Left Atrial Appendage Occlusion — Closure or Just the Beginning?  

Oleh:

Maisel, William H.

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: The New England Journal of Medicine (keterangan: ada di Proquest) vol. 360 no. 25 (Jun. 2009), page 2601-2603.
Topik: left atrial appendage; occlusion

Ketersediaan

Perpustakaan FK Nomor Panggil: N08.K.2009.03 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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More than 3 million Americans have atrial fibrillation, which increases their risk of stroke by a factor of 5.1,2 Patients with atrial fibrillation account for one of every six strokes, and thromboemboli originating from the left atrial appendage are the suspected culprit in the vast majority of these cases.1,2 Warfarin, a vitamin K antagonist, is the most commonly prescribed treatment for stroke prevention in patients with atrial fibrillation; yet despite warfarin's proven benefit, its effective delivery is challenged by a narrow therapeutic window and an increased risk of bleeding. Efforts have been made to develop alternative treatment strategies — including occlusion of the left atrial appendage. In August 2008, the Food and Drug Administration (FDA) granted expedited-review status to an application submitted by Atritech for the Watchman Left Atrial Appendage Closure Technology, recognizing that the device might represent a breakthrough technology. Although ischemic stroke and arterial occlusion in atrial fibrillation are generally attributed to dislodgement of thrombi from the left atrial appendage, the pathogenesis of thromboembolism is complex. Up to 25% of strokes in patients with atrial fibrillation may be due to intrinsic cerebrovascular disease or emboli from an atheromatous proximal aorta or other cardiac source.1 Nevertheless, interest in removing or occluding the left atrial appendage for stroke prevention dates back to the 1930s.3 Many centers now routinely remove it during valve or arrhythmia surgery, and removal is recommended to reduce the risk of stroke in selected patients undergoing cardiac-valve surgery. Interest in nonsurgical closure of the left atrial appendage has spawned development of percutaneous devices, but no device has been approved by the FDA for this purpose. The Watchman device is a self-expanding structure made of nitinol (a nickel–titanium alloy) that is delivered percutaneously, with the use of femoral venous access and a transseptal technique, to the left atrial appendage

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