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

CardioVascular and Interventional Radiology volume 45, pages 1462–1469 (2022)Cite this article

Abstract

Purpose

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.

Results

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.

Conclusions

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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Abbreviations

MISACE:

Minimally invasive segmental artery coil embolization

TAAA:

Thoracoabdominal aortic aneurysm

EVAR:

Endovascular aortic repair

BEVAR:

Branched EVAR

FEVAR:

Fenestrated EVAR

TEVAR:

Thoracic EVAR

SCI:

Spinal cord ischemia

SA:

Segmental artery

T:

Thoracic vertebral level

L:

Lumbar Vertebral level

CFA:

Common femoral artery

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Authors and Affiliations

  1. Department of Vascular and Interventional Radiology, University Health Network, Toronto, Canada

    Jamil A. K. Addas, Sebastian Mafeld, Arshdeep Sidhu & Kong Teng Tan

  2. Division of Vascular Surgery, University Health Network, Toronto, Canada

    Daniyal N. Mahmood & Thomas F. Lindsay

  3. Division of Cardiovascular Surgery, University Health Network, Toronto, Canada

    Maral Ouzounian

Authors
  1. Jamil A. K. Addas
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  2. Sebastian Mafeld
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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). https://doi.org/10.1007/s00270-022-03230-y

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Keywords

  • MISACE
  • TAAA
  • Spinal cord ischemia
  • Segmental arteries