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Case Reports
. 2022 Nov 2;4(21):1409-1413.
doi: 10.1016/j.jaccas.2022.07.037.

Massive Device-Related Thrombus After LAA Occlusion: Intraoperative Insights Into Mechanism

Damir Vukomanovic  1 , Samuel Unzek  2 , Kashif Malik  3 , Alicia Taase  3 , Michael Zawaneh  2 , Peter Weiss  2 , Kenith Fang  4 , Roderick Tung  2
Affiliations
Case Reports

Massive Device-Related Thrombus After LAA Occlusion: Intraoperative Insights Into Mechanism

Damir Vukomanovic et al. JACC Case Rep. .

Abstract

In patients with a contraindication to oral anticoagulation, the left atrial appendage occlusion devices are an approved alternative. Device-related thrombus is a recognized complication, but underlying mechanisms are incompletely understood. In this case series, the authors describe potentially the same mechanism of thrombosis with intraoperative images of incomplete endothelialization. (Level of Difficulty: Intermediate.).

Keywords: AF, atrial fibrillation; DRT, device-related thrombus; INR, international normalized ratio; LAA, left atrial appendage; LAAO, left atrial appendage occlusion; TEE, transesophageal echocardiogram; Watchman; atrial fibrillation; device-related thrombus; left atrial appendage occlusion device.

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Conflict of interest statement

The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Transesophageal Echocardiogram Findings: Case 1 Biplane transesophageal echocardiogram still frame image featuring a 3.5 × 2.2-cm thrombus situated on the left atrial appendage occlusion device with various degrees of maturation (white arrow).
Figure 2
Figure 2
Intraoperative Findings: Case 1 (A) Nonendothelialized central screw hub in dashed circle. (B) Excised left atrial appendage occlusion device encased in organized thrombus. (C) Organized thrombus excised from above the device.
Figure 3
Figure 3
Intraoperative Findings: Case 2 (A) Nonendothelialized central screw hub in dashed circle. (B) Excised organized thrombus removed in fragments from the left atrial appendage occlusion device. (C) Additional view of incompletely endothelialized central screw hub.
See this image and copyright information in PMC

References

    1. Dukkipati S.R., Kar S., Holmes D.R., et al. Device-related thrombus after left atrial appendage closure: incidence, predictors, and outcomes. Circulation. 2018;138:874–885. - PubMed
    1. Ellis C.R., Piccini J.P. Left atrial appendage closure. Two steps forward, one step back. Circulation. 2018;138:886–888. - PubMed
    1. Kubo S., Mizutani Y., Meemook K., et al. Incidence, characteristics, and clinical course of device-related thrombus after Watchman left atrial appendage occlusion device implantation in atrial fibrillation patients. J Am Coll Cardiol EP. 2017;3:1380–1386. - PubMed
    1. Saw J., Nielsen-Kudsk J.E., Bergmann M., et al. Antithrombotic therapy and device-related thrombosis following endovascular left atrial appendage closure. J Am Coll Cardiol Intv. 2019;12:1067–1076. - PubMed
    1. Della Rocca D.G., Horton R.P., Di Biase L., et al. Incidence of device-related thrombosis in watchman patients undergoing a genotype-guided antithrombotic strategy. J Am Coll Cardiol EP. 2021;7:1533–1543. - PubMed

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