Percutaneous Aspiration Thrombectomy in Patients With Persistent Left Atrial Appendage Thrombus: A Case Series.

Background: Persistent left atrial appendage (LAA) thrombosis in patents with contraindications or who are refractory to intensive antithrombotic therapy remains a clinical challenge. Although LAA closure with limited manipulation is performed in patients with small distal nonmobile thrombi, larger more proximal mobile thrombi are usually deemed a contraindication to percutaneous LAA closure due to the inherent risk of iatrogenic thromboembolism. In this population, percutaneous aspiration thrombectomy (AT) is a potential treatment modality.

Objectives: In this study the authors describe their experience with percutaneous AT.

Methods: This was a 4-center case series of 22 consecutive patients who underwent percutaneous LAA AT before closure for the presence of a persistent LAA thrombus. Large-bore (≥12-F) AT was performed either manually (n = 16 [a 60-mL syringe was used in 14 patients and AlphaVac System in 2 patients]) or mechanically using the pump-assisted Indigo system (n = 6).

Results: Percutaneous AT was technically successful in all patients, achieving evacuation of the LAA thrombus and allowing subsequent LAA closure with either a Watchman (n = 21) or Lariat (n = 1) device without AT-related complications.

Conclusions: Percutaneous AT followed by LAA closure is safe and feasible when performed by experienced operators proficient in left atrial interventional procedures. It may offer an alternative to surgery in patients with a proximally located persistent LAA thrombus.