Early Closure of Left Atrial Appendage for Patients With Atrial Fibrillation and Ischemic Stroke Despite Anticoagulation Therapy

Inclusion Criteria: * Age ≥ 18 years * Written informed consent * Permanent, persistent, or paroxysmal spontaneous AF previously known or diagnosed during the index hospitalization. * Recent (≤3 months) symptomatic ischemic stroke. * Active and ongoing anticoagulation therapy at stroke onset assessed based on medical history (i.e. any therapeutic oral anticoagulation therapy \[Vitamin K antagonist/DOAC according to prescription recommendations for AF; inadequate low-dose DOAC therapy allowed for inclusion\] not stopped/paused for \>48 hours due to any reason, i.e. medical intervention or non-adherence). * Active or planned long-term therapy with DOAC Exclusion Criteria: * Contraindications to DOAC therapy * Life expectancy \<1 year according to the opinion of the investigator * Stroke due to: Ipsilateral intra/extracranial high-grade stenosis, Isolated lacunar stroke, Other well-defined stroke aetiologies (i.e., endocarditis, vasculitis, Reversible Cerebral Vasoconstriction Syndrome \[RCVS\], Posterior Reversible Encephalopathy Syndrome \[PRES\], cerebral sinus venous thrombosis) * Previous persistent foramen ovale or atrial septum defect closure. * Rheumatic heart disease * Severe heart valve disease that requires treatment (severe aortic stenosis or regurgitation, severe mitral stenosis or regurgitation). * Contraindications for TEE (relevant esophageal varices, esophageal stricture, history of esophageal cancer). * Cardiac or non-cardiac surgical procedure within 30 days of randomization * Enrolled in another investigation of a cardiovascular device or investigating secondary prevention therapy. * Severely reduced Left Ventricular Ejection Fraction (LVEF) \<30%. * Severe renal impairment as described in the summary of medicinal product characteristics for the chosen DOAC (e.g. rivaroxaban, apixaban and edoxaban creatinine clearance \<15 ml/min; dabigatran creatinine clearance \<30 ml/min). * Hypertrophic cardiomyopathy * Intracardiac tumor * Ventricular thrombus * Acute cardiac decompensation * LAA is obliterated or surgically ligated * Persistent proximal LAA thrombus despite 4 weeks of anticoagulation (if a proximal thrombus in the LAA is found, anticoagulation with vitamin K antagonist (INR 2.5-3.5) may be started, and if the thrombus disappears, the patient may be eligible for LAAO) * Pregnancy or breastfeeding (pregnancy test in urine or blood to be performed at screening for women of childbearing potential)