Left Atrial Appendage Closure in Patients With Atrial Fibrillation and Coexisting Cerebral Amyloid Angiopathy

Blanc, Clémence; Blanc, Grégoire; Boveda, Serge; Calvière, Lionel; Combes, Nicolas; Viguier, Alain; Mondoly, Pierre; Albucher, Jean‐François; Gollion, Cédric; Fabry, Vincent; Barbieux-Guillot, Marianne; Olivot, Jean Marc; Elbaz, Meyer; Raposo, Nicolas

doi:10.1161/strokeaha.121.037248

Cited by 3 publications

(7 citation statements)

References 3 publications

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“…An increased risk of lobar microbleeds has been observed in CAA‐patients with a history of ICH treated with AP 8 A further option is LAAC 3–5 . Although apparently an elegant solution, LAAC has several disadvantages which are frequently disregarded.…”

Section: Discussionmentioning

confidence: 99%

“… 8 A further option is LAAC. 3 , 4 , 5 Although apparently an elegant solution, LAAC has several disadvantages which are frequently disregarded. The left atrial appendage (LAA) plays an important hemodynamic role.…”

Section: Discussionmentioning

confidence: 99%

“…Renou et al 4 Schrag et al 3 Blanc et al 5 F I G U R E 1 Cerebral magnetic resonance imaging showing global atrophy, leukoaraiosis, periventricular T2 hyperintense spots (A), subcortical microbleeds (B), and bleeding in the left thalamus (C). These findings were consistent with the diagnosis "probable cerebral amyloid angiopathy" according to the modified Boston criteria.…”

Section: Authormentioning

confidence: 99%

“… 2 Both antiplatelet drugs (AP) and anticoagulants (AC) increase the risk of recurrent ICH, why left atrial appendage closure (LAAC) is suggested (Table 1 ). 3 , 4 , 5 By presenting the following case, we critically discuss the different therapeutic options.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Authormentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“…Some indication regarding the safety of this approach in patient at high bleeding risk can be extrapolated from a few small observational cohorts of symptomatic CAA patients with coexisting AF, which suggest that left atrial appendage closure might probably be safe-and a promising option-in this population. 73,74 The optimal antithrombotic management after left atrial appendage occlusion procedure varies between centers and is constantly changing. A multidisciplinary model including both stroke neurologists and cardiologists and a case-by-case discussion of possible candidates will be the safest and most thoughtful approach.…”

Section: Management Of Patients With Silent Cmbs and Css Who Have An ...mentioning

confidence: 99%

Cardiovascular Management in Asymptomatic (Silent) Cerebral Microbleeds and Suspected Cerebral Amyloid Angiopathy

Charidimou,

Smith

2024

Stroke

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Cerebral microbleeds (CMBs) detected on blood-sensitive magnetic resonance imaging sequences are usually a sign of an underlying cerebral small vessel disease such as sporadic cerebral amyloid angiopathy or sporadic nonamyloid small vessel pathology (eg, arteriolosclerosis). Much of the enduring interest in CMBs relates to their high prevalence (partly due to the widespread use of magnetic resonance imaging) in the context of stroke, cognitive impairment and in healthy individuals, and the clinical uncertainties created about the safety of antithrombotic medications due to their association with both future hemorrhagic and ischemic stroke. Historically, the research literature overwhelmingly emphasized the future hemorrhagic risk associated with CMBs, potentially leading to unnecessary withholding of treatments proven effective at preventing thrombosis, such as anticoagulants in patients with atrial fibrillation who happened to have some microbleeds. The lack of strong guidelines in this area contributes to wide variation in clinical practice. In this article, we critically review and discuss the implications of silent CMBs and cortical superficial siderosis (ie, without symptomatic intracerebral hemorrhage) in different clinical settings: the general population, patients with ischemic stroke, and the memory clinic. Emerging evidence, albeit not from randomized controlled trials, suggests that in most patients, CMBs alone should not prevent the use of antithrombotics or anticoagulants for stroke prevention, when they are otherwise indicated. Where possible, we provide specific suggestions for clinical care grounded in both the limited available literature and our personal clinical practice.

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Effectiveness and Safety of Oral Anticoagulants in Cardiac Amyloidosis: Lights and Shadows

Lisi

Caccamo

Damerino

et al. 2023

Current Problems in Cardiology

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Left Atrial Appendage Closure in Patients With Atrial Fibrillation and Coexisting Cerebral Amyloid Angiopathy

Cited by 3 publications

References 3 publications

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

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

Cardiovascular Management in Asymptomatic (Silent) Cerebral Microbleeds and Suspected Cerebral Amyloid Angiopathy

Effectiveness and Safety of Oral Anticoagulants in Cardiac Amyloidosis: Lights and Shadows

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