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Left Atrial Appendage Occlusion as Adjunctive Therapy to Anticoagulation for Stroke Recurrence
Xavier Freixa1, Ignacio Cruz-González, Ander Regueiro
1Hospital Clinic de Barcelona, c/ Villarroel 170, Escala 3 Planta 6, 08015 Barcelona, Spain. xavierfreixa@hotmail.com.
The Journal of Invasive Cardiology
|May 16, 2019
Summary
Left atrial appendage occlusion (LAAO) offers a safe adjunctive therapy for patients experiencing recurrent strokes despite optimal oral anticoagulation (OAC). This procedure significantly reduces cerebrovascular events, demonstrating its potential in managing high-risk cardiovascular patients.
Area of Science:
- Cardiology
- Neurology
- Interventional Cardiology
Background:
- Recurrent stroke despite optimal oral anticoagulation (OAC) presents a clinical challenge.
- Valvular atrial fibrillation (VAF) is common in these patients, increasing stroke risk.
- Left atrial appendage occlusion (LAAO) is explored as an adjunctive therapy.
Purpose of the Study:
- To evaluate the safety and efficacy of LAAO as an adjunctive therapy to OAC in patients with recurrent stroke.
- To assess the reduction in cerebrovascular events post-LAAO.
Main Methods:
- Retrospective analysis of consecutive patients undergoing percutaneous LAAO (2009-2017).
- Inclusion criteria: recurrent stroke despite optimal OAC; exclusion: contraindications to OAC.
- Successful device implantation and follow-up for clinical and imaging outcomes.
Main Results:
- 22 patients (2.6%) met inclusion criteria; 38% had VAF, 59% had multiple cardioembolic events.
- Successful LAAO with no procedural major adverse events; anticoagulation continued in most patients.
- Significant reduction in cerebrovascular events (2.0 events pre-LAAO vs. 0.1 post-LAAO; P<.01) with one case of device thrombosis.
Conclusions:
- LAAO is a feasible and safe adjunctive therapy for patients with recurrent cardioembolic events despite optimal OAC.
- This strategy is associated with a low rate of post-procedural cerebrovascular events.
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