Perioperative
ischemic stroke occurs in approximately 0.08-0.7% of patients after non-cardiovascular surgery and confers a significant risk of morbidity and mortality. The mortality rate of this major complication is similar in non-cardiovascular and cardiovascular surgery. Its incidence appears to be similar in Japan, Europe, and the United States. Perioperative physicians should be aware of the pathophysiology and predictors of
ischemic stroke, and the anti-thrombotic strategies to prevent it. The main causes of perioperative
ischemic stroke include cerebral
atherothrombosis; lacuna
stroke; cardiac thrombi due to
atrial fibrillation;
dehydration;
hypotension; and perioperative systemic
hypercoagulability. Perioperative management includes detailed informed consent regarding potential
stroke risks, counseling, careful surgical treatment decisions, and identification of the high-risk patient for perioperative antithrombotic strategies. The 2009 Japanese guidelines for the management of
stroke recommend using the appropriate
intravenous infusions to avoid
dehydration and consideration of anticoagulation in the patients who are at high risk for
thrombosis and embolism while
antithrombotic agents are discontinued. Understanding how to prevent perioperative
ischemic stroke remains a challenge. In this article, we review the incidence, timing of the occurrence, mortality, risk factors, and pathophysiology of perioperative
ischemic stroke in the non-cardiovascular surgery patient.