{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T07:22:47Z","timestamp":1793604167343,"version":"4.5.0"},"reference-count":21,"publisher":"American Medical Association (AMA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Neurol"],"published-print":{"date-parts":[[2026,1,1]]},"abstract":"<jats:sec>\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>In the Left Atrial Appendage Occlusion Study III (LAAOS III), surgical occlusion of the LAA during cardiac surgery for patients with known history of atrial fibrillation (AF) substantially reduced the risk of stroke.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess the impact of LAAO on ischemic stroke subtype and outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>\n                      This was a post hoc exploratory analysis of the LAAOS III randomized clinical trial. Data were adjudicated from June 28, 2023, to November 29, 2023, and the main analyses took place from December 18, 2023, to April 29, 2024. The LAAOS III trial recruited participants from 105 centers in 27 countries between July 2012 and October 2018. Patients with AF and a CHA\n                      <jats:sub>2<\/jats:sub>\n                      DS\n                      <jats:sub>2<\/jats:sub>\n                      -VASc score of at least 2 undergoing cardiac surgery for other indications were included in the analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Surgical LAAO plus standard care vs standard care alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>For strokes occurring during the trial, the functional outcome as measured by the modified Rankin Scale (mRS) score at day 7 or discharge, mortality, the presence of cortical infarcts, and the occurrence of infarcts of presumed cardioembolic origin were examined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 4811 participants in the LAAOS III trial followed up for 3.8 years, 273 had a first ischemic stroke. The mean (SD) age of participants at the time of the first ischemic stroke was 75 (7) years, 104 were female (38%), and 169 were male (62%). Participants allocated to receive LAAO had reduced (common odds ratio [OR],\u20090.80; 95% CI, 0.65-0.99) mRS scores at 7 days or discharge and a lower risk for mortality at 30 days (16.5% vs 20.1%; hazard ratio [HR],\u20090.55; 95% CI, 0.31-0.97) after a stroke event. Participants allocated to LAAO had fewer cortical infarcts on neuroimaging (46.2% vs 61.3%; difference in proportions: \u221215.2%; 95% CI, \u221226.7% to \u22123.7%), as well as a lower proportion of ischemic strokes of presumed cardioembolic etiology when compared with ischemic strokes in the no-LAAO group (42.9% vs 57.9%; difference in proportions: \u221215.1%; 95% CI, \u221226.5% to \u22123.7%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>This study found that LAAO in patients with AF undergoing cardiac surgery was associated with a decreased risk of presumed cardioembolic stroke, reduced disability, and mortality from stroke. These findings underscore the benefit of LAAO for patients with AF undergoing cardiac surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>\n                      ClinicalTrials.gov Identifier:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\/study\/NCT01561651\">NCT01561651<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamaneurol.2025.4478","type":"journal-article","created":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T16:31:02Z","timestamp":1763397062000},"page":"76","source":"Crossref","is-referenced-by-count":9,"title":["Stroke Mechanism and Severity After Left Atrial Appendage Occlusion"],"prefix":"10.1001","volume":"83","author":[{"given":"Aristeidis H.","family":"Katsanos","sequence":"first","affiliation":[{"name":"Population Health Research Institute, and Hamilton Health Sciences, Hamilton, Ontario, Canada"},{"name":"Division of Neurology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard P.","family":"Whitlock","sequence":"additional","affiliation":[{"name":"Population Health Research Institute, and Hamilton Health Sciences, Hamilton, Ontario, Canada"},{"name":"Division of Cardiac Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilie P.","family":"Belley-C\u00f4t\u00e9","sequence":"additional","affiliation":[{"name":"Population Health Research Institute, and Hamilton Health Sciences, Hamilton, Ontario, Canada"},{"name":"Divisions of Cardiology and Critical Care, Department of Medicine, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katheryn","family":"Brady","sequence":"additional","affiliation":[{"name":"Population Health Research Institute, and Hamilton Health Sciences, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Wang","sequence":"additional","affiliation":[{"name":"Population Health Research Institute, and Hamilton Health Sciences, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhilekh","family":"Srivastava","sequence":"additional","affiliation":[{"name":"Division of Neurology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory","family":"Jacquin","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Montr\u00e9al, Facult\u00e9 de M\u00e9decine, D\u00e9partement de Neurosciences, Montr\u00e9al Qu\u00e9bec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viktor","family":"Weiss","sequence":"additional","affiliation":[{"name":"Department of Neurology, St. Anne\u2019s University Hospital, Masaryk University, Brno, Czech Republic & Department of Neurology, Tomas Bata Hospital, Zlin, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ond\u0159ej","family":"Voln\u00fd","sequence":"additional","affiliation":[{"name":"University of Ostrava Faculty of Medicine, Department of Clinical Neurosciences, Ostrava, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Sramek","sequence":"additional","affiliation":[{"name":"Department of Neurology, Military University Hospital Prague, Prague, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andre","family":"Peeters","sequence":"additional","affiliation":[{"name":"Department of Neurology, Cliniques Universitaires Saint Luc, UCLouvain, Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo\u00e3o Pedro","family":"Marto","sequence":"additional","affiliation":[{"name":"Department of Neurology, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pawel","family":"Wrona","sequence":"additional","affiliation":[{"name":"Department of Neurology, Jagiellonian University Medical College, Krakow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthoula","family":"Tsolaki","sequence":"additional","affiliation":[{"name":"First Department of Neurology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Macedonia, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linxin","family":"Li","sequence":"additional","affiliation":[{"name":"Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, Oxford University, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonia","family":"Nucera","sequence":"additional","affiliation":[{"name":"Neurovascular Treatment Unit, Spaziani Hospital, Frosinone, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Mikulik","sequence":"additional","affiliation":[{"name":"Department of Neurology, St. Anne\u2019s University Hospital, Masaryk University, Brno, Czech Republic & Department of Neurology, Tomas Bata Hospital, Zlin, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kanjana","family":"Perera","sequence":"additional","affiliation":[{"name":"Population Health Research Institute, and Hamilton Health Sciences, Hamilton, Ontario, Canada"},{"name":"Division of Neurology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luciana","family":"Catanese","sequence":"additional","affiliation":[{"name":"Population Health Research Institute, and Hamilton Health Sciences, Hamilton, Ontario, Canada"},{"name":"Division of Neurology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashkan","family":"Shoamanesh","sequence":"additional","affiliation":[{"name":"Population Health Research Institute, and Hamilton Health Sciences, Hamilton, Ontario, Canada"},{"name":"Division of Neurology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mukul","family":"Sharma","sequence":"additional","affiliation":[{"name":"Population Health Research Institute, and Hamilton Health Sciences, Hamilton, Ontario, Canada"},{"name":"Division of Neurology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"1","key":"noi250078r1","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1001\/jamacardio.2015.0382","article-title":"Preventing stroke in patients with atrial fibrillation\u2014a steep climb away from achieving peak performance.","volume":"1","author":"Piccini","year":"2016","journal-title":"JAMA Cardiol"},{"issue":"1 Pt C","key":"noi250078r2","article-title":"Atrial fibrillation and stroke: state-of-the-art and future directions.","volume":"49","author":"Elsheikh","year":"2024","journal-title":"Curr Probl Cardiol"},{"issue":"15","key":"noi250078r3","doi-asserted-by":"crossref","first-page":"1236","DOI":"10.1161\/CIRCULATIONAHA.114.010942","article-title":"Age-specific incidence, outcome, cost, and projected future burden of atrial fibrillation-related embolic vascular events: a population-based study.","volume":"130","author":"Yiin","year":"2014","journal-title":"Circulation"},{"issue":"1","key":"noi250078r4","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1161\/STROKEAHA.108.516344","article-title":"Potentially preventable strokes in high-risk patients with atrial fibrillation who are not adequately anticoagulated.","volume":"40","author":"Gladstone","year":"2009","journal-title":"Stroke"},{"issue":"3","key":"noi250078r5","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1161\/CIRCRESAHA.116.308407","article-title":"Cardioembolic stroke.","volume":"120","author":"Kamel","year":"2017","journal-title":"Circ Res"},{"issue":"12","key":"noi250078r6","doi-asserted-by":"crossref","first-page":"857","DOI":"10.7326\/0003-4819-146-12-200706190-00007","article-title":"Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation.","volume":"146","author":"Hart","year":"2007","journal-title":"Ann Intern Med"},{"issue":"9921","key":"noi250078r7","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1016\/S0140-6736(13)62343-0","article-title":"Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomized trials.","volume":"383","author":"Ruff","year":"2014","journal-title":"Lancet"},{"issue":"24","key":"noi250078r8","doi-asserted-by":"crossref","first-page":"2371","DOI":"10.1161\/CIRCULATIONAHA.120.049768","article-title":"Stroke prevention in atrial fibrillation: looking forward.","volume":"142","author":"Katsanos","year":"2020","journal-title":"Circulation"},{"issue":"22","key":"noi250078r9","doi-asserted-by":"crossref","first-page":"2081","DOI":"10.1056\/NEJMoa2101897","article-title":"Left atrial appendage occlusion during cardiac surgery to prevent stroke.","volume":"384","author":"Whitlock","year":"2021","journal-title":"N Engl J Med"},{"key":"noi250078r10","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/j.ahj.2018.03.027","article-title":"Stroke type and severity in patients with subclinical atrial fibrillation: an analysis from the Asymptomatic Atrial Fibrillation and Stroke Evaluation in Pacemaker Patients and the Atrial Fibrillation Reduction Atrial Pacing Trial (ASSERT).","volume":"201","author":"Perera","year":"2018","journal-title":"Am Heart J"},{"issue":"1","key":"noi250078r11","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1001\/jamaneurol.2019.2984","article-title":"Association between low-dose rivaroxaban with or without aspirin and ischemic stroke subtypes: a secondary analysis of the COMPASS trial.","volume":"77","author":"Perera","year":"2020","journal-title":"JAMA Neurol"},{"issue":"1","key":"noi250078r12","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1161\/01.STR.24.1.35","article-title":"Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial: TOAST Trial of Org 10172 in Acute Stroke Treatment.","volume":"24","author":"Adams","year":"1993","journal-title":"Stroke"},{"key":"noi250078r13","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.carrev.2024.12.007","article-title":"Impact of percutaneous left atrial appendage occlusion on the severity of ischemic stroke.","volume":"74","author":"Maraey","year":"2025","journal-title":"Cardiovasc Revasc Med"},{"key":"noi250078r16","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.ahj.2024.10.006","article-title":"The Left Atrial Appendage Exclusion for Prophylactic Stroke Reduction (LEAAPS) trial: rationale and design.","volume":"284","author":"Whitlock","year":"2025","journal-title":"Am Heart J"},{"key":"noi250078r18","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.ahj.2023.06.003","article-title":"The Left Atrial Appendage Closure by Surgery 2 (LAACS-2) trial protocol rationale and design of a randomized multicenter trial investigating if left atrial appendage closure prevents stroke in patients undergoing open-heart surgery irrespective of preoperative atrial fibrillation status and stroke risk.","volume":"264","author":"Madsen","year":"2023","journal-title":"Am Heart J"},{"issue":"4","key":"noi250078r19","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1016\/S1474-4422(13)70310-7","article-title":"Embolic strokes of undetermined source: the case for a new clinical construct.","volume":"13","author":"Hart","year":"2014","journal-title":"Lancet Neurol"},{"issue":"1","key":"noi250078r20","doi-asserted-by":"crossref","DOI":"10.1136\/bmjno-2021-000177","article-title":"Predicting 90-day modified Rankin Scale score with discharge information in acute ischemic stroke patients following treatment.","volume":"3","author":"ElHabr","year":"2021","journal-title":"BMJ Neurol Open"},{"issue":"1","key":"noi250078r21","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.jacc.2023.08.017","article-title":"2023 ACC\/AHA\/ACCP\/HRS guideline for the diagnosis and management of atrial fibrillation: a report of the American College of Cardiology\/American Heart Association joint committee on clinical practice guidelines.","volume":"83","author":"Joglar","year":"2024","journal-title":"J Am Coll Cardiol"},{"key":"noi250078r14","unstructured":"The Fourth Left Atrial Appendage Occlusion Study (LAAOS-4). ClinicalTrials.gov identifier: NCT05963698. Updated October 3, 2025. Accessed October 24, 2025. https:\/\/www.clinicaltrials.gov\/study\/NCT05963698"},{"key":"noi250078r15","unstructured":"Left Atrial Appendage Exclusion for Prophylactic Stroke Reduction Trial (LeAAPS). ClinicalTrials.gov identifier: NCT05478304. Updated August 12, 2025. Accessed October 24, 2025. https:\/\/www.clinicaltrials.gov\/study\/NCT05478304"},{"key":"noi250078r17","unstructured":"Left Atrial Appendage Closure by Surgery 2 (LAACS-2). ClinicalTrials.gov identifier: NCT03724318. Updated December 9, 2024. Accessed October 24, 2025. https:\/\/www.clinicaltrials.gov\/study\/NCT03724318"}],"container-title":["JAMA Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamaneurology\/articlepdf\/2841567\/jamaneurology_katsanos_2025_oi_250078_1767644879.26954.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T16:01:04Z","timestamp":1768233664000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamaneurology\/fullarticle\/2841567"}},"subtitle":["Insights From the LAAOS III Randomized Clinical Trial"],"short-title":[],"issued":{"date-parts":[[2026,1,1]]},"references-count":21,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamaneurol.2025.4478","relation":{},"ISSN":["2168-6149"],"issn-type":[{"value":"2168-6149","type":"print"}],"subject":[],"published":{"date-parts":[[2026,1,1]]}}}