An Unusual Case of Ischemic Stroke.

Abstract

Left atrial appendage closure (LAAC) represents an alternative to anticoagulation therapy for stroke prevention in selected patients with atrial fibrillation (AF). Mitral valve repair with the MitraClip system is nowadays a specific therapy for patients who are not eligible for surgery. G. G. 71 years old, F, admitted to the neurology ward of our hospital with a diagnosis of ischemic stroke. Recent discharge from the cardiology unit after mitral valve repair with the MitraClip system and LAAC with the Amplatzer device. A transoesophageal echocardiography (TEE) was performed. The TEE showed good position of the LAAC device with no leaks and the presence of a thrombotic formation (0.9 cm × 0.7 cm) on the atrial surface of the LAAC device [Figure 1a arrows and Video 1]. Anticoagulant therapy with LMWH 6000 UI X2 was started. A follow-up TEE was performed 1 month postdischarge, showing the complete resolution of the thrombotic formation [Figure 1b and Video 2]. LAAC is a safe and effective procedure with a low rate of complications. Device-related thrombosis occurred in a minority of cases (2.8%). Combined MitraClip and LAAC is deemed feasible and safe, even though there are no large specific trials on this topic. In our case, we assume that the rapid reduction in mitral regurgitation and the rapid increase of aortic valve gradient, even if of little entity, could have caused a prothrombotic state that has caused the LAA device thrombosis. a device-related thrombosis must be taken into account in patients presenting with ischemic stroke without a clear cause.