title: Unexpected challenging case of coronary sinus lead extraction.
abstract: An 84-year-old woman implanted with cardiac resynchronization therapy defibrillator underwent transvenous lead extraction 4 mo after the implant due to pocket infection. Atrial and right ventricular leads were easily extracted, while the attempt to remove the coronary sinus (CS) lead was unsuccessful. A few weeks later a new extraction procedure was performed in our center. A stepwise approach was used. Firstly, manual traction was unsuccessfully attempted, even with proper-sized locking stylet. Secondly, mechanical dilatation was used with a single inner sheath placed close to the CS ostium. Finally, a modified sub-selector sheath was successfully advanced over the electrode until it was free of the binding tissue. The post-extraction lead examination showed an unexpected fibrosis around the tip. No complications occurred during the postoperative course. Fibrous adhesions could be found in CS leads recently implanted requiring non-standard techniques for its transvenous extraction.
authors.affiliation: Luca Bontempi, Manuel Cerini, Francesca Salghetti, Niccolò Dasseni, Clara Villa, Lorenza Inama, Francesca Vassanelli, Antonio Curnis, Chair and Unit of Cardiology, University of Brescia, Spedali Civili Hospital, 25123 Brescia, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Bontempi
authors.affiliation: Luca Bontempi, Manuel Cerini, Francesca Salghetti, Niccolò Dasseni, Clara Villa, Lorenza Inama, Francesca Vassanelli, Antonio Curnis, Chair and Unit of Cardiology, University of Brescia, Spedali Civili Hospital, 25123 Brescia, Italy.
authors.forename: Donatella
authors.initials: D
authors.lastname: Tempio
authors.affiliation: Luca Bontempi, Manuel Cerini, Francesca Salghetti, Niccolò Dasseni, Clara Villa, Lorenza Inama, Francesca Vassanelli, Antonio Curnis, Chair and Unit of Cardiology, University of Brescia, Spedali Civili Hospital, 25123 Brescia, Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: De Vito
authors.affiliation: Luca Bontempi, Manuel Cerini, Francesca Salghetti, Niccolò Dasseni, Clara Villa, Lorenza Inama, Francesca Vassanelli, Antonio Curnis, Chair and Unit of Cardiology, University of Brescia, Spedali Civili Hospital, 25123 Brescia, Italy.
authors.forename: Manuel
authors.initials: M
authors.lastname: Cerini
authors.affiliation: Luca Bontempi, Manuel Cerini, Francesca Salghetti, Niccolò Dasseni, Clara Villa, Lorenza Inama, Francesca Vassanelli, Antonio Curnis, Chair and Unit of Cardiology, University of Brescia, Spedali Civili Hospital, 25123 Brescia, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Salghetti
authors.affiliation: Luca Bontempi, Manuel Cerini, Francesca Salghetti, Niccolò Dasseni, Clara Villa, Lorenza Inama, Francesca Vassanelli, Antonio Curnis, Chair and Unit of Cardiology, University of Brescia, Spedali Civili Hospital, 25123 Brescia, Italy.
authors.forename: Niccolò
authors.initials: N
authors.lastname: Dasseni
authors.affiliation: Luca Bontempi, Manuel Cerini, Francesca Salghetti, Niccolò Dasseni, Clara Villa, Lorenza Inama, Francesca Vassanelli, Antonio Curnis, Chair and Unit of Cardiology, University of Brescia, Spedali Civili Hospital, 25123 Brescia, Italy.
authors.forename: Clara
authors.initials: C
authors.lastname: Villa
authors.affiliation: Luca Bontempi, Manuel Cerini, Francesca Salghetti, Niccolò Dasseni, Clara Villa, Lorenza Inama, Francesca Vassanelli, Antonio Curnis, Chair and Unit of Cardiology, University of Brescia, Spedali Civili Hospital, 25123 Brescia, Italy.
authors.forename: Abdallah
authors.initials: A
authors.lastname: Raweh
authors.affiliation: Luca Bontempi, Manuel Cerini, Francesca Salghetti, Niccolò Dasseni, Clara Villa, Lorenza Inama, Francesca Vassanelli, Antonio Curnis, Chair and Unit of Cardiology, University of Brescia, Spedali Civili Hospital, 25123 Brescia, Italy.
authors.forename: Lorenza
authors.initials: L
authors.lastname: Inama
authors.affiliation: Luca Bontempi, Manuel Cerini, Francesca Salghetti, Niccolò Dasseni, Clara Villa, Lorenza Inama, Francesca Vassanelli, Antonio Curnis, Chair and Unit of Cardiology, University of Brescia, Spedali Civili Hospital, 25123 Brescia, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Vassanelli
authors.affiliation: Luca Bontempi, Manuel Cerini, Francesca Salghetti, Niccolò Dasseni, Clara Villa, Lorenza Inama, Francesca Vassanelli, Antonio Curnis, Chair and Unit of Cardiology, University of Brescia, Spedali Civili Hospital, 25123 Brescia, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Luzi
authors.affiliation: Luca Bontempi, Manuel Cerini, Francesca Salghetti, Niccolò Dasseni, Clara Villa, Lorenza Inama, Francesca Vassanelli, Antonio Curnis, Chair and Unit of Cardiology, University of Brescia, Spedali Civili Hospital, 25123 Brescia, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Curnis
keywords: Cardiac pacing; Cardiac resynchronization therapy; Coronary sinus lead; Fibrosis; Transvenous lead extraction