Abstract SNACC-81

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Risk Factors for Perioperative Ischemic Stroke/TIA in Patients with Atherosclerotic Extracranial Cerebrovascular Stenosis Undergoing Angioplasty and Stenting

Zhao W, Wang A, Han R
Beijing Tiantan Hospital, Capital Medical University, Beijing, , China

Background: Angioplasty and Stenting is a treatment for atherosclerotic cerebrovascular stenosis in patients at high risk of stroke despite maximal medical therapy. Perioperative ischemic stroke is a major complication following cerebral artery stenting. However, the role of intraoperative blood pressure in the occurrence and evolution of on perioperative ischemic stroke in this high-risk population is largely unknown[1].
Methods: We retrospectively evaluated data on 328 extracranial cerebrovascular stenting from Match 2012 to February 2013 at a single academic medical center (Beijing Tiantan Hospital, Capital Medical University, Beijing, China). Intraoperative hypotension was defined as intraoperative systolic blood pressure< 90 mm Hg for at least 5 minutes. Perioperative stroke was defined as any new focal or global neurological deficit that changed the NIH stroke scale and lasting greater than 24 hours with associated radiographic evidence of acute cerebral infarction. Perioperative TIA was neurological deficit that changed the NIH stroke scale and completely resolved or returned to baseline within 24hrs without acute cerebral infarction or hemorrhage on CT scan. Logistic regression was used to analyze the role of sociodemographic, comorbidity, neurological and angiographic characteristics, and more importantly, hemodynamic variables on perioperative ischemic strokes/TIA.
Results: Among the 266 male (81.1%) and 62 female (18.9%) patients with a mean age of 64.8 ± 9.2 years, perioperative ischemic stroke/TIA occurred in 10 of 318 (3.0%) procedures, no intracerebral hemorrhage or perioperative death occurred. Multivariable predictors of perioperative ischemic stroke/TIA were presence of untreated intracranial artery stenosis (odds ratio [OR], 9.44; 95% confidence interval [CI], 2.36-37.71; p=0.001) and intraoperative hypotension (OR, 9.13; 95% CI, 1.35-61.76; p = 0.023)(Table 1).
Conclusion: Perioperative stroke/TIA is a potentially complication following angioplasty and stenting for extracranial cerebrovascular stenosis. Patients suffer from untreated intracranial stenosis are associated with an increased risk for this complication. Intraoperative hypotension might be a potential modifiable risk factor in the development of perioperative ischemic stroke/TIA. Especially for systolic blood pressure less than 90mmHg for at least 5 minutes, an association with perioperative ischemic stroke risks was observed.
1. Reddy U, Smith M: Anesthetic management of endovascular procedures for cerebrovascular atherosclerosis. Current Opinion in Anaesthesiology 2012, 25(4):486-492.

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