Efficient Removal of Nascent Left Atrial Appendage Thrombus to Facilitate Left Atrial Appendage Closure.

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.