Percutaneous LAA occlusion with cerebral embolic protection was successfully performed in an 82-year-old with persistent LAA thrombus despite anticoagulation, avoiding severe events.
Does percutaneous LAAO with cerebral embolic protection prevent severe adverse events and allow for successful closure in patients with persistent LAA thrombosis despite optimal anticoagulation?
LAAO performed with cerebral embolic protection may serve as a safe, individualized bail-out strategy for highly selected patients with persistent LAA thrombosis who fail optimal oral anticoagulation.
Absolute Event Rate: 0% vs 0%
Abstract Background Atrial fibrillation (AF) significantly increases the risk of ischemic stroke, primarily due to left atrial appendage (LAA) thrombosis. Percutaneous left atrial appendage occlusion (LAAO) offers an alternative approach to oral anticoagulation. However, the presence of LAA thrombosis has been considered a contraindication due to the risk of cerebral embolization. Case summary An 82-year-old woman presented to our department with dyspnea and history of non-valvular persistent atrial fibrillation as well as heart failure. Serial transesophageal echocardiography (TEE) revealed persistent left atrial appendage (LAA) thrombosis despite optimal oral anticoagulation. As a therapeutic alternative, percutaneous LAA closure with cerebral embolic protection was carried out successfully with no severe adverse events reported. In the following, the patient also underwent cryoballoon pulmonary vein isolation (PVI) to achieve rhythm control. In the follow-up examination the anticoagulation was replaced with aspirin and transthoracic echocardiography (TTE) showed normalization of the left ventricular ejection fraction in sinus rhythm. Discussion This case report illustrates that in highly selected patients with persistent LAA thrombus despite prolonged, optimized anticoagulation, LAAO performed under meticulous procedural precautions and cerebral embolic protection may represent a carefully justified, individualized bail-out strategy
Althoff et al. (Tue,) reported a other. Percutaneous LAA occlusion with cerebral embolic protection was successfully performed in an 82-year-old with persistent LAA thrombus despite anticoagulation, avoiding severe events.