Impact and predictors of device-related thrombus after percutaneous left atrial appendage closure

Abstract

Device-related thrombus (DRT) is a known complication occurring in up to 7% of patients undergoing percutaneous left atrial appendage closure (LAAC). Since the target population of LAAC is generally ineligible for oral anticoagulant therapies, DRT raises important concerns. The aim of this review will be to summarize available evidence on DRT after LAAC focusing on its possible impact on outcomes. Recent findings showed a tighter association between DRT and neurological ischemic events. Antithrombotic regimen adopted after LAAC may have a protective effect against DRT. Many patient-related and procedural factors have been identified as possible predictors of DRT. A tailored approach, which takes into account DRT, is needed in the patient selection for LAAC and in the postprocedural follow-up.

Lights and shadows on left atrial appendage occlusion: mind the gap in knowledge and think twice on long-term outcomes

“…In light of recent literature, a strict correlation between neurological events and DRT was shown. 22 Particularly, ischemic stroke or systemic embolism occurred in 15.4-26.2% of patients with DRT and 3.2-6.8% of patients without documented DRT. 22,24,25 A similar prognostic trend was shown by Alkhouli et al's.…”

“…22 Particularly, ischemic stroke or systemic embolism occurred in 15.4-26.2% of patients with DRT and 3.2-6.8% of patients without documented DRT. 22,24,25 A similar prognostic trend was shown by Alkhouli et al's. 26 meta-analysis showing a higher incidence of ischemic events in DRT patients in comparison with no-DRT patients (13.2% and 3.8%, respectively).…”

“…1 Smoking and female sex are independent predictors of DRT at early to mid-term follow-up. 20 As reported in the literature, DRT is significantly less frequent (incidence 3.74-3.80%) 1 than PDL, but occurrs in up to 7.2% of patients who underwent percutaneous LAA occlusion in some casistics 22 (taking into account that DRT may be underdiagnosed, possibly because diagnosis is challenging 1 ). In two-thirds of the cases, seemingly, DRT occurs within 180 days after LAA occlusion.…”

“…23 The risk factors/predictors of DRT include older age, prior transient ischemic attack (TIA)/stroke/ thromboembolism, higher CHA 2 DS 2 -VASc score, left ventricular dysfunction, deeper (>10 mm from the pulmonary vein limbus) device implantation, periprocedural pericardial effusion, renal disease, hypercoagulability, concomitant vasculopathy, and nonparoxysmal AF. 1,22 CCT could be important in order to increase the TEE diagnostic capacity. 1 Effectively, CCT may be able to detect the subtle changes in hypoattenuated thickening on the device atrial surface, which sometimes cannot be optimally evaluated by TEE.…”

The role of cardiac imaging before and after left atrial appendage standalone thoracoscopic exclusion

“…[9][10][11][12] However, patient candidates for percutaneous LAA occlusion may require dual antiplatelet therapy (DAPT), in order to prevent the risk of device-related thrombus that might be also difficult to manage in patients at risk of bleeding. 13 In 2011, a novel technique for LAA exclusion by clipping, using an epicardial device, was described (AtriClip Pro II); the device can be used either during open-chest or thoracoscopic surgery, the latter performed as part of a minimally invasive atrial fibrillation ablation procedure or standalone to clip the LAA. In 2015, a multicentre trial reported a success rate for AtriClip LAA open-chest exclusion of 95%.…”