Late Hybrid Retrieval of a Embolized Left Atrial Appendage Occlusion Device

Figures

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  Figure 1. Computed Tomography Angiogram of Aortic Arch Computed tomography angiogram demonstrated the presence of the embolized Amulet left atrial appendage occlusion device in the transverse aorta at the left subclavian artery ostium.

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  Figure 2. Intraprocedural Transesophageal Echocardiography Image Transesophageal echocardiography showing intramural hematoma after device dislodgement from the transverse aorta.

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  Figure 3. Fluoroscopic Images Demonstrating Amulet Device Within the ONO Basket in the Aortic Arch (A and B) An initial attempt was made to secure the embolized Amulet with a Raptor grasping device, but there was difficulty in getting the device coaxially aligned with the device. (C and D) A 15-mm gooseneck snare was used to grasp the button on the Amulet, allowing it to be withdrawn into the ONO basket. The encaged Amulet was withdrawn to the right common femoral artery, where further attempts to compress and reorient it for withdrawal into the 24-F DrySeal sheath were unsuccessful.

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  Figure 4. Open Retrieval of Embolized Amulet Device Within ONO Basket After withdrawal of the embolized Amulet within the ONO basket to the right common femoral artery, evolving limb ischemia prompted urgent vascular surgery consultation. (A and B) Vascular surgery proceeded to a mini midline laparotomy, where the device was extracted through the infrarenal abdominal aorta. (C) The device was heavily infiltrated with tissue and adherent thrombus, which likely accounted for the difficulty in compressing and removing the device through an entirely percutaneous route.

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  Visual Summary. Late Embolization of an LAAO Device With Hybrid Retrieval A 72-year-old man presented with an ischemic stroke 2 years after LAAO implantation. CT angiography identified the device lodged across the left subclavian artery ostium in the transverse aortic arch. Percutaneous capture was achieved using a basket retrieval system under fluoroscopy and TEE guidance, but chronic tissue ingrowth prevented resheathing into a large-bore sheath. A hybrid bailout with infrarenal aortotomy enabled safe extraction, avoiding sternotomy and cardiopulmonary bypass. CT = computed tomography; LAAO = left atrial appendage occlusion; TEE = transesophageal echocardiography.