PDF(Pubmed)
Abstract：
Atrial fibrillation is a global epidemic due to aging and chronic diseases. Treatment options are expanding to prevent thromboembolism in anticoagulant-ineligible patients. The left atrial appendage, implicated in 90% of embolic strokes, is increasingly managed with occlusion devices like the AtriClip. A 62-year-old woman with prior stroke, severe gastrointestinal bleeding on anticoagulation, and paroxysmal atrial fibrillation experienced sudden left-sided weakness and altered mental status three days post-AtriClip procedure. Brain MRI revealed acute infarcts in the right cerebellum and scattered punctate infarcts in both cerebral hemispheres. No further invasive investigations or interventions were recommended, as they would not influence management. Left-sided weakness improved, and the patient was discharged to a subacute rehabilitation center. Despite the AtriClip\'s ability to lower stroke incidence by occluding the left atrial appendage, there remains a residual risk of cerebrovascular events that can significantly impact morbidity and mortality. This case underscores persistent risks despite complete appendage closure, emphasizing the need for broader studies on post-AtriClip stroke risk.
摘要：
心房颤动是由于衰老和慢性疾病引起的全球性流行病。治疗方案正在扩大，以预防抗凝剂不合格患者的血栓栓塞。左心耳,与90%的栓塞性中风有关,越来越多地使用像AtriClip这样的闭塞装置进行管理。一名62岁的女性，之前有中风，严重的胃肠道出血抗凝，阵发性心房颤动在AtriClip手术后三天出现突然的左侧无力和精神状态改变。脑MRI显示右小脑急性梗塞和两个大脑半球分散的点状梗塞。没有建议进一步的侵入性调查或干预措施，因为他们不会影响管理。左侧无力改善，病人出院到亚急性康复中心。尽管AtriClip能够通过封堵左心耳来降低中风发生率,脑血管事件的残余风险仍可显著影响发病率和死亡率.尽管附肢完全闭合，但该病例强调了持续的风险，强调需要对AtriClip后卒中风险进行更广泛的研究。
