Consults for Stroke risk and timing of surgery

Blacker Dj et al The preoperative cerebrovascular consultation. Common cerebrovascular questions before general or cardiac surgery. Mayo Clin Proc 2004;79: 223-229.


Table one described stroke risk in various scenarios. CABG + valve surgery led with 4-13 % risk. CABG after prior stroke/TIA 8 %, CABG with carotid occlusion, 7 %, surgery with symptomatic VB stenosis, 6 %, CABG with bilateral > 50 % stenosis 5 %, unilateral 3%, after prior stroke 2.9 %, all surgery stroke risk 0.2 %. Other important factors are PVD, cardiac arrythmias, and chronic airway disease.

For CABG, prior stroke or TIA is very risky, worse with advanced age, recent MI, angina, DM smoking, impaired renal function. Authors suggest carotid surgery before CABG if dual disease, if carotid disease is symptomatic. and if carotid is not symptomatic, avoiding dual procedure (ie not doing CABG and CEA together). They also suggest waiting one month after stroke to do carotid surgery.