Seeger Julia, Seppelt Philipp, Iturbe-Orbe Mario, Leistner David, Wöhrle Jochen, Joner Michael
Department of Cardiology and Intensive Care, Medical Campus Lake Constance, 88048 Friedrichshafen, Germany.
University of Ulm, 89081 Ulm, Germany.
J Cardiovasc Dev Dis. 2024 Dec 26;12(1):5. doi: 10.3390/jcdd12010005.
(1) Background: Cerebral magnetic resonance imaging has reported new cerebral ischemic lesions after left atrial appendage (LAA) closure in about one- third of patients. Stroke occurs predominantly periprocedurally. This study evaluated the characteristics of embolized debris captured by the SENTINEL cerebral embolic protection system in patients undergoing LAA closure; (2) Methods: Sixty filters of 30 consecutive patients undergoing LAA closure with the WATCHMAN FLX device were collected and captured debris was analyzed by histopathology and histomorphometry. Clinical outcome measures were disabling and non-disabling stroke within 72 h; (3) Results: In most filters, no material was captured. The predominant captured debris was acute or organized thrombi. The most common pattern was acute fibrin-rich thrombus, which was detected in 11/30 (33.3%) patients. Particles of heart tissue were seen in 6/30 (20%) patients, and foreign material was seen in one (3.3%) patient. The number of particles ranged from 0 to 52 per patient with a maximum of 31 in the distal and 21 in the proximal filter. Particle diameter ranged from 131 to 2614 µm. By logistic regression analysis, only protected time remained a multivariable predictor for larger particles ( = 0.039). There was no disabling or non-disabling stroke. Compared to transfemoral aortic valve replacement, the number of particles is only about 1.5%. (4) Conclusion: LAA occlusion with the WATCHMAN FLX was associated with a very low number of embolized particles captured with the double-filter SENTINEL embolic protection system and no periprocedural stroke.
（1）背景：脑磁共振成像显示，约三分之一的患者在左心耳（LAA）封堵术后出现新的脑缺血性病变。中风主要发生在手术过程中。本研究评估了接受LAA封堵术的患者中，SENTINEL脑栓塞保护系统捕获的栓塞碎片的特征；（2）方法：收集30例连续使用WATCHMAN FLX装置进行LAA封堵术患者的60个滤网，并通过组织病理学和组织形态计量学分析捕获的碎片。临床结局指标为72小时内的致残性和非致残性中风；（3）结果：在大多数滤网中，未捕获到物质。捕获的主要碎片是急性或机化血栓。最常见的模式是富含急性纤维蛋白的血栓，在11/30（33.3%）的患者中检测到。6/30（20%）的患者可见心脏组织颗粒，1例（3.3%）患者可见异物。每位患者的颗粒数量从0到52不等，远端滤网最多31个，近端滤网最多21个。颗粒直径范围为131至2614 µm。通过逻辑回归分析，只有保护时间仍然是较大颗粒的多变量预测因子（P = 0.039）。没有发生致残性或非致残性中风。与经股主动脉瓣置换术相比，颗粒数量仅约为1.5%。（4）结论：使用WATCHMAN FLX进行LAA封堵术时，双滤网SENTINEL栓塞保护系统捕获的栓塞颗粒数量非常少，且围手术期无中风发生。
