Internal carotid bulb occlusion by a giant thrombus after thoracoscopic left upper lung lobectomy successfully treated with endovascular stenting: a case report

Abstract

BackgroundPerioperative 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 presentationA 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.ConclusionsWe 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.