Revascularization for In-Hospital Acute Ischemic Stroke After Video-Assisted Thoracic Surgery: Report of 2 Cases and Literature Review.

Abstract

BACKGROUND:

Postoperative cerebral embolism after left upper lobectomy caused by a thrombus in the pulmonary vein stump (PVS) is a serious complication. However, it is unclear whether cerebral embolism can develop after other types of lobectomy. We present 2 cases of revascularization for in-hospital acute ischemic stroke after video-assisted thoracic surgery (VATS).

CASE DESCRIPTION:

Patient 1 is a 71-year-old man with a history of hypertension and dyslipidemia. VATS was performed for lung cancer in the left upper lobe. On day 0 after VATS, he developed an acute ischemic stroke (left M3 occlusion). Revascularization was performed, and TICI 2b was obtained. He was transferred to a recovery rehabilitation hospital with a modified Rankin Scale score of 3. No ischemic or hemorrhagic stroke was observed 12 months postoperatively. Patient 2 is a 76-year-old man who had a history of hypertension. VATS was performed for metastatic lung cancer in the left lower lobe. On day 6 after VATS, he developed an acute ischemic stroke (left M1 occlusion). Revascularization was performed and TICI 3 was obtained. He was transferred to a recovery rehabilitation hospital with a modified Rankin Scale score of 1. No ischemic or hemorrhagic stroke was observed 13 months postoperatively.

CONCLUSIONS:

Postoperative PVS thrombosis causes embolisms, and dabigatran has been effective in preventing postoperative recurrences. Further study of preventive and perioperative management is necessary.

• Authors: Yusuke Morinaga, Kouhei Nii, Kimiya Sakamoto, Ritsurou Inoue, Takafumi Mitsutake, Hayatsura Hanada
• Journal: World neurosurgery (World Neurosurg) Vol. 129 Pg. 28-33 (Sep 2019) ISSN: 1878-8769 [Electronic] United States
• PMID: 31150859 (Publication Type: Case Reports, Journal Article, Review)
• Copyright: Copyright © 2019 Elsevier Inc. All rights reserved.

Topics

• Aged
• Endovascular Procedures (methods)
• Humans
• Intracranial Embolism (etiology)
• Intracranial Thrombosis (etiology)
• Male
• Pneumonectomy (adverse effects, methods)
• Stroke (etiology, surgery)
• Thoracic Surgery, Video-Assisted (adverse effects)
• Thrombectomy (methods)
• Venous Thrombosis (etiology)