Risk of spinal cord infarction in aortic aneurysm repair

Spinal Cord infarction represents roughly 1% of all strokes and can lead to severe impairment, like paraplegia or quadriplegia. Aortic endovascular and surgical repair of aortic aneurysms or dissections could result in spinal cord infarction, because the vascular supply of the spinal cord largely originates directly from the aorta.

Spinal cord ischemia (SCI) rate in patients undergoing aortic repair varies depending on the presence and location of dissection, aneurysm rupture and repair strategy (endovascular or surgical).

Reports go from rates as low as 0.2% to those as high as 16%, and basically come from one center studies.

Since new intra-procedural techniques to reduce risks have recently been developed (such as cerebrospinal fluid drain), it’s about time we reassess the risk this complication poses to our patients.

Also read: “Successful CTO reduces local and remote residual ischemia”.

The study used data from a number of centers, of patients undergoing surgical or endovascular repair of aortic aneurysm or dissection between 2005 and 2013. Primary end point was SCI during index hospitalization for aortic repair. Analyses were stratified by whether the aneurysm or dissection had ruptured and by type of repair. 

91,212 patients who had had an aortic aneurysm or dissection repaired were identified. SCI occurred in 235 cases (0.26%). In patients with ruptured aneurysm or dissection, the risk was almost three times higher than the general population’s (0.74%) and far higher than the 0.16% of patients with unruptured aneurysm.

This serious complication was similar when comparing endovascular repair (0.91%) vs. surgical repair (0.68%; p=0.147) in the context of complicated aneurysms and dissection. However, when the problem to be solved was an unruptured aneurysm, the risk of spinal cord ischemia was higher with surgery (0.20% vs 0.11%; p<0.01).

Conclusion

1 every 130 patients undergoing aortic repair of aortic dissection of ruptured aneurysm present spinal cord ischemia and 1 every 600 patients undergoing aortic repair of unruptured aneurysms.

Editorial Comment

In this large, heterogeneous population of patients undergoing endovascular or surgical aortic repair to treat an aortic dissection or aneurysm, spinal cord ischemia was relatively low (0.26%). This global rate increases significantly when treating patients with ruptured aneurysms or dissections. In these cases, the two strategies (endovascular or surgical) showed similar outcomes. However, in programmed patients with unruptured aneurysms, endovascular repair significantly lowers the risk of SCI. 

Original Title: Rates of Spinal Cord Infarction after Repair of Aortic Aneurysm or Dissection.

Reference: Gino Gialdini et al. Stroke. 2017;48:00-00.

We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.