Percutaneous left atrial appendage closure for atrial fibrillation-related ischemic stroke despite direct oral anticoagulation: a case report

A 79-year-old woman developed weakness in her right upper and lower limbs despite appropriate therapy with edoxaban 30 ‍mg once daily for non-valvular atrial fibrillation (CHA2DS2-VASc score of 7, HAS-BLED score of 3). Brain MRI revealed an acute infarct in the territory of the left long insular artery or white-matter medullary artery. Transesophageal echocardiogram showed spontaneous echo contrast and reduced flow velocities in the left atrial appendage (LAA), leading to a diagnosis of cardioembolic stroke. Edoxaban was continued, and the patient underwent percutaneous left atrial appendage occlusion (LAAO). Her clinical course was uncomplicated by recurrent ischemic stroke or device-related thrombosis. For patients with atrial fibrillation-related ischemic stroke despite anticoagulation, adding LAAO to ongoing anticoagulation may be an effective option for secondary prevention.