Stroke After Surgical Left Atrial Appendage Clip With Residual Neck Thrombus: Transcatheter Plug Closure.

Authors

Charbel Noujaim, Karen Jabbour, Mohammad Abbasi, Rhonda L Miyasaka, Bo Xu, Pasquale Santangeli, Wael A Jaber, Mohamed H Kanj

Published in

JACC. Case reports. Pages 110558. Sep 30, 2026. Epub Sep 30, 2026.

Abstract

Incomplete left atrial appendage clip closure is a recognized complication and may increase thromboembolic risk.
A 72-year-old woman with persistent atrial fibrillation presented with a left middle cerebral artery stroke while on apixaban. History included mitral valve repair with epicardial left atrial appendage clip and AV-junction ablation with a leadless pacemaker. Local transesophageal echocardiogram (TEE) reported complete ligation without thrombus; cardiac computed tomography at our institution demonstrated incomplete ligation with a narrow residual ostium and an 11 × 6 mm thrombus. With Sentinel cerebral embolic protection, intraprocedural TEE identified a 6 × 5 mm residual communication. Single transseptal access (Agilis sheath, VersaCross RF wire) permitted traversal of the neck; a 12-mm Amplatzer Vascular Plug II was implanted. TEE and angiography confirmed complete seal; recovery was uneventful.
Computed tomography and TEE should confirm exclusion before stopping anticoagulation after clip ligation. Plug occlusion performed with cerebral embolic protection can convert incomplete surgical exclusion to complete closure.

PMID:
42814047
Bibliographic data and abstract were imported from PubMed on 30 Sep 2026.

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