Perioperative Neurological Evaluation and Management to Lower the Risk of Acute Stroke in Patients Undergoing Noncardiac, Nonneurological Surgery: A Scientific Statement From the American Heart Association/American Stroke Association

Abstract

Perioperative stroke is a potentially devastating complication in patients undergoing noncardiac, nonneurological surgery. This scientific statement summarizes established risk factors for perioperative stroke, preoperative and intraoperative strategies to mitigate the risk of stroke, suggestions for postoperative assessments, and treatment approaches for minimizing permanent neurological dysfunction in patients who experience a perioperative stroke. The first section focuses on preoperative optimization, including the role of preoperative carotid revascularization in patients with high-grade carotid stenosis and delaying surgery in patients with recent strokes. The second section reviews intraoperative strategies to reduce the risk of stroke, focusing on blood pressure control, perioperative goal-directed therapy, blood transfusion, and anesthetic technique. Finally, this statement presents strategies for the evaluation and treatment of patients with suspected postoperative strokes and, in particular, highlights the value of rapid recognition of strokes and the early use of intravenous thrombolysis and mechanical embolectomy in appropriate patients.

Preoperative and intraoperative risk factors of postoperative stroke in total aortic arch replacement and stent elephant trunk implantation

“…The incidence of perioperative stroke in cardiac surgery is about 1% to 4%, 7 but for AAAD, the incidence is 10% to 12% in patients who underwent TAAR and SETI. 8 , 9 There lacks systematic study on risk factors of postoperative stroke in TAAR and SETI, but from other surgical studies, we can analogise some preoperative and intraoperative factors, such as disorders of coagulation system, 10 diabetic history, 11 and intraoperative blood transfusion 12 that may cause or aggravate brain injury.…”

Perioperative stroke: A perspective on challenges and opportunities for experimental treatment and diagnostic strategies

“…In this context, it is important to consider that about half of all PS occur within 24 h and 93% within 72 h after surgery. 11 Table 1 provides an overview on potential experimental treatment that may be feasible for PS.…”

“…In detail, mortality rates in PS patients can be up to eightfold higher than in comparable NS populations, with mortality rates of up to 26%. 11,12 This illustrates the additional burden that PS inflicts on patients, their relatives, caretakers, and healthcare systems.…”

Recent highlights in periopeative neurological disorders, from bench to bedside

“…Wang TL (CNSNT-2021-485). Although a few prevention and treatment strategies have been developed for each disorder, 2 especially for perioperative stroke in patients undergoing both cardiac and noncardiac operations, [3][4][5] there is still a lack of effective treatments and the underlying mechanisms are far from well-understood. This special issue is dedicated to introducing the recent advances in new strategies toward the management of perioperative neurological disorders.…”