Left atrial appendage occlusion for stroke despite oral anticoagulation (resistant stroke). Results from the Amplatzer Cardiac Plug registry

Cruz-González, Ignacio; González‐Ferreiro, Rocío; Freixa, Xavier; Gafoor, Sameer; Shakir, Samera; Omran, Heyder; Berti, Sérgio; Santoro, Gennaro; Kefer, Joëlle; Landmesser, Ulf; Nielsen‐Kudsk, Jens Erik; Kanagaratnam, Prapa; Nietlispach, Fabiàn; Gloekler, Steffen; Aminian, Adel; Danna, Paolo; Rezzaghi, Marco; Stock, Friederike; Stolcova, Miroslava; Paiva, Luís; Costa, Marco A.; Millán, Xavier; Ibrahim, Réda; Tichelbäcker, Tobias; Schillinger, Wolfgang; Park, Jai‐Wun; Sievert, Horst; Meier, Bernhard

doi:10.1016/j.rec.2019.02.013

Cited by 24 publications

(27 citation statements)

References 24 publications

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“…Estimated frequency of resistant stroke is 11%, and there is insufficient evidence, to date, to decide the management of these patients. Nevertheless, new emerging cohort studies have shown similar effectiveness and safety outcomes for LAAO in this group of patients, suggesting that LAAO could be a viable alternative to medical treatment ( 5 , 6 ).…”

Section: Discussionmentioning

confidence: 84%

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Acute Mitral Regurgitation Secondary to Spontaneous Left Atrial Appendage Occluder Migration

et al. 2021

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A patient underwent left atrial appendage occlusion due to recurrent stroke despite new oral anticoagulant therapy. The patient later presented with severe acute mitral regurgitation secondary to occluder device migration, which was retrieved percutaneously from the descending aorta via the femoral artery. Mitral surgical repair was required and successfully performed. ( Level of Difficulty: Intermediate. )

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Section: Discussionmentioning

confidence: 84%

“…The most common major adverse events are major bleeding and pericardial effusion or tamponade, which occur at a rate of 1.5% for both and usually appear within the first days after the procedure. Cardiac surgery is required in <3% of overall cases ( 5 , 6 , 8 ).…”

Section: Discussionmentioning

confidence: 99%

Acute Mitral Regurgitation Secondary to Spontaneous Left Atrial Appendage Occluder Migration

et al. 2021

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“…However, there are still rare individuals in which, despite anticoagulation, episodes of stroke or transient ischemic attack occur, and LAAO might be of benefit for such cases. A study that came out in 2020 put forward the proposition that in patients with resistant stroke, LAAO leads to a reduction in episodes of stroke during follow-up [15]. Another study by Pouru et al in the same year also showed the same results [16].…”

Section: Figure 1: Safety Concerns With Laao and Oacmentioning

confidence: 88%

Comparison Between Oral Anticoagulation and Left Atrial Appendage Occlusion in the Prevention of Stroke With Regard to Non-Valvular Atrial Fibrillation

Sandhu¹,

Aftab²,

Anthony³

et al. 2020

Cureus

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In the past, the most common type of atrial fibrillation leading to stroke was valvular; this was predominantly due to the prevalence of rheumatic fever, but with the advent of better-hospitalized care, the cases of valvular atrial fibrillation declined. In recent years, there has been an increase in cases of stroke due to non-valvular atrial fibrillation. Stasis of blood in the left atrial pouch leads to coagulation and thrombi formation, which may lead to stroke. Oral medication or mechanical intervention can prevent thrombi formation. Both oral anticoagulation and left atrial appendage occlusion (LAAO) have been compared to see which has better outcomes. It was observed that LAAO has greater efficacy, but with time throughout a couple of years, no considerable difference was seen when compared to warfarin. Most of the long-term randomized controlled trials have been performed with the Watchman ® device. Although the Lariat and Amplatzer LAAO devices have also shown favorable outcomes, there is still a deficiency when it comes to trials of high-quality evidence using these devices as an intervention. Dual therapy with both of these approaches showed a decline in the count of major bleeding episodes on follow-up. Overall, albeit both methods have proven useful, LAAO has a slight advantage in efficacy and leads to less hemorrhagic events.

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“…Other LAA features, such as trabeculation, orifice area, LAA flow velocity, seem to identify LAA at high risk of thrombosis (5). One study explored the safety and efficacy of LAAO as secondary prevention in patients with nonvalvular atrial fibrillation who have experienced a stroke/transient ischemic attack despite anticoagulant treatment (6). A recent prospective, observational study on 19 patients explored the efficacy to combine LAAO to anticoagulants (7).…”

Section: Discussionmentioning

confidence: 99%

Atrial Fibrillation and Resistant Stroke: Does Left Atrial Appendage Morphology Matter? A Case Report

et al. 2020

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Introduction: Patients with atrial fibrillation (AF) can experience ischemic stroke despite adequate anticoagulant therapy. The secondary prevention strategy of these so-called “resistant strokes” is empirical. Since about 90% of patients with ischemic stroke due to atrial fibrillation have thrombus in left atrial appendage (LAA) we sought to explore the possibility that resistant stroke could have a LAA morphology resistant to anticoagulants. Case Report: A 77 years old man affected by AF experienced two cardioembolic ischemic stroke while on anticoagulants. The study of LAA showed a windsock-like morphology in the proximal part while distally the LAA presented a cauliflower morphology with a large amount of pectinate muscles and blood stagnation. The precise characteristics of LAA were properly understood integrating images obtained by cardiac CT, transesophageal echocardiography, and selective angiography. A high risky LAA for thrombus formation was diagnosed and its occlusion (LAAO) as an add-on therapy to anticoagulants was proposed and performed. Six month follow-up was uneventfully. Conclusion: The systematic study of LAA in patients with resistant-stroke could help to identify LAA malignant morphology. The efficacy on stroke recurrence of the combined therapy (anticoagulants plus LAAO) is worthy to be tested in randomized trials.

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Left atrial appendage occlusion for stroke despite oral anticoagulation (resistant stroke). Results from the Amplatzer Cardiac Plug registry

Cited by 24 publications

References 24 publications

Acute Mitral Regurgitation Secondary to Spontaneous Left Atrial Appendage Occluder Migration

Acute Mitral Regurgitation Secondary to Spontaneous Left Atrial Appendage Occluder Migration

Comparison Between Oral Anticoagulation and Left Atrial Appendage Occlusion in the Prevention of Stroke With Regard to Non-Valvular Atrial Fibrillation

Atrial Fibrillation and Resistant Stroke: Does Left Atrial Appendage Morphology Matter? A Case Report

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