Vij, VivianVivianVijCruz-González, IgnacioIgnacioCruz-GonzálezGalea, RobertoRobertoGaleaPiayda, KerstinKerstinPiaydaNelles, DominikDominikNellesVogt, LaraLaraVogtGloekler, SteffenSteffenGloeklerFürholz, MonikaMonikaFürholzMeier, BernhardBernhardMeierRäber, LorenzLorenzRäberO'Hara, GillesGillesO'HaraArzamendi, DabitDabitArzamendiAgudelo, VictorVictorAgudeloAsmarats, LluisLluisAsmaratsFreixa, XavierXavierFreixaFlores-Umanzor, EduardoEduardoFlores-UmanzorDe Backer, OleOleDe BackerSondergaard, LarsLarsSondergaardNombela-Franco, LuisLuisNombela-FrancoMcInerney, AngelaAngelaMcInerneySalinas, PabloPabloSalinasKorsholm, KasperKasperKorsholmNielsen-Kudsk, Jens ErikJens ErikNielsen-KudskAfzal, ShaziaShaziaAfzalZeus, TobiasTobiasZeusOperhalski, FelixFelixOperhalskiSchmidt, BorisBorisSchmidtMontalescot, GillesGillesMontalescotGuedeney, PaulPaulGuedeneyIriart, XavierXavierIriartMiton, NoelieNoelieMitonSaw, JacquelineJacquelineSawGilhofer, ThomasThomasGilhoferFauchier, LaurentLaurentFauchierVeliqi, EgzonEgzonVeliqiMeincke, FelixFelixMeinckePetri, NilsNilsPetriNordbeck, PeterPeterNordbeckGonzalez-Ferreiro, RocioRocioGonzalez-FerreiroBhatt, Deepak LDeepak LBhattLaricchia, AlessandraAlessandraLaricchiaMangieri, AntonioAntonioMangieriOmran, HeyderHeyderOmranSchrickel, Jan WilkoJan WilkoSchrickelRodes-Cabau, JosepJosepRodes-CabauNickenig, GeorgGeorgNickenigSievert, HorstHorstSievertSedaghat, AlexanderAlexanderSedaghat2024-10-262024-10-262023-12https://boris-portal.unibe.ch/handle/20.500.12422/172848BACKGROUND Device-related thrombus (DRT) after left atrial appendage closure (LAAC) is associated with adverse outcomes, i.e. ischemic stroke or systemic embolism (SE). Data on predictors of stroke/SE in the context of DRT are limited. AIMS This study aimed to identify predisposing factors for stroke/SE in DRT patients. In addition, the temporal connection of stroke/SE to DRT diagnosis was analyzed. METHODS The EUROC-DRT registry included 176 patients, in whom DRT after LAAC were diagnosed. Patients with symptomatic DRT, defined as stroke/SE in the context of DRT diagnosis, were compared against patients with non-symptomatic DRT. Baseline characteristics, anti-thrombotic regimens, device position, and timing of stroke/SE were compared. RESULTS Stroke/SE occurred in 25/176 (14.2%) patients diagnosed with DRT (symptomatic DRT). Stroke/SE occurred after a median of 198 days (IQR 37-558) after LAAC. In 45.8% stroke/SE occurred within one month before/after DRT diagnosis (DRT-related stroke). Patients with symptomatic DRT had lower left ventricular ejection fractions (50.0 ± 9.1% vs. 54.2 ± 11.0%, p = 0.03) and higher rates of non-paroxysmal atrial fibrillation (84.0% vs. 64.9%, p = 0.06). Other baseline parameters and device positions were not different. Most ischemic events occurred among patients with single antiplatelet therapy (50%), however, stroke/SE was also observed under dual antiplatelet therapy (25%) or oral anticoagulation (20%). CONCLUSION Stroke/SE are documented in 14.2% and occur both in close temporal relation to the DRT finding and chronologically independently therefrom. Identification of risk factors remains cumbersome, putting all DRT patients at substantial risk for stroke/SE. Further studies are necessary to minimize the risk of DRT and ischemic events.enAtrial fibrillation Device-related thrombus Left atrial appendage closure Stroke600 - Technology::610 - Medicine & healtharticle10.48350/1909153729431110.1007/s00392-023-02237-w