RESUMEN
BACKGROUND: In recent years, there have anecdotal reports of intra-arterial thrombolysis (IAT) for the treatment of spinal cord ischemia (SCI) with encouraging results. We describe a patient with acute cervical SCI who underwent IAT with Tenecteplase at our institution. CASE PRESENTATION: A 20-year-old man presented to the emergency department with a 12-hour history of progressive onset upper and lower extremity numbness, weakness, and urinary incontinence after sustaining a fall. MRI of cervical spine demonstrated T2 and STIR hyperintensity in the ventral aspect of the spinal cord spanning the C3, C4, and C5 levels suggestive of SCI. He demonstrated progression of neurologic deficits to C4 ASIA B spinal cord injury with complete loss of motor function, diminished sensation, and absent rectal tone. Emergent angiography was performed with prominent anterior spinal supply via the left ascending cervical artery. A total of 30 mg of Tenecteplase was administered intra-arterially in the bilateral vertebral arteries, bilateral ascending cervical arteries, and bilateral inferior thyroid arteries. Two-week post-intervention neurologic examination demonstrated improvement in injury level and severity. The patient was C6 ASIA C SCI, with 2/5 strength in the distal upper and lower extremities and improved sensation. CONCLUSION: IAT with Tenecteplase may be a feasible option for the treatment of acute spinal cord ischemia in carefully selected patients.
Asunto(s)
Médula Cervical , Isquemia de la Médula Espinal , Masculino , Humanos , Adulto Joven , Adulto , Tenecteplasa , Médula Espinal , Isquemia de la Médula Espinal/diagnóstico por imagen , Isquemia de la Médula Espinal/tratamiento farmacológico , Isquemia de la Médula Espinal/etiología , Vértebras Cervicales/diagnóstico por imagen , Isquemia , Terapia TrombolíticaRESUMEN
Here, we report the case of a woman in her 40s who came with pyogenic meningitis and infarcts in the brain. While on treatment with antibiotics, she developed new-onset weakness involving bilateral lower limbs and one upper limb 2 weeks into the course of illness. MRI of the spine showed an infarct in the spinal cord. Spinal cord infarction as a complication of pyogenic meningitis is not well recognised unlike tuberculosis meningitis. Unlike ischaemic strokes where thrombolysis is done, for stroke related to infections, there are no definite strategies. Our patient was treated with physiotherapy, continued on antibiotics and slowly recovered over months and at 18-month follow-up, she was walking with a walker. The exact mechanism of thrombosis is not known but may be due to inflammation of the arterial wall and activation of the procoagulant cascade by infection-triggered inflammation. Spinal cord infarction can occur at any phase of the infection and may occur despite appropriate response to antibiotic treatments.
Asunto(s)
Ataque Isquémico Transitorio , Meningitis Bacterianas , Meningoencefalitis , Isquemia de la Médula Espinal , Femenino , Humanos , Isquemia de la Médula Espinal/diagnóstico por imagen , Isquemia de la Médula Espinal/etiología , Médula Espinal/diagnóstico por imagen , Meningitis Bacterianas/complicaciones , Infarto/etiología , Streptococcus pneumoniae , Imagen por Resonancia Magnética , Antibacterianos/uso terapéutico , Inflamación/complicaciones , Ataque Isquémico Transitorio/complicaciones , Meningoencefalitis/complicacionesRESUMEN
A 75-year-old man developed sudden-onset tetraparesis preceded by chest pain. MRI of the cervical spine on the day of onset showed no abnormalities. Although his motor symptoms improved gradually, the weakness of the muscles innervated by the C5 nerve root persisted. Sensory and autonomic deficits were detected on an additional neurological examination, and follow-up MRI eight days after onset revealed spinal cord infarction at the right anterior horn at C3-C4. This case suggests that motor symptoms mimicking a radiculopathy could be present during the course of spinal cord infarction.
Asunto(s)
Traumatismos de la Médula Espinal , Isquemia de la Médula Espinal , Masculino , Humanos , Anciano , Cuadriplejía , Imagen por Resonancia Magnética , Isquemia de la Médula Espinal/diagnóstico por imagen , Isquemia de la Médula Espinal/etiología , Vértebras Cervicales/diagnóstico por imagen , Médula Espinal/diagnóstico por imagen , Infarto/diagnóstico por imagen , Infarto/etiologíaRESUMEN
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.
Asunto(s)
Aneurisma de la Aorta Torácica , Disección Aórtica , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Isquemia de la Médula Espinal , Femenino , Humanos , Aneurisma de la Aorta Torácica/cirugía , Implantación de Prótesis Vascular/efectos adversos , Procedimientos Endovasculares/efectos adversos , Resultado del Tratamiento , Disección Aórtica/complicaciones , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/cirugía , Isquemia de la Médula Espinal/diagnóstico por imagen , Isquemia de la Médula Espinal/etiología , Paraplejía/etiología , Estudios Retrospectivos , Médula EspinalAsunto(s)
Enfermedades de los Cartílagos , Embolia , Isquemia de la Médula Espinal , Humanos , Isquemia de la Médula Espinal/diagnóstico por imagen , Isquemia de la Médula Espinal/etiología , Enfermedades de los Cartílagos/complicaciones , Enfermedades de los Cartílagos/diagnóstico por imagen , Embolia/complicaciones , Embolia/diagnóstico por imagen , Médula Espinal/diagnóstico por imagen , Infarto/diagnóstico por imagen , Infarto/etiologíaRESUMEN
The purpose of our study was to assess the usefulness of the apparent diffusion coefficient (ADC) value in differentiating between a normal spinal cord and a spinal cord with acute ischemia. Control group of 113 and 8 acute spinal cord ischemia patients were enrolled in this study. The ADC values were measured when diffusion-weighted imaging was first performed after the onset of acute spinal cord ischemia. The mean ADC value each of the control group and acute spinal cord ischemia patients was 0.99 ± 0.19 × 10-3 mm2/s and 0.70 ± 0.15 × 10-3 mm2/s. The mean ADC value in patients with acute spinal cord ischemia was significantly lower than that in patients with a normal spinal cord (P < 0.01). We found the cutoff ADC value (0.86 × 10-3 mm2/s) to be a useful indicator of acute spinal cord ischemia (sensitivity = 100.0%, specificity = 71.7%, AUC = 0.92). In conclusions, it is suggested that the ADC value may be useful in the diagnosis of acute spinal cord ischemia.
Asunto(s)
Imagen de Difusión por Resonancia Magnética , Isquemia de la Médula Espinal , Humanos , Imagen de Difusión por Resonancia Magnética/métodos , Isquemia de la Médula Espinal/diagnóstico por imagen , Diagnóstico DiferencialRESUMEN
OBJECTIVES: There have been sporadic reports of ischemic spinal cord injury (SCI) during venoarterial extracorporeal membrane oxygenation (VA-ECMO) support. The authors observed a troubling pattern of this catastrophic complication and evaluated the potential mechanisms of SCI related to ECMO. DESIGN: This study was a case series. SETTING: This study was performed at a single institution in a University setting. PARTICIPANTS: Patients requiring prolonged VA-ECMO were included. INTERVENTIONS: No interventions were done. This was an observational study. MEASUREMENTS AND MAIN RESULTS: Four hypotheses of etiology were considered: (1) hypercoagulable state/thromboembolism, (2) regional hypoxia/hypocarbia, (3) hyperperfusion and spinal cord edema, and (4) mechanical coverage of spinal arteries. The SCI involved the lower thoracic (T7-T12 level) spinal cord to the cauda equina in all patients. Seven out of 132 (5.3%) patients with prolonged VA-ECMO support developed SCI. The median time from ECMO cannulation to SCI was 7 (range: 6-17) days.There was no evidence of embolic SCI or extended regional hypoxia or hypocarbia. A unilateral, internal iliac artery was covered by the arterial cannula in 6/7 86%) patients, but flow into the internal iliac was demonstrated on imaging in all available patients. The median total flow (ECMO + intrinsic cardiac output) was 8.5 L/min (LPM), and indexed flow was 4.1 LPM/m2. The median central venous oxygen saturation was 88%, and intracranial pressure was measured at 30 mmHg in one patient, suggestive of hyperperfusion and spinal cord edema. CONCLUSIONS: An SCI is a serious complication of extended peripheral VA-ECMO support. Its etiology remains uncertain, but the authors' preliminary data suggested that spinal cord edema from hyperperfusion or venous congestion could contribute.
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Oxigenación por Membrana Extracorpórea , Traumatismos de la Médula Espinal , Isquemia de la Médula Espinal , Humanos , Oxigenación por Membrana Extracorpórea/efectos adversos , Oxigenación por Membrana Extracorpórea/métodos , Traumatismos de la Médula Espinal/diagnóstico por imagen , Traumatismos de la Médula Espinal/etiología , Traumatismos de la Médula Espinal/terapia , Isquemia de la Médula Espinal/diagnóstico por imagen , Isquemia de la Médula Espinal/etiología , Hipoxia/etiología , Hipoxia/terapia , Infarto , Estudios RetrospectivosRESUMEN
BACKGROUND: A clinically relevant mouse model of thoracic endovascular aortic repair-induced ischemic spinal cord injury has been lacking since the procedure was first employed in 1991. The hypothesis was that ligation of mouse intercostal arteries would simulate thoracic endovascular aortic repair-induced ischemic spinal cord injury and behavioral deficit. The aim was to create a mouse model of thoracic endovascular aortic repair-induced spinal cord hypoperfusion by ligating five pairs of mouse intercostal vessels. METHODS: Mice were divided into sham (n = 53) and ligation (n = 60) groups. The procedures called for double ligation of three pairs and single ligation of two pairs of thoracic intercostal arteries in adult C57BL/6 mice. A laser Doppler probe was used in vivo on the spinal cords and intercostal arteries to document the extent of arterial ligation and spinal cord hypoperfusion. The Basso Mouse Scale for Locomotion, histological studies, and electron microscopy demonstrated postligation locomotive and histopathological changes. RESULTS: Ligation induced a significant and instantaneous drop in blood flow in the intercostal arteries (% change; mean = -63.81; 95% CI, -72.28 to -55.34) and the thoracic spinal cord (% change; mean = -68.55; 95% CI, -80.23 to -56.87). Paralysis onset was immediate and of varying degree, with behavioral deficit stratified into three groups: 9.4% exhibited severe paralysis, 37.5% moderate paralysis, and 53.1% mild paralysis at day 1 (n = 32; P < 0.001). Mild and moderate paralysis was transient, gradually improving over time. Severe paralysis showed no improvement and exhibited a higher mortality rate (83%; n = 15 of 18) compared to moderately (33%; n = 6 of 18) and mildly (24%; n = 6 of 25) paralyzed mice (P < 0.001). The overall ligation group survival rate (84%; n = 46 of 55) was significantly lower than the sham group (100%; n = 48 of 48) with P = 0.003. CONCLUSIONS: The mouse model generates reproducible spinal cord hypoperfusion and accompanying histopathological ischemic spinal cord damage. The resulting anatomical changes and variable behavioral deficits mimic the variability in radiological and clinical findings in human patients.
Asunto(s)
Aneurisma de la Aorta Torácica , Procedimientos Endovasculares , Traumatismos de la Médula Espinal , Isquemia de la Médula Espinal , Adulto , Humanos , Ratones , Animales , Ratones Endogámicos C57BL , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/cirugía , Isquemia de la Médula Espinal/diagnóstico por imagen , Isquemia de la Médula Espinal/etiología , Isquemia de la Médula Espinal/patología , Parálisis/etiología , Traumatismos de la Médula Espinal/diagnóstico por imagen , Traumatismos de la Médula Espinal/etiología , Modelos Animales de Enfermedad , Procedimientos Endovasculares/efectos adversosRESUMEN
PURPOSE: The aim of this study is to report an Italian multicenter experience analyzing the incidence and the risk factors associated with spinal cord ischemia (SCI) in a large cohort of thoracoabdominal aortic aneurysms (TAAAs) treated by fenestrated-branched endovascular aneurysm repair (F-/B-EVAR). MATERIALS AND METHODS: All consecutive patients undergoing F-/B-EVAR in 4 Italian university centers between 2008 and 2019 were prospectively recorded and retrospectively analyzed. Spinal cord ischemia, 30 day/in-hospital adverse events, and mortality were assessed as early outcomes. Risk factors for SCI were determined by multivariable analysis. RESULTS: A total of 351 patients received F-/B-EVAR for a TAAA. Twenty-eight (8.0%) patients died within 30 postoperative days or during the hospitalization. Regarding SCI, 47 patients (13.4%) developed neurological symptoms related to spinal cord impaired perfusion. Among them, 17 (4.8%) had a major permanent impairment. The multivariable analysis identified that SCI was associated with Crawford extent I to III (odds ratio [OR]: 20.90, p=0.004, 95% confidence interval [CI]=2.69-162.57), and with endovascular procedures performed for ruptured TAAA (OR: 5.74, p=0.010, 95% CI=1.53-21.57). Spinal cord ischemia was also significantly associated with a grade 3 bleeding during the visceral stage (OR: 4.34, p=0.005, 95% CI=1.55-12.16) and a grade 2 renal insufficiency at 30 days (OR: 7.45, p=0.002, 95% CI=2.12-26.18). CONCLUSION: The present study indicates that SCI is still an open issue after extent I to III TAAA endovascular repair, while its incidence in extent IV TAAA and pararenal/juxtarenal aneurysms is rare. Thoracoabdominal aortic aneurysms extension, urgent TAAA repair for rupture, severe bleeding, and 30 day renal insufficiency have been identified as significant risk factors for SCI. In the presence of such factors, adjunctive strategies may be considered to reduce SCI rates, while in low-risk patients invasive or potentially-risky maneuvers might not be justified.
Asunto(s)
Aneurisma de la Aorta Abdominal , Aneurisma de la Aorta Torácica , Aneurisma de la Aorta Toracoabdominal , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Insuficiencia Renal , Isquemia de la Médula Espinal , Humanos , Prótesis Vascular/efectos adversos , Reparación Endovascular de Aneurismas , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/cirugía , Estudios Retrospectivos , Resultado del Tratamiento , Isquemia de la Médula Espinal/diagnóstico por imagen , Isquemia de la Médula Espinal/epidemiología , Isquemia de la Médula Espinal/etiología , Factores de Riesgo , Insuficiencia Renal/complicaciones , Insuficiencia Renal/cirugía , Sistema de RegistrosRESUMEN
This is a case report about spinal cord ischaemia (SCI) in a 47-year-old woman with no known cerebrovascular risk factors. SCI is a rare entity with debilitating consequences, which typically presents with acute pain corresponding to the involved cord level, followed by flaccid paralysis, decreased sensation and autonomic dysfunction. The most common cause is aortic atheromatosis. Progression of symptoms, normal cerebrospinal fluid analysis and MRI are of key importance for the diagnosis of this entity, yet the latter can initially be normal. Anticoagulant therapy is the initial treatment of choice followed by long-term rehabilitation.
Asunto(s)
Isquemia de la Médula Espinal , Accidente Cerebrovascular , Anticoagulantes , Femenino , Humanos , Imagen por Resonancia Magnética/efectos adversos , Persona de Mediana Edad , Parálisis , Médula Espinal/diagnóstico por imagen , Isquemia de la Médula Espinal/diagnóstico por imagen , Isquemia de la Médula Espinal/etiología , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/etiologíaRESUMEN
BACKGROUND: Endovascular repair of the thoracic aorta (TEVAR) outcomes have been studied with an interest in complications related to left subclavian artery (LSA) coverage in patients with atherosclerotic pathologies; however, specific data on the management of the LSA in a trauma population are lacking. The objective of this study is to evaluate outcomes following TEVAR for traumatic aortic injury based on LSA coverage. METHODS: The Vascular Quality Initiative thoracic endovascular aortic repair module (2010-2017) was analyzed. Patients were included if they had a traumatic aortic injury requiring TEVAR. Patients were placed in 2 groups based on coverage of the LSA. Patients were propensity score matched and the primary outcomes were cerebrovascular symptoms and spinal cord ischemia. Additional clinical and resource utilization outcomes were analyzed. RESULTS: Four hundred and fifty one patients were included in the analysis. There were 268 patients in the LSA not-covered group and 183 patients in the LSA covered group. The mean aortic injury grade was 2.88 ± 0.056 vs. 2.88 ± 0.049 in the covered versus not-covered group (P = 0.957). Glasgow coma scale and injury severity score were not different between the groups. There was no difference between groups for cerebrovascular symptoms or spinal cord ischemia, 1.4% vs. 2.8%, P = 0.684 and 0% vs. 2.1%, P = 0.247, after propensity score matching. Significant differences in access site complications and resource utilization were identified between groups. CONCLUSIONS: This is the largest series to evaluate complications based on LSA coverage following TEVAR in trauma patients. Our data demonstrate that coverage of the LSA during TEVAR following blunt trauma is associated with no difference in central nervous system outcomes. As such, LSA revascularization strategies, while possible, are not directly supported by these data and should be individualized based on each patient's specific clinical scenario.
Asunto(s)
Aneurisma de la Aorta Torácica , Enfermedades de la Aorta , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Isquemia de la Médula Espinal , Lesiones del Sistema Vascular , Humanos , Arteria Subclavia/diagnóstico por imagen , Arteria Subclavia/cirugía , Implantación de Prótesis Vascular/efectos adversos , Procedimientos Endovasculares/efectos adversos , Factores de Riesgo , Resultado del Tratamiento , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/cirugía , Aorta Torácica/lesiones , Enfermedades de la Aorta/cirugía , Isquemia de la Médula Espinal/diagnóstico por imagen , Isquemia de la Médula Espinal/etiología , Lesiones del Sistema Vascular/diagnóstico por imagen , Lesiones del Sistema Vascular/etiología , Lesiones del Sistema Vascular/cirugía , Estudios Retrospectivos , Aneurisma de la Aorta Torácica/cirugíaRESUMEN
BACKGROUND: Thoracic Endovascular Aortic Repair has been widely performed to treat various thoracic aortic pathologies. However, stent-graft placement in the thoracic aorta may result in left subclavian artery coverage, potentially leading to ischemic complications. The role of the left subclavian artery revascularization procedure to prevent ischemic complications remains controversial. Therefore, we conducted a systematic review and meta-analysis to identify ischemic outcomes in patients who underwent thoracic Endovascular Aortic Repair with or without left subclavian artery revascularization. METHODS: A systematic search through electronic databases, including PubMed, Ovid Medline, and Cochrane, was conducted to identify relevant studies. The outcome parameters were left arm ischemia, stroke, and spinal cord ischemia. Risk ratio (RR) and Confidence Interval (CI) of 95% were measured and reported. RESULTS: A total of 11,386 patients were identified from 22 studies. Patients who underwent left subclavian artery revascularization had lower risk of left arm ischemia (RR 0.25, 95% CI 0.09-0.68; P = 0.0006; I2 = 71%), lower risk of stroke (RR 0.52, 95% CI 0.30-0.88; P = 0.02; I2 = 70%), and lower risk of spinal cord ischemia (odds ratio OR 0.72, 95% CI 0.55-0.95; P = 0.02; I2 = 0%) between the 2 groups. CONCLUSIONS: Revascularization procedure in patients with left subclavian artery coverage during thoracic Endovascular Aortic Repair is associated with a lower risk of left arm ischemia, stroke, and spinal cord ischemia. Left subclavian artery revascularization should be performed in anatomically high-risk patients. High-quality studies are needed to validate the outcomes.
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Aneurisma de la Aorta Torácica , Enfermedades de la Aorta , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Isquemia de la Médula Espinal , Accidente Cerebrovascular , Humanos , Arteria Subclavia/diagnóstico por imagen , Arteria Subclavia/cirugía , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/cirugía , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/métodos , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de la Aorta/cirugía , Enfermedades de la Aorta/etiología , Resultado del Tratamiento , Isquemia de la Médula Espinal/diagnóstico por imagen , Isquemia de la Médula Espinal/etiología , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/métodos , Isquemia , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/complicaciones , Factores de Riesgo , Estudios RetrospectivosAsunto(s)
Enfermedades de los Cartílagos , Embolia , Isquemia de la Médula Espinal , Embolia/complicaciones , Embolia/diagnóstico por imagen , Humanos , Infarto/diagnóstico por imagen , Infarto/etiología , Médula Espinal/diagnóstico por imagen , Isquemia de la Médula Espinal/diagnóstico por imagen , Isquemia de la Médula Espinal/etiologíaRESUMEN
We report 2 cases of successful thoracic endovascular aortic repair (TEVAR) for acute type B aortic dissection (ABAD) complicated with spinal cord ischemia (SCI). Case 1. A 70-year-old gentleman found with an uncomplicated ABAD with false lumen occluded, developed SCI shortly after admission during the initial medical management. Cerebrospinal fluid drainage (CSFD) was initiated followed by emergent TEVAR. SCI improved, and the patient was discharged. Case 2. A 52-year-old gentleman developed uncomplicated ABAD with patent false lumen. 5 hours after admission, he developed SCI during the initial medical management. Emergent TEVAR was performed followed by CSFD, and the SCI improved before discharge. These cases prompted us to address prompt TEVAR for primary entry closure and true lumen dilatation with postoperative hypertensive management to relieve the dynamic obstruction of the segmental arteries responsible for the compromised spinal cord circulation in complicated ABAD.
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Aneurisma de la Aorta Torácica , Disección Aórtica , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Isquemia de la Médula Espinal , Anciano , Disección Aórtica/complicaciones , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/cirugía , Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/cirugía , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Isquemia de la Médula Espinal/diagnóstico por imagen , Isquemia de la Médula Espinal/etiología , Resultado del TratamientoAsunto(s)
Aneurisma de la Aorta Torácica , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Isquemia de la Médula Espinal , Accidente Cerebrovascular , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/complicaciones , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/cirugía , Humanos , Estudios Retrospectivos , Isquemia de la Médula Espinal/diagnóstico por imagen , Isquemia de la Médula Espinal/etiología , Arteria Subclavia/diagnóstico por imagen , Arteria Subclavia/cirugía , Resultado del TratamientoRESUMEN
BACKGROUND: This study aimed to investigate the impact of segmental artery reimplantation and its patency on spinal cord ischemia (SCI) in thoracoabdominal aorta replacement. METHODS: For 193 patients who underwent early postoperative computed tomographic (CT) angiography after thoracoabdominal aorta replacement, the technique of segmental artery reimplantation, their patency, and postoperative SCI were retrospectively investigated. RESULTS: The early patency rate of reimplanted segmental artery was 83.3% (210 of 252), as 13 were taken down intraoperatively and 42 were not visualized in the postoperative CT angiography. The patency rate differed according to the reimplantation technique: 93.6% (131/140) for en bloc patch, 95.6% (43/45) for small individual patch, and 53.7% (36/67) for graft interposition. SCI occurred in 13 (6.3%) patients, 4 of whom (2.0%) remained paraplegic permanently. SCI was significantly more frequent (P=0.044) in the patients in whom segmental artery reimplantation was not successful (take-down or occlusion, 6/37=16.2%) than in those who had all segmental arteries sacrificed intentionally (2/64=3.1%) and those who showed patency of all reimplanted segmental arteries (5/92=5.4%). Especially, there was no permanent paraplegia in the last group. Failure of intended segmental artery reimplantation was a significant risk factor of postoperative SCI in logistic regression analysis (P=0.012; odds ratio 4.65, 95% confidence interval 1.41-15.36). CONCLUSIONS: During thoracoabdominal aorta replacement, attention should be paid to the segmental artery reimplantation technique, which affects the risk of occlusion or intraoperative take-down and thereby may have impact on postoperative SCI.
Asunto(s)
Aorta Abdominal/cirugía , Aorta Torácica/cirugía , Implantación de Prótesis Vascular/efectos adversos , Isquemia de la Médula Espinal/epidemiología , Grado de Desobstrucción Vascular , Aorta Abdominal/diagnóstico por imagen , Aorta Abdominal/fisiopatología , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/fisiopatología , Aortografía , Angiografía por Tomografía Computarizada , Humanos , Incidencia , Reimplantación , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Isquemia de la Médula Espinal/diagnóstico por imagen , Isquemia de la Médula Espinal/fisiopatología , Factores de Tiempo , Resultado del TratamientoAsunto(s)
Isquemia Encefálica , Isquemia de la Médula Espinal , Accidente Cerebrovascular , Isquemia Encefálica/complicaciones , Isquemia Encefálica/diagnóstico por imagen , Isquemia Encefálica/tratamiento farmacológico , Fibrinolíticos/uso terapéutico , Humanos , Isquemia de la Médula Espinal/diagnóstico por imagen , Isquemia de la Médula Espinal/tratamiento farmacológico , Accidente Cerebrovascular/tratamiento farmacológico , Terapia Trombolítica , Activador de Tejido Plasminógeno/uso terapéuticoRESUMEN
Spinal cord infarction (SCI) occurs rarely and is characterized by abrupt onset of neck or back pain and neurologic deterioration. Fibrocartilaginous embolism (FCE) of the spinal cord is a rare but possible cause of acutely progressive spinal cord symptoms. Here, we report the case of an older woman who developed acute paraplegia with SCI on the 10th day after thoracic spine surgery. Although definitive FCE diagnosis can be confirmed only histologically, the characteristic clinical and radiological features were highly suggestive of FCE. Furthermore, 40 clinically suspected cases of FCE are reviewed.