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主动脉支架置入术前对供应脊髓前动脉的节段动脉进行微血管栓塞：技术与安全性

Microvascular Plug Embolization of Anterior Spinal Artery Bearing Segmental Arteries Prior Aortic Stenting: Technique and Safety.

作者信息

Deniz Sinan, Öcal Osman, Fabritius Matthias, Puhr-Westerheide Daniel, Abaci Gizem, Wildgruber Moritz, Ümütlü Muzaffer Reha, Gök Mustafa, Stana Jan, Rantner Barbara, Tsilimparis Nikolaos, Ricke Jens, Seidensticker Max

机构信息

Department of Radiology, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany.

Department of Diagnostic and Interventional Radiology, Heidelberg University, Heidelberg, Germany.

出版信息

Cardiovasc Intervent Radiol. 2025 Jan;48(1):95-101. doi: 10.1007/s00270-024-03909-4. Epub 2024 Nov 27.

DOI:10.1007/s00270-024-03909-4
PMID:39604696
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11706880/
Abstract

PURPOSE

This study aims to present our experience with superselective embolization of the anterior spinal artery-bearing segmental artery (ASAbSA) using a microvascular plug (MVP) during the minimally invasive segmental artery coil embolization (MISACE) procedure prior endovascular repair of the thoracoabdominal aortic aneurysms.

METHODS

We retrospectively evaluated all MISACE procedures performed between May 2018 and July 2023, where MVP was deployed into an angiographically confirmed ASAbSA. Data were analyzed regarding interventional details, technical aspects, and safety protocols. The standard procedure for MVP embolization involves detaching the plug after 10 min, provided no neurological symptoms occur.

RESULTS

A total of 22 patients underwent MVP deployment into the proximal segmental artery supplying the ASAbSA. There were no instances of non-target embolization or segmental artery dissection. Furthermore, none of the patients experienced temporary or permanent spinal cord ischemia.

CONCLUSION

MVP deployment into the ASAbSA is a safe strategy for protecting the spinal cord during preemptive embolization of segmental arteries prior to endovascular aortic repair.

摘要

目的

本研究旨在介绍我们在胸腹主动脉瘤血管内修复术前的微创节段动脉弹簧圈栓塞（MISACE）过程中，使用微血管栓塞装置（MVP）对携带脊髓前动脉的节段动脉（ASAbSA）进行超选择性栓塞的经验。

方法

我们回顾性评估了2018年5月至2023年7月期间所有进行的MISACE手术，其中MVP被部署到经血管造影证实的ASAbSA中。分析了有关介入细节、技术方面和安全协议的数据。MVP栓塞的标准程序是在10分钟后分离栓塞装置，前提是没有出现神经症状。

结果

共有22例患者将MVP部署到供应ASAbSA的近端节段动脉中。没有发生非靶栓塞或节段动脉夹层的情况。此外，没有患者出现暂时性或永久性脊髓缺血。

结论

在血管内主动脉修复术前对节段动脉进行预防性栓塞时，将MVP部署到ASAbSA中是一种保护脊髓的安全策略。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cef9/11706880/5dcbcffb4066/270_2024_3909_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cef9/11706880/65fa5729d9af/270_2024_3909_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cef9/11706880/b07dffff7185/270_2024_3909_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cef9/11706880/5dcbcffb4066/270_2024_3909_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cef9/11706880/65fa5729d9af/270_2024_3909_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cef9/11706880/b07dffff7185/270_2024_3909_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cef9/11706880/5dcbcffb4066/270_2024_3909_Fig3_HTML.jpg

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本文引用的文献

1
Minimally Invasive Segmental Artery Coil Embolization (MISACE) Prior to Endovascular Thoracoabdominal Aortic Aneurysm Repair.微创节段性动脉线圈栓塞术（MISACE）在血管内胸腹主动脉瘤修复之前。
Cardiovasc Intervent Radiol. 2022 Oct;45(10):1462-1469. doi: 10.1007/s00270-022-03230-y. Epub 2022 Aug 4.
2
Initial Experience With the Microvascular Plug in Selective Renal Artery Embolization.微血管栓塞剂在选择性肾动脉栓塞中的初步经验
Vasc Endovascular Surg. 2020 Apr;54(3):240-246. doi: 10.1177/1538574419897500. Epub 2020 Jan 13.
3
First-in-man endovascular preconditioning of the paraspinal collateral network by segmental artery coil embolization to prevent ischemic spinal cord injury.
首例经皮节段动脉线圈栓塞治疗脊柱旁侧支网络的血管内预处理，以预防缺血性脊髓损伤。
J Thorac Cardiovasc Surg. 2015 Apr;149(4):1074-9. doi: 10.1016/j.jtcvs.2014.12.025. Epub 2014 Dec 18.
4
Minimally invasive segmental artery coil embolization for preconditioning of the spinal cord collateral network before one-stage descending and thoracoabdominal aneurysm repair.微创节段动脉弹簧圈栓塞术用于一期降主动脉和胸腹主动脉瘤修复术前脊髓侧支循环网络的预处理。
Innovations (Phila). 2014 Jan-Feb;9(1):60-5. doi: 10.1097/IMI.0000000000000038.
5
Endovascular coil embolization of segmental arteries prevents paraplegia after subsequent thoracoabdominal aneurysm repair: an experimental model.节段性动脉血管内线圈栓塞可预防胸腹主动脉瘤修复后继发性截瘫：实验模型。
J Thorac Cardiovasc Surg. 2014 Jan;147(1):220-6. doi: 10.1016/j.jtcvs.2013.09.022. Epub 2013 Nov 9.
6
The collateral network concept: a reassessment of the anatomy of spinal cord perfusion.侧支网络概念：对脊髓灌注解剖结构的再评估。
J Thorac Cardiovasc Surg. 2011 Apr;141(4):1020-8. doi: 10.1016/j.jtcvs.2010.06.023.
7
Staged repair significantly reduces paraplegia rate after extensive thoracoabdominal aortic aneurysm repair.分期修复显著降低广泛胸腹主动脉瘤修复后的截瘫发生率。
J Thorac Cardiovasc Surg. 2010 Jun;139(6):1464-72. doi: 10.1016/j.jtcvs.2010.02.037.
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Contemporary analysis of descending thoracic and thoracoabdominal aneurysm repair: a comparison of endovascular and open techniques.降主动脉和胸腹主动脉瘤修复的当代分析：血管内技术与开放技术的比较
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Spinal cord blood flow and ischemic injury after experimental sacrifice of thoracic and abdominal segmental arteries.胸段和腹段节段性动脉实验性牺牲后的脊髓血流与缺血性损伤
Eur J Cardiothorac Surg. 2008 Jun;33(6):1030-8. doi: 10.1016/j.ejcts.2008.01.069. Epub 2008 Apr 11.
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Spinal cord perfusion and protection during descending thoracic and thoracoabdominal aortic surgery: the collateral network concept.降胸段和胸腹主动脉手术期间的脊髓灌注与保护：侧支网络概念
Ann Thorac Surg. 2007 Feb;83(2):S865-9; discussion S890-2. doi: 10.1016/j.athoracsur.2006.10.092.