Endovascular coil embolization of segmental arteries prevents paraplegia after subsequent thoracoabdominal aneurysm repair: an experimental model.
OBJECTIVE
To test a strategy for minimizing ischemic spinal cord injury after extensive thoracoabdominal aneurysm (TAAA) repair, we occluded a small number of segmental arteries (SAs) endovascularly 1 week before simulated aneurysm repair in an experimental model.


METHODS
Thirty juvenile Yorkshire pigs (25.2 ± 1.7 kg) were randomized into 3 groups. All SAs, both intercostal and lumbar, were killed by a combination of surgical ligation of the lumbar SAs and occlusion of intercostal SAs with thoracic endovascular stent grafting. Seven to 10 days before this simulated TAAA replacement, SAs in the lower thoracic/upper lumbar region were occluded using embolization coils: 1.5 ± 0.5 SAs in group 1 (T13/L1), and 4.5 ± 0.5 SAs in group 2 (T11-L3). No SAs were coiled in the controls. Hind limb function was evaluated blindly from daily videotapes using a modified Tarlov score (0 = paraplegia, 9 = full recovery). After death, each segment of spinal cord was graded histologically using the 9-point Kleinman score (0 = normal, 8 = complete necrosis).


RESULTS
Hind limb function remained normal after coil embolization. After simulated TAAA repair, paraplegia occurred in 6 of 10 control pigs, but in only 2 of 10 pigs in group 1; no pigs in group 2 had a spinal cord injury. Tarlov scores were significantly better in group 2 (control vs group 1, P = .06; control vs group 2, P = .0002; group 1 vs group 2, P = .05). A dramatic reduction in histologic damage, most prominently in the coiled region, was seen when SAs were embolized before simulated TAAA repair.


CONCLUSIONS
Endovascular coiling of 2 to 4 SAs prevented paraplegia in an experimental model of extensive hybrid TAAA repair, and helped protect the spinal cord from ischemic histopathologic injury. A clinical trial in a selected patient population at high risk for postoperative spinal cord injury may be appropriate.
Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, NY. Electronic address: sarah.geisbuesch@hotmail.com.
Sarah
S
Geisbüsch
Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, NY.
Angelina
A
Stefanovic
Department of Cardiology, Mount Sinai Medical Center, New York, NY.
Jacob S
JS
Koruth
Department of Health Evidence and Policy, Mount Sinai Medical Center, New York, NY.
Hung-Mo
HM
Lin
Department of Neuropathology, Mount Sinai Medical Center, New York, NY.
Susan
S
Morgello
Department of Neurology, Mount Sinai Medical Center, New York, NY.
Donald J
DJ
Weisz
Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, NY.
Randall B
RB
Griepp
Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, NY.
Gabriele
G
Di Luozzo
D000818:Animals; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D004621:Embolization, Therapeutic; D057510:Endovascular Procedures / Q000009:adverse effects*; D006614:Hindlimb; D008161:Lumbosacral Region / Q000098:blood supply*; D023421:Models, Animal; D018482:Muscle, Skeletal / Q000098:blood supply*; D010264:Paraplegia / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D020127:Recovery of Function; D012039:Regional Blood Flow; D020760:Spinal Cord Ischemia / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000517:prevention & control*; D013552:Swine; D013895:Thoracic Arteries; D013997:Time Factors; D014741:Video Recording
26.1; MAP; SA; TAAA; mean arterial pressure; segmental artery; thoracoabdominal aortic aneurysm