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Review
. 2022 Aug:41:35-46.
doi: 10.1016/j.carrev.2022.01.028. Epub 2022 Feb 3.

Cardiac Computed Tomography Angiography for Device-Related Thrombus Assessment After WATCHMAN FLX™ Occluder Device Implantation: A Single-Center Retrospective Observational Study

Tyler Miller  1 , David Hana  1 , Saikrishna Patibandla  2 , Daniel Brito Guzman  2 , Juan Carlo Avalon  1 , Irfan Zeb  2 , Madhavi Kadiyala  2 , Jim Mills  2 , Sudarshan Balla  2 , Cathy Kim  3 , Mark Lisle  3 , Mohammad Kawsara  2 , Bryan Raybuck  2 , Ramesh Daggubati  2 , Partho P Sengupta  4 , Yasmin S Hamirani  5
Affiliations
Review

Cardiac Computed Tomography Angiography for Device-Related Thrombus Assessment After WATCHMAN FLX™ Occluder Device Implantation: A Single-Center Retrospective Observational Study

Tyler Miller et al. Cardiovasc Revasc Med. 2022 Aug.

Abstract

Background/purpose: Device-related thrombosis (DRT) is one of the greatest challenges of transcatheter left atrial appendage device occlusion. Due to the invasive nature of transesophageal echocardiography (TEE), cardiac computed tomography angiography (CCTA) is being increasingly utilized in several centers for assessing adequate left atrial appendage closure and monitoring for DRT. There is a paucity of data regarding the standardized definition of DRT on CCTA for the WATCHMAN FLX™ device.

Methods/materials: A retrospective review was conducted on 43 patients receiving WATCHMAN FLX™ device implantation with CCTA performed at the first follow-up at our institution. A comparative review of DRT predictors was performed on 10 patients who had both CCTA and TEE at the time of follow-up.

Results: Hypoattenuated thickening (HAT) was a common finding on CCTA and was noted to be present in 95.35% of the patients. The combination of a large device size, peridevice gap >4 mm, and HAT located on the device gutter and 1 shoulder were characteristics present on CCTA observed in 2 patients with confirmed DRT on TEE.

Conclusion: CCTA is a noninvasive imaging modality for DRT monitoring, with guidelines still in development. We report potential predictors of DRT on CCTA. Additional studies are needed to further determine standardized parameters for DRT detection on CCTA and the significance of HAT with multimodality correlation.

Keywords: Cardiac computed tomography angiography; Device related thrombosis; Left atrial appendage occlusion; WATCHMAN FLX™.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Partho P Sengupta, MD reports a relationship with HeartSciences that includes: equity or stocks. Dr. Partho P Sengupta, MD reports a relationship with Ultromics that includes: equity or stocks. Dr. Partho P Sengupta, MD reports a relationship with Kencor Health that includes: equity or stocks.

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