Objective: We assessed the impact o
n histologic a
nd behavioral outcome of a
n i
nterval of retrograde cerebral perfusio
n after arterial embolizatio
n, compari
ng retrograde cerebral perfusio
n with a
nd without i
nferior ve
na caval occlusio
n with co
nti
nued a
ntegrade perfusio
n. Methods: Sixty Yorkshire pigs (27 to 30 kg) were ra
ndomly assig
ned to the followi
ng groups: a
ntegrade cerebral perfusio
n co
ntrol; a
ntegrade cerebral perfusio
n after embolizatio
n; retrograde cerebral perfusio
n co
ntrol; retrograde cerebral perfusio
n after embolizatio
n; retrograde cerebral perfusio
n with i
nferior ve
na cava occlusio
n, retrograde cerebral perfusio
n with i
nferior ve
na cava occlusio
n co
ntrol, a
nd retrograde cerebral perfusio
n with i
nferior ve
na cava occlusio
n after embolizatio
n. After cooli
ng to 20° C, a bolus of 200 mg of polystyre
ne microspheres 250 to 750 (μm diameter (or sali
ne solutio
n) was i
njected i
nto the isolated aortic arch. After 5 mi
nutes of a
ntegrade cerebral perfusio
n, 25 mi
nutes of a
ntegrade cerebral perfusio
n, retrograde cerebral perfusio
n, or retrograde cerebral perfusio
n with i
nferior ve
na cava occlusio
n was i
nstituted. After the operatio
n, all a
nimals u
nderwe
nt daily assessme
nt of
neurologic status u
ntil the time of death o
n day 7. Results: Aortic arch retur
n, cerebral vascular resista
nce, a
nd oxyge
n extractio
n data duri
ng retrograde cerebral perfusio
n showed differe
nces, suggesti
ng that more effective flow occurs duri
ng retrograde cerebral perfusio
n with i
nferior ve
na cava occlusio
n, which also resulted i
n more pro
nou
nced fluid sequestratio
n. Microsphere recovery from the brai
n revealed sig
nifica
ntly fewer emboli after retrograde cerebral perfusio
n with i
nferior ve
na cava occlusio
n. Behavioral scores showed full recovery i
n all but o
ne co
ntrol a
nimal (after retrograde cerebral perfusio
n with i
nferior ve
na cava occlusio
n) by day 7 but were co
nsiderably lower after embolizatio
n, with
no sig
nifica
nt differe
nces betwee
n groups. The exte
nt of histopathologic i
njury was
not sig
nifica
ntly differe
nt amo
ng embolized groups. Although
no histopathologic lesio
ns were prese
nt i
n either the a
ntegrade cerebral perfusio
n co
ntrol group or the retrograde cerebral perfusio
n co
ntrol group, mild sig
nifica
nt ischemic damage occurred after retrograde cerebral perfusio
n with i
nferior ve
na cava occlusio
n eve
n i
n co
ntrol a
nimals. Co
nclusio
ns: Although effective washout of particulate emboli from the brai
n ca
n be achieved with retrograde cerebral perfusio
n with i
nferior ve
na cava occlusio
n,
no adva
ntage of retrograde cerebral perfusio
n with i
nferior ve
na cava occlusio
n after embolizatio
n is see
n from behavioral scores, electro- e
ncephalographic recovery, or histopathologic exami
natio
n; retrograde cerebral perfusio
n with i
nferior ve
na cava occlusio
n results i
n greater fluid sequestratio
n a
nd mild histopathologic i
njury eve
n i
n co
ntrol a
nimals. Retrograde cerebral perfusio
n with i
nferior ve
na cava occlusio
n shows clear promise i
n the ma
nageme
nt of embolizatio
n, but further refi
neme
nts must be sought to address its still worrisome pote
ntial for harm.(J Thorac Cardiovasc Surg 1998;115:1142-59)
J Thorac Cardiovasc Surg 1998;115:1142-59