Percutaneous Left Atrial Appendage Closure in Patients With Cardioembolic Breakthrough Stroke: An International...

Area of Science:

• Cardiology
• Neurology
• Medical Devices

Background:

• Patients with non-valvular atrial fibrillation (AF) experiencing ischemic stroke despite oral anticoagulation (OAC) have a high risk of recurrence (5.3%-8.9% annually).
• Optimal secondary prevention strategies for these high-risk patients remain undetermined.

Purpose of the Study:

• To evaluate the safety and efficacy of percutaneous left atrial appendage closure (LAAC) in AF patients who have experienced a cardioembolic ischemic stroke while on OAC.
• To assess the rate of recurrent ischemic stroke and procedure-related complications following LAAC in this patient cohort.

Main Methods:

• A review of prospectively collected data from four European centers on LAAC procedures in AF patients with ischemic stroke under OAC.
• Inclusion criteria required neurologist-confirmed cardioembolic stroke and adequate OAC at the time of the event.
• Primary endpoint was recurrent ischemic stroke at 2 years; secondary endpoints included complications and mortality.

Main Results:

• Of 2234 LAAC procedures, 95 involved patients with cardioembolic breakthrough strokes, with LAAC performed a mean of 4 months post-stroke.
• The majority of patients (83% at discharge, 79% at follow-up) remained on OAC.
• At a median follow-up of 713 days, 4% experienced recurrent ischemic stroke, with rare complications (1%) and 5% mortality.

Conclusions:

• Percutaneous left atrial appendage closure (LAAC) is a safe and feasible option for AF patients with cardioembolic breakthrough stroke.
• LAAC may provide additive protection against recurrent stroke compared to OAC alone, warranting further investigation.
• Results from ongoing randomized trials are necessary to confirm these findings.