Mechanical thrombus aspiration as a bailout strategy for device related thrombus after LAAC
V La Fazia, M Marino, E Chiarazzo, C Gianni, S Mohanty, G Stifano, W Bode, K Awad, J Gallinghause, D Burkardt, R P Horton, A Al-Ahmad, L Di Biase, A NataleAbstract
Background
Despite technological advances, device related thrombus (DRT) after left atrial appendage closure (LAAC) remains a concern.
Purpose
To assess safety and efficacy of a novel mechanical thrombus aspiration (MTA) system
Methods
7(mean age 76±11years, 4 males) consecutive patients underwent MTA with Flowrunner 14Fr-100cm catheter, guided by both transesophageal (TEE) and intracardiac echocardiography, were included in this analysis. All patients underwent thromboembolic protection using a modified Watchman device deployed in the ascending aorta. The appropriate device size was chosen according to the corresponding diameter of the ascending aorta.
The system consisted of a dual-catheter design with a distal valve, where the inner catheter rapidly advanced and retracted to aspirate and fragment the thrombus, while the valve prevented blood ingress and minimized blood loss through saline flushing.
Results
Mean CHADS2VA was 5±1. Mean time from LAAC implantation was 16±8months. 6 patients had a WatchmanFLX and 1 patient an Amulet. All patients were receiving aspirin at the time the clot was detected. Mean clot size was 13±4 x 19±6 mm. Total aspiration time was 9±3 minutes. Blood loss was 70±15 cc. No residual thrombus was seen on the LAAC device at the end of the procedure. When removing the modified watchman from the aorta no clot was found on the device. No patients experienced neurological symptoms after the procedure, and all were discharged on a half-dose oral anticoagulation regimen. At the TEE follow-up after 63±16 days no DRT was found on the device.
Conclusion
MTA was safe, effective, and achieved complete thrombus removal.