Review article: the role of hypotension in perioperative stroke

A stroke is an uncommon but potentially devastating complication after surgery. Although hypoperfusion is often mentioned as a possible cause of a perioperative stroke, a thorough investigation is needed into the role of intraoperative and/or postoperative hypotension in the occurrence and development of perioperative cerebral ischemia. In this review article, we present an overview of the available literature on the possible role of hypotension in perioperative stroke, and we place these studies in a broader context.

Perioperative strokes are most frequently thromboembolic in origin and commonly occur within the first 72 postoperative hours after a symptom-free interval. Case reports have shown a causal relationship between hypotension and perioperative stroke; nevertheless, many other factors contribute to its pathophysiology. Hypotension contributes as a primary factor or likely more frequently as a secondary factor in the development of a perioperative stroke. Among the main difficulties in studying this association is the lack of standardized definitions of perioperative hypotension, baseline blood pressure, and the length of the postoperative period. To guide future research, we propose a selection of problems to address in order to gain more insight into the problem of perioperative cerebral ischemia.

Unusually low blood pressure will eventually result in neurological damage; however, the threshold and duration at which an association might be found between a perioperative stroke and hypotension have not been well investigated. Thus, the exact role of hypotension in the etiology of perioperative stroke is still largely unknown.