AnalyzeDirect 
The small number of effective options to treat neurological dysfunctions following coronary artery bypass grafting provides a strong impetus for defining strategies that may reduce their incidence.
Ischemic preconditioning offers a powerful form of endogenous protection against myocardial infarction. It is performed alternating brief cycles of nonlethal ischemia – restriction in blood supply to tissues – and reperfusion – restoration of blood flow. This chain of events induces ischemic tolerance via key survival signaling pathways and alterations in gene expression and finally renders tissues more tolerant to a subsequent prolonged ischemic event.
Remote ischemic preconditioning (RIPC) is a novel variation of myocardial ischemic preconditioning. It describes the phenomenon by which transient non-lethal ischemia and reperfusion of one organ or tissue confers resistance to a later episode of lethal ischemia reperfusion injury in a remote organ or tissue. Through this experimental technique, the concept of remote organ protection has now been extended beyond that of solely protecting the heart to providing a general form of inter-organ protection.
Researchers from the University Hospital Center Zagreb have developed a prospective randomized study protocol in which RIPC will be evaluated as a neuroprotective strategy in the cardiac surgical arena. The trial will enroll adult patients undergoing primary coronary artery bypass grafting. RIPC will be induced by alternating periods of upper limb ischemia and reperfusion by inflating and deflating a blood pressure cuff. This sequence will be repeated three times prior to the surgical incision.
A comprehensive set of brain MRI tools will be used for the analysis and quantification of structural and functional brain impairment following the surgical procedure. Analyze software will be used to calculate the volumes of new ischemic lesions detected on diffusion-weighted imaging scans (DWI), while the analysis of resting state functional MRI (rs-fMRI) data will provide a measurement of neural activity and impairment in brain connectivity.
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This combination of MRI sequences, coupled with neurocognitive testing that can document decline in attention, memory or fine motor skills, will allow for the identification of neurologic injuries and will increase the trial’s diagnostic sensitivity. Should the results of this trial indicate that RIPC promotes protection against neurological events in patients undergoing coronary artery bypass grafting, this study could have a meaningful impact on cardiac surgery outcome.
Tags: Brain Lesions, Heart Disease, Neural Networks