A 76-Year-Old Man With Hemorrhagic Stroke, Recurrent Thromboembolic Events, and Atrial Fibrillation Under Optimal Medical Treatment: When Anticoagulants Fail

Figures

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  Figure 1. Electrocardiogram upon arrival indicating AF with rapid ventricular response AF: atrial fibrillation

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  Figure 2. Urgent brain CT scan indicating focal intracerebral hemorrhage in the right thalamus and right semioval center CT: computed tomography

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  Figure 3. Twenty-four-hour follow-up scan revealing increased focal dimensions without active hemorrhage

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  Figure 4. Triplex sonography of the left internal carotid artery indicating the plaque (red arrow) and stenosis percentage (white arrow)

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  Figure 5. Triplex sonography of the right internal carotid artery indicating the plaque (blue arrow) and stenosis percentage (white arrow)

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  Figure 6. Two-dimensional six-week follow-up TEE indicating appropriate device anchoring on the LAA landing zone (white arrow) TEE: transesophageal echocardiography, LAA: left atrial appendage

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  Figure 7. Four-dimensional TEE performed at six-week follow-up demonstrating complete device endothelialization with the endothelialized surface of the Watchman occluder (black arrow) TEE: transesophageal echocardiography

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  Figure 8. Two-dimensional TEE performed at six-week follow-up demonstrating minimal peri-device leak (white arrow) with no evidence of a major residual jet TEE: transesophageal echocardiography

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  Figure 9. Two-dimensional TEE performed at six-week follow-up demonstrating the Watchman occluder and left atrium without evidence of thrombus (white arrow) TEE: transesophageal echocardiography

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  Figure 10. Timeline of antithrombotic regimens, stroke occurrence, and interventions LAAO: left atrial appendage occlusion