A history of cerebrovascular disease (CVD) is the most important risk factor for postoperative stroke, an uncommon but highly morbid complication of surgery. Recent data suggest that perioperative stroke risk may level off around 9 months after a stroke event. It is important to optimize CVD risk factors and treat specific causes of stroke before a patient undergoes elective surgery. Truly asymptomatic carotid bruits do not require further evaluation or treatment before surgery. Postoperative stroke management must be coordinated with the surgical team, e.g., the use of thrombolytics or anticoagulants may be contraindicated and permissive hypertension may be limited by the type of surgical procedure.
KeywordsPerioperative Preoperative Cerebrovascular disease Stroke Transient ischemic attack
Christopher J. Wong, MD, Associate Professor, Division of General Internal Medicine, Department of Medicine, University of Washington.
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