The overall rate of complications related to cranioplasty after craniectomy is not negligible, and certain factors may be associated with increased risk. Therefore, when evaluating the need to perform a large decompressive craniectomy, the surgeon should also be aware that the patient is not only subject to the risks of the initial operation, but also the risks of subsequent cranioplasty.

Correlation between Cold Pressure Testing (CPT)/ 99 Tc MIBI-SPECT defects and intracoronary acetylcholine (ACH) paradoxical constriction was published by our group. The usefulness of CPT non -invasive diagnosis of dysfunction (ED) was demonstrated by our observation in coincidence with other authors. There is little information on ED incidence on moderate risk asymptomatic (MRA) patients according to ATP III/Framingham index. Objective: This study is aimed at analyzing the incidence and localization of 99 Tc MIBI/ SPECT myocardial perfusion (MP) defects during CPT as indicator of ED on MRA patients. Methods: 124 patients (78 female) currently compounding PARADIGMA Study Register were analyzed. PARADIGMA is a prospective multicenter study that will include once completed a total number of 450 MRA patients according to ATP III/ Framingham index (Ͻ 20% events at 10 years ), with normal exercise MP and no cardiovascular disease history. CPT-MP imaging was obtained in all these patients. MP extension score was used in a 17 segment model , reported by two observers on consensus. Mann-Whitney U Test statistical analysis was performed. l Results: positive CPT 25/113 patients (22,12 %). CPT extension perfusion score positive 5,77Ϯ2,38(pϽ0.0001). CPT was positive in 30,76 % men and 17,56 % women (pϽ0.001). Localization : anterior wall 4 3%,i n ferior wall 47 %, lateral wall 4,5% and anterior with inferior walls 4,5 %. Conclusion: These results suggest high incidence of ED on MRA patients, who are also free from exercise --related ischemia. There were no significant differences in clinical data and defects localization. Further studies will indicate whether this positive CPT population would have higher risk of cardiovascular events during follow-up Age, Bood Pressure and Cholesterol pns (*) AGE SBP DBP CHOLEST. HDL LDL TRIGL. CPT ( ϩ ) 55.9 Ϯ10 130Ϯ 12 84 Ϯ 5 245 Ϯ 90 48 Ϯ 19 156Ϯ 49 246 Ϯ143 CPT (-) 53.5 Ϯ 9 129 Ϯ 15 79 Ϯ9 228 Ϯ 45 51 Ϯ 12 157 Ϯ 34 160 Ϯ72 7.2Effects of percutaneous intramyocardial plasmid gene transfer of vascular endothelial growth factor (phVEGF-A165 ) on myocardial perfusion measured by N-13 ammonia-PET.