Percutaneous Left Atrial Appendage Closure with the LAmbre Device Protected by a Cerebral Protection System in a 76-Year-Old Man with Persistent Left Atrial Appendage Thrombus

Abstract

Patient: Male, 76-year-old Final Diagnosis: Left atrial appendage thrombus despite optimal anticoagulation Symptoms: Palpitations Medication: — Clinical Procedure: Cryoballoon-based ablation • percutaneous left atrial appendage closure • transesophageal echocardiogram Specialty: Cardiology Objective: Unusual clinical course Background: Despite use of optimal oral anticoagulation regimens, left atrial appendage (LAA) thrombus may develop and persist in patients with atrial fibrillation (AF). The therapeutic options in this population are limited. Percutaneous LAA closure (LAAC) is performed to reduce thrombus formation and the risk of thromboembolism. However, this approach is prohibited in patients with LAA thrombus. We report the case of a 76-year-old man with AF and persistent LAA thrombus who underwent percutaneous LAAC with the LAmbre device protected by the SENTINEL Cerebral Protection System (CPS). Case Report: A 76-year-old man with history of persistent AF treated with pulmonary veins and LAA isolation developed LAA thrombus resistant to different anticoagulation therapies, including apixaban and Phenprocoumon, with a target international normalized ratio (INR) of 3–3,5. Repeated follow-up transesophageal echocardiography showed a persistent LAA thrombus despite optimal INR values. Thus, we performed a percutaneous LAAC using a double-umbrella-designed appendage occluder and a CPS to minimize the risk of intraprocedural cerebral embolization. The procedure was guided by transesophageal echocardiography and fluoroscopy. No signs of systemic thromboembolism were noted, and the CPS filters showed no evidence of thrombotic material. Conclusions: This report shows that the use of a CPS during percutaneous LAAC may reduce the risk of procedural cerebral embolization and could be used as an alternative therapy for patients with contraindication or lack of effectiveness of oral anticoagulation.

Overcoming barriers for left atrial appendage thrombus: a systematic review of left atrial appendage closure

“…The SL1 sheath was changed over a guidewire with the LAmbre sheath and the device landing zone diameter was measured by TEE and biplane angiography. The corresponding device was loaded on the delivery system and then advanced in the LA through the LAmbre sheath [ 25 ] Tan 2021 Watchman = 2 N/A N/A 1 2 TEE The Sentinel CPS device was placed using standard practices via the right radial artery with the two filters successfully deployed in the brachiocephalic and left common carotid artery. Using a 14 Fr double curve Watchman access sheath, a 30 mm Watchman device was successfully deployed at the ostium [ 26 ] Tsai 2023 Watchman = 2 Amulet Amplatzer = 8 10 10 9 10 TEE No-touch technique.…”

Should left atrial appendage closure be considered in resistant left atrial appendage thrombus cases? ‘Former Foe, New Ally’

“…As operators gained more experience over time, several authors published case reports on LAA occlusion in patients with thrombus present in the LAA. [12][13][14] In a previous study, we reported our own series of LAA occlusion procedures performed in patients with LAAT. 3,8,15 To the best of our knowledge, the current study represents the largest single-center registry focused on evaluating the effectiveness and safety of the LAAC procedure in patients with LAAT.…”

“…Thrombus formation in the LAA was traditionally considered to be a contraindication to percutaneous LAA closure. As operators gained more experience over time, several authors published case reports on LAA occlusion in patients with thrombus present in the LAA 12–14 . In a previous study, we reported our own series of LAA occlusion procedures performed in patients with LAAT 3,8,15 .…”