You are here

  • Home
  • Archive
  • Volume 96, Issue 6
  • Left atrial appendage occlusion in patients with atrial fibrillation and intracerebral haemorrhage associated with cerebral amyloid angiopathy: a multicentre observational study and pooled analysis of published studies

Article Text

Article menu
Download PDFPDF
Cerebrovascular disease
Systematic review
Left atrial appendage occlusion in patients with atrial fibrillation and intracerebral haemorrhage associated with cerebral amyloid angiopathy: a multicentre observational study and pooled analysis of published studies
  1. Kitti Thiankhaw1,2,
  2. Jonathan Best1,
  3. Sonal Srivastava1,
  4. Ishika Prachee3,
  5. Smriti Agarwal4,
  6. Serena Tan4,
  7. Patrick A Calvert5,6,
  8. Asim Chughtai5,
  9. Richard Ang3,
  10. Oliver R Segal3,
  11. David J Werring1
  1. 1 Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
  2. 2 Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand
  3. 3 Department of Cardiac Electrophysiology, Saint Bartholomew's Hospital Barts Heart Centre, London, UK
  4. 4 Department of Stroke Medicine, Clinical Neurosciences, Addenbrooke’s Hospital, Cambridge, UK
  5. 5 Department of Cardiology, Royal Papworth Hospital, Cambridge, UK
  6. 6 University of Cambridge, Cambridge, UK
  1. Correspondence to Dr David J Werring; d.werring{at}ucl.ac.uk

Abstract

Background Cerebral amyloid angiopathy (CAA) is a common cause of intracerebral haemorrhage (ICH) with a high recurrence risk. Left atrial appendage occlusion (LAAO) is a method for ischaemic stroke prevention in patients with atrial fibrillation (AF), potentially reducing the risk of intracranial bleeding in CAA-associated ICH. We aimed to determine the outcomes of patients with AF with CAA-associated ICH undergoing LAAO.

Methods We conducted a multicentre study of patients with CAA-associated ICH who underwent LAAO for stroke prevention. We pooled our findings with data from a systematic review of relevant published studies of LAAO for AF in ICH survivors reporting CAA diagnosis.

Results We included data from two published studies (n=65) with CAA-specific data and our cohort study (n=37), providing a total of 102 participants (mean age 76.2±8.0 years, 74.6% male) with CAA-related symptomatic ICH and AF treated with LAAO. The median follow-up period was 9.4 months (IQR 4.2–20.6). Postprocedural antithrombotic regimens varied between single (73.0%) or dual antiplatelet therapy (16.2%), or direct oral anticoagulant (DOAC) (10.8%), with a median duration of 42 days (IQR 35–74). Postprocedural complications were uncommon, but included transient arrhythmias (2.1%) and non-life-threatening tamponade (2.1%). Pooled incidence rates of ischaemic stroke and ICH during follow-up were 5.16 (95% CI 1.36 to 17.48) and 2.73 (95% CI 0.41 to 13.94) per 100 patient years, respectively.

Conclusions LAAO followed by short-term antithrombotic therapy might be a safe and effective ischaemic stroke preventive strategy in people with CAA-associated ICH and AF. However, randomised controlled trials are needed to determine how LAAO compares with long-term DOAC in this population.

PROSPERO registration number CRD42023415354.

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/jnnp-2024-334718

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

    View Full Text

    Footnotes

    • X @UCLStrokeRes

    • KT, JB and SS contributed equally.

    • Contributors Conceptualisation: KT, JB, SS and DJW. Data curation: KT, JB, SS, IP, SA, ST, PAC and AC. Formal analysis: KT, JB, SS, IP and DJW. Methodology: KT, JB, SS, IP, SA, PAC, RA, ORS and DJW. Supervision: RA, ORS and DJW. Visualisation: KT, JB, SS, IP, SA, and PAC. Writing – original draft: KT, JB and SS. Writing – review and editing: SA, PAC, ORS and DJW. DJW is the study guarantor. All authors read, critically revised, and approved the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.