Despite medical advances, stroke remains a disabling and sometimes lethal disorder, with more than 800,000 strokes occurring in the United States each year. It remains the fourth leading cause of death in the United Sates.
There are many reasons for strokes. Most frequently a stroke occurs when a migrating clot stops the blood flow in one of the brain arteries. Atrial fibrillation, or A-fib, is a heart rhythm disorder that is associated with clot formation and dislodgement leading to arterial blockages anywhere in the circulation. It can lead to strokes if the clot migrates into the brain arteries.
A-fib is seen frequently in patients with hypertension, diabetes and/or heart failure. It is also often seen in elderly patients. In fact, more than 30 percent of all strokes in those age 75 and older are due to A-fib.
To reduce risk of stroke in patients with A-fib, the standard of care is to place the patient on oral anticoagulants, commonly called blood thinners. The gold standard has been a medication called warfarin (Coumadin), however, the drug is particularly difficult to regulate due to interactions with other drugs and dietary changes. Failure to regulate its effects can lead to devastating bleeding or clotting complications.
Recent innovations in medicine lead to the development of novel anticoagulants (Pradaxa, Xarelto, and Eliqius), which appear to have a more predictable effect and safety compared to warfarin.
The use of these medications is limited, however, by their cost, lack of reversing agents and a noted rebound increase in clotting risk if the medication is stopped.
Furthermore, a large number of patients with A-fib are not candidates for any anticoagulant, such as those with history of life threatening bleeding events, high risk for falls, noncompliance or bleeding disorders.
With the advent of new technology, we have multiple new devices that are used now to isolate the left atrial appendage, which is known to be the site of clot formation in patients with A-fib. By employing these technologies, we can now reduce the risk of A-fib-related stroke significantly, in patients who are unable to take an anticoagulant.
One such device, the LARIAT, is an FDA approved device that is deployed in minimally invasive fashion to isolate the left atrial appendage, isolating it from the arterial circulation, thus eliminating the risk of clot formation and dislodgement into the circulatory system.
The minimally invasive procedure is done in cardiac catheterization lab. During the procedure, an interventional cardiologist will put a catheter in the right femoral vein (in the groin area) and another catheter through a small incision under the sternum (breast bone). The patient is expected to spend the night following procedure in the intensive care unit and is usually sent home within 48 hours.
While not every patient is a good candidate for the device, medical innovations continue to bring newer devices that will address patients who are not suitable for the LARIAT.
If you haven't been able to take blood thinner medications to control your risk of stroke from A-fib, be sure to talk to your doctor about the non-invasive methods to reduce your risk of stroke.
Dr. Nezar Falluji in an interventional cardiologist specializing in structural heart disease with KentuckyOne Health Cardiology.