Patients do not usually think about stroke as a risk of surgery, but the possibility of stroke should be weighed when considering surgery and rigorous precautions should be taken to decrease the risk as much as possible.
Conditions and surgeries that increase the risk of stroke
While the risk of perioperative stroke, in general, is less than 1%, it can be up to 5% for operations on tumors of the head or neck, and as much as 10% for heart surgery.
The risk of stroke during or shortly after an operation is elevated when certain other factors are present, including advanced age, female gender, obesity, high blood pressure, smoking, peripheral vascular disease, chronic obstructive pulmonary disease, diabetes, and high cholesterol.
Why heart surgery is a stroke risk
Actor Bill Paxton’s death from a stroke after his 2017 heart surgery brought more attention to the very real risk of stroke after heart surgery, especially open heart surgery and bypass surgery. The chief cause of stroke from heart surgery is blood clots, made more likely due to the manipulation of blood vessels and the use of a heart-lung machine that mechanically keeps the blood flowing around the heart when the heart is being operated on.
The use of the heart-lung machine offers two points at which clots can occur: at the beginning, when the heart’s aorta is clamped so the patient can be attached to the machine, and at the end when the clamp is removed and the deflated heart – having been without blood flowing through it for a time – is suddenly re-inflated with blood. Both of these points can cause clots to form, especially if there is existing atherosclerosis, or plaque buildup, in the arteries. Plaque could easily break off from vascular manipulation and travel to the brain.
Besides blood clots from atherosclerosis, shock and septic clots or clots from infections elsewhere in the body can also cause stroke during or shortly after heart surgery.
The importance of precautions
If you are being considered for surgery, discuss with your doctor alternative therapies. If surgery is the best or only recourse and there is time, discuss how existing risk factors such as obesity, blood pressure, or high cholesterol can be alleviated to decrease your risk of stroke.
Choose a hospital that specializes in open-heart surgery, doing a minimum of 250 every year, and look for a veteran doctor who has many years of experience. Anesthesia has an impact on stroke risk as well, so insist on a veteran anesthesiologist, and that you be taken to intensive care after surgery, with intensive care doctors on staff at all times.
That said, the doctors and nurses will not be monitoring you constantly because they will have other patients. That is why we at Neuralert created a stroke detection monitor to be the 24/7 eyes and ears for the busy medical staff. Our unique, non-invasive wristband technology combined with our state-of-the-art patented algorithm developed by the University of Pennsylvania detects asymmetry in arm movement, one of the initial indications of stroke onset, while mathematically ruling out other causes of asymmetry in order to eliminate false positives. Your nurses will know that if they get an alert from the Neuralert technology you need immediate attention. Quick treatment decreases the severity of the effects of stroke, should one occur.
More and more hospitals are partnering with Neuralert to improve post-operative care and decrease the risks of long-term stroke damage. Ask your hospital if they are using Neuralert.