Computed Tomography-Guided Risk Assessment in Percutaneous Lead Extraction.
Computed Tomography-Guided Risk Assessment in Percutaneous Lead Extraction.
复制标题
计算机断层扫描引导经皮铅提取的风险评估。
DOI：
10.1016/j.jacep.2019.09.007
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发表时间：
2019
期刊：
影响因子：
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通讯作者：
Birgersdotter-Green,Ulrika
中科院分区：
文献类型：
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作者：
Svennberg,Emma;Jacobs,Kathleen;McVeigh,Elliot;Pretorius,Victor;Birgersdotter-Green,Ulrika
本研究的目的是评估术前计算机断层扫描(CT)是否能够识别高危手术特征并预测手术复杂性的增加。已知粘连会影响留置时间较长的导联，但可能会不可预测地影响较新的导联。方法连续接受CT检查的患者在计划的导联拔除(LE)前90天行≤。根据预先设定的检查表，对CTS进行盲法检查。结果在2015年1月1日至2018年7月1日期间，143名患者接受了CT和LE。中位年龄为68岁(四分位数范围：54.4至76.5)，其中35%为女性。提取的导线年龄中位数为111个月，其中126个(43%)为10岁。CT发现导联穿孔≥5 mm(n=13)，Lt；5 mm(n=355)，严重导联粘连(n=65)，导联触及血管壁1 cm(n=1020)，导联骨折(n=10.8)，严重同侧静脉狭窄/闭塞(n=3.36)。63例手术操作复杂。死亡2例，主要并发症6例。严重铅粘连的患者有更复杂的操作(n=36 vs29；p=0.04)，而CT上的其他发现均与较差的预后无关。在导联留置时间为10年的患者中(n=872)，多因素分析显示严重的导联粘连与预后不良相关(优势比：6.4；95%可信区间：1.4~30.2；p=0.02)。结论术前CT可用于定位计划拔除导联的患者的严重导联粘连。在留置导引时间为10年的患者中，术前CT有助于识别容易进行复杂拔除的患者。
ObjectivesThe aim of this study was to assess if pre-procedural computed tomography (CT) could identify high-risk operative features and predict increased procedural complexity.BackgroundUnpredictable lead adhesions can make lead extraction complicated. Adhesions are known to affect leads with longer indwelling time but can unpredictably affect newer leads.MethodsConsecutive patients who had CTs performed ≤90 days before their planned lead extraction (LE) were included. CTs were reviewed blinded to outcome according to a preset checklist. The outcome was a combined endpoint of procedural complexity and major complications.ResultsBetween January 1, 2015 and July 1, 2018, 143 patients underwent CT and LE. Median age was 68 years (interquartile range [IQR]: 54.4 to 76.5), and 35% were female. Median age of extracted leads was 111 months, and 126 (43%) were >10 years. CT detected lead perforation ≥5 mm (n = 13), <5 mm (n = 55), severe lead adhesions (n = 65), leads touching vessel wall >1 cm (n = 102), lead fracture (n = 8), and severe ipsilateral venous stenosis/occlusion (n = 36). The procedure was complex in 63 cases. There were 2 deaths, and 6 major complications. Patients with severe lead adhesions had more complex procedures (n = 36 vs 29; p = 0.04), whereas none of the other findings on CT were significantly associated with worse outcome. In patients with leads that had an indwelling time <10 years (n = 72), severe lead adhesions on CT was associated with worse outcome in multivariable analysis (odds ratio: 6.4; 95% confidence interval: 1.4 to 30.2; p = 0.02).ConclusionsPre-procedural CT can be used to locate severe lead adhesions in patients planned for lead extraction. In patients with indwelling leads <10 years, pre-procedural CT aids in identifying patients prone to complex extractions.