Cardiac Computed Tomography Angiography for Device-Related Thrombus Assessment After WATCHMAN FLX™ Occluder Device Implantation: A Single-Center Retrospective Observational Study

Miller, Thomas W.; Hana, David; Patibandla, Saikrishna; Guzman, Daniel Brito; Avalon, Juan Carlo; Zeb, Irfan; Kadiyala, Madhavi; Mills, Jim; Balla, Sudarshan; Kim, Cathy; Lisle, Mark; Kawsara, Mohammad Akram; Raybuck, Bryan; Sengupta, Partho P.; Hamirani, Yasmin S.

doi:10.1016/j.carrev.2022.01.028

Cited by 9 publications

(4 citation statements)

References 19 publications

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“…However, the conclusion was different in another recent single-center retrospective study[ 17 ]. Miller et al [ 17 ] included 43 patients who underwent Watchman FLX implantation from July 2020 to September 2021, and the final results showed that more than 40% of patients (17/43) implanted with Watchman FLX had PDL. Only 53% of patients (23/43) had complete closure of the LAA.…”

Section: Incidence Of Pdlmentioning

confidence: 57%

Progress in the study and treatment of peri-device leak after left atrial appendage closure

Qi,

Chu

2023

World J Clin Cases

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Insulin, a small protein with 51 amino acids synthesized by pancreatic β-cells, is crucial to sustain glucose homeostasis at biochemical and molecular levels. Numerous metabolic dysfunctions are related to insulin-mediated altered glucose homeostasis. One of the significant pathophysiological conditions linked to the insulin associated disorder is diabetes mellitus (DM) (type 1, type 2, and gestational). Insulin resistance (IR) is one of the major underlying causes of metabolic disorders despite its association with several physiological conditions. Metabolic syndrome (MS) is another pathophysiological condition that is associated with IR, hypertension, and obesity. Further, several other pathophysiological disorders/diseases are associated with the insulin malfunctioning, which include polycystic ovary syndrome, neuronal disorders, and cancer. Insulinomas are an uncommon type of pancreatic β-cell-derived neuroendocrine tumor that makes up 2% of all pancreatic neoplasms. Literature revealed that different biochemical events, molecular signaling pathways, microRNAs, and microbiota act as connecting links between insulin disorder and associated pathophysiology such as DM, insuloma, neurological disorder, MS, and cancer. In this review, we focus on the insulin-related disorders and the underlying mechanisms associated with the pathophysiology.

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Section: Incidence Of Pdlmentioning

confidence: 57%

Progress in the study and treatment of peri-device leak after left atrial appendage closure

Qi,

Chu

2023

World J Clin Cases

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“…Meanwhile, it allows for a thorough evaluation of the atrial device surface, including the evaluation of hypoattenuated thickening (HAT) as a marker of contrast sparring. Several studies have suggested low-grade HAT as a proxy for benign endothelialization, while high-grade HAT has been associated with a higher thromboembolic risk [26,41,[89][90][91]. In one study, simultaneous CT and histology were performed in five canines, showing low-grade HAT to be associated with both macroscopic and histological evidence of neo-endothelialization [26].…”

Section: Device Healing-imagingmentioning

confidence: 99%

“…In one study, simultaneous CT and histology were performed in five canines, showing low-grade HAT to be associated with both macroscopic and histological evidence of neo-endothelialization [26]. Throughout several studies, HAT across the device surface on early follow-up CT has been observed in up to 61% and 64% of patients specifically implanted with Watchman FLX, while another study specifically evaluating ACP-and Amulet-implanted patients found HAT only in 6% of patients [26,41,91]. While this variability might suggest large differences in early endothelialization, the coupling of HAT with endothelial coverage needs additional validation.…”

Section: Device Healing-imagingmentioning

confidence: 99%

Left Atrial Appendage Occlusion and Post-procedural Antithrombotic Management

Kramer,

Patti,

Nielsen-Kudsk

et al. 2024

JCM

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Left atrial appendage occlusion (LAAO) is an established alternative to oral anticoagulation for stroke prevention in atrial fibrillation. Antithrombotic therapy is used in the post-procedural period to prevent device-related thrombosis (DRT). The risk of DRT is considered highest in the first 45–90 days after device implantation, based on animal studies of the device healing process. Clinically applied antithrombotic regimens vary greatly across studies, continents, and centers. This article gives an overview of the evidence behind current antithrombotic regimens, ongoing randomized trials, and future post-procedural management.

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“…However, due to a lack of standardized definition of DRT on computed tomography angiography for WATCHMAN, guidelines are still in development, and additional studies are needed to determine standardized parameters for DRT diagnosis. 61 Additional use of serum biomarkers, such as the level of prothrombin fragments 1 + 2 and D-dimer, could be viable options and may potentially help us better understand and manage the post-WATCHMAN device implantation healing process. However, the relationship between these parameters and imaging-confirmed DRT is yet to be validated.…”

Section: The Rationale For Antithrombotic Therapymentioning

confidence: 99%

The WATCHMAN Device Review: A new era for stroke prophylaxis

Khan¹,

Naz²,

Khan³

et al. 2023

Journal of Community Hospital Internal Medicine Perspectives

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Atrial fibrillation (AF) is a major risk factor for ischemic stroke, accounting for more than 37 million cases worldwide. In AF, the left atrial appendage (LAA) is the most common site of thrombus formation, and its ligation/closure with the WATCHMAN device is a good alternative to long-term oral anticoagulation, especially in patients with contraindications to warfarin. However, the implantation procedure is associated with various risks and complications. A short-term anticoagulant and antithrombotic administration are essential after implantation. However, no consensus has been reached on the optimal regimen. The WATCHMAN device is non-inferior to warfarin and is a safe alternative for the prevention of stroke and systemic embolization related to non-valvular atrial fibrillation (NVAF). Important procedure-related complications include pericardial effusion (PE), device embolization, procedure-related ischemic stroke, and device-related thrombosis (DRT) formation. It is essential to optimize post-implantation therapy according to individual patient bleeding risk, DRT formation, and contraindication to direct oral anticoagulants (DOACs). Recent studies have also shown that DOACs are a convenient and non-inferior substitute for warfarin. Furthermore, patients with absolute contraindications to OACs/DOACs can only be managed with dual antiplatelet therapy (DAPT). Transesophageal echocardiography (TEE) should be used to assess residual peridevice flow and possible DRT formation at days 45 and 12 months. Low molecular weight heparin (LMWH) and OAC are excellent choices for DRT treatment if detected. This review summarizes the most important complications of the WATCHMAN device in the existing literature and discusses various anticoagulation strategies and challenges post-implementation.

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Cardiac Computed Tomography Angiography for Device-Related Thrombus Assessment After WATCHMAN FLX™ Occluder Device Implantation: A Single-Center Retrospective Observational Study

Cited by 9 publications

References 19 publications

Progress in the study and treatment of peri-device leak after left atrial appendage closure

Progress in the study and treatment of peri-device leak after left atrial appendage closure

Left Atrial Appendage Occlusion and Post-procedural Antithrombotic Management

The WATCHMAN Device Review: A new era for stroke prophylaxis

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