title: Peri-procedural silent cerebral infarcts after left atrial appendage occlusion.
abstract: To determine the rate of peri-interventional silent brain infarcts after left atrial appendage occlusion (LAAO).
  
  
  
  In this prospective, uncontrolled single-center pilot study, consecutive patients with atrial fibrillation undergoing LAAO between July 2013 and January 2016 were included. The Amplatzer Cardiac Plug, WATCHMAN or Amulet device was used. A neurological examination and cranial magnetic resonance imaging (MRI) were performed within 48 h before and after the procedure. MRI was evaluated for new diffusion-weighted imaging (DWI) hyperintensities, cerebral microbleeds (CMBs) and white-matter lesions (WMLs).
  
  
  
  Left atrial appendage occlusion was performed in 21 patients (mean age, 73.2 ± 9.5 years). Main reasons for LAAO were previous intracerebral hemorrhage (n = 11) and major systemic bleeding (n = 6). No clinically overt stroke occurred peri-interventionally. After the intervention, one patient had a small cerebellar hyperintensity on DWI (4.8%; 95% confidence interval, 0.0-14.3) that was not present on the MRI 1 day before the procedure. Among 11 patients with available MRI just before LAAO, there were no significant changes in the number of CMBs and the severity of WMLs after LAAO.
  
  
  
  This study of peri-interventional MRI in LAAO suggests a low rate of silent peri-procedural infarcts in this elderly population. Confirmation in larger studies is needed.
authors.affiliation: Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Laible
authors.affiliation: Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Möhlenbruch
authors.affiliation: Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Horstmann
authors.affiliation: Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Pfaff
authors.affiliation: Department of Internal Medicine III, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: N A
authors.initials: NA
authors.lastname: Geis
authors.affiliation: Department of Internal Medicine III, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Pleger
authors.affiliation: Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Schüler
authors.affiliation: Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Rizos
authors.affiliation: Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Bendszus
authors.affiliation: Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.|Department of Stroke Medicine, Imperial College London, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Veltkamp
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020517:Atrial Appendage; D001281:Atrial Fibrillation / Q000150:complications / Q000628:therapy; D002543:Cerebral Hemorrhage / Q000453:epidemiology / Q000209:etiology; D002544:Cerebral Infarction / Q000453:epidemiology* / Q000209:etiology*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D010865:Pilot Projects; D011446:Prospective Studies; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D060205:Therapeutic Occlusion / Q000009:adverse effects* / Q000706:statistics & numerical data; D016896:Treatment Outcome; D066127:White Matter / Q000000981:diagnostic imaging / Q000473:pathology
keywords: left atrial appendage occlusion; magnetic resonance imaging; silent brain infarction