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Updated: Jun 10, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
[Preoperative evaluation and prognosis of patients with cerebrovascular disease]
Junji Egawa1, Masahiko Kawaguchi, Hitoshi Furuya
1Department of Anesthesiology, Nara Medical University, Kashihara 634-8521.
Insights
Perioperative stroke evaluation is crucial for patients with cerebrovascular disease. Delaying surgery after ischemic stroke and assessing cardiovascular risks in carotid artery stenosis are key considerations for anesthesiologists.
Area of Science:
- Anesthesiology
- Neurology
- Vascular Surgery
Context:
- Stroke is a significant perioperative concern for anesthesiologists.
- Cerebrovascular disease management requires careful preoperative evaluation.
- Understanding stroke subtypes and their perioperative implications is essential.
Purpose:
- To describe the preoperative evaluation and prognosis for patients with cerebrovascular disease.
- To outline management strategies for perioperative stroke risk.
- To review current evidence on interventions for carotid artery disease.
Summary:
- Cerebral infarction constitutes over 60% of strokes; surgery should be postponed for at least one month post-ischemic stroke.
- Carotid artery stenosis (15-20% of ischemic strokes) necessitates cardiovascular evaluation due to common comorbidities.
- Carotid endarterectomy (CEA) is effective; carotid artery stenting (CAS) is less invasive but carries higher risks than CEA in suitable candidates.
- Subarachnoid hemorrhage (SAH) requires cardiac and respiratory assessments, with rebleeding and vasospasm impacting outcomes.
Impact:
- Informs anesthesiologists on optimizing perioperative care for patients with cerebrovascular disease.
- Highlights the importance of tailored surgical timing and risk assessment.
- Provides insights into the comparative effectiveness and risks of interventions for carotid artery stenosis.
- Emphasizes the need for comprehensive preoperative assessment in SAH patients to mitigate adverse outcomes.
Abstract:
Stroke remains a major perioperative problem for anesthesiologists. In this article, we have described preoperative evaluation and prognosis of patients with cerebrovascular disease. Cerebral infarction accounts for more than 60% of stroke. In patients with recently developed ischemic stroke, a surgery should be delayed at least for a month. Carotid artery stenosis accounts for 15 to 20% of ischemic stroke. In these patients, since the incidence of cardiovascular disease is common, cardiovascular examinations may be required preoperatively. The efficacy of carotid endarterectomy (CEA) to prevent stroke is well established, whereas carotid artery stenting (CAS) has been increasingly advocated as less invasive treatment. Several studies have indicated that the risks of CAS are higher than those of CEA, suggesting that CAS may not be used in good surgical candidates. In the patients with subarachnoid hemorrhage (SAH), preoperative assessments of cardiac and respiratory condition are required. It is reported that unfavorable outcome after SAH is related to rebleeding and cerebral vasospasm.
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