TY - JOUR
T1 - Cardiac Computed Tomography Angiography for Device-Related Thrombus Assessment After WATCHMAN FLX™ Occluder Device Implantation
T2 - A Single-Center Retrospective Observational Study
AU - Miller, Tyler
AU - Hana, David
AU - Patibandla, Saikrishna
AU - Guzman, Daniel Brito
AU - Avalon, Juan Carlo
AU - Zeb, Irfan
AU - Kadiyala, Madhavi
AU - Mills, Jim
AU - Balla, Sudarshan
AU - Kim, Cathy
AU - Lisle, Mark
AU - Kawsara, Mohammad
AU - Raybuck, Bryan
AU - Daggubati, Ramesh
AU - Sengupta, Partho P.
AU - Hamirani, Yasmin S.
N1 - Publisher Copyright:
© 2022
PY - 2022/8
Y1 - 2022/8
N2 - Background/purpose: Device-related thrombosis (DRT) is one of the greatest challenges of transcatheter left atrial appendage device occlusion. Due to the invasive nature of transesophageal echocardiography (TEE), cardiac computed tomography angiography (CCTA) is being increasingly utilized in several centers for assessing adequate left atrial appendage closure and monitoring for DRT. There is a paucity of data regarding the standardized definition of DRT on CCTA for the WATCHMAN FLX™ device. Methods/materials: A retrospective review was conducted on 43 patients receiving WATCHMAN FLX™ device implantation with CCTA performed at the first follow-up at our institution. A comparative review of DRT predictors was performed on 10 patients who had both CCTA and TEE at the time of follow-up. Results: Hypoattenuated thickening (HAT) was a common finding on CCTA and was noted to be present in 95.35% of the patients. The combination of a large device size, peridevice gap >4 mm, and HAT located on the device gutter and 1 shoulder were characteristics present on CCTA observed in 2 patients with confirmed DRT on TEE. Conclusion: CCTA is a noninvasive imaging modality for DRT monitoring, with guidelines still in development. We report potential predictors of DRT on CCTA. Additional studies are needed to further determine standardized parameters for DRT detection on CCTA and the significance of HAT with multimodality correlation.
AB - Background/purpose: Device-related thrombosis (DRT) is one of the greatest challenges of transcatheter left atrial appendage device occlusion. Due to the invasive nature of transesophageal echocardiography (TEE), cardiac computed tomography angiography (CCTA) is being increasingly utilized in several centers for assessing adequate left atrial appendage closure and monitoring for DRT. There is a paucity of data regarding the standardized definition of DRT on CCTA for the WATCHMAN FLX™ device. Methods/materials: A retrospective review was conducted on 43 patients receiving WATCHMAN FLX™ device implantation with CCTA performed at the first follow-up at our institution. A comparative review of DRT predictors was performed on 10 patients who had both CCTA and TEE at the time of follow-up. Results: Hypoattenuated thickening (HAT) was a common finding on CCTA and was noted to be present in 95.35% of the patients. The combination of a large device size, peridevice gap >4 mm, and HAT located on the device gutter and 1 shoulder were characteristics present on CCTA observed in 2 patients with confirmed DRT on TEE. Conclusion: CCTA is a noninvasive imaging modality for DRT monitoring, with guidelines still in development. We report potential predictors of DRT on CCTA. Additional studies are needed to further determine standardized parameters for DRT detection on CCTA and the significance of HAT with multimodality correlation.
KW - Cardiac computed tomography angiography
KW - Device related thrombosis
KW - Left atrial appendage occlusion
KW - WATCHMAN FLX™
UR - http://www.scopus.com/inward/record.url?scp=85124148615&partnerID=8YFLogxK
U2 - 10.1016/j.carrev.2022.01.028
DO - 10.1016/j.carrev.2022.01.028
M3 - Article
C2 - 35140053
AN - SCOPUS:85124148615
SN - 1553-8389
VL - 41
SP - 35
EP - 46
JO - Cardiovascular Revascularization Medicine
JF - Cardiovascular Revascularization Medicine
ER -