Massive Device-Related Thrombus After LAA Occlusion: Intraoperative Insights Into Mechanism

Damir Vukomanovic; Samuel Unzek; Kashif Malik; Alicia Taase; Michael Zawaneh; Peter Weiss; Kenith Fang; Roderick Tung

doi:10.1016/j.jaccas.2022.07.037

Massive Device-Related Thrombus After LAA Occlusion: Intraoperative Insights Into Mechanism

JACC Case Rep. 2022 Nov 2;4(21):1409-1413. doi: 10.1016/j.jaccas.2022.07.037.

Authors

Damir Vukomanovic¹, Samuel Unzek², Kashif Malik³, Alicia Taase³, Michael Zawaneh², Peter Weiss², Kenith Fang⁴, Roderick Tung²

Affiliations

¹ Department of Internal Medicine, University of Arizona College of Medicine, Banner University Medical Center-Phoenix, Phoenix, Arizona, USA.
² Division of Cardiology, University of Arizona College of Medicine, Banner University Medical Center-Phoenix, Phoenix, Arizona, USA.
³ Department of General Surgery, University of Arizona College of Medicine, Banner University Medical Center-Phoenix, Phoenix, Arizona, USA.
⁴ Department of Cardiothoracic Surgery, Banner University Medical Center-Phoenix, Phoenix, Arizona, USA.

Abstract

In patients with a contraindication to oral anticoagulation, the left atrial appendage occlusion devices are an approved alternative. Device-related thrombus is a recognized complication, but underlying mechanisms are incompletely understood. In this case series, the authors describe potentially the same mechanism of thrombosis with intraoperative images of incomplete endothelialization. (Level of Difficulty: Intermediate.).

Keywords: AF, atrial fibrillation; DRT, device-related thrombus; INR, international normalized ratio; LAA, left atrial appendage; LAAO, left atrial appendage occlusion; TEE, transesophageal echocardiogram; Watchman; atrial fibrillation; device-related thrombus; left atrial appendage occlusion device.

Publication types

Case Reports