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Address reprint requests and correspondence: Dr. Charles Kennergren, Department of Cardiothoracic Surgery, The Sahlgrenska University Hospital, SE 413 45 Gothenburg, Sweden.
If manual extraction is not successful, a locking stylet is used after the inner lumen
is reamed using another stylet to remove debris. Use of a locking stylet with a very
flexible tip is essential so that a tortuous lead can be negotiated. Equally important
is locking the stylet as close as possible to the lead tip and not allowing the stylet
to slip during the procedure. The risk of severing the sometimes fragile interpolar
section of encapsulated bipolar leads is high if a positive lock close to the lead
tip cannot be achieved. To avoid pulling out the core of the lead and leaving the
outer insulation in place, a ligature is used to fasten the insulation to the rest
of the lead and to the locking stylet. I recommend using a large-diameter ligature
and distributing the tension using at least two separate knots to avoid cutting the
insulation with the ligature (Figure 1). A long ligature (reeled) is used to avoid obstructing knots inside sheaths.
Figure 1Leads ready for extraction with locking stylets inserted and insulation sutures attached.
