Results Significantly more patients were found to have neuropsychological deficits in the group without the arterial line filter at both 8 days (P<.05) and 8 weeks (P<.03) after surgery. In addition, more "soft" neurological signs were found in the nonfiltered group 24 hours after surgery (P<.05). More high-intensity transcranial signals were found in the nonfiltered group, and the number of high-intensity transcranial signals was found to be related to the likelihood of a patient having a neuropsychological deficit at 8 weeks.Conclusions These data suggest that neuropsychological deficits after routine cardiopulmonary bypass are related to the number of microemboli delivered during surgery. Furthermore, the numbers of microemboli may be reduced by including a 40-^m filter on the arterial line. (Stroke. 1994;25:1393-1399

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Arterial microemboli, which may be reduced by arterial line filtration, have been proposed as a factor contributing to cardiopulmonary bypass (CPB)-related cerebral dysfunction. The authors report on a study investigating the effects of arterial line filtration on the incidence of microemboli and the neuropsychological outcome in patients undergoing coronary artery surgery. Patients were randomized to filtered (40 micron) and nonfiltered CPB. Change from preoperative neuropsychological performance was assessed eight weeks after surgery by a battery of ten tests plus a mood state assessment. Perfusion technique (pressure at UNIVERSITY OF TOLEDO LIBRARIES on March 15, 2015 ves.sagepub.com Downloaded from 35 > 50mmHg, flow 1.8-2.4L/m 2 /min) was standardized and continuously monitored. Transcranial Doppler measured middle cerebral artery blood velocity and the incidence of microembolic events (MEE). Forty patients (median age fifty-six years, range forty-three to seventy) have completed the protocol. MEE occurred in all patients during aortic cannulation and at inception of bypass. During bypass, patients with filtered CPB had fewer MEE (0-10 per thirty minutes) than nonfiltered CPB patients (30-> 250 per thirty minutes) did. Seven of 20 nonfiltered CPB patients showed soft neurologic signs on the first postoperative day compared with 3/20 in the filtered CPB group (P = 0.27, Fisher's). The filtered CPB patients performed better on a verbal memory test (P < 0.01, Wilcoxon) at eight weeks than the nonfiltered CPB group did.