{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T12:20:42Z","timestamp":1763727642479,"version":"3.37.3"},"reference-count":20,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,1,30]],"date-time":"2020-01-30T00:00:00Z","timestamp":1580342400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2020,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The optimal approach to the extraction of leads with large vegetations remains uncertain.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>High\u2010risk patients with lead associated vegetations undergoing device extraction at Vanderbilt Hospital with concomitant use of the Penumbra Aspiration System (Penumbra Inc, Alameda, CA) are described. An 8.5 Fr Agilis NXT (Abbott Inc, St. Paul, MN) was advanced to the right atrium, through which a Penumbra Indigo Cat\u20108 catheter was advanced. Using intracardiac echocardiography, the Penumbra was positioned directly on the vegetation, suction was applied until adherent, and the Indigo catheter and Agilis sheath were then removed en\u2010bloc and aspirated debris flushed out. This was repeated until debulking was considered successful.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Eight cases were performed. The median vegetation size was 2\u2009cm. Pathogens were Enterococcus, Staphylococcus, Candida, Cutibacterium, and Enterobacter. In seven of eight cases, aspiration successfully reduced vegetations to less than 1\u2009cm before successful percutaneous cardiac implantable electronic device removal. One patient underwent surgical removal via thoracotomy. There were no acute complications related to the Penumbra catheter. Three patients had CT evidence of small pulmonary emboli postprocedure. The length of stay was 3 to 27 days. One patient died on POD 1 of refractory ventricular tachycardia unrelated to the procedure. One patient died of ongoing sepsis 2 weeks postextraction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The Penumbra Indigo Aspiration system can be useful for vegetation debulking before transvenous lead extraction.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.14363","type":"journal-article","created":{"date-parts":[[2020,1,31]],"date-time":"2020-01-31T07:01:01Z","timestamp":1580454061000},"page":"718-722","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Use of a clot aspiration system during transvenous lead extraction"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9772-0308","authenticated-orcid":false,"given":"Travis D.","family":"Richardson","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Medicine, Arrhythmia Section Vanderbilt University Medical Center, Vanderbilt Heart and Vascular Institute  Nashville Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ricardo M.","family":"Lugo","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Arrhythmia Section Vanderbilt University Medical Center, Vanderbilt Heart and Vascular Institute  Nashville Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0096-8401","authenticated-orcid":false,"given":"George H.","family":"Crossley","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Arrhythmia Section Vanderbilt University Medical Center, Vanderbilt Heart and Vascular Institute  Nashville Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7333-5720","authenticated-orcid":false,"given":"Christopher R.","family":"Ellis","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Arrhythmia Section Vanderbilt University Medical Center, Vanderbilt Heart and Vascular Institute  Nashville Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,1,30]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2009.05.020"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2017.09.001"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehx080"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/jocs.12087"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/jocs.13806"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.13692"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2017.06.011"},{"issue":"1","key":"e_1_2_7_9_1","first-page":"17","article-title":"Simultaneous lead extraction and vacuum\u2010assisted vegetation removal","volume":"2","author":"Issa 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