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Percutaneous LAA Occlusion

Abstract

Recommended Article

Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomised non-inferiority trial Percutaneous Left Atrial Appendage Transcatheter Occlusion (PLAATO System) to Prevent Stroke in High-Risk Patients With Non-Rheumatic Atrial Fibrillation: Results From the International Multi-Center Feasibility Trials EHRA/EAPCI expert consensus statement on catheter-based left atrial appendage occlusion – an update Percutaneous Closure of the Left Atrial Appendage Versus Warfarin Therapy for Prevention of Stroke in Patients With Atrial Fibrillation: A Randomised Non-Inferiority Trial Subclinical and Device-Detected Atrial Fibrillation: Pondering the Knowledge Gap: A Scientific Statement From the American Heart Association Atrial Fibrillation: JACC Council Perspectives 2020 ACC Expert Consensus Decision Pathway on Management of Bleeding in Patients on Oral Anticoagulants: A Report of the American College of Cardiology Solution Set Oversight Committee Percutaneous Left Atrial Appendage Closure for Stroke Prophylaxis in Patients With Atrial Fibrillation: 2.3-Year Follow-up of the PROTECT AF (Watchman Left Atrial Appendage System for Embolic Protection in Patients With Atrial Fibrillation) Trial

Clinical Case Study

JOURNAL:CBSMD Article Link

Clinical Case : Significant LM Diameter Mismatch Treated with IVUS-guidance

Bill Gogas, Fei Ye (syndicatedfeeds)

Pre-reading

Procedure

LTRA 6F JL4 GC w/ Seldinger technique.


Buddy wire technique to cross angulated ostium of LAD w/ Runthrough NS.


Following distal placement of BMW wire, Runtrhough NS was retrieved.


Sequential balloon dilatations w/ 2,5 NC Sprinter Legend from distal to proximal with increasing atmospheres from 10 to 18 was performed. IVUS indicated distal LAD w/ RVD of at least 2,5 mm and proximal LAD media to media diameter of 3,5 mm suggested by IVUS (BS, US) which equals (3,5 mm - 0,25 mm) to vessel diameter of 3,25 mm.


Distal LM PB: 45-50% while proximal LM: >55%.


Distal LAD was treated w/ a 2,5 x 35 DES and mid- to prox-LAD up to distal LM with 3.0 x 28 mm DES*.

*DES of 3.0 or 3.5 mm can be post-dilated up to 4.25 mm



Proximal LAD was post-dilated with 3.0 NC Sprinter balloon to reach expansion of 3,5 mm and LM was post-dilated with 4.0 NC balloon to reach diameter of 4.5 mm.


IVUS confirmed MSAs: LM > 11mm2 & LAD > 7 mm2.


Good angiographic result confirmed by IVUS optimal geometric indices post-stent deployments.



Case Presenter Bill Gogas, Interventional Cardiologist, Visiting Professor of Medicine (Cardiology) at Nanjing First Hospital, China

Case Performed in The Spencer B. King III Catheterization Laboratory

Mentors Spencer B. King III, Shao-liang Chen