The Imaging Spectrum of Device-Related Thrombus After Percutaneous Left Atrial Appendage Occlusion

Area of Science:

• Cardiology
• Medical Imaging
• Interventional Cardiology

Background:

• Transcatheter left atrial appendage occlusion (LAAO) is an alternative to anticoagulation for stroke risk reduction in atrial fibrillation.
• Post-procedural surveillance imaging, typically with transesophageal echocardiography (TEE) or cardiac computed tomography (CT), is crucial for assessing device position and detecting complications.
• Device-related thrombus (DRT) is a significant complication, associated with a higher risk of stroke and systemic embolization.

Observation:

• Current surveillance protocols for DRT detection after LAAO show considerable variability in timing, frequency, and imaging modality.
• The distinction between early device endothelization and pathological DRT formation remains unclear.
• Imaging findings on TEE and CT can be diverse, making consistent interpretation challenging.

Findings:

• DRT detection during surveillance is linked to a substantially increased risk of thromboembolic events within six months.
• Variability in surveillance practices contributes to inconsistent DRT detection rates.
• The spectrum of imaging findings for DRT and benign device healing requires further elucidation.

Implications:

• Standardized definitions and reporting criteria for surveillance imaging are essential for consistent DRT detection and risk stratification.
• Unified imaging protocols may improve the accuracy of identifying patients at high risk for stroke after LAAO.
• Further research is needed to understand the pathophysiology of DRT formation versus device endothelization.