How to safely occlude left atrial appendage with a thrombus inside?

In clinical practice, the presence of a thrombus in the left atrial appendage (LAA) is considered a contraindication to percutaneous LAA occlusion. However, in rare circumstances, as in the present case, LAA occlusion is needed despite the presence of a thrombus. While attempting to occlude the LAA in such a case, there is a high risk of thrombus dislodgement. The available data regarding the safety measures that are recommended in terms of the procedural technique are sparse and can be found in only a few case reports and series (1-6). Each report described a different aspect of these safety measures. In the present case, we combined them completely. Some measures are first described in the present case.