Cryptogenic Stroke: A logical approach to a common clinical problem
|
|
|
- Sarah Small
- 6 years ago
- Views:
Transcription
1 Cryptogenic Stroke: A logical approach to a common clinical problem Alphonse M. Ambrosia, DO, FACC Interventional Cardiologist CardioVascular Associates of Mesa Mesa, Arizona
2 Speakers Bureau Boston Scientific Medtronics Vascular Philips/Volcano Corp Novartis Disclosures
3 Objectives Review common causes for cryptogenic stroke Review cardiovascular work up for stroke Review CHADS2Vasc score and the associated risk for stroke with atrial fibrillation Review the ROPE score and use in stroke associated with PFO Review interventional treatments to reduce risk of stroke
4 Importance of Stroke 795,000 strokes per year with 140,000 deaths 87% are of strokes are ischemic $34 billion yearly cost in US Leading cause of disability in the US 5th leading cause of death
5 Causes of stroke Most common is carotid artery disease or large vessel atheroembolism Hypertension/lacunar strokes Atrial fibrillation: cardioembolic Aneurysm rupture Rare/look alikes: tumors/endocarditis/seizures/ migraine
6 Patient Example 47 y.o. female presents to the ER with sudden speech difficulty associated with mild headache PMHx: migraines, no HTN, DM, HLP Medication: Imitrex prn VS: BP 138/86, HR 88, afebrile, sat 97% on RA Exam: normal except mild right sided weakness and slurred speech CT in ER, normal without bleed ECG: sinus rhythm without ST changes ER Labs: normal
7 Patient Example Patient seen by neurology and given TPA with resolution of symptoms in 2 hours Admitted to floor MRI shows left MCA stroke Carotid doppler study without plaque EEG negative MRA shows normal intracranial vessels Cardiology consulted: Dx Cryptogenic stroke
8 Cryptogenic Stroke 20-30% of strokes are classified as cryptogenic Stroke with no identifiable cause after initial work up Most common causes: Paroxysmal atrial fibrillation PFO Aortic atheroma
9 Patient Example Cardiology recommended: Telemetry monitoring for 48 hours Initial assessment for AF Bubble study Initial assessment for PFO TEE Assessment for PFO and aortic atheroma
10 Paroxysmal Atrial fibrillation stroke risk same as permanent af stroke risk dependent on multiple risk factors highest incidence with conversion of atrial fibrillation to sinus rhythm Patient often in NSR on arrival
11 Why we worry about atrial fibrillation
12 CHADS2Vasc Score Age >65 Age >75 Female Hypertension Diabetes Previous TIA/Stroke Vascular disease (coronary, carotid or PAD)
13
14 Detecting Atrial Fibrillation Rare during hospitalization 2 week event monitor as outpatient Implantable loop recorder more frequently used Patients over age 60 Multiple atrial fibrillation risk factors Symptoms of palpitations
15 Implantable loop recorders
16 Treatment Oral Anticoagulation Warfarin Novel oral anticoagulants: Pradaxa, Xarelto, Eliquis, Savaysa Left atrial appendage ligation/exclusion Surgical Endovascular Lariat Watchman Amulet
17 Oral Anticoagulation
18 Oral Anticoagulation is Standard of Care, but Not Ideal for All Warfarin Bleeding risk Daily regimen High non-adherence rates Regular INR monitoring Food and drug interaction issues Complicates surgical procedures AF Patients Using Anticoagulation 100% 75% Novel Oral Anticoagulants Bleeding risk 50% Daily regimen High non-adherence rates 25% Complicates surgical procedures Lack of reversal agents High cost 0% Anticoagulation Use Declines with Increased Stroke Risk 1 p < (n=27,164) CHADS 2 Score
19 Stroke Treatment Option: warfarin (Coumadin ) Warfarin is an effective means of stroke reduction in patients with AF but can present challenges Many patients spend a significant amount of time outside of the therapeutic range. Warfarin tops the list for emergency hospitalizations for adverse drug events in older Americans 2 44% of bleeding events occur in patients above Therapeutic Range 48% of thromboembolic events occur in patients INR Over-anti- Under-anti-
20 Stroke Treatment Option: Novel Oral Anticoagulants (NOACs) Treatment Study Drug Discontinuation Rate Major Bleeding (rate/year) Rivaroxaban 1 24% 3.6% Apixaban 2 25% 2.1% Dabigatran 3 (150 mg) Edoxaban 4 (60 mg / 30 mg) 21% 3.3% 33 % / 34% 2.8% / 1.6% Warfarin % %
21 Surgical left atrial appendage ligation
22 Lariat
23 WATCHMAN LAAC Closure Device Minimally Invasive, Local Solution Available sizes: 21, 24, 27, 30, 33 mm diameter Intra-LAA design Avoids contact with left atrial wall to help prevent complications Nitinol Frame Conforms to unique anatomy of the LAA to reduce embolization risk 10 active fixation anchors - designed to engage tissue for stability Proximal Face Minimizes surface area facing the left atrium to reduce post-implant thrombus formation 160 micron membrane PET cap designed to block emboli and promote healing Warfarin Cessation 92% after 45 days, >99% after 12 months 1 95% implant success rate 1
24 Watchman Performed in a cardiac cath lab/ep suite,performed by a Heart Team IC/EP or IC&EP, TEE, General Anesthesia, Surgical Back- up, WATCHMAN Clinical Specialist Transfemoral Access: Catheter advanced to the LAA via the femoral vein 1 hour procedure and 1-2 day hospital stay
25 WATCHMAN Device Outcomes Events in PROTECT AF trial at 2,621 patient years % lower 60% lower 34% lower Primary Efficacy WATCHMAN Group N= CV or All-Cause Death Unexplained Death Warfarin Group N=244 All three endpoints met statistical superiority
26 PFO Common in general population: 10-25% of the population based on autopsy studies Dynamic structure 50% will be seen on trans thoracic echo with bubble study 90% will be seen on trans esophageal echo with bubble study Transcranial doppler, more sensitive but less specific
27 PFO Embryology
28 Association between PFO and Stroke Lechat in 1988 credited with first paper to describe the association between PFO and stroke in NEJM. Multiple studies have had different results Controversy has existed since the first FDA HDE for PFO closure before 2006, when it was removed to promote enrollment in trials CLOSURE, PC, RESPECT and REDUCE all took longer than expected to enroll patients
29 Are PFO s associated with stroke?
30
31 Treatment Medical Therapy Aspirin Aspirin plus dipyridamole Aspirin plus clopidogrel Warfarin Device Closure
32 Medical Therapy PICCS trial showed no difference between aspirin and warfarin and no association between size of PFO and ASA and stroke risk Controversy has existed because of FDA guidelines for closure for recurrent stroke or TIA on medical therapy
33 Device Closure One FDA approved device Amplatzer PFO occluder One FDA reviewing device Gore Cardioform
34 Amplatzer Device
35 RESPECT Trial
36
37
38 Cardioform Device
39 REDUCE Study: Recurrent clinical ischemic stroke
40 Primary endpoint result: New brain infarct 49 percent relative risk reduction for PFO closure on new brain infarct at 2 years Difference in incidence of new brain infarct of 5.6 percent Caution: Investigational Device. Limited by United States law to Investigational Use for the indication under study. Products listed may not be available in all markets. GORE and designs are trademarks of W. L. Gore & Associates.
41
42
43 Summary Cryptogenic stroke: 20-30% of stroke Atrial fibrillation and PFO most common AF requires long monitoring to exclude PFO requires bubble and TEE (age <60) Devices for monitoring and treatment of both readily available, safe and effective CHADS2Vasc and ROPE scores helpful in assessing individual patient risk
Left Atrial Appendage Occlusion
Left Atrial Appendage Occlusion A new strategy to prevent stroke in atrial fibrillation Ashok Talreja MD and Arijit Chanda MD VHVI symposium 24th February 2018 Outline of presentation 1. Risk of stroke
Appendage Closure. Jason Rogers, MD. Director, Interventional Cardiology UC Davis Medical Center Sacramento, California
Appendage Closure Jason Rogers, MD Director, Interventional Cardiology UC Davis Medical Center Sacramento, California Left Atrium: Atrial Fibrillation Left Atrial Appendage Left Atrium Incidence of Atrial
A PATIENT S GUIDE TO THE LEFT ATRIAL APPENDAGE CLOSURE. Reducing the risk of stroke in atrial fibrillation
A PATIENT S GUIDE TO THE LEFT ATRIAL APPENDAGE CLOSURE Reducing the risk of stroke in atrial fibrillation TABLE OF CONTENTS IMPORTANT Please Note: Information provided by Boston Scientific Corporation
Primary Care Atrial Fibrillation Update: Anticoagulation and Left Atrial Appendage Occlusion. Greg Francisco, MD, FACC
Primary Care Atrial Fibrillation Update: Anticoagulation and Left Atrial Appendage Occlusion Greg Francisco, MD, FACC DISCLOSURES None to declare Estimated 33.5million have AF worldwide (6-7million in
Left Atrial Appendage Closure: Moving Beyond Blood Thinners to Prevent Stroke in Atrial Fibrillation October 29, 2016
Left Atrial Appendage Closure: Moving Beyond Blood Thinners to Prevent Stroke in Atrial Fibrillation October 29, 2016 Jesse Jorgensen, MD, FACC Director, Cardiac Cath Lab, Greenville Health System Disclosures
Left Atrial Appendage Occlusion in the Era of Novel Anticoagulants
Left Atrial Appendage Occlusion in the Era of Novel Anticoagulants Saibal Kar, MD, FACC, FSCAI Professor of Medicine Director of Interventional Cardiac Research Heart Institute, Cedars-Sinai Medical Center,
What the general cardiologist should know about arrhythmia Stroke prevention in AF" Peter Ammann Kantonsspital St. Gallen
What the general cardiologist should know about arrhythmia Stroke prevention in AF" Peter Ammann Kantonsspital St. Gallen What the cardiologist should know about arrhythmia and stroke are there real low
Watchman. Left Atrial Appendage Closure Device. Uniquely engineered for the LAA 1-3 with proven safety and longterm efficacy. 4-8
TM Watchman Left Atrial Appendage Closure Device PROOF OFLEADERSHIP Uniquely engineered for the LAA 1-3 with proven safety and longterm efficacy. 4-8 Patients with AF have a 5x increased risk of stroke.
Devices to Protect Against Stroke in Atrial Fibrillation
Devices to Protect Against Stroke in Atrial Fibrillation Jonathan C. Hsu, MD, MAS Associate Clinical Professor Division of Cardiology, Section of Cardiac Electrophysiology June 2, 2018 Disclosures Honoraria
Left Atrial Appendage Closure Devices. Atrial Fibrillation 10/11/2017
Left Atrial Appendage Closure Devices Emile Daoud, MD Chief, Cardiac Electrophysiology Wexner Medical Center, The Ohio State University Atrial Fibrillation 1 Adjusted Annual Stroke Risk Using CHA 2 DS
Devices for Stroke Prevention. Douglas Ebersole, MD Interventional Cardiology Watson Clinic LLP
Devices for Stroke Prevention Douglas Ebersole, MD Interventional Cardiology Watson Clinic LLP Overview Left Atrial Appendage Closure FDA Approved Watchman Investigational Amulet PFO Closure Atrial Fibrillation
Page 1. Current Trends in the Management of Atrial Fibrillation: Left Atrial Appendage Occlusion. Atrial fibrillation: Scope of the problem
Current Trends in the Management of Atrial Fibrillation: Left Atrial Appendage Occlusion Benjamin A. D Souza, MD, FACC, FHRS Assistant Professor of Clinical Medicine Penn Presbyterian Medical Center Cardiac
Patients selection criteria for LAA occlusion. Young Keun On, MD, PhD, FHRS Samsung Medical Center Sungkyunkwan University School of Medicine
Patients selection criteria for LAA occlusion Young Keun On, MD, PhD, FHRS Samsung Medical Center Sungkyunkwan University School of Medicine Atrial Fibrillation The most common cardiac arrhythmia. Confers
Occlusion de l'auricule gauche: Niche ou réel avenir? D Gras, MD, Nantes, France
Occlusion de l'auricule gauche: Niche ou réel avenir? D Gras, MD, Nantes, France LAA Occlusion Is there a real future? Background Protect AF Trial Other Studies CAP, ASAP, Prevail Left Atrial Appendage
Listen to Your Heart. What Everyone Needs To Know About Atrial Fibrillation & Stroke. The S-ICD System. The protection you need
Listen to Your Heart The S-ICD System What Everyone Needs To Know About Atrial Fibrillation & Stroke The protection you need without Stroke. touching Are you your at heart risk? Increase your knowledge.
PFO Management update
PFO Management update May 12, 2017 Peter Casterella, MD Swedish Heart and Vascular 1 PFO Update 2017: Objectives Review recently released late outcomes of RESPECT trial and subsequent FDA approval of PFO
Management and Investigation of Ischemic Stroke By Etiology
Management and Investigation of Ischemic Stroke By Etiology Andrew M. Demchuk MD FRCPC Director, Calgary Stroke Program Deputy Dept Head, Clinical Neurosciences Heart and Stroke Foundation Chair in Stroke
Left Atrial Appendage Closure
Left Atrial Appendage Closure Matthew J. Price MD Director, Cardiac Catheterization Laboratory Scripps Clinic La Jolla, CA, USA price.matthew@scrippshealth.org Risk Factors for Stroke From The Perspective
CARDIOLOGY GRAND ROUNDS
CARDIOLOGY GRAND ROUNDS Title: Reintroduction Overview: Watchman Speaker: Mario Goessl, MD, FACC, FAHA, FESC, FSCAI Minneapolis Heart Institute at Abbott Northwestern Hospital Date: Monday, October 24,
State of the Art Management on Atrial Fibrillation in Monica Lo, MD, FACC, FHRS April 15, 2016
State of the Art Management on Atrial Fibrillation in 2016 Monica Lo, MD, FACC, FHRS April 15, 2016 Scope of the Problem More than 30 million people worldwide 1 5 million new cases each year 1 in 4 lifetime
Atrial Fibrillation: Risk Stratification and Treatment New Cardiovascular Horizons St. Louis September 19, 2015
Atrial Fibrillation: Risk Stratification and Treatment New Cardiovascular Horizons St. Louis September 19, 2015 Christopher E. Bauer, MD, FACC, FHRS SSM Health Heart & Vascular Care Clinical Cardiac Electrophysiology
Management of Atrial Fibrillation. Leon Ptaszek, MD, PhD, FACC, FHRS 25 March 2018
Management of Atrial Fibrillation Leon Ptaszek, MD, PhD, FACC, FHRS 25 March 2018 Disclosures Speaker: St. Jude Medical, Biotronik Consultant: St. Jude Medical, World Care Clinical Objectives Recognize
Cryptogenic Stroke: What Don t We Know. Siddharth Sehgal, MD Medical Director, TMH Stroke Center Tallahassee Memorial Healthcare
Cryptogenic Stroke: What Don t We Know Siddharth Sehgal, MD Medical Director, TMH Stroke Center Tallahassee Memorial Healthcare Financial Disclosures None Objectives Principles of diagnostic evaluation
Alan Barber. Professor of Clinical Neurology University of Auckland
Alan Barber Professor of Clinical Neurology University of Auckland Presented with L numbness & slurred speech 2 episodes; 10 mins & 2 hrs Hypertension Type II DM Examination pulse 80/min reg, BP 160/95
Patent Foramen Ovale and Cryptogenic Stroke: Do We Finally Have Closure? Christopher Streib, MD, MS
Patent Foramen Ovale and Cryptogenic Stroke: Do We Finally Have Closure? Christopher Streib, MD, MS 11-8-18 Outline 1. Background 2. Anatomy of patent foramen ovale (PFO) 3. Relationship between PFO and
Updates in Atrial Fibrillation
Updates in Atrial Fibrillation Michael Curley, MD Cardiac Electrophysiologist Wheaton Franciscan Medical Group #1 Most common heart rhythm disturbance 1 in 4 Americans over 40 will be diagnosed 3,500,000
THINK OUTSIDE THE PILLBOX
WATCHMAN : A CLINICALLY PROVEN AND SAFE THERAPY FOR YOUR NVAF PATIENTS WATCHMAN reduces the risk of stroke in NVAF patients as effectively as warfarin WATCHMAN also reduces the long-term risk of bleeding
Watchman Implantation Case Presentation and Discussion
Watchman Implantation Case Presentation and Discussion Walid Saliba, MD, FHRS Director Atrial Fibrillation Center Co-Director AF Stroke Prevention Center Cleveland Clinic Indication FDA NonValvular AF
Update in the Management of Atrial Fibrillation
Update in the Management of Atrial Fibrillation Gregory M Marcus, MD, MAS Associate Professor of Medicine Division of Cardiology University of California, San Francisco Disclosures Research: Gilead, Medtronic,
Basics of Atrial Fibrillation. By Mini Thannikal NP-BC Mount Sinai St Luke s Hospital New York, NY
Basics of Atrial Fibrillation By Mini Thannikal NP-BC Mount Sinai St Luke s Hospital New York, NY Atrial Fibrillation(AF) is a supraventricular tachyarrhythmia characterized by uncoordinated atrial activation
Index. cardiology.theclinics.com. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Acute ischemic stroke TOAST classification of, 270 Acute myocardial infarction (AMI) cardioembolic stroke following, 207 208 noncardioembolic
Afib, Stroke, and DOAC. Albert Luo, MD. Cardiology Lindsey Frischmann, DO. Neurology Xiao Cai, MD. HBS
Afib, Stroke, and DOAC Albert Luo, MD. Cardiology Lindsey Frischmann, DO. Neurology Xiao Cai, MD. HBS Disclosure of Relevant Financial Relationships I have no relevant financial relationships with commercial
Watchman and Structural update..the next frontier. Ari Chanda, MD Cardiology Associates of Fredericksburg
Watchman and Structural update..the next frontier Ari Chanda, MD Cardiology Associates of Fredericksburg Different Left Atrial Appendage (LAA) morphologies Watchman (the device) Fabric Anchors Device structure
Gauging stroke risk across the AF spectrum and selecting the appropriate patient for LAA closure. Miguel Valderrábano, MD
Gauging stroke risk across the AF spectrum and selecting the appropriate patient for LAA closure Miguel Valderrábano, MD Risk of Stroke in Atrial Fibrillation CHADS 2 -CHA 2 DS 2 -VASc Scores Adjusted
Stroke Case Studies. Dr Stuti Joshi Neurology Advanced Trainee Telestroke fellow
Stroke Case Studies Dr Stuti Joshi Neurology Advanced Trainee Telestroke fellow Case 1 64 year old female with dysphasia and right arm weakness 3 hours prior CT head: dense M1 sign. No established ischaemia
Alan Barber. Professor of Clinical Neurology University of Auckland
Alan Barber Professor of Clinical Neurology University of Auckland Presented with Non-fluent dysphasia R facial weakness Background Ischaemic heart disease Hypertension Hyperlipidemia L MCA branch
Invasive and Medical Treatments for Atrial Fibrillation. Thomas J Dresing, MD Section of Electrophysiology and Pacing Cleveland Clinic
Invasive and Medical Treatments for Thomas J Dresing, MD Section of Electrophysiology and Pacing Cleveland Clinic Disclosures Fellow s advisory panel for St Jude Medical Speaking honoraria from: Boston
Trick or Treat 2: A New Era of Stroke Prevention in AF? WATCHMAN and LARIAT?
Trick or Treat 2: A New Era of Stroke Prevention in AF? WATCHMAN and LARIAT? Disclosure SentreHeart, Inc Consultant Equity holder A cardiac disease that kills by producing emboli The most severe consequence
Left Atrial Appendage Closure for Atrial Fibrillation 2015 UPDATE
Left Atrial Appendage Closure for Atrial Fibrillation 2015 UPDATE Adam Greenbaum, MD NCVH Detroit 2015-09-12 Disclosures Former proctor: SentreHEART Discussion may include the use of non-fda approved devices
Role of cardiac imaging for catheterbased left atrial appendage closure
Role of cardiac imaging for catheterbased left atrial appendage closure Ana G. Almeida, MD, PhD Cardiology University Hospital Santa Maria, Lisbon Ana G. Almeida, MD, PhD, FESC University Hospital Santa
Asif Serajian DO FACC FSCAI
Anticoagulation and Antiplatelet update: A case based approach Asif Serajian DO FACC FSCAI No disclosures relevant to this talk Objectives 1. Discuss the indication for antiplatelet therapy for cardiac
2017 Cardiovascular Symposium CRYPTOGENIC STROKE: A CARDIOVASCULAR PERSPECTIVE DR. WILLIAM DIXON AND DR. VENKATA BAVAKATI SOUTHERN MEDICAL GROUP, P.A.
CRYPTOGENIC STROKE: 2017 Cardiovascular Symposium A CARDIOVASCULAR PERSPECTIVE DR. WILLIAM DIXON AND DR. VENKATA BAVAKATI SOUTHERN MEDICAL GROUP, P.A. CRYPTOGENIC STROKE CRYPTOGENIC: OF OBSCURE OR UNKNOWN
Controversies in Atrial Fibrillation and HF
Controversies in Atrial Fibrillation and HF Dr.Yahya Al Hebaishi Cardiac electrophysiology division, PSCC, Riyadh Atrial Fibrillation: Rate or Rhythm? HF and AF: the twin epidemic of cardiovascular disease.
GERIATRICS CASE PRESENTATION
GERIATRICS CASE PRESENTATION CASE 79 year old Patient X was admitted to hospital with SOB. He had a hx of sarcoidosis and asbestosis. Home oxygen requirement is 3-3.5litre. He was admitted, given ceftriaxone
Rahul Jhaveri, M.D. The Heart Group of Lancaster General Health
Rahul Jhaveri, M.D. The Heart Group of Lancaster General Health INTRODUCTION Three recently published randomized controlled trials in The New England Journal of Medicine provide new information about closure
Atrial Fibrillation. Atrial Fibrillation
Atrial Fibrillation Stroke and Blood Thinning Medications What else is available? Srinivas Iyengar, MD, FACC, with Boulder Heart Structural Heart Director, Boulder Community Health 303-622-5849 Atrial
Gamechangers in Cardiology: 2018
Gamechangers in Cardiology: 2018 Jacqueline Joza, MD Cardiac Electrophysiology, McGill University Annual Refresher Course for Family Physicians November 26, 2018 jacqueline.joza@mcgill.ca FAX: 514-843-2813
MEET 2007: Evaluation and treatment of the stroke and TIA patient for the non-neurointerventionist. neurointerventionist
MEET 2007: Evaluation and treatment of the stroke and TIA patient for the non-neurointerventionist neurointerventionist Steve Ramee, MD Ochsner Medical Center New Orleans DISCLOSURE Nothing Nothing to
Update on the NOAC s: 2018 Daniel Blanchard, MD, FACC, FAHA
Update on the NOAC s: 2018 Daniel Blanchard, MD, FACC, FAHA Professor of Medicine Director, Cardiology Fellowship Program Sulpizio Cardiovascular Center UC San Diego The NOACS, chronologically Dabigatran:
Left Atrial Appendage Closure in SCRIPPS CLINIC
Left Atrial Appendage Closure in Atrial Fibrillation to Prevent Stroke Matthew J. Price MD Director, Cardiac Catheterization Laboratory Scripps Clinic La Jolla, CA, USA price.matthew@scrippshealth.org
Management of Atrial Fibrillation in the Hospitalized Patient
Management of Atrial Fibrillation in the Hospitalized Patient Gregory M Marcus, MD, MAS Associate Professor of Medicine Division of Cardiology University of California, San Francisco Disclosures Research:
TIA: Updates and Management 2008
TIA: Updates and Management 2008 S. Andrew Josephson, MD Department of Neurology, Neurovascular Division University of California San Francisco Commonly Held TIA Misconceptions TIA is easy to diagnose
Updates in Stroke Management. Jessica A Starr, PharmD, FCCP, BCPS Associate Clinical Professor Auburn University Harrison School of Pharmacy
Updates in Stroke Management Jessica A Starr, PharmD, FCCP, BCPS Associate Clinical Professor Auburn University Harrison School of Pharmacy Disclosure I have no actual or potential conflict of interest
LAA Occluders: The Right Device for the Right Patient ACC/SHA MEETING OCTOBER 31 ST 2015 JEDDAH, KSA OMER A. M. ELAMIN, MD, FACC
LAA Occluders: The Right Device for the Right Patient ACC/SHA MEETING OCTOBER 31 ST 2015 JEDDAH, KSA OMER A. M. ELAMIN, MD, FACC INTERVENTIONAL CARDIOLOGIST DIRECTOR, ADULT CARDIOLOGY FELLOWSHIP TRAINING
Prof. Fiorenzo Gaita
Adavances in Cardiac Arrhythmias and Great Innovations in Cardiology Turin 2014 Can rhythm control strategy reduce the risk of clinical and silent cerebral ischemia? Prof. Fiorenzo Gaita Director of the
Dad needed to get off his blood thinner. His doctor told us about an alternative. It s called
Dad needed to get off his blood thinner. His doctor told us about an alternative. It s called A one-time procedure that may reduce stroke risk for a lifetime in people with AFib not caused by a heart valve
True cryptogenic stroke
True cryptogenic stroke Arne Lindgren, MD, PhD Dept of Clinical Sciences Lund, Neurology, Lund University Dept of Neurology and Rehabilitation Medicine Skåne University Hospital Lund, Sweden Disclosures
Left Atrial Appendage Occlusion: Shutting Out Embolic Disease Without Anticoagulation
Left Atrial Appendage Occlusion: Shutting Out Embolic Disease Without Anticoagulation Zoltan G. Turi, M.D. Rutgers Robert Wood Johnson Medical School New Brunswick, NJ Disclosure Information Zoltan G.
Update in Left Atrial Appendage Closure Devices. Faisal Al-Samadi MBBS, FRCPC, FACP, FACC, FSCAI, FHRS
Update in Left Atrial Appendage Closure Devices Faisal Al-Samadi MBBS, FRCPC, FACP, FACC, FSCAI, FHRS Atrial Fibrillation - Overview Higher stroke risk for older patients and those with prior stroke or
The Poor Long-Term Candidate for Warfarin: NOAC or Left Atrial Appendage Closure?
The Poor Long-Term Candidate for Warfarin: NOAC or Left Atrial Appendage Closure? Suneet Mittal, MD, FACC, FHRS Director, Electrophysiology Laboratory Valley Health System Ridgewood, NJ and New York, NY
Dysrhythmias 11/7/2017. Disclosures. 3 reasons to evaluate and treat dysrhythmias. None. Eliminate symptoms and improve hemodynamics
Dysrhythmias CYDNEY STEWART MD, FACC NOVEMBER 3, 2017 Disclosures None 3 reasons to evaluate and treat dysrhythmias Eliminate symptoms and improve hemodynamics Prevent imminent death/hemodynamic compromise
Update in Left Atrial Appendage Occlusion: More Options
Update in Left Atrial Appendage Occlusion: More Options Sajjad A Sabir, MD Director, Structural Heart Disease Program Director, Interventional Echocardiography Director, Heart Valve Clinic Non-Valvular
Secondary Stroke Prevention: A Precautionary Tale
Secondary Stroke Prevention: A Precautionary Tale Kirsten George-Phillips, BSP Clinical Practice Leader, AHS Clinical Pharmacist, AHS Owen Stroke Prevention Clinic Learning Objectives! Examine literature
Why Should We Treat PFO?
Why Should We Treat PFO? SCAI Interventional Cardiology Fellows Course December 7, 2012 Jonathan Tobis, MD Director of Interventional Cardiology UCLA Disclosures Jonathan Tobis, MD 1. A Principal Investigator
Rate or Rhythm Control? Epidemiology. Relevant Advances in Atrial Fibrillation 6/20/2011. Stroke Prophylaxis
Relevant Advances in Atrial Fibrillation Stroke Prophylaxis Managing Atrial Fibrillation: Tips for the Generalist Antiarrhythmic Drug Therapy Ablation Gregory M Marcus, MD, MAS Assistant Professor of Medicine
NEW APPROACHES AND NEW ANTICOAGULANTS FOR ATRIAL FIBRILLATION
NEW APPROACHES AND NEW ANTICOAGULANTS FOR ATRIAL FIBRILLATION MAY 1, 2015 Melissa R. Robinson, MD FACC FHRS CCDS Assistant Professor of Medicine Director of the Complex Arrhythmia Service POINTS TO MAKE
Advances in Prevention and Treatment of Stroke: What Every Primary Care Physician Needs to Know. Case 1 4/5/11. What treatment should you initiate?
Advances in Prevention and Treatment of Stroke: What Every Primary Care Physician Needs to Know S. Andrew Josephson, MD Director, Neurohospitalist Program Medical Director, Inpatient Neurology University
RESPECT Safety Findings
CO-1 SCAI Town Hall Meeting Monday, October 31, 2016 Washington, DC RESPECT Safety Findings John D. Carroll, M.D., MSCAI Professor of Medicine Cardiology University of Colorado School of Medicine University
DEBATE: PFO MANAGEMENT TO CLOSE OR NOT TO CLOSE. Matthew Starr, MD Stroke Attending
DEBATE: PFO MANAGEMENT TO CLOSE OR NOT TO CLOSE Matthew Starr, MD Stroke Attending DISCLOSURES None DEBATE Should PFO be closed? * * Sometimes yes THE CASE AGAINST PFO CLOSURE 1. Did the PFO cause the
8/16/2016. Disclosures. Is Uninterrupted OAC Standard of Care for AF Ablation? CHRS 2016, San Francisco. Risk of Stroke Peri-Ablation
Disclosures Is Uninterrupted OAC Standard of Care for AF Ablation? CHRS 2016, San Francisco Atul Verma, MD FRCPC FHRS Director, Heart Rhythm Program Southlake Regional Health Centre Newmarket, Ontario,
ANTI-THROMBOTIC THERAPY in NON-VALVULAR ATRIAL FIBRILLATION
ANTI-THROMBOTIC THERAPY in NON-VALVULAR ATRIAL FIBRILLATION Colin Edwards Auckland Heart Group Waitemata Health June 2015 PFIZER Lecture series Disclosures EPIDEMIOLOGY Atrial fibrillation is the most
EP Clinical Research Program Summary. Daniel L Lustgarten MD PhD Associate Professor The University of Vermont School of Medicine
EP Clinical Research Program Summary Daniel L Lustgarten MD PhD Associate Professor The University of Vermont School of Medicine Financial Disclosures Consultant and/or Research Support: Medtronic Biosense
Left Atrial Appendage Closure: The Rationale
Left Atrial Appendage Closure: The Rationale JOHN D. HUMMEL, MD DIRECTOR OF CLINCAL ELECTROPHYSIOLOGY RESEARCH PROFESSOR OF CLINICAL INTERNAL MEDICINE OHIO STATE UNIVERSITY WEXNER MEDICAL CENTER 1 Disclosures
William A. Gray MD System Chief of Cardiovascular Services, Main Line Health President, Lankenau Heart Institute Wynnewood, Pennsylvania USA
William A. Gray MD System Chief of Cardiovascular Services, President, Wynnewood, Pennsylvania USA What does Guilty until Effective mean? A fact is a simple statement that everyone believes. It is innocent
Left atrial appendage occlusion
Kardiologie Left atrial appendage occlusion Mischa Kühne Kardiolunch, 10.9.2015 Overall stroke rate 5% per year CHA 2 DS 2 VASC score Most AF patients need protection from stroke ESC guidelines AF, 2010/2012
Permanent foramen ovale: when to close?
Permanent foramen ovale: when to close? Pierre Amarenco INSERM U-698 and Denis Diderot University - Paris VII Department of Neurology and Stroke Center Bichat hospital, Paris, France PFO - Pathology TEE
Guiding Secondary Stroke Prevention through Evaluation of Ischemic Stroke Etiology
Guiding Secondary Stroke Prevention through Evaluation of Ischemic Stroke Etiology Ann M. Leonhardt Caprio, MS, RN, ANP-BC Program Coordinator Comprehensive Stroke Center, Strong Memorial Hospital Clinical
The Emerging Atrial Fibrillation Epidemic: Treat It, Leave It or Burn It. Chandra Kumbar MD FACC FHRS The Heart Group, Evansville IN
The Emerging Atrial Fibrillation Epidemic: Treat It, Leave It or Burn It Chandra Kumbar MD FACC FHRS The Heart Group, Evansville IN Disclosures Consultant Advisory Board, Medtronic Atrial fibrillation
NCVH Birmingham 2013 August 24, Michael S. Bailey, MD Birmingham Heart Clinic
NCVH Birmingham 2013 August 24, 2013 Michael S. Bailey, MD Birmingham Heart Clinic NCVH Birmingham 2015 August 29, 2015 Michael S. Bailey, MD Birmingham Heart Clinic Left Atrial Anatomy Part of a larger
Tricky Cases in Primary Care Anticoagulation in AF
Tricky Cases in Primary Care Anticoagulation in AF Dr John Wong GPwSI Cardiology & GP Principal Leatherhead Hospital Ashlea Medical Practice 54 year old F Case 1 PMH CREST Syndrome calcinosis finger tips
Subject Expert. Michelle Whaley MSN, CNS, CCNS, ANVP-BC Swedish Medical Center Englewood, CO
Stroke 101 Subject Expert Michelle Whaley MSN, CNS, CCNS, ANVP-BC Swedish Medical Center Englewood, CO 2 Objectives Types of strokes Stroke warning signs Stroke risk factors Medical test performed following
Atrial Fibrillaiton and Heart Failure: Anticoagulation therapy in all cases?
Atrial Fibrillaiton and Heart Failure: Anticoagulation therapy in all cases? Nicolas Lellouche Fédération de Cardiologie Hôpital Henri Mondor Créteil Disclosure Statement of Financial Interest I currently
Watchman a Stroke Prevention Technology for Patients with Atrial Fibrillation
Watchman a Stroke Prevention Technology for Patients with Atrial Fibrillation Scripps hospital,la Jolla, CA Atrial fibrillation is a major source of cardiogenic embolic related stroke 500,000 strokes per
Shawke A. Soueidan, MD. Riverside Neurology & Sleep Specialists
Shawke A. Soueidan, MD Riverside Neurology & Sleep Specialists 757-221-0110 Epidemiology of stroke 2018 Affects nearly 800,000 people in the US annually Approximately 600000 first-ever strokes and 185000
Stroke Update. Claire J. Creutzfeldt, MD January 12, 2018
Stroke Update Claire J. Creutzfeldt, MD January 12, 2018 Disclosures None relevant to this presentation I receive funding from the NINDS What s new in stroke? A new model for cardioembolic stroke: atrial
Manuel Castellá Cardiovascular Surgery Hospital Clínic, Universidad de
When not to exclude the LAA Manuel Castellá Cardiovascular Surgery Hospital Clínic, Universidad de Barcelona mcaste@clinic.ub.es @mcastellamd Normal hearts Patient in sinus rhythm Patient in AF (with
Cryptogenic Strokes: Evaluation and Management
Cryptogenic Strokes: Evaluation and Management 77 yo man with hypertension and hyperlipidemia developed onset of left hemiparesis and right gaze preference, last seen normal at 10:00 AM Brought to ZSFG
Left Atrial Appendage Closure Techniques: 2015
Left Atrial Appendage Closure Techniques: 2015 Ramon Quesada, MD, FACP, FACC, FSCAI Medical Director, Interventional Cardiology & Cardiac Research Medical Director, Structural Heart and TAVR Program Baptist
Sixth Annual Intensive Update in Neurology 9/15-16/2016. W Tom Kushner DO Swedish Stroke Clinic Neurohospitalist
W Tom Kushner DO Swedish Stroke Clinic Neurohospitalist 1 One Strategy for cryptogenic stroke: ESUS Positively defined criteria FDA allows clinical trials NOACs have lower risk profile Another strategy
How to Evaluate Patients with Cryptogenic Stroke
How to Evaluate Patients with Cryptogenic Stroke Jeffrey Saver, MD Professor of Neurology Director, How to Evaluate Patients with Cryptogenic Stroke Disclosure Scientific Consultant, Unpaid Trialist: AGA
MANAGING ATRIAL FIBRILLATION: BEYOND ANTICOAGULATION December 9, 2017
MANAGING ATRIAL FIBRILLATION: BEYOND ANTICOAGULATION December 9, 2017 1 Faculty Disclosure Faculty: Peter Leong-Sit MSc, MD, FRCPC, FHRS Associate Professor, Western University Cardiologist, London Heart
Stroke Prevention in AF: How will it change in the next 5 years? Jeff Healey MD, MSc, FHRS Population Health Research Institute McMaster University
Stroke Prevention in AF: How will it change in the next 5 years? Jeff Healey MD, MSc, FHRS Population Health Research Institute McMaster University Disclosures Research Grants and speaking fees St. Jude
Why Treat Patent Forman Ovale
Why Treat Patent Forman Ovale Clifford J Kavinsky, MD, PHD Professor of Medicine and pediatrics Associate Director, Center for Congenital and Structural Heart Disease Rush University Medical Center Conclusions
LEFT ATRIAL APPENDAGE CLOSURE INSTEAD OF ANTICOAGULATION; INDICATIONS AND OUTCOMES. Sheetal Chandhok, MD
LEFT ATRIAL APPENDAGE CLOSURE INSTEAD OF ANTICOAGULATION; INDICATIONS AND OUTCOMES Sheetal Chandhok, MD Disclosures Boston Scientific: Speaker (Watchman) Trainer (Watchman) SentreHeart Primary Investigator
Live in a Box: Left Atrial Appendage Closure Device
Live in a Box: Left Atrial Appendage Closure Device Fayez Bokhari, MD, FRCPC KFAFH, Jeddah Saudi Arabia Joint Saudi Heart Association/SACIS April 18, 2015 News: Interventional Cardiologists harm patients
PFO closure group total no. PFO closure group no. of males
Suppl Table. Characteristics of the five trials included in this meta-analysis. Trial name Device used for Definition of medical Primary Endpoint group total no. group no. of males group age (yrs) group
Role of Imaging in Complex LAA Closure Anatomies
Role of Imaging in Complex LAA Closure Anatomies Sameer Gafoor 1,2 1 Swedish Heart and Vascular: Ming Zhang, Paul Huang, Darryl Wells, Adam Zivin, John Petersen II, Madalena Petrescu, Nimish Muni, Eric
Left Atrial Appendage Occlusion: A Valid Option to Anticoagulation for Long-term Prevention of Stroke Saibal Kar, MD
Left Atrial Appendage Occlusion: A Valid Option to Anticoagulation for Long-term Prevention of Stroke Saibal Kar, MD Director of Interventional Cardiac Research Cedars Sinai Medical Center Disclosure Statement
PERCUTANEOUS STRUCTURAL UPDATES TAVR WATCHMAN(LEFT ATRIAL APPENDAGE OCCLUDERS) MITRACLIP PARAVALVULAR LEAK REPAIRS ASD/PFO CLOSURES VALVULOPLASTIES
PERCUTANEOUS STRUCTURAL UPDATES TAVR WATCHMAN(LEFT ATRIAL APPENDAGE OCCLUDERS) MITRACLIP PARAVALVULAR LEAK REPAIRS ASD/PFO CLOSURES VALVULOPLASTIES Dr.Vinny K.Ram No disclosures TAVR 1 Lesson number 1:
16th ANGIOPLASTY SUMMIT-TCTAP TCTAP 2011 Seoul, Korea, April 27 29, 2011 Left Atrial Appendage Closure State of the Art Horst Sievert, Nina Wunderlich, Maik Gonzaga, Annkathrin Braut, Ilona Hofmann CardioVascular