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Perioperative stroke: a question of timing?

Perioperative stroke is a potentially devastating complication with an incidence of 0.1–0.6% in non-cardiac surgery. Although rare, stroke in the perioperative setting is associated with an adjusted 8-fold increase in mortality, thus developing preventive strategies is of paramount importance. The recent consensus statement on the prevention of perioperative stroke from the Society for Neuroscience in Anesthesiology and Critical Care (SNACC) is a step in this direction. A history of ischaemic stroke is a strong predictor of perioperative stroke and important recent data from Jorgensen and colleagues have added further information regarding the optimal interval between the stroke event and elective surgery. In this editorial, the preoperative approach to a patient at high risk of stroke is reviewed based on the SNACC consensus statement, with additional discussion of the crucial question of when to schedule surgery in patients with a history of stroke.