Usefulness of Motor Evoked Potential Measurement and Analysis of Risk Factors for Spinal Cord Ischaemia from 300 Cases of Thoracic Endovascular Aortic Repair

This study investigated the usefulness of motor evoked potentials (MEPs) for intra-operative monitoring to detect the risk of spinal cord ischaemia (SCI) during thoracic endovascular aortic repair (TEVAR). Risk factors for SCI in TEVAR were also analysed. Among 330 TEVARs performed from February 200...

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Veröffentlicht in:European journal of vascular and endovascular surgery 2024-08, Vol.68 (2), p.171-179
Hauptverfasser: Ando, Mizuki, Kise, Yuya, Kuniyoshi, Yukio, Higa, Shotaro, Nagano, Takaaki, Furukawa, Kojiro
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container_end_page 179
container_issue 2
container_start_page 171
container_title European journal of vascular and endovascular surgery
container_volume 68
creator Ando, Mizuki
Kise, Yuya
Kuniyoshi, Yukio
Higa, Shotaro
Nagano, Takaaki
Furukawa, Kojiro
description This study investigated the usefulness of motor evoked potentials (MEPs) for intra-operative monitoring to detect the risk of spinal cord ischaemia (SCI) during thoracic endovascular aortic repair (TEVAR). Risk factors for SCI in TEVAR were also analysed. Among 330 TEVARs performed from February 2009 to October 2018, 300 patients underwent intra-operative MEP monitoring. SCI risk groups were extracted based on MEP amplitude changes using a cutoff value of 50%. When the amplitude decreased to < 50% of the pre-operative value, intra-operative mean arterial pressure (MAP) was increased by about 20 mmHg using noradrenaline, whereas MAP was usually controlled to about 80 mmHg during surgery. Other efforts were also made to increase MEP amplitude by increasing cardiac output, correcting anaemia, and finishing the surgery promptly. Based on MEP amplitude data, SCI risk groups were extracted and risk factors for SCI in TEVAR were analysed. A total of 283 non-SCI risk patients and 17 SCI risk patients by MEP monitoring were extracted; only 1.0% developed immediate paraplegia and none developed delayed paraplegia. Bivariable analysis showed significant differences in chronic kidney disease, haemodialysis, artery of Adamkiewicz closure, and stent graft (SG) covered length ≥ 8 vertebral bodies. Logistic regression analysis showed hyperlipidaemia (odds ratio [OR] 3.55, 95% confidence interval [CI] 1.08 – 11.67; p = .037), SG covered length ≥ 8 vertebral bodies (OR 1.35, 95% CI 1.02 – 1.78; p = .034), and haemodialysis (OR 27.78, 95% CI 6.02 – 128.22; p < .001) were the most influential risk factors for SCI in TEVAR. MEPs might be a useful monitoring tool to predict SCI in TEVAR. In addition, hyperlipidaemia, SG covered length ≥ 8 vertebral bodies, and haemodialysis represent key risk factors for SCI during TEVAR.
doi_str_mv 10.1016/j.ejvs.2024.03.014
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Risk factors for SCI in TEVAR were also analysed. Among 330 TEVARs performed from February 2009 to October 2018, 300 patients underwent intra-operative MEP monitoring. SCI risk groups were extracted based on MEP amplitude changes using a cutoff value of 50%. When the amplitude decreased to &lt; 50% of the pre-operative value, intra-operative mean arterial pressure (MAP) was increased by about 20 mmHg using noradrenaline, whereas MAP was usually controlled to about 80 mmHg during surgery. Other efforts were also made to increase MEP amplitude by increasing cardiac output, correcting anaemia, and finishing the surgery promptly. Based on MEP amplitude data, SCI risk groups were extracted and risk factors for SCI in TEVAR were analysed. A total of 283 non-SCI risk patients and 17 SCI risk patients by MEP monitoring were extracted; only 1.0% developed immediate paraplegia and none developed delayed paraplegia. Bivariable analysis showed significant differences in chronic kidney disease, haemodialysis, artery of Adamkiewicz closure, and stent graft (SG) covered length ≥ 8 vertebral bodies. Logistic regression analysis showed hyperlipidaemia (odds ratio [OR] 3.55, 95% confidence interval [CI] 1.08 – 11.67; p = .037), SG covered length ≥ 8 vertebral bodies (OR 1.35, 95% CI 1.02 – 1.78; p = .034), and haemodialysis (OR 27.78, 95% CI 6.02 – 128.22; p &lt; .001) were the most influential risk factors for SCI in TEVAR. MEPs might be a useful monitoring tool to predict SCI in TEVAR. 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Bivariable analysis showed significant differences in chronic kidney disease, haemodialysis, artery of Adamkiewicz closure, and stent graft (SG) covered length ≥ 8 vertebral bodies. Logistic regression analysis showed hyperlipidaemia (odds ratio [OR] 3.55, 95% confidence interval [CI] 1.08 – 11.67; p = .037), SG covered length ≥ 8 vertebral bodies (OR 1.35, 95% CI 1.02 – 1.78; p = .034), and haemodialysis (OR 27.78, 95% CI 6.02 – 128.22; p &lt; .001) were the most influential risk factors for SCI in TEVAR. MEPs might be a useful monitoring tool to predict SCI in TEVAR. 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control</topic><topic>Thoracic endovascular aortic repair</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ando, Mizuki</creatorcontrib><creatorcontrib>Kise, Yuya</creatorcontrib><creatorcontrib>Kuniyoshi, Yukio</creatorcontrib><creatorcontrib>Higa, Shotaro</creatorcontrib><creatorcontrib>Nagano, Takaaki</creatorcontrib><creatorcontrib>Furukawa, Kojiro</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of vascular and endovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ando, Mizuki</au><au>Kise, Yuya</au><au>Kuniyoshi, Yukio</au><au>Higa, Shotaro</au><au>Nagano, Takaaki</au><au>Furukawa, Kojiro</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Usefulness of Motor Evoked Potential Measurement and Analysis of Risk Factors for Spinal Cord Ischaemia from 300 Cases of Thoracic Endovascular Aortic Repair</atitle><jtitle>European journal of vascular and endovascular surgery</jtitle><addtitle>Eur J Vasc Endovasc Surg</addtitle><date>2024-08-01</date><risdate>2024</risdate><volume>68</volume><issue>2</issue><spage>171</spage><epage>179</epage><pages>171-179</pages><issn>1078-5884</issn><issn>1532-2165</issn><eissn>1532-2165</eissn><abstract>This study investigated the usefulness of motor evoked potentials (MEPs) for intra-operative monitoring to detect the risk of spinal cord ischaemia (SCI) during thoracic endovascular aortic repair (TEVAR). Risk factors for SCI in TEVAR were also analysed. Among 330 TEVARs performed from February 2009 to October 2018, 300 patients underwent intra-operative MEP monitoring. SCI risk groups were extracted based on MEP amplitude changes using a cutoff value of 50%. When the amplitude decreased to &lt; 50% of the pre-operative value, intra-operative mean arterial pressure (MAP) was increased by about 20 mmHg using noradrenaline, whereas MAP was usually controlled to about 80 mmHg during surgery. Other efforts were also made to increase MEP amplitude by increasing cardiac output, correcting anaemia, and finishing the surgery promptly. Based on MEP amplitude data, SCI risk groups were extracted and risk factors for SCI in TEVAR were analysed. A total of 283 non-SCI risk patients and 17 SCI risk patients by MEP monitoring were extracted; only 1.0% developed immediate paraplegia and none developed delayed paraplegia. Bivariable analysis showed significant differences in chronic kidney disease, haemodialysis, artery of Adamkiewicz closure, and stent graft (SG) covered length ≥ 8 vertebral bodies. Logistic regression analysis showed hyperlipidaemia (odds ratio [OR] 3.55, 95% confidence interval [CI] 1.08 – 11.67; p = .037), SG covered length ≥ 8 vertebral bodies (OR 1.35, 95% CI 1.02 – 1.78; p = .034), and haemodialysis (OR 27.78, 95% CI 6.02 – 128.22; p &lt; .001) were the most influential risk factors for SCI in TEVAR. MEPs might be a useful monitoring tool to predict SCI in TEVAR. In addition, hyperlipidaemia, SG covered length ≥ 8 vertebral bodies, and haemodialysis represent key risk factors for SCI during TEVAR.</abstract><cop>England</cop><pub>Elsevier B.V</pub><pmid>38499146</pmid><doi>10.1016/j.ejvs.2024.03.014</doi><tpages>9</tpages><orcidid>https://orcid.org/0009-0004-4757-5853</orcidid><orcidid>https://orcid.org/0000-0003-2869-3155</orcidid><oa>free_for_read</oa></addata></record>
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identifier ISSN: 1078-5884
ispartof European journal of vascular and endovascular surgery, 2024-08, Vol.68 (2), p.171-179
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subjects Aged
Aged, 80 and over
Aorta, Thoracic - physiopathology
Aorta, Thoracic - surgery
Aortic Aneurysm, Thoracic - physiopathology
Aortic Aneurysm, Thoracic - surgery
Endovascular Aneurysm Repair - adverse effects
Evoked Potentials, Motor
Female
Humans
Intraoperative Neurophysiological Monitoring - methods
Male
Middle Aged
Motor evoked potential
Predictive Value of Tests
Retrospective Studies
Risk Assessment - methods
Risk Factors
Spinal cord ischaemia
Spinal Cord Ischemia - diagnosis
Spinal Cord Ischemia - etiology
Spinal Cord Ischemia - physiopathology
Spinal Cord Ischemia - prevention & control
Thoracic endovascular aortic repair
Treatment Outcome
title Usefulness of Motor Evoked Potential Measurement and Analysis of Risk Factors for Spinal Cord Ischaemia from 300 Cases of Thoracic Endovascular Aortic Repair
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