Perioperative stroke risk in 173 consecutive patients with a past history of stroke
J. Landercasper, B. J. Merz, T. H. Cogbill, P. J. Strutt, R. H. Cochrane, R. A. Olson and R. D. Hutter
Department of General and Vascular Surgery, Gundersen/Lutheran Medical Center, La Crosse, Wis.
During an 8-year period ending in 1988, 173 consecutive patients with a
history of previous cerebrovascular accident underwent general anesthesia
for surgery. Five patients (2.9%) had documented postoperative
cerebrovascular accidents from 3 to 21 days (mean, 12.2 days) after
surgery. The risk of postoperative cerebrovascular accident did not
correlate with age, sex, history of multiple cerebrovascular accidents,
poststroke transient ischemic attacks, American Society for Anesthesia
physical status, aspirin use, coronary artery disease, peripheral vascular
disease, intraoperative blood pressure, time since previous cerebrovascular
accident, or cause of previous cerebrovascular accident. Postoperative
stroke was more common in patients given preoperative heparin sodium. We
conclude that the risk of perioperative stroke is low (2.9%) but not easily
predicted and that the risk continues beyond the first week of
convalescence. Unlike myocardial infarction, cerebral reinfarction risk
does not seem to depend on time since previous infarct.
