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202 an attempt was made to dissolve the thrombus with the use of anticoagulants or low ‐molecular‐ ‐weight heparin. In the remaining patients, such an attempt was not made owing to absolute con‐ traindications to this therapy. Initially, aortog‐ raphy was performed via the radial approach to visualize the aortic arch and the anatomy of the carotid arteries. The aortic arch type was de‐ termined based on the brachiocephalic trunk di‐ ameter and the distance between it and the top of the aortic arch. For type I aortic arch, that dis‐ tance was shorter than 1 width of the brachio‐ cephalic trunk. If the distance ranged between 1 and 2 diameters of the brachiocephalic trunk, it indicated a type II aortic arch, and if the dis‐ tance was greater than 2 diameters of the bra‐ chiocephalic trunk, the aortic arch was denot‐ ed as type III.1 In the next step, the Sentinel CPS was intro‐ duced. Its proximal filter was deployed in the bra‐ chiocephalic trunk, whereupon the distal filter was opened in the left common carotid artery. Angiography of the LAA was abandoned to re‐ duce the risk of thrombus release. All procedures were conducted using the Amplatzer Amulet oc‐ cluder (St. Jude Medical, Minneapolis, Minneso‐ ta, United States), which does not require deep catheter placement in the LAA. The Sentinel CPS filters were removed directly after Amplatzer Am‐ ulet occluder implantation, flushed with saline, and visually evaluated for the presence of embol‐ ic material. After the procedure, the patients re‐ mained on dual antiplatelet therapy for 6 weeks. During the follow ‐up examination, the patients were evaluated for neurological deficiencies; ad‐ ditionally, TEE was repeated. Introduction Percutaneous left atrial appendage closure (LAAC) is an option for stroke preven‐ tion in patients with atrial fibrillation who are not good candidates for long ‐term oral anticoag‐ ulation or those in whom antithrombotic treat‐ ment is contraindicated. Excluding the presence of a thrombus in the left atrium is a mandatory step of this procedure, since stroke is one of the most severe complications during LAAC. Periprocedural stroke may also be potentially avoided by taking advantage of cerebral protection systems (CPSs). The main purpose of using CPSs is to apply a me‐ chanical measure to reduce the risk of stroke as‐ sociated with intraprocedural transcatheter aor‐ tic implantation, but the use of CPSs may increase the safety of LAAC procedures and makes it po‐ tentially suitable for patients with a clot within the left atrium. Here, we report a series of LAAC procedures using Sentinel CPSs in patients with a thrombus in the left atrial appendage (LAA). The course of procedures, factors determining the efficacy of neuroprotection, and short ‐term follow ‐up outcomes were also analyzed.

polskie archiwum medycyny wewnętrznej

Rationale for cerebral protection in patients with left atrial appendage thrombus during percutaneous left atrial appendage closure: a single-center initial experience