Introduction: Revascularization surgery for patients with carotid occlusion and moyamoya is associated with a risk of perioperative stroke. The stroke risk for such patients who undergo non-cerebrovascular (CV) surgeries is not known.
Methods: This single-center retrospective study was designed to characterize the perioperative stroke risk for patients with potential CV insufficiency undergoing elective non-CV surgeries. Patients diagnosed with moyamoya or with stenosis or occlusion of the internal carotid artery or middle cerebral artery were identified by searching admission records based on ICD-9, ICD-10, and CPT codes. Their charts were reviewed to extract the relevant clinical and radiological data.
Results: Thirty-four patients with relevant CV steno-occlusive diagnoses underwent 63 elective non-CV surgeries. The qualifying CV diagnoses included moyamoya disease (n=10), moyamoya syndrome (n=11), intracranial atherosclerosis resulting in hypoperfusion (n=6), and cervical ICA occlusion with hypoperfusion (n=7). The average age of patients was 42. Perioperative strokes occurred in three cases within 30 days of the non-CV surgery (4.7%). These strokes occurred following local flap reconstruction for a scalp defect (n=1), T2-ilium instrumented fusion (n=1), and anterior cervical discectomy and fusion (n=1). The onset of stroke symptoms occurred on postoperative day four, seven, and 14, respectively. The first occurred during the same admission, while the other two occurred post-discharge after routine postoperative stays, resulting in readmission. Previous direct or indirect bypass procedures had been performed in 87% of all cases, but only in one of three patients who suffered perioperative stroke. All three strokes were small and non-disabling.
Conclusions: The perioperative stroke rate of 4.7% for patients with CV steno-occlusive disease and suspected hemodynamic insufficiency is low, and no disabling strokes were encountered. Such patients should be informed of the stroke risk but should not be deterred from pursing indicated surgeries.
Patient Care: The results of this project will help practitioners inform patients with moyamoya disease, carotid occlusion, and related disorders regarding perioperative stroke risk when undergoing elective non-cerebrovascular surgeries.
Learning Objectives: By the end of this session, participants should be able to:
1) Identify the risk of stroke for patients with cerebrovascular steno-occlusive disease undergoing non-cerebrovascular surgeries under general anesthesia.
2) Characterize the timing and severity of these perioperative strokes.