Kitti Thiankhaw, Jonathan Best, Sonal Srivastava, Ishika Prachee, Smriti Agarwal, Serena Tan, Patrick A Calvert, Asim Chughtai, Richard Ang, Oliver R Segal, David J Werring
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We pooled our findings with data from a systematic review of relevant published studies of LAAO for AF in ICH survivors reporting CAA diagnosis.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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. 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引用次数: 0
摘要
背景：脑淀粉样血管病（CAA）是脑出血（ICH）的常见原因，具有高复发风险。左心耳闭塞术（LAAO）是房颤（AF）患者缺血性卒中预防的一种方法，可能降低房颤相关性脑出血患者颅内出血的风险。我们的目的是确定房颤合并caa相关性脑出血患者行LAAO的结果。方法：我们进行了一项多中心研究，对caa相关性脑出血患者进行LAAO预防卒中。我们将研究结果与相关已发表的LAAO治疗报告CAA诊断的脑出血幸存者房颤的研究数据进行了系统回顾。结果：我们纳入了两项已发表的caa特异性研究（n=65）和我们的队列研究（n=37）的数据，共提供了102名患者（平均年龄76.2±8.0岁，74.6%男性），这些患者与caa相关的症状性脑出血和房颤接受LAAO治疗。中位随访时间为9.4个月（IQR 4.2-20.6）。术后抗血栓治疗方案在单一（73.0%）或双重抗血小板治疗（16.2%）或直接口服抗凝剂（DOAC）（10.8%）之间变化，中位持续时间为42天（IQR 35-74）。术后并发症不常见，但包括短暂性心律失常（2.1%）和非危及生命的填塞（2.1%）。随访期间缺血性卒中和脑出血的合并发病率分别为5.16 （95% CI 1.36 ~ 17.48）和2.73 (95% CI 0.41 ~ 13.94) / 100患者年。结论：LAAO与短期抗栓治疗可能是caa相关性脑出血和房颤患者安全有效的缺血性卒中预防策略。然而，需要随机对照试验来确定LAAO与长期DOAC在该人群中的比较。普洛斯彼罗注册号：CRD42023415354。
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.
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.
期刊介绍：
The Journal of Neurology, Neurosurgery & Psychiatry (JNNP) aspires to publish groundbreaking and cutting-edge research worldwide. Covering the entire spectrum of neurological sciences, the journal focuses on common disorders like stroke, multiple sclerosis, Parkinson’s disease, epilepsy, peripheral neuropathy, subarachnoid haemorrhage, and neuropsychiatry, while also addressing complex challenges such as ALS. With early online publication, regular podcasts, and an extensive archive collection boasting the longest half-life in clinical neuroscience journals, JNNP aims to be a trailblazer in the field.
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