Cardioembolic Stroke Three Days Post-Video-Assisted Thoracoscopic AtriClip in a Patient With Paroxysmal Atrial Fibrillation

TL;DR

A patient had a stroke three days after an AtriClip procedure to manage atrial fibrillation, highlighting ongoing risks despite the device's intended protective effect.

Contribution

This case report highlights residual stroke risk after AtriClip use, urging further study on post-procedure cerebrovascular events.

Findings

A 62-year-old woman experienced a stroke three days after AtriClip placement for atrial fibrillation.

MRI showed acute infarcts in the cerebellum and cerebral hemispheres, indicating a cardioembolic event.

The case suggests that stroke risk persists even after left atrial appendage occlusion with the AtriClip.

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.

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