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Atrial Fibrillation and Resistant Stroke: Does Left Atrial Appendage Morphology Matter? A Case Report.
- Source :
-
Frontiers in neurology [Front Neurol] 2020 Nov 12; Vol. 11, pp. 592458. Date of Electronic Publication: 2020 Nov 12 (Print Publication: 2020). - Publication Year :
- 2020
-
Abstract
- Introduction: Patients with atrial fibrillation (AF) can experience ischemic stroke despite adequate anticoagulant therapy. The secondary prevention strategy of these so-called "resistant strokes" is empirical. Since about 90% of patients with ischemic stroke due to atrial fibrillation have thrombus in left atrial appendage (LAA) we sought to explore the possibility that resistant stroke could have a LAA morphology resistant to anticoagulants. Case Report: A 77 years old man affected by AF experienced two cardioembolic ischemic stroke while on anticoagulants. The study of LAA showed a windsock-like morphology in the proximal part while distally the LAA presented a cauliflower morphology with a large amount of pectinate muscles and blood stagnation. The precise characteristics of LAA were properly understood integrating images obtained by cardiac CT, transesophageal echocardiography, and selective angiography. A high risky LAA for thrombus formation was diagnosed and its occlusion (LAAO) as an add-on therapy to anticoagulants was proposed and performed. Six month follow-up was uneventfully. Conclusion: The systematic study of LAA in patients with resistant-stroke could help to identify LAA malignant morphology. The efficacy on stroke recurrence of the combined therapy (anticoagulants plus LAAO) is worthy to be tested in randomized trials.<br /> (Copyright © 2020 Sarti, Stolcova, Scrima, Mori, Failli, Accavone, Biagini, Rapillo, Nencini, Mattesini, Di Mario and Meucci.)
Details
- Language :
- English
- ISSN :
- 1664-2295
- Volume :
- 11
- Database :
- MEDLINE
- Journal :
- Frontiers in neurology
- Publication Type :
- Report
- Accession number :
- 33304313
- Full Text :
- https://doi.org/10.3389/fneur.2020.592458