JACC. Case reports · 2026
Stroke After Surgical Left Atrial Appendage Clip With Residual Neck Thrombus: Transcatheter Plug Closure.
Клинический случайСтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
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.
Noujaim Charbel, Jabbour Karen, Abbasi Mohammad, Miyasaka Rhonda L, Xu Bo, Santangeli Pasquale, Jaber Wael A, Kanj Mohamed H
Аннотация
BACKGROUND: Incomplete left atrial appendage clip closure is a recognized complication and may increase thromboembolic risk.
CASE SUMMARY: A 72-year-old woman with persistent atrial fibrillation presented with a left middle cerebral artery stroke while on apixaban. History included mitral valve repair with epicardial left atrial appendage clip and AV-junction ablation with a leadless pacemaker. Local transesophageal echocardiogram (TEE) reported complete ligation without thrombus; cardiac computed tomography at our institution demonstrated incomplete ligation with a narrow residual ostium and an 11 × 6 mm thrombus. With Sentinel cerebral embolic protection, intraprocedural TEE identified a 6 × 5 mm residual communication. Single transseptal access (Agilis sheath, VersaCross RF wire) permitted traversal of the neck; a 12-mm Amplatzer Vascular Plug II was implanted. TEE and angiography confirmed complete seal; recovery was uneventful.
TAKE-HOME MESSAGES: Computed tomography and TEE should confirm exclusion before stopping anticoagulation after clip ligation. Plug occlusion performed with cerebral embolic protection can convert incomplete surgical exclusion to complete closure.
CASE SUMMARY: A 72-year-old woman with persistent atrial fibrillation presented with a left middle cerebral artery stroke while on apixaban. History included mitral valve repair with epicardial left atrial appendage clip and AV-junction ablation with a leadless pacemaker. Local transesophageal echocardiogram (TEE) reported complete ligation without thrombus; cardiac computed tomography at our institution demonstrated incomplete ligation with a narrow residual ostium and an 11 × 6 mm thrombus. With Sentinel cerebral embolic protection, intraprocedural TEE identified a 6 × 5 mm residual communication. Single transseptal access (Agilis sheath, VersaCross RF wire) permitted traversal of the neck; a 12-mm Amplatzer Vascular Plug II was implanted. TEE and angiography confirmed complete seal; recovery was uneventful.
TAKE-HOME MESSAGES: Computed tomography and TEE should confirm exclusion before stopping anticoagulation after clip ligation. Plug occlusion performed with cerebral embolic protection can convert incomplete surgical exclusion to complete closure.