Perioperative stroke.

Area of Science:

• Neurology
• Anesthesiology
• Cardiovascular Surgery

Background:

• Perioperative stroke presents a significant clinical challenge, associated with high rates of morbidity and mortality.
• The true incidence of perioperative stroke may be underestimated, particularly in non-cardiac surgical populations.

Purpose of the Study:

• To review the significance, pathophysiology, risk factors, and evidence-based recommendations for perioperative stroke prevention and management.
• To highlight the evolving understanding and management strategies for perioperative stroke.

Main Methods:

• A narrative review of literature sourced from the PubMed database.
• Analysis and incorporation of evidence-based recommendations from the Society for Neuroscience in Anesthesiology and Critical Care.

Main Results:

• Overt perioperative stroke is most common after cardiac and major vascular surgery; covert stroke may affect up to 10% of non-cardiac surgery patients.
• Pathophysiology involves thrombotic, cardioembolic, and hypoxia-related mechanisms. Key risk factors include advanced age, prior cerebrovascular disease, ischemic heart disease, heart failure, atrial fibrillation, and renal disease.
• Current recommendations for prevention and management are evolving, with ongoing research into modifiable factors like anticoagulation, antiplatelet therapy, transfusion thresholds, and beta-blockade.

Conclusions:

• Perioperative stroke imposes a substantial clinical burden and may be more prevalent than previously thought.
• Diverse pathophysiological pathways contribute to perioperative stroke.
• Further research is crucial for advancing the understanding, prevention, and management of perioperative stroke.