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

Gen Thorac Cardiovasc Surg Cases. 2023 Nov 28;2(1):104. doi: 10.1186/s44215-023-00116-4.

Abstract

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.

Keywords: Acute ischemic stroke; Carotid occlusion; Endovascular stenting; Endovascular thrombectomy; Hypercoagulable state; Left upper lung lobectomy.