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Incidence and Predictors of Hypoattenuated Thickening and Device‐Related Thrombus at Three Months Postprocedural CT Assessment Following Left Atrial Appendage Occlusion With Amplatzer Devices—A Single‐Center Cohort

Year: 2025

Type: article

Abstract: BACKGROUND: Left atrial appendage occlusion (LAAO) has become a valuable alternative to long-term anticoagulation for stroke prevention in patients with non-valvular atrial fibrillation (AF), especially in those at high bleeding risk. Hypoattenuated thickening (HAT) and device-related thrombus (DRT) remain notable postprocedural concerns. Identifying reliable predictors is essential to optimize post-LAAO management. AIMS: The aim of this study was to assess the incidence of HAT and DRT at 3 months following percutaneous LAAO and to identify clinical, anatomical, and procedural predictors-based on CT imaging evaluation-that may guide optimization of postprocedural antithrombotic strategies. METHODS: We conducted a retrospective single-center study including adult patients who underwent percutaneous LAAO with Amplatzer Amulet or ACP devices at Dijon University Hospital between April 2016 and May 2024, with available pre- and 3-month postprocedural CT scans. Baseline clinical, echocardiographic, biological, procedural, and anatomical data were collected. The primary objective was to determine the incidence and predictors of HAT and DRT at 3 months. RESULTS: Among 102 patients (mean age 76 ± 7 years, mean CHADS-VASc 4.4 ± 1.4), HAT was observed in 25 (24%), and DRT in 3 (2.9%). Female sex and prior stroke/TIA were significantly associated with HAT occurrence. Importantly, patients discharged on dual antiplatelet therapy (DAPT) demonstrated a markedly lower incidence of HAT/DRT, suggesting a protective effect. In contrast, no anatomical parameter, including the Cressa classification, predicted thrombotic events. While Cressa morphology correlated with procedural complexity, it had no value for thrombotic risk stratification. CONCLUSIONS: This study highlights the absence of anatomical predictors of HAT/DRT, emphasizing instead clinical determinants and the protective role of DAPT. These findings support tailoring antithrombotic therapy after LAAO according to individual clinical risk profiles, particularly in patients with prior stroke/TIA or women, who may benefit from reinforced preventive strategies. Larger multicenter studies are needed to refine postprocedural management algorithms and improve risk stratification beyond anatomical assessment.

Source: Catheterization and Cardiovascular Interventions

DOI: 10.1002/ccd.70421