Safety of cerebrospinal fluid drainage for spinal cord ischemia prevention in thoracic endovascular aortic repair

Spratt, John R.; Walker, Kristen; Wallen, Tyler; Neal, Dan; Zasimovich, Yury; Arnaoutakis, George J.; Martin, Tomas D.; Back, Martin R.; Scali, Salvatore T.; Beaver, Thomas M.

doi:10.1016/j.xjtc.2022.05.001

Cited by 8 publications

(3 citation statements)

References 34 publications

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“…The risk of SCI following TEVAR varies and depends primarily on the extent of coverage of the segmental arteries and the vigor of the paraspinal collateral network. Several risk factors predispose TEVAR patients to SCI [ 30 , 31 ]. These include severe calcification or extensive coverage of the descending thoracic aorta (≥ 20 cm long), coverage of the left subclavian artery without revascularization, coverage of the celiac artery, or occlusion of the hypogastric plexus.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of the effect of cerebrospinal fluid drainage on outcomes after endovascular type B aortic dissection repair

Zheng,

Lin,

Cheng

et al. 2024

J Cardiothorac Surg

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Objective The aim of the present systematic review was to determine whether prophylactic use of cerebrospinal fluid drainage (CSFD) contributes to a lower rate of spinal cord ischemia (SCI) after thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD). Methods PubMed, Embase, Web of Science and Cochrane Library databases were systematically searched to identify all relevant studies reported before May 7, 2023. A systematic review was conducted in accordance with PRISMA guidelines (PROSPERO registration no. CRD42023441392). The primary outcome was permanent SCI. Secondary outcomes were temporary SCI and 30-day/in-hospital mortality. The data were presented as the pooled event rates (ERs) and 95% confidence intervals (CIs). Results A total of 1008 studies were screened, of which 34 studies with 2749 patients were included in the present analysis. The mean Downs and Black quality assessment score was 8.71 (range, 5–12). The pooled rate of permanent SCI with prophylactic CSFD was identical to that without prophylactic CSFD (2.0%; 95% CI, 1.0–3.0; P = 0.445). No statistically significant difference was found between the rates of permanent SCI with routine vs. selective prophylactic CSFD (P = 0.596). The pooled rate of temporary SCI was 1.0% (95% CI, 0.00–1.0%). The pooled rate for 30-day or in-hospital mortality was not significantly different (P = 0.525) in patients with prophylactic CSFD (4.0, 95% CI 2.0–6.0) or without prophylactic CSFD (5.0, 95% CI 2.0–7.0). Conclusions The systematic review has shown that prophylactic CSFD was not associated with a lower rate of permanent SCI and 30-day or in-hospital mortality after TEVAR for TBAD.

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Section: Discussionmentioning

confidence: 99%

Systematic review of the effect of cerebrospinal fluid drainage on outcomes after endovascular type B aortic dissection repair

Zheng,

Lin,

Cheng

et al. 2024

J Cardiothorac Surg

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“… 5 Complications are reported in 1–4% of cases, with a recent retrospective, single-center study reporting a complication rate of 6.4%. 8 …”

Section: Discussionmentioning

confidence: 99%

The Other Aortic Syndrome–Intramural Hematoma and Neurological Deficit: Case Report

Walker,

Marcellino,

Gali

2023

Clinical Practice and Cases in Emergency Medicine

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Introduction: Acute thoracic aortic syndromes are among the most concerning presentations in emergency medicine and are associated with signiﬁcant morbidity and mortality. Thoracic aortic dissection is most common, followed by penetrating aortic ulcer and, least commonly, intramural hematoma.Case Report: A 67-year-old woman presented to the emergency department with chest and back pain, and sudden onset of paraparesis. Aortic intramural hematoma was diagnosed, and she underwent spinal drain placement with blood pressure control to optimize spinal cord perfusion.Discussion: When neurological deﬁcits are present, rapid diagnosis of spinal ischemia and blood pressure optimization is vital. Spinal drains may be considered as an adjunctive treatment.

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“…In the case of TAAAs, recommendations are evolving and based on practices of large volume centers. However, there is an argument for avoiding routine CSF drainage due to the increased risk of drain-related complications among endovascular repair patients, such as intracranial hemorrhage and spinal cord hematomas (6)(7)(8). A small multi-center pilot study is currently ongoing to determine the feasibility and processes for a larger, prospective randomized controlled trial comparing prophylactic with therapeutic CSF drainage (ClinicalTrials.gov Identifier: NCT04941157).…”

mentioning

confidence: 99%

Spinal cord protection: lessons learned from endovascular repair

Tenorio,

Oderich

2023

Ann Cardiothorac Surg

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Safety of cerebrospinal fluid drainage for spinal cord ischemia prevention in thoracic endovascular aortic repair

Cited by 8 publications

References 34 publications

Systematic review of the effect of cerebrospinal fluid drainage on outcomes after endovascular type B aortic dissection repair

Systematic review of the effect of cerebrospinal fluid drainage on outcomes after endovascular type B aortic dissection repair

The Other Aortic Syndrome–Intramural Hematoma and Neurological Deficit: Case Report

Spinal cord protection: lessons learned from endovascular repair

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