Three cases of cerebral infarction after pulmonary resection for left lung cancer

Abstract

We herein report three patients who underwent lobectomy (two left upper lobectomies and one left lower lobectomy) for lung cancer, and developed embolic cerebral infarction in the early postoperative period. Two of these patients were treated with endovascular thrombectomy, which markedly improved their general condition; however, the remaining patient did not receive aggressive endovascular treatment because cerebral infarction occurred in an extended area of the cerebral hemisphere. Recent reports suggested that embolic cerebral infarction after pulmonary resection may cause thrombosis in the stump of the pulmonary vein in patients who undergo lobectomy. Such a complication is particularly frequent in patients who undergo left upper lobectomy compared with other lobectomies. These three patients with brain infarction had undergone a lobectomy of the left lung and there were no other risk factors causing cerebral infarction. Therefore, we considered it highly likely that the thrombus generated on the stump of the pulmonary vein caused the brain infarction. Endovascular thrombectomy is extremely useful for treating acute embolic cerebral infarction. However, realistically, it is difficult to prevent thrombus formation at the stump of the pulmonary vein through surgical techniques. It is thus necessary to consider anticoagulant therapy in patients after undergoing left-sided lobectomy.