First Experience of Transcatheter Leak Occlusion With Detachable Coils Following Left Atrial Appendage Closure

Domenico G. Della Rocca, Rodney P. Horton, Luigi Di Biase, Mohamed Bassiouny, Amin Al-Ahmad, Sanghamitra Mohanty, Alessio Gasperetti, Veronica N. Natale, Chintan Trivedi, Carola Gianni, J. David Burkhardt, G. Joseph Gallinghouse, Patrick Hranitzky, Javier E. Sanchez, Andrea Natale

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Abstract

Objectives: The aim of this study was to assess the feasibility and efficacy of transcatheter leak closure with detachable coils in patients with incomplete left atrial appendage (LAA) closure. Background: Incomplete LAA closure is common after interventional therapies targeting the LAA, potentially hindering effective thromboembolic prevention. Detachable coils have found a wide range of applications for transcatheter vascular occlusion and embolization procedures. Methods: Thirty consecutive patients at high thromboembolic risk with clinically relevant residual leaks (mean age 72 ± 9 years, 73.3% men, mean CHA2DS2-VASc score 4.4 ± 1.4, mean HAS-BLED score 3.6 ± 0.8) underwent percutaneous closure of the LAA patency using embolization coils. Transesophageal echocardiography was performed at 60 ± 15 days post-procedure. Results: LAA closure had been previously attempted with the Watchman device in 25 patients, the Amulet device in 2 patients, and the LARIAT device in 3 patients. Baseline transesophageal echocardiography documented moderate and severe leaks in 20 (66.7%) and 10 (33.3%) patients, respectively. After a single procedure, 25 patients (83.3%) showed complete LAA sealing or minimal leaks. Five patients (16.7%) had moderate residual leaks; 3 patients of them were offered repeat procedures. Mean procedure and fluoroscopy times were 76 ± 41 min and 21 ± 14 min, respectively; the mean volume of iodinated contrast medium used was 80 ± 47 ml. Coil deployment was successful in all cases. The overall complication rate was 6.1%. After a median follow-up period of 54 days (range 43 to 265 days) and an average of 1.1 procedures/patient, transesophageal echocardiography revealed complete LAA sealing or negligible residual leaks in 28 patients (93.3%; 25 with no residual leak, 3 patients with minimal to mild residual leaks) and moderate residual leaks in 2 patients (6.7%). Conclusions: Transcatheter LAA leak occlusion using endovascular coils appears to be a safe, effective, and promising approach in patients at high echo time risk with incomplete LAA closure. (Transcatheter Leak Closure With Detachable Coils Following Incomplete Left Atrial Appendage Closure Procedures [TREASURE]; NCT03503253)

Original languageEnglish (US)
Pages (from-to)306-319
Number of pages14
JournalJACC: Cardiovascular Interventions
Volume13
Issue number3
DOIs
StatePublished - Feb 10 2020

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Keywords

  • atrial fibrillation
  • coil
  • leak
  • left atrial appendage
  • stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Della Rocca, D. G., Horton, R. P., Di Biase, L., Bassiouny, M., Al-Ahmad, A., Mohanty, S., Gasperetti, A., Natale, V. N., Trivedi, C., Gianni, C., Burkhardt, J. D., Gallinghouse, G. J., Hranitzky, P., Sanchez, J. E., & Natale, A. (2020). First Experience of Transcatheter Leak Occlusion With Detachable Coils Following Left Atrial Appendage Closure. JACC: Cardiovascular Interventions, 13(3), 306-319. https://doi.org/10.1016/j.jcin.2019.10.022