PO-04-009 A UNIQUE CASE OF POST-LARIAT LEAK COIL EMBOLIZATION IN A PATIENT WITH NITINOL ALLERGY

Abstract

Nickel allergy is quite common. The predominant component of nitinol is nickel. Nickel allergy is rare in clinical practice but well established. Most closure devices for the LAA employ nitinol. Lariat ligation of the LAA avoids exposure to nitinol. The incidence of post-lariat leak is variable in the reported literature. Central leaks occur in epicardial devices due to the gunny sack effect. We report a unique case of central leak coil embolization in a patient with a nitinol allergy. In patients with a nickel or nitinol allergy, the use of multiple steel coils to close left atrial appendage closure leaks is feasible and can avoid allergen exposure. N/A A 70-year-old female with a past medical history of atrial fibrillation and atrial flutter s/p endocardial ablation with recurrence. The patient underwent convergent procedure modified with a lariat as the patient had a nitinol allergy. Postoperative TEE revealed the presence of an 8 mm x 4 mm flow in the LAA (Fig 1). The patient later returned leak embolization. A vascular occluder could not be used given the nitinol allergy. Thus, seven platinum coils (60 cmx2, 40 cmx2, 35 cmx2, and 30 cm) (Penumbra, Alameda, CA, USA). Leak closure was subsequently confirmed using TEE and fluoroscopy (Figure). The patient has done well post procedure and is now off oral anticoagulants. The incidence of post-LAAC leak reported in available literature is highly variable. Central leaks occur in epicardial devices due to the gunny sack effect, whereas peripheral leaks occur in endocardial devices due to lack of edge opposition. Just like LAA occlusion or closure, most options for leak closure require exposure to nitinol. A vascular occluder which would ordinarily be used contains nitinol. Radiofrequency ablation requires contact to endocardium and thus not an option for a central leak of this size.