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Review
. 2018 Jan;49(1):247-254.
doi: 10.1161/STROKEAHA.117.017081. Epub 2017 Dec 4.

Nonpharmacological Management of Atrial Fibrillation in Patients at High Intracranial Hemorrhage Risk

M Edip Gurol  1
Affiliations
Review

Nonpharmacological Management of Atrial Fibrillation in Patients at High Intracranial Hemorrhage Risk

M Edip Gurol. Stroke. 2018 Jan.
No abstract available

Keywords: atrial appendage; atrial fibrillation; hemorrhage; intracranial hemorrhage; prevention; stroke; subdural hematoma.

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Figures

Figure 1
Figure 1. Select devices and procedures used for left atrial appendage closure
A) Left: The WATCHMAN® device (Boston Scientific, Plymouth, MN, USA) FDA-approved for stroke prevention in non-valvular atrial fibrillation through left atrial appendage (LAA) closure (LAAC). Middle: Schematic showing the placement of WATCHMAN device in LAA, note septal puncture. Right: Schematic of LAA orifice after WATCHMAN device covered by tissue, LAA is sealed off. B) The AMPLATZER/Amulet® device (St. Jude Medical, St. Paul, MN, USA) currently tested in clinical trials. C) Left: The AtriClip® LAA Occlusion System (AtriCure, Inc., West Chester, OH), FDA-approved for epicardial LAA exclusion during open surgery. Right: External exclusion of LAA using AtriClip®. Images are reproduced with permission from the following copyright holders. Panel A: Boston Scientific © 2017 Boston Scientific Corporation or its affiliates. Panel B: St Jude Medical © 2017 St Jude Medical, LLC, and its affiliates. Panel C: AtriCure © 2017 AtriCure, Inc. - All rights reserved by their respective owners.
Figure 2
Figure 2. MRI appearance of cerebral amyloid angiopathy (CAA) related pathologies and associated bleeding risk
A) Probable CAA per Boston criteria, lobar intraparenchymal hemorrhage (IPH, big arrow) and multiple strictly lobar/cortical microbleeds (small arrows); ~5–10% annual IPH recurrence risk. B) White matter disease in the same patient as A (IPH, big arrow), moderate periventricular FLAIR hyperintensities (arrowheads) and subcortical spots (pentagons). C) Multifocal/extensive cortical superficial siderosis (curved arrows) in a CAA patient who had IPH (not seen on this cut) and multiple lobar microbleeds (small arrows). High IPH recurrence risk (~27% annually).
Figure 3
Figure 3. MRI appearance of other common cerebral hemorrhagic pathologies and associated bleeding risk
A) Hypertensive deep IPH in left basal ganglia (big arrow), ~1.6–2% yearly recurrence risk. B) Mixed location (deep and lobar) ICH (big arrows) and microbleeds (small arrows). About 5% annual risk of IPH recurrence. C) Lobar microbleed only CAA (small arrows), associated with 5% yearly risk of first-time symptomatic IPH.
See this image and copyright information in PMC

References

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