title: [Interventional prevention of ischemic stroke].
abstract: Stroke is an extremely common condition, the important functional and financial impact of which requires intense prevention policy. This strategy includes the prevention of thromboembolic complications of atrial fibrillation. The management of atrial fibrillation includes risk stratification for stroke with theCHA(2)DS(2)VASc score and assessment of hemorrhagic risk with HASBLED score. The reference preventive treatment is anticoagulant therapy with vitamin K antagonists. Nevertheless, many patients potentially eligible for this treatment will not benefit from it, because of a high risk of bleeding, or because recurrence of thromboembolism occurs despite well-conducted anticoagulation. A new alternative intrventional treatment has been proposed for these clinical situations: left atrial appendage percutaneous closure. Several studies examined the feasibility, effectiveness and safety of three devices: the device PLAATO the WATCHMAN(©), and AmplatzerCardiacPlug™. The prospective multicenter randomized PROTECT-AF study demonstrated non-inferiority of the WATCHMAN(©) device compared to conventional warfarin therapy. Yet a medical reflection is still needed to determine the target population which may actually benefit from interventional treatment. Currently, clinical evaluation programs have begun in France with the aim to clarify the indication of non-drug preventive treatment of stroke.
authors.affiliation: Unité de cathétérisme cardiaque, service d'explorations fonctionnelles, centre hospitalier Henri-Mondor, Assistance publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil, France. Electronic address: pryscille.kamtchueng@hmn.aphp.fr.
authors.forename: P
authors.initials: P
authors.lastname: Kamtchueng
authors.forename: E
authors.initials: E
authors.lastname: Teiger
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D020517:Atrial Appendage; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy / Q000517:prevention & control*; D006328:Cardiac Catheterization / Q000379:methods; D005240:Feasibility Studies; D006801:Humans; D011474:Prosthesis Design; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D055989:Septal Occluder Device; D020521:Stroke / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants
keywords: Accident vasculaire cérébral; Atrial fibrillation; Auricule gauche; Bleeding risk; Fermeture percutanée; Fibrillation auriculaire; Left atrium appendage; Oral anticoagulant therapy; Percutaneous closure; Risque hémorragique; Stroke; Traitement anticoagulant