Kiani Jawad, Holmes David R
The Division of Cardiovascular Diseases and Department of Internal Medicine, Mayo Clinic and Mayo Foundation, 200 First Street SW, Rochester, MN, 55905, USA.
Curr Atheroscler Rep. 2015 Nov;17(11):65. doi: 10.1007/s11883-015-0542-5.
The pathophysiologic mechanism of thromboembolic stroke in the setting of non-valvular atrial fibrillation (AF) resides in the left atrial appendage (LAA). In this setting, approximately 90 % of all strokes originate from this structure. Percutaneous left atrial appendage occlusion (LAAO) therapy has recently emerged as an important strategy for prevention of stroke and systemic embolism in patients with non-valvular AF. Systemic anticoagulation therapy in this AF population, while effective, is associated with a significant bleeding risk, drug compliance issues, and limited reversal strategies. In this manuscript, we will review the percutaneous devices and techniques that allow endovascular closure of the LAA, including their efficacy in stroke prevention, the safety profile of these local site-specific therapies, comparison of the multiple approaches being studied, the index patient populations involved, and long-term follow-up in comparison with systemic anticoagulation therapy. The percutaneous LAAO approach indeed represents an exciting and revolutionary advance in the field of stroke prevention in AF.
非瓣膜性心房颤动（AF）患者发生血栓栓塞性卒中的病理生理机制在于左心耳（LAA）。在此情况下，约90%的卒中都源于该结构。经皮左心耳封堵术（LAAO）治疗最近已成为预防非瓣膜性AF患者发生卒中和全身性栓塞的一项重要策略。在这一AF人群中，全身性抗凝治疗虽有效，但存在显著的出血风险、药物依从性问题以及有限的逆转策略。在本手稿中，我们将回顾能够实现LAA血管内闭合的经皮装置和技术，包括它们在预防卒中方面的疗效、这些局部部位特异性治疗的安全性概况、正在研究的多种方法的比较、所涉及的目标患者群体，以及与全身性抗凝治疗相比的长期随访情况。经皮LAAO方法确实代表了AF卒中预防领域一项令人兴奋的革命性进展。
