University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany.
University of Leipzig, Saxonian Incubator for Clinical Translation (SIKT), Leipzig, Germany.
Eur J Cardiothorac Surg. 2019 Jul 1;56(1):126-134. doi: 10.1093/ejcts/ezy463.
Minimally invasive staged segmental artery coil- and plug embolization (MIS2ACE) has been introduced for spinal cord injury prevention prior to open or endovascular thoraco-abdominal aortic aneurysm repair. To date, no optimal pattern has been developed. The aim of this study was to identify the optimal MIS2ACE occlusion pattern.
Twenty-five juvenile pigs were randomly assigned to 3 MIS2ACE occlusion patterns (2 stages) and a control group [single-stage segmental artery (SA) occlusion, N = 7]. The first pattern started with occlusion of all lumbar segmental arteries in the first stage and the remaining thoracic arteries in the second stage (regional pattern, N = 6). In group 2, an alternating approach with occlusion of every other SA in the first stage and the remainder in the second stage was used (alternating pattern, N = 6). The third pattern started with occluding the watershed area between thoracic level 12 and lumbar level 2 in the first stage and the remaining arteries in the second stage (watershed pattern, N = 6). Neurological assessment at 6-h intervals and spinal cord tissue perfusion measurements via microspheres at 6 time points were performed. At the end of the experiments, the spinal cord was histopathologically examined.
An average of 6 ± 2 coils were used per SA. In the control group a total of 57% (N = 4) of animals experienced permanent paraplegia, 1 animal (16%) of the alternating and watershed intervention group suffered from permanent paraplegia. Animals from the staged regional pattern did not experience permanent paraplegia. Furthermore, no evidence of significant tissue damage was observed (P < 0.05 vs control). Tissue perfusion of the lumbar spinal cord in the regional pattern group recovered within 3 days after the second stage to 89.2 ± 47 percent-of-baseline (P = 0.393), whereas mean perfusion of the other 2 intervention groups and the control remained significantly lower compared to the baseline (35.7 ± 16%, 30.2 ± 11% and 63.2 ± 19, P < 0.05).
This study provides evidence that MIS2ACE (minimally invasive staging) may result in less ischaemic spinal cord injury and favourable neurological outcomes compared to complete (1 stage) SA occlusion. A regional-based occlusion pattern (starting with the lumbar segmental arteries) seems to be the best 2-stage approach.
微创分期节段性动脉线圈和栓子栓塞术（MIS2ACE）已被引入用于预防开放性或血管内胸腹主动脉瘤修复前的脊髓损伤。迄今为止，尚未制定出最佳模式。本研究的目的是确定最佳的 MIS2ACE 闭塞模式。
25 头幼年猪随机分为 3 组 MIS2ACE 闭塞模式（2 期）和对照组[单阶段节段性动脉（SA）闭塞，N=7]。第一组在第一阶段闭塞所有腰节段动脉，第二阶段闭塞剩余胸段动脉（区域性闭塞模式，N=6）。在第 2 组中，使用第 1 阶段每隔一个 SA 闭塞和第 2 阶段剩余 SA 闭塞的交替方法（交替闭塞模式，N=6）。第三组在第一阶段闭塞胸 12 水平和腰 2 水平之间的分水岭区，第二阶段闭塞剩余动脉（分水岭闭塞模式，N=6）。在 6 小时的间隔内进行神经评估，并通过微球在 6 个时间点测量脊髓组织灌注。实验结束时，对脊髓进行组织病理学检查。
每个 SA 平均使用 6±2 个线圈。对照组共有 57%（N=4）的动物发生永久性截瘫，1 只动物（16%）的交替和分水岭干预组发生永久性截瘫。分期区域性闭塞模式的动物未发生永久性截瘫。此外，未观察到明显的组织损伤证据（P<0.05 与对照组相比）。区域性闭塞模式组的腰段脊髓组织灌注在第 2 阶段后 3 天内恢复至 89.2±47%的基线（P=0.393），而其他 2 个干预组和对照组的平均灌注仍明显低于基线（35.7±16%，30.2±11%和 63.2±19%，P<0.05）。
本研究表明，与完全（1 期）SA 闭塞相比，MIS2ACE（微创分期）可能导致较少的缺血性脊髓损伤和较好的神经功能结果。基于区域性的闭塞模式（从腰节段动脉开始）似乎是最佳的 2 期方法。
