Characterization of Cerebrovascular Events After Left Atrial Appendage Occlusion

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• 作者：Xavier Freixa ; MD ; PhD^a ; ^{xavierfreixa@hotmail.com} ; Laura Llull ; MD ; PhD^a ; Sameer Gafoor ; MD^b ; ^c ; Ignacio Cruz-Gonzalez ; MD ; PhD^d ; Samera Shakir ; MD^e ; Heyder Omran ; MD^f ; Sergio Berti ; MD^g ; Gennaro Santoro ; MD^h ; Joelle Kefer ; MD ; PhDⁱ ; Ulf Landmesser ; MD ; PhD^j ; Jens Erik Nielsen-Kudsk ; MD ; DMSc^k ; Prapa Kanagaratnam ; MD ; PhD^l ; Fabian Nietlispach ; MD ; PhD^m ; Steffen Gloekler ; MD^e ; Adel Aminian ; MDⁿ ; Paolo Danna ; MD ; PhD^o ; Marco Rezzaghi ; MD^g ; Friederike Stock ; MD^f ; Miroslava Stolcova ; MD^h ; Luis Paiva ; MD^p ; Marco Costa ; MD ; PhD^p ; Xavier Millá ; n ; MD^q ; Reda Ibrahim ; MD^q ; Tobias Tichelbä ; cker ; MD^r ; Wolfgang Schillinger ; MD^r ; Jai-Wun Park ; MD ; PhD^s ; Horst Sievert ; MD^b ; Bernhard Meier ; MD^e ; Apostolos Tzikas ; MD ; PhD^t
• 刊名：The American Journal of Cardiology
• 出版年：2016
• 出版时间：15 December 2016
• 年：2016
• 卷：118
• 期：12
• 页码：1836-1841
• 全文大小：220 K
• 卷排序：118

文摘

Cardioembolic strokes are generally more lethal and disabling than other source of strokes. Data from PROTECT AF (Watchman Left Atrial Appendage Closure Technology for Embolic Protection in Patients With Atrial Fibrillation) 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 of 3 to 6 at 90 days after the event. A total of 1,047 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 2 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 (interquartile range 234 to 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 nondisabling.