An article appearing in the Expert Review of Neurotherapeutics suggests that while strokes that occur during or shortly after surgery can pose the risk of fatality, long-term disability, or longer hospital stays, prompt identification and treatment may assist in improving neurological outcomes.
Stroke specialists Sarkis Morales-Vidal, MD, and Michael Schneck, MD, Loyola University Medical Center, note that risk factors for perioperative stroke include advanced age, female gender, obesity, high blood pressure, smoking, peripheral vascular disease, chronic obstructive pulmonary disease, diabetes and high cholesterol. The study authors reportedly investigated several therapies to treat perioperative strokes caused by blood clots.
The study first assessed intravenous clot-busting drug (rtPA), which researchers concluded should not be recommended for patients who have undergone major surgery within the previous 14 days. However, researchers add, rtPA may be safe following minor surgeries, such as muscle biopsies. Researchers say they also investigated delivering rtPA by catheter, but noted that using the technique in any patient population, “is not currently substantiated by randomized controlled trials,” Morales-Vidal and Schneck say.
The study also evaluated mechanical clot busting, using catheter systems such as MERCI, Solitaire, and Penumbra. The authors caution that these systems are, “untested and unproven in perioperative stroke.” Sonothrombolysis and its use of ultrasound was an additional therapy researchers investigated. The authors emphasize that the evidence for sonothrombolysis in stroke is not conclusive and the perioperative population unstudied.
Hemicraniectomy rounded out the therapies, with the authors concluding that, “In appropriate cases, hemicraniectomy has shown clear benefit, improving survival and functional outcomes.”
Source: Loyola University Health System