Stroke has long been a devastating complication of any cardiovascular procedure that unfavorably affects survival and quality of life. Over time, strategies have been developed to substantially reduce the incidence of stroke after traditional cardiovascular procedures such as coronary artery bypass grafting, isolated valve surgery, and carotid endarterectomy. Subsequently, with the advent of minimally invasive technologies including percutaneous coronary intervention, carotid artery stenting, and transcatheter valve therapies, operators were faced with a new host of procedural risk factors, and efforts again turned toward identifying novel ways to reduce the risk of stroke. Fortunately, by understanding the procedural factors unique to these new techniques and applying many of the lessons learned from prior experiences, we are seeing significant improvements in the safety of these new technologies. In this review, the authors: 1) carefully analyze data from different cardiac procedural experiences ranging from traditional open heart surgery to percutaneous coronary intervention and transcatheter valve therapies; 2) explore the unique risk factors for stroke in each of these areas; and 3) describe how these risks can be mitigated with improved patient selection, adjuvant pharmacotherapy, procedural improvements, and novel technological advancements.

中文翻译：

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心血管手术后的脑血管事件

中风长期以来一直是任何心血管手术的破坏性并发症，对生存和生活质量产生不利影响。随着时间的推移，已经制定了一些策略来大幅降低传统心血管手术（例如冠状动脉旁路移植术、孤立瓣膜手术和颈动脉内膜切除术）后中风的发生率。随后，随着包括经皮冠状动脉介入治疗、颈动脉支架置入术和经导管瓣膜治疗在内的微创技术的出现，操作者面临着一系列新的手术风险因素，并且努力再次转向寻找降低中风风险的新方法。幸运的是，通过了解这些新技术所特有的程序因素并应用从先前经验中吸取的许多教训，我们看到这些新技术的安全性有了显着改善。在这篇综述中，作者：1) 仔细分析了来自不同心脏手术经验的数据，从传统的心脏直视手术到经皮冠状动脉介入治疗和经导管瓣膜治疗；2) 探索每个领域中中风的独特危险因素；3) 描述如何通过改进患者选择、辅助药物治疗、程序改进和新技术进步来减轻这些风险。2) 探索每个领域中中风的独特危险因素；3) 描述如何通过改进患者选择、辅助药物治疗、程序改进和新技术进步来减轻这些风险。2) 探索每个领域中中风的独特危险因素；3) 描述如何通过改进患者选择、辅助药物治疗、程序改进和新技术进步来减轻这些风险。