Successful Endovascular Treatment for Middle Cerebral Artery Occlusion Caused by the Thrombus Formation in the Pulmonary Vein Stump Following Left Upper Lung Lobectomy

Abstract

Thrombus formation in the pulmonary vein (PV) stump after lung resection can cause rare cases of cerebral infarction. These infarctions can result in embolism and ischemia in the relatively large intracranial vessels, severely impacting the quality of life (QOL) of these patients. We performed endovascular thrombectomy successfully for this rare complication after lung lobectomy. A 73-year-old woman with paroxysmal atrial fibrillation (AF) suffered from sudden left complete hemiplegia 19 days after undergoing a left upper lung lobectomy (LUL). Magnetic resonance imaging (MRI) showed middle cerebral artery occlusion. Her left hemiplegia improved after the endovascular thrombectomy. Cardiogenic embolism was first suspected, but contrast-enhanced computed tomography (CECT) showed thrombus formation in the PV stump. We continued anticoagulant therapy, and the thrombus resolved completely two months after the stroke. Our patient had a relatively good outcome due to the immediate reperfusion of the affected area. This embolic source may be overlooked because AF frequently occurs after thoracic surgeries. Care should be taken during the postoperative phase to avoid overlooking these emboli. All thoracic surgeons should be informed about mechanical thrombectomy as an effective treatment for postoperative cerebral infarction.

Severe acute ischaemic stroke early after wedge resection in middle-aged patients: analysis and endovascular treatment

“…Except 2 patients, other 7 patients received endovascular thrombus aspiration promptly and had good neurological prognosis. The advent of strategy has resulted in drastic success in stroke management [ 9 ]. The recanalization rate is high as 81.6% with better neurological improvement and lower adverse effects compared with traditional treatment [ 10 ].…”

Endovascular treatment for postoperative cerebral embolism after video-assisted thoracic surgery: Report of 3 cases and literature review

“…We reported three cases of cerebral infarction after video-assisted thoracic surgery on the lungs, obtained good functional outcomes after mechanical thrombectomy in the emergency, aiming to emphasize on the perioperative stroke associated with thoracic interventional treatment, and to confirm the effectiveness of emergent endovascular treatment for the disease. The review of previous reported and our patients' characteristics are listed in the table 1 [6,9,14,16].…”