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血管内支架修复后的脊髓损伤，在脊髓诱发电位（ESCP）监测下，在主动脉内放置一种新型可回收支架（retriver），暂时阻断肋间动脉。一种可拆卸的支架移植系统是新开发的永久性支架移植代替寻回器。方法：寻回犬由自膨胀的之字形支架与纵向支柱串联连接。每个支柱被收集成一束固定在推杆上。支架内衬ePTFE片。经知情同意后，对位于降主动脉中、远段动脉瘤的患者行血管内支架修复术。Rehiever在支架植入前被暂时放置。21分钟后，寻回犬被收回鞘…更多。在使用retriver进行预部署测试结果良好的患者中部署永久性支架。通过脉动流模拟循环，验证了可拆卸支架移植系统的力学功能和安全性。结果：在42例患者中放置了寻回犬。在猎犬放置之前和放置期间获得的ESCP记录没有变化。取出后，所有动脉瘤均通过永久性支架移植排除。没有任何患者在支架植入后出现坏死缺陷。支架框架由多个纵向支板覆盖，以实现在主动脉内的有效移动，并通过钩或螺钉与收集支板连接。支架可以从收集支撑物上分离并部署在正确的位置。结论：在ESCP监测下，使用retriver进行预部署试验有望预测胸主动脉瘤支架移植修复候选患者的脊髓缺血。可拆卸支架移植系统是实现微创胸主动脉瘤血管内支架植入术的可行方法。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 The Retriever was retracted into the sheath 21 minutes later … More .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