Update in the Evaluation and Management of Perioperative Stroke

This review will review the current knowledge and gaps in the literature on the relationship between surgery and ischemic stroke. Surgery and ischemic stroke are interrelated phenomena as surgery is an independent risk factor for stroke and perioperative stroke increases morbidity and mortality leading to poor outcomes after surgery. This relationship and the risk of adverse outcome apply not only the clinically apparent stroke in the perioperative period but also clinically silent brain infarction detected only on radiological studies. The risk of perioperative stroke depends on several factors including (i) patient-related factors (age, history of prior stroke, and other comorbidities), (ii) procedure-related factors (type of surgery/procedure, use of cardiopulmonary bypass, antiplatelet/antithrombotic interruption, and metabolic derangement), and (iii) perioperative atrial fibrillation. With observation and retrospective data, the literature is limited to prevention and management of perioperative stroke.