Navigation Links
Strokes associated with surgery can be devastating

MAYWOOD, Il. Strokes that occur during or shortly after surgery can be devastating, resulting in longer hospital stays and increased risks of death or long-term disability.

But prompt identification and treatment of such strokes can improve neurologic outcomes, according to an article in the journal Expert Review of Neurotherapeutics by Loyola University Medical Center stroke specialists Sarkis Morales-Vidal, MD and Michael Schneck, MD.

The article answers commonly asked questions about the management of perioperative stroke. (A perioperative stroke is a stroke that occurs anytime between the time a patient is hospitalized for surgery until the patient is discharged from the hospital.)

Risk factors for peroperative stroke include advanced age, female gender, obesity, high blood pressure, smoking, peripheral vascular disease, chronic obstructive pulmonary disease, diabetes and high cholesterol. For most surgeries, the risk of perioperative stroke is less than 1 percent. But the risk can be as high as 5 percent for surgeries for head and neck tumors and between 2 and 10 percent for various heart surgeries.

The most common cause of perioperative stroke is blood clots. Blood thinners can reduce the risk of strokes, but can increase the risk of bleeding. Morales and Schneck write that in managing surgery patients, physicians must balance the risk of stroke versus the risk of significant bleeding complications. Studies have found that for many surgeries, including cardiovascular procedures, the benefits of giving patients aspirin (a blood thinner) outweigh the risks of bleeding.

The authors examine the evidence for several therapies to treat perioperative strokes caused by blood clots:

  • Intravenous clot-busting drug (rtPA). Because of the risk of bleeding, rtPA is not indicated for patients who have undergone major surgery within the previous 14 days. But rtPA probably is safe following minor surgeries such as muscle biopsies and dental procedures.

    Delivering rtPA by catheter. In this procedure, a high concentration of the clot-busting drug is delivered by a catheter directly to the clot. But using this technique in any patient population, surgical or otherwise, "is not currently substantiated by randomized controlled trials," the authors write.

  • Mechanical clot busting. Catheter systems such as MERCI, Penumbra and Solitaire, which use mechanical devices to bust clots, have been deemed safe by the Food and Drug Administration. But these systems are "untested and unproven in perioperative stroke," Morales and Schneck write.

  • Ultrasound. Sonothrombolysis uses ultrasound to enhance the break-up of blood clots in the brain. "The evidence for sonothrombolysis in stroke is far from conclusive, and the perioperative population is unstudied," the authors write.

  • Hemicraniectomy. Large strokes can cause life-threatening brain swelling. A hemicraniectomy is surgery to relieve the swelling. The surgeon temporarily removes part of the skull, allowing the swollen brain to expand beyond the confines of the skull. "In appropriate cases, hemicraniectomy has shown clear benefit, improving survival and functional outcomes," Morales and Schneck write.


Contact: Jim Ritter
Loyola University Health System

Related medicine news :

1. Docs, Families May Underestimate Patients Odds After Some Strokes: Study
2. Artist Brushstrokes Launches Exclusive Beauty Strokes H.I.S Shaving Brushes on
3. Blau, Brown & Leonard, LLC Settlements Near Two Million Dollars on Behalf of Women who Endured DVT's, PE's and Strokes from Yaz, Yasmin and Ocella
4. Mini-Strokes May Be More Damaging Than Thought
5. Heart Attacks, Strokes Jumped After Japan Earthquake, Study Finds
6. NIH launches trial to evaluate anti-inflammatory treatment for preventing heart attacks, strokes, and cardiovascular deaths
7. Blacks More Prone to Hypertension After Certain Strokes
8. ACP joins Million Hearts to help save lives from preventable heart attacks and strokes
9. Strokes More Common in Southern States: CDC
10. Around-the-clock labor coverage associated with decrease in C-section
11. Maternal exposure to outdoor air pollution associated with low birth weights worldwide
Post Your Comments:
(Date:11/27/2015)... ... 2015 , ... Avid collector, Andrew Hawley from Vintage Rock Posters, announces his ... is one of Joplin's most famous and beautiful concert posters. The concert was held ... Ann Arbor. The According to Hawley, "It is hard to believe that Joplin's stardom ...
(Date:11/26/2015)... NV (PRWEB) , ... November 26, 2015 , ... Inevitably ... strategy. Many customers choose to buy during the Black Friday and Cyber Monday ... Shoppers don’t need to search the Internet high and low to find the best ...
(Date:11/26/2015)... (PRWEB) , ... November 26, 2015 , ... ... of workshops to discuss bioavailability and the need to integrate dose form selection ... in collaboration with OBN, the membership organization supporting and bringing together the UK’s ...
(Date:11/26/2015)... ... November 26, 2015 , ... WorldCare ... participated in the 61st annual Employee Benefits Conference. The Employee Benefits Conference was ... November 8th through Wednesday, November 11th, 2015. The conference was held at the ...
(Date:11/26/2015)... ... November 26, 2015 , ... Indosoft Inc., developer and distributor ... application server to improve system efficiency and reliability. , The new Q-Suite 6 platform ... standards, the system avoids locking itself into a specific piece of software for many ...
Breaking Medicine News(10 mins):
(Date:11/26/2015)... 2015 Research and Markets ( ) has ... Market Outlook to 2019 - Rise in Cardiac Disorders and ... report to their offering. Boston ... scientific and others. --> The ... Boston scientific and others. ...
(Date:11/26/2015)... , November 26, 2015 ... of the "2016 Future Horizons and ... Abuse Testing Market: Supplier Shares, Country Segment ... to their offering. --> ... "2016 Future Horizons and Growth Strategies ...
(Date:11/26/2015)... , November 26, 2015 ... Juntendo universitetssjukhus ser potential att använda SyMRI ... (MR-bilder) för patienter med multipel skleros ... forskningsavtal med SyntheticMR AB för att kunna ... på sjukhuset. Med SyMRI kan man generera ...
Breaking Medicine Technology: