Department of Vascular Surgery, University Hospital Leipzig, Germany.
EuroIntervention. 2018 Sep 20;14(7):828-835. doi: 10.4244/EIJ-D-18-00200.
The purpose of our study was to report our experience with minimally invasive segmental artery coil embolisation (MISACE) to prevent spinal cord ischaemia (SCI) after endovascular repair (ER) of thoracoabdominal aortic aneurysm (TAAA).
A cohort of 57 patients with TAAAs was treated by MISACE followed by ER between October 2014 and December 2017. The TAAA Crawford classification was: type I, n=5; type II, n=12; type III, n=27; type IV, n=13. The average maximum aortic diameter was 62.7±8.8 mm. Patients had a median of 5 coiled SAs (range: 1-19). MISACE was completed in one (n=22), two (n=24), three (n=7), four (n=3) or five (n=1) sessions. The maximum number of coiled SAs per session was six. After completion of MISACE, 77.7% of direct segmental arterial flow was occluded. After a mean of 83±62 days, 55 of the patients received total ER of their TAAA. At 30 days after ER, no patient developed SCI and three patients had died.
MISACE to precondition the paraspinous collateral network prior to endovascular repair of thoracoabdominal aortic aneurysm is clinically feasible. The safety profile is promising and there is good reason to explore this new staging strategy further.
本研究旨在报告我们在胸主动脉瘤腔内修复（ER）后采用微创节段动脉线圈栓塞（MISACE）预防脊髓缺血（SCI）的经验。
2014 年 10 月至 2017 年 12 月，我们对 57 例胸主动脉瘤患者进行了 MISACE 治疗，随后进行了 ER。TAAA Crawford 分类为：I 型，n=5；II 型，n=12；III 型，n=27；IV 型，n=13。平均最大主动脉直径为 62.7±8.8mm。患者有中位数为 5 个 coil SAs（范围：1-19）。MISACE 一次完成（n=22）、两次（n=24）、三次（n=7）、四次（n=3）或五次（n=1）。每次 coil SAs 的最大数量为 6 个。MISACE 完成后，77.7%的直接节段动脉血流闭塞。平均 83±62 天后，55 例患者接受了 TAAA 的完全 ER。ER 后 30 天，无患者发生 SCI，3 例患者死亡。
在胸主动脉瘤腔内修复前采用 MISACE 预处理脊柱旁侧支网络是临床可行的。该方法的安全性有一定保障，因此有充分的理由进一步探索这种新的分期策略。
