Paraplegia Prevention in Aortic Aneurysm Repair by Thoracoabdominal staging with 'Minimally-Invasive Segmental Artery Coil-Embolization' (MISACE): A Randomized Controlled Multicentre Trial (PAPA_ARTiS)

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Chronic aortic aneurysms are permanent and localized dilations of the aorta that remain asymptomatic for long periods of time, but continue to increase in diameter before they eventually rupture. Left untreated, the patients’ prognosis is dismal, since the internal bleeding of the rupture brings about sudden death. Although successful treatment cures the disease, the risky procedures compromise spinal cord blood supply acutely and permanently, frequently leading to paraplegia, particularly for aneurysms involving crucial segmental arteries, i.e. thoracoabdominal aortic aneurysms of Crawford type II & III. Although various strategies have achieved a remarkable decrease in the incidence of paraplegia, it is still no less than 10-20%. However, the principal investigator’s team has recently found that the deliberate staged occlusion of the segmental arteries to the paraspinous collateral network finally supplying the spinal cord can trigger arterial collateralization, thus stabilizing blood supply from alternate inflow sources and preventing ischaemia. This translated to a clinically available therapeutic option, ‘minimally invasive segmental artery coil embolization’ (MISACE), which proceeds in a ‘staged’ manner to occlude groups of arteries under highly controlled conditions, after which, time must be allowed for arteriogenesis to build a robust collateral blood supply. PAPA-ARTiS is a trial to demonstrate that a staged treatment approach, selectively occluding segmental arteries prior to curative aneurysm treatment, can reduce paraplegia and mortality dramatically.