Why the study?
The indication and timing of cardiac thrombectomy after the onset of cerebral infarction have not been standardized and appear to differ among individuals.
The optimal timing of left atrial thrombectomy after cardioembolic stroke remains unstandardized and should be individualized based on thrombus and infarct characteristics.
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Timing of left atrial thrombectomy after cardioembolic stroke warrants caution; case reports leave open need for individualized protocols and prospective data.
Two men (Case 1, 74 years old; Case 2, 65 years old) developed cardioembolic stroke due to self-interruption of anticoagulants for treating atrial fibrillation. They both had mobile thrombus in the left atrial appendage. In Case 1, a left atrial thrombectomy was scheduled on day 8, but infarction re-occurred on the morning of the the surgery, producing neurological sequelae. In Case 2, left atrial thrombectomy and left atrial appendage closure were performed successfully on day 8. The indication and timing of cardiac thrombectomy after the onset of cerebral infarction have not been standardized, and they seem to differ among individuals. Therefore, in the future, the optimal timing of left atrial thrombectomy should be decided based on the size and morphology of the left atrial thrombus, the size of the cerebral infarction and the presence or absence of hemorrhagic infarction.
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Sakuwa et al. (2020) studied this question.
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