Management and outcomes of patients with left atrial appendage thrombus prior to percutaneous closure.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Marroquin Luis, Tirado-Conte Gabriela, Pracoń Radosław, Streb Witold, Gutierrez Hipolito, Boccuzzi Giacomo, Arzamendi-Aizpurua Dabit, Cruz-González Ignacio, Ruiz-Nodar Juan Miguel, Kim Jung-Sun, Freixa Xavier, Lopez-Minguez Jose Ramon, De Backer Ole, Ruiz-Salmeron Rafael, Dominguez Antonio, McInerney Angela, Peral Vicente, Estevez-Loureiro Rodrigo, Fernandez-Nofrerias Eduard, Freitas-Ferraz Afonso B, Saia Francesco, Huczek Zenon, Gheorghe Livia, Salinas Pablo, Demkow Marcin, Delgado-Arana Jose R, Fernandez Peregrina Estefania, Kalarus Zbibniew, Elvira Laffond Ana, Jang Yangsoo, Fernandez Camacho Jose Carlos, Lee Oh-Hyun, Hernández-Garcia Jose M, Mas-Llado Caterina, Caneiro Queija Berenice, Amat-Santos Ignacio J, Dabrowski Maciej, Rodés-Cabau Josep, Nombela Franco Luis
Аннотация
METHODS: This multicentre observational registry included 126 consecutive patients referred for LAAC with LAA thrombus on preprocedural imaging. Treatment strategies included intensification of antithrombotic therapy (IAT) or direct LAAC. The primary and secondary endpoints were a composite of bleeding, stroke and death at 18 months, and procedural success, respectively.
RESULTS: IAT was the preferred strategy in 57.9% of patients, with total thrombus resolution observed in 60.3% and 75.3% after initial and subsequent IAT, respectively. Bleeding complications and stroke during IAT occurred in 9.6% and 2.9%, respectively, compared with 3.8% bleeding and no embolic events in the direct LAAC group before the procedure. Procedural success was 90.5% (96.2% vs 86.3% in direct LAAC and IAT group, respectively, p=0.072), without cases of in-hospital thromboembolic complications. The primary endpoint occurred in 29.3% and device-related thrombosis was found in 12.8%, without significant difference according to treatment strategy. Bleeding complications at 18 months occurred in 22.5% vs 10.5% in the IAT and direct LAAC group, respectively (p=0.102).
CONCLUSION: In the presence of LAA thrombus, IAT was the initial management strategy in half of our cohort, with initial thrombus resolution in 60% of these, but with a relatively high bleeding rate (~10%). Direct LAAC was feasible, with high procedural success and absence of periprocedural embolic complications. However, a high rate of device-related thrombosis was detected during follow-up.