Why the study?
Perioperative acute ischemic stroke following lung resection is a devastating complication, with patients undergoing left upper lung lobectomy being particularly susceptible.
Does endovascular stenting improve outcomes in a patient with carotid bulb occlusion by a giant thrombus following lung lobectomy?
Does endovascular stenting improve outcomes in a patient with carotid bulb occlusion by a giant thrombus following lung lobectomy?
Endovascular stenting can be an effective treatment for carotid bulb thromboembolism caused by a giant thrombus following lung lobectomy when endovascular thrombectomy fails.
Alerts clinicians to POD2 stroke risk after left upper lobectomy; leaves open targeted prophylaxis trials.
BACKGROUND: Perioperative acute ischemic stroke following lung resection is relatively rare, though a devastating complication. Specifically, patients undergoing left upper lung lobectomy for lung cancer are likely to develop perioperative acute ischemic stroke. CASE PRESENTATION: A 67-year-old man underwent thoracoscopic left upper lung lobectomy for lung adenocarcinoma; he experienced sudden-onset left hemiparesis and dysarthria on the morning of the second postoperative day. Angiography revealed occlusion of the bulbs of the right internal and external carotid arteries by a giant thrombus, which could not be removed through endovascular thrombectomy. We deployed a stent at the right carotid bifurcation to foist the giant thrombus, achieving revascularization 4 h after the onset. Treatment response was assessed as good improvement with a modified Rankin scale score of 0, and the patient was discharged home 19 days after symptom onset. CONCLUSIONS: We present a unique case of carotid bulb thromboembolism resulting from a giant thrombus following thoracoscopic left upper lung lobectomy, for which endovascular stenting was effective.
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Saito et al. (2023) studied this question.
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