Kawaguchi S, Ishimaru S, Koizumi N, Shimazaki T, Obitsu Y, Ishikawa M
Second Department of Surgery, Tokyo Medical College, Japan.
Jpn J Thorac Cardiovasc Surg. 1998 Oct;46(10):1047-51. doi: 10.1007/BF03217872.
Multiple aortic aneurysms in Behçet's disease were repaired with transluminaly placed endovascular stent grafts. Before deploying the stent graft device for permanent implantation for the saccular aneurysm located in the descending thoracic aorta, from which feeding arteries for the spinal cord possibly branched, a retrievable stent graft was inserted and evoked spinal cord potential (ESP) were monitored in order to predict spinal cord ischemia. The original retrievable stent graft, constructed of a self-expandable Z-shaped stainless steel stent covered with e-PTFE, can be easily withdrawn into a 18 Fr. sheath after deployment. Blood flow into intercostal arteries branching from that part of the descending aorta where the permanent stent graft is planned to be implanted, is intercepted by the retrievable stent graft. A change of ESP during the temporary implantation of the device indicates that spinal cord ischemia would be caused by permanent implantation of the stent graft. In this case, no change of ESP was observed and the patient showed no postoperative paraplegia. The retrievable stent graft was useful for prediction of spinal cord ischemia before endoluminal stent graft repair of the descending aortic aneurysm. However, the device is not flexible enough to fit a severely tortuous aorta, therefore we are obliged to select patients to some extent. Further improvement of the device is required to make prediction of spinal cord ischemia with the retrievable stent graft possible in all cases.
白塞病的多发性主动脉瘤采用经腔内放置血管内支架移植物进行修复。在将支架移植物装置永久植入位于胸降主动脉的囊状动脉瘤之前（脊髓的供血动脉可能由此处分支），先插入一个可回收支架移植物，并监测诱发性脊髓电位（ESP），以预测脊髓缺血情况。最初的可回收支架移植物由覆盖有e-PTFE的自膨胀Z形不锈钢支架构成，在展开后可轻松回撤至18F鞘管内。从计划植入永久支架移植物的胸降主动脉部位分支出来的肋间动脉的血流，会被可回收支架移植物拦截。在装置临时植入期间ESP的变化表明，永久植入支架移植物会导致脊髓缺血。在这种情况下，未观察到ESP变化，且患者术后未出现截瘫。可回收支架移植物在胸降主动脉瘤腔内支架移植物修复术前预测脊髓缺血方面很有用。然而，该装置的柔韧性不足以适应严重迂曲的主动脉，因此我们在一定程度上必须挑选患者。需要对该装置进行进一步改进，以使在所有情况下都能用可回收支架移植物预测脊髓缺血成为可能。
