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Catheter Cardiovasc Interv ; 92(2): 327-333, 2018 08 01.
Article in English | MEDLINE | ID: mdl-29737618

ABSTRACT

BACKGROUND: Left atrial appendage closure (LAAC) for stroke prevention is an increasingly performed intervention. AIMS: This prospective study aims to evaluate the incidence of long-term magnetic resonance imaging (MRI)-detected brain lesions as well as potential changes of neurocognitive function after percutaneous LAAC. METHODS: Brain MRI at 3 T was performed within 24 hr before and after LAAC. A follow-up MRI was carried out after three months. Neuro-cognitive examination using the National Institutes of Health Stroke Scale (NIHSS) score and the Montreal Cognitive Assessment (MoCA) Test was performed. RESULTS: Successful device implantation was achieved in all 25 patients (age 74.6 ± 10.2 years, male = 17) using the Amulet (n = 20), Occlutech (n = 3), or a Lambre (n = 2) device. In 12/25 (48%) patients, acute brain lesions (ABL) were detected after LAAC. A three-month follow-up MRI was performed in seven patients, and no new ABLs were seen. In 5/7 (71%) patients, there were no residual changes from the ABLs detectable. However, the FLAIR sequence was still positive in two patients. After LAAC, there were no significant differences in the MoCA-test (mean 24.3 ± 4.5 vs. 23.5 ± 4.5; P = 0.1) and the NIHSS-score (mean 0.9 ± 1.6 vs. 1.2 ± 1.8; P = 0.1). This was the same at the three-month follow-up (MoCA-test 23.5 ± 4.5 vs. 23.8 ± 2.7; P = 0.3; NIHSS-score 1.2 ± 1.8 vs. 1.0 ± 0.8; P = 0.4). CONCLUSION: While new MRI-detected brain lesions are commonly observed after percutaneous LAAC, ABLs were no longer detectable in 71% of the patients at the three-month follow-up. There were no significant changes in neurocognitive function after LAAC and at the three-month follow-up.


Subject(s)
Atrial Appendage , Atrial Fibrillation/therapy , Brain/diagnostic imaging , Cardiac Catheterization , Cerebrovascular Disorders/diagnostic imaging , Diffusion Magnetic Resonance Imaging , Aged , Aged, 80 and over , Atrial Appendage/diagnostic imaging , Atrial Fibrillation/complications , Atrial Fibrillation/diagnostic imaging , Brain/physiopathology , Cardiac Catheterization/adverse effects , Cardiac Catheterization/instrumentation , Cerebrovascular Disorders/etiology , Cerebrovascular Disorders/physiopathology , Cerebrovascular Disorders/psychology , Cognition , Echocardiography, Transesophageal , Female , Humans , Male , Middle Aged , Neuropsychological Tests , Pilot Projects , Predictive Value of Tests , Prospective Studies , Risk Factors , Time Factors , Treatment Outcome
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