Risk Assessment and Prevention of Perioperative Stroke

  • A. Papangelou
  • M. Mirski
Conference paper


Perioperative stroke is a potentially devastating medical occurrence that complicates patient management during the postoperative critical care period. Irreversible cerebral ischemia or hemorrhage may be incited either during surgery or in the postoperative period. This latter risk period need not be immediate, as some studies link postoperative stroke up to 30 days following the procedure.


Atrial Fibrillation Mean Arterial Pressure Carotid Endarterectomy Carotid Stenosis Carotid Artery Disease 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Selim M (2007) Perioperative stroke. N Engl J Med 356: 706–713CrossRefPubMedGoogle Scholar
  2. 2.
    Bucerius J, Gummert JF, Borger MA, et al (2003) Stroke after cardiac surgery: a risk factor analysis of 16,184 consecutive adult patients. Ann Thorac Surg 75: 472–478CrossRefPubMedGoogle Scholar
  3. 3.
    Likosky DS, Marrin CA, Caplan LR, et al (2003) Determination of etiologic mechanisms of strokes secondary to coronary artery bypass graft surgery. Stroke 34: 2830–2834CrossRefPubMedGoogle Scholar
  4. 4.
    Lahtinen J, Biancari F, Salmela E, et al (2004) Postoperative atrial fibrillation is a major cause of stroke after on-pump coronary bypass surgery. Ann Thorac Surg 77: 1241–1244CrossRefPubMedGoogle Scholar
  5. 5.
    Gottesman, RF, Sherman PM, Grega MA, et al (2006) Watershed Strokes After Cardiac Surgery. Stroke 37: 2306–2311CrossRefPubMedGoogle Scholar
  6. 6.
    Gold JP, Charlson ME, Williams-Russo P, et al (1995) Improvements of outcomes after coronary artery bypass: a randomized trial comparing intraoperative high versus low mean arterial pressure. J Thorac Cardiovasc Surg 110: 1302–1311CrossRefPubMedGoogle Scholar
  7. 7.
    van Wermeskerken GK, Lardenoye JW, Hill SE, et al (2000) Intraoperative physiologic variables and outcome in cardiac surgery: Part II. Neurologic outcome. Ann Thorac Surg 69: 1077–1083CrossRefPubMedGoogle Scholar
  8. 8.
    Naylor AR, Mehta Z, Rothwell PM, Bell PR (2002) Carotid artery disease and stroke during coronary artery bypass: a critical review of the literature. Eur J Vase Endovasc Surg 23: 283–294CrossRefGoogle Scholar
  9. 9.
    Hart R, Hindman B (1982) Mechanisms of perioperative cerebral infarction. Stroke 13: 766–772PubMedGoogle Scholar
  10. 10.
    Larsen SF, Zaric D, Boysen G (1988) Postoperative cerebrovascular accidents in general surgery. Acta Anaesthesiol Scand 32: 698–701CrossRefPubMedGoogle Scholar
  11. 11.
    Landercasper J, Merz BJ, Cogbill TH, et al (1990) Perioperative stroke risk in 173 consecutive patients with a past history of stroke. Arch Surgery 125: 986–989Google Scholar
  12. 12.
    Axelrod DA, Stanley JC, Upchurch GR, et al (2004) Risk for stroke after elective noncarotid vascular surgery. J Vase Surg 39: 67–72CrossRefGoogle Scholar
  13. 13.
    Limburg M, Wijdicks EFM, Li H (1998) Ischemic stroke after surgical procedures Clinical features, neuroimaging, and risk factors. Neurology 50: 895–901PubMedGoogle Scholar
  14. 14.
    Wong GY, Warner DO, Schroeder DR, et al (2000) Risk of surgery and anesthesia for ischemic stroke. Anesthesiology 92: 425–432CrossRefPubMedGoogle Scholar
  15. 15.
    Lekprasert V, Akavipat P, Sirinan C, et al (2005) Perioperative stroke and coma in Thai Anesthesia Incidents Study (THAI Study). J Med Assoc Thai 88: S113–117PubMedGoogle Scholar
  16. 16.
    Reston JT, Tregear SJ, Turkelson CM (2003) Meta-analysis of short-term and mid-term outcomes following off-pump coronary bypass grafting. Ann Thorac Surg 76: 1510–1515CrossRefPubMedGoogle Scholar
  17. 17.
    Cheng DC, Bainbridge D, Martin JE, et al (2005) Does off-pump coronary artery bypass reduce mortality, morbidity, and resource utilization when compared with conventional coronary artery bypass? A meta-analysis of randomized trials. Anesthesiology 102: 188–203Google Scholar
  18. 18.
    Anyanwu AC, Filsoufi F, Salzberg SP, et al (2007) Epidemiology of stroke after cardiac surgery in the current era. J Thorac Cardiovasc Surg 134: 1121–1127CrossRefPubMedGoogle Scholar
  19. 19.
    Hogue CW Ir, De Wet CJ, Schechtman KB, et al (2003) The importance of prior stroke for the adjusted risk of neurologic injury after cardiac surgery for women and men. Anesthesiology 98: 823–829CrossRefPubMedGoogle Scholar
  20. 20.
    Antunes PE, de Oliveira JF, Antunes MJ (2003) Predictors of cerebrovascular events in patients subjected to isolated coronary surgery. The importance of aortic cross-clamping. Eur J Cardiothorac Surg 23: 328–333CrossRefPubMedGoogle Scholar
  21. 21.
    Goto T, Baba T, Ito A, et al (2007) Gender differences in stroke risk among the elderly after coronary artery surgery. Anesth Analg 104: 1016–1022CrossRefPubMedGoogle Scholar
  22. 22.
    Borger MA, Ivanov J, Weisel RD, et al (2001) Stroke during coronary bypass surgery: principal role of cerebral macroemboli. Eur J Cardiothorac Surg 19: 627–632CrossRefPubMedGoogle Scholar
  23. 23.
    Bilfinger TV, Reda H, Giron F, et al (2000) Coronary and carotid operations under prospective standardized conditions: incidence and outcome. Ann Thorac Surg 69: 1792–1798CrossRefPubMedGoogle Scholar
  24. 24.
    Hartman GS, Yao FS, Bruefach M 3rd, et al (1996) Severity of atheromatous disease diagnosed by transesophageal echocardiography predicts stroke and other outcomes associated with coronary artery surgery: a prospective study. Anesth Analg 83: 701–708CrossRefPubMedGoogle Scholar
  25. 25.
    Katz ES, Tunick PA, Rusinek H, et al (1992) Protruding aortic atheromas predict stroke in elderly patients undergoing cardiopulmonary bypass: experience with intraoperative transesophageal echocardiography. J Am Coll Cardiol 20: 70–77CrossRefPubMedGoogle Scholar
  26. 26.
    Aboyans V, Labrousse L, Lacroix P, et al (2006) Predictive factors of stroke in patients undergoing coronary bypass grafting: statins are protective. Eur J Cardiothorac Surg 30: 300–304CrossRefPubMedGoogle Scholar
  27. 27.
    Likosky DS, Leavitt BJ, Marrin CA, et al (2003) Intra-and postoperative predictors of stroke after coronary artery bypass grafting. Ann Thorac Surg 76: 428–434CrossRefPubMedGoogle Scholar
  28. 28.
    McKhann GM, Grega MA, Borowicz LM Jr. et al (2002) Encephalopathy and stroke after coronary bypass grafting: incidence, consequences, and prediction. Arch Neurol 59: 1422–1428CrossRefPubMedGoogle Scholar
  29. 29.
    Engelman DT, Cohn LH, Rizzo RJ (1999) Incidence and predictors of tias and strokes following coronary artery bypass grafting: report and collective review. Heart Surg Forum 2: 242–245PubMedGoogle Scholar
  30. 30.
    Hirotani T, Kameda T, Kumamoto T, et al (2000) Stroke after coronary artery bypass grafting in patients with cerebrovascular disease. Ann Thorac Surg 70: 1571–1576CrossRefPubMedGoogle Scholar
  31. 31.
    Ascione R, Reeves BC, Chamberlain MH, et al (2002) Predictors of stroke in the modern era of coronary artery bypass grafting: a case control study. Ann Thorac Surg 74: 474–480CrossRefPubMedGoogle Scholar
  32. 32.
    Hogue CW Jr, Murphy SF, Schechtman KB, et al (1999) Risk factors for early or delayed stroke after cardiac surgery. Circulation 100: 642–647PubMedGoogle Scholar
  33. 33.
    Baker RA, Hallsworth LJ, Knight JL (2005) Stroke after coronary artery bypass grafting. Ann Thorac Surg 80: 1746–1750CrossRefPubMedGoogle Scholar
  34. 34.
    John R, Choudhri AF, Weinberg AD, et al (2000) Multicenter review of preoperative risk factors for stroke after coronary artery bypass grafting. Ann Thorac Surg 69: 30–35CrossRefPubMedGoogle Scholar
  35. 35.
    Stamou SC, Hill PC, Dangas G, et al (2001) Stroke after coronary artery bypass: incidence, predictors and clinical outcome. Stroke 32: 1508–1513PubMedGoogle Scholar
  36. 36.
    Boeken U, Litmathe J, Feindt P, et al (2005) Neurological complications after cardiac surgery: risk factors and correlation to the surgical procedure. Thorac Cardiovasc Surg 53: 33–36CrossRefPubMedGoogle Scholar
  37. 37.
    Gutsche JT, Cheung AT, McGarvey ML, et al (2007) Risk factors for perioperative stroke after thoracic endovascular aortic repair. Ann Thorac Surg 84: 1195–200CrossRefPubMedGoogle Scholar
  38. 38.
    Buth J, Harris PL, Hobo R, et al (2007) Neurologic complications associated with endovascular repair of thoracic aortic pathology: Incidence and risk factors. A study from the European Collaborators on Stent/Graft Techniques for Aortic Aneurysm Repair (EUROSTAR) Registry. J Vase Surg 46: 1103–1111CrossRefGoogle Scholar
  39. 39.
    Cina CS, Clase CM, Haynes BR (1999) Refining the indications for carotid endarterectomy in patients with symptomatic carotid stenosis: A systematic review. J Vase Surg 30: 606–617CrossRefGoogle Scholar
  40. 40.
    Rerkasem K, Bond R, Rothwell PM (2004) Local versus general anesthesia for carotid endarterectomy. Cochrane Database Syst Rev CD000126Google Scholar
  41. 41.
    Bond R, Rerkasem K, Naylor AR, et al (2004) Systematic review of randomized controlled trials of patch angioplasty versus primary closure and different types of patch materials during carotid endarterectomy. J Vase Surg 40: 1126–1135CrossRefGoogle Scholar
  42. 42.
    Bond R, Rerkasem K, Cuffe R, et al (2005) A systematic review of the associations between age and sex and the operative risks of carotid endarterectomy. Cerebrovasc Dis 20: 69–77CrossRefPubMedGoogle Scholar
  43. 43.
    Chambers BR, Donnan GA (2005) Carotid endarterectomy for asymptomatic carotid stenosis. Cochrane Database Syst Rev CDOO1923Google Scholar
  44. 44.
    Barnett HJ, Taylor DW, Eliasziw M, et al (1998) Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med 339: 1415–1425CrossRefPubMedGoogle Scholar
  45. 45.
    European Carotid Surgery Trialists' Collaborative Group (1998) Randomized trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet 351: 379–1387Google Scholar
  46. 46.
    Taylor DW, Barnett HJ, Haynes RB, et al (1999) Low-dose and high-dose acetylsalicylic acid for patients undergoing carotid endarterectomy: A randomized controlled trial. ASA and Carotid Endarterectomy (ACE) Trial Collaborators. Lancet 353: 2179–2184CrossRefPubMedGoogle Scholar
  47. 47.
    Halliday A, Mansfield A, Marro J, et al (2004) Asymptomatic Carotid Surgery Trial (ACST) Collaborative Group: Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: Randomised controlled trial. Lancet 363: 1491–1502CrossRefPubMedGoogle Scholar
  48. 48.
    European Carotid Surgery Trialists' Collaborative Group (1991) MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70–99 %) or with mild (0–29 0/0) carotid stenosis. Lancet 337: 1235–1243CrossRefGoogle Scholar
  49. 49.
    Executive Committee for the Asymptomatic Carotid Atherosclerosis Study (1995) Endarterectomy for asymptomatic carotid artery stenosis. JAMA 273: 1421–1428CrossRefGoogle Scholar
  50. 50.
    North American Symptomatic Carotid Endarterectomy Trial Collaborators (1991) Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 325: 445–453CrossRefGoogle Scholar
  51. 51.
    Tu JV, Wang H, Bowyer B, et al (2003) Risk factors for death or stroke after carotid endarterectomy: observations from the Ontario Carotid Endarterectomy Registry. Stroke 34: 2568–2573CrossRefPubMedGoogle Scholar
  52. 52.
    Dacey LJ, Likosky DS, Leavitt BJ, et al (2005) Perioperative stroke and long-term survival after coronary bypass graft surgery. Ann Thorac Surg 79: 532–536CrossRefPubMedGoogle Scholar
  53. 53.
    Schmitz C, Blackstone EH, International Council of Emboli Management (ICEM) Study Group (2001) International Council of Emboli Management (ICEM) Study Group results: risk adjusted outcomes in intra-aortic filtration. Eur J Cardiothorac Surg 20: 986–991CrossRefPubMedGoogle Scholar
  54. 54.
    Leacche M, Carrier M, Bouchard D, et al (2003) Improving neurologic outcome in off-pump surgery: the “no touch” technique. Heart Surg Forum 6: 169–175PubMedGoogle Scholar
  55. 55.
    Eckstein HH, Ringleb P, Dörfler A, et al (2002) The Carotid Surgery for Ischemic Stroke trial: a prospective observational study on carotid endarterectomy in the early period after ischemic stroke. J Vase Surg 36: 997–1004CrossRefGoogle Scholar
  56. 56.
    Luebke T, Aleksic M, Brunkwall J (2007) Meta-analysis of randomized trials comparing carotid endarterectomy and endovascular treatment. Eur J Vase Endovasc Surg 34: 470–479CrossRefGoogle Scholar
  57. 57.
    Parilch S, Cohen JR (1993) Perioperative stroke after general surgical procedures. NY State J Med 93: 162–165Google Scholar

Copyright information

© Springer Science + Business Media Inc. 2010

Authors and Affiliations

  • A. Papangelou
    • 1
  • M. Mirski
    • 1
  1. 1.Department of Anesthesiology and Critical Care MedicineBaltimoreUSA

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