Thiankhaw Kitti, Best Jonathan, Srivastava Sonal, Prachee Ishika, Agarwal Smriti, Tan Serena, Calvert Patrick A, Chughtai Asim, Ang Richard, Segal Oliver R, Werring David J
Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK.
Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand.
J Neurol Neurosurg Psychiatry. 2025 May 14;96(6):528-536. doi: 10.1136/jnnp-2024-334718.
Cerebral amyloid angiopathy (CAA) is a common cause of intracerebral haemorrhage (ICH) with a high recurrence risk. Left atrial appendage occlusion (LAAO) is a method for ischaemic stroke prevention in patients with atrial fibrillation (AF), potentially reducing the risk of intracranial bleeding in CAA-associated ICH. We aimed to determine the outcomes of patients with AF with CAA-associated ICH undergoing LAAO.
We conducted a multicentre study of patients with CAA-associated ICH who underwent LAAO for stroke prevention. We pooled our findings with data from a systematic review of relevant published studies of LAAO for AF in ICH survivors reporting CAA diagnosis.
We included data from two published studies (n=65) with CAA-specific data and our cohort study (n=37), providing a total of 102 participants (mean age 76.2±8.0 years, 74.6% male) with CAA-related symptomatic ICH and AF treated with LAAO. The median follow-up period was 9.4 months (IQR 4.2-20.6). Postprocedural antithrombotic regimens varied between single (73.0%) or dual antiplatelet therapy (16.2%), or direct oral anticoagulant (DOAC) (10.8%), with a median duration of 42 days (IQR 35-74). Postprocedural complications were uncommon, but included transient arrhythmias (2.1%) and non-life-threatening tamponade (2.1%). Pooled incidence rates of ischaemic stroke and ICH during follow-up were 5.16 (95% CI 1.36 to 17.48) and 2.73 (95% CI 0.41 to 13.94) per 100 patient years, respectively.
LAAO followed by short-term antithrombotic therapy might be a safe and effective ischaemic stroke preventive strategy in people with CAA-associated ICH and AF. However, randomised controlled trials are needed to determine how LAAO compares with long-term DOAC in this population.
CRD42023415354.
脑淀粉样血管病（CAA）是脑出血（ICH）的常见病因，复发风险高。左心耳封堵术（LAAO）是预防心房颤动（AF）患者缺血性卒中的一种方法，可能降低CAA相关ICH患者的颅内出血风险。我们旨在确定接受LAAO的CAA相关ICH合并AF患者的预后。
我们对因预防卒中而接受LAAO的CAA相关ICH患者进行了一项多中心研究。我们将研究结果与对已发表的关于ICH幸存者中LAAO用于AF且报告CAA诊断的相关研究的系统评价数据进行汇总。
我们纳入了两项已发表研究（n = 65）的CAA特异性数据以及我们的队列研究（n = 37）的数据，共有102名参与者（平均年龄76.2±8.0岁，74.6%为男性）患有CAA相关症状性ICH且AF接受了LAAO治疗。中位随访期为9.4个月（四分位间距4.2 - 20.6）。术后抗栓方案包括单一抗血小板治疗（73.0%）、双联抗血小板治疗（16.2%）或直接口服抗凝剂（DOAC）（10.8%），中位持续时间为42天（四分位间距35 - 74）。术后并发症不常见，但包括短暂性心律失常（2.1%）和非危及生命的心包填塞（2.1%）。随访期间缺血性卒中和ICH的合并发生率分别为每100患者年5.16（95%置信区间1.36至17.48）和2.73（95%置信区间0.41至13.94）。
LAAO联合短期抗栓治疗可能是CAA相关ICH合并AF患者安全有效的缺血性卒中预防策略。然而，需要随机对照试验来确定LAAO与该人群长期DOAC治疗相比的效果。
PROSPERO注册号：CRD42023415354。
