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

Abstract

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