First Experience of Transcatheter Leak Occlusion With Detachable Coils Following Left Atrial Appendage Closure

被引：47

作者：

Della Rocca, Domenico G. ^{[1
]}

Horton, Rodney P. ^{[1
]}

Di Biase, Luigi ^{[1
,2
,3
]}

Bassiouny, Mohamed ^{[1
]}

Al-Ahmad, Amin ^{[1
]}

Mohanty, Sanghamitra ^{[1
]}

Gasperetti, Alessio ^{[1
]}

Natale, Veronica N. ^{[4
]}

Trivedi, Chintan ^{[1
]}

Gianni, Carola ^{[1
]}

Burkhardt, J. David ^{[1
]}

Gallinghouse, G. Joseph ^{[1
]}

Hranitzky, Patrick ^{[1
]}

Sanchez, Javier E. ^{[1
]}

Natale, Andrea ^{[1
,5
,6
,7
,8
]}

机构：

[1] St Davids Med Ctr, Texas Cardiac Arrhythmia Inst, 3000 North I-35,Suite 720, Austin, TX 78705 USA

[2] Montefiore Med Ctr, Albert Einstein Coll Med, Arrhythmia Serv, Dept Med, Bronx, NY 10467 USA

[3] Univ Foggia, Dept Clin & Expt Med, Foggia, Italy

[4] Johns Hopkins Univ, Bloomberg Sch Publ Hlth, Baltimore, MD USA

[5] Scripps Clin, Intervent Electrophysiol, La Jolla, CA USA

[6] Case Western Reserve Univ, Sch Med, MetroHlth Med Ctr, Dept Cardiol, Cleveland, OH USA

[7] Stanford Univ, Div Cardiol, Stanford, CA 94305 USA

[8] Univ Texas Austin, Dell Med Sch, Austin, TX 78712 USA

来源：

JACC-CARDIOVASCULAR INTERVENTIONS | 2020年 / 13卷 / 03期

关键词：

atrial fibrillation; coil; leak; left atrial appendage; stroke; INITIAL-EXPERIENCE; CLINICAL IMPACT; HIGH-RISK; FIBRILLATION; DEVICE; LIGATION; STROKE; EXCLUSION; WATCHMAN; THROMBUS;

D O I：

10.1016/j.jcin.2019.10.022

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

OBJECTIVES The aim of this study was to assess the feasibility and efficacy of transcatheter leak closure with detachable coils in patients with incomplete left atrial appendage (LAA) closure. BACKGROUND Incomplete LAA closure is common after interventional therapies targeting the LAA, potentially hindering effective thromboembolic prevention. Detachable coils have found a wide range of applications for transcatheter vascular occlusion and embolization procedures. METHODS Thirty consecutive patients at high thromboembolic risk with clinically relevant residual leaks (mean age 72 +/- 9 years, 73.3% men, mean CHA(2)DS(2)-VASc score 4.4 +/- 1.4, mean HAS-BLED score 3.6 +/- 0.8) underwent percutaneous closure of the LAA patency using embolization coils. Transesophageal echocardiography was performed at 60 +/- 15 days post-procedure. RESULTS LAA closure had been previously attempted with the Watchman device in 25 patients, the Amulet device in 2 patients, and the LARIAT device in 3 patients. Baseline transesophageal echocardiography documented moderate and severe leaks in 20 (66.7%) and 10 (33.3%) patients, respectively. After a single procedure, 25 patients (83.3%) showed complete LAA sealing or minimal leaks. Five patients (16.7%) had moderate residual leaks; 3 patients of them were offered repeat procedures. Mean procedure and fluoroscopy times were 76 +/- 41 min and 21 +/- 14 min, respectively; the mean volume of iodinated contrast medium used was 80 +/- 47 ml. Coil deployment was successful in all cases. The overall complication rate was 6.1%. After a median follow-up period of 54 days (range 43 to 265 days) and an average of 1.1 procedures/patient, transesophageal echocardiography revealed complete LAA sealing or negligible residual leaks in 28 patients (93.3%; 25 with no residual leak, 3 patients with minimal to mild residual leaks) and moderate residual leaks in 2 patients (6.7%). CONCLUSIONS Transcatheter LAA leak occlusion using endovascular coils appears to be a safe, effective, and promising approach in patients at high echo time risk with incomplete LAA closure. (C) 2020 by the American College of Cardiology Foundation.

引用

页码：306 / 319

页数：14

共 28 条

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