title: Frequency and clinical course of cerebral embolism in patients undergoing transcatheter left atrial appendage closure.
abstract: OBJECTIVE
  The aim of this study was to assess silent and clinically apparent cerebral embolic events in patients undergoing transcatheter left atrial appendage closure.
  
  
  RESULTS
  In this prospective single-centre study, 28 patients underwent percutaneous closure of the left atrial appendage. In all patients, a diffusion-weighted magnetic resonance imaging (DW-MRI) study was performed before, the day after the procedure, and during routine follow-up after 45 days. All patients underwent neurological assessment at the time of DW-MRI. Additionally, transcranial Doppler ultrasound monitoring (TCD) for the detection of microembolic material during the procedure was performed. The procedure was successfully completed in all patients. New embolic lesions were detected in nine patients (32%) after the procedure, of which three (33%) were detectable as gliotic lesions at follow-up. One (3.6%) new lesion was observed at 45-day follow-up. Neurological assessment showed no neurological deficits. We observed no relationship between the numbers of microembolic signals on TCD monitoring and the occurrence of cerebral infarctions on DW-MRI.
  
  
  CONCLUSIONS
  New cerebral embolic events occur after transcatheter closure of the left atrial appendage. However, most of the lesions demonstrate no gliotic transformation at follow-up. In all patients, the cerebral lesions were clinically unapparent.
authors.affiliation: University of Leipzig, Heart Center, Department of Internal Medicine/Cardiology, Leipzig, Germany.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Majunke
authors.forename: Franziska
authors.initials: F
authors.lastname: Eplinius
authors.forename: Matthias
authors.initials: M
authors.lastname: Gutberlet
authors.forename: Sven
authors.initials: S
authors.lastname: Moebius-Winkler
authors.forename: Ingo
authors.initials: I
authors.lastname: Daehnert
authors.forename: Matthias
authors.initials: M
authors.lastname: Grothoff
authors.forename: Stephan
authors.initials: S
authors.lastname: Schürer
authors.forename: Norman
authors.initials: N
authors.lastname: Mangner
authors.forename: Philipp
authors.initials: P
authors.lastname: Lurz
authors.forename: Sandra
authors.initials: S
authors.lastname: Erbs
authors.forename: Katharina
authors.initials: K
authors.lastname: Kirsch
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuler
authors.forename: Marcus
authors.initials: M
authors.lastname: Sandri
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020517:Atrial Appendage / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000601:surgery*; D006801:Humans; D020766:Intracranial Embolism / Q000209:etiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods