Spinal cord ischaemia

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was in patients supported with peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO), what factors are associated with the development of spinal cord ischaemia? Altogether more than 22 papers were found using the reported search, of which 10 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated...

OBJECTIVE: This study investigated the usefulness of motor evoked potentials (MEPs) for intra-operative monitoring to detect the risk of spinal cord ischaemia (SCI) during thoracic endovascular aortic repair (TEVAR). Risk factors for SCI in TEVAR were also analysed. METHODS: Among 330 TEVARs performed from February 2009 to October 2018, 300 patients underwent intra-operative MEP monitoring. SCI risk groups were extracted based on MEP amplitude changes using a cutoff value of 50%...

Spinal cord ischaemia leading to paraplegia or paraparesis is one of the most devastating complications of aortic surgery. The risk of ischaemia is particularly high in repairs involving both the thoracic and abdominal segments, because in these cases blood flow to the spinal arteries can be interrupted. Multimodal protocols have now been developed to reduce the incidence of this complication, and include measures such as cerebrospinal fluid (CSF) drainage, avoidance of hypotension and anaemia, systemic hypothermia, neuromonitoring, maintaining distal perfusion during proximal clamping of the aorta, and reimplantation of intercostal or lumbar arteries, whenever feasible...

INTRODUCTION: Degenerative cervical myelopathy (DCM) is a form of chronic spinal cord injury, with a natural history of potential for progression over time. Whilst driven by mechanical stress on the spinal cord from degenerative and congenital pathology, the neurological phenotype of DCM is likely to be modified by multiple systemic factors. The role of metabolic factors is therefore of interest, particularly given that ischaemia is considered a key pathological mechanism of spinal cord injury...

PURPOSE: Mental stress is of essential consideration when assessing cardiovascular pathophysiology in all patient populations. Substantial evidence indicates associations among stress, cardiovascular disease and aberrant brain-body communication. However, our understanding of the flow of stress information in humans, is limited, despite the crucial insights this area may offer into future therapeutic targets for clinical intervention. METHODS: Key terms including mental stress, cardiovascular disease and central control, were searched in PubMed, ScienceDirect and Scopus databases...

OBJECTIVE: Although open repair has been the traditional mainstay therapy for thoracoabdominal aortic aneurysms (TAAAs), it remains a surgical challenge. Recently, hybrid repair (HR) and total endovascular repair (TEVR) have emerged as viable alternatives in treating TAAAs. Thus, we aimed to compare the primary outcomes of in-hospital/30-day mortality, as well as secondary outcomes of postoperative complications including spinal cord ischemia, bowel ischemia, long-term dialysis, myocardial infarction and lower limb ischemia for HR vs TEVR for the treatment of TAAAs...

The extent of repair in patients with acute type A aortic dissection is often determined by factors such as entry tear location, aortic anatomy, malperfusion and team expertise. The hybrid arch frozen elephant trunk, which has become an established technique to extend the distal acute type A aortic dissection repair, is particularly useful in malperfusion; however, it remains technically challenging and is associated with increased duration of circulatory arrest and risks of spinal cord ischaemia. Proximal dissection flap extension often determines repairability versus replacement of the aortic root...

OBJECTIVES: The ideal treatment for aneuryms of aberrant left subclavian arteries with Kommerell's diverticulum arising from right aortic arches remains open. METHODS: Between January 2015 and December 2020, five patients with aneurysms from a right-sided aortic arch with aberrant left subclavian artery and Kommerell's diverticulum underwent repair by using the frozen elephant trunk (FET) technique in three aortic centers. Patients' characteristics were retrospectively reviewed and the surgical procedure and outcomes are presented...

OBJECTIVE: The aim of this study was to analyze risks and benefits of cerebrospinal fluid drainage (CSFD) placement in patients undergoing thoracic endovascular aortic repair (TEVAR). METHODS: Between 2009 and 2020, 411 patients underwent TEVAR in one institution where 236 patients (57%) received a preoperative CSFD. Patient and outcome characteristics were retrospectively analyzed and compared between patients with and without preoperative CSFD placement. RESULTS: Preoperative CSFD was performed significantly more frequently in elective patients, especially those undergoing distal stent graft extension following frozen elephant trunk-stent placement (p < 0...

OBJECTIVE: To investigate outcomes of a novel, off the shelf multibranched endovascular stent graft for treatment of thoraco-abdominal aortic aneurysm (TAAA) and pararenal abdominal aortic aneurysm (PAAA). METHODS: Prospective, single centre study including 15 patients (mean age, 63.4 ± 10.7 years; 13 male) with TAAA or PAAA treated from October 2019 to March 2021 with a G-Branch endograft featuring a mixed multibranch design with two inner and two outer branches for reconstruction of the visceral and bilateral renal arteries, respectively...

No abstract text is available yet for this article.

Spinal cord ischemia leading to paraplegia is a rare, life-limiting complication of acute type B aortic dissection. We report a case of spinal cord ischemia occurred in a young woman treated with endovascular scissor technique in urgent setting. The patient had an uneventful post-procedural course. After 4 months, computed tomography angiography confirmed false lumen reperfusion and major symptoms were regressed. In selected cases, this procedure is a tool to improve false lumen perfusion in type B dissections, and demonstrated to be helpful in our case of spinal cord ischaemia...

Cerebral palsy (CP) is caused by a variety of factors that damage the developing central nervous system. Impaired motor control, including muscle stiffness and spasticity, is the hallmark of spastic CP. Rabbits that experience hypoxic-ischaemic (HI) injury in utero (at 70%-83% gestation) are born with muscle stiffness, hyperreflexia and, as recently discovered, increased 5-HT in the spinal cord. To determine whether serotonergic modulation of spinal motoneurons (MNs) contributes to motor deficits, we performed ex vivo whole cell patch clamp in neonatal rabbit spinal cord slices at postnatal day (P) 0-5...

Spinal cord injury (SCI) is a severe medical condition with lasting effects. The efficacy of numerous clinical treatments is hampered by the intricate pathophysiological mechanism of SCI. Fibroblast growth factor 18 (FGF-18) has been found to exert neuroprotective effects after brain ischaemia, but its effect after SCI has not been well explored. The aim of the present study was to explore the therapeutic effect of FGF-18 on SCI and the related mechanism. In the present study, a mouse model of SCI was used, and the results showed that FGF-18 may significantly affect functional recovery...

BACKGROUND: Spinal cord injury (SCI) is a significant cause of morbidity and mortality with an incidence of 40-83/million/year. Sympathetic denervation in SCI leads to cardiovascular abnormalities including orthostatic hypotension, rhythm disturbance, and repolarization changes. Electrocardiographic (ECG) findings include bradyarrhythmias, ectopic beats, long QT interval, and ST-T changes that may be mistaken for myocardial ischaemia. CASE SUMMARY: A patient in their 40 s with free past medical history was referred to our centre with the diagnosis of non-ST elevation acute coronary syndrome...

OBJECTIVE: A proximal scallop design allows aortic arch repair without complex endovascular manipulation in the aortic arch. The aim was to assess the safety and efficacy at one year of the Relay proximal scallop stent graft. METHODS: A prospective multicentre study evaluated consecutive patients treated with the Relay proximal scallop stent graft in 10 French aortic centres. All consecutive patients eligible for elective thoracic endovascular repair with proximal scallop in the 10 participating centres between January 2015 and July 2018 were included...

OBJECTIVES: To evaluate incidence and outcomes of ischaemic organ complications after thoracic endovascular aortic repair (TEVAR). METHODS: This is a multicentre, retrospective, observational cohort study. We analyzed data from patients treated with TEVAR between June 22nd 2001 and December 10th 2022. Primary outcomes were postoperative overall organ ischaemic complications and early (≤ 30 days) survival. Secondary outcomes were long-term survival, and freedom from aorta-related mortality (ARM)...

OBJECTIVES: While open surgical repair remains the gold standard for thoracoabdominal aortic aneurysm (TAAA) treatment, there is still no consensus regarding perioperative neuromonitoring technique for prevention of spinal cord ischaemia. METHODS: In this systematic review, we aimed to explore the effects and practices of neuromonitoring during the open TAAA repair. A systematic literature search in PubMed, Embase via Ovid, Cochrane library and ClinicalTrialsGov until December 2022 was performed...

Bone marrow mesenchymal stem cell (BMSC)-derived exosomes are a promising therapeutic agent for human disease, but their effects on neural stem cells (NSCs) subject to spinal cord ischaemia-reperfusion injury (SCIRI) remain unknown. Here, we examine the impact of miR-199a-5p-enriched exosomes derived from BMSCs on NSC proliferation. We establish a rat model of aortic cross-clamping to induce SCIRI in vivo and a primary NSC model of oxygen-glucose deprivation/reoxygenation (OGD/R) to simulate SCIRI in vitro ...

Preserving haemodynamics is expected to positively affect tissue oxygen saturation. We hypothesized that maintaining mean arterial blood pressure (MAP) (using phenylephrine (PE) or dobutamine (Dobu)) would equally affect regional cerebral and paravertebral tissue saturation (rSc O2 and rSpv O2 , respectively). Thirty-four patients were randomly assigned to receive either PE or Dobu, in order to keep MAP within 20% of the preoperative value. Their effect on haemodynamics, rSc O2 and rSpv O2 at thoracic level T3 -T4 , T9 -T10 and lumbar level L1 -L2 was calculated at different doses...