Strategies to Manage Paraplegia Risk After Endovascular Stent Repair of Descending Thoracic Aortic Aneurysms Albert T. Cheung, MD, Alberto Pochettino,

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Strategies to Manage Paraplegia Risk After Endovascular Stent Repair of Descending Thoracic Aortic Aneurysms Albert T. Cheung, MD, Alberto Pochettino, MD, Michael L. McGarvey, MD, Jehangir J. Appoo, MD, Ronald M. Fairman, MD, Jeffrey P. Carpenter, MD, William G. Moser, RN, Edward Y. Woo, MD, Joseph E. Bavaria, MD The Annals of Thoracic Surgery Volume 80, Issue 4, Pages 1280-1289 (October 2005) DOI: 10.1016/j.athoracsur.2005.04.027 Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Decreased amplitude of lower extremity SEPs consistent with spinal cord ischemia after deployment of the endovascular stent graft (black) superimposed on the baseline potentials (grey). Upper extremity SEPs were not different from baseline during the event (not shown). (SEP = somatosensory evoked potential.) The Annals of Thoracic Surgery 2005 80, 1280-1289DOI: (10.1016/j.athoracsur.2005.04.027) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Relation between arterial pressure and two separate episodes of delayed-onset paraparesis after endovascular stent repair. A decrease in blood pressure preceded the onset of paraparesis at 9 hours (event A) and 39 hours after operation (event B). Full recovery of neurologic function coincided with increased arterial pressure. (iv = intravenous.) The Annals of Thoracic Surgery 2005 80, 1280-1289DOI: (10.1016/j.athoracsur.2005.04.027) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Proposed algorithm to manage the risk of spinal cord ischemia in patients undergoing endovascular stent repair of descending thoracic aortic aneurysms. (AAA = abdominal aortic aneurysm; CSF = cerebrospinal fluid; hr = hours; LE = lower extremity; MAP = mean arterial pressure; Rx = drug therapy; SEP = somatosensory evoked potential.) The Annals of Thoracic Surgery 2005 80, 1280-1289DOI: (10.1016/j.athoracsur.2005.04.027) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions