Strokes may be the result of medical conditions or they may result from medical procedures. As you may have read, preventing a stroke is the first line for treatment. Should a patient suffer a stroke, providers must act quickly to assess and treat the clot to prevent further injury. These principles similarly hold true for strokes resulting from or shortly following a surgery, also known as a perioperative strokes.

Surgery itself is a risk factor for stroke, while some types of surgery see higher incidents of perioperative stroke. The risk of stroke is higher in and following cardiac surgery than non-vascular surgeries. For example, coronary artery bypass graft, whereby a vein is grafted onto an artery on the heart to improve blood supply, sees a stroke in as many as 5% of patients. Heart valve surgery and stent replacements similarly require particular attention for prevention and monitoring.

Appropriate prevention of perioperative stroke may include continuing or starting use of statins, and stopping certain antiplatelet drugs, while the risk/benefit analysis of tapering certain antithrombotic drugs needs to be closely considered. If the patient has a history of stroke, elective surgeries should be delayed following stroke, perhaps for up to six months or more.

While prevention is significant, recognizing the signs and symptoms of perioperative stroke are critical to preserve brain function. Failing to do so may lead to devastating injury and a medical malpractice claim. Under general anesthesia a patient does not show clinical signs of stroke, so patient monitoring is done via neuromonitoring (eg. Transcranial doppler or EEG), blood pressure management, or cerebral oximetry, for example.

Intervention when stroke is suspected still requires identification of the clot’s location, and use of a clot buster medication, or mechanical intervention to physical remove the clot. As before, timely recognizing the need for intervention is critical to preserve brain function.