Multimodality approach to detect device-related thrombus after left atrial appendage occlusion: a case report

Background There has been a growing interest in using left atrial appendage occlusion (LAAO) for stroke prevention in patients with atrial fibrillation (AF) who are ineligible for oral anticoagulation. However, device-related thrombus (DRT) may occur after LAAO implantation and poses significant diagnostic and treatment challenges. Case summary We describe a case of a patient who suffered an intracranial pontine haemorrhage while on anticoagulation with rivaroxaban for permanent atrial fibrillation and successfully underwent implantation of the LAAO device. Early follow-up transoesophageal echocardiography with 3D multiplane reconstruction revealed a large echo-dense mass on the left atrial aspect of the device. Cardiac computed tomography angiography confirmed a thrombus adherent to the LAAO device. After deciding on the treatment strategy, complete thrombus resolution was achieved at the 6 months follow-up and the patient was free of any thromboembolic and bleeding events. Discussion Although DRT is a rare complication following LAAO procedure, an accurate diagnosis is crucial for the specific treatment. Multimodality imaging approach with transoesophageal echocardiography and cardiac computed tomographic angiography as complementary methods is helpful to detect complications after LAAO procedure in challenging cases.