Mechanical thrombectomy for perioperative acute ischemic stroke: Two noncardiac and non-neurosurgical case reports and a literature review
Iranian Red Crescent Medical Journal


Postoperative complications

How to Cite

Zhu, X., Li, H., Shi, Z., Zhang, L., Feng, X., Yang, L., Cao, J., & Chen, J. (2020). Mechanical thrombectomy for perioperative acute ischemic stroke: Two noncardiac and non-neurosurgical case reports and a literature review. Iranian Red Crescent Medical Journal, 22(9).


Background: Perioperative acute ischemic strokes (PAISs) are rare; however, they have potentially catastrophic complications and outcomes. Endovascular therapy is the standard care in appropriately selected patients with acute ischemic stroke; nonetheless, there are no guidelines on the treatment of PAIS, and the majority of the patients receive conservative treatments.

Objectives: This study aimed to present two cases of mechanical thrombectomy (MT) for the treatment of PAIS.

Clinical presentation: The first patient was a 43-year-old female who fell into a coma and had left limb dysfunction three h after undergoing hysteromyomectomy with a National Institute of Health Stroke Scale (NIHSS) score of 22. A right middle cerebral artery (M1) occlusion was detected on computed tomography angiography (CTA) leading to MT. The modified Rankin Scale (mRS) score was obtained at 1 three months after treatment. The second patient was a 59-year-old male who suddenly fell into a coma and had right limb dysfunction three h after undergoing a lung cancer operation with NIHSS score of 24. The CTA showed a left M1 occlusion leading to MT. The mRS score was 1 three months after treatment. Both patients were admitted to and treated in the Wuxi Clinical College of Anhui Medical University, Wuxi, China, in 2018.

Conclusion: The PAIS is a rare but serious complication after noncardiac surgery. In both cases, diagnosis and treatment were very difficult. Further evidence was provided to regard MT as a useful and safe method to treat PAIS.


  1. Selim M. Perioperative stroke. N Engl J Med. 2007;356(7):706-13. doi: 10.1056/NEJMra062668. [PubMed: 17301301].
  2. Bateman BT, Schumacher HC, Wang S, Shaefi S, Berman MF. Perioperative acute ischemic stroke in noncardiac and nonvascular surgery incidence, risk factors, and outcomes. Anesthesiology. 2009;110(2):231-8. doi: 10.1097/ALN.0b013e318194b5ff. [PubMed: 19194149].
  3. Chang R, Reddy RP, Sudadi S, Balzer J, Crammond DJ, Anetakis K, et al. Diagnostic accuracy of various EEG changes during carotid endarterectomy to detect 30-day perioperative stroke: a systematic review. Clin Neurophysiol. 2020;131(7):1508-16. doi: 10.1016/j.clinph.2020.03.037. [PubMed: 32403063].
  4. Mashour GA, Shanks AM, Kheterpal S. Perioperative stroke and associated mortality after noncardiac, nonneurologic surgery. Anesthesiology. 2011;114(6):1289-96. doi: 10.1097/ALN.0b013e318216e7f4. [PubMed: 21478735].
  5. Ng JL, Chan MT, Gelb AW. Perioperative stroke in noncardiac, nonneurosurgical surgery. Anesthesiology. 2011;115(4):879-90. doi: 10.1097/ALN.0b013e31822e9499. [PubMed: 21862923].
  6. El-Saed A, Kuller LH, Newman AB, Lopez O, Costantino J, McTigue K, et al. Geographic variations in stroke incidence and mortality among older populations in four US communities. Stroke. 2006;37(8):1975-9. doi: 10.1161/01.Str.0000231453.98473.67. [PubMed: 16794205].
  7. Premat K, Clovet O, Polara GF, Shotar E, Bartolini B, Yger M, et al. Mechanical thrombectomy in perioperative strokes a case-control study. Stroke. 2017;48(11):3149-51. doi: 10.1161/strokeaha.117.018033. [PubMed: 29018130].
  8. Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015;372(11):1019-30. doi: 10.1056/NEJMoa1414905. [PubMed: 25671798].
  9. Saver JL, Goyal M, Bonafe A, Diener HC, Levy EI, Pereira VM, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med. 2015;372(24):2285-95. doi: 10.1056/NEJMoa1415061. [PubMed: 25882376].
  10. Jovin TG, Chamorro A, Cobo E, de Miquel MA, Molina CA, Rovira A, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015;372(24):2296-306. doi: 10.1056/NEJMoa1503780. [PubMed: 25882510].
  11. Campbell BC, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med. 2015;372(11):1009-18. doi: 10.1056/NEJMoa1414792. [PubMed: 25671797].
  12. Bracard S, Ducrocq X, Mas JL, Soudant M, Oppenheim C, Moulin T, et al. Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (THRACE): a randomised controlled trial. Lancet Neurol. 2016;15(11):1138-47. doi: 10.1016/s1474-4422(16)30177-6. [PubMed: 27567239].
  13. Bell DS, Goncalves E. Stroke in the patient with diabetes (part 1)- Epidemiology, etiology, therapy and prognosis. Diabetes Res Clin Pract. 2020;164:108193. doi: 10.1016/j.diabres.2020.108193. [PubMed: 32442554].
  14. Willis EF, MacDonald KPA, Nguyen QH, Garrido AL, Gillespie ER, Harley SBR, et al. Repopulating microglia promote brain repair in an IL-6-dependent manner. Cell. 2020;180(5):833-46.e16. doi: 10.1016/j.cell.2020.02.013. [PubMed: 32142677].
  15. Wolf PA. Fifty years at Framingham: contributions to stroke epidemiology. Adv Neurol. 2003;92:165-72. [PubMed: 12760179].
  16. Matsumoto K, Sato S, Okumura M, Niwa H, Hida Y, Kaga K, et al. Left upper lobectomy is a risk factor for cerebral infarction after pulmonary resection: a multicentre, retrospective, case-control study in Japan. Surg Today. 2020;In Press. doi: 10.1007/s00595-020-02032-4. [PubMed: 32556550].
  17. Kato M, Shukuya T, Mori K, Kanemaru R, Honma Y, Nanjo Y, et al. Cerebral infarction in advanced non-small cell lung cancer: a case control study. BMC Cancer. 2016;16:203. doi: 10.1186/s12885-016-2233-1. [PubMed: 26964872].
  18. Ohtaka K, Hida Y, Kaga K, Kato T, Muto J, Nakada-Kubota R, et al. Thrombosis in the pulmonary vein stump after left upper lobectomy as a possible cause of cerebral infarction. Ann Thorac Surg. 2013;95(6):1924-8. doi: 10.1016/j.athoracsur.2013.03.005. [PubMed: 23622699].
  19. Oneill BP, Dinapoli RP, Okazaki H. Cerebral infarction as a result of tumor emboli. Cancer. 1987;60(1):90-5. doi: 10.1002/1097-0142(19870701)60:1<90::Aid-cncr2820600116>3.0.Co;2-c. [PubMed: 3581035].
  20. Park JH, Seo HS, Park SK, Suh J, Kim DH, Cho YH, et al. Spontaneous systemic tumor embolism caused by tumor invasion of pulmonary vein in a patient with advanced lung cancer. J Cardiovasc Ultrasound. 2010;18(4):148-50. doi: 10.4250/jcu.2010.18.4.148. [PubMed: 21253365].
  21. Hiatt BK, Lentz SR. Prothrombotic states that predispose to stroke. Curr Treat Options Neurol. 2002;4(6):417-25. doi: 10.1007/s11940-002-0009-1. [PubMed: 12354368].
  22. Kothari V, Stevens RJ, Adler AI, Stratton IM, Manley SE, Neil HA, et al. UKPDS 60 - risk of stroke in type 2 diabetes estimated by the UK prospective diabetes study risk engine. Stroke. 2002;33(7):1776-81. doi: 10.1161/01.Str.0000020091.07144.C7. [PubMed: 12105351].
  23. Rost NS, Wolf PA, Kase CS, Kelly-Hayes M, Silbershatz H, Massaro JM, et al. Plasma concentration of C-reactive protein and risk of ischemic stroke and transient ischemic attack - the framingham study. Stroke. 2001;32(11):2575-9. doi: 10.1161/hs1101.098151. [PubMed: 11692019].