Acute coronary syndrome during pregnancy is rare with limited evidence; management must be tailored to safeguard both mother and fetus. A 40-year-old woman with type 2 diabetes presented with acute coronary syndrome at 11+3 weeks' gestation. She underwent intracoronary imaging-guided percutaneous coronary intervention (PCI) (3.0- × 28-mm stent, mean external elastic lamina diameter: 3.07 mm, lesion length: 28 mm) under minimal radiation (estimated fetal dose: ≈0.00004 mGy). After optimal stent implantation, 6 weeks of dual antiplatelet therapy with aspirin and clopidogrel were followed by lifelong aspirin. Pregnancy was uncomplicated with healthy infant delivered at 39 weeks. Postpartum angiography confirmed good result, and statin was initiated. Intracoronary imaging-guided PCI enables precise diagnosis and tailored therapy with reduced radiation exposure. Drug regimens balance maternal benefit and fetal safety. Intracoronary imaging-guided PCI allows precise and safe treatment in pregnant ACS patients. Drug therapy must be adapted to avoid fetal risk while ensuring maternal protection.

Objective: To determine the incidence of recurrent ischemic stroke following percutaneous left atrial appendage closure in patients with previous thromboembolic events despite oral anticoagulation. Methods: We conducted a systematic review and meta-analysis of studies of any design reporting ischemic stroke recurrence after left atrial appendage closure in patients with prior ischemic stroke despite oral anticoagulation therapy. The literature search was conducted in MEDLINE, Embase, and the Cochrane Library for studies published between 1 January 2010 and 31 December 2025. Data on study design, population characteristics, indexed intervention, and outcomes were extracted from each included report. The primary outcome was ischemic stroke occurring after left atrial appendage closure, as defined by each individual study. A pooled incidence rate was estimated using a random-effects model to account for anticipated between-study heterogeneity. The study is registered in Open Science Framework. The Risk of Bias in Non-randomized Studies of Interventions assessment tool was used to assess the risk of bias. Results: Overall, eight studies of a total of 1091 patients met the eligibility criteria. Patients were elderly (mean age range 71.8 to 78.1 years), 33% to 53% were women, and thromboembolic risk was consistently high (mean CHA₂DS₂-VASc scores ≥ 5.0). The risk of bias across the included studies was either moderate or serious. Antithrombotic therapy after left atrial appendage closure varied considerably across the included studies. In one study, all patients were discharged on dual antiplatelet therapy, whereas in five studies >70% received oral anticoagulation alone or in combination with antiplatelet therapy at discharge. In six studies, antithrombotic therapy at follow-up was reported, with the proportion of patients on oral anticoagulation alone or in combination with antiplatelet therapy at follow-up ranging from 8.1% to 100% in individual studies. Follow-up duration ranged from 1.0 to 3.1 years. At a mean follow-up of 17.7 months the pooled incidence of the ischemic stroke recurrence rate following left atrial appendage closure was 3.1% per year (95% confidence interval 2.35–4.20%). Conclusions: Among elderly patients with prior ischemic stroke despite oral anticoagulation, the recurrence rate of ischemic stroke following left atrial appendage closure was 3.1% per year. Given the residual risk of stroke recurrence and the substantial heterogeneity in post-procedural antithrombotic management observed across studies, prospective randomized trials are urgently needed to define both the protective impact of left atrial appendage closure and the optimal antithrombotic strategy in this high-risk population.

Background—Percutaneous left atrial appendage (LAA) closure (LAAC) offers a valid alternative to oral anticoagulation in patients with atrial fibrillation (AF) at high risk of bleeding. However, its impact on AF burden and device function in patients with cardiac implantable electronic devices (CIEDs) remains largely unexplored. Methods—From our prospective LAAC registry (clinicaltrial.gov—NCT04628078), which includes all consecutive LAAC procedures performed at our institution, we identified patients with a CIED and retrospectively analyzed procedural and follow-up data. The primary endpoint was defined as a composite of death, TIA/stroke, systemic or pulmonary embolism and major bleeding (BARC 3-5) within 7 days of the procedure. The secondary endpoint was CIED lead dislodgement. Additionally, AF burden was compared before and after LAAC. Results—Of the 586 LAAC procedures performed between August 2015 and January 2023, 36 patients (6%) had a CIED. The median CHA₂DS₂-VASC and HAS-BLED scores were 4.0 and 3.0, respectively. The primary endpoint occurred in one (3%) patient, and no patient experienced CIED lead dislodgement. AF burden data before and after LAAC were available in 20 patients. The mean AF burden increased from 6% to 31% following LAAC (p = 0.064). Conclusions—A CIED was present in 6% of LAAC procedures, and LAAC appears feasible and safe in this patient population. Larger, prospective studies are warranted to further evaluate the impact of LAAC on AF burden.