How do you assess periprocedural risk for patients with incidental silent ischemic infarcts scheduled for elective surgeries, major or intravascular procedures?

If the infarct is definite, I would initiate some work-up to determine risk, at least a CTA head/neck, and an echocardiogram. If hypertensive lacune, BP control might be all that is needed. If a cryptogenic, cortical/subcortical infarction, the CTA and echo would be more important. A risk estimate of surgery could then be approached.