Perioperative ischemic stroke

Abstract

Periopertaive stroke, although uncommon, can complicate various surgical procedures leading to major consequences including mortality. In this chapter, our focus is in ischemic stroke occurring in the intra-operative and post-operative periods of non-neurological surgeries. Previously reported risk factors for perioperative stroke include a history of cerebrovascular events, chronic obstructive pulmonary disease, peripheral vascular diseases and cardiac arrhythmias. The mechanism of perioperative stroke is likely to be diverse; hence a ―splitter‖ approach should be adopted when evaluating individual cases. Hypoperfusion is conventionally believed to be an important contributing factor in perioperative stoke. Current evidence, however, shows that its role is still controversial. Although anesthesia can induce hypotension, cerebral perfusion is seldom impaired. It is observed that watershed infarction, which is usually attributable to low blood pressure, is actually uncommon in previous case series. There are so far no good predictors for perioperative stroke. Scoring systems had been developed for stroke risk stratification, but there is no clear consensus yet in their routine applications. Various measures, including prophylactic use of statin or beta-blockers have been studied to prevent perioperative stroke.