Cerebral embolic stroke caused by a thrombus in the pulmonary vein stump after left pulmonary lobectomy is a serious complication. We retrospectively analyzed four patients who underwent mechanical thrombectomy for large-vessel occlusion after left pulmonary lobectomy between January 2014 and March 2022. Two cases occurred after left upper lobectomy and the others occurred after left lower lobectomy. All patients presented with cerebral embolic stroke from the day after surgery to the 9th postoperative day, and successful reperfusion was achieved in all cases. Two patients had good outcomes at 90 days. Thrombus in the pulmonary vein stump is the probable cause of cerebral embolism, and mechanical thrombectomy is effective. Further studies are required to establish preventive measures and perioperative management strategies.

PURPOSE: Conventional coil embolization for large carotid cavernous aneurysms (CCAs) has limited utility due to its inability to prevent recurrences and reduce mass effect. Trapping of the parent artery may have a risk of ischemic complications due to intracranial perfusion disorders. We successfully treated 24 patients with large CCAs using a flow diverter (Pipeline™ embolic device: PED), and this report discusses the safety and efficacy of this method. MATERIALS AND METHODS: Twenty four patients (23 females, mean age 71.5 years old) with large CCAs, including 6 giant CCAs, were treated with a PED over three years. Under sufficient dual anti-platelet management, the PED was deployed over the orifice of the aneurysm. Two patients required multiple telescoping stents. Clinical and radiological states were checked with MRI at 1, 3 and 6 months post-surgically. Angiographic follow-up was performed at 6 months. RESULTS: In all patients, PED was appropriately deployed. Stagnation of contrast with eclipse signs was observed post-angiogram in 21 cases. One patient requiring 5 telescoping stents experienced temporary ischemic symptoms. Fourteen patients experienced improvement of ocular motor impairment deficiency, including 6 patients who recovered. Angiograms at 6 months follow-up showed complete occlusion in 63% (12/19) of patients, and MRI showed reduction of aneurysm volume in 89% (17/19) of patients. CONCLUSION: Flow diverters for large CCAs showed promising clinical and radiological efficacy. They can shrink the aneurysm and improve symptoms without sacrificing the parent artery. It will be necessary to summarize the cases and to verify the long-term results.
Aneurysm* ; Arteries ; Embolization, Therapeutic ; Female ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Methods ; Parents ; Perfusion ; Recurrence ; Stents