Introduction A 54-year-old man with superior vena cava occlusion was referred to our institution for an upgrade to cardiac resynchronization therapy defibrillator. Methods and results Right ventricular lead extraction with modified venoplasty, rocket-shape crossing technique (RCT), was performed. In RCT, the integration of the inflated balloon, halfway inside the laser sheath, and the laser sheath are advanced through the occlusion like a “rocket-shape crossing”. Conclusion Modified venoplasty can be useful during device upgrades in patients with venous occlusion.

We introduce a fast and easy method of successfully grasping a lead without a free end called the “Wire ThRoUgh Snare Twice (Wire TRUST)” technique in a 49-year-old male patient who required transvenous lead extraction (TLE) and lead replacement due to lead malfunction. Our proposed technique is less difficult than using the Needle’s eye snare because the pigtail catheter is softer and has better operability. The Wire TRUST technique promptly allows a combined superior and femoral approach for TLE, even when the lead tip is difficult to free because of severe adhesion.