The Incidence of Spinal Cord Ischaemia Following Thoracic and Thoracoabdominal Aortic Endovascular Intervention

Abstract

SCI following thoracic and thoracoabdominal aortic endovascular intervention is associated with the proportion of aorta covered. The degree of risk varies between different types of procedure and this should be carefully considered in both selection and consenting of patients.

Risk factors, outcomes, and clinical manifestations of spinal cord ischemia following thoracic endovascular aortic repair

“…4,7-12 Comparing outcomes after thoracic aortic endovascular interventions can be difficult, however, given the heterogeneity of the procedures performed. Drinkwater et al 16 recently demonstrated a significant rise in the risk of SCI with increasing magnitude of procedure type; TEVAR (stent graft confined to the thoracic aorta) was associated with the least risk at 1.8%; arch hybrid 10%, fenestrated/branched graft 14.3%, and visceral hybrid 20%. Although we aimed to maximize validity by intentionally choosing to focus on a single procedure type, we also observed an increase in the incidence of SCI within our excluded patient subgroups; The extent of neurologic deficits attributed to SCI after TEVAR can range from mild paraparesis to flaccid paralysis.…”

Risk factors for spinal cord ischemia after endovascular repair of thoracoabdominal aortic aneurysms

“…3 The reported incidence of SCI ranged between 0% and 10% for thoracic endovascular aortic repair (TEVAR) and between 0% and 30% for endovascular TAAA repair. 4 Comparably, the "real-world" incidence of SCI after open TAAA repair still ranges between 5% and 11% for all types of TAAAs and up to 22% for Crawford type II TAAAs. 4 Of note, several centers of excellence have reported SCI rates after open surgical repair of Crawford type II TAAAs of <4%.…”

“…4 Comparably, the "real-world" incidence of SCI after open TAAA repair still ranges between 5% and 11% for all types of TAAAs and up to 22% for Crawford type II TAAAs. 4 Of note, several centers of excellence have reported SCI rates after open surgical repair of Crawford type II TAAAs of <4%. 5 In contrast to open repair, in which the refinement of the surgical technique and the adoption of several adjunctive measures led to a significant reduction of SCI, the literature on endovascular TAAA repair lacks evidence about specific interventions or measures that warrant routine spinal cord monitoring and perfusion.…”

Anti-Inflammatory Effect of Lycopene on Experimental Spinal Cord Ischemia Injury via Cyclooxygenase-2 Suppression

“…In a report investigating spinal cord ischemia during thoracic aortic procedures between 2001 and 2009, the global incidence rate was found to be nearly 1 in 10 [2]. Despite the pressing need to better understand SCII, very little is known regarding the pathological mechanisms underlying its detrimental impacts.…”