Mechanical Thrombectomy for Acute Ischemic Stroke Arising from Thrombus of the Left Superior Pulmonary Vein Stump after Left Pneumonectomy: A Case Report

Sonobe, Shinya; Yoshida, Masahiro; Niizuma, Kuniyasu; Tominaga, Teiji

doi:10.2176/nmccrj.cr.2018-0163

Cited by 9 publications

(8 citation statements)

References 14 publications

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“…Our findings also revealed that pulmonary procedure seems to be another prominent risk factor for inpatient LVO, which has been reported in a few cases before 20–22 . The causes of ischemic stroke after lung lobectomy are multifactorial, and among them, thrombus formation in the pulmonary vein stump after lung lobectomy has been identified as the main cause of ischemic stroke 20–22 . In the present study, inpatient stroke alerts activation after pulmonary lobectomy occurred in 8 patients, all of them had a final diagnosis of LVO.…”

Section: Discussionsupporting

confidence: 71%

“…In our LVO cohort (n = 94), the proportion of atrial fibrillation was 41.5% (39/94), stroke onset among cardiology wards was 50.0% (47/94), and 20.2% (19/94) of them occurred after the cardiac procedure, which were significantly higher than those (14.8%, 22/149; 21.5%, 32/149; 4.0%, 6/149) in the non-LVO cohort (n = 149), respectively. Our findings also revealed that pulmonary procedure seems to be another prominent risk factor for inpatient LVO, which has been reported in a few cases before 20–22 . The causes of ischemic stroke after lung lobectomy are multifactorial, and among them, thrombus formation in the pulmonary vein stump after lung lobectomy has been identified as the main cause of ischemic stroke 20–22 .…”

Section: Discussionsupporting

confidence: 71%

“…Our findings also revealed that pulmonary procedure seems to be another prominent risk factor for inpatient LVO, which has been reported in a few cases before. [20][21][22] The causes of ischemic stroke after lung lobectomy are multifactorial, and among them, thrombus formation in the pulmonary vein stump after lung lobectomy has been identified as the main cause of ischemic stroke. [20][21][22] In the present study, inpatient stroke alerts activation after pulmonary lobectomy occurred in 8 patients, all of them had a final diagnosis of LVO.…”

Section: Discussionmentioning

confidence: 99%

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Design and Validation of a Novel Evaluation Scale to Predict Inpatient Large Vessel Occlusion Strokes: Clinical Assessment Stroke Severity for Inpatient Scale

Qiu¹,

Ke²,

Jia³

et al. 2023

J Comput Assist Tomogr

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Objectives: A large quantity of ischemic stroke events occur in patients hospitalized for non-stroke-related reason. No scale has been developed to identify the large vessel occlusion (LVO) among inpatient stroke alerts. We aimed to develop a novel evaluation scale to predict LVO from in-hospital stroke alerts.Methods: Data from consecutive in-hospital stroke alerts were analyzed at a single high volume stroke center between January 2016 and October 2020. We developed a predictive scale based on the first half of patients (training group) using multivariate logistic regression and evaluated it in the remaining half of patients (validation group) adopting receiver operating curve. Receiver operating characteristics of the scale were analyzed to evaluate its value for the detection of LVO.Results: A total of 243 patients were enrolled for further study, among them, 94 (38.7%) had confirmed LVO. Three risk factors independently predicted the presence of LVO: recent cardiac or pulmonary procedure (1 point), neurological deficit scale (≥1: 2 points), and history of atrial fibrillation (1 point). The CAPS scale was generated based on predictive factors and demonstrated highly effective discrimination in identifying the presence of LVO in the training group (area under curve = 0.956) and the validation group (area under curve = 0.940). When the score ≥2, CAPS scale showed 97.9% sensitivity, 79.2% specificity, 74.8% positive predictive value, and 98.3% negative predictive value for discriminating LVO.Conclusions: CAPS scale was developed for identifying LVO among inpatient stroke alerts with high sensitivity and specificity, which may help to quickly prompt responses by appropriate stroke teams.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

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Design and Validation of a Novel Evaluation Scale to Predict Inpatient Large Vessel Occlusion Strokes: Clinical Assessment Stroke Severity for Inpatient Scale

Qiu¹,

Ke²,

Jia³

et al. 2023

J Comput Assist Tomogr

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“…Thus, we speculate that left pneumonectomy may also be a risk factor for postoperative stroke. However, there is only one case report that mentions the relationship between left pneumonectomy and stroke 12 . In addition, these studies are retrospective in nature and are only performed in patients with lung cancer, and whether this conclusion is applicable to patients other than lung cancer remains relatively unknown.…”

Section: Introductionmentioning

confidence: 99%

Both left upper lobectomy and left pneumonectomy are risk factors for postoperative stroke

Xie

Meng

et al. 2019

Sci Rep

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Retrospective studies have found that left upper lobectomy (LUL) may be a new risk factor for stroke, and the potential mechanism is pulmonary vein thrombosis, which more likely develops in the left superior pulmonary vein (LSPV) stump. The LSPV remaining after left pneumonectomy is similar to that remaining after LUL. However, the association between left pneumonectomy, LUL, and postoperative stroke remains unclear. Thus, we sought to analyze whether both LUL and left pneumonectomy are risk factors for postoperative stroke. We prospectively included consecutive patients who underwent resection between November 2016 and March 2018 at our institution with 6 months of follow-up. Baseline demographic and clinical data were taken. A logistic regression model was used to determine independent predictors of postoperative stroke. In our study, 756 patients who underwent an isolated pulmonary lobectomy procedure were screened; of these, 637 patients who completed the 6-month follow-up were included in the analysis. Multivariable logistic regression analysis adjusted for common risk factors showed that the LUL and left pneumonectomy were independent predictors of stroke (odds ratio, 18.12; 95% confidence interval, 2.12–155.24; P = 0.008). Moreover, diabetes mellitus also was a predictor of postoperative stroke. In conclusion, both LUL and left pneumonectomy are significant risk factors for postoperative stroke.

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“…Moreover, the recovery of motor function after stroke has been a primary target of recent studies [ 12 - 15 ]. PVTs also have the potential to cause IS [ 16 ]; therefore, we need to pay attention to PVTs to prevent cardioembolism occurrence and recurrence.…”

Section: Introductionmentioning

confidence: 99%

The Desirable Effects of Edoxaban on Thrombi in the Left Atrium Are Seemingly Connected to Pulmonary Vein Thrombi

Takeuchi

2024

Cureus

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Ischemic stroke (IS) causes various degrees of disability that sometimes induce social problems: therefore, preventing the occurrence and recurrence of IS is important. The recovery of motor function has been extensively studied. The characteristics of retrieved thrombi have become clearer; however, it is unclear what thrombi cause IS. Pulmonary vein thrombi (PVTs), such as those of the IS, can cause systemic thrombosis, by releasing several sizes of particles. PVTs are common but are underrated and can be detected via enhanced computed tomography (CT) and transesophageal echocardiography (TEE). PVTs often extend to the left atrium (LA) and can be mainly diagnosed using not enhanced CT but rather TEE. Extended LA thrombi are characterized by a lack of periodic movement with heartbeats. Direct oral anticoagulants (DOACs) are useful for preventing IS. We reported that rivaroxaban partially dissolved LA thrombi and PVTs using enhanced CT and TEE; however, the effects of edoxaban on LA thrombi and PVTs are unclear. We checked the images using enhanced CT and TEE and treated them with edoxaban. The patient was a 73-year-old female with easy fatigability. Edoxaban desirably affected the LA thrombi, and edoxaban partially dissolved the thrombi in the right lower pulmonary vein (RLPV). A decreased dose of edoxaban (15 mg, once a day) had similar effects on LA thrombi and RLPV thrombi, suggesting that this treatment could be useful for preventing IS.

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Mechanical Thrombectomy for Acute Ischemic Stroke Arising from Thrombus of the Left Superior Pulmonary Vein Stump after Left Pneumonectomy: A Case Report

Cited by 9 publications

References 14 publications

Design and Validation of a Novel Evaluation Scale to Predict Inpatient Large Vessel Occlusion Strokes: Clinical Assessment Stroke Severity for Inpatient Scale

Design and Validation of a Novel Evaluation Scale to Predict Inpatient Large Vessel Occlusion Strokes: Clinical Assessment Stroke Severity for Inpatient Scale

Both left upper lobectomy and left pneumonectomy are risk factors for postoperative stroke

The Desirable Effects of Edoxaban on Thrombi in the Left Atrium Are Seemingly Connected to Pulmonary Vein Thrombi

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