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Arterial territory included 37 middle cerebral artery,11 posterior circulation,7 borderzone,and 6 multiple.Median procedure to stroke interval was 2 days(range 0 to 16);10 patients had intraoperative strokes. Three major risk factors emerged:previous cerebrovascular disease(AOR 12. 57,95%CL 2.14/73.70),chronic obstructive pulmonary disease(COPD)(7.51,1. 87/30.12)and peripheral vascular disease(PVD)(5.35,1.25/22.94).After adding stroke-related factors,PVD(14.70,2.02/107.71)and COPD(10.04,1.90/ 53.14)remained the strongest variables;blood pressure(1.05,1.01/1.10)and urea(1.04,1.01/1.07)contributed slightly.Hypotension did not contribute. Four patients(6.6%)and no controls had diffuse intravascular coagulation (p=0.01).Four stroke patients had myocardial infarction(6.6%versus 0%;p=0. 01).Ischemic strokes after general surgery most commonly occur after an asymptomatic interval.Previous cerebrovascular disease,COPD,and PVD greatly increase the risk.Hypotension rarely accounts for postoperative strokes.Major comorbidity of the patient at risk seems more important than complicating events during surgery. |
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