The Imaging Spectrum of Device-Related Thrombus After Percutaneous Left Atrial Appendage Occlusion

Surveillance imaging at 45 to 90 days after transcatheter left atrial appendage occlusion device implantation with transesophageal echocardiography (TEE) or cardiac computed tomography (CT) is recommended to assess device position and the presence of device-related complications such as device-related thrombus (DRT) or peridevice leak. Detection of DRT is associated with a significantly increased risk of a stroke or systemic embolization event within 6 months of detection. Nonetheless, there is significant variability in detection of DRT as a result of timing, frequency, and imaging modality used for surveillance. The process of DRT formation vs benign device endothelization is not known. Here we highlight the spectrum of imaging findings seen on TEE and CT and emphasize the need for unified definitions and standardized reporting of imaging findings.