[Cerebral amyloid angiopathy and left atrial appendage occlusion: evidence and possible management for a collaborative approach between Cardiology and Neurology]

This review highlights the epidemiological and clinical challenge associated with managing patients who have cerebral amyloid angiopathy (CAA) and atrial fibrillation. As the population ages, clinicians are increasingly required to devise appropriate management strategies for this specific patient subgroup. These patients face not only the risk of intracerebral hemorrhage associated with oral anticoagulant therapy but also complications due to CAA. CAA is an age-related small vessel disease characterized by the deposition of β-amyloid in the walls of cortical and leptomeningeal arteries, arterioles, and capillaries. This condition progressively weakens the vascular integrity, thereby increasing the risk of major bleeding events. The lack of randomized clinical trials necessitates a multiparametric and multidisciplinary approach to assess the extent of vasculopathy and balance thromboembolic and hemorrhagic risks, aiming to tailor the most effective management strategy for each patient. In managing such cases, it is crucial to address concomitant risk factors and consider both pharmacological and non-pharmacological interventions, such as left atrial appendage occlusion, to mitigate the risk of stroke.