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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Objective-To investigate whether ischaemic preconditioning could reduce myocardial injury, as manifest by troponin T release, in patients undergoing elective coronary artery bypass surgery. Design-Randomised controlled trial. Setting-Cardiothoracic unit of a tertiary care centre. Patients-Patients with three vessel coronary artery disease and stable angina admitted for first time elective coronary artery bypass surgery were invited to take part in the study; 33 patients were randomised into control or preconditioning groups. Intervention-Patients in the preconditioning group were exposed to two additional three minute periods of myocardial ischaemia at the beginning of the revascularisation operation, before the ischaemic period used for the first coronary artery bypass graft distal anastomosis. Main outcome measure-Serum troponin T concentration at 72 hours after cardiopulmonary bypass. Results-The troponin T assays were performed by blinded observers at a different hospital. All patients had undetectable serum troponin T (< 0a1 ugIl) before cardiopulmonary bypass, and troponin T was raised postoperatively in all patients. At 72 hours, serum troponin T was lower (P = 0.05) in the preconditioned group (median 0 3 ugIl) than in the control group (median 14 4ugl). Conclusions-The direct application of a preconditioning stimulus in clinical practice has been shown, for the first time, to protect patients against irreversible myocyte injury.