Safety and efficacy of TightRail mechanical sheath for transvenous lead extraction

Objectives This study aimed to evaluate the safety and efficacy of the bidirectional rotational mechanical sheath TightRail (Spectranetics Corp., Colorado Springs, CO, USA) for lead extraction in an Indian center. Material and Methods A prospective study of patients who underwent transvenous lead extractions (TLE) in whom manual extraction was ineffective during the period from March 2018 to March 2021. Results A total of 28 patients underwent lead extraction using TightRail. The mean age at the time of extraction was 62.4±18.07 years. The average duration between implantation and extraction was 8.8±4.6 years. The most common etiology was pocket site infection (78.6%), followed by lead endocarditis (7.1%), chronic pain (3.6%), and lead fracture (10.7%). In total, 53 lead extractions were attempted, with 51 procedures, resulting in a clinical success rate of 96.2%. Approximately 7.14% patients required blood transfusions, and 3.6% developed pericardial effusion. There was no incidents of cardiac avulsion, death or arrhythmias requiring cardioversion. Conclusion This extensive clinical study in India demonstrated that the use of TightRail provides high safety and efficacy for lead extractions across a wide range of lead age. The incidence of infectious etiology was found to be much higher in Indian patients compared to Western literature.