Perioperative strokes: uncovering risks, sequelae, and a therapeutic future
Abstract This article provides an overview of perioperative strokes—a pressing concern given the rising number of surgical or interventional procedures performed worldwide. Mechanisms underlying perioperative stroke include atherosclerotic plaque instability, induction of a pro-inflammatory state (a...
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| Format: | Article |
| Language: | English |
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Springer
2025-03-01
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| Series: | Anesthesiology and Perioperative Science |
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| Online Access: | https://doi.org/10.1007/s44254-025-00089-3 |
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| author | Aravind Ganesh |
| author_facet | Aravind Ganesh |
| author_sort | Aravind Ganesh |
| collection | DOAJ |
| description | Abstract This article provides an overview of perioperative strokes—a pressing concern given the rising number of surgical or interventional procedures performed worldwide. Mechanisms underlying perioperative stroke include atherosclerotic plaque instability, induction of a pro-inflammatory state (aggravated by vascular risk factors), hemodynamic dysfunction through hypotension and blood loss, and disruption of the endothelial glycocalyx. The frequency of perioperative stroke varies considerably depending on the type of procedure, being higher with aortic valve and neurovascular procedures. Covert or silent strokes are commonly seen on post-operative magnetic resonance imaging in as many as one in two patients after procedures like brain aneurysm coiling. Risk factors for perioperative stroke include patient factors such as age, sex, race, and comorbidities, as well as operator and procedural factors such as operator experience, institutional procedural volume, use of certain devices, and vascular access site. Overt periprocedural stroke is associated with higher mortality, longer hospital stays, and higher long-term disability. The long-term sequelae of covert strokes are still being characterized, but recent studies have indicated that a higher burden of such infarcts is associated with worse functional and cognitive outcomes. Key considerations to prevent perioperative strokes include screening plus risk factor control, pre-medication, and procedural considerations including anesthetic choice. The management of perioperative ischemic stroke has been aided by advancements in reperfusion therapies and stroke systems of care that allow rapid treatment of major stroke. Ongoing work seeks to address the enduring need for evidence-based therapeutic strategies to prevent these strokes and mitigate their adverse impact. |
| format | Article |
| id | doaj-art-9a891295e76f4f3a976cfc82abf909be |
| institution | DOAJ |
| issn | 2731-8389 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Springer |
| record_format | Article |
| series | Anesthesiology and Perioperative Science |
| spelling | doaj-art-9a891295e76f4f3a976cfc82abf909be2025-08-20T02:59:23ZengSpringerAnesthesiology and Perioperative Science2731-83892025-03-01311710.1007/s44254-025-00089-3Perioperative strokes: uncovering risks, sequelae, and a therapeutic futureAravind Ganesh0Calgary Stroke Program, Departments of Clinical Neurosciences and Community Health Sciences, University of Calgary Cumming School of MedicineAbstract This article provides an overview of perioperative strokes—a pressing concern given the rising number of surgical or interventional procedures performed worldwide. Mechanisms underlying perioperative stroke include atherosclerotic plaque instability, induction of a pro-inflammatory state (aggravated by vascular risk factors), hemodynamic dysfunction through hypotension and blood loss, and disruption of the endothelial glycocalyx. The frequency of perioperative stroke varies considerably depending on the type of procedure, being higher with aortic valve and neurovascular procedures. Covert or silent strokes are commonly seen on post-operative magnetic resonance imaging in as many as one in two patients after procedures like brain aneurysm coiling. Risk factors for perioperative stroke include patient factors such as age, sex, race, and comorbidities, as well as operator and procedural factors such as operator experience, institutional procedural volume, use of certain devices, and vascular access site. Overt periprocedural stroke is associated with higher mortality, longer hospital stays, and higher long-term disability. The long-term sequelae of covert strokes are still being characterized, but recent studies have indicated that a higher burden of such infarcts is associated with worse functional and cognitive outcomes. Key considerations to prevent perioperative strokes include screening plus risk factor control, pre-medication, and procedural considerations including anesthetic choice. The management of perioperative ischemic stroke has been aided by advancements in reperfusion therapies and stroke systems of care that allow rapid treatment of major stroke. Ongoing work seeks to address the enduring need for evidence-based therapeutic strategies to prevent these strokes and mitigate their adverse impact.https://doi.org/10.1007/s44254-025-00089-3StrokeIschemic strokeIatrogenic infarctIatrogenic strokePerioperative strokePrevention |
| spellingShingle | Aravind Ganesh Perioperative strokes: uncovering risks, sequelae, and a therapeutic future Anesthesiology and Perioperative Science Stroke Ischemic stroke Iatrogenic infarct Iatrogenic stroke Perioperative stroke Prevention |
| title | Perioperative strokes: uncovering risks, sequelae, and a therapeutic future |
| title_full | Perioperative strokes: uncovering risks, sequelae, and a therapeutic future |
| title_fullStr | Perioperative strokes: uncovering risks, sequelae, and a therapeutic future |
| title_full_unstemmed | Perioperative strokes: uncovering risks, sequelae, and a therapeutic future |
| title_short | Perioperative strokes: uncovering risks, sequelae, and a therapeutic future |
| title_sort | perioperative strokes uncovering risks sequelae and a therapeutic future |
| topic | Stroke Ischemic stroke Iatrogenic infarct Iatrogenic stroke Perioperative stroke Prevention |
| url | https://doi.org/10.1007/s44254-025-00089-3 |
| work_keys_str_mv | AT aravindganesh perioperativestrokesuncoveringriskssequelaeandatherapeuticfuture |