Seike Yoshimasa, Nishii Tatsuya, Yoshida Kazufumi, Yokawa Koki, Masada Kenta, Inoue Yosuke, Fukuda Tetsuya, Matsuda Hitoshi
Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
Department of Radiology, National Cerebral and Cardiovascular Center, Osaka, Japan.
JTCVS Open. 2023 Dec 1;17:14-22. doi: 10.1016/j.xjon.2023.11.014. eCollection 2024 Feb.
This study aimed to determine the relationship between covering the intercostal artery branching of the Adamkiewicz artery (ICA-AKA) and spinal cord ischemia (SCI) during thoracic endovascular aortic repair (TEVAR).
Patients who underwent TEVAR from 2008 to 2022 were enrolled. Stent grafts covered the ICA-AKA in 108 patients (covered AKA group) and stent grafts didn't cover the ICA-AKA in 114 patients (uncovered AKA group). The characteristics of 58 patients from each group were matched based on propensity scores.
No significant differences in SCI rates were detected between the covered AKA (10%; 11/108) and uncovered AKA (3.5%; 4/114) groups ( = .061). Shaggy aorta (odds ratio [OR], 5.16; 95% confidence interval [CI], 1.74-15.3, = .003), iliac artery access (OR, 6.81; 95% CI, 2.22-20.9, = .001), and procedural time (OR, 1.01; 95% CI, 1.00-1.02, = .003) were risk factors for SCI in the entire cohort. Although covering the ICA-AKA (OR, 2.60; 95% CI, 0.86-7.88, = .058) was not a significant risk factor, shaggy aorta (OR, 8.15; 95% CI, 2.07-32.1, = .003), iliac artery access (OR, 9.09; 95% CI, 2.22-37.2, = .002), and procedural time (OR, 1.01; 95% CI, 1.01-1.02, = .008) were risk factors for SCI in the covered AKA group. No significant risk factors were detected in the uncovered AKA group.
Covering the ICA-AKA was not an independent risk for SCI in TEVAR. However, covering the ICA-AKA was indirectly associated with the risk of SCI in patients with shaggy aorta, iliac access, and procedural time.
本研究旨在确定在胸主动脉腔内修复术（TEVAR）期间，覆盖Adamkiewicz动脉的肋间动脉分支（ICA-AKA）与脊髓缺血（SCI）之间的关系。
纳入2008年至2022年接受TEVAR的患者。108例患者的支架移植物覆盖了ICA-AKA（覆盖AKA组），114例患者的支架移植物未覆盖ICA-AKA（未覆盖AKA组）。根据倾向评分匹配每组中的58例患者。
覆盖AKA组（10%；11/108）和未覆盖AKA组（3.5%；4/114）之间的SCI发生率未检测到显著差异（P = 0.061）。主动脉粥样硬化（优势比[OR]，5.16；95%置信区间[CI]，1.74 - 15.3，P = 0.003）、髂动脉入路（OR，6.81；95% CI，2.22 - 20.9，P = 0.001）和手术时间（OR，1.01；95% CI，1.00 - 1.02，P = 0.003）是整个队列中SCI的危险因素。虽然覆盖ICA-AKA（OR，2.60；95% CI，0.86 - 7.88，P = 0.058）不是显著危险因素，但主动脉粥样硬化（OR，8.15；95% CI，2.07 - 32.1，P = 0.003）、髂动脉入路（OR，9.09；95% CI，2.22 - 37.2，P = 0.002）和手术时间（OR，1.01；95% CI，1.01 - 1.02，P = 0.008）是覆盖AKA组中SCI的危险因素。在未覆盖AKA组中未检测到显著危险因素。
在TEVAR中，覆盖ICA-AKA不是SCI的独立危险因素。然而，在主动脉粥样硬化、髂动脉入路和手术时间较长的患者中，覆盖ICA-AKA与SCI风险间接相关。
