title: Characterization of Cerebrovascular Events After Left Atrial Appendage Occlusion.
abstract: 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 CHADS2score 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.
authors.affiliation: Department of Cardiology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain. Electronic address: xavierfreixa@hotmail.com.
authors.forename: Xavier
authors.initials: X
authors.lastname: Freixa
authors.affiliation: Department of Cardiology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Llull
authors.affiliation: Department of Cardiology, CardioVascular Center Frankfurt, Frankfurt, Germany; Department of Cardiology, Swedish Medical Center, Seattle, Washington.
authors.forename: Sameer
authors.initials: S
authors.lastname: Gafoor
authors.affiliation: Department of Cardiology, University Hospital of Salamanca, Salamanca, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Cruz-Gonzalez
authors.affiliation: Department of Cardiology, University Hospital of Bern, Bern, Switzerland.
authors.forename: Samera
authors.initials: S
authors.lastname: Shakir
authors.affiliation: Department of Cardiology, University Hospital of Bonn, Bonn, Germany.
authors.forename: Heyder
authors.initials: H
authors.lastname: Omran
authors.affiliation: Department of Cardiology, Fondazione Toscana Gabriele Monasterio, Massa, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Berti
authors.affiliation: Department of Cardiology, Ospedale Careggi di Firenze, Florence, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Santoro
authors.affiliation: Department of Cardiology, Cliniques Universitaires Saint-Luc, University of Louvain, Brussels, Belgium.
authors.forename: Joelle
authors.initials: J
authors.lastname: Kefer
authors.affiliation: Department of Cardiology, Charite Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Ulf
authors.initials: U
authors.lastname: Landmesser
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Skejby, Denmark.
authors.forename: Jens Erik
authors.initials: JE
authors.lastname: Nielsen-Kudsk
authors.affiliation: Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom.
authors.forename: Prapa
authors.initials: P
authors.lastname: Kanagaratnam
authors.affiliation: Department of Cardiology, University Heart Center, Cardiology, Zurich, Switzerland.
authors.forename: Fabian
authors.initials: F
authors.lastname: Nietlispach
authors.affiliation: Department of Cardiology, University Hospital of Bern, Bern, Switzerland.
authors.forename: Steffen
authors.initials: S
authors.lastname: Gloekler
authors.affiliation: Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium.
authors.forename: Adel
authors.initials: A
authors.lastname: Aminian
authors.affiliation: Department of Cardiology, Ospedale Luigi Sacco, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Danna
authors.affiliation: Department of Cardiology, Fondazione Toscana Gabriele Monasterio, Massa, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Rezzaghi
authors.affiliation: Department of Cardiology, University Hospital of Bonn, Bonn, Germany.
authors.forename: Friederike
authors.initials: F
authors.lastname: Stock
authors.affiliation: Department of Cardiology, Ospedale Careggi di Firenze, Florence, Italy.
authors.forename: Miroslava
authors.initials: M
authors.lastname: Stolcova
authors.affiliation: Department of Cardiology, Coimbra's Hospital Center, Coimbra, Portugal.
authors.forename: Luis
authors.initials: L
authors.lastname: Paiva
authors.affiliation: Department of Cardiology, Coimbra's Hospital Center, Coimbra, Portugal.
authors.forename: Marco
authors.initials: M
authors.lastname: Costa
authors.affiliation: Department of Cardiology, Montreal Heart Institute, Montreal, Canada.
authors.forename: Xavier
authors.initials: X
authors.lastname: Millán
authors.affiliation: Department of Cardiology, Montreal Heart Institute, Montreal, Canada.
authors.forename: Reda
authors.initials: R
authors.lastname: Ibrahim
authors.affiliation: Department of Cardiology, Universitätsmedizin Göttingen, Göttingen, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Tichelbäcker
authors.affiliation: Department of Cardiology, Universitätsmedizin Göttingen, Göttingen, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schillinger
authors.affiliation: Department of Cardiology, Asklepios Hospital Hamburg, Hamburg, Germany.
authors.forename: Jai-Wun
authors.initials: JW
authors.lastname: Park
authors.affiliation: Department of Cardiology, CardioVascular Center Frankfurt, Frankfurt, Germany.
authors.forename: Horst
authors.initials: H
authors.lastname: Sievert
authors.affiliation: Department of Cardiology, University Hospital of Bern, Bern, Switzerland.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meier
authors.affiliation: Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece.
authors.forename: Apostolos
authors.initials: A
authors.lastname: Tzikas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020517:Atrial Appendage / Q000601:surgery*; D001281:Atrial Fibrillation / Q000150:complications / Q000628:therapy*; D015331:Cohort Studies; D019468:Disease Management; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000209:etiology / Q000517:prevention & control*; D002546:Ischemic Attack, Transient / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D055989:Septal Occluder Device; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome