Central nervous ischemia after surgery of the thoracic aorta, functional characterization of the intraspinal collateral pathways in a large animal model

主动脉疾病通常通过传统的外科手术或基于导管的技术进行治疗。在传统的人工主动脉置换术和支架移植物置入术中，脊髓动脉的灌流压力下降。如果不能建立足够的侧支循环，这可能会导致截瘫。根据手术类型和特定主动脉病变的程度，截瘫的发生率高达2%至20%。新的主动脉弓治疗方法伴随着高比例的脊髓缺血率。对椎管内侧支生理的详细了解是在主动脉手术前进行未来风险分层的基础。在外科大动物模型中，将研究脊柱侧支循环的生理基础，特别是椎管内侧支循环的生理基础。在一项比较研究中，将展示椎管内弓在快速恢复脊髓灌注压方面的基本作用。因此，一组椎内侧支完整的动物以及一组椎内侧支中断的动物将接受模拟的主动脉手术。特别是脊髓前根动脉的确切作用将被研究。目的是弄清楚这些动脉的数量和其中两个动脉之间的最大距离是多少，才能安全地在胸主动脉上进行手术。这可能是未来术前风险分层的基础，而这在今天仍然是不可能的。

Aortic diseases are usually treated by conventional surgical procedures or catheter-based techniques. During conventional prosthetic aortic replacement, as well as during placement of a stent-graft, perfusion pressure in spinal arteries drops. This can lead to paraplegia if sufficient collateral flow cannot be established. Depending on the type of procedure and on the extent of the specific aortic pathology, the incidence of paraplegia is as high as two to twenty percent. New treatment modalities of the aortic arch are accompanied by high rates of spinal ischemia. Detailed knowledge of the intraspinal collateral physiology is the basis of future risk stratification before an aortic procedure. In a surgical large animal model the physiological basis of spinal collateral flow, specifically of the intraspinal collateral compartment, will be studied. In a comparative study the basic role of the intraspinal arcades for a rapid recovery of spinal perfusion pressures will be shown. A group of animals with intact intraspinal collaterals as well as a group of animals with interrupted intraspinal collaterals will therefore undergo a simulated aortic procedure. Especially the exact role of the anterior radiculo-medullary arteries will be studied. The aim is to clarify which number of these arteries and what maximal distance between two of these arteries is required in order to safely perform a procedure on the thoracic aorta. This can be the basis of future preoperative risk stratification, which is still not possible today.