Perioperative Stroke

Leary, Megan; Varade, Preet

doi:10.1007/s11910-020-01033-7

Cited by 29 publications

(21 citation statements)

References 142 publications

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“…Previous studies have adequately shed light on the impact perioperative strokes have on both perioperative and longterm mortality, but they have not evaluated cause-specific mortality in this population. [3][4][5]7,[9][10][11][12][19][20][21] Cardiac and vascular surgery patients often have comorbidities such as atrial fibrillation and severe atherosclerotic disease which are known to increase the risk for large vessel cardioembolic and vessel-to-vessel ischemic events. 18 In combination with the high degree of vessel manipulation associated with cardiac and vascular surgery procedures, the risk of perioperative stroke in this population is particularly elevated.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of perioperative stroke is particularly elevated following high-risk cardiac and vascular procedures such as double or triple valve replacements and carotid endarterectomies which have rates ranging up to 9.7% and 2.15%, respectively. [3][4][5][6][7][8] Although independent risk factors and the overall risk of mortality following a perioperative stroke have been defined in many surgical populations, there is a paucity of data regarding cause-specific mortality associated with perioperative strokes in the cardiac and vascular surgical populations. 3,[9][10][11][12] By understanding cause-specific mortality following perioperative strokes in these surgical populations, early intervention strategies aimed at improving survival outcomes may be strengthened.…”

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confidence: 99%

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Cause-Specific Mortality as a Sequalae of Perioperative Stroke Following Cardiac and Vascular Surgery

et al. 2021

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Background: There is a paucity of data regarding cause-specific mortality following a perioperative stroke. In this study, we aim to establish the risk of cause-specific mortality associated with perioperative stroke following cardiac and vascular procedures at 30 days, 90 days, and 1-year postoperative. It is hoped that this fund of knowledge will enhance perioperative risk stratification and medical management for patients who have suffered a perioperative stroke.Methods: This is a retrospective cohort study evaluating 277,654 cardiac and vascular surgical patients dually documented within the Inpatient Discharge Claims Database and the Pennsylvania Department of Health Death Statistics database. A univariate assessment followed by a multivariate logistic regression analysis was used to determine the odds of cerebrovascular, cardiovascular, pulmonary, malignancy, infectious, and dementia causes of mortality following perioperative stroke.Results: Perioperative stroke significantly increased the odds of overall mortality (P < 0.0001) as well as cause-specific mortality in all categories (P < 0.05) except dementia (P = 0.8907) at all-time endpoints. Cerebrovascular-related mortality was most impacted by perioperative stroke [adjusted odds ratio: 34.5 (29.1, 40.9), P < 0.0001 at 30 d].Conclusions: Perioperative stroke in the cardiac and vascular surgical population is associated with increased odds of overall, cerebrovascular, cardiovascular, pulmonary, malignancy, and infectious causes of mortality at 30 days, 90 days, and 1-year postoperatively when compared with patients who did not experience a perioperative stroke.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Cause-Specific Mortality as a Sequalae of Perioperative Stroke Following Cardiac and Vascular Surgery

et al. 2021

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“…Another broad terminology used is “neurological injury post cardiac surgery.” Perioperative stroke, delirium and encephalopathy are some of the neurological sequelae of cardiac surgery [ 16 ]. The risk of stroke varies depending on the type of surgery performed [ 17 ]. For example, double or triple valve surgery is associated with a 10% risk of stroke, while the risk is lower in patients referred for “beating-heart”, also known as “off-pump”, coronary artery bypass graft (CABG) surgery [ 17 ].…”

Section: Incidence and Prevalence Of Neurological Deficit After Cardiac Surgerymentioning

confidence: 99%

“…The risk of stroke varies depending on the type of surgery performed [ 17 ]. For example, double or triple valve surgery is associated with a 10% risk of stroke, while the risk is lower in patients referred for “beating-heart”, also known as “off-pump”, coronary artery bypass graft (CABG) surgery [ 17 ].…”

Section: Incidence and Prevalence Of Neurological Deficit After Cardiac Surgerymentioning

confidence: 99%

Contemporary Neuroprotection Strategies during Cardiac Surgery: State of the Art Review

Chakane

Mogane

Moutlana

et al. 2021

IJERPH

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Open-heart surgery is the leading cause of neuronal injury in the perioperative state, with some patients complicating with cerebrovascular accidents and delirium. Neurological fallout places an immense burden on the psychological well-being of the person affected, their family, and the healthcare system. Several randomised control trials (RCTs) have attempted to identify therapeutic and interventional strategies that reduce the morbidity and mortality rate in patients that experience perioperative neurological complications. However, there is still no consensus on the best strategy that yields improved patient outcomes, such that standardised neuroprotection protocols do not exist in a significant number of anaesthesia departments. This review aims to discuss contemporary evidence for preventing and managing risk factors for neuronal injury, mechanisms of injury, and neuroprotection interventions that lead to improved patient outcomes. Furthermore, a summary of existing RCTs and large observational studies are examined to determine which strategies are supported by science and which lack definitive evidence. We have established that the overall evidence for pharmacological neuroprotection is weak. Most neuroprotective strategies are based on animal studies, which cannot be fully extrapolated to the human population, and there is still no consensus on the optimal neuroprotective strategies for patients undergoing cardiac surgery. Large multicenter studies using universal standardised neurological fallout definitions are still required to evaluate the beneficial effects of the existing neuroprotective techniques.

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“…Common clinical reasons for the unfavorable outcome after PS are delayed diagnosis and intervention in case of covert PS, and potential difficulties in applying recanalization treatments (thrombolysis and thrombectomy) due to the recent surgery, medications that affect the coagulation system or the general condition of the patient. 13 Recent SNACC guidelines recommend that early endovascular thrombectomy should be considered in PS patients to restore the cerebral blood flow. 14 However, this therapeutic strategy requires clinical detection of the ischemic event and cerebral imaging including visualization of cerebral arteries in a narrow time window.…”

Section: Introductionmentioning

confidence: 99%

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

Jin

Michalski

et al. 2022

CNS Neurosci Ther

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Perioperative stroke is an ischemic or hemorrhagic cerebral event during or up to 30 days after surgery. It is a feared condition due to a relatively high incidence, difficulties in timely detection, and unfavorable outcome compared to spontaneously occurring stroke. Recent preclinical data suggest that specific pathophysiological mechanisms such as aggravated neuroinflammation contribute to the detrimental impact of perioperative stroke. Conventional treatment options are limited in the perioperative setting due to difficult diagnosis and medications affecting coagulation in may cases. On the contrary, the chance to anticipate cerebrovascular events at the time of surgery may pave the way for prevention strategies. This review provides an overview on perioperative stroke incidence, related problems, and underlying pathophysiological mechanisms. Based on this analysis, we assess experimental stroke treatments including neuroprotective approaches, cell therapies, and conditioning medicine strategies regarding their potential use in perioperative stroke. Interestingly, the specific aspects of perioperative stroke might enable a more effective application of experimental treatment strategies such as classical neuroprotection whereas others including cell therapies may be of limited use. We also discuss experimental diagnostic options for perioperative stroke augmenting classical clinical and imaging stroke diagnosis. While some experimental stroke treatments may have specific advantages in perioperative stroke, the paucity of established guidelines or multicenter clinical research initiatives currently limits their thorough investigation.

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Perioperative Stroke

Cited by 29 publications

References 142 publications

Cause-Specific Mortality as a Sequalae of Perioperative Stroke Following Cardiac and Vascular Surgery

Cause-Specific Mortality as a Sequalae of Perioperative Stroke Following Cardiac and Vascular Surgery

Contemporary Neuroprotection Strategies during Cardiac Surgery: State of the Art Review

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

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