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Nagaraja N, Ballur Narayana Reddy V. Prevalence of Concomitant Neurological Disorders and Long-Term Outcome of Patients Hospitalized for Intracerebral Hemorrhage with Versus without Cerebral Amyloid Angiopathy. Neurocrit Care 2024; 40:486-494. [PMID: 37258986 DOI: 10.1007/s12028-023-01753-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 05/10/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Patients with intracerebral hemorrhage (ICH) related to cerebral amyloid angiopathy (CAA) are at increased risk of developing epilepsy and cognitive disorders such as Alzheimer's disease (AD), mild cognitive impairment (MCI), and vascular dementia. In a retrospective cohort observation study of patients hospitalized for ICH with CAA versus ICH without CAA, we evaluated the prevalence of neurological comorbidities at admission and the risk of new diagnosis of epilepsy, relevant cognitive disorders, and mortality at 1 year. METHODS In the TriNetX health research network, adult patients aged ≥ 55 years hospitalized with a diagnosis of ICH were stratified based on presence or absence of concomitant CAA diagnosis. Demographics and medical comorbidities were compared by using χ2 test and Student's t-test. After 1:1 propensity score matching, 1-year survival was assessed with Kaplan-Meier curves. The 1-year risk of new diagnosis of epilepsy, AD, MCI, vascular dementia, and dementia unspecified was assessed with Cox proportional hazards estimate. RESULTS The study included a total of 1757 patients with ICH and CAA and 53,364 patients with ICH without CAA. Patients with CAA were older compared with those without CAA (74.1 ± 7.5 vs. 69.8 ± 8.8 years, p ≤ 0.001). Compared with ICH without CAA, patients with ICH and CAA had higher baseline prevalence of cerebral infarction (30% vs. 20%), nontraumatic ICH (36% vs. 7%), nontraumatic subarachnoid hemorrhage (14% vs. 5%), epilepsy (11% vs. 6%), and AD (5% vs. 2%) with significance at p < 0.001. After propensity score matching, a total of 1746 patients were included in both cohorts. In the matched cohorts, compared with patients with ICH without CAA, patients with ICH and CAA had lower 1-year all-cause mortality (479 [27%] vs. 563 [32%]; hazard ratio [HR] 0.80; 95% confidence interval [CI] 0.71-0.90) and higher risk of new diagnosis of epilepsy (280 [18%] vs. 167 [11%]; HR 1.70; 95% CI 1.40-2.06), AD (101 [6%] vs. 38 [2%]; HR 2.62; 95% CI 1.80-3.80), MCI (85 [5%] vs. 35 [2%]; HR 2.39; 95% CI 1.61-3.54), vascular dementia (117 [7%] vs. 60 [4%]; HR 1.92; 95% CI 1.41-2.62), and dementia unspecified (245 [16%] vs. 150 [9%]; HR 1.70; 95% CI 1.39-2.08). CONCLUSIONS Among patients admitted for ICH, patients with CAA have lower mortality but have 2-3 times more risk of diagnosis of epilepsy and dementia at 1 year, compared with those without CAA.
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Affiliation(s)
- Nandakumar Nagaraja
- Department of Neurology, Milton S. Hershey Medical Center, Penn State College of Medicine, 30 Hope Drive EC037, Hershey, PA, 17033, USA.
| | - Varalakshmi Ballur Narayana Reddy
- Department of Neurology, Milton S. Hershey Medical Center, Penn State College of Medicine, 30 Hope Drive EC037, Hershey, PA, 17033, USA
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Abstract
Differences exist between genders in intracerebral hemorrhage cause, epidemiology, and outcomes. These gender differences are in part attributable to physiologic differences; however, demographic, social/behavioral risk factors, along with health care system variation and potential family and/or clinician bias play a role as well. These factors vary from region to region and interact, making comprehensive and definitive conclusions regarding sex differences a challenging task. Differences between the genders in intracerebral hemorrhage epidemiology and extensive differences in underlying pathophysiology, intervention, risk factors, and outcome are all discussed.
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Affiliation(s)
- Nicholas Dykman Osteraas
- Department of Neurological Sciences, Division of Cerebrovascular Diseases, Rush University Medical Center, 1725 West Harrison Street Suite 118, Chicago, IL 60612, USA.
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Che R, Zhang M, Sun H, Ma J, Hu W, Liu X, Ji X. Long-term outcome of cerebral amyloid angiopathy-related hemorrhage. CNS Neurosci Ther 2022; 28:1829-1837. [PMID: 35975394 PMCID: PMC9532921 DOI: 10.1111/cns.13922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 11/30/2022] Open
Abstract
Object The long‐term functional outcome of cerebral amyloid angiopathy‐related hemorrhage (CAAH) patients is unclear. We sought to assess the long‐term functional outcome of CAAH and determine the prognostic factors associated with unfavorable outcomes. Methods We enrolled consecutive CAAH patients from 2014 to 2020 in this observational study. Baseline characteristics and clinical outcomes were presented. Multivariable logistic regression analysis was performed to identify the prognostic factors associated with long‐term outcome. Results Among the 141 CAAH patients, 76 (53.9%) achieved favorable outcomes and 28 (19.9%) of them died at 1‐year follow‐up. For the longer‐term follow‐up with a median observation time of 19.0 (interquartile range, 12.0–26.5) months, 71 (50.4%) patients obtained favorable outcomes while 33 (23.4%) died. GCS on admission (OR, 0.109; 95% CI, 0.021–0.556; p = 0.008), recurrence of ICH (OR, 2923.687; 95% CI, 6.282–1360730.14; p = 0.011), WML grade 3–4 (OR, 31.007; 95% CI, 1.041–923.573; p = 0.047), severe central atrophy (OR, 4220.303; 95% CI, 9.135–1949674.84; p = 0.008) assessed by CT was identified as independent predictors for long‐term outcome. Interpretation Nearly 50% of CAAH patients achieved favorable outcomes at long‐term follow‐up. GCS, recurrence of ICH, WML grade and cerebral atrophy were identified as independent prognostic factors of long‐term outcome.
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Affiliation(s)
- Ruiwen Che
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine, Beijing, China
| | - Mengke Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hailiang Sun
- Department of Neurosurgery, Beijing Fengtai You'anmen Hospital, Beijing, China
| | - Jin Ma
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wenbo Hu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xin Liu
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xunming Ji
- Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine, Beijing, China.,Department of Neurosurgery, Xuan Wu Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Brain Disorders, Beijing, China.,Capital Medical University, Beijing, China
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Ward RC, Graff-Radford J, Ponamgi S, English S, Meskill A, Challa AB, Hodge DO, Slusser JP, Rabinstein AA, Asirvatham SJ, Holmes D, DeSimone CV. Time in therapeutic range of anticoagulation among patients with atrial fibrillation and cerebral amyloid angiopathy. Proc (Bayl Univ Med Cent) 2021; 35:162-167. [DOI: 10.1080/08998280.2021.2013393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Robert C. Ward
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | | | - Shiva Ponamgi
- Department of Cardiology, Creighton University, Omaha, Nebraska
| | | | - Alayna Meskill
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Apurva B. Challa
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - David O. Hodge
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida
| | - Joshua P. Slusser
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | | | | | - David Holmes
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
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Sasannejad C, Sheth KN. Anticoagulation in Acute Neurological Disease. Semin Neurol 2021; 41:530-540. [PMID: 34619779 DOI: 10.1055/s-0041-1733793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
While anticoagulation and its reversal have been of clinical relevance for decades, recent academic and technological advances have expanded the repertoire of its application in neurological disease. The advent of direct oral anticoagulants provides effective, mechanistically elegant, and relatively safer therapeutic options than warfarin for eligible patients at risk for neurological sequelae of prothrombotic states, particularly given the recent availability of corresponding reversal agents. In this review, we examine the provenance, indications, safety, and reversal tools for anticoagulant medications in the context of neurological disease, with specific attention to acute ischemic stroke, cerebral venous sinus thrombosis, and intracerebral hemorrhage. We will use specific clinical scenarios to illustrate the complex factors that must be considered in the use of anticoagulation, including intracranial pathology such as intracerebral hemorrhage, traumatic brain injury, or malignancy; metabolic complications such as chronic kidney disease; pregnancy; and advanced age.
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Affiliation(s)
- Cina Sasannejad
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, Connecticut
| | - Kevin N Sheth
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, Connecticut
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Wagner A, Groetsch C, Wilfling S, Schebesch KM, Kilic M, Nenkov M, Wendl C, Linker RA, Schlachetzki F. Index event of cerebral amyloid angiopathy (CAA) determines long-term prognosis and recurrent events (retrospective analysis and clinical follow-up). Neurol Res Pract 2021; 3:51. [PMID: 34565480 PMCID: PMC8474746 DOI: 10.1186/s42466-021-00152-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/17/2021] [Indexed: 11/25/2022] Open
Abstract
Background The modified Boston criteria (mBC) define the probability for the diagnosis of cerebral amyloid angiopathy (CAA). Its initial clinical presentation differs from asymptomatic cerebral microbleedings (cMBs), acute ischemic stroke (AIS), cortical hemosiderosis (cSS), to lobar ICH (lICH). Methods Retrospective analyses and clinical follow-ups of individuals with at least mBC “possible” CAA from 2005 to 2018. Results 149 patients were classified in subgroups due to the index event: lICH (n = 91), AIS (n = 32), > 3 cMBs only (n = 16) and cSS (n = 10). Patients in the lICH subgroup had a significantly higher percentage of single new lICHs compared to other groups, whereas patients in the AIS-group had a significantly higher percentage of multiple new AIS. cMBs as index event predisposed for AIS during follow up (p < 0.0016). Patients of the cMBs- or cSS-group showed significantly more TFNEs (transient focal-neurological episodes) and lower numbers of asymptomatic patients (for epilepsy and TFNEs) at the index event than patients with lICH or AIS (p < 0.0013). At long-term follow-up, the cMBs- and cSS-group were characterized by more TFNEs and fewer asymptomatic patients. Conclusions A new classification system of CAA should add subgroups according to the initial clinical presentation to the mBCs allowing individual prognosis, acute treatment and secondary prophylaxis. Supplementary Information The online version contains supplementary material available at 10.1186/s42466-021-00152-x.
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Affiliation(s)
- Andrea Wagner
- Department of Neurology, University of Regensburg, Bezirksklinikum, Universitätsstraße 84, 93053, Regensburg, Germany.
| | - Christiane Groetsch
- Department of Neurology, University of Regensburg, Bezirksklinikum, Universitätsstraße 84, 93053, Regensburg, Germany
| | - Sibylle Wilfling
- Department of Neurology, University of Regensburg, Bezirksklinikum, Universitätsstraße 84, 93053, Regensburg, Germany
| | - Karl-Michael Schebesch
- Department of Neurosurgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Mustafa Kilic
- Department of Neurology, University of Regensburg, Bezirksklinikum, Universitätsstraße 84, 93053, Regensburg, Germany
| | - Marjan Nenkov
- Department of Neurology, University of Regensburg, Bezirksklinikum, Universitätsstraße 84, 93053, Regensburg, Germany
| | - Christina Wendl
- Institute for Neuroradiology, University Hospital Regensburg and Bezirksklinikum, Universitätsstraße 84, 93053, Regensburg, Germany
| | - Ralf A Linker
- Department of Neurology, University of Regensburg, Bezirksklinikum, Universitätsstraße 84, 93053, Regensburg, Germany
| | - Felix Schlachetzki
- Department of Neurology, University of Regensburg, Bezirksklinikum, Universitätsstraße 84, 93053, Regensburg, Germany
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Johnson JA, Haq KT, Lutz KJ, Peters KK, Paternostro KA, Craig NE, Stencel NWL, Hawkinson LF, Khayyat-Kholghi M, Tereshchenko LG. Electrophysiological ventricular substrate of stroke: a prospective cohort study in the Atherosclerosis Risk in Communities (ARIC) study. BMJ Open 2021; 11:e048542. [PMID: 34479935 PMCID: PMC8420653 DOI: 10.1136/bmjopen-2020-048542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 08/16/2021] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES The goal of the study was to determine an association of cardiac ventricular substrate with thrombotic stroke (TS), cardioembolic stroke (ES) and intracerebral haemorrhage (ICH). DESIGN Prospective cohort study. SETTING The Atherosclerosis Risk in Communities (ARIC) study in 1987-1989 enrolled adults (45-64 years), selected as a probability sample from four US communities (Minneapolis, Minnesota; Washington, Maryland; Forsyth, North Carolina; Jackson, Mississippi). Visit 2 was in 1990-1992, visit 3 in 1993-1995, visit 4 in 1996-1998 and visit 5 in 2011-2013. PARTICIPANTS ARIC participants with analysable ECGs and no history of stroke were included (n=14 479; age 54±6 y; 55% female; 24% black). Ventricular substrate was characterised by cardiac memory, spatial QRS-T angle (QRS-Ta), sum absolute QRST integral (SAIQRST), spatial ventricular gradient magnitude (SVGmag), premature ventricular contractions (PVCs) and tachycardia-dependent intermittent bundle branch block (TD-IBBB) on 12-lead ECG at visits 1-5. OUTCOME Adjudicated TS included a first definite or probable thrombotic cerebral infarction, ES-a first definite or probable non-carotid cardioembolic brain infarction. Definite ICH was included if it was the only stroke event. RESULTS Over a median 24.5 years follow-up, there were 899 TS, 400 ES and 120 ICH events. Cox proportional hazard risk models were adjusted for demographics, cardiovascular disease, risk factors, atrial fibrillation, atrial substrate and left ventricular hypertrophy. After adjustment, PVCs (HR 1.72; 95% CI 1.02 to 2.92), QRS-Ta (HR 1.15; 95% CI 1.03 to 1.28), SAIQRST (HR 1.20; 95% CI 1.07 to 1.34) and time-updated SVGmag (HR 1.19; 95% CI 1.08 to 1.32) associated with ES. Similarly, PVCs (HR 1.53; 95% CI 1.03 to 2.26), QRS-Ta (HR 1.08; 95% CI 1.01 to 1.16), SAIQRST (HR 1.07; 95% CI 1.01 to 1.14) and time-updated SVGmag (HR 1.11; 95% CI 1.04 to 1.19) associated with TS. TD-IBBB (HR 3.28; 95% CI 1.03 to 10.46) and time-updated SVGmag (HR 1.23; 95% CI 1.03 to 1.47) were associated with ICH. CONCLUSIONS PVC burden (reflected by cardiac memory) is associated with ischaemic stroke. Transient cardiac memory (likely through TD-IBBB) precedes ICH.
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Affiliation(s)
- John A Johnson
- Department of Medicine, Cardiovascular Division or Knight Cardiovascular Institute, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Kazi T Haq
- Department of Medicine, Cardiovascular Division or Knight Cardiovascular Institute, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Katherine J Lutz
- Department of Medicine, Cardiovascular Division or Knight Cardiovascular Institute, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Kyle K Peters
- Department of Medicine, Cardiovascular Division or Knight Cardiovascular Institute, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Kevin A Paternostro
- Department of Medicine, Cardiovascular Division or Knight Cardiovascular Institute, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Natalie E Craig
- Department of Medicine, Cardiovascular Division or Knight Cardiovascular Institute, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Nathan W L Stencel
- Department of Medicine, Cardiovascular Division or Knight Cardiovascular Institute, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Lila F Hawkinson
- Department of Medicine, Cardiovascular Division or Knight Cardiovascular Institute, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Maedeh Khayyat-Kholghi
- Department of Medicine, Cardiovascular Division or Knight Cardiovascular Institute, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Larisa G Tereshchenko
- Department of Medicine, Cardiovascular Division or Knight Cardiovascular Institute, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Wagner A, Maderer J, Wilfling S, Kaiser J, Kilic M, Linker RA, Schebesch KM, Schlachetzki F. Cerebrovascular Risk Factors in Possible or Probable Cerebral Amyloid Angiopathy, Modifier or Bystander? Front Neurol 2021; 12:676931. [PMID: 34354659 PMCID: PMC8335403 DOI: 10.3389/fneur.2021.676931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 06/07/2021] [Indexed: 11/13/2022] Open
Abstract
Goal: Cerebral amyloid angiopathy (CAA) is a frequent cause of atypical intracerebral hemorrhage (ICH) in the elderly. Stroke risk factors such as arterial hypertension (AHT), atrial fibrillation (AFib), diabetes mellitus (DM), and renal dysfunction (RD) are increasingly apparent in these patients. In this retrospective study, we analyzed the presence of these stroke risk factors in different initial CAA presentations comprising cerebral microbleeds (CMB), acute ischemic stroke (AIS), cortical superficial hemosiderosis (cSS), or lobar ICH (LICH) and evaluated their influence on the initial clinical presentation of patients with CAA. Material and Methods: We identified patients with at least possible CAA defined by the modified Boston criteria admitted to the Department of Neurology or Neurosurgery from 2002 to 2018. Findings: In the overall cohort of 209 patients, we analyzed the correlation between the number of stroke risk factors and the initial clinical presentation of patients with CAA and could show the high multimorbidity of the collective. There are large differences between the subgroups with different initial clinical presentations, e.g., patients with CMB as initial CAA presentation have the highest number of cerebrovascular risk factors and recurrent AIS, whereas AFib is more frequent in the Neurosurgery Department. Conclusion: There is a distinct overlap between the subgroups of CAA manifestations and stroke risk factors that need to be verified in larger patient collectives. Since these comorbidities are likely to influence the clinical course of CAA, they represent possible targets for secondary prevention until specific treatment for CAA becomes available.
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Affiliation(s)
- Andrea Wagner
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Jonas Maderer
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Sibylle Wilfling
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Johanna Kaiser
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Mustafa Kilic
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Ralf A Linker
- Department of Neurology, University of Regensburg, Regensburg, Germany
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Schrag M, Mac Grory B, Nackenoff A, Eaton J, Mistry E, Kirshner H, Yaghi S, Ellis CR. Left Atrial Appendage Closure for Patients with Cerebral Amyloid Angiopathy and Atrial Fibrillation: the LAA-CAA Cohort. Transl Stroke Res 2020; 12:259-265. [PMID: 32770310 DOI: 10.1007/s12975-020-00838-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 12/11/2022]
Abstract
Anticoagulation increases the risk of intracerebral hemorrhage (ICH) in patients with cerebral amyloid angiopathy (CAA), so the management of stroke-risk in patients with both atrial fibrillation (AF) and CAA is controversial. Advances in left atrial appendage closure (LAAC) techniques provide a stroke-risk-reduction option which avoids long-term oral anticoagulation (OAC). We aimed to evaluate the safety of this intervention in patients with CAA. This is an observational cohort study of patients with severe CAA (with or without ICH) and AF who were treated with LAA closure. The Watchman™ and Amulet® LAAC devices and Lariat procedure or open surgical closure of the LAA were all considered acceptable means of closure. Patients with symptomatic ICH and those naïve to anticoagulation were placed on clopidogrel and/or aspirin for 6 weeks after the procedure; patients who previously tolerated anticoagulation remained on warfarin or a DOAC for 6 weeks post-procedure. All anticoagulation therapy was discontinued after confirmation of LAAC. All patients had aggressively optimized blood pressure and fall precautions in addition to surgical intervention. Safety, tolerability, stroke, and hemorrhage rates were documented. Twenty-six patients with a mean CHA2DS2-VASc score of 4.6 were treated, 13 with a history of symptomatic lobar hemorrhage and 13 without. All patients who completed LAAC tolerated the device implantation. There were no documented ischemic strokes or symptomatic ICH during the 30 days after device implantation. Patients were followed for an average of 25 months. One patient who underwent Lariat LAAC had an ischemic stroke in follow-up, but recovered well; there were no other thromboemboli in this cohort. This cohort study provides evidence that LAAC appears to be a safe and tolerable treatment to reduce stroke risk in patients with CAA. Because of the small size of the cohort and relatively short follow-up, the efficacy for stroke and ICH prevention is not conclusive, but the preliminary results are encouraging. LAA closure may be a good alternative to anticoagulation in patients with CAA and atrial fibrillation.
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Affiliation(s)
- Matthew Schrag
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Brian Mac Grory
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | - Alex Nackenoff
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James Eaton
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eva Mistry
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Howard Kirshner
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shadi Yaghi
- Department of Neurology, New York University, New York, NY, USA
| | - Christopher R Ellis
- Department of Medicine, Cardiovascular Electrophysiology section, Vanderbilt University Medical Center, Nashville, TN, USA
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