Immediate reoperation for perioperative stroke after 2250 carotid endarterectomies: Differences between intraoperative and early postoperative stroke

Abstract Background Post-operative stroke increases morbidity and mortality after cardiac surgery. Data on characteristics and outcomes of stroke after heart transplantation (HT) are limited. Methods We conducted a retrospective analysis of the UNOS database from 2009 to 2020 to identify adults who developed stroke after orthotropic HT. HT recipients were divided according to the presence or absence of postoperative stroke. The primary endpoint was all-cause mortality after HT. Results A total of 25,015 HT recipients were analyzed, including 719 (2.9%) patients who suffered perioperative stroke. The rates of stroke increased from 2.1% in 2009 to 3.7% in 2019 and the risk of stroke was higher after the implantation of the new allocation system (odds ratio 1.29, 1.29, 95% Confidence Intervals [CI] 1.06–1.56, p=0.01). HT recipients with postoperative stroke were older (p=0.008), with higher rates of prior cerebrovascular accident (CVA) (p=0.004), prior cardiac surgery (p<0.001), longer waitlist time (p=0.04), higher rates of extracorporeal membrane oxygenation support (ECMO) (p<0.001), left ventricular assist devices (LVAD) (p<0.001), mechanical ventilation (p=0.003) and longer ischemic time (p<0.001). After multivariable adjustment for recipient and donor characteristics, age, prior cardiac surgery, CVA, support with LVAD, ECMO, ischemic time and mechanical ventilation at the time of HT were independent predictors of postoperative stroke. Stroke was associated with increased risk of 30-day and all-cause mortality after HT (hazard ratio [HR] 1.49, CI 1.12–1.99, p=0.007). Conclusion Perioperative stroke after HT is infrequent but associated with higher mortality. Redo sternotomy, LVAD and ECMO support at HT are among the risk factors identified. FUNDunding Acknowledgement Type of funding sources: None. Risk factors for stroke

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Clamped Carotid Dissection Can Reduce Postoperative Stroke After Carotid Endarterectomy

Vascular and Endovascular Surgery ◽

10.1177/15385744211052218 ◽

2021 ◽

pp. 153857442110522

Author(s):

Rodolfo Pini ◽

Gianluca Faggioli ◽

Sergio Palermo ◽

Sara Fronterrè ◽

Moad Alaidroos ◽

...

Keyword(s):

General Anesthesia ◽

Carotid Endarterectomy ◽

Near Infrared ◽

Intraoperative Complications ◽

Carotid Bifurcation ◽

Perioperative Stroke ◽

Acute Thrombosis ◽

Technical Errors ◽

Postoperative Stroke ◽

Asymptomatic Patients

Background: The outcomes of carotid endarterectomy (CEA) are constantly reported in a multitude of studies; however, the specific causes of perioperative stroke have been scarcely investigated. The aim of the present study was to analyze and categorize the causes of perioperative strokes after CEA. Methods: All CEAs performed from 2006 to 2019 in a single center were collected. CEA was routinely performed under general anesthesia, with routine shunting and patching, using cerebral near-infrared spectroscopy monitoring. Carotid exposure technique was classified as either clamped-dissection (CD) or preclamping-dissection (PCD) if the carotid bifurcation was dissected after or prior to carotid clamping. Perioperative and 30-day strokes and their possible mechanisms were evaluated according to preoperative symptoms and surgical technique adopted. Results: Among 1760 CEAs performed, 30 (1.7%) perioperative strokes occurred. 14 (47%) were identified upon emergence from general anesthesia, and 16 (53%) were noted in the first 30 days following intervention. Stroke etiology was categorized as follows: technical (acute thrombosis or intimal flap or due to intraoperative complications), embolic (no recognized technical defect), hemorrhagic, or contralateral. Symptomatic patients had a significantly higher rate of any type of stroke than asymptomatic patients (3.8% vs 0.9%, P = .0001). CD was protective for postoperative stroke (0.9% vs 3.1%, P = .001) in both symptomatic and asymptomatic patients (2.5% vs 5.9%, P = .05; 0.4% vs 1.9%, P = .005), particularly for the cohort in which symptomatic patients (0.7% vs 3.2%, P = .04) suffered postoperative embolic stroke. Conclusion: Perioperative stroke in CEA may be multifactorial in etiology, including a result of technical errors. A CD technique may help reduce the incidence of perioperative stroke.

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Hyperglycemia Independently Increases the Risk of Perioperative Stroke, Myocardial Infarction, and Death after Carotid Endarterectomy

Yearbook of Anesthesiology and Pain Management ◽

10.1016/s1073-5437(08)70106-2 ◽

2007 ◽

Vol 2007 ◽

pp. 112-113

Author(s):

S. Black

Keyword(s):

Myocardial Infarction ◽

Carotid Endarterectomy ◽

Perioperative Stroke

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Perioperative acute internal carotid thrombosis after general surgery

Perspectives in Surgery ◽

10.33699/pis.2020.99.3.136-140 ◽

2020 ◽

Vol 99 (3) ◽

pp. 136-140

Keyword(s):

Cardiac Surgery ◽

Internal Carotid ◽

Right Hemicolectomy ◽

Diagnostic Assessment ◽

Left Carotid Artery ◽

Perioperative Stroke ◽

Internal Carotid Occlusion ◽

Acute Brain Ischemia ◽

Selection Of Patients ◽

Selection Of

Introduction: The average incidence of perioperative stroke during major non-cardiac surgery is less than 1%, suggesting that it is rarely a major problem for the vast majority of patients. Methods: In our paper we present a 46-year-old patient undergoing acute right hemicolectomy who developed right-sided hemiparesis in the perioperative setting. Immediate CTAg examination showed an ischemic stroke in the left hemisphere as a result of left internal carotid thrombosis. A surgical procedure to recanalize the left carotid artery was performed 14 hours from the onset of neurological symptomatology and the neurological deficit gradually recovered fully. Conclusion: Our case report supports studies showing that a thorough diagnostic assessment allows the selection of patients who may benefit from urgent revascularization of acute internal carotid occlusion during the phase of acute brain ischemia.

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