Spinal cord injury after thoracic endovascular aortic aneurysm repair

Awad, Hamdy; Ramadan, Mohamed Ehab; Sayed, Hosam F. El; Tolpin, Daniel A.; Tili, Esmerina; Collard, Charles D.

doi:10.1007/s12630-017-0974-1

Cited by 97 publications

(94 citation statements)

References 106 publications

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“…The rate of paralysis following TAAA repair remains high (5–10%) [1]. The pathophysiology of aortic cross-clamping -induced spinal cord injury, histopathologic changes, and molecular mechanisms leading to paralysis remain largely unknown.…”

Section: Introductionmentioning

confidence: 99%

MiR-155 deletion reduces ischemia-induced paralysis in an aortic aneurysm repair mouse model: Utility of immunohistochemistry and histopathology in understanding etiology of spinal cord paralysis

Awad

Bratasz

Nuovo

et al. 2018

Annals of Diagnostic Pathology

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Spinal cord paralysis is relatively common after surgical repair of thoraco-abdominal aortic aneurysm (TAAA) and its etiology is unknown. The present study was designed to examine the histopathology of the disease and investigate whether miR-155 ablation would reduce spinal cord ischemic damage and delayed hindlimb paralysis induced by aortic cross-clamping (ACC) in our mouse model. The loss of locomotor function in ACC-paralyzed mice correlated with the presence of extensive gray matter damage and central cord edema, with minimal white matter histopathology. qRTPCR and Western blotting showed that the spinal cords of wild-type ACC mice that escaped paralysis showed lower miR-155 expression and higher levels of transcripts encoding Mfsd2a, which is implicated in the maintenance of blood-brain barrier integrity. In situ based testing demonstrated that increased miR-155 detection in neurons was highly correlated with the gray matter damage and the loss of one of its targets, Mfsd2a, could serve as a good biomarker of the endothelial cell damage. In vitro, we demonstrated that miR-155 targeted Mfsd2a in endothelial cells and motoneurons and increased endothelial cell permeability. Finally, miR-155 ablation slowed the progression of central cord edema, and reduced the incidence of paralysis by 40%. In sum, the surgical pathology findings clearly indicated that the epicenter of the ischemic-induced paralysis was the gray matter and that endothelial cell damage correlated to Mfsd2a loss is a good biomarker of the disease. MiR-155 targeting therefore offers new therapeutic opportunity for edema caused by traumatic spinal cord injury and diagnostic pathologists, by using immunohistochemistry, can clarify if this mechanism also is important in other ischemic diseases of the CNS, including stroke.

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Section: Introductionmentioning

confidence: 99%

MiR-155 deletion reduces ischemia-induced paralysis in an aortic aneurysm repair mouse model: Utility of immunohistochemistry and histopathology in understanding etiology of spinal cord paralysis

Awad

Bratasz

Nuovo

et al. 2018

Annals of Diagnostic Pathology

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“…After TEVAR, there is a risk of occlusion of the aortic branch vessels supplied by the false lumen, whereas flow to the vessels is preserved with the fenestration procedure. Fenestration, therefore, eliminates the risk of spinal cord ischemia, which is a serious complication seen in 2-10% of patients following TEVAR [16]. Other limitations of TEVAR include a high risk of early complications and failures that necessitate reintervention.…”

Section: Discussionmentioning

confidence: 99%

Type B Aortic Dissection with Visceral Artery Involvement Following Blunt Trauma: A Case Report

Han

Lee

Park

et al. 2017

Journal of Trauma and Injury

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“…This includes paraplegia as in the case of Mr X. Although there are advantages of TEVAR when compared to open repair, there is still a significant incidence of spinal cord injury; the overall incidence ranges from 2.5-8% 8 , 14 . Scali et al found a 9.2% incidence in a study looking at 741 TEVAR procedures 15 .…”

Section: Tevarmentioning

confidence: 99%

“…This then leads to oedema of the cord with hypotension in certain regions and reduced perfusion of the vasculature 18 . The latter is more associated with TEVAR with respect to open repair 14 There many factors that contribute to the occurrence of spinal cord ischaemia during and after aortic surgery 18 . Three key aspects were identified by Svensson et al: the duration and degree of ischemia, the failure to re-establish blood flow to spinal cord after repair, and biochemically mediated reperfusion injury 19 .…”

Section: Tevarmentioning

confidence: 99%

See 1 more Smart Citation

Aortic Dissection Complicated by Paraplegia

Prachee

Howard²

2020

JNDS

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This case report illustrates the complexity and severity of acute aortic dissection. This condition has one of the highest mortality rates of any cardiovascular emergency and is often extremely challenging to treat with both open and endovascular intervention often required. This patient presented with a ruptured aortic dissection which is rare and often immediately fatal. He survived urgent extensive aortic endovascular stenting, but, despite preventative measures, developed spinal cord ischaemia post-intervention. The contemporary management of acute aortic dissection, and the pathophysiology and prevention of spinal cord ischaemia are covered in this fantastic case report.

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Spinal cord injury after thoracic endovascular aortic aneurysm repair

Cited by 97 publications

References 106 publications

MiR-155 deletion reduces ischemia-induced paralysis in an aortic aneurysm repair mouse model: Utility of immunohistochemistry and histopathology in understanding etiology of spinal cord paralysis

MiR-155 deletion reduces ischemia-induced paralysis in an aortic aneurysm repair mouse model: Utility of immunohistochemistry and histopathology in understanding etiology of spinal cord paralysis

Type B Aortic Dissection with Visceral Artery Involvement Following Blunt Trauma: A Case Report

Aortic Dissection Complicated by Paraplegia

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