Department of Neurosurgery, Harasanshin Hospital, Fukuoka, Japan.
Department of Neurosurgery, Harasanshin Hospital, Fukuoka, Japan.
J Stroke Cerebrovasc Dis. 2019 Nov;28(11):104321. doi: 10.1016/j.jstrokecerebrovasdis.2019.104321. Epub 2019 Aug 15.
Brain infarction is a critical complication after lung resection using video-assisted thoracoscopic surgery. Recent reports have described its association with thrombosis in the pulmonary vein (PV) stump. However, the optimal management of this complication remains controversial. We describe serial 3 cases of brain infarctions associated with thrombosis in the PV stumps, which were successfully treated with the oral Xa inhibitor rivaroxaban.
We retrospectively reviewed medical records of 3 patients. The first case was a 72-year-old man who underwent left upper lobectomy for treatment of lung adenocarcinoma. The second case was a 55-year-old man who underwent right lower segmentectomy for treatment of metastatic tumor from Barrett's esophageal carcinoma. The third case was a 73-year-old man who underwent left upper lobectomy for treatment of metastatic tumor from colon adenocarcinoma. In the first case, a large cerebellar infarction was developed and a decompressive craniotomy was performed on postoperative day 4. In the second and the third case, cerebral infarctions in the territories of right middle cerebral arteries occurred on postoperative day 2. In all cases, contrast-enhanced computed tomography demonstrated the thrombi in the stumps of the PVs. They were treated with oral administration of rivaroxaban without adverse effect, and the thrombi in the PVs disappeared within 1 month.
Blood flow stasis in the long PV stump after lung resection might contribute to thrombosis development. Oral Xa inhibitor rivaroxaban appeared to be safe and useful for the management of ischemic stroke associated with PV thrombosis after lung resection.
肺切除术后的视频辅助胸腔镜手术是一种严重的并发症。最近的报告描述了其与肺静脉（PV）残端血栓形成的关系。然而，这种并发症的最佳治疗方法仍存在争议。我们描述了 3 例与 PV 残端血栓形成相关的脑梗死连续病例，这些病例成功地接受了口服 Xa 抑制剂利伐沙班治疗。
我们回顾性地审查了 3 名患者的病历。第一个病例是一名 72 岁男性，因治疗肺腺癌而行左肺上叶切除术。第二个病例是一名 55 岁男性，因治疗巴雷特食管腺癌的转移性肿瘤而行右肺下叶切除术。第三个病例是一名 73 岁男性，因治疗结肠腺癌的转移性肿瘤而行左肺上叶切除术。第一个病例，术后第 4 天出现大面积小脑梗死，并进行了减压性颅骨切开术。第二个和第三个病例，术后第 2 天出现大脑中动脉区域的脑梗死。在所有病例中，增强 CT 显示 PV 残端有血栓形成。他们接受了口服利伐沙班治疗，没有不良反应，PV 内的血栓在 1 个月内消失。
肺切除术后长 PV 残端的血流停滞可能导致血栓形成。口服 Xa 抑制剂利伐沙班似乎对肺切除术后与 PV 血栓形成相关的缺血性脑卒中的管理是安全有效的。
