Experimental near-infrared spectroscopy-guided minimally invasive segmental artery occlusion. (4th February 2021)

• Record Type: Journal Article
• Authors: von Aspern, Konstantin; Haunschild, Josephina; Heier, Marcus; Ossmann, Susann; Mohr, Friedrich W; Borger, Michael A; Etz, Christian D
• Is Part Of: European journal of cardio-thoracic surgery. Volume 60:Number 1(2021)
• Page Start: 48
• Page End: 55
• Publication Date: 2021-02-04
• Subjects: Collateral network near-infrared spectroscopy -- Minimally invasive segmental artery coil- and plug embolization -- Non-invasive spinal cord monitoring; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Periodicals; 617.54
• DOI: 10.1093/ejcts/ezab005
• Languages: English
• ISSNs: 1010-7940

Abstract

Abstract: OBJECTIVES: Minimally invasive staged segmental artery (SA) coil- and plug embolization is a new method for paraplegia prevention associated with extensive aortic procedures. Near-infrared spectroscopy of the paraspinal collateral network (cnNIRS) has emerged as a non-invasive method for spinal cord monitoring. The aim of this study was to evaluate cnNIRS to guide minimally invasive SA occlusion. METHODS: In a chronic large animal experiment, 18 juvenile pigs underwent two-stage minimally invasive staged SA coil- and plug embolization for complete SA occlusion. Coil-embolization was performed either by SA main stem occlusion (characteristic of pig anatomy) or separately for the left- and right SA. Lumbar cnNIRS was recorded during and after the procedure. Neurological status was assessed up to 3 days after complete SA occlusion. RESULTS: Mean time from SA coil embolization to minimum cnNIRS values was 11 ± 5 min with an average decrease from 101 ± 2% to 78 ± 8% of baseline (difference: −23 ± 9, P < 0.001). Lumbar cnNIRS demonstrated significant differences between left and right when SAs were occluded separately in all cases (−7 ± 4%, 1 min after first SA occlusion; P = 0.001). Permanent paraplegia occurred in 2 (11%) and any kind of neurological deficit—temporary or permanent—in 7 animals (39%). Association between lumbar cnNIRS and neurological outcome after minimally invasive staged SA coil- and plug embolization suggests positive correlation ( R = 0.5, P = 0.052). CONCLUSIONS: Lumbar cnNIRS independently reacts to unilateral SA occlusion. cnNIRS-guided SA occlusion is feasible and may become a useful adjunct facilitating adequate and complete vessel occlusion.