Evidence map›Paper›PMID 40985135›Full record

Observational studyEuropean journal of neurology2025

Percutaneous Left Atrial Appendage Closure in Patients With Cardioembolic Breakthrough Stroke: An International Observational Study.

Roberto Galea, Gavino Casu, Tommaso Bini, Angelo Laconi, Pier Luigi Merella, Konstantina Chalkou, Alberto Preda, Marco Cerciello, Giuseppe D'Angelo, Paolo Della Bella and 6 more

Abstract readObservational StudyMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in European journal of neurology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Review
  2. Article
  3. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors.

Roberto GaleaDepartment of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.
Gavino CasuClinical and Interventional Cardiology, University of Sassari, Sassari, Italy.
Tommaso BiniDepartment of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.
Angelo LaconiClinical and Interventional Cardiology, University of Sassari, Sassari, Italy.
Pier Luigi MerellaClinical and Interventional Cardiology, University of Sassari, Sassari, Italy.ORCID 0000-0001-6758-0343
Konstantina ChalkouDepartment of Clinical Research, University of Bern, Bern, Switzerland.
Alberto PredaElectrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy.
Marco CercielloDepartment of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele University Hospital, Milan, Italy.
Giuseppe D'AngeloDepartment of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele University Hospital, Milan, Italy.ORCID 0000-0002-1198-9745
Paolo Della BellaDepartment of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele University Hospital, Milan, Italy.
Patrizio MazzoneElectrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy.
Elias AuerGraduate School for Health Sciences, University of Bern, Bern, Switzerland.
Antanas GasysDepartment of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.
David Julian SeiffgeDepartment of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland.
Urs FischerDepartment of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland.
Lorenz RäberDepartment of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPatients with non-valvular atrial fibrillation (AF) who experience an ischemic stroke despite oral anticoagulation (OAC) are at particularly high risk of recurrence, with a reported annualized ischemic stroke rate of 5.3%-8.9%. The optimal strategy for secondary prevention in these patients remains unknown.

methodsWe reviewed all percutaneous left atrial appendage closures (LAAC) attempted in AF patients experiencing an ischemic stroke under OAC and who were prospectively collected in four European centers. All index strokes were categorized by an experienced neurologist to exclude patients with non-cardioembolic etiology or insufficient OAC. The primary endpoint was a recurrent ischemic stroke at 2 years after the procedure. Secondary endpoints included procedure-related complications and 2-year death.

resultsOf 2234 patients submitted to LAAC procedure, 95 had a cardioembolic breakthrough stroke. LAAC procedures were performed at a mean of 4 months after the breakthrough stroke. The main antithrombotic therapy at discharge (83%) and at the latest follow-up (79%) consisted of OAC. At the median follow-up of 713 days, the primary endpoint occurred in 4 patients (4%). Procedure-related complications were rare (1%) whereas death occurred in 5% of patients.

conclusionLAAC procedures were safe and feasible in patients with cardioembolic breakthrough stroke. Recurrent stroke rates were lower than those reported in previous studies with OAC continuation after breakthrough stroke, suggesting a potential additive protection by LAAC on top of OAC. Results from ongoing randomized trials are required to validate our findings.

Indexed as

Atrial AppendageAtrial FibrillationEmbolic StrokeIschemic StrokeStrokeAgedAged, 80 and overAnticoagulantsFemaleHumansLeft Atrial Appendage ClosureMaleMiddle AgedProspective StudiesRecurrenceSecondary PreventionAnticoagulantsatrial fibrillationbreakthrough strokeleft atrial appendage closureoral anticoagulationstroke

Identifiers

PMID40985135
PMCPMC12455140

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.