Development of prediction and treatment for delayed paraplegia after thoracic endovascular aortic repair

• Project/Area Number: 16K10660
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Research Field: Cardiovascular surgery
• Research Institution: Hiroshima University
• Principal Investigator: Katayama Keijiro 広島大学, 病院(医), 助教 (40773057)
• Co-Investigator(Kenkyū-buntansha): 末田 泰二郎 広島大学, 医歯薬保健学研究科(医), 教授 (10162835) ; 高橋 信也 広島大学, 病院(医), 講師 (70423382)
• Project Period (FY): 2016-04-01 – 2019-03-31
• Project Status: Completed (Fiscal Year 2018)
• Budget Amount: ¥4,810,000 (Direct Cost: ¥3,700,000、Indirect Cost: ¥1,110,000); Fiscal Year 2018: ¥910,000 (Direct Cost: ¥700,000、Indirect Cost: ¥210,000); Fiscal Year 2017: ¥1,560,000 (Direct Cost: ¥1,200,000、Indirect Cost: ¥360,000); Fiscal Year 2016: ¥2,340,000 (Direct Cost: ¥1,800,000、Indirect Cost: ¥540,000)
• Keywords: 脊髄虚血 / 対麻痺 / 大動脈手術 / 遅発性対麻痺 / ステントグラフト治療 / Adamkiewitz動脈 / 脊髄虚血障害 / 運動誘発電位 / 大血管外科学

Outline of Final Research Achievements

Experimental and clinical studies were conducted to predict delayed paraplegia after thoracic endovascular aortic repair (TEVAR) and develop its treatment. Development of delayed paraplegia rabbit model was unsuccessful. Motor evoked potential (MEP) monitoring during TEVAR was performed in 81 cases. Multivariate analysis revealed that lowest mean arterial pressure less than 55 mmHg was a independent predictor of spinal cord ischemia. MEP changes depended on the position of the stent graft and hemodynamics.

Academic Significance and Societal Importance of the Research Achievements

大動脈ステントグラフト治療における対麻痺のおよび遅発性対麻痺の発生機序には、Th9以下の肋間動脈が閉塞することと、血圧低下が関与する。脊髄誘発電位は、術中平均血圧が55mmHg以下であるときに低下することがある。この値は脊髄灌流に必要な平均血圧を示していると考えられる。術後遅発性対麻痺は、循環動態が変動するイベントに際して発生することが多く、遅発性対麻痺発症時の平均血圧は、術中に脊髄誘発電位が低下する平均血圧よりも高い値である。これには周術期等において、脊髄および周囲組織の血液灌流が低下することが関与していると考えられる。

Research Products

• [Journal Article] Total Aortic Arch Replacement after Thoracic Endovascular Aortic Repair Using Left Subclavian Arterial Perfusion (2020)
  • Author(s): Sueda T, Takahashi S, Katayama K.
  • Journal Title: Annals of Thoracic and Cardiovascular Surgery Volume: 26 Issue: 2 Pages: 100-103
  • DOI: 10.5761/atcs.cr.18-00001
  • NAID: 130007833453
  • ISSN: 1341-1098, 2186-1005
  • Peer Reviewed / Open Access
• [Journal Article] Mesenchymal Stem Cell-Based Therapy Improves Lower Limb Movement After Spinal Cord Ischemia in Rats. (2018)
  • Author(s): Takahashi S, Nakagawa K, Tomiyasu M, Nakashima A, Katayama K, Imura T, Herlambang B, Okubo F, Arihiro K, Kawahara Y, Yuge L, Sueda T
  • Journal Title: Ann Thorac Surg. Volume: 105 Issue: 5 Pages: 1523-1530
  • DOI: 10.1016/j.athoracsur.2017.12.014
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Association between false lumen segmental arteries and spinal cord ischemia in type A acute aortic dissection. (2018)
  • Author(s): Kodama H, Takahashi S, Okazaki T, Morita S, Go S, Watanabe M, Yamane Y, Katayama K, Kurosaki T, Sueda T.
  • Journal Title: J Cardiovasc Surg (Torino) Volume: 20 Issue: 2
  • DOI: 10.23736/s0021-9509.18.10639-2
  • Peer Reviewed / Open Access
• [Journal Article] The long-term outcomes of partial arch repair using the frozen elephant trunk technique for distal arch aortic aneurysm. (2018)
  • Author(s): Sueda T, Takahashi S, Katayama K, Morita S, Watanabe M, Kurosaki T.
  • Journal Title: Surg Today Volume: 48 Issue: 12 Pages: 1035-1039
  • DOI: 10.1007/s00595-018-1688-x
  • Peer Reviewed / Open Access
• [Journal Article] Spinal cord injury as a complication of thoracic endovascular aneurysm repair. (2017)
  • Author(s): Sueda T, Takahashi S.
  • Journal Title: Surg Today. Volume: 48 Issue: 5 Pages: 473-477
  • DOI: 10.1007/s00595-017-1588-5
  • Peer Reviewed
• [Journal Article] [Prevention of Spinal Cord Ischemia During Thoracic Endovascular Aortic Repair]. (2017)
  • Author(s): Takahashi S, Sueda T.
  • Journal Title: Kyobu Geka Volume: 70 Pages: 251-256
  • NAID: 40021150389
• [Journal Article] Prevention of Spinal Cord Ischemia During Thoracic Endovascular Aortic Repair (2017)
  • Author(s): Shinya Takahashi, Taijiro Sueda
  • Journal Title: Kyoubu Geka Volume: 70(4) Pages: 251-256
  • NAID: 40021150389
  • Peer Reviewed
• [Presentation] Outcome of thoracic endovascular aortic repair with left subclavian artery transposition (2018)
  • Author(s): Keijiro Katayama, Shinya Takahashi, Shohei Morita, Seimei Go, Kazuki Maeda, Tatsuya Kurosaki and Taijiro Sueda
  • Organizer: The 26th Annual Meeting of the Asian Society for Cardiovascular and Thoracic Surgery
  • Int'l Joint Research
• [Presentation] Dorsal false lumen: Segmental communication artery and spinal cord ischemia in type A acute aortic dissection (2018)
  • Author(s): Shinya Takahashi, Keijiro Katayama, Seimei Go, Shohei Morita, Tatsuya Kurosaki, Kazuki Maeda, Taijiro Sueda
  • Organizer: The 26th Annual Meeting of the Asian Society for Cardiovascular and Thoracic Surgery
  • Int'l Joint Research
• [Presentation] Hybrid aortic arch repair of distal residual entry following ascending aortic replacement for acute type A aortic dissection (2017)
  • Author(s): Keijiro Katayama, Shinya Takahashi, Taijiro Sueda
  • Organizer: The 25th Annual Meeting of the Asian Society for Cardiovascular and Thoracic Surgery
  • Place of Presentation: Seoul, Korea
  • Year and Date: 2017-03-23
  • Int'l Joint Research
• [Presentation] 胸腹部大動脈瘤に対するGastroduodenal arcaを使用したvisceral debranching TEVAR (2016)
  • Author(s): 片山桂次郎, 髙橋信也, 末田泰二郎
  • Organizer: 第44回日本血管外科学会学術総会
  • Place of Presentation: 東京都
  • Year and Date: 2016-05-25
• [Presentation] Hybrid Visceral Debranching TEVAR In Patients With Thoracoabdominal Aortic Aneurysm And Gastroduodenal Arcade (2016)
  • Author(s): Keijiro Katayama, Shinya Takahashi, Taijiro Sueda
  • Organizer: American Association For Thoracic Surgery, Aortic Symposium 2016
  • Place of Presentation: New York, USA
  • Year and Date: 2016-05-12
  • Int'l Joint Research