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Endovascular repair and open repair surgery of thoraco-abdominal aortic aneurysms cause drastically different types of spinal cord injury

Authors :
Hamdy Awad
Esmerina Tili
Gerard Nuovo
Hesham Kelani
Mohamed Ehab Ramadan
Jim Williams
Katherine Binzel
Jayanth Rajan
David Mast
Alexander A. Efanov
Kareem B. Rasul
Sarah Moore
Michele Basso
Adel Mikhail
Mostafa Eltobgy
Raphael A. Malbrue
Eric Bourekas
Michael Oglesbee
Valerie Bergdall
Michael Knopp
Jean-Jacques Michaille
Hosam El-Sayed
Source :
Scientific Reports, Vol 11, Iss 1, Pp 1-13 (2021)
Publication Year :
2021
Publisher :
Nature Portfolio, 2021.

Abstract

Abstract Both endovascular repair (EVR) and open repair (OR) surgery of thoraco-abdominal aortic aneurysms cause spinal cord (SC) injury that can lead to paraparesis or paraplegia. It has been assumed that mechanisms responsible for SC damage after EVR are similar to those after OR. This pilot study compared the pathophysiology of SC injury after EVR versus OR using a newly developed EVR dog model. An increasing number of stents similar to those used in patients were inserted in the aorta of three dogs to ensure thoracic or thoracic plus lumbar coverage. The aorta of OR dogs was cross-clamped for 45 min. Behavior assessment demonstrated unique patterns of proprioceptive ataxia and evolving paraparesis in EVR versus irreversible paraplegia in OR. MRI showed posterior signal in lumbar SC after EVR versus central cord edema after OR. Histopathology showed white matter edema in L3–L5 localized to the dorsal column medial lemniscus area associated with loss of myelin basic protein but not neurons after EVR, versus massive neuronal loss in the gray matter in L3–L5 after OR. Metabolome analysis demonstrates a distinctive chemical fingerprint of cellular processes in both interventions. Our results call for the development of new therapeutics tailored to these distinct pathophysiologic findings.

Subjects

Subjects :
Medicine
Science

Details

Language :
English
ISSN :
20452322
Volume :
11
Issue :
1
Database :
Directory of Open Access Journals
Journal :
Scientific Reports
Publication Type :
Academic Journal
Accession number :
edsdoj.6193119cbed04fe0af4761d2f0c2327a
Document Type :
article
Full Text :
https://doi.org/10.1038/s41598-021-87324-6