Cerebrovascular Disease

  • Anna L. GolobEmail author


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.


Perioperative Preoperative Cerebrovascular disease Stroke Transient ischemic attack 



Christopher J. Wong, MD, Associate Professor, Division of General Internal Medicine, Department of Medicine, University of Washington.


  1. 1.
    Bell R, Merli G. Perioperative assessment and management of the surgical patient with neurologic problems. In: Merli G, Weitz H, editors. Medical management of the surgical patient. Philadelphia: W. B. Saunders; 1998. p. 283.Google Scholar
  2. 2.
    Selim M. Perioperative stroke. N Engl J Med. 2007;356:706–13. Open image in new windowGoogle Scholar
  3. 3.
    Parikh S, Cohen J. Perioperative stroke after general surgical procedures. N Y State J Med. 1993;93:162–5.PubMedGoogle Scholar
  4. 4.
    Landercasper J, Merz BJ, Cogbill TH, et al. Perioperative stroke risk in 173 consecutive patients with a past history of stroke. Arch Surg. 1990;125:986–9.CrossRefGoogle Scholar
  5. 5.
    Limburg M, Wijdicks EF, Li H. Ischemic stroke after surgical procedures: clinical features, neuroimaging, and risk factors. Neurology. 1998;50:895–901.CrossRefGoogle Scholar
  6. 6.
    Jorgensen ME, Torp-Pedersen C, Gislason GH, et al. Time elapsed after ischemic stroke and risk of adverse cardiovascular events and mortality following elective noncardiac surgery. JAMA. 2014;312(3):269–77. Open image in new windowGoogle Scholar
  7. 7.
    Ng PY, Ng AK, Subramaniam B, et al. Association of preoperatively diagnosed foramen ovale with perioperative ischemic stroke. JAMA. 2018;319(5):452–62.CrossRefGoogle Scholar
  8. 8.
    Timm FP, Houle TT, Grabitz SD, et al. Migraine and risk of perioperative ischemic stroke and hospital readmission: hospital based registry study. BMJ. 2017;10:356.Google Scholar
  9. 9.
    Fleisher LA, Beckman JA, Brown KA, et al. ACC/AHA 2007 guidelines on perioperative cardiovascularevaluation and care for noncardiac surgery: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. Circulation. 2007;116:e418–500.PubMedGoogle Scholar
  10. 10.
    Ropper AH, Wechsler LR, Wilson LS. Carotid bruit and the risk of stroke in elective surgery. N Engl J Med. 1982;307(22):1388–90.CrossRefGoogle Scholar
  11. 11.
    Hines GL, Scott WC, Schubach SL, et al. Prophylactic carotid endarterectomy in patients with high-grade carotid stenosis undergoing coronary bypass: does it decrease the incidence of perioperative stroke? Ann Vasc Surg. 1998;12:23.CrossRefGoogle Scholar
  12. 12.
    Szeder V, Torbey MT. Prevention and treatment of perioperative stroke. Neurologist. 2008;14(1):30–6.Open image in new windowGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Medicine, Division of General Internal MedicineUniversity of WashingtonSeattleUSA

Personalised recommendations