Is the number of covered intercostal arteries a predictor of postoperative spinal cord ischemia after thoracic endovascular aortic repair?


Objective: The purpose of this study was to investigate the impact of the number of covered intercostal arteries (ICAs) on postoperative spinal cord ischemia (SCI) after Thoracic endovascular aortic repair (TEVAR).Methods: A retrospective review of a collected database was performed for all patients who underwent TEVAR at the Sapporo Medical University between January 2006 and February 2016. The pre- and post-operative thin slice contrast-enhanced computed tomography was performed, and ICAs were evaluated. Preoperative demographics, procedure-related variables, and clinical details related to SCI were examined. Logistic regression analysis was performed to identify risk factors for the development of SCI.Results: Of the 263 patients who underwent TEVAR during the study period, 11 patients (4.1%) developed SCI. The number of patent preoperative ICAs was 10.1 ± 4.4. There was no significant difference in the number of patent ICAs between the SCI and No SCI groups. On the other hand, the number of postoperative covered ICAs was 4.8 ± 3.3. The number of covered ICAs was higher in the SCI than No SCI group (8.3 ± 2.9 vs 4.7 ± 3.2, p = 0.001). The cut-off value was set at 6 ICAs by ROC curve analysis. Multivariate analysis demonstrated that in TEVAR, the covering of 6 or more ICAs by stent grafts became a significant risk factor for SCI (odds ratio, 10.9; p = 0.029).Conclusions: The number of covered ICAs becomes a predictor of postoperative SCI after TEVAR. The patient with 6 or more ICAs covered by stent grafts is deemed to require a more careful perioperative management

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Last time updated on 20/03/2019

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