Extraction of a coronary sinus lead: always so easy?

Lead extraction is a complex procedure associated with potential risks and requires considerable experience of the operator in the use of specific techniques and tools. With the exception of active fixation leads, the extraction procedure of coronary sinus leads is less complex and risky, in the absence of adhesions with other vascular leads. We report a difficult coronary sinus lead extraction, which required both superior (subclavian) and inferior (femoral) approaches and the use of multiple lead extraction tools. In order to perform a well tolerated and effective extraction procedure, well trained and experienced staff in a well equipped setting is, therefore, mandatory even for apparently simple cases.