Can retrograde perfusion mitigate cerebral injury after particulate XXXX ? A study in a chronic porcine model.

@entity1707 @entity852 @entity2806 @entity26 @entity1416 @entity887 @entity432 @entity204 @entity130
OBJECTIVE: We assessed the impact on histologic and behavioral outcome of an interval of retrograde cerebral perfusion after @entity1416 , comparing retrograde cerebral perfusion with and without @entity432 with continued antegrade perfusion. METHODS: Sixty Yorkshire @entity1707 (27 to 30 kg) were randomly assigned to the following groups: antegrade cerebral perfusion control; antegrade cerebral perfusion after @entity887 ; retrograde cerebral perfusion control; retrograde cerebral perfusion after @entity887 ; retrograde cerebral perfusion with @entity432 , retrograde cerebral perfusion with @entity432 control, and retrograde cerebral perfusion with @entity432 after @entity887 . After cooling to 20 degrees C, a bolus of 200 mg of @entity852 microspheres 250 to 750 (microm diameter (or saline solution) was injected into the isolated aortic arch. After 5 minutes of antegrade cerebral perfusion, 25 minutes of antegrade cerebral perfusion, retrograde cerebral perfusion, or retrograde cerebral perfusion with @entity432 was instituted. After the operation, all animals underwent daily assessment of neurologic status until the time of @entity204 on day 7. RESULTS: Aortic arch return, cerebral vascular resistance, and @entity26 extraction data during retrograde cerebral perfusion showed differences, suggesting that more effective flow occurs during retrograde cerebral perfusion with @entity432 , which also resulted in more pronounced fluid sequestration. Microsphere recovery from the brain revealed significantly fewer emboli after retrograde cerebral perfusion with @entity432 . Behavioral scores showed full recovery in all but one control animal (after retrograde cerebral perfusion with @entity432 ) by day 7 but were considerably lower after @entity887 , with no significant differences between groups. The extent of @entity130 was not significantly different among embolized groups. Although no histopathologic lesions were present in either the antegrade cerebral perfusion control group or the retrograde cerebral perfusion control group, mild significant @entity2806 occurred after retrograde cerebral perfusion with @entity432 even in control animals. CONCLUSIONS: Although effective washout of particulate emboli from the brain can be achieved with retrograde cerebral perfusion with @entity432 , no advantage of retrograde cerebral perfusion with @entity432 after @entity887 is seen from behavioral scores, electroencephalographic recovery, or histopathologic examination; retrograde cerebral perfusion with @entity432 results in greater fluid sequestration and mild @entity130 even in control animals. Retrograde cerebral perfusion with @entity432 shows clear promise in the management of @entity887 , but further refinements must be sought to address its still worrisome potential for harm.
