Freixa Xavier, Llull Laura, Gafoor Sameer, Cruz-Gonzalez Ignacio, Shakir Samera, Omran Heyder, Berti Sergio, Santoro Gennaro, Kefer Joelle, Landmesser Ulf, Nielsen-Kudsk Jens Erik, Kanagaratnam Prapa, Nietlispach Fabian, Gloekler Steffen, Aminian Adel, Danna Paolo, Rezzaghi Marco, Stock Friederike, Stolcova Miroslava, Paiva Luis, Costa Marco, Millán Xavier, Ibrahim Reda, Tichelbäcker Tobias, Schillinger Wolfgang, Park Jai-Wun, Sievert Horst, Meier Bernhard, Tzikas Apostolos
Department of Cardiology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.
Department of Cardiology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.
Am J Cardiol. 2016 Dec 15;118(12):1836-1841. doi: 10.1016/j.amjcard.2016.08.075. Epub 2016 Sep 15.
Cardioembolic strokes are generally more lethal and disabling than other source of strokes. Data from PROTECT AF (Watchman Left Atrial Appendage Closure Technology for Embolic Protection in Patients With Atrial Fibrillation) suggest that strokes after left atrial appendage occlusion (LAAO) with the Watchman device are less disabling than those in the warfarin group. No data assessing the severity of strokes after LAAO with the AMPLATZER Cardiac Plug (ACP) are available. The objective of the study was to evaluate the severity of cerebrovascular events after LAAO with the ACP in a population mostly characterized by an absolute or relative contraindication to oral anticoagulation. Data from the ACP multicenter registry were analyzed. Disabling strokes were defined as those with a modified Rankin score of 3 to 6 at 90 days after the event. A total of 1,047 subjects were included. The mean age and CHADS score were 75 ± 8 years and 2.8 ± 1.3, respectively. Procedural success was achieved in 97.3% and 4.9% of the patients presented procedural major adverse events. Clinical follow-up was complete in 98.2% of patients with a median of 13 months. There were 9 strokes (0.9%), 9 transient ischemic attacks (0.9%), and no intracranial hemorrhages (0%) at follow-up. After excluding 2 patients with pre-LAAO disability, functional assessment showed disabling events in 3 (19%) of the remaining 16 patients. The median time of presentation was 420 days (interquartile range 234 to 671) after LAAO, and 17 patients (94%) were on single-antiplatelet therapy when the event occurred. According to our results, cerebrovascular events after LAAO with the ACP system were infrequent and mostly nondisabling.
心源性栓塞性中风通常比其他类型的中风更具致死性和致残性。来自PROTECT AF（用于房颤患者栓塞保护的Watchman左心耳封堵技术）的数据表明，使用Watchman装置进行左心耳封堵（LAAO）后的中风致残性低于华法林组。目前尚无评估使用AMPLATZER心脏封堵器（ACP）进行LAAO后中风严重程度的数据。本研究的目的是评估在主要存在口服抗凝绝对或相对禁忌证的人群中，使用ACP进行LAAO后脑血管事件的严重程度。对ACP多中心注册研究的数据进行了分析。致残性中风定义为事件发生后90天改良Rankin评分为3至6分的中风。共纳入1047名受试者。平均年龄和CHADS评分分别为75±8岁和2.8±1.3。97.3%的患者手术成功，4.9%的患者出现手术相关的主要不良事件。98.2%的患者完成了临床随访，中位随访时间为13个月。随访期间有9例中风（0.9%）、9例短暂性脑缺血发作（0.9%），无颅内出血（0%）。排除2例LAAO前即有残疾的患者后，功能评估显示，其余16例患者中有3例（19%）发生致残性事件。LAAO后出现症状的中位时间为420天（四分位间距234至671天），事件发生时17例患者（94%）正在接受单药抗血小板治疗。根据我们的结果，使用ACP系统进行LAAO后脑血管事件发生率低，且大多不会导致残疾。
