PT  - JOURNAL ARTICLE
AU  - Thiankhaw, Kitti
AU  - Best, Jonathan
AU  - Srivastava, Sonal
AU  - Prachee, Ishika
AU  - Agarwal, Smriti
AU  - Tan, Serena
AU  - Calvert, Patrick A
AU  - Chughtai, Asim
AU  - Ang, Richard
AU  - Segal, Oliver R
AU  - Werring, David J
TI  - 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
AID  - 10.1136/jnnp-2024-334718
DP  - 2025 Jun 01
TA  - Journal of Neurology, Neurosurgery & Psychiatry
PG  - 528--536
VI  - 96
IP  - 6
4099  - http://jnnp.bmj.com/content/96/6/528.short
4100  - http://jnnp.bmj.com/content/96/6/528.full
SO  - J Neurol Neurosurg Psychiatry2025 Jun 01; 96
AB  - 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.All data relevant to the study are included in the article or uploaded as supplementary information.