Mechanisms of Symptomatic Spinal Cord Ischemia After TEVAR: Insights From the European Registry of Endovascular Aortic Repair Complications (EuREC).

Détails

ID Serval
serval:BIB_7958EEF48804
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Mechanisms of Symptomatic Spinal Cord Ischemia After TEVAR: Insights From the European Registry of Endovascular Aortic Repair Complications (EuREC).
Périodique
Journal of Endovascular Therapy
Auteur⸱e⸱s
Czerny M., Eggebrecht H., Sodeck G., Verzini F., Cao P., Maritati G., Riambau V., Beyersdorf F., Rylski B., Funovics M., Loewe C., Schmidli J., Tozzi P., Weigang E., Kuratani T., Livi U., Esposito G., Trimarchi S., van den Berg J.C., Fu W., Chiesa R., Melissano G., Bertoglio L., Lonn L., Schuster I., Grimm M.
ISSN
1545-1550 (Electronic)
ISSN-L
1526-6028
Statut éditorial
Publié
Date de publication
2012
Peer-reviewed
Oui
Volume
19
Numéro
1
Pages
37-43
Langue
anglais
Notes
Publication types: Journal Article
Résumé
Abstract Purpose: To test the hypothesis that simultaneous closure of at least 2 independent vascular territories supplying the spinal cord and/or prolonged hypotension may be associated with symptomatic spinal cord ischemia (SCI) after thoracic endovascular aortic repair (TEVAR). Methods: A pattern matching algorithm was used to develop a risk model for symptomatic SCI using a prospective 63-patient single-center cohort to test the positive predictive value (PPV) of prolonged intraoperative hypotension and/or simultaneous closure of at least 2 of 4 the vascular territories supplying the spinal cord (left subclavian, intercostal, lumbar, and hypogastric arteries). This risk model was then applied to data extracted from the multicenter European Registry on Endovascular Aortic Repair Complications (EuREC). Between 2002 and 2010, the 19 centers participating in EuREC reported 38 (1.7%) cases of symptomatic spinal cord ischemia among the 2235 patients in the database. Results: In the single-center cohort, direct correlations were seen between the occurrence of symptomatic SCI and both prolonged intraoperative hypotension (PPV 1.00, 95% CI 0.22 to 1.00, p = 0.04) and simultaneous closure of at least 2 independent spinal cord vascular territories (PPV 0.67, 95% CI 0.24 to 0.91, p = 0.005). Previous closure of a single vascular territory was not associated with an increased risk of symptomatic spinal cord ischemia (PPV 0.07, 95% CI 0.01 to 0.16, p = 0.56). The combination of prolonged hypotension and simultaneous closure of at least 2 territories exhibited the strongest association (PPV 0.75, 95% CI 0.38 to 0.75, p<0.0001). Applying the model to the entire EuREC cohort found an almost perfect agreement between the predicted and observed risk factors (kappa 0.77, 95% CI 0.65 to 0.90). Conclusion: Extensive coverage of intercostal arteries alone by a thoracic stent-graft is not associated with symptomatic SCI; however, simultaneous closure of at least 2 vascular territories supplying the spinal cord is highly relevant, especially in combination with prolonged intraoperative hypotension. As such, these results further emphasize the need to preserve the left subclavian artery during TEVAR.
Pubmed
Web of science
Création de la notice
06/03/2012 19:23
Dernière modification de la notice
20/08/2019 14:35
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