Left Atrial Appendage Closure for Patients with Cerebral Amyloid Angiopathy and Atrial Fibrillation: the LAA-CAA Cohort

Schrag, Matthew; Grory, Brian Mac; Nackenoff, Alex; Eaton, James E.; Mistry, Eva; Kirshner, Howard S.; Yaghi, Shadi; Ellis, Christopher R.

doi:10.1007/s12975-020-00838-5

Cited by 19 publications

(25 citation statements)

References 34 publications

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“…Direct oral anticoagulants consistently show a ∼50% lower ICH risk than vitamin K antagonists, 57 so are preferred after TFNEs associated with cSAH when there is a need for oral anticoagulation. In patients with atrial fibrillation and high ischemic stroke risk, left atrial appendage occlusion is a potential option in those at very high intracranial bleeding risk on oral anticoagulation, 58 although the procedure does not obviate the need for postprocedure antithrombotics, at least in the short term, and randomized data are not available in patients with cSAH.…”

Section: Methodsmentioning

confidence: 99%

Cerebral Amyloid Angiopathy–Related Transient Focal Neurologic Episodes

et al. 2021

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Transient focal neurological episodes (TFNEs) are brief disturbances in motor, somatosensory, visual or language functions that can occur in patients with cerebral amyloid angiopathy (CAA) and may be difficult to distinguish from transient ischemic attacks (TIAs) or other transient neurological syndromes. They herald a high rate of future lobar intracerebral hemorrhage, making it imperative to differentiate them from TIAs to avoid potentially dangerous use of antithrombotic drugs. Cortical spreading depression or depolarization triggered by acute or chronic superficial brain bleeding, a contributor to brain injury in other neurological diseases, may be the underlying mechanism. This review discusses diagnosis, pathophysiology, and management of CAA-related TFNEs.

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Section: Methodsmentioning

confidence: 99%

Cerebral Amyloid Angiopathy–Related Transient Focal Neurologic Episodes

et al. 2021

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“…A cohort study evaluating LAAC in patients with CAA has proven this method to be safe and effective in reducing stroke risk in patients with CAA; thus, allowing avoidance of oral anticoagulation and its associated risks. 6 PROTECT AF and PREVAIL are two randomized trials which compared LAAC to warfarin therapy for stroke prevention in patients with A-Fib. 17 However, this data for ischemic stroke prevention via LAAC is difficult to interpret.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…One must then walk the delicate balance between managing the risk of cerebral thromboembolism associated with A-Fib and the risk of cerebral hemorrhage associated with CAA. 6 In this report, we present the case of a 67-year-old woman with A-Fib and onset of amyloid spells.…”

Section: Introductionmentioning

confidence: 97%

“…One must then walk the delicate balance between managing the risk of cerebral thromboembolism associated with A-Fib and the risk of cerebral hemorrhage associated with CAA. 6…”

Section: Introductionmentioning

confidence: 99%

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Cerebral Amyloid Angiopathy and Atrial Fibrillation: An up to Date Case Report

Battistin

AlQassim

Hallak

et al. 2022

The Neurohospitalist

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Concurrent Cerebral Amyloid Angiopathy (CAA) and Atrial Fibrillation are becoming an increasingly common dilemma in clinical practice due to the aging population and the comorbidities associated with it. In such patients, the physician must appreciate and strike the difficult balance between the risk of ischemic strokes from atrial fibrillation on one hand, and that of intracerebral hemorrhage from coexisting CAA on the other. Anticoagulation is necessary for the former but potentially deleterious for the latter. In this case report, we present the case of a 67-year-old woman with a long history of atrial fibrillation on rivaroxaban who recently began to experience recurrent transient neurological deficits that were later diagnosed as amyloid spells related to concomitant CAA. While there is no clear-cut consensus in published literature on how to best manage these patients regarding the use of anticoagulation, it is recommended to involve a multidisciplinary team for optimal management of these patients.

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Stroke prevention in an octogenarian with atrial fibrillation, cerebral amyloid angiopathy and intracerebral hemorrhage

Stöllberger

Finsterer

2023

Clinical Case Reports

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Left-atrial-appendage-closure (LAAC) is suggested as alternative to antiplatelet/ anticoagulant therapy (AP/AC) for stroke-prevention in patients with cerebralamyloid-angiopathy (CAA), intracerebral hemorrhage (ICH) and atrial fibrillation (AF). Disadvantages of LAAC are the need for postinterventional AP and impairment of left atrial function, thus promoting heart-failure. Therefore, in an 83-year-old edoxaban-treated AF-patient with ICH and CAA, only antihypertensive therapy with neither AP/AC nor LAAC was recommended. Twenty-seven months without stroke/ICH support this strategy, which needs confirmation by a randomized-trial. K E Y W O R D S anticoagulant therapy, atrial fibrillation, cerebral amyloid angiopathy, cerebral bleeding, left atrial appendage closure How to cite this article: Stöllberger C, Finsterer J, Schneider B. Stroke prevention in an octogenarian with atrial fibrillation, cerebral amyloid angiopathy and intracerebral hemorrhage.

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Left Atrial Appendage Closure for Patients with Cerebral Amyloid Angiopathy and Atrial Fibrillation: the LAA-CAA Cohort

Cited by 19 publications

References 34 publications

Cerebral Amyloid Angiopathy–Related Transient Focal Neurologic Episodes

Cerebral Amyloid Angiopathy–Related Transient Focal Neurologic Episodes

Cerebral Amyloid Angiopathy and Atrial Fibrillation: An up to Date Case Report

Stroke prevention in an octogenarian with atrial fibrillation, cerebral amyloid angiopathy and intracerebral hemorrhage

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