Reducing Risk for Perioperative Stroke

Perioperative stroke is a potentially devastating complication of surgery that is associated with substantial morbidity and a 5- to 10-fold greater likelihood of in-hospital mortality. The incidence of clinically recognized perioperative stroke varies widely with the type and timing of surgical procedure, which likely reflects the underlying surgical anatomy, the risk for vascular compromise and injury, the patient’s overall preoperative health status, and the methods employed to detect stroke. As such, there are no simple solutions to prevent this complex perioperative complication. Available techniques and methods to reduce perioperative stroke include measures to be taken early in the preoperative setting, such as predictive modeling and identification of modifiable risk factors, as well as medication and surgical optimization. Intraoperative measures to reduce the risk for perioperative stroke are increasing and involve preoperative and intraoperative strategic decision making, sophisticated detection techniques and surgical expertise, and multimodality neuromonitoring. Lastly, identification of perioperative stroke requires collaboration among an interdisciplinary and multiprofessional perioperative team to initiate early therapy such as embolectomy.