UHN/MSH Medical Consult Service
Carotid Stenosis & Perioperative Stroke


>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%

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

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


  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