Late migration of a left atrial appendage closure device to the bifurcation of common iliac arteries: a case report and novel percutaneous retrieval technique

Transcatheter left atrial appendage closure (LAAC) serves as a mechanical stroke prevention strategy for patients with non-valvular atrial fibrillation (NVAF) who are unsuitable for long-term oral anticoagulation. Although device dislodgement following LAAC is rare, it carries potentially life-threatening risks. This case report describes a 65-year-old male with permanent atrial fibrillation (CHA2DS2-VASc = 4, HAS-BLED = 3) who underwent LAAC with an 18 mm LAmbre occluder. Despite confirmed proper positioning at 1-month follow-up, device migration to the iliac bifurcation was detected at 105 days post-procedure, potentially associated with interim chest trauma. Percutaneous retrieval was performed via a novel approach: catheter-based endothelial detachment followed by bidirectional traction, avoiding large-bore sheaths. A Watchman FLX device was subsequently implanted successfully.