UHN/MSH Medical Consult Service
Neurology
Stroke
Carotid Stenosis & Perioperative Stroke

Prevalence:

>50% stenosis occurs in 7% of women and 9% of men aged > 65
Annual risk of ipsilateral stroke is 2-3%
>50% stenosis - risk is 1.4%
80-99% stenosis - risk is 2.8%

Incidence:
Stroke after general surgical procedure is < 1%
Risk factors are:
  • Hypertension
  • Smoking
  • Earlier Neurological symptoms
  • Abnormal Cardiac Rhythm

Special consideration:
Bilateral severe carotid stenosis (especially with poor collateral circulation)
Unproven whether endarterectomy is of value
Etiology of Perioperative Stroke
References:

Paciaroni,M, et al.:
Management of asymptomatic carotid stenosis in patients undergoing general and vascular surgical procedures
J Neurol Neurosurg Psychiatry - Vol 76, 2005; 1332-1336

Selim, M
Perioperative Stroke.
N Engl J Med 356;7 Feb 15, 2007; 706-713

Press M, Halm, E, et al.
Predicting Medical ans Surgical Complications of Carotid Endarterectomy.  Arch Intern Med Vol 166
Apr 24, 2006
Perioperative Stroke

Outline:

  1. Incidence
  2. Etiology
  3. Risk Factors
  4. Carotid Stenosis
  5. Halm Score - CEA Stroke Risk
  6. References
Risk Factors for Perioperative Stroke
Halm Risk Score for complication following endarterectomy

The Halm Score includes 3 factors that increase the risk of complications:
  1. active coronary artery disease (unstable angina or CCS III or IV angina)
  2. stroke as indication for surgery
  3. contralateral stenosis > 50%

and 1 protective factor:
  1. use of local anesthesia