoral or superior approach.

In the single-center trial, success and complication rates were similar between groups, with no patient dying from a periprocedural complication; however, researchers reported a significantly shorter procedure (51 ± 22 minutes vs. 86 ± 51 minutes) and total fluoroscopic exposure duration (7 ± 7 minutes vs. 21 ± 17 minutes) in the laser sheath group.

For patients in the multicenter trial, the major procedural complication rate was 3% in laser and femoral groups, with the rates of complete, partial and unsuccessful extractions also similar between the two arms.

"We found no significant difference between the proximal approach, using laser, and the femoral approach, using snares, with respect to procedural success and complication rates,"� the researchers concluded. "However, procedures performed using the femoral approach were longer and were associated with a longer exposure of the operators and patients to fluoroscopy."

Follow CardiologyToday.com on Twitter.