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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
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Impact of percutaneous left atrial appendage occlusion on the severity of ischemic stroke

Ahmed Maraey1, Hadeer Elsharnoby2, Mona Mahmoud1

  • 1Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, OH, United States of America.

Cardiovascular Revascularization Medicine : Including Molecular Interventions
|December 28, 2024
PubMed

Insights

Percutaneous left atrial appendage occlusion (pLAAO) reduces severe and fatal ischemic strokes in atrial fibrillation patients compared to anticoagulation. This finding suggests pLAAO may offer improved stroke outcome protection.

Area of Science:

  • Cardiology
  • Neurology
  • Medical Devices

Background:

  • Percutaneous left atrial appendage occlusion (pLAAO) is an alternative to anticoagulation (AC) for stroke prevention in atrial fibrillation (Afib) patients at high risk of bleeding.
  • pLAAO has shown reduced rates of disabling stroke, primarily due to fewer hemorrhagic strokes.
  • The impact of pLAAO on the severity of ischemic strokes remains understudied.

Purpose of the Study:

  • To investigate the effect of pLAAO on the severity of ischemic strokes (IS) in patients with atrial fibrillation.
  • To compare the outcomes of IS in patients treated with pLAAO versus those on AC.

Main Methods:

  • Retrospective analysis of the National Readmission Database (2016-2020).
  • Identified 6-month readmissions for IS after pLAAO and compared with Afib patients on AC admitted for IS.
  • Utilized propensity score matching to control for confounding factors; excluded patients with intracranial hemorrhage or surgical LAAO.

Main Results:

  • Matched analysis included 342 observations per group (weighted: 583 pLAAO vs. 663 AC).
  • pLAAO was associated with a significantly decreased risk of fatal stroke (5.1% vs. 10.0%, OR 0.48, P=0.018).
  • pLAAO also showed a decreased risk of non-fatal severe stroke at 6 months (50.5% vs. 59.6%, OR 0.69, P=0.029).

Conclusions:

  • Patients with pLAAO experiencing ischemic strokes had a lower likelihood of severe and fatal outcomes compared to those on AC.
  • These findings suggest pLAAO may offer superior protection against severe stroke outcomes.
  • Further research is warranted to confirm these results.
Abstract

Keywords:
AnticoagulationAtrial fibrillationOutcomesStrokepLAAO

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