Prediction and treatment of delayed paraplegia after thoracic endovascular aortic repair

2016 Fiscal Year Final Research Report

• Project/Area Number: 26462108
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Research Field: Cardiovascular surgery
• Research Institution: Department of Clinical Research, National Hospital Organization Kure Medical Center (2015-2016); Hiroshima University (2014)
• Principal Investigator: Takasaki Taiichi 独立行政法人国立病院機構(呉医療センター臨床研究部), その他部局等, 医師 (10383564)
• Project Period (FY): 2014-04-01 – 2017-03-31
• Keywords: 脊髄虚血 / 遅発性対麻痺 / 胸部大動脈瘤 / 胸腹部大動脈瘤 / ステントグラフト

Outline of Final Research Achievements

1) Comparative study using two rabbit models was performed to establish a new paraplegia model by ligating AKA and to investigate the mechanism of collateral circulation development. MEP decreasing just after clamping the aorta was associated with immediate postoperative paraplegia, however, delayed paraplegia did not occur in any rabbits.
2) Mechanism of postoperative delayed paraplegia was investigated in clinical cases. Thoracic endovascular aortic repair (TEVAR) was performed in 245 cases and 11 cases developed paraplegia. MEP monitoring was performed in 69 of 245 cases and 7 of 69 cases developed paraplegia, and the incidence of paraplegia in cases with MEP was significantly higher than without (7/69 vs 4/132, p=0.03). Lowest mean arterial pressure less than 55mmHg and stentgraft placement under than Th9 level were independent predictors of MEP decreasing. However, MEP decreasing did not predict the occurrence of delayed paraplegia.

Free Research Field

心臓血管外科学