Study on Prediction of Spinal Cord Injury in Minimally Invasive Endovascular Stent Graft Treatment of Thoracic Aortic Aneurysm

目的：为了预测胸降主动脉瘤覆膜支架腔内修复术后的脊髓损伤，在诱发脊髓电位（ESCP）监测下，通过在主动脉中放置新型可回收覆膜支架（取栓器），暂时中断肋间动脉。一种新开发的可拆卸覆膜支架系统，用于放置永久性覆膜支架，而不是Retriever.Methods：Retriever包括自膨胀锯齿形支架连接在串联与纵向支柱。将每个支柱收集在固定在推杆上的一束中。支架内衬ePTFE片材。在获得知情同意书后，对位于降主动脉中段和远段的动脉瘤患者进行了胸降主动脉瘤的血管内覆膜支架修复术。在覆膜支架展开前临时放置了Rehiever。21分钟后，将取栓装置撤回鞘管中 ...更多信息 .使用取栓装置在具有良好展开前试验结果的患者体内展开了永久性使用的覆膜支架。机械功能和安全性的可脱性覆膜支架系统证实了模拟循环与脉动流。结果：回收器放置在42例患者。在取栓装置放置之前和期间获得的ESCP记录没有变化。取出取栓装置后，所有动脉瘤均通过永久性支架植入术排除。所有患者在覆膜支架展开后均未出现坏死缺陷。支架框架由多个纵向支柱覆盖以实现在主动脉中的有效运动，并通过钩或螺钉与收集支柱连接。支架移植物可以从收集支柱和部署在correct position.Conclusions分离：部署前测试使用的回收器下ESCP监测是有前途的预测脊髓缺血的候选人的胸主动脉瘤支架移植修复术。可解脱覆膜支架系统可用于通过腔内支架植入术进行微创胸主动脉瘤修复术。少

Objective : In order to predict spinal cord injury following endovascular stent-graft repair of descending thoracic aortic aneurysms, temporary interruption of the intercostal arteries was performed by placement of a novel retrievable stent graft (Retriever), in the aorta under evoked spinal cord potential (ESCP) monitoring. A detachable stent graft system was newly developed for placement of the permanent stent graft instead of the Retriever.Methods : The Retriever consisted of self-expandable zigzag stents connected in tandem with longitudinal struts. Each strut was collected in a bundle fixed to a pushing rod. The stent was lined with an ePTFE sheet. Endovascular stent-graft repair of descending thoracic aortic aneurysms was performed in patients with aneurysm located in the middle and distal segment of the descending aorta after obtaining informed consent. The Rehiever was placed temporarily before stent-graft deployment. The Retriever was retracted into the sheath 21 minutes later … More . A stent graft for permanent use was deployed in patients with favorable pre-deployment test results using the Retriever. Mechanical function and safety of a detachable stent graft system were confirmed by a mock circulation with pulsatile flow.Results : The Retriever was placed in 42 patients. There were no changes in ESCP records obtained before and during Retriever placement. After withdrawal of the Retriever, all aneurysms were excluded by permanent stent grafting. There were no necrologic deficits after stent-graft deployment in any patient. Stent framework was covered by multiple longitudinal struts to achieve efficient movement in the aorta, and connected with the collecting struts by hooks or screws. Stent graft could be detached from the collecting struts and deployed in the correct position.Conclusions : The pre-deployment test using the Retriever under ESCP monitoring is promising as a predictor of spinal cord ischemia in candidates for stent-graft repair of thoracic aortic aneurysms. A detachable stent graft system is feasible to secure minimally invasive thoracic aortic aneurysm repair by endovascular stent grafting. Less