Percutaneous Retrieval Strategies Following Left Atrial Appendage Occluder and Peri-Device Leak Closure Embolization

Percutaneous LAAO is an established stroke-prevention strategy in atrial fibrillation patients unsuitable for long-term anticoagulation. Device embolization is uncommon but can cause severe complications requiring urgent intervention.

We report 2 related cases of device embolization associated with left atrial appendage occlusion and subsequent peri-device leak closure. The first involved early Amulet occluder embolization with mitral inflow obstruction and hemodynamic instability. The second occurred during peri-device leak closure after prior WATCHMAN implantation, when a 6 × 4-mm vascular occluder embolized upon release. In both cases, intraprocedural transesophageal echocardiography and fluoroscopy guided successful snare-based percutaneous retrieval with coaxial sheath-assisted extraction, avoiding surgery. Both devices were retrieved intact without major complications.

Percutaneous retrieval of embolized LAAO devices is achievable with systematic planning and multidisciplinary preparedness. Growing LAAO volumes and leak reinterventions underscore the need for structured embolization rescue protocols.