PeriopStroke Shanghai 09.pptVIP

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PeriopStroke Shanghai 09.ppt

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PeriopStroke Shanghai 09

30 Day Efficacy AnalysisAspirin CEA Trial (ACE) * * * * * * * * * * * * * * * * * * * * * * . (A) Forest plot of retrieved studies evaluating statin use and the incidence of stroke after cardiac surgery. (B) Forest plot of retrieved studies evaluating statin use and the incidence of stroke after vascular surgery. CI = confidence interval; OR = odds ratio. From: ? Hindler: Anesthesiology, Volume 105(6).December 2006.1260-1272 * * Statins Prinz V Anesth Analg 2009; 109:572 Hindler K Anesthesiology 2006; 105:1260-1272 Meta-analysis of Stroke and Pre-op Statin Statin vs non-Statin pretreatment Carotid Endarterectomy McGirt MJ Vasc Surg. 2005; 42:829-36 * * P0.002 Conclusion Stroke effects 0.2 – 1.5% of patients We need prospective data Need to understand pathophysiology Why does it occur How do we prevent it 非常感谢！ For how long after a stroke should surgery be deferred Stroke. 2002; 33:2182 Soluble Intercellular Adhesion Molecule-1 and Risk of Future Ischemic Stroke A Nested Case-Control Study From the Bezafibrate Infarction Prevention (BIP) Study Cohort David Tanne et al Conclusions— Elevated concentrations of sICAM-1, a marker of inflammation, are associated with increased risk of ischemic stroke (OR 2.1) independent of other traditional cerebrovascular risk factors Patient with Previous StrokeFor How Long Should Surgery be Delayed? Most agree that surgery should be avoided in the first month after a stroke Some recommend delaying elective surgery for 1 - 3 months after a stroke if possible Transient Ischemic Attack (TIA) A focal neurological deficit of sudden onset that resolves rapidly after a period lasting more than a few seconds but less than 24 hours. Risk factors – type of surgery Stroke Rate % Risk of Recurrent Embolism 0.5% per DAY in 1st month 12% per year Kearon C, Hirsh J. New Eng J Med 336:1506, 1997 Atrial Fibrillation Johnston SC et al. JAMA 284:2901, 2000 Stroke and Event-Free Survival Within 90 Days of TIA Adverse events = Stroke,