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The Risk of Spinal Cord Ischemia during Thoracic Aorta Endografting

Spinal cord ischemia (SCI) is a devastating complication of thoracic aortic surgery and its physiopathology is still poorly understood. Endovascular treatment with stentgrafts for the thoracic aorta (TEVAR) has significantly reduced the morbidity associated to thoracotomy and aortic cross clamping, but the incidence of SCI is still not negligible. We believe that TEVAR provides an opportunity to improve the knowledge of this devastating complication, since it removes the background noise of aortic cross-clamping and intercostal artery reimplantation. Management of thoracic aorta pathology with endovascular aortic repair had reduced in-hospital mortality, post-operative morbidity and recent series have reported encouraging midterm results. However the incidence of immediate and delayed SCI ranges from 0% and 12% (Table I). The results of three multicenter investigational trials for FDA approval of different thoracic endografts have been recently published with rates of SCI ranging from 2.8% to 8.7% (1-3) (Table II). Moreover these trials fail to demonstrate any statistically significant difference in the incidence of SCI between TEVAR and open repair.