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

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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 The Retriever was retracted into the sheath 21 minutes later … More .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