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Updated: May 5, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Efficient Removal of Nascent Left Atrial Appendage Thrombus to Facilitate Left Atrial Appendage Closure
Jeffrey Arkles1, Ross Biggs1, Matthew Bernabei1
1Department of Cardiology, Penn Medicine-Lancaster General Health, Lancaster, Pennsylvania, USA.
Background:
Left atrial appendage (LAA) thrombus often precludes immediate closure owing to embolic risk, complicating care for high-risk patients needing stroke prevention.
Case Summary:
A 78-year-old woman with atrial fibrillation and recent intracranial hemorrhage was referred for left atrial appendage closure (LAAC). Imaging revealed a nascent thrombus at the LAA ostium. Given her high bleeding risk, thrombus aspiration was attempted. Using a deflectable delivery sheath and computer-assisted vacuum catheter, the thrombus was successfully removed en face without embolization. A 27-mm LAAC device was deployed, with excellent results. She was discharged on low-dose apixaban (2.5 mg bid) and remained event-free at 45 days.
Discussion:
This case highlights a feasible, minimally invasive technique for aspirating LAA thrombus using standard LAAC tools, enabling safe closure without bypass.
Take-Home Message:
Aspiration of LAA thrombus can be performed efficiently with a vacuum-assisted catheter delivered through a standard deflectable LAAC sheath.
