Left atrial appendage patency and device-related thrombus after percutaneous left atrial appendage occlusion: a computed tomography study

Cochet, Hubert; Iriart, Xavier; Sridi, Soumaya; Camaioni, Claudia; Corneloup, O.; Montaudon, Michel; Laurent, François; Selmi, Wieme; Renou, Pauline; Jalal, Zakaria; Thambo, Jean-Benoît

doi:10.1093/ehjci/jey010

Cited by 65 publications

(42 citation statements)

References 21 publications

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“…The median duration of the first follow-up period was 105.2 (62.3-187.5) days for CCTA and 90 (47-137.4) days for TEE. In addition, five studies had multiple follow-up CCTAs for varying indications (10,11,12,13,14). Three studies reported CCTA and TEE performed at the same follow-up visit, which was approximately 45 days.…”

Section: Resultsmentioning

confidence: 99%

“…In the three studies that reported the average gap size on both CCTA and TEE (12,19,20), the average gap size between the modalities was not significantly different. Four studies (11,15,18,20,21) evaluated adequate LAA device closure on CCTA by assessing both the peridevice gap and contrast enhancement in the LAA distal to the device. The prevalence of incomplete LAA closure in these studies was 60%, 98%, and 51%, amongst which 38%, 28%,43% of patients respectively had peridevice gap (27,30,32).…”

Section: J O U R N a L P R E -P R O O Fmentioning

confidence: 99%

See 1 more Smart Citation

CT assessment of the left atrial appendage post-transcatheter occlusion – A systematic review and meta analysis

Banga

Sengupta

Benjamin

et al. 2021

Journal of Cardiovascular Computed Tomography

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Section: Resultsmentioning

confidence: 99%

Section: J O U R N a L P R E -P R O O Fmentioning

confidence: 99%

CT assessment of the left atrial appendage post-transcatheter occlusion – A systematic review and meta analysis

Banga

Sengupta

Benjamin

et al. 2021

Journal of Cardiovascular Computed Tomography

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“…However, the choice of imaging modality influence the process. 2,7 Several prior studies have reported high rate of device thrombus formation in patients with PDLs 5,8,9 although others have failed to show any association between PDL and clinical events. 2,10 Consequently, the diagnosis of PDL is a very significant part of post-LAAO follow-up.…”

Section: Discussionmentioning

confidence: 99%

A simple method to detect leaks after left atrial appendage occlusion with Watchman

Ayhan

Mohanty

Gedikli

et al. 2020

Cardiovasc electrophysiol

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Background We evaluated the efficacy of a new method in identifying peri‐device leak (PDL) using morphology of the thrombus formed inside the left atrial appendage (LAA) as seen on follow‐up transesophageal echo (TEE). Method A total of 291 consecutive patients undergoing Watchman procedure were included in this analysis. TEE was performed at 45 days postprocedure. Based on the presence of the thrombus inside the LAA behind the device, patients were grouped as (1) white (W) group: LAA completely filled with thrombus (n = 101), 2) nonwhite (NW) group: LAA completely black or mixed (part black and part white; n = 190). Follow‐up TEE was repeated at 6 and 12 months. Results Baseline characteristics were comparable between groups except the device size, number of patients with chicken‐wing morphology, and prevalence of left atrial “smoke” that were significantly higher in the NW group. Detection of black appearance was comparable between the pre‐coil closure image and the NW population (26/36 [72.2%] vs 99/154 [64.3%], p = .37). After adjusting for clinically relevant covariates, NW appearance of the LAA was associated with the presence of significant leak (odds ratio: 47.96, 95% confidence interval: 2.91–790.2, p < .001). The 11 patients with mixed appearance at the 6‐month TEE remained unchanged (part black and part white) at the 12‐month TEE. LAA appearance was white in all 36 patients following coil closure. Conclusion Our findings demonstrated white and nonwhite appearance of the appendage on TEE to be reliable markers of complete closure and leak respectively, following LAA occlusion with the Watchman device.

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“…21 In a computed tomography follow-up study including 117 patients with both WATCHMAN and AMPLATZER (Cardiac Plug and Amulet), the DRT prevalence was 16% at 3 months after implantation. 22 There have been reports on early and late occurrence of LAAO thrombosis. In a recent systematic registry, early (within 1.5 months), late (between 1.5 and 6 months), and very late (between 6 and 12 months) LAAO thrombosis occurred in 28.6, 28.6, and 42.9% of the cases, respectively.…”

Section: Risk Factors For Left Atrial Appendage Closure Device Thrombmentioning

confidence: 99%

Thrombogenicity and Antithrombotic Strategies in Structural Heart Interventions and Nonaortic Cardiac Device Therapy—Current Evidence and Practice

et al. 2019

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As the number of, and the indications for, structural heart interventions are increasing worldwide, the optimal secondary prevention to reduce device thrombosis is becoming more important. To date, most of the recommendations are empiric. The current review discusses mechanisms behind device-related thrombosis, the available evidence with regard to antithrombotic regimen after cardiac device implantation, as well as providing an algorithm for identification of risk factors for device thrombogenicity and for management of device thrombosis after implantation of patent foramen ovale and left atrial appendage occluders, MitraClips/transcatheter mitral valve replacement, pacemaker leads, and left ventricular assist devices. Of note, the topic of antithrombotic therapy and thrombogenicity of prostheses in aortic position (transcatheter aortic valve replacement, surgical, mechanical, and bioprostheses) is not part of the present article and is discussed in detail in other contemporary focused articles.

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Left atrial appendage patency and device-related thrombus after percutaneous left atrial appendage occlusion: a computed tomography study

Abstract: LAA patency on CT is common after LAA occlusion, particularly on venous phase images. Leaks relate to LA/LAA size at baseline, and device malposition and incomplete thrombosis at follow-up. DRT is also quite common but poorly predicted by patient and device-related factors.

Cited by 65 publications

References 21 publications

CT assessment of the left atrial appendage post-transcatheter occlusion – A systematic review and meta analysis

CT assessment of the left atrial appendage post-transcatheter occlusion – A systematic review and meta analysis

A simple method to detect leaks after left atrial appendage occlusion with Watchman

Thrombogenicity and Antithrombotic Strategies in Structural Heart Interventions and Nonaortic Cardiac Device Therapy—Current Evidence and Practice

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