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Abstract：
BACKGROUND: Minimally Invasive Staged Segmental Artery Coil Embolization (MIS2ACE) is a novel technique of spinal cord preconditioning used to reduce the risk of paraplegia in thoracoabdominal aortic aneurysm (TAAA) repair. In this study, we report our experience with MIS2ACE, including both degenerative and post-dissection TAAA, while we attempt to systematically summarize relevant data available in the literature.
METHODS: single-center observational study with systematic review of the literature and meta-analysis.
METHODS: Initial retrospective analysis of 7 patients undergoing MIS2ACE over 12 sessions with a subsequent systematic review of the literature and meta-analysis of the available published data (PROSPERO protocol number: CRD42023477411). Baseline patient and aneurysm characteristics, along with procedural technique and outcomes, were analyzed. One-arm pooling of proportions was used to summarize available published data.
RESULTS: We treated seven patients (5 males, 71%) with a median age of 69 years (IQR 55,69). According to the Crawford classification, five patients (1%) had extent II TAAA, and two (29%) had extent III TAAA. Five patients (71%) had post-dissection -TAAA; four of them were after Stanford type A dissection, and one had a chronic type B dissection. Three patients (43%) had connective tissue disease. Of the seven patients, six (86%) underwent previous aortic surgery, while the median aneurysm diameter was 58 mm (IQR 55,58). MIS2ACE was successful in 11 sessions (92%). The median number of embolized arteries was 4 (IQR 1,4). There were no periprocedural complications in any embolization. The median embolization-operation time interval was 37.0 days (IQR 31,78). Two patients had open and five endovascular treatment. There were no events of spinal cord ischemia either after MIS2ACE or after the aortic repair. Out of the 432 initially retrieved articles, we included two studies in the meta-analysis, including patients with MIS2ACE for spinal cord preconditioning in addition to our cohort. The prevalence of pooled postoperative spinal cord ischemia among MIS2ACE patients is 1.9% (95% CI -0.028 to 0.066, p = 0.279; 3 studies; 81 patients, 127 coiling sessions).
CONCLUSIONS: While the current published data is limited, our study further confirms that MIS2ACE is a technically feasible and safe option for spinal cord preconditioning.
METHODS: single-center observational study with systematic review of the literature and meta-analysis.
METHODS: Initial retrospective analysis of 7 patients undergoing MIS2ACE over 12 sessions with a subsequent systematic review of the literature and meta-analysis of the available published data (PROSPERO protocol number: CRD42023477411). Baseline patient and aneurysm characteristics, along with procedural technique and outcomes, were analyzed. One-arm pooling of proportions was used to summarize available published data.
RESULTS: We treated seven patients (5 males, 71%) with a median age of 69 years (IQR 55,69). According to the Crawford classification, five patients (1%) had extent II TAAA, and two (29%) had extent III TAAA. Five patients (71%) had post-dissection -TAAA; four of them were after Stanford type A dissection, and one had a chronic type B dissection. Three patients (43%) had connective tissue disease. Of the seven patients, six (86%) underwent previous aortic surgery, while the median aneurysm diameter was 58 mm (IQR 55,58). MIS2ACE was successful in 11 sessions (92%). The median number of embolized arteries was 4 (IQR 1,4). There were no periprocedural complications in any embolization. The median embolization-operation time interval was 37.0 days (IQR 31,78). Two patients had open and five endovascular treatment. There were no events of spinal cord ischemia either after MIS2ACE or after the aortic repair. Out of the 432 initially retrieved articles, we included two studies in the meta-analysis, including patients with MIS2ACE for spinal cord preconditioning in addition to our cohort. The prevalence of pooled postoperative spinal cord ischemia among MIS2ACE patients is 1.9% (95% CI -0.028 to 0.066, p = 0.279; 3 studies; 81 patients, 127 coiling sessions).
CONCLUSIONS: While the current published data is limited, our study further confirms that MIS2ACE is a technically feasible and safe option for spinal cord preconditioning.
摘要：
背景：微创分期节段动脉线圈栓塞术（MIS2ACE）是一种新的脊髓预处理技术，用于降低胸腹主动脉瘤（TAAA）修复中截瘫的风险。在这项研究中,我们报告我们的MIS2ACE的经验，包括退行性和解剖后的TAAA，而我们试图系统地总结文献中可用的相关数据。
方法：单中心观察性研究，系统回顾文献和荟萃分析。
方法：对7例接受MIS2ACE治疗12次的患者进行初步回顾性分析，随后对文献进行系统回顾，并对现有发表的数据进行荟萃分析（PROSPERO方案编号：CRD42023477411）。基线患者和动脉瘤特征，以及程序技术和结果，进行了分析。单臂比例汇总用于总结可用的已发表数据。
结果：我们治疗了7名患者（5名男性，71%），中位年龄为69岁（IQR55,69）。根据克劳福德分类，五名患者（1%）患有II级TAAA，和两个（29％）有程度IIITAAA。5例患者（71％）有解剖后-TAAA；其中4例在StanfordA型解剖后，其中一人患有慢性B型夹层。3名患者（43％）患有结缔组织疾病。七个病人中,6人（86%）曾接受过主动脉手术，而动脉瘤的中位直径为58mm（IQR55,58）。MIS2ACE在11次会议中获得了成功（92％）。栓塞动脉的中位数为4（IQR1,4）。任何栓塞都没有围手术期并发症。中位栓塞手术时间间隔为37.0天（IQR31,78）。2例患者进行了开放治疗和5例血管内治疗。MIS2ACE后或主动脉修复后均未发生脊髓缺血事件。在最初检索的432篇文章中，我们在荟萃分析中纳入了两项研究，除我们的队列外，还包括MIS2ACE用于脊髓预处理的患者。MIS2ACE患者合并术后脊髓缺血的患病率为1.9％（95％CI-0.028至0.066，p=0.279；3项研究；81例患者，127卷会议）。
结论：虽然目前公布的数据有限，我们的研究进一步证实MIS2ACE是一种技术上可行且安全的脊髓预处理选择.
方法：单中心观察性研究，系统回顾文献和荟萃分析。
方法：对7例接受MIS2ACE治疗12次的患者进行初步回顾性分析，随后对文献进行系统回顾，并对现有发表的数据进行荟萃分析（PROSPERO方案编号：CRD42023477411）。基线患者和动脉瘤特征，以及程序技术和结果，进行了分析。单臂比例汇总用于总结可用的已发表数据。
结果：我们治疗了7名患者（5名男性，71%），中位年龄为69岁（IQR55,69）。根据克劳福德分类，五名患者（1%）患有II级TAAA，和两个（29％）有程度IIITAAA。5例患者（71％）有解剖后-TAAA；其中4例在StanfordA型解剖后，其中一人患有慢性B型夹层。3名患者（43％）患有结缔组织疾病。七个病人中,6人（86%）曾接受过主动脉手术，而动脉瘤的中位直径为58mm（IQR55,58）。MIS2ACE在11次会议中获得了成功（92％）。栓塞动脉的中位数为4（IQR1,4）。任何栓塞都没有围手术期并发症。中位栓塞手术时间间隔为37.0天（IQR31,78）。2例患者进行了开放治疗和5例血管内治疗。MIS2ACE后或主动脉修复后均未发生脊髓缺血事件。在最初检索的432篇文章中，我们在荟萃分析中纳入了两项研究，除我们的队列外，还包括MIS2ACE用于脊髓预处理的患者。MIS2ACE患者合并术后脊髓缺血的患病率为1.9％（95％CI-0.028至0.066，p=0.279；3项研究；81例患者，127卷会议）。
结论：虽然目前公布的数据有限，我们的研究进一步证实MIS2ACE是一种技术上可行且安全的脊髓预处理选择.
