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Albert T. Cheung - One of the best experts on this subject based on the ideXlab platform.

  • Spinal Cord Ischemia Monitoring and Protection
    Evidence-Based Practice in Perioperative Cardiac Anesthesia and Surgery, 2020
    Co-Authors: Albert T. Cheung, Jaime R. Lopez
    Abstract:

    Spinal Cord Ischemia, Spinal Cord infarction, and paraplegia remain an important complication of patients undergoing open surgical or endovascular repair of the thoracic and thoracoabdominal aorta. Improvements in surgical techniques such as endovascular repair, partial left heart bypass, reimplantation of segmental arteries, and staged repairs combined with anesthetic techniques that include arterial pressure augmentation, deliberate hypothermia, lumbar cerebroSpinal fluid drainage, and intraoperative neurophysiologic monitoring has decreased the risk of intraoperative Spinal Cord Ischemia. Despite improvements, patients remain at risk for delayed onset Spinal Cord Ischemia. Serial neurologic assessment and precise circulatory management are necessary to prevent and detect delayed onset Spinal Cord Ischemia. Immediate treatment of delayed onset Spinal Cord Ischemia with arterial pressure augmentation and lumbar cerebroSpinal fluid drainage is often effective for preventing paraplegia or decreasing the severity of the permanent neurologic injury in patients with reversible ischemic Spinal Cord syndrome.

  • reversible Spinal Cord Ischemia as a complication of acute aortic intramural hematoma
    Vascular, 2015
    Co-Authors: Brant W. Ullery, Reilly D. Hobbs, Albert T. Cheung
    Abstract:

    Aortic intramural hematoma is a variant of acute aortic dissection characterized by localized hemorrhage into the aortic media causing a separation of the intimal and adventitial layers of the aorta. Malperfusion represents an unusual presenting sign of acute intramural hematoma. Herein, we describe the case of a patient with an acute Type A IMH who developed reversible ischemic Spinal Cord syndrome after presenting with paraplegia as a consequence of malperfusion. A decision was made to delay operative repair and, instead, emergently apply medical interventions to increase Spinal Cord perfusion pressure. Medical treatment was effective for the treatment of Spinal Cord Ischemia and operative repair of the intramural hematoma was accomplished after complete recovery of neurologic function. This is the third case ever reported of an intramural hematoma presenting in the form of Spinal Cord Ischemia.

  • Protocol for prevention of Spinal Cord Ischemia after thoracoabdominal aortic surgery.
    Vascular, 2015
    Co-Authors: Reilly D. Hobbs, Brant W. Ullery, Allison R Mentzer, Albert T. Cheung
    Abstract:

    ObjectiveThis manuscript was written to present a systemic protocol for the prevention, early detection, and treatment of Spinal Cord Ischemia following open and endovascular thoracoabdominal aorti...

  • The treatment of Spinal Cord Ischemia following thoracic endovascular aortic repair.
    Neurocritical care, 2007
    Co-Authors: Michael L. Mcgarvey, Joseph E. Bavaria, Steven R. Messé, Michael T. Mullen, Edward Y. Woo, Yanni G. Augoustides, Albert T. Cheung
    Abstract:

    Introduction Thoracic endovascular aortic repair (TEVAR) is a promising alternative to the traditional open surgical approach, though Spinal Cord Ischemia remains a challenging complication. Spinal Cord Ischemia has been treated using lumbar cerebral Spinal fluid (CSF) drainage.

Michael L. Mcgarvey - One of the best experts on this subject based on the ideXlab platform.

  • Predictors of Outcome in Patients with Spinal Cord Ischemia after Open Aortic Repair
    Neurocritical Care, 2013
    Co-Authors: Danielle A. Becker, Michael L. Mcgarvey, Catherine Rojvirat, Joseph E. Bavaria, Steven R. Messé
    Abstract:

    Introduction Spinal Cord Ischemia is a potentially devastating complication of thoracic aortic surgery. However, predictors of outcome have not been well characterized. The study objective was to generate a prognostic score that accurately stratifies patient outcomes, aiding in future management and planning. Methods A retrospective review of 224 consecutive open thoracic aortic surgeries identified patients with Spinal Cord Ischemia, defined as changes on intraoperative somatosensory evoked potentials (SSEP) and/or paraparesis/paraplegia postoperatively. The outcome of interest was poor outcome, defined as death or discharge with a lower extremity motor score ≤40, indicating impaired ambulation. Demographic and clinical characteristics were tested in univariate analyses and significant factors were incorporated in multivariate modeling to determine independent predictors of poor outcome. Results Seventy-five patients were identified with Spinal Cord Ischemia, of which 43(57 %) had poor outcomes including 28(37 %) that died prior to discharge. Factors associated with poor outcome in univariate analysis included absent lumbar CSF drain ( p  = 0.03), surgical repair that crossed the diaphragm ( p  = 0.002), permanent intraoperative SSEP change ( p  = 0.02), postoperative renal failure ( p  = 0.004), paraplegia ( p  = 0.001), and concomitant stroke ( p  = 0.04). In multivariable analysis, surgical repair crossing the diaphragm (OR 4.8, CI 1.4–16.7, p  = 0.02), paraplegia (OR 4.5, CI 1.4–14.0, p  = 0.01), and renal failure (OR 6.1, CI 1.7–21.2, p  = 0.005) were independently associated with poor outcome. Patients with transient intraoperative neurophysiologic changes were least likely to have poor outcome when compared to patients with no or permanent SSEP changes, and those not monitored ( p  = 0.03). Conclusion Development of Spinal Cord Ischemia with thoracic aortic repair often leads to death or disability. Characteristics known at the time of event can accurately predict the likelihood of poor outcome.

  • The treatment of Spinal Cord Ischemia following thoracic endovascular aortic repair.
    Neurocritical care, 2007
    Co-Authors: Michael L. Mcgarvey, Joseph E. Bavaria, Steven R. Messé, Michael T. Mullen, Edward Y. Woo, Yanni G. Augoustides, Albert T. Cheung
    Abstract:

    Introduction Thoracic endovascular aortic repair (TEVAR) is a promising alternative to the traditional open surgical approach, though Spinal Cord Ischemia remains a challenging complication. Spinal Cord Ischemia has been treated using lumbar cerebral Spinal fluid (CSF) drainage.

Sung Hee Han - One of the best experts on this subject based on the ideXlab platform.

  • Reproducible Motor Deficit Following Aortic Occlusion in a Rat Model Of Spinal Cord Ischemia.
    Journal of visualized experiments : JoVE, 2017
    Co-Authors: Jin Young Hwang, Hye Min Sohn, Jin Hee Kim, Seong Joo Park, Jin-woo Park, Mi Sun Lim, Sung Hee Han
    Abstract:

    Spinal Cord Ischemia is a fatal complication following thoracoabdominal aortic aneurysm surgery. Researchers can investigate the strategies for preventing and treating this complication using experimental models of Spinal Cord Ischemia. The model described here demonstrates varying degrees of paraplegia that relate to the length of occlusion following thoracic aortic occlusion in a rat Spinal Cord Ischemia model. A 2-Fr. balloon-tipped catheter was advanced through the femoral artery into the descending thoracic aorta until the catheter tip was placed at the left subclavian artery in anesthetized male Sprague-Dawley rats. Spinal Cord Ischemia was induced by inflating the catheter balloon. After a set period of occlusion (9, 10, or 11 min), the balloon was deflated. Neurologic assessment was performed using the motor deficit index at 24 h after surgery, and the Spinal Cord was harvested for histopathological examination. Rats that underwent 9 min of aortic occlusion showed mild and reversible motor impairment in the hind limb. Rats subjected to 10 min of aortic occlusion presented with moderate but reversible motor impairment. Rats subjected to 11 min of aortic occlusion displayed complete and persistent paralysis. The motor neurons in the Spinal Cord sections were more preserved in rats subjected to shorter duration of aortic occlusion. Researchers can achieve a reproducible hind limb motor deficit following thoracic aortic occlusion using this Spinal Cord Ischemia model.

  • Effect of coenzyme Q10 on Spinal Cord Ischemia-reperfusion injury
    Journal of neurosurgery. Spine, 2015
    Co-Authors: Jin Young Hwang, Jin Hee Kim, Seong Won Min, Young Tae Jeon, Jung-won Hwang, Sang Hyun Park, Sung Hee Han
    Abstract:

    OBJECT Spinal Cord Ischemia remains a serious complication of thoracoabdominal aortic aneurysm surgery. Coenzyme Q10, a potent antioxidant, has been reported to exert a neuroprotective effect. In the present study, we evaluated the effect of coenzyme Q10 pretreatment on Spinal Cord Ischemia-reperfusion injury. METHODS Male Sprague-Dawley rats were treated with either 300 mg/kg coenzyme Q10 (CoQ10 group, n = 12) or saline (control and sham groups, n = 12 for each group) for 5 days before Ischemia. Spinal Cord Ischemia was induced in the control and CoQ10 groups. Neurological function was assessed using the Basso-Beattie-Bresnahan (BBB) motor rating scale until 7 days after reperfusion, and then the Spinal Cord was harvested for histopathological examinations and an evaluation of malondialdehyde level. RESULTS On post-reperfusion Day 1, the CoQ10 group showed higher BBB scores compared with those in the control group, although the difference was not significant. However, on Day 2, the CoQ10 group showed a s...

  • Effect of pretreatment with simvastatin on Spinal Cord Ischemia-reperfusion injury in rats.
    Journal of cardiothoracic and vascular anesthesia, 2012
    Co-Authors: Jin Young Hwang, Jong In Han, Sung Hee Han
    Abstract:

    Objective The aim of this study was to evaluate the pretreatment effect of simvastatin on Spinal Cord Ischemia-reperfusion injury. Design Prospective, interventional study. Setting University research laboratory. Participants Forty-five male Sprague-Dawley rats. Interventions Rats were treated with oral simvastatin, 10 mg/kg (simvastatin group; n = 15) or saline (control group; n = 15) for 5 days before Ischemia. Spinal Cord Ischemia was induced using a balloon-tipped catheter placed in the proximal descending aorta in the control and simvastatin groups, but not in the sham group (n = 15). Measurements and Main Results Neurologic function was assessed daily using the motor deficit index until 7 days after reperfusion. After the last neurologic evaluation, a histologic examination of the Spinal Cord was performed. At day 1 after reperfusion, the simvastatin group showed a significantly lower motor deficit index compared with the control group (2.0, 2.0-2.0, v 4.0, 3.5-5.0; p v 4.0, 3.0-4.0; p v 20.4 ± 4.4; p p = 0.005). Conclusions Pretreatment with simvastatin, 10 mg/kg, given orally for 5 days before the Ischemia-reperfusion insult, improved the neurologic outcome and preserved more normal motor neurons compared with the control group in a rat model of Spinal Cord Ischemia-reperfusion.

  • Pretreatment with erythropoietin attenuates the neurological injury after Spinal Cord Ischemia.
    Spinal cord, 2011
    Co-Authors: Jin Young Hwang, Jin Hee Kim, Young Tae Jeon, Jin Huh, Sang-il Cho, Sung Hee Han
    Abstract:

    Pretreatment with erythropoietin attenuates the neurological injury after Spinal Cord Ischemia

Steven R. Messé - One of the best experts on this subject based on the ideXlab platform.

  • Predictors of Outcome in Patients with Spinal Cord Ischemia after Open Aortic Repair
    Neurocritical Care, 2013
    Co-Authors: Danielle A. Becker, Michael L. Mcgarvey, Catherine Rojvirat, Joseph E. Bavaria, Steven R. Messé
    Abstract:

    Introduction Spinal Cord Ischemia is a potentially devastating complication of thoracic aortic surgery. However, predictors of outcome have not been well characterized. The study objective was to generate a prognostic score that accurately stratifies patient outcomes, aiding in future management and planning. Methods A retrospective review of 224 consecutive open thoracic aortic surgeries identified patients with Spinal Cord Ischemia, defined as changes on intraoperative somatosensory evoked potentials (SSEP) and/or paraparesis/paraplegia postoperatively. The outcome of interest was poor outcome, defined as death or discharge with a lower extremity motor score ≤40, indicating impaired ambulation. Demographic and clinical characteristics were tested in univariate analyses and significant factors were incorporated in multivariate modeling to determine independent predictors of poor outcome. Results Seventy-five patients were identified with Spinal Cord Ischemia, of which 43(57 %) had poor outcomes including 28(37 %) that died prior to discharge. Factors associated with poor outcome in univariate analysis included absent lumbar CSF drain ( p  = 0.03), surgical repair that crossed the diaphragm ( p  = 0.002), permanent intraoperative SSEP change ( p  = 0.02), postoperative renal failure ( p  = 0.004), paraplegia ( p  = 0.001), and concomitant stroke ( p  = 0.04). In multivariable analysis, surgical repair crossing the diaphragm (OR 4.8, CI 1.4–16.7, p  = 0.02), paraplegia (OR 4.5, CI 1.4–14.0, p  = 0.01), and renal failure (OR 6.1, CI 1.7–21.2, p  = 0.005) were independently associated with poor outcome. Patients with transient intraoperative neurophysiologic changes were least likely to have poor outcome when compared to patients with no or permanent SSEP changes, and those not monitored ( p  = 0.03). Conclusion Development of Spinal Cord Ischemia with thoracic aortic repair often leads to death or disability. Characteristics known at the time of event can accurately predict the likelihood of poor outcome.

  • The treatment of Spinal Cord Ischemia following thoracic endovascular aortic repair.
    Neurocritical care, 2007
    Co-Authors: Michael L. Mcgarvey, Joseph E. Bavaria, Steven R. Messé, Michael T. Mullen, Edward Y. Woo, Yanni G. Augoustides, Albert T. Cheung
    Abstract:

    Introduction Thoracic endovascular aortic repair (TEVAR) is a promising alternative to the traditional open surgical approach, though Spinal Cord Ischemia remains a challenging complication. Spinal Cord Ischemia has been treated using lumbar cerebral Spinal fluid (CSF) drainage.

Joachim Berkefeld - One of the best experts on this subject based on the ideXlab platform.

  • Spinal Cord Ischemia: aetiology, clinical syndromes and imaging features
    Neuroradiology, 2015
    Co-Authors: Stefan Weidauer, Michael Nichtweiß, Elke Hattingen, Joachim Berkefeld
    Abstract:

    Introduction The purpose of this study was to analyse MR imaging features and lesion patterns as defined by compromised vascular territories, correlating them to different clinical syndromes and aetiological aspects. Methods In a 19.8-year period, clinical reCords and magnetic resonance imaging (MRI) features of 55 consecutive patients suffering from Spinal Cord Ischemia were evaluated. Results Aetiologies of infarcts were arteriosclerosis of the aorta and vertebral arteries (23.6 %), aortic surgery or interventional aneurysm repair (11 %) and aortic and vertebral artery dissection (11 %), and in 23.6 %, aetiology remained unclear. Infarcts occurred in 38.2 % at the cervical and thoracic level, respectively, and 49 % of patients suffered from centromedullar syndrome caused by anterior Spinal artery Ischemia. MRI disclosed hyperintense pencil-like lesion pattern on T2WI in 98.2 %, Cord swelling in 40 %, enhancement on post-contrast T1WI in 42.9 % and always hyperintense signal on diffusion-weighted imaging (DWI) when acquired. Conclusion The most common clinical feature in Spinal Cord Ischemia is a centromedullar syndrome, and in contrast to anterior Spinal artery Ischemia, infarcts in the posterior Spinal artery territory are rare. The exclusively cervical location of the Spinal sulcal artery syndrome seems to be a likely consequence of anterior Spinal artery duplication which is observed preferentially here.

  • Spinal Cord Ischemia aetiology clinical syndromes and imaging features
    Neuroradiology, 2015
    Co-Authors: Stefan Weidauer, Elke Hattingen, Michael Nichtweis, Joachim Berkefeld
    Abstract:

    The purpose of this study was to analyse MR imaging features and lesion patterns as defined by compromised vascular territories, correlating them to different clinical syndromes and aetiological aspects. In a 19.8-year period, clinical reCords and magnetic resonance imaging (MRI) features of 55 consecutive patients suffering from Spinal Cord Ischemia were evaluated. Aetiologies of infarcts were arteriosclerosis of the aorta and vertebral arteries (23.6 %), aortic surgery or interventional aneurysm repair (11 %) and aortic and vertebral artery dissection (11 %), and in 23.6 %, aetiology remained unclear. Infarcts occurred in 38.2 % at the cervical and thoracic level, respectively, and 49 % of patients suffered from centromedullar syndrome caused by anterior Spinal artery Ischemia. MRI disclosed hyperintense pencil-like lesion pattern on T2WI in 98.2 %, Cord swelling in 40 %, enhancement on post-contrast T1WI in 42.9 % and always hyperintense signal on diffusion-weighted imaging (DWI) when acquired. The most common clinical feature in Spinal Cord Ischemia is a centromedullar syndrome, and in contrast to anterior Spinal artery Ischemia, infarcts in the posterior Spinal artery territory are rare. The exclusively cervical location of the Spinal sulcal artery syndrome seems to be a likely consequence of anterior Spinal artery duplication which is observed preferentially here.