A 79-year-old patient was subject, for the first time at Hospital da Luz, to a left atrial appendage percutaneous closure, resorting to a nitinol device, for stroke prevention (cerebrovascular accident). This is an innovating treatment , expanding in Europe and in the USA, that represents an alternative to anticoagulant medicines, where it is required to prevent thromboembolic cerebral accidents, usually indicated for patients with secondary effects and/or intolerance to oral hypocoagulation (generally haemorrhages). This first intervention at Hospital da Luz Lisboa was carried out on 2020 November 30 to a diabetic, hypertensive patient with a serious coronary disease history (that had already been subject to angioplasty in our institution, in 2016), having a previous history of ischemic stroke and intolerance to the new oral anticoagulant medicines. Via catheterization, a nitinol device was implanted (a metal alloy of nickel and titanium, with the capacity to recover its original shape upon exposure to blood), of approximately 2 cm and shaped like a parachute. Implanted in the heart, this device allows to close the left atrial appendage – a kind of a pouch located in the left auricle of the heart –, where about 80% of the clots causing thromboembolic strokes are formed. With the closure of the left atrial appendage, the displacement of those blood clots through the aorta towards the cerebral arteries is prevented, as well as subsequent strokes . In this interventional catheterization, the procedure is guided by intraoperative ultrasound, and the patient may be discharged from hospital within 24 hours. This treatment was carried out in the Hemodynamic/Interventional Cardiology Laboratory from Hospital da Luz Lisboa, ensured by a multidisciplinary team (in the photo above) coordinated by the interventional cardiologist Rui Campante Teles , who counted with other specialists in Hemodynamics and Arrhythmology – namely, Henrique Mesquita Gabriel and Diogo Cavaco : Echocardiography, and Anaesthesiology: Marisa Trabulo , Filipa Aguiar and Nuno Cardim –, as well as nurses and technicians. A month later, the patient benefits from the protection of the device, as he had to suspend once again the anticoagulants, and maintains a favourable clinical evolution, being followed up in consultation.
