Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Strokes associated with surgery can be devastating

12.02.2013
But prompt identification and outcomes can improve outcomes

Strokes that occur during or shortly after surgery can be devastating, resulting in longer hospital stays and increased risks of death or long-term disability.

But prompt identification and treatment of such strokes can improve neurologic outcomes, according to an article in the journal Expert Review of Neurotherapeutics by Loyola University Medical Center stroke specialists Sarkis Morales-Vidal, MD and Michael Schneck, MD.

The article answers commonly asked questions about the management of perioperative stroke. (A perioperative stroke is a stroke that occurs anytime between the time a patient is hospitalized for surgery until the patient is discharged from the hospital.)

Risk factors for peroperative stroke include advanced age, female gender, obesity, high blood pressure, smoking, peripheral vascular disease, chronic obstructive pulmonary disease, diabetes and high cholesterol. For most surgeries, the risk of perioperative stroke is less than 1 percent. But the risk can be as high as 5 percent for surgeries for head and neck tumors and between 2 and 10 percent for various heart surgeries.

The most common cause of perioperative stroke is blood clots. Blood thinners can reduce the risk of strokes, but can increase the risk of bleeding. Morales and Schneck write that in managing surgery patients, physicians must balance the risk of stroke versus the risk of significant bleeding complications. Studies have found that for many surgeries, including cardiovascular procedures, the benefits of giving patients aspirin (a blood thinner) outweigh the risks of bleeding.

The authors examine the evidence for several therapies to treat perioperative strokes caused by blood clots:

Intravenous clot-busting drug (rtPA). Because of the risk of bleeding, rtPA is not indicated for patients who have undergone major surgery within the previous 14 days. But rtPA probably is safe following minor surgeries such as muscle biopsies and dental procedures.

Delivering rtPA by catheter. In this procedure, a high concentration of the clot-busting drug is delivered by a catheter directly to the clot. But using this technique in any patient population, surgical or otherwise, "is not currently substantiated by randomized controlled trials," the authors write.

Mechanical clot busting. Catheter systems such as MERCI, Penumbra and Solitaire, which use mechanical devices to bust clots, have been deemed safe by the Food and Drug Administration. But these systems are "untested and unproven in perioperative stroke," Morales and Schneck write.

Ultrasound. Sonothrombolysis uses ultrasound to enhance the break-up of blood clots in the brain. "The evidence for sonothrombolysis in stroke is far from conclusive, and the perioperative population is unstudied," the authors write.

Hemicraniectomy. Large strokes can cause life-threatening brain swelling. A hemicraniectomy is surgery to relieve the swelling. The surgeon temporarily removes part of the skull, allowing the swollen brain to expand beyond the confines of the skull. "In appropriate cases, hemicraniectomy has shown clear benefit, improving survival and functional outcomes," Morales and Schneck write.

Morales is an assistant professor in the Department of Neurology of Loyola University Chicago Stritch School of Medicine. Schneck is a professor and medical director of the Neurosciences intensive care unit.

Jim Ritter | EurekAlert!
Further information:
http://www.lumc.edu

More articles from Health and Medicine:

nachricht How cancer metastasis happens: Researchers reveal a key mechanism
19.01.2018 | Weill Cornell Medicine

nachricht Researchers identify new way to unmask melanoma cells to the immune system
17.01.2018 | Duke University Medical Center

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Artificial agent designs quantum experiments

On the way to an intelligent laboratory, physicists from Innsbruck and Vienna present an artificial agent that autonomously designs quantum experiments. In initial experiments, the system has independently (re)discovered experimental techniques that are nowadays standard in modern quantum optical laboratories. This shows how machines could play a more creative role in research in the future.

We carry smartphones in our pockets, the streets are dotted with semi-autonomous cars, but in the research laboratory experiments are still being designed by...

Im Focus: Scientists decipher key principle behind reaction of metalloenzymes

So-called pre-distorted states accelerate photochemical reactions too

What enables electrons to be transferred swiftly, for example during photosynthesis? An interdisciplinary team of researchers has worked out the details of how...

Im Focus: The first precise measurement of a single molecule's effective charge

For the first time, scientists have precisely measured the effective electrical charge of a single molecule in solution. This fundamental insight of an SNSF Professor could also pave the way for future medical diagnostics.

Electrical charge is one of the key properties that allows molecules to interact. Life itself depends on this phenomenon: many biological processes involve...

Im Focus: Paradigm shift in Paris: Encouraging an holistic view of laser machining

At the JEC World Composite Show in Paris in March 2018, the Fraunhofer Institute for Laser Technology ILT will be focusing on the latest trends and innovations in laser machining of composites. Among other things, researchers at the booth shared with the Aachen Center for Integrative Lightweight Production (AZL) will demonstrate how lasers can be used for joining, structuring, cutting and drilling composite materials.

No other industry has attracted as much public attention to composite materials as the automotive industry, which along with the aerospace industry is a driver...

Im Focus: Room-temperature multiferroic thin films and their properties

Scientists at Tokyo Institute of Technology (Tokyo Tech) and Tohoku University have developed high-quality GFO epitaxial films and systematically investigated their ferroelectric and ferromagnetic properties. They also demonstrated the room-temperature magnetocapacitance effects of these GFO thin films.

Multiferroic materials show magnetically driven ferroelectricity. They are attracting increasing attention because of their fascinating properties such as...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

10th International Symposium: “Advanced Battery Power – Kraftwerk Batterie” Münster, 10-11 April 2018

08.01.2018 | Event News

See, understand and experience the work of the future

11.12.2017 | Event News

Innovative strategies to tackle parasitic worms

08.12.2017 | Event News

 
Latest News

Let the good tubes roll

19.01.2018 | Materials Sciences

How cancer metastasis happens: Researchers reveal a key mechanism

19.01.2018 | Health and Medicine

Meteoritic stardust unlocks timing of supernova dust formation

19.01.2018 | Physics and Astronomy

VideoLinks
B2B-VideoLinks
More VideoLinks >>>