Left atrial appendage occlusion in recurrent ischaemic stroke, a multicentre experience

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Stroke Prevention

Background:

• Oral anticoagulation therapy (OAC) is standard for preventing ischemic stroke in non-valvular atrial fibrillation (NVAF) patients.
• Percutaneous left atrial appendage occlusion (LAAO) is an alternative for patients intolerant to OAC.
• Recurrent stroke on OAC is considered treatment failure, suggesting LAAO as a potential option based on expert opinion.

Purpose of the Study:

• To evaluate the efficacy, safety, and mortality of LAAO in NVAF patients with recurrent ischemic stroke.
• To assess LAAO outcomes after excluding other potential causes of recurrent stroke.

Main Methods:

• A multicenter retrospective cohort study.
• Inclusion of NVAF patients who experienced recurrent ischemic stroke despite ongoing OAC.
• Exclusion of other plausible causes for recurrent stroke.

Main Results:

• Fifteen LAAO procedures were performed in high-risk NVAF patients (mean CHA2DS2-VASc score 6, HAS-BLED score 5).
• Successful LAAO implantation was achieved in all patients (Amplatzer and Watchman devices), with high feasibility and low complication rates.
• Low rates of recurrent stroke (two ischemic, zero hemorrhagic) and mortality were observed during follow-up, with OAC continued long-term in most patients.

Conclusions:

• LAAO can be considered a feasible and safe adjunctive therapy, not a replacement, for NVAF patients with recurrent stroke despite adequate OAC.
• The findings support LAAO as a valuable option for stroke risk reduction in this specific high-risk patient population.