Neurointervention.  2022 Nov;17(3):168-173. 10.5469/neuroint.2022.00367.

Mechanical Thrombectomy for Acute Ischemic Stroke due to Thrombus in the Pulmonary Vein Stump after Left Pulmonary Lobectomy: A Case Series

• Tsuji Y
• Yagi R
• Hiramatsu R
• Wanibuchi M

• KMID: 2535952
• DOI: http://doi.org/10.5469/neuroint.2022.00367

Abstract

Cerebral embolic stroke caused by a thrombus in the pulmonary vein stump after left pulmonary lobectomy is a serious complication. We retrospectively analyzed four patients who underwent mechanical thrombectomy for large-vessel occlusion after left pulmonary lobectomy between January 2014 and March 2022. Two cases occurred after left upper lobectomy and the others occurred after left lower lobectomy. All patients presented with cerebral embolic stroke from the day after surgery to the 9th postoperative day, and successful reperfusion was achieved in all cases. Two patients had good outcomes at 90 days. Thrombus in the pulmonary vein stump is the probable cause of cerebral embolism, and mechanical thrombectomy is effective. Further studies are required to establish preventive measures and perioperative management strategies.

Keyword

Thrombectomy; Stroke; Pulmonary vein stump; Pulmonary lobectomy

Figure

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  Fig. 1. (A) Diffusion-weighted imaging showing acute ischemic stroke in the left caudate head and insular ribbon (arrows). (B) Fluid-attenuated inversion recovery showing hyperintense vessels in the middle cerebral artery (arrowheads). (C) Magnetic resonance angiography showing complete occlusion of the left internal cerebral artery (ICA) (arrow). (D) Left carotid angiography showing left ICA occlusion. (E) Left carotid angiography showing complete reperfusion. (F) Axial chest contrast-enhanced computed tomography showing a suspected thrombus in the pulmonary vein stump (arrowhead).

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  Fig. 2. (A) Diffusion-weighted imaging (DWI) showing hyperintense signals in the right deep white matter, M4 and M5 evaluated with diffusion imaging (arrow). (B) Magnetic resonance angiography showing occlusion of the right middle cerebral artery (MCA) (arrow). (C) Right carotid angiography showing left MCA occlusion. (D) Right carotid angiography showing complete reperfusion after aspiration. (E) Coronal chest contrast-enhanced computed tomography showing no thrombus in the pulmonary vein stump. DWI-ASPECTS, Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Scores.

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