Perioperative ischemic stroke

Perioperative strokes are mainly ischemic and embolic

The most consistent risk factor is a history of stroke.

General surgery associated with stroke 0.2% of cases.

General surgery after a prior stroke associated with 2.9% of stroke.

General surgery in patients with carotid stenosis and bruit or prior symptoms associated with stroke with a 3.6% risk.

CABG surgery associated with a risk of stroke of 1-2%.

CABG surgery with prior stroke or TIA associated with a risk of stroke of 8.5%.

CABG surgery with valve surgery associated with a risk of stroke of 4.2-13%.

Cardiac and vascular surgeries, and especially combined cardiac procedures associated with higher risks of perioperative stroke.

More common after urgent than elective surgery.

CABG surgery with unilateral carotid stenosis or bilateral carotid stenosis associated with a 3 and 5 % risk of stroke, respectively.

CABG surgery with carotid occlusion associated with a risk of stroke of 7.0%.

Incidence of perioperative stroke has not decreased despite improved surgery and perioperative care which indicates increased age of the population and increased number of elderly with conditions requiring surgery.

Increases hospital stay, increases rates of disability and use of long term facilities and death after surgery.

Stroke after coronary artery bypass graft associated with embolic infarcts in 62% of cases and hemorrhage in only 1% of cases.

The timing of embolic strokes after surgery associated with a bimodal distribution with approximately 45% of such stokes within the first day of surgery and remaining 55% from the second postoperative day on.

Early embolic stroke results from the manipulations of the heart and aorta or the release from particulate matter from the cardiopulmonary bypass pump device.

The embolisms associated with a delay from surgery associated with postoperative atrial fibrillation, myocardial infarction or an imbalance in oxygen needs of the myocardium and the presence of a coagulopathy.

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