Key result
In patients with atrial fibrillation and CAA-associated intracerebral haemorrhage, left atrial appendage occlusion resulted in pooled incidence rates of 5.16 ischaemic strokes and 2.73 ICH events per 100 patient-years.
Why the study?
Cerebral amyloid angiopathy is a common cause of intracerebral haemorrhage with high recurrence risk, and the outcomes of left atrial appendage occlusion for stroke prevention in patients with AF and CAA-associated ICH are not well established.
Does LAAO prevent ischaemic stroke and ICH in patients with AF and CAA-associated ICH?
Observational (n=102)
Yes
Does LAAO prevent ischaemic stroke and ICH in patients with AF and CAA-associated ICH?
Effect estimate: 5.16 per 100 patient-years (95% CI 1.36-17.48)
LAAO followed by short-term antithrombotic therapy appears to be a safe and effective strategy for ischaemic stroke prevention in patients with AF and CAA-associated ICH, though randomized trials are needed.
BACKGROUND: Cerebral amyloid angiopathy (CAA) is a common cause of intracerebral haemorrhage (ICH) with a high recurrence risk. Left atrial appendage occlusion (LAAO) is a method for ischaemic stroke prevention in patients with atrial fibrillation (AF), potentially reducing the risk of intracranial bleeding in CAA-associated ICH. We aimed to determine the outcomes of patients with AF with CAA-associated ICH undergoing LAAO. METHODS: We conducted a multicentre study of patients with CAA-associated ICH who underwent LAAO for stroke prevention. We pooled our findings with data from a systematic review of relevant published studies of LAAO for AF in ICH survivors reporting CAA diagnosis. RESULTS: We included data from two published studies (n=65) with CAA-specific data and our cohort study (n=37), providing a total of 102 participants (mean age 76.2±8.0 years, 74.6% male) with CAA-related symptomatic ICH and AF treated with LAAO. The median follow-up period was 9.4 months (IQR 4.2-20.6). Postprocedural antithrombotic regimens varied between single (73.0%) or dual antiplatelet therapy (16.2%), or direct oral anticoagulant (DOAC) (10.8%), with a median duration of 42 days (IQR 35-74). Postprocedural complications were uncommon, but included transient arrhythmias (2.1%) and non-life-threatening tamponade (2.1%). Pooled incidence rates of ischaemic stroke and ICH during follow-up were 5.16 (95% CI 1.36 to 17.48) and 2.73 (95% CI 0.41 to 13.94) per 100 patient years, respectively. CONCLUSIONS: LAAO followed by short-term antithrombotic therapy might be a safe and effective ischaemic stroke preventive strategy in people with CAA-associated ICH and AF. However, randomised controlled trials are needed to determine how LAAO compares with long-term DOAC in this population. PROSPERO REGISTRATION NUMBER: CRD42023415354.
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Thiankhaw et al. (2024) conducted an observational in Atrial fibrillation and intracerebral haemorrhage associated with cerebral amyloid angiopathy (n=102). Left atrial appendage occlusion was evaluated on Incidence rate of ischaemic stroke (5.16 per 100 patient-years, 95% CI 1.36-17.48). In patients with atrial fibrillation and CAA-associated intracerebral haemorrhage, left atrial appendage occlusion resulted in pooled incidence rates of 5.16 ischaemic strokes and 2.73 ICH events per 100 patient-years.
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