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Case Reports
. 2024 Jul 13;16(7):e64459.
doi: 10.7759/cureus.64459. eCollection 2024 Jul.

Cardioembolic Stroke Three Days Post-Video-Assisted Thoracoscopic AtriClip in a Patient With Paroxysmal Atrial Fibrillation

Sammudeen Ibrahim  1 , Kwasi Asamoah Opare-Addo  1 , Ibrahim Shamasneh  1 , Basilio Addo  1
Affiliations
Case Reports

Cardioembolic Stroke Three Days Post-Video-Assisted Thoracoscopic AtriClip in a Patient With Paroxysmal Atrial Fibrillation

Sammudeen Ibrahim et al. Cureus. .

Abstract

Atrial fibrillation is a global epidemic due to aging and chronic diseases. Treatment options are expanding to prevent thromboembolism in anticoagulant-ineligible patients. The left atrial appendage, implicated in 90% of embolic strokes, is increasingly managed with occlusion devices like the AtriClip. A 62-year-old woman with prior stroke, severe gastrointestinal bleeding on anticoagulation, and paroxysmal atrial fibrillation experienced sudden left-sided weakness and altered mental status three days post-AtriClip procedure. Brain MRI revealed acute infarcts in the right cerebellum and scattered punctate infarcts in both cerebral hemispheres. No further invasive investigations or interventions were recommended, as they would not influence management. Left-sided weakness improved, and the patient was discharged to a subacute rehabilitation center. Despite the AtriClip's ability to lower stroke incidence by occluding the left atrial appendage, there remains a residual risk of cerebrovascular events that can significantly impact morbidity and mortality. This case underscores persistent risks despite complete appendage closure, emphasizing the need for broader studies on post-AtriClip stroke risk.

Keywords: acute cardioembolic stroke; atrial fibrillation (af); atriclip; complications of anticoagulation; left atrial appendage occlusion.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. An EKG showed subtle S-T segment elevation in lead II without any reciprocal changes.
EKG: electrocardiogram
Figure 2
Figure 2. The MRI T2 (A) and FLAIR (B) show an acute right tiny cerebellar infarct (blue arrow).
MRI: magnetic resonance imaging; T2: transverse relaxation time; FLAIR: fluid-attenuated inversion recovery
Figure 3
Figure 3. Post-procedural TEE showed a successfully ligated LAA with a very small residual scallop-shaped LAA with laminal flow.
TEE: transesophageal echocardiogram; LAA: left atrial appendage
See this image and copyright information in PMC

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