Stroke, spinal cord ischemia and upper limb ischemia in patients undergoing TEVAR with coverage of the left subclavian artery: a case series study

Abstract Background We performed routine spinal fluid drainage for patients who underwent TEVAR for thoracic aortic pathology together with left subclavian artery coverage, which was needed for achievement of a safe proximal sealing zone. We assessed the occurrence of spinal cord ischemia as well th...

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Autores principales:	Mohamed Abd El-Monem Abd El-Salam Rizk, Mohamed Ismail Mohamed Ismail, Kareem Sabry Gohar
Formato:	article
Lenguaje:	EN
Publicado:	SpringerOpen 2021
Materias:	Thoracic aorta Stroke Spinal cord ischemia Spinal drainage Left subclavian coverage Revascularization Medical physics. Medical radiology. Nuclear medicine R895-920
Acceso en línea:	https://doaj.org/article/33737bfb4742422f875b778325f1100a
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spelling	oai:doaj.org-article:33737bfb4742422f875b778325f1100a2021-11-21T12:26:46ZStroke, spinal cord ischemia and upper limb ischemia in patients undergoing TEVAR with coverage of the left subclavian artery: a case series study10.1186/s43055-021-00654-32090-4762https://doaj.org/article/33737bfb4742422f875b778325f1100a2021-11-01T00:00:00Zhttps://doi.org/10.1186/s43055-021-00654-3https://doaj.org/toc/2090-4762Abstract Background We performed routine spinal fluid drainage for patients who underwent TEVAR for thoracic aortic pathology together with left subclavian artery coverage, which was needed for achievement of a safe proximal sealing zone. We assessed the occurrence of spinal cord ischemia as well the rate of occurrence of other complications such as stroke, and upper limb ischemia. Results This was a case series study done between July 2014 and April 2020, in them all the left subclavian artery was covered to ensure a proximal safe seal zone. Routine spinal fluid drainage was done, keeping the spinal fluid pressure < 10–15 mmHg with catheter in place for 48 h. Data was obtained from twenty-three patients who underwent TEVAR for thoracic aortic dissection (73.91%), thoracic aortic aneurysm (21.74%), or ulcer (4.35%). Planning was based upon multi-slice computed tomographic angiography and covering the left subclavian was mandatory to achieve a proximal sealing zone. Technical success was achieved in 100% of cases. 4.35% of patients had three endograft, 56.52% had two endografts, 39.13% had one endograft. All patients lost their radial pulsations immediately after implantation, 8.70% developed post implantation syndrome(fever) that was managed conservatively, 4.35% developed stroke related to the anterior circulation, 4.35% developed signs of spinal cord ischemia. During the follow up, one patient died within 6 h after the procedure due to extensive myocardial infarction (patient was scheduled for CABG after our procedure). 17.40% developed upper limb symptoms that were tolerable and were managed conservatively. Conclusion By adopting routine spinal cord drainage and pressure monitoring, we can consider not to revascularize the left subclavian artery prior to TEVAR if it will be covered.Mohamed Abd El-Monem Abd El-Salam RizkMohamed Ismail Mohamed IsmailKareem Sabry GoharSpringerOpenarticleThoracic aortaStrokeSpinal cord ischemiaSpinal drainageLeft subclavian coverageRevascularizationMedical physics. Medical radiology. Nuclear medicineR895-920ENThe Egyptian Journal of Radiology and Nuclear Medicine, Vol 52, Iss 1, Pp 1-8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Thoracic aorta Stroke Spinal cord ischemia Spinal drainage Left subclavian coverage Revascularization Medical physics. Medical radiology. Nuclear medicine R895-920
spellingShingle	Thoracic aorta Stroke Spinal cord ischemia Spinal drainage Left subclavian coverage Revascularization Medical physics. Medical radiology. Nuclear medicine R895-920 Mohamed Abd El-Monem Abd El-Salam Rizk Mohamed Ismail Mohamed Ismail Kareem Sabry Gohar Stroke, spinal cord ischemia and upper limb ischemia in patients undergoing TEVAR with coverage of the left subclavian artery: a case series study
description	Abstract Background We performed routine spinal fluid drainage for patients who underwent TEVAR for thoracic aortic pathology together with left subclavian artery coverage, which was needed for achievement of a safe proximal sealing zone. We assessed the occurrence of spinal cord ischemia as well the rate of occurrence of other complications such as stroke, and upper limb ischemia. Results This was a case series study done between July 2014 and April 2020, in them all the left subclavian artery was covered to ensure a proximal safe seal zone. Routine spinal fluid drainage was done, keeping the spinal fluid pressure < 10–15 mmHg with catheter in place for 48 h. Data was obtained from twenty-three patients who underwent TEVAR for thoracic aortic dissection (73.91%), thoracic aortic aneurysm (21.74%), or ulcer (4.35%). Planning was based upon multi-slice computed tomographic angiography and covering the left subclavian was mandatory to achieve a proximal sealing zone. Technical success was achieved in 100% of cases. 4.35% of patients had three endograft, 56.52% had two endografts, 39.13% had one endograft. All patients lost their radial pulsations immediately after implantation, 8.70% developed post implantation syndrome(fever) that was managed conservatively, 4.35% developed stroke related to the anterior circulation, 4.35% developed signs of spinal cord ischemia. During the follow up, one patient died within 6 h after the procedure due to extensive myocardial infarction (patient was scheduled for CABG after our procedure). 17.40% developed upper limb symptoms that were tolerable and were managed conservatively. Conclusion By adopting routine spinal cord drainage and pressure monitoring, we can consider not to revascularize the left subclavian artery prior to TEVAR if it will be covered.
format	article
author	Mohamed Abd El-Monem Abd El-Salam Rizk Mohamed Ismail Mohamed Ismail Kareem Sabry Gohar
author_facet	Mohamed Abd El-Monem Abd El-Salam Rizk Mohamed Ismail Mohamed Ismail Kareem Sabry Gohar
author_sort	Mohamed Abd El-Monem Abd El-Salam Rizk
title	Stroke, spinal cord ischemia and upper limb ischemia in patients undergoing TEVAR with coverage of the left subclavian artery: a case series study
title_short	Stroke, spinal cord ischemia and upper limb ischemia in patients undergoing TEVAR with coverage of the left subclavian artery: a case series study
title_full	Stroke, spinal cord ischemia and upper limb ischemia in patients undergoing TEVAR with coverage of the left subclavian artery: a case series study
title_fullStr	Stroke, spinal cord ischemia and upper limb ischemia in patients undergoing TEVAR with coverage of the left subclavian artery: a case series study
title_full_unstemmed	Stroke, spinal cord ischemia and upper limb ischemia in patients undergoing TEVAR with coverage of the left subclavian artery: a case series study
title_sort	stroke, spinal cord ischemia and upper limb ischemia in patients undergoing tevar with coverage of the left subclavian artery: a case series study
publisher	SpringerOpen
publishDate	2021
url	https://doaj.org/article/33737bfb4742422f875b778325f1100a
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Stroke, spinal cord ischemia and upper limb ischemia in patients undergoing TEVAR with coverage of the left subclavian artery: a case series study

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