Upgrading procedure is relatively common since indications to cardiac resynchronization therapy (CRT) and implantable
defibrillator are increasing. A relatively frequent phenomenon that the operator may encounter is some degree of venous obstruction
around the previously implanted leads, which may become completely occlusive. In these situations, upgrading procedure may
be challenging and various manoeuvers have been described. We describe a case of intraprocedural percutaneous transluminal
angioplasty (PTA) of occlusive stenosis of the innominate vein, performed during an upgrading procedure from bicameral cardiac
implantable defibrillator (ICD) to CRT-D.