Comprehensive Therapy

, Volume 28, Issue 4, pp 230–234

Perioperative stroke: Evaluation, management, and possible preventive measures

  • Roger E. Kelley
Original Article


Mechanisms of perioperative ischemic stroke include: hypotension, hypercoagulability, arrhythmias with embolism, or direct vascular insult. Mechanisms of perioperative hemorrhagic stroke include: use of antithrombotics, hypertension, or direct vascular insult.


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  1. 1.
    Walker AG, Robins M, Weinfeld FD. The National Survey of Stroke. Clinical findings. Stroke. 1981;Suppl. 1:13–44.Google Scholar
  2. 2.
    Knapp RB, Topkins MJ, Artuso JF. The cerebrovascular accident and coronary occulusion in anesthesia. JAMA. 1962; 182:332–334.PubMedGoogle Scholar
  3. 3.
    Breuer AC, Furlan AJ, Hanson MR, et al. Central nervous system complications of coronary artery bypass surgery. Stroke. 1883;14:682–687.Google Scholar
  4. 4.
    Shaw PJ, Bates D, Cartlidge NEF, et al. Neurologic and neuropsychologic morbidity following major surgery. Stroke. 1987;18:70–77.Google Scholar
  5. 5.
    Ferguson GG, Eliasziw M, Barr HWK, et al. for the North American Symptomatic Carotid Endarterectomy Trial (NASCET) Collaborators. The North American Symptomatic Carotid Endarterectomy Trial. Surgical results in 1415 patients. Stroke. 1999;30:1751–1758.PubMedGoogle Scholar
  6. 6.
    Hamdan AD, Pomposelli FB Jr, Gibbons GW, Campbell DR, LoGerlo FW. Perioperative strokes after 1001 consecutive carotid endarterectomy procedures with an electroencephalogram: Incidence, mechanism, and recovery. Arch Surg. 1999;134:412–415.PubMedCrossRefGoogle Scholar
  7. 7.
    Executive Commitee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for asymptomatic carotid stenosis. JAMA. 1995;273:1421–1428.CrossRefGoogle Scholar
  8. 8.
    Orgitano TC, Al-Mefty O, Leonetti JP, DeMonte F, Reichman H. Vascular considerations and complications in cranial base surgery. Neurosurgery. 1994;35:351–362.CrossRefGoogle Scholar
  9. 9.
    Behrens E, Schramm J, Zentner J, Konig R. Surgical and neurosurgical complications in a series of 708 epilepsy surgery patients. Neurosurgery. 1997;41:1–9.PubMedCrossRefGoogle Scholar
  10. 10.
    de Bie RMA, de Haan RJ, Schuurman PR, Esselink RAJ, Bosch DA, Speelman JD. Morbidity and mortality following pallidotomy in Parkinson's disease. A systematic review. Neurology. 2002;58:1008–1012.PubMedGoogle Scholar
  11. 11.
    Hart R, Hindman B. Mechanisms of perioperative cerebral infarction. Stroke. 1982;13:766–773.PubMedGoogle Scholar
  12. 12.
    Kelley RE. Stroke in the postoperative period. Med Clin North Am. 2001;85:1263–76PubMedCrossRefGoogle Scholar
  13. 13.
    Torvik A. The pathogenesis of watershed infarction. Stroke. 1984;15:221–223.PubMedGoogle Scholar
  14. 14.
    Stamou SC, Hill PC, Sample GA, et al. Prevention of atrial fibrillation after cardiac surgery. The significance of postoperative oral amiodarone. Chest. 2001;120:1936–1941.PubMedCrossRefGoogle Scholar
  15. 15.
    Stamou SC, Jill PC, Dangas G, et al. Stroke after coronary artery bypass. Incidence, predictors, and clinical outcome. Stroke. 2001;32:1508–1513.PubMedGoogle Scholar
  16. 16.
    Stamou SC, Corso PJ. Coronary revascularization without cardiopulmonary bypass in high-risk patients: A route to the future. Ann Thorac Surg. 2001;71:1056–1061.PubMedCrossRefGoogle Scholar
  17. 17.
    Reed GI, Singer DE, Picard EH, DeSanctis RW. Stroke following coronary-artery bypass. A case-control estimate of the risk from carotid bruits. N Engl J Med. 1988;319:1246–1250.PubMedCrossRefGoogle Scholar
  18. 18.
    Evans BA, Wijdicks EFM. High-grade carotid stenosis detected before general surgery. Neurology. 2001;57:1328–1330.PubMedGoogle Scholar
  19. 19.
    Ramirez-Lassepas M, Cipolle RJ, Bjork RJ, et al. Can embolic stroke be diagnosed on the basis of neurologic clinical criteria? Arch Neurol. 1987;44:87–89.PubMedGoogle Scholar
  20. 20.
    Kittner SJ, Sharkness CM, Price TR, et al. Infarcts with a cardiac source of embolism in the NINDS Stroke Data Bank: Historical features. Neurology. 1990;40:281–284.PubMedGoogle Scholar
  21. 21.
    Kittner SJ, Sharkness CM, Sloan MA, et al. Infarcts with a cardiac source of embolism in the NINDS Stroke Data Bank: Neurologic examination. Neurology. 1992;42:299–302.PubMedGoogle Scholar
  22. 22.
    Minematsu K, Yamaguchi T, Omae T. Spectacular shrinking deficit': Rapid recovery from a hemispheric syndrome by migration of an embolus. Neurology. 1992;42:157–162.PubMedGoogle Scholar
  23. 23.
    Hirsh J, Warkentin TE, Shaughnessy SG, et al. Heparin and low-molecular heparin. Mechanisms of action, pharmacokinetics, dosing, monitoring, efficacy and safety. Chest. 2001;119:64S-94S.PubMedCrossRefGoogle Scholar
  24. 24.
    Vermeulen M, van Gijn J. The diagnosis of subarachnoid hemorrhage. J. Neurol Neurosurg Psychiatry. 1990;53:365–372.PubMedCrossRefGoogle Scholar
  25. 25.
    Ackerstaff RGA, Moons KGM, van de Vlasakker CJW, et al. Association of intraoperative transcranial Doppler monitoring variables with stroke from carotid endarterectomy. Stroke. 2000;31:1817–1823.PubMedGoogle Scholar
  26. 26.
    Barbut D, Hinton RB, Szatrowski TP, et al. Cerebral emboli detected during bypass surgery are associated with clamp removal. Stroke. 1994;25:2398–2402.PubMedGoogle Scholar
  27. 27.
    Barbut D, Yao FS, Hager DN, et al. Comparison of transcranial Doppler ultrasonography and transesophageal echocar-diography to monitor emboli during coronary artery bypass surgery. Stroke. 1996;27:87–90.PubMedGoogle Scholar
  28. 28.
    Cujec B, Polasek P, Voll C, Shuaib A. Transesophageal echocardiography in the detection of intracardiac embolic sources in patients with transient ischemic attacks. Stroke. 1991;22:727–733.PubMedGoogle Scholar
  29. 29.
    Pullicino PM, Halperin JL, Thompson JLP. Stroke in patients with heart failure and reduced left ventricular ejection fraction. Neurology. 2000;54:288–294.PubMedGoogle Scholar
  30. 30.
    Hart RG, Halperin JL, Atrial fibrillation and stroke. Current concepts and controversies. Stroke. 2001;32:803–808.PubMedGoogle Scholar
  31. 31.
    Adams Jr HP. Emergent use of anticoagulation for treatment of patients with ischemic stroke. Stroke. 2002;33:856–861.PubMedCrossRefGoogle Scholar
  32. 32.
    Barnett HJM, Taylor DW, Eliasziw M, et al. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe carotid stenosis. N Engl J Med. 1998;339:1415–1425.PubMedCrossRefGoogle Scholar
  33. 33.
    Taylor DW, Barnett HJM, Haynes RB, et al. Low-dose and high-dose acetylsalicylic acid for patients undergoing carotid endarterectomy: A randomized controlled trial. Lancet. 1999;353:2179–2184.PubMedCrossRefGoogle Scholar
  34. 34.
    Kelley RE, Kovacs AG. Mechanism of in-hospital cerebral ischemia. Stroke. 1986;17:430–433.PubMedGoogle Scholar
  35. 35.
    Safi HJ, Brien HW, Winter JN, et al. Brain protection via cerebral retrograde perfusion during aortic arch aneurysm repair. Ann Thorac Surg. 2001;71:1062–1063.PubMedCrossRefGoogle Scholar
  36. 36.
    Gold JP, Charlson ME, Williams-Russo P, et al. Improvement of outcomes after coronary artery bypass. A randomized trial comparing intraoperative high versus low mean arterial pressure. J. Thorac Cardovasc Surg. 1995;110:1302–1314.CrossRefGoogle Scholar
  37. 37.
    Bernstein M, Fleming JF, Deck JF. Cerebral hyperperfusion after carotid endarterectomy: A cause of cerebral hemorrhage. Neurosurgery. 1984;15:50–56.PubMedCrossRefGoogle Scholar
  38. 38.
    Pomposelli FB, Lamparello PJ, Riles TS, Craighead CC, Giangola G, Imparato AM. Intracranial hemorrhage after carotid endarterectomy. J Vasc Surg. 1988;7:248–255.PubMedCrossRefGoogle Scholar
  39. 39.
    Kernan WN, Viscoll CM, Brass LM, et al. Phenyl-propanolamine and the risk of hemorrhagic stroke. N Engl J Med. 2000;343:1826–1832.PubMedCrossRefGoogle Scholar
  40. 40.
    Jiang H, Whelton PK, Vu B, Klag MJ. Aspirin and risk of hemorrhagic stroke. A meta-analysis of randomized controlled trials. JAMA. 1998;280:1930–1935.CrossRefGoogle Scholar
  41. 41.
    Hart RG, Boop BS, Anderson DC. Oral anticoagulants and intracranial hemorrhage. Facts and hypothesis. Stroke. 1995; 26:1471–1477.PubMedGoogle Scholar
  42. 42.
    Dandapani BK, Suzuki S, Kelley RE, Reyes-Iglesias Y, Duncan RC. Relation between blood pressure and outcome in intracerebral hemorrhage. Stroke. 1995;26:21–24.PubMedGoogle Scholar

Copyright information

© Humana Press Inc. 2002

Authors and Affiliations

  • Roger E. Kelley
    • 1
  1. 1.Department of NeurologyLouisiana State University Health Sciences CenterShreveportUSA

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