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Review
. 2024 Feb;86(1):16-23.
doi: 10.18999/nagjms.86.1.16.

＜Editors' Choice＞ Thoracic endovascular aortic repair and spinal cord injury

Hiroshi Banno  1 , Changi Lee  1 , Shuta Ikeda  1 , Yohei Kawai  1 , Masayuki Sugimoto  1 , Kiyoaki Niimi  1
Affiliations
Review

＜Editors' Choice＞ Thoracic endovascular aortic repair and spinal cord injury

Hiroshi Banno et al. Nagoya J Med Sci. 2024 Feb.

Abstract

We previously reported that spinal cord injury following thoracic endovascular aortic repair for a thoracic aortic aneurysm is a micro embolism caused by a vulnerable mural thrombus. Conversely, patients who underwent thoracic endovascular aortic repair for aortic dissection develop spinal cord injury less frequently due to fewer mural thrombi. Paying attention to preserving blood flow toward the spinal cord, namely collateral circulation and steal phenomenon, prevents spinal cord injury following thoracic endovascular aortic repair for aortic dissection.

Keywords: spinal cord injury; thoracic endovascular aortic repair.

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Conflict of interest statement

Hiroshi Banno received scholarship donations from Japan Gore, Medtronic Japan, and Terumo Corporation. Other co-authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Case 1 The patient developed no SCI although all intercostal arteries were occluded during TEVAR. SCI: spinal cord injury TEVAR: thoracic endovascular aortic repair
Fig. 2
Fig. 2
Case 2 The patient underwent endovascular aortic repair (EVAR) with a previous unilateral hypogastric embolization. The contralateral hypogastric artery was embolized due to type Ib endoleak a few years later. Afterward, the patient underwent total arch repair without the left subclavian reconstruction. The stent graft was implanted in the whole descending thoracic aorta. Results revealed no hypogastric artery, no left subclavian artery, and no intercostal artery after TEVAR, and the patient developed no SCI. TEVAR: thoracic endovascular aortic repair SCI: spinal cord injury
Fig. 3
Fig. 3
Case 3 Ruptured case. All intercostal arteries were in the thrombosed false lumen. The patient showed no neurological deficits preoperatively. Emergent zone 2 TEVAR without left subclavian reconstruction was performed. This is the only case that developed SCI after TEVAR for AD. TEVAR: thoracic endovascular aortic repair SCI: spinal cord injury AD: aortic dissection
Fig. 4
Fig. 4
Illustration of steal phenomenon Steal phenomenon after entry tear coverage by the endograft causing retrograde flow in an intercostal artery due to a decreased pressure within the false lumen.
Fig. 5
Fig. 5
Case 4 (Embolization of false lumen branches) Branch arteries of the false lumen were embolized before zone 2 TEVAR and EVAR to prevent a steal phenomenon in the false lumen. TEVAR: thoracic endovascular aortic repair EVAR: endovascular aortic repair
See this image and copyright information in PMC

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