Frequency and clinical course of cerebral embolism in patients undergoing transcatheter left atrial appendage closure

Abstract

New cerebral embolic events occur after transcatheter closure of the left atrial appendage. However, most of the lesions demonstrate no gliotic transformation at follow-up. In all patients, the cerebral lesions were clinically unapparent.

Long‐term follow up of 3 T MRI‐detected brain lesions after percutaneous catheter‐based left atrial appendage closure

“…Interestingly, the results of the follow‐up data from our study and the study from Majunke et al were similar. Majunke et al detected gliotic lesions in 3/9 (33%) patients at the 45‐day follow‐up , and our study showed a persistently positive FLAIR sequence in 2/7 patients (29%) at the three‐month follow‐up. It will be interesting to see the long‐term follow‐up results of larger studies.…”

“…Thus, the data on long‐term follow up of ABLs after LAAC is sparse. Laible et al did not provide long‐term follow up in their study , whereas Majunke et al reported on one (3.6%) new lesion at the 45‐day follow‐up after LAAC . Therefore, our study is the first to provide categorical long‐term follow at three months after LAAC of MRI detected ABLs as well as neurocognitive testing and neurological examination.…”

“…Deneke et al demonstrated that 94% of all MRI detected lesions healed without scarring at follow up >2 weeks after AF ablation . Majunke et al reported on one (3.6%) new lesion at the 45‐day follow‐up after LAAC . There is clearly a need for further clarification.…”

“…The PROTECT AF and PREVAIL trails have shown a significant reduction in bleeding events, but the same risk of stroke after percutaneous LAA occlusion as compared to warfarin [7,8]. Several studies have shown that acute brain lesions (ABL) can occur after LAAC [9][10][11]. The incidence has been described to be between 4.8% and 5.2% [9][10][11].…”

“…Several studies have shown that acute brain lesions (ABL) can occur after LAAC [9][10][11]. The incidence has been described to be between 4.8% and 5.2% [9][10][11]. The clinical implications of ABLs is not fully understood, as the long-term clinical course of ABLs during followup has varied.…”