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Minimally Invasive Segmental Artery Coil Embolization (MISACE) Prior to Endovascular Thoracoabdominal Aortic Aneurysm Repair



Minimally Invasive Segmental Artery Coil Embolization (MISACE) is a novel approach to reduce paraplegia risk in Thoracoabdominal aortic aneurysm (TAAA) repair with limited data. We report our experience with MISACE as a method of spinal cord pre-conditioning to prevent spinal cord ischemia following endovascular repair of TAAA.

Material and Methods

A retrospective analysis of 17 patients who had an attempted MISACE prior to endovascular TAAA repair with mean follow-up of 350 days (2017–2020). Baseline patient and aneurysm characteristics along with procedural technique and outcomes were analyzed.


Mean age of 69 years and 76.5% were males. TAAA Crawford classification were II, n = 6 (35.3%), III, n = 4 (23.5%) and IV, n = 5 (29.4%). The mean aortic diameter was 70.6 ± 10.9 mm. Staged repair was performed on 9 patients. Technically successful embolization occurred in 14 patients (82.4%) and was unsuccessful in 3 patients. The median number of embolized arteries was 3 and 71% of the target arteries were between T9 and T12. Mean fluoroscopy time was 51.5 ± 22.5 min and mean contrast volume used was 132.8 ± 56.1 mL. Average number of catheters used was 4.6 and 3.5 wires. No complications related to the procedure. Mean interval between embolization to endovascular TAAA repair was 51.2 days (5–110 days). All patients received spinal drainage at the time of repair. Postoperatively, 2/14 of patients developed paraparesis in the MISACE successful group and 1/3 patients developed paraplegia in the unsuccessful group.


MISACE is a promising strategy to prevent SCI. This data demonstrates the technique is feasible and safe but anatomic challenges remain.

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Fig. 1
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Fig. 3



Minimally invasive segmental artery coil embolization


Thoracoabdominal aortic aneurysm


Endovascular aortic repair


Branched EVAR


Fenestrated EVAR


Thoracic EVAR


Spinal cord ischemia


Segmental artery


Thoracic vertebral level


Lumbar Vertebral level


Common femoral artery


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Correspondence to Jamil A. K. Addas.

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Conflict of interests

Thomas F. Lindsay: Cook Canada Proctor and Clinical Trial participation. Maral Ouzounian: Consulting agreements with Terumo, Edwards, Medtronic, and Gore. Abstract presented at International Symposium on Endovascular Therapy (ISET) 2021.

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Addas, J.A.K., Mafeld, S., Mahmood, D.N. et al. Minimally Invasive Segmental Artery Coil Embolization (MISACE) Prior to Endovascular Thoracoabdominal Aortic Aneurysm Repair. Cardiovasc Intervent Radiol 45, 1462–1469 (2022).

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  • TAAA
  • Spinal cord ischemia
  • Segmental arteries