1 IntroductionCerebral infarction represents a relatively uncommon yet prognostically significant complication in the perioperative setting, with a documented incidence of 0.9% following thoracic surgical procedures [1]. While conventional etiologies such as atherosclerotic thromboembolism and cardioembolic events secondary to atrial fibrillation account for most postoperative cerebral infarctions, pulmonary surgery introduces a distinct mechanism: pulmonary vein stump thrombosis (PVST). This condition arises when thrombotic material formed at the surgically resected pulmonary vein stump migrates retrograde into the left atrium, subsequently embolizing to the cerebral artery [2].Despite its catastrophic neurological consequences, PVST-related AIS remains underrecognized in clinical practice, often leading to delayed diagnosis and suboptimal management. This case report illustrates a characteristic presentation of PVST-induced AIS, accompanied by a systematic review of literature regarding its pathogenesis and evidence-based management strategies, aiming to enhance clinical vigilance and therapeutic decision-making.