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SPECTRANETICS CORPORATION TIGHTRAIL ROTATING DILATOR SHEATH; DILATOR, VESSEL, FOR PERCUTANEOUS CATHETERIZATION
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| Model Number |
545-511 |
| Medical Device Problem Code |
Adverse Event Without Identified Device or Use Problem (2993)
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| Health Effect - Clinical Codes |
Great Vessel Perforation (2152); Pericardial Effusion (3271)
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| Date of Event |
11/05/2025
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Type of Reportable Event
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Serious Injury
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Additional Manufacturer Narrative
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A3b) patient gender - not available from facility.H3) the tightrail was discarded, thus no product investigation was performed.H6) per ifu, perforation is listed as a potential adverse event with use of the tightrail device.Submission of this report does not, in itself, represent a conclusion by the manufacturer and/or authorized representative or the national competent authority that the content of this report is complete or accurate, that the medical device(s) listed failed in any manner and/or that the medical device(s) caused or contributed to an alleged death or deterioration in the state of the health of any person.
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Event or Problem Description
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A lead extraction procedure commenced to remove a right atrial (ra) lead due to mri.A right ventricular (rv) lead was present in the patient, but was not targeted for extraction.A spectranetics lld lead locking device (lld) was inserted into the lead to provide traction.Beginning with a spectranetics 11f tightrail rotating dilator sheath, the ra lead was removed.However, the patient¿s blood pressure dropped, and a pericardial effusion was detected via intracardiac echocardiography (ice).Rescue efforts began, including rescue balloon, pericardiocentesis, and sternotomy.A perforation in the superior vena cava (svc) was discovered and repaired.The patient survived the procedure.This report captures the 11f tightrail device in use when the perforation occurred, requiring intervention.There was no alleged malfunction of any spectranetics devices in use during the procedure.
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