Feasibility of Left Atrial Appendage Occlusion in Left Atrial Appendage Thrombus

Sharma, Sharan Prakash; Cheng, Jie; Turagam, Mohit K.; Gopinathannair, Rakesh; Horton, Rodney; Lam, Yat‐Yin; Tarantini, Giuseppe; D’Amico, Gianpiero; Rofastes, Xavier Freixa; Lange, Mathias; Lakkireddy, Dhanunjaya

doi:10.1016/j.jacep.2019.11.017

Cited by 40 publications

(60 citation statements)

References 40 publications

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“…A recent publication assessed the feasibility of Watchman placement in patients with an LAA thrombus. 7 Cerebral protection devices were used in 29% of patients, and there was no procedure-related stroke but 1 late stroke a year later. The thrombi were distally located, and patients with proximal thrombus were excluded from the study.…”

Section: Discussionmentioning

confidence: 99%

High-risk left atrial appendage occlusion via isoproterenol infusion and carotid filter placement

Lador

Cheng

Valderrábano

et al. 2021

HeartRhythm Case Reports

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Section: Discussionmentioning

confidence: 99%

High-risk left atrial appendage occlusion via isoproterenol infusion and carotid filter placement

Lador

Cheng

Valderrábano

et al. 2021

HeartRhythm Case Reports

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“…However, patients with LA thrombi have been excluded from major RCTs due to concerns of possible clot dislodgement and subsequent thromboembolism thereby limiting available data. A recent systematic review of 58 patients does however indicate the safety and feasibility of LAAO in persistent distal LAA thrombi 95 . A “no‐touch” technique with minimal catheter manipulation is favored with lobe‐disc devices such as the ATRICLIP or AMULET.…”

Section: Special Considerationsmentioning

confidence: 99%

Current practice and future prospects in left atrial appendage occlusion

Narasimhan

Aedma

Bhatia

et al. 2021

Pacing Clinical Electrophis

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The thromboembolic complications of Atrial fibrillation (AF) remain a major problem in contemporary clinical practice. Despite advances and developments in anticoagulation strategies, therapy is complicated by the high risk of bleeding complications and need for meticulous medication compliance. Over the past few decades, the left atrial appendage has emerged as a promising therapeutic target to prevent thromboembolic events while mitigating bleeding complications and compliance issues. Emerging data indicates that it is a safe, effective and feasible alternative to systemic anticoagulation in patients with non‐valvular AF. A number of devices have been developed for endocardial or epicardial based isolation of the left atrial appendage. Increasing experience has improved overall procedural safety and ease while simultaneously reducing device related complication rates. Furthermore, increasing recognition of the non‐mechanical advantages of this procedure has led to further interest in its utility for further indications beyond the prevention of thromboembolic complications. In this review, we present a comprehensive overview of the evolution of left atrial appendage occlusion, commercially available devices and the role of this modality in the current management of AF. We also provide a brief outline of the landmark trials supporting this approach as well as the ongoing research and future prospects of left atrial appendage occlusion

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“…CPDs used included Triguard, Sentinel, and FilterWires. All procedures were performed without any procedural complications [66]. There are no larger studies or even RCTs available for the use of CPDs during LAAO.…”

Section: Left Atrial Appendage Occlusionmentioning

confidence: 99%

Cerebral Protection Devices during Transcatheter Interventions: Indications, Benefits, and Limitations

Haußig

Linke

2020

Curr Cardiol Rep

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Purpose of Review Stroke remains a devastating complication of cardiovascular interventions. This review is going to discuss stroke rates and outcomes in different cardiovascular procedures with a highlight on the current evidence for the use of cerebral protection devices (CPD). Recent Findings Depending on the quality of neurological assessment, stroke occurs in up to 9.1% after TAVI, 3.9% after mitral clipping, 3.1% in LAAO patients, 0.4% after PCIs, and 1.8% after catheter ablation. CPDs are available for routine use. They are easy to use in most anatomies, feasible, and safe. Data on clinical impact and stroke reduction from RCTs are still missing. Summary Most evidence for the routine use of CPDs exists in TAVI patients, who are at the highest risk. The PROTECTED TAVI RCT will shed more light on the clinical impact of CPD-use in TAVI patients. In other cardiovascular procedures like mitral clipping, PCIs, and ablation, the current data do not support the routine use of CPDs in these patients. Keywords Cerebral protection. Stroke. Cardiovascular interventions Abbreviations AS Aortic stenosis CEL Cerebral embolic lesion CVE Cerebrovascular event CPD Cerebral protection device DW-MRI Diffusion-weighted magnetic resonance imaging GFR Glomerular filtration rate LAAO Left atrial appendage occlusion PCI Percutaneous coronary intervention SBI Silent brain infarct TAVI Transcatheter aortic valve implantation VIV Valve in valve VT Ventricular tachycardia This article is part of the Topical Collection on Structural Heart Disease

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Feasibility of Left Atrial Appendage Occlusion in Left Atrial Appendage Thrombus

Cited by 40 publications

References 40 publications

High-risk left atrial appendage occlusion via isoproterenol infusion and carotid filter placement

High-risk left atrial appendage occlusion via isoproterenol infusion and carotid filter placement

Current practice and future prospects in left atrial appendage occlusion

Cerebral Protection Devices during Transcatheter Interventions: Indications, Benefits, and Limitations

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