title: Advanced techniques for chronic lead extraction: heading from the laser towards the evolution system.
abstract: OBJECTIVE
  The evolution mechanical dilator sheath has been reported to be an effective tool for chronic lead extraction (LE). We examined safety and efficacy of evolution system as compared with laser system.
  
  
  RESULTS
  From 2005 to 2009, all extractions requiring the use of a powered sheath were performed using the excimer laser system (n = 73). Since 2009, laser system was no longer available and the evolution system was introduced as the first-line method for powered extraction (n = 48). All procedures were performed by a single first operator. Success and complications were defined according to the current guidelines. Patients of the evolution group compared with those of the laser group had a greater number of extracted leads per patient (2.77 vs. 2.4, P = 0.049) and a longer implant duration (101.1 vs. 62.4 months, P = 0.001). Additional use of snare was required in 27.1% of the evolution group and 8.2% of the laser group (P = 0.005). Complete procedural success was achieved in 91.7% of the evolution group and 97.3% of the laser group (P = 0.16). There was also no difference between evolution and laser groups in clinical success (97.9 vs. 98.6%, P = 0.76), as well as regarding major (4.2 vs. 2.7%, P = 0.66) or minor complications (4.2 vs. 5.5%, P = 0.76).
  
  
  CONCLUSIONS
  Use of the recently introduced evolution system for LE exhibit acceptably high levels of safety, as well as of procedural and clinical success, although additional use of snare was required more frequently in the evolution compared with the laser group.
authors: Arrhythmia Unit and Electrophysiology Laboratories, Department of Cardiology and Cardiothoracic Surgery, Ospedale San Raffaele, via Olgettina 60, Milan, Italy.
authors: Patrizio
authors: P
authors: Mazzone
authors: Dimitris
authors: D
authors: Tsiachris
authors: Alessandra
authors: A
authors: Marzi
authors: Giuseppe
authors: G
authors: Ciconte
authors: Gabriele
authors: G
authors: Paglino
authors: Nicoleta
authors: N
authors: Sora
authors: Simone
authors: S
authors: Gulletta
authors: Pasquale
authors: P
authors: Vergara
authors: Paolo
authors: P
authors: Della Bella
mesh_terms: D000368:Aged; D062906:Cardiac Catheters; D017147:Defibrillators, Implantable; D020878:Device Removal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D004106:Dilatation / Q000009:adverse effects / Q000295:instrumentation; D004867:Equipment Design; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects / Q000295:instrumentation; D054018:Lasers, Excimer; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D015641:Radiography, Interventional; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Lead extraction; Powered sheath; Snare