Risk of ischemic stroke in patients with symptomatic vertebrobasilar stenosis undergoing surgical procedures.
OBJECTIVE
There is little information to provide an estimate for stroke risk in patients with established stenosis or occlusion in the basilar or intracranial vertebral arteries undergoing surgical procedures. The objective of this study was to determine the ischemic stroke risk in this specific patient population.


METHODS
A medical records linkage system retrospectively identified patients with a diagnosis of symptomatic vertebrobasilar stenosis or occlusion matched with surgical procedures. Patients were selected if they had stenosis or occlusion of the basilar or intracranial vertebral arteries identified on vascular imaging before undergoing surgical procedures under general anesthesia. Clinical and radiographic features were reviewed, along with the nature of the surgeries and details of the perioperative management. Records were reviewed for the diagnosis of stroke occurring within 1 month of surgery.


RESULTS
Thirty-eight patients with a history of symptomatic vertebrobasilar ischemia underwent 50 operations under general anesthesia, and 3 had ischemic strokes in the vertebrobasilar territory immediately after surgery, a per-procedure rate of 6.0% (95% confidence interval, 1.2 to 16.6) All 3 had episodes of prolonged hypotension (systolic blood pressure <100 mm Hg for >10 minutes) during surgery.


CONCLUSIONS
The risk of perioperative stroke in patients with vertebrobasilar stenosis undergoing surgery under general anesthesia is 6.0%, which is notably higher than the risk for patients with other patterns of cerebrovascular disease.
Blacker
David J
DJ
Department of Neurology, Mayo Clinic, 200 First St SW, Rochester, Minn 55905, USA.
Flemming
Kelly D
KD
Wijdicks
Eelco F M
EF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D001488:Basilar Artery / Q000000981:diagnostic imaging; D002545:Brain Ischemia / Q000209:etiology*; D002533:Cerebral Angiography; D015897:Comorbidity; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D016347:Medical Records Systems, Computerized / Q000706:statistics & numerical data; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D020521:Stroke / Q000209:etiology*; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D014711:Vertebral Artery / Q000000981:diagnostic imaging; D014715:Vertebrobasilar Insufficiency / Q000150:complications* / Q000000981:diagnostic imaging