JACC. Case reports · 2025
Efficient Removal of Nascent Left Atrial Appendage Thrombus to Facilitate Left Atrial Appendage Closure.
Клинический случайСтатьяНазвание и аннотация: Перевод пока не подготовлен
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Arkles Jeffrey, Biggs Ross, Bernabei Matthew
Аннотация
BACKGROUND: Left atrial appendage (LAA) thrombus often precludes immediate closure owing to embolic risk, complicating care for high-risk patients needing stroke prevention.
CASE SUMMARY: A 78-year-old woman with atrial fibrillation and recent intracranial hemorrhage was referred for left atrial appendage closure (LAAC). Imaging revealed a nascent thrombus at the LAA ostium. Given her high bleeding risk, thrombus aspiration was attempted. Using a deflectable delivery sheath and computer-assisted vacuum catheter, the thrombus was successfully removed en face without embolization. A 27-mm LAAC device was deployed, with excellent results. She was discharged on low-dose apixaban (2.5 mg bid) and remained event-free at 45 days.
DISCUSSION: This case highlights a feasible, minimally invasive technique for aspirating LAA thrombus using standard LAAC tools, enabling safe closure without bypass.
TAKE-HOME MESSAGE: Aspiration of LAA thrombus can be performed efficiently with a vacuum-assisted catheter delivered through a standard deflectable LAAC sheath.
CASE SUMMARY: A 78-year-old woman with atrial fibrillation and recent intracranial hemorrhage was referred for left atrial appendage closure (LAAC). Imaging revealed a nascent thrombus at the LAA ostium. Given her high bleeding risk, thrombus aspiration was attempted. Using a deflectable delivery sheath and computer-assisted vacuum catheter, the thrombus was successfully removed en face without embolization. A 27-mm LAAC device was deployed, with excellent results. She was discharged on low-dose apixaban (2.5 mg bid) and remained event-free at 45 days.
DISCUSSION: This case highlights a feasible, minimally invasive technique for aspirating LAA thrombus using standard LAAC tools, enabling safe closure without bypass.
TAKE-HOME MESSAGE: Aspiration of LAA thrombus can be performed efficiently with a vacuum-assisted catheter delivered through a standard deflectable LAAC sheath.