Thrombus aspiration in the left atrial appendage: an option or a walk on the tightrope?

To the Editor, The presence of a thrombus in the left atrial appendage is a formal contraindication for its percutaneous closure and poses a serious dilemma during the therapeutic management of the patient. The option of intensifying anticoagulation to achieve the dissolution of the thrombus whether through better monitoring of the international normalized ratio (INR) parameters or through the introduction of direct anticoagulants is not often possible in most patients eligible for the percutaneous closure of the left atrial appendage. Therefore, the possibility of closing the left atrial appendage in certain cases of thrombosis (mural thrombus away from the landing zone) by using a modified technique to deploy the Amplatzer Amulet device (Abbott, United States) has been described.1 In a non-closure setting, a percutaneous method for thrombus aspiration in the left atrial appendage with a large caliber device (22-Fr) and extracorporeal circulation has been reported.2 This is the case of an 86-year-old male patient (former smoker) with hypertension and non-valvular atrial fibrillation for which he was being anticoagulated with vitamin K antagonists. The previous month, the patient had suffered a cardioembolic ischemic stroke despite anticoagulation. During that admission, the cerebral magnetic resonance performed showed cerebral amyloid angiopathy with evidence of multiple microhemorrhages and...