PMC7693558_01
CT scan of the brain. (A) Left side: cortico-subcortical temporo-parieto-insular hypodensity. Right side: subcortical lenticular hypodensity. (B) Left side: cortico-subcortical parietal hypodensity. (C,D) Right side: cortico-subcortical parietal hypodensity.
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F1
Neuroimaging revealed a left temporo-parieto-insular cortico-subcortical ischemic lesion (Figures 1A,B). Two months later the patient had another ischemic stroke characterized by motor impairment in the left hand associated with a right cortico-subcortical parietal ischemic lesion (Figures 1C,D).
(A) CT scan of the LAA. Proximally the LAA presented a single lobe with oval-shaped ostium while distally it divided into multiple lobes, favoring blood stagnation (arrows), configuring a cactus morphology (B). (C) Transesophageal echocardiography, performed intraprocedurally revealed a "plus" image in the distal part of the appendage (arrows). (D) selective angiography revealed stagnation of dye in the distal lobe, with a slow wash out (E - star). (F) Final result after successful LAA occlusion with implantation of a 25 mm Amplatzer Amulet device (Abbott, Chicago, IL, USA).
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It revealed an oval-shaped LAA with windsock-like morphology in the proximal part (ostium and landing zone) while distally the LAA presented multi-lobated with a large amount of pectinate muscles and a small retro-verse distal lobe with a small amount of blood stagnation (Figure 2A), configuring a cauliflower morphology according to Di Biase criteria (Figure 2B). Transesophageal echocardiography was performed prior to the procedure revealing a "plus" image in the distal part of the appendage suspected of being a clot (Figure 2C). Selective angiography showed stagnation of contrast in the distal lobe, with a slow wash out (Figures 2D,E). LAA-occlusion was successfully performed with a 25 mm Amplatzer Amulet occluder (Abbott, Chicago, IL, USA) (Figure 2F) and subsequent recovery was uneventful.