"Cerebral Infarction with the Heart in Atrial Fibrillation and the Brain with Cavernoma: What to Do in the Face of a Cross of Contraindications?"

Abstract

 Atrial fibrillation (AF) is the most common sustained arrhythmia and a major risk factor for stroke. Anticoagulant management becomes challenging in patients with cerebral cavernous malformations (CCMs) due to the high risk of intracranial hemorrhage.
We report the case of a 68-year-old woman recently diagnosed with AF, CHA₂DS₂-VA score of 4, and HAS-BLED score of 5, who suffered a cerebral infarction and had imaging evidence of cerebellar hemorrhage. Multiple CCMs were identified, contraindicating the use of oral anticoagulants. Given the high thromboembolic burden and contraindication to standard treatment, percutaneous left atrial appendage occlusion (LAAO) was considered as an alternative therapy.
This case highlights the clinical challenge of managing patients with both high thromboembolic and hemorrhagic risk and underscores the efficacy and safety of LAAO when oral anticoagulation is contraindicated.
It is concluded that in complex clinical scenarios involving conflicting risks, interventional therapies such as LAAO may provide a viable solution. Inclusion of this therapy in public health policies should be considered to broaden access to advanced treatments for high-risk populations.