Characterization of Cerebrovascular Events after Left Atrial Appendage Occlusion

Abstract Cardio-embolic strokes are generally more lethal and disabling than other source of strokes. Data from PROTECT-AF suggest that strokes after left atrial appendage occlusion (LAAO) with the Watchman device are less disabling than those in the warfarin group. No data assessing the severity of...

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Veröffentlicht in:	The American journal of cardiology 2016-12, Vol.118 (12), p.1836-1841
Hauptverfasser:	Freixa, Xavier, MD, PhD, Llull, Laura, MD, PhD, Gafoor, Sameer, MD, Cruz-Gonzalez, Ignacio, MD, PhD, Shakir, Samera, MD, Omran, Heyder, MD, Berti, Sergio, MD, Santoro, Gennaro, MD, Kefer, Joelle, MD, PhD, Landmesser, Ulf, MD, PhD, Nielsen-Kudsk, Jens Erik, MD, DMSc, Kanagaratnam, Prapa, MD, PhD, Nietlispach, Fabian, MD, PhD, Gloekler, Steffen, MD, Aminian, Adel, MD, Danna, Paolo, MD, PhD, Rezzaghi, Marco, MD, Stock, Friederike, MD, Stolcova, Miroslava, MD, Paiva, Luis, MD, Costa, Marco, MD, PhD, Millán, Xavier, MD, Ibrahim, Reda, MD, Tichelbäcker, Tobias, MD, Schillinger, Wolfgang, MD, Park, Jai-Wun, MD, PhD, Sievert, Horst, MD, Meier, Bernhard, MD, Tzikas, Apostolos, Md, PhD
Format:	Artikel
Sprache:	eng
Schlagworte:	Aged Aged, 80 and over Anticoagulants Appendages Atrial Appendage - surgery Atrial Fibrillation - complications Atrial Fibrillation - therapy Cardiac arrhythmia Cardiovascular Cerebrovascular system Cohort Studies Disease Management Embolisms Female Hemorrhage Humans Intracranial Hemorrhages - etiology Intracranial Hemorrhages - prevention & control Ischemia Ischemic Attack, Transient - etiology Ischemic Attack, Transient - prevention & control Male Medical treatment Middle Aged Mortality Occlusion Performance evaluation Population studies Registries Retrospective Studies Septal Occluder Device Stroke Stroke - etiology Stroke - prevention & control Studies Treatment Outcome Variables
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Zusammenfassung:	Abstract Cardio-embolic strokes are generally more lethal and disabling than other source of strokes. Data from PROTECT-AF suggest that strokes after left atrial appendage occlusion (LAAO) with the Watchman device are less disabling than those in the warfarin group. No data assessing the severity of strokes after LAAO with the Amplatzer Cardiac Plug (ACP) are available. The objective of the study was to evaluate the severity of cerebrovascular events after LAAO with the ACP in a population mostly characterized by an absolute or relative contraindication to oral anticoagulation. Data from the ACP multicenter-registry were analyzed. Disabling strokes were defined as those with a modified Rankin score (mRS) of 3-6 at 90 days after the event. A total of 1047 subjects were included. The mean age and CHADS2 score were 75±8 years and 2.8±1.3, respectively. Procedural success was achieved in 97.3% and 4.9% of the patients presented procedural major adverse events. Clinical follow-up was complete in 98.2% of patients with a median of 13 months. There were 9 strokes (0.9%), 9 transient ischemic attacks (0.9%), and no intracranial hemorrhages (0%) at follow-up. After excluding two patients with pre-LAAO disability, functional assessment showed disabling events in 3 (19%) of the remaining 16 patients. The median time of presentation was 420 days (IQR 234-671) after LAAO and 17 patients (94%) were on single antiplatelet therapy when the event occurred. According to our results, cerebrovascular events after LAAO with the ACP system were infrequent and mostly non-disabling.
ISSN:	0002-9149 1879-1913
DOI:	10.1016/j.amjcard.2016.08.075