Stroke After Surgical Left Atrial Appendage Clip With Residual Neck Thrombus

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Stroke with residual neck thrombus after surgical left atrial appendage clip (n=1). Intervention: Transseptal implantation of an Amplatzer Vascular Plug II with Sentinel cerebral embolic protection.

Q: What does this research mean for the field?

Percutaneous plug occlusion performed with cerebral embolic protection can successfully convert incomplete surgical left atrial appendage clip exclusion into complete closure. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Charbel Noujaim; Karen Jabbour; Mohammad Abbasi; Rhonda Miyasaka; Bo Xu; Pasquale Santangeli; Wael A. Jaber; Mohamed H. Kanj

doi:10.1016/j.jaccas.2026.110558

September 1, 2026JACC Case ReportsOpen Access

Stroke After Surgical Left Atrial Appendage Clip With Residual Neck Thrombus

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Key result

Amplatzer Vascular Plug II successfully seals residual ostium after incomplete surgical LAA clip ligation.

n=1

Graphical abstract published by JACC Case Reports — Graphical abstract · Published by JACC Case Reports · CC BY 4.0

Why the study?

Incomplete left atrial appendage clip closure is a recognized complication that may increase thromboembolic risk, requiring confirmation of exclusion before stopping anticoagulation.

Does transcatheter plug occlusion with cerebral embolic protection successfully treat an incomplete surgical left atrial appendage clip complicated by residual thrombus and stroke in a patient with atrial fibrillation?

Key Points

To describe the diagnosis and catheter-based management of a thromboembolic stroke resulting from incomplete surgical left atrial appendage clip ligation.
Evaluated a 72-year-old woman with persistent atrial fibrillation presenting with acute ischemic stroke despite apixaban therapy and prior surgical clip placement.
Utilized cardiac computed tomography and intraprocedural transesophageal echocardiography to identify a narrow residual ostium (6 × 5 mm) harboring an 11 × 6 mm thrombus.
Performed transcatheter closure using a 12-mm Amplatzer Vascular Plug II with Sentinel cerebral embolic protection via single transseptal puncture.
Cardiac computed tomography detected incomplete surgical ligation and an 11 × 6 mm thrombus that initial local echocardiography had missed.
Deployment of the vascular plug under cerebral protection achieved complete closure of the residual communication without intraprocedural complications.
Post-procedure imaging confirmed a complete seal, and the patient experienced an uneventful clinical recovery.

Study Design

Type

Case Report (n=1)

Structured PICO

Does transcatheter plug occlusion with cerebral embolic protection successfully treat an incomplete surgical left atrial appendage clip complicated by residual thrombus and stroke in a patient with atrial fibrillation?

P

Population

A 72-year-old woman with persistent atrial fibrillation and prior epicardial LAA clip who presented with a stroke due to an incomplete ligation and residual thrombus.

I

Intervention

Transcatheter implantation of a 12-mm Amplatzer Vascular Plug II via single transseptal access (Agilis sheath, VersaCross RF wire) to occlude the residual ostium, performed with Sentinel cerebral embolic protection.

O

Outcome

Procedural success (complete seal of the residual communication as confirmed by TEE and angiography)surrogate

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Implication

Transcatheter plug occlusion with cerebral embolic protection is a viable strategy to achieve complete closure in patients with incomplete surgical left atrial appendage exclusion and residual thrombus.

Abstract

BACKGROUND: Incomplete left atrial appendage clip closure is a recognized complication and may increase thromboembolic risk. CASE SUMMARY: A 72-year-old woman with persistent atrial fibrillation presented with a left middle cerebral artery stroke while on apixaban. History included mitral valve repair with epicardial left atrial appendage clip and AV-junction ablation with a leadless pacemaker. Local transesophageal echocardiogram (TEE) reported complete ligation without thrombus; cardiac computed tomography at our institution demonstrated incomplete ligation with a narrow residual ostium and an 11 × 6 mm thrombus. With Sentinel cerebral embolic protection, intraprocedural TEE identified a 6 × 5 mm residual communication. Single transseptal access (Agilis sheath, VersaCross RF wire) permitted traversal of the neck; a 12-mm Amplatzer Vascular Plug II was implanted. TEE and angiography confirmed complete seal; recovery was uneventful. TAKE-HOME MESSAGES: Computed tomography and TEE should confirm exclusion before stopping anticoagulation after clip ligation. Plug occlusion performed with cerebral embolic protection can convert incomplete surgical exclusion to complete closure.

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Cite This Study

Noujaim et al. (2026) conducted a case report in Stroke with residual neck thrombus after surgical left atrial appendage clip (n=1). Transseptal implantation of an Amplatzer Vascular Plug II with Sentinel cerebral embolic protection was evaluated. Transseptal implantation of an Amplatzer Vascular Plug II with cerebral embolic protection successfully achieved complete closure of a residual ostium after incomplete surgical LAA clip ligation.

synapsesocial.com/papers/6ace6db8b52af824ab02bb6a https://doi.org/10.1016/j.jaccas.2026.110558

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Stroke After Surgical Left Atrial Appendage Clip With Residual Neck Thrombus

Key Points

Study Design

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Stroke After Surgical Left Atrial Appendage Clip With Residual Neck Thrombus

Key Points

Study Design

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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