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Abramovitz Fouks A, Yaghi S, Gokcal E, Das AS, Rotschild O, Silverman SB, Singhal AB, Romero J, Kapur S, Greenberg SM, Gurol ME. Left atrial appendage closure for patients with atrial fibrillation at high intracranial haemorrhagic risk. Stroke Vasc Neurol 2024:svn-2024-003142. [PMID: 38821554 DOI: 10.1136/svn-2024-003142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/14/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Although left atrial appendage closure (LAAC) is performed in patients with non-valvular atrial fibrillation (NVAF) at increased risk of intracranial haemorrhage (ICH), outcome data are scarce. We assessed the detailed neurological indications for LAAC and outcomes after LAAC in high ICH risk patients. METHODS Study population included consecutive patients with NVAF who underwent LAAC in a single hospital network between January 2015 and October 2021 because of prior ICH or the presence of high ICH risk imaging markers on brain MRI (cerebral microbleeds (CMBs)). Primary safety and efficacy outcome measures were the occurrence of ICH and thromboembolic events, respectively, after LAAC. RESULTS Among 146 patients with NVAF who underwent LAAC for high ICH risk, 122 had a history of ICH, while 24 presented with high ICH risk imaging markers only. Mean age was 75.7±7.61, 42 (28.8%) were women. Mean CHA2DS2-VASc score was 5.23±1.52. Of 122 patients with ICH history, 58 (47.5%) had intraparenchymal haemorrhage (IPH), 40 (32.8%) had traumatic ICH (T-ICH) and 18 (14.7%) had non-traumatic subdural haemorrhage. Of 85 patients with brain MRIs including necessary sequences, 43 (50.6%) were related to cerebral amyloid angiopathy and 37 (43.5%) to hypertensive microangiopathy. While 70% of patients were discharged on oral anticoagulants (OAC), 92% were not taking OAC at 1 year. Over 2.12 years mean follow-up, one patient had recurrent non-traumatic IPH (incidence rate (IR) 0.32 per 100 patient-years), five had T-ICH (IR 1.61 per 100 patient-years) and six had an ischaemic stroke (IR 1.94 per 100 patient-years). CONCLUSIONS Among patients with NVAF at high ICH risk, LAAC demonstrated a low risk of recurrent ICH or ischaemic stroke compared with previously published data. LAAC in high ICH risk populations should be considered in clinical practice per FDA approval and recent guidelines.
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Affiliation(s)
| | - Shadi Yaghi
- Neurology, Brown University, Warren Alpert Medical School, Providence, RI, USA
| | - Elif Gokcal
- Neurology, Massachussets General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alvin S Das
- Neurology, Massachussets General Hospital, Harvard Medical School, Boston, MA, USA
- Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ofer Rotschild
- Neurology, Massachussets General Hospital, Harvard Medical School, Boston, MA, USA
| | - Scott B Silverman
- Neurology, Massachussets General Hospital, Harvard Medical School, Boston, MA, USA
| | - Aneesh B Singhal
- Neurology, Massachussets General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jorge Romero
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sunil Kapur
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Steven M Greenberg
- Neurology, Massachussets General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mahmut Edip Gurol
- Neurology, Massachussets General Hospital, Harvard Medical School, Boston, MA, USA
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Gurol ME, Fisher M. Roundtable of Academia and Industry in Stroke Prevention. Stroke 2024; 55:203-204. [PMID: 38134257 DOI: 10.1161/strokeaha.123.043698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/10/2023] [Indexed: 12/24/2023]
Affiliation(s)
- M Edip Gurol
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (M.E.G.)
| | - Marc Fisher
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F)
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