Percutaneous Left Atrial Appendage Balloon-Occlusive Aspiration Thrombectomy With Subsequent Occluder Implant

BACKGROUND: There is currently no standard clinical approach to patients in need of left atrial appendage (LAA) occlusion device with persistent LAA thrombus. The steerable, balloon-tipped SafeCross transseptal introducer system provides the opportunity for a novel approach to LAA thrombectomy by blockading the LAA os with its balloon tip, creating a closed system for embolic protection during aspiration. CASE SUMMARY: Consecutive patients from the Medical University of South Carolina were included who underwent balloon-occlusive aspiration thrombectomy (BOAT) of the LAA with the SafeCross system followed by LAA occlusion device implantation. DISCUSSION: Four patients, with a mean age of 79.5 ± 4.04 years and 75% male, were included. Balloon occlusion was achieved in 75% of cases during BOAT of the LAA. All cases resulted in successful aspiration of the LAA thrombus and subsequent successful placement of Watchman FLX Pro without periprocedural complications or adverse events at 45-day follow-up. TAKE-HOME MESSAGE: Our small case series demonstrates the feasibility of performing a transseptal LAA BOAT thrombectomy with the SafeCross transseptal system to facilitate LAA occluder implant.