Acute ischemic stroke after right middle lobectomy with favorable clinical outcome of mechanical thrombectomy: A case report

RATIONALE: Acute ischemic stroke after lung resection is a rare and serious complication, often caused by a venous stump thrombus. This study presents the first reported case of cerebral embolism caused by a venous stump thrombus after right middle lobe resection and aims to raise clinical awareness and provide evidence for stroke prevention and management strategies in the perioperative period. PATIENT CONCERNS: A 41-year-old woman who had undergone thoracoscopic right middle lobectomy for lung adenocarcinoma with right hemiplegia and complete motor aphasia was admitted to our hospital. DIAGNOSES: After obtaining clinical manifestations, and medical history, the final diagnosis was a cerebral embolism presumably caused by a thrombus in the pulmonary vein stump after right middle lobectomy for lung cancer. INTERVENTIONS: An urgent mechanical thrombectomy was performed under general anesthesia. Following surgical intervention, subcutaneous injections of low molecular weight heparin calcium were initiated at a dosage of twice daily. This regimen was maintained for a period of 5 days. OUTCOMES: On postoperative day 6, the patient was transferred to the rehabilitation department with a modified Rankin Scale score of 2. Imaging studies revealed extensive infarction in the middle cerebral artery territory, along with intracerebral hemorrhage. The patient showed significant neurological improvement over time. LESSONS: We reported a case of a patient who underwent mechanical thrombectomy for acute ischemic stroke after lobectomy for lung cancer. Although all test results were negative, the thrombus source in the patient was still considered to be due to thrombus formation at the residual pulmonary vein. Therefore, it is very important to further explore the etiological prevention and treatment strategies for the perioperative period.