Editorial commentary: Percutaneous left atrial appendage closure for stroke prevention☆

摘要: “The left atrial appendage: our most lethal human attachment... Johnson WD et al.” The appendage (LAA) was recognized as a potential harbinger of thrombus with thromboembolic risks since the 1940s, and first surgical excision LAA reported by Madden in 1949 [1]. In setting fibrillation (AF), undergoes remodeling resulting larger luminal surface area, smoother endocardial surface, higher fibroelastosis, which together Virchow triad events can contribute to formation [2,3]. Indeed, transesophageal echocardiography (TEE) studies that 91% thrombi non-valvular AF were located [4]. These no doubt implicated etiology for majority cardioembolic strokes AF. stroke-risk is increased on average 5-fold, incremental be estimated validated modern risk-scores like CHADS2 or CHA2DS2-VASc scores. However, despite multinational guidelines endorse utility these scores recommend oral anticoagulation (OAC), approximately 40% patients at high remain unanticoagulated because contraindications intolerance OAC [5]. Thus, alternative strategies especially local targeted therapy exclude/ excise source has been explored over half century ago. closure achieved an open-surgical percutaneous fashion; performed via endovascular epicardial approach.