Cerebrovascular disease and perioperative neurologic vulnerability: A prospective cohort study

Phillip E. Vlisides, Bryan Kunkler, Aleda Thompson, Mackenzie Zierau, Remy Lobo, Mary O. Strasser, Michael J. Cantley, Amy McKinney, Allen D. Everett, George A. Mashour, Paul Picton

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Background: Stroke is a devastating perioperative complication without effective methods for prevention or diagnosis. The objective of this study was to analyze evidence-based strategies for detecting cerebrovascular vulnerability and injury in a high-risk cohort of noncardiac surgery patients. Methods: This was a single-center, prospective cohort study. Fifty patients undergoing non-cardiac surgery were recruited −25 with known cerebrovascular disease and 25 matched controls. Neurologic vulnerability was measured with intraoperative cerebral oximetry as the primary outcome. Perioperative neurocognitive testing and serum biomarker analysis (S-100β, neuron specific enolase, glial fibrillary acid protein, and matrix metalloproteinase-9) were measured as secondary outcomes. Results: Cerebral desaturation events (an oximetry decrease ≥20% from baseline or <50% absolute value for ≥3 min) occurred in 7/24 (29%) cerebrovascular disease patients and 2/24 (8.3%) controls (relative risk 3.5, 95% CI 0.81–15.2; P = 0.094). Cognitive function trends were similar in both groups, though overall scores (range: 1,500–7,197) were ~1 standard deviation lower in cerebrovascular patients across the entire perioperative period (−1,049 [95% CI −1,662, −436], P < 0.001). No significant serum biomarker differences were found between groups over time. One control patient experienced intraoperative hypoxic-ischemic injury, but no robust biomarker or oximetry changes were observed. Conclusions: Cerebrovascular disease patients did not demonstrate dramatic differences in cerebral oximetry, cognitive trajectory, or molecular biomarkers compared to controls. Moreover, a catastrophic hypoxic-ischemic event was neither predicted nor detected by any strategy tested. These findings support the need for novel research into cerebrovascular risk and vulnerability.

Original languageEnglish (US)
Article number560
JournalFrontiers in Neurology
Issue numberMAY
StatePublished - 2019


  • Biomarkers
  • Cerebrovascular disease
  • Cognitive dysfunction
  • Hypoxia-ischemia
  • Perioperative care
  • Stroke

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


Dive into the research topics of 'Cerebrovascular disease and perioperative neurologic vulnerability: A prospective cohort study'. Together they form a unique fingerprint.

Cite this