Mechanical thrombectomy for perioperative acute ischemic stroke: Two noncardiac and non-neurosurgical case reports and a literature review

Abstract

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.