ESOC 2025 | Left atrial appendage occlusion closure for secondary stroke prevention: ongoing clinical trials
Valeria Caso, MD, PhD, FESO, Santa Maria Della Misericordia Hospital, University of Perugia, Perugia, Italy, highlights the growing interest in left atrial appendage occlusion closure as a potential strategy to reduce stroke recurrence in patients who have had a stroke despite optimal medical treatment. She notes two ongoing randomized trials, including the LAAOS-4 (NCT05963698) study, that aim to provide further evidence. This interview took place at the 11th European Stroke Organisation Conference (ESOC) in Helsinki, Finland.
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So, the left appendage occlusion is becoming more and more of interest for stroke neurologists, in patients who had a stroke, despite the best medical treatment. Probably there are some patients who have a cardiogenic recurrence, which is not due to the control of the risk factors, but by the high thrombotic risk of the auricle. And in these cases, we have now some data from observational studies and also some indirect data from randomized studies that on top of medical treatment, left appendage occlusion, as well as surgical as percutaneous, can reduce the risk of recurrence. Now, after this first data that were collected in the stroke community, now we have two randomized trials which are going on. One is the LAAOS-4 trial and one is the ALAPS trial, which is performed in Switzerland together with other countries. It’s a multi-international, multi-center trial that will explore the risk reduction of stroke occurrence in patients treated with left appendage occlusion and best medical treatment compared to those who are treated only with best medical treatment. Hopefully, in two years we will have the results and so we can also have a new opportunity for treatment in our patients.
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