Predictors of Device-Related Thrombus Following Percutaneous Left Atrial Appendage Occlusion

Simard, Trevor; Jung, Richard G.; Lehenbauer, Kyle; Piayda, Kerstin; Pracoń, Radosław; Jackson, Gregory; Flores‐Umanzor, Eduardo; Faroux, Laurent; Korsholm, Kasper; Chun, Julian; Chen, Shaojie; Maarse, Moniek; Montrella, Kristi; Chaker, Zakeih; Spoon, Jocelyn; Pastormerlo, Luigi Emilio; Meincke, Felix; Sawant, Abhishek C.; Moldovan, Carmen; Qintar, Mohammed; Aktaş, Mehmet K.; Branca, Luca; Radinovic, Andrea; Ram, Pradhum; El‐Zein, Rayan; Flautt, Thomas; Ding, Wern Yew; Sayegh, Bassel; Benito‐González, Tomas; Lee, Oh Hyun; Badejoko, Solomon; Paitazoglou, Christina; Karim, N; Zaghloul, Ahmed; Agrawal, Himanshu; Kaplan, Rachel; Alli, Oluseun; Ahmed, Aamir; Suradi, Hussam; Knight, Bradley P.; Alla, Venkata; Panaich, Sidakpal; Wong, Tom; Bergmann, Martin; Chothia, Rashaad A.; Kim, Jung Sun; Prado, Armando Pérez de; Bazaz, Raveen; Gupta, Dhiraj; Valderrábano, Miguel; Sanchez, Carlos E.; El‐Chami, Mikhael F.; Mazzone, Patrizio; Adamo, Marianna; Ling, Fred S.; Wang, Dee Dee; O’Neill, William W.; Wojakowski, Wojtek; Pershad, Ashish; Berti, Sérgio; Spoon, Daniel B.; Kawsara, Akram; Jabbour, George; Boersma, Lucas V.A.; Schmidt, Boris; Nielsen‐Kudsk, Jens Erik; Rodés‐Cabau, Josep; Freixa, Xavier; Ellis, Christopher R.; Fauchier, Laurent; Demkow, Marcin; Sievert, Horst; Main, Michael L.; Hibbert, Benjamin; Holmes, David R.; Alkhouli, Mohamad

doi:10.1016/j.jacc.2021.04.098

Cited by 140 publications

(112 citation statements)

References 16 publications

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“…The causal mechanisms behind this association remain unknown, nevertheless, similar associations have been reported by a recently presented study 26 . Additionally, nonparoxysmal AF have been associated with device‐related thrombosis (DRT) 27 …”

Section: Discussionmentioning

confidence: 99%

Temporal changes and clinical significance of peridevice leak following left atrial appendage occlusion with Amplatzer devices

Korsholm

Jensen

Nørgaard

et al. 2022

Cathet Cardio Intervent

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Background: The natural history of peridevice leak (PDL) following left atrial appendage occlusion (LAAO) is unknown. This study sought to investigate changes of PDL from 2 until 12 months after LAAO, using cardiac computed tomography (CT), and to assess the potential association between persistent PDL and clinical outcomes Methods: Single-center observational study of Amplatzer LAAO implants between 2010 and 2017 (n = 206). Patients with 2 and 12 months cardiac CT were included in the study (n = 153). Images were blindly analyzed. PDL was characterized by frequency and size at the device disc, lobe, and left atrial appendage contrast patency. Patients were followed for the composite outcome of ischemic stroke, transient ischemic attack, systemic embolism, or all-cause death. Median follow up from LAAO was 3.1 (2.3-4.3) years.Results: Contrast patency was present in 101 (66%) and 72 (47%) (p < 0.001) at 2 and 12 months, respectively. PDL was identified at the disc in 103 (67%) patients at 2 months versus 93 (61%) at 12 months (p = 0.08), and at the lobe in 29 (19%) at both time points. PDL area at the disc did not change significantly over time, ∆ area: −8.95 mm (95% confidence interval [CI]: −18.9; 1.01) p = 0.08. Permanent atrial fibrillation was independently associated with persistent PDL. Persistent versus no PDL was associated with a 62% worse clinical outcome, however not statistically significant, hazard ratio (HR): 1.62 (95% CI: 0.9-2.93), p = 0.11. Conclusion:Persistent PDL was frequently observed following LAAO with Amplatzer devices. The PDL frequency and size appeared unchanged between 2 and 12 months. Persistent PDL was not significantly associated with worse clinical outcomes, yet this needs further delineation in future studies.

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Section: Discussionmentioning

confidence: 99%

Temporal changes and clinical significance of peridevice leak following left atrial appendage occlusion with Amplatzer devices

Korsholm

Jensen

Nørgaard

et al. 2022

Cathet Cardio Intervent

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“… 5 When DRTs occur experts recommend aggressive anticoagulation and closer follow-up without specifics. 2 This approach was not feasible.…”

Section: Discussionmentioning

confidence: 99%

“…Intravenous anticoagulation with heparin is not always feasible or effective. 2 This report demonstrates successful percutaneous extraction of a left atrial (LA) thrombus attached to a Watchman™ (Boston Scientific Inc., Maple Grove, MN, USA) device using thrombus extraction technology with cerebral protection.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous extraction of a large device-related thrombus on a Watchman™ device: a case report

Vyas

Kohler

Pershad

2021

European Heart Journal - Case Reports

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Background Left atrial appendage occlusion devices are commonly used to prevent stroke in patients with persistent atrial fibrillation who are unable to tolerate anticoagulation. However certain patient and device related characteristics increase the risk for the development of a device related thrombus. The presence of a device related thrombus increases the risk of stroke and should be treated. Management of device related thrombus lacks consensus but is mostly focused on anticoagulation. In patients with large thrombi that need to be managed urgently, percutaneous extraction may be a viable option. Case Summary In this report we describe the successful management of a device related thrombus via percutaneous thrombus extraction technology in an 81-year-old woman with a large thrombus attached to a WATCHMAN™ device. The patient initially presented with shortness of breath, and on imaging a pedunculated thrombus was detected. The thrombus was extracted using a Penumbra Lightning 12™ (Penumbra Inc., Alameda, CA) catheter with a Sentinel™ (Boston Scientific, Marlborough, Massachusetts) cerebral embolic protection device. The patient had no neurologic sequelae and was started on anticoagulation. Discussion Percutaneous thrombectomy can be safely performed to extract large left atrial occlusion device related thrombus that require urgent management, without any neurologic sequelae. We believe this can be used in patients with a large device related thrombus who would not be adequately managed with anticoagulation and in whom surgery is not feasible.

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“…Die Rate an Device-assoziierten Thromben beträgt ca. 3-4 % in Abhängigkeit von der Häufigkeit von echokardiografischen Verlaufsuntersuchungen [21]. Diese Thromben sind mit vermehrten klinischen Ereignissen (Schlaganfall, Thrombembolie) assoziiert [21] und können bei ca.…”

Section: Perkutaner Vorhofohrverschluss Nach Schlaganfallunclassified

“…3-4 % in Abhängigkeit von der Häufigkeit von echokardiografischen Verlaufsuntersuchungen [21]. Diese Thromben sind mit vermehrten klinischen Ereignissen (Schlaganfall, Thrombembolie) assoziiert [21] und können bei ca. 80 % der Patienten mittels Antikoagulation oder Plättcheninhibition erfolgreich aufgelöst werden [22].…”

Section: Perkutaner Vorhofohrverschluss Nach Schlaganfallunclassified

Perkutaner Vorhofohrverschluss nach Schlaganfall

Skurk¹,

Häusler²,

Endres³

et al. 2022

Nervenheilkunde

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ZUSAMMENFASSUNGDer katheterbasierte Verschluss des linken Vorhofohrs stellt bei Patienten mit Vorhofflimmern, welche nicht für eine Langzeittherapie mit oralen Antikoagulanzien geeignet sind, eine potenzielle Therapieoption zur Reduktion des Schlaganfallrisikos dar. Die Weiterentwicklung der Device- und Implantationstechnik führte in den letzten Jahren zu einer Verbesserung des Sicherheitsprofils der Behandlungsmethode. Das Therapieprinzip wird durch neue Daten unterstützt, die die Wirksamkeit des operativen Verschlusses des linken Vorhofohrs zusätzlich zur Antikoagulation im Rahmen von kardiochirurgischen Eingriffen zeigen. Aktuell wird der katheterbasierte Verschluss des linken Vorhofohres in verschiedenen Patientenpopulationen in randomisierten Studien evaluiert. Die Datenlage, die Einsatzgebiete und randomisierte Studien unter besonderer Berücksichtigung der CLOSURE-AF-Studie sollen in der vorliegenden Übersichtsarbeit diskutiert werden.

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Predictors of Device-Related Thrombus Following Percutaneous Left Atrial Appendage Occlusion

Cited by 140 publications

References 16 publications

Temporal changes and clinical significance of peridevice leak following left atrial appendage occlusion with Amplatzer devices

Temporal changes and clinical significance of peridevice leak following left atrial appendage occlusion with Amplatzer devices

Percutaneous extraction of a large device-related thrombus on a Watchman™ device: a case report

Perkutaner Vorhofohrverschluss nach Schlaganfall

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