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Left atrial appendage occlusion (LAAO) has emerged as a potential alternative to OAC for stroke prevention in high-bleeding-risk AF patients. Small observational studies suggest that LAAO may be safe and feasible in patients with ICrH, when using single or dual antiplatelet therapy or short-term OAC post-procedure, though data remain limited. This systematic review and meta-analysis aims to consolidate evidence on the safety and efficacy of LAAO in patients with prior ICrH or CAA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We conducted a systematic review and meta-analysis examining the safety and efficacy of LAAO in patients with non-valvular AF and prior ICrH and\/or CAA. PubMed\/MEDLINE and EMBASE (via Scopus) databases were systematically searched from inception until 29 February 2024. Eligible studies included randomized control trials, observational studies, and case series (\u2a7e10 participants) reporting stroke events in patients with AF and previous history of ICrH and\/or CAA undergoing LAAO. Pooled incidence rates (IRs) with corresponding 95% confidence intervals (CIs) were calculated for primary outcomes (post-procedural ischemic stroke and recurrent ICrH) and secondary outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Fourteen studies including 1235 patients met inclusion criteria. The pooled average follow-up period was 17.1\u2009months. The pooled IRs for ischemic stroke, recurrent ICrH, and major hemorrhage were 2% (95% CI: 1\u20133%, I\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20092%), 2% (95% CI: 0.4\u20133%, I\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200945%) and 3% (95% CI: 1\u20135%, I\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200954%), respectively. In prespecified subgroup analyses of studies focusing on patients with intraparenchymal hemorrhage and\/or CAA, pooled IRs for ischemic stroke, recurrent ICrH, and major hemorrhage IR of 4% (95% CI: 1\u20138%), 4% (95% CI: 0.4\u201310%) and 6% (95% CI: 3\u201312%), respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>LAAO may be a safe and effective treatment for selected AF patients with a history of ICrH and\/or CAA, but the quality of evidence is poor. Future randomized controlled trials are essential to validate LAAO\u2019s efficacy and long-term safety.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17474930251360076","type":"journal-article","created":{"date-parts":[[2025,7,11]],"date-time":"2025-07-11T04:34:41Z","timestamp":1752208481000},"page":"1049-1059","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":12,"title":["Left atrial appendage occlusion in patients with atrial fibrillation and previous Intracranial Hemorrhage or Cerebral Amyloid Angiopathy: A systematic review and meta-analysis"],"prefix":"10.1177","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5952-5106","authenticated-orcid":false,"given":"Theodoros","family":"Mavridis","sequence":"first","affiliation":[{"name":"Department of Neurology, Tallaght University Hospital (TUH)\/The Adelaide and Meath Hospital, Dublin, Incorporating the National Children\u2019s Hospital (AMNCH), Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6660-6916","authenticated-orcid":false,"given":"Paraschos","family":"Archontakis-Barakakis","sequence":"additional","affiliation":[{"name":"Redington-Fairview General Hospital, Skowhegan, Maine, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David-Dimitris","family":"Chlorogiannis","sequence":"additional","affiliation":[{"name":"Department of Radiology, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5891-337X","authenticated-orcid":false,"given":"Andreas","family":"Charidimou","sequence":"additional","affiliation":[{"name":"Department of Neurology, Boston University Medical Center, Boston University School of Medicine, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,8,3]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(91)90585-W"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199011293232201"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-146-12-200706190-00007"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.288.19.2441"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.84.2.527"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199211123272002"},{"key":"e_1_3_2_8_2","first-page":"687","article-title":"Warfarin versus aspirin for prevention of thromboembolism in atrial fibrillation: stroke prevention in atrial fibrillation II study","volume":"343","author":"Investigators SPiAF","year":"1994","unstructured":"Investigators SPiAF. 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