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Review
. 2023 Sep 28;12(5):463-467.
doi: 10.21037/acs-2023-scp-0062. Epub 2023 Sep 4.

Rationale of the PAPAartis trial

Affiliations
Review

Rationale of the PAPAartis trial

Martin Misfeld et al. Ann Cardiothorac Surg. .

Abstract

Surgical and interventional repair of thoracoabdominal aortic aneurysms improve survival significantly compared to the natural history of the disease. However, both strategies are associated with a substantial risk of spinal cord ischemia, which has been reported to occur-even in contemporary series by expert centers-in up to 12% of patients, depending on the extent of the disease. Following improved neurological outcomes after staged approaches in extensive clinical and long-term large animal studies, and the description of the "collateral network", the concept of "Minimally Invasive Staged Segmental Artery Coil Embolization" (MIS2ACE) was introduced by Etz et al. This concept of priming the collateral network in order to improve spinal cord blood supply showed promising experimental and early clinical outcomes, and consequently led to the initiation of the randomized controlled multicenter PAPAartis trial (Paraplegia Prevention in Aortic Aneurysm Repair by Thoracoabdominal Staging). This Keynote Lecture describes the background and rationale for this trial and gives an update on the current status.

Keywords: Thoracoabdominal aortic repair; aortic surgery; spinal cord ischemia (SCI).

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
List of participating centers. MISACE, Minimally Invasive Staged Segmental Artery Coil Embolization; ca., circa.
Figure 2
Figure 2
Participant timeline. CH, Switzerland; DE, Germany; FR, France; IT, Italy; NL, Netherlands; PL, Poland; SE, Sweden; UK, United Kingdom; US, Unites States of America.
Video
Video
Rationale of the PAPAartis trial.

References

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