SHM Converge Scientific Abstract ePoster Gallery-Rare Case of Embolic Strokes Due to Watchman Device Thrombosis

Pdf Summary

This case report describes a 76-year-old man with atrial fibrillation, coronary artery disease, and COPD who had received a WATCHMAN left atrial appendage closure device three years earlier. He presented with one day of altered mental status, generalized weakness, and dysarthria. Neurologic examination showed intermittent confusion and dysarthria without other focal deficits. Laboratory testing was unrevealing, and a non-contrast CT scan of the brain showed no acute abnormality.<br /><br />MRI of the brain, however, revealed multiple acute to subacute ischemic infarcts in the right parieto-occipital junction, left occipital lobe, and left frontal deep white matter, suggesting embolic stroke. A transesophageal echocardiogram (TEE) subsequently demonstrated a large thrombus attached to the WATCHMAN device, identifying the likely source of emboli.<br /><br />The patient was treated with heparin infusion and later transitioned to apixaban. The device was not removed, and the team planned continued medical management of both the thrombus and the strokes. His mental status and dysarthria improved during hospitalization.<br /><br />The report emphasizes that although WATCHMAN devices are used to reduce thromboembolic risk in patients with non-valvular atrial fibrillation who cannot take long-term anticoagulation, device-related thrombus can still occur. Thrombus formation is usually seen within the first year after implantation but may also present years later. Reported incidence ranges from 3.7% to 6.6%, and TEE is the preferred diagnostic test. Risk factors include permanent atrial fibrillation, vascular disease, prior stroke, and low ejection fraction. Management generally involves anticoagulation, but there are no standardized guidelines for optimal treatment duration or for device removal after thrombus formation.<br /><br />The authors conclude that clinicians should consider WATCHMAN device thrombosis in patients presenting with embolic stroke symptoms.

Asset Subtitle

Sharnjyot Wander

Meta Tag

Author List Ayse Durgun, Benjamin Ossai, Bhargava Pulipati, Hugh Xian, Jonathan London, Jonathan Ma, Sharnjyot Wander

Category Clinical Vignettes

Concept Watchman Device

Concept Device thrombosis

Concept Left Atrial Appendage Closure

Concept Thromboembolism

Concept Embolic Stroke

Distinguished Non-Finalist

Presenter Organization Long Island Community Hospital

Presenting Author Sharnjyot Wander

Track Adult

Keywords

WATCHMAN device thrombosis

atrial fibrillation

embolic stroke

left atrial appendage closure

transesophageal echocardiogram

device-related thrombus

ischemic infarcts

apixaban

heparin infusion

altered mental status

Watchman Device

Device thrombosis

Left Atrial Appendage Closure

Thromboembolism

Embolic Stroke