# Case report: three ways to mitigate the risk of embolization during left atrial appendage closure in a patient with a massive and proximal left atrial appendage thrombus

## TL;DR

This case report describes a safe left atrial appendage closure in a patient with a large blood clot, using careful planning and techniques to prevent complications.

## Contribution

The paper presents a novel approach combining pre-procedure planning and embolization prevention techniques for high-risk LAAC.

## Key findings

- A massive proximal thrombus was safely managed using CT scan and device modeling.
- Thrombus trapping techniques reduced the risk of embolization during the procedure.
- Precise transoesophageal echocardiography guidance ensured safe LAAC completion.

## Abstract

Left atrial appendage (LAA) thrombus is a contraindication for LAA closure (LAAC). However, in selected cases, oral anticoagulants are strictly contraindicated because of a history of life-threatening bleeding, and LAAC remains the only possible therapy to avoid systemic and especially cerebral embolization.

We report a case of LAAC despite a massive proximal thrombus in a patient who had an absolute contraindication to anticoagulant therapy, with thorough pre-planning using CT scan, device modelling and thrombus trapping techniques to reduce the risk of systemic embolic events and perform LAAC safely.

Although LAAC remains at high risk in this setting, the use of cautious techniques and tools, from pre-procedure planning to systemic embolization prevention systems associated to a precise transoesopheageal echocardiography guiding throughout the procedure, allows it to be performed as safely as possible when no other option is available.