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Magnetic resonance imaging in patients with atrial fibrillation before left atrial appendage closure after brain hemorrhage

Benoit A, Rioufol G, Ong E, Mechtouff L, Cho TH, Derex L, Thibault H, Berthezane Y, Ovize M and Nighoghossian N

Background: Brain MRI may be helpful for selecting patients at higher risk of further bleeding after a first hemorrhagic stroke in patients with atrial fibrillation treated by oral anticoagulants. MRI may detect imaging markers consistent with an increased risk of further bleeding that could improve patient selection for left atrial appendage closure (LAAC). Method: We studied clinical and imaging data of patients with atrial fibrillation treated by oral anticoagulants who experienced hemorrhagic stroke. MRI was performed for the detection of small vessels disease abnormalities (cerebral amyloid angiopathy (AA) or severe hypertensive microangiopathy) suggesting a higher hemorrhagic risk thus supporting the choice of LAAC closure instead of anticoagulants to prevent thromboembolic events. Results: Between December 2013 and February 2016, 37 patients were included. Among them 25 patients experienced brain hemorrhage and underwent a cerebral MRI before LAAC. 16% (4/25) had severe white matter damage, 24% (6/25) exhibit MRI features consistent with hypertensive microangiopathy/or multiple cortical microbleeds (CMBs) and cortical superficial siderosis (CSS) consistent with AA. 16% (4/25) with mixed anomalies and 11 (44%) had undetermined small vessel disease. Conclusion: Brain MRI after a first hemorrhagic stroke may provide helpful information on the risk of bleeding recurrence before LAAC.