623 PERCUTANEOUS LEFT ATRIAL APPENDAGE CLOSURE AND TRANSCATHETER CEREBRAL EMBOLIC PROTECTION: TWO CASES REPORT

Abstract Introduction Percutaneous left atrial appendage closure (LAAC) in AF patients is not inferior to oral anticoagulation (OAC) terms of systemic embolism. LAA Closure usually contraindicated presence intracardiac thrombus, a condition far from uncommon. The feasibility and safety transcatheter cerebral embolic protection (TCEP) has been reported literature as successful off – label option retrieving debris during percutaneous LAAC. We present two cases Watchman Flex insertion the setting thrombus prophylactic use TCEP. Cases report first patient was an 88-year-old male with history symptomatic post traumatic bleeding, who referred LAAC because high risk bleeding using OAC. Transthoracic echocardiography (TTE) documented severely dilatated preserved ventricular systolic function. Transesophageal (TEE) revealed “chicken wing” shaped spontaneous echo-contrast sludge effect confirmed medium “SonoVue”. ECG gated cardiac CT (CCT) showed filling defect diagnosis thrombus. second 75-year-old man valvular permanent multiple ischemic strokes despite OAC therapy Warfarin. TTE dilated ventricle depressed ejection fraction; TEE “windstock” incompletely distal opacification Both were candidate concomitant CEPDs event neurological complication. TriGUARD 3 (TG3, Keystone Heart) deployed aortic arch through right femoral artery access before procedure. Following transseptal puncture device (Boston Scientific, Marlborough, MA) without complications or residual peri-device leaks. At end TriGurad retracted no noted at operatory inspection. discharged afterward daily acetylsalicylic acid 100 mg Clopidogrel 75 underwent follow-up four weeks. Neither related nor thrombotic/hemorrhagic adverse events have so far. Discussion very for stroke bleeding. They theoretically TCEP (including TG3) small retrospective study by Tarantini et al. some case series. Procedures always uneventful. Moreover, captured on visual examination proved its efficacy. mentioned even Beneduce safer more feasible strategy patients. Conclusion Prophylactic implantation safe feasible.