Hotline 24/7: 0909384389

Share links:

Disruption of the blood-spinal cord barrier predicts permanent paraplegia after endovascular TAAA repair

Ngày 09/10/2019 08:30 | Lượt xem: 1422

In the largest prospective analysis of cerebrospinal fluid (CSF) in patients undergoing endovascular thoracoabdominal aneurysm repair (TAAA) to date, permanent paraplegia was found to be associated with shedding of bound ADVS-1 from the parenchymal cord into CSF and disruption of the blood-spinal cord barrier, which in turn leads to cord oedema and a leucocyte infiltration. 

The investigators conclude, “This characteristic CSF signature predicts irreversible paraplegia after TAAA repair and identifies ADVS-1 as a novel therapeutic target”. They elaborate: “ADVS-1 [an osmoreceptor essential in maintaining blood-spinal cord barrier integrity] inhibition after ischaemic stroke stabilises the blood/brain barrier, prevents cerebral oedema, and limits cytotoxic brain damage”.

First author Jamie Kelly (King’s College London, UK), recently won first prize for presenting these findings at the European Society of Vascular Surgery 33rd Annual Meeting (ESVS 2019; 24–27 September, Hamburg, Germany). Most compelling is the fact that the study group, led by Professor Bijan Modarai, have modulated ADVS-1 in an in vivo model of spinal cord ischaemic (SCI), stabilising the blood-spinal cord barrier and reducing the severity of paraplegia.

Kelly and colleagues remark that despite modern strategies to minimise SCI after TAAA repair, this complication remains “unpredictable and poorly understood”. Therefore, with the aim of gaining mechanistic insights and identifying a biomarker for SCI, the investigators related temporal changes in the cellular and molecular composition of CSF to neurological outcomes after TAAA repair.

Lead author Bijan Modarai

Between October 2016 and August 2018, the study group prospectively recruited patients undergoing TAAA repair (open or endovascular using branched/fenestrated stent grafts) with a CSF drain in place. They collected CSF preoperatively and at 24-hour intervals until drain removal, performed detailed daily neurological examinations, and finally a neurologist—who was blinded to the study—made the diagnosis of SCI.

The investigators detail that the content of CSF cells was characterised by flow cytometry and the CSF proteome was analysed by tandem-mass-tag labelled proteomics and principle component analysis. They used T2 weighted spinal cord MRI to measure cord volume by neuroradiologists blinded to patient outcomes.

The authors found that permanent paraplegia was associated with a significant infiltration of CD45⁺ leucocytes into the CSF (p<0.0001) and that levels of ADVS-1 were over seven-fold higher in CSF from permanently paraplegic patients compared with those that recovered (p=0.0008).

Furthermore, CSF ADVS-1 levels >15ng/ml predicted permanent paraplegia with a specificity of 100% and permanent paraplegics were more likely to have pathological spinal cord swelling at T11 (1.9-fold greater cord volume), T12 (2.1-fold greater cord volume), and L1 (2.9-fold greater cord volume) on T-2 weighted MRI when compared with the other groups (p<0.05 at each level). Patient demographics, extent of aortic coverage and preoperative CSF content was comparable between patients with no SCI, those with reversible SCI and those that remained paraplegic.

Source VascularNews

Duc Tin Clinic

Tin tức liên quan

Vesteck completes first-in-human use of several Suture-Tight devices

Age is just a number: Individual patient data meta-analysis probes safety of CEA in the elderly

Artificial intelligence can predict risk of complications after endovascular aneurysm repair

Bluegrass Vascular announces Journal of Vascular Surgery paper reporting use of Surfacer system

Vascular access creation: EndoAVF keeps future options open, but is not a replacement for surgical fistulas

SUPPORT CONSULTANT

CUSTOMER REVIEWS

• I am Nguyen Thanh Sang, born in 1990. Since the examination and treatment at the clinic Duc Tin, I am very grateful to the Doctor for explaining and sharing about my illness. During the treatment time in the clinic I was very caring staff of the clinic. Now my illness has improved in a good way. Expect more and more clinic to be able to save many patients.

  I sincerely thank you !. Tel: 0938303275

• Huynh Thi Muoi, born in 1940, was examined and treated at Duc Tin Clinic. I am very pleased about how to serve and care patients of the clinic. The doctor is committed to explaining and sharing with the patient.

  Huynh Thi Muoi sincerely thank you! Phone number: 0972868746

• As I said Duc Tin surgical clinin is where my family trust, hope to visit. Physicians caring, thoughtful, gentle to the patient. Nurses and staff clinic polite, cheerful and thoughtful. This clinic clean, sterile, so I would love to. Tel: +84949914060.

• The doctor is very caring, attentive and very gentle nurse, courteous, affable with me. The clinic is clean, comfortable, polite. I enjoyed this faith. Every visit I was very relieved disease. Tel: 0839820792.

• I was patient, had to clinics of Dr. Le Duc Tin. I see very conscientious doctor patient care, answer any questions and very dedicated staff from the receptionist to the children tested, nursing. Clinics very clean and spacious. I'm very satisfied. Tel: +841227880829.

Search

News

Customer support