Preserving Access After Lead Extraction in Venous Stenosis Using Snaring: The Cowboy Bridge Technique

Maintaining continuous access to the right heart chambers during lead extraction is essential, especially when venous stenosis is present. The Cowboy Bridge technique is a novel and reproducible approach that implies retrograde snaring from a femoral access. We report our results applying this technique in two patients with venous stenosis who required a device upgrade with lead extraction. This procedure facilitates the implantation of new leads by maintaining thorough-and-through access and lowering the risk of perforation compared to anterograde or retrograde attempts to traverse the stenotic site with additional wires or catheters.