Minimally Invasive Segmental Artery Coil Embolization (MISACE) Prior to Endovascular Thoracoabdominal Aortic Aneurysm Repair

Addas, J.; Mafeld, Sebastian; Mahmood, Daniyal N.; Sidhu, Arshdeep; Ouzounian, Maral; Lindsay, Thomas F.; Tan, Kong Teng

doi:10.1007/s00270-022-03230-y

Cited by 10 publications

(12 citation statements)

References 19 publications

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“…The other patient with spontaneous bleeding in the Tarlov cyst under anticoagulation and without CSFD, after being discharged without any neurological symptoms, had no signs of CSI in the MRI one week after the aortic repair. Early postoperatively, Branzan et al reported three deaths (5%, 3/57), and Addas et al one death (6%, 1/17), the latter one after suffering early postoperative paraplegia [ 4 , 8 ]. Neither series reported any periprocedural complications after MIS 2 ACE [ 4 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…Early postoperatively, Branzan et al reported three deaths (5%, 3/57), and Addas et al one death (6%, 1/17), the latter one after suffering early postoperative paraplegia [ 4 , 8 ]. Neither series reported any periprocedural complications after MIS 2 ACE [ 4 , 8 ]. Although limited in numbers, our meta-analysis shows a clear tendency that MIS 2 ACE is a safe procedure with low morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

“…Branzan et al reported a median of five occluded segmental arteries per session, with only 40% of all patients having one session, and the rest had at least two coiling sessions [ 4 ]. Addas et al conducted only one MIS 2 ACE session per patient with a median of three occluded segmental arteries per patient [ 8 ]. After the aortic treatment, they reported two MIS 2 ACE patients with paraparesis and one patient with paraplegia after unsuccessful embolization [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…Addas et al conducted only one MIS 2 ACE session per patient with a median of three occluded segmental arteries per patient [ 8 ]. After the aortic treatment, they reported two MIS 2 ACE patients with paraparesis and one patient with paraplegia after unsuccessful embolization [ 8 ]. In this series, all patients had perioperative CSFD and still encountered a higher incidence of SCI [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…After the aortic treatment, they reported two MIS 2 ACE patients with paraparesis and one patient with paraplegia after unsuccessful embolization [ 8 ]. In this series, all patients had perioperative CSFD and still encountered a higher incidence of SCI [ 8 ]. This might ignite the discussion of the benefit of CSFD on one side and the minimum number of occluded segmental arteries on the other side, including the meaning of the occlusion pattern prior to the aortic repair.…”

Section: Discussionmentioning

confidence: 99%

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The Safety and Outcome of Minimally Invasive Staged Segmental Artery Coil Embolization (MIS2ACE) Prior Thoracoabdominal Aortic Aneurysm Repair: A Single-Center Study, Systematic Review, and Meta-Analysis

Dabravolskaite,

Xourgia,

Kotelis

et al. 2024

JCM

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Background: Minimally Invasive Staged Segmental Artery Coil Embolization (MIS2ACE) is a novel technique of spinal cord preconditioning used to reduce the risk of paraplegia in thoracoabdominal aortic aneurysm (TAAA) repair. In this study, we report our experience with MIS2ACE, including both degenerative and post-dissection TAAA, while we attempt to systematically summarize relevant data available in the literature. Design: single-center observational study with systematic review of the literature and meta-analysis. Methods: Initial retrospective analysis of 7 patients undergoing MIS2ACE over 12 sessions with a subsequent systematic review of the literature and meta-analysis of the available published data (PROSPERO protocol number: CRD42023477411). Baseline patient and aneurysm characteristics, along with procedural technique and outcomes, were analyzed. One-arm pooling of proportions was used to summarize available published data. Results: We treated seven patients (5 males, 71%) with a median age of 69 years (IQR 55,69). According to the Crawford classification, five patients (1%) had extent II TAAA, and two (29%) had extent III TAAA. Five patients (71%) had post-dissection -TAAA; four of them were after Stanford type A dissection, and one had a chronic type B dissection. Three patients (43%) had connective tissue disease. Of the seven patients, six (86%) underwent previous aortic surgery, while the median aneurysm diameter was 58 mm (IQR 55,58). MIS2ACE was successful in 11 sessions (92%). The median number of embolized arteries was 4 (IQR 1,4). There were no periprocedural complications in any embolization. The median embolization-operation time interval was 37.0 days (IQR 31,78). Two patients had open and five endovascular treatment. There were no events of spinal cord ischemia either after MIS2ACE or after the aortic repair. Out of the 432 initially retrieved articles, we included two studies in the meta-analysis, including patients with MIS2ACE for spinal cord preconditioning in addition to our cohort. The prevalence of pooled postoperative spinal cord ischemia among MIS2ACE patients is 1.9% (95% CI −0.028 to 0.066, p = 0.279; 3 studies; 81 patients, 127 coiling sessions). Conclusions: While the current published data is limited, our study further confirms that MIS2ACE is a technically feasible and safe option for spinal cord preconditioning.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Safety and Outcome of Minimally Invasive Staged Segmental Artery Coil Embolization (MIS2ACE) Prior Thoracoabdominal Aortic Aneurysm Repair: A Single-Center Study, Systematic Review, and Meta-Analysis

Dabravolskaite,

Xourgia,

Kotelis

et al. 2024

JCM

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Invited Commentary to: Minimally Invasive Segmental Artery Coil Embolization (MISACE) Prior to Endovascular Thoracoabdominal Aortic Aneurysm Repair

Verhoeven

2022

Cardiovasc Intervent Radiol

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Microvascular Plug Embolization of Anterior Spinal Artery Bearing Segmental Arteries Prior Aortic Stenting: Technique and Safety

Deniz,

Öcal,

Fabritius

et al. 2024

Cardiovasc Intervent Radiol

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Purpose This study aims to present our experience with superselective embolization of the anterior spinal artery-bearing segmental artery (ASAbSA) using a microvascular plug (MVP) during the minimally invasive segmental artery coil embolization (MISACE) procedure prior endovascular repair of the thoracoabdominal aortic aneurysms. Methods We retrospectively evaluated all MISACE procedures performed between May 2018 and July 2023, where MVP was deployed into an angiographically confirmed ASAbSA. Data were analyzed regarding interventional details, technical aspects, and safety protocols. The standard procedure for MVP embolization involves detaching the plug after 10 min, provided no neurological symptoms occur. Results A total of 22 patients underwent MVP deployment into the proximal segmental artery supplying the ASAbSA. There were no instances of non-target embolization or segmental artery dissection. Furthermore, none of the patients experienced temporary or permanent spinal cord ischemia. Conclusion MVP deployment into the ASAbSA is a safe strategy for protecting the spinal cord during preemptive embolization of segmental arteries prior to endovascular aortic repair. Graphical Abstract

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Minimally Invasive Segmental Artery Coil Embolization (MISACE) Prior to Endovascular Thoracoabdominal Aortic Aneurysm Repair

Cited by 10 publications

References 19 publications

The Safety and Outcome of Minimally Invasive Staged Segmental Artery Coil Embolization (MIS2ACE) Prior Thoracoabdominal Aortic Aneurysm Repair: A Single-Center Study, Systematic Review, and Meta-Analysis

The Safety and Outcome of Minimally Invasive Staged Segmental Artery Coil Embolization (MIS2ACE) Prior Thoracoabdominal Aortic Aneurysm Repair: A Single-Center Study, Systematic Review, and Meta-Analysis

Invited Commentary to: Minimally Invasive Segmental Artery Coil Embolization (MISACE) Prior to Endovascular Thoracoabdominal Aortic Aneurysm Repair

Microvascular Plug Embolization of Anterior Spinal Artery Bearing Segmental Arteries Prior Aortic Stenting: Technique and Safety

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