What do you advise regarding the timing and safety of major surgery in patients with moderate to severe intracranial atherosclerosis?

One way to approach the question is by considering the timing of surgery following a stroke in general. Observational studies have indicated a heightened risk of perioperative stroke for several months after the initial event. For instance, Jørgensen et al. found that the risk remains elevated for up to 6 months, while Glance et al. observed a heightened risk up to 60 days post-stroke. The guidelines from the American Heart Association/American Stroke Association on perioperative management for non-cardiac non-neurological surgery also address this issue, recommending a delay of at least 6 months and preferably 9 months from the time of the stroke incident before elective surgery is considered. However, I personally find this guideline's de...