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Sotir A, Klopf J, Brostjan C, Neumayer C, Eilenberg W. Biomarkers of Spinal Cord Injury in Patients Undergoing Complex Endovascular Aortic Repair Procedures-A Narrative Review of Current Literature. Biomedicines 2023; 11:biomedicines11051317. [PMID: 37238988 DOI: 10.3390/biomedicines11051317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Complex endovascular aortic repair (coEVAR) of thoracoabdominal aortic aneurysms (TAAA) has greatly evolved in the past decades. Despite substantial improvements of postoperative care, spinal cord injury (SCI) remains the most devastating complication of coEVAR being associated with impaired patient outcome and having an impact on long-term survival. The rising number of challenges of coEVAR, essentially associated with an extensive coverage of critical blood vessels supplying the spinal cord, resulted in the implementation of dedicated SCI prevention protocols. In addition to maintenance of adequate spinal cord perfusion pressure (SCPP), early detection of SCI plays an integral role in intra- and postoperative patient care. However, this is challenging due to difficulties with clinical neurological examinations during patient sedation in the postoperative setting. There is a rising amount of evidence, suggesting that subclinical forms of SCI might be accompanied by an elevation of biochemical markers, specific to neuronal tissue damage. Addressing this hypothesis, several studies have attempted to assess the potential of selected biomarkers with regard to early SCI diagnosis. In this review, we discuss biomarkers measured in patients undergoing coEVAR. Once validated in future prospective clinical studies, biomarkers of neuronal tissue damage may potentially add to the armamentarium of modalities for early SCI diagnosis and risk stratification.
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Affiliation(s)
- Anna Sotir
- Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Johannes Klopf
- Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Christine Brostjan
- Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Christoph Neumayer
- Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Wolf Eilenberg
- Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna, 1090 Vienna, Austria
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Harky A, Fok M, Fraser H, Howard C, Rimmer L, Bashir M. Could Cerebrospinal Fluid Biomarkers Offer Better Predictive Value for Spinal Cord Ischaemia Than Current Neuromonitoring Techniques During Thoracoabdominal Aortic Aneurysm Repair - A Systematic Review. Braz J Cardiovasc Surg 2019; 34:464-471. [PMID: 31454201 PMCID: PMC6713370 DOI: 10.21470/1678-9741-2018-0375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objective Cerebrospinal fluid (CSF) drainage is a technique that has significantly
reduced the incidence of spinal cord ischaemia (SCI). We present results of
a systematic review to assess the literature on this topic in relation to
thoracoabdominal aortic aneurysm repair (TAAR). Methods Major medical databases were searched to identify papers related to CSF
biomarkers measured during TAAAR. Results Fifteen papers reported measurements of CSF biomarkers with 265 patients in
total. CSF biomarkers measured included S-100ß, neuron-specific
endolase (NSE), lactate, glial fibrillary acidic protein A (GFPa), Tau, heat
shock protein 70 and 27 (HSP70, HSP27), and proinflammatory cytokines.
Lactate and S-100ß were reported the most, but did not correlate with
SCI, which was also the case with NSE and TAU. GFPa showed significant CSF
level rises, both intra and postoperative in patients who suffered SCI and
warrants further investigation, similar results were seen with HSP70, HSP27
and IL-8. Conclusions Although there is significant interest in this topic, there still remains a
significant lack of high-quality studies investigating CSF biomarkers during
TAAR to detect SCI. A large and multicentre study is required to identify
the significant role of each biomarker.
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Affiliation(s)
- Amer Harky
- Liverpool Heart and Chest Hospital Department of Cardiothoracic Surgery Liverpool UK Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Matthew Fok
- Royal Liverpool Hospital Department of Vascular Surgery Liverpool UK Department of Vascular Surgery, Royal Liverpool Hospital, Liverpool, UK
| | - Holly Fraser
- University of Liverpool School of Medicine Liverpool UK School of Medicine, University of Liverpool, Liverpool, UK
| | - Callum Howard
- University of Manchester Faculty of Biology, Medicine and Health Manchester UK Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Lara Rimmer
- University of Liverpool School of Medicine Liverpool UK School of Medicine, University of Liverpool, Liverpool, UK
| | - Mohamad Bashir
- Manchester Royal Infirmary Department of Aortovascular Surgery Manchester UK Department of Aortovascular Surgery, Manchester Royal Infirmary, Manchester, UK
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Choong AMTL, Wee IJY, Almond M, Muratani M, Kovari F, Russai R, Jenkins MP. A Systematic Review of the Use of Biochemical Markers in the Assessment of Spinal Cord Ischemia in Thoracoabdominal Aortic Aneurysm Repair. Vasc Endovascular Surg 2018; 53:230-241. [DOI: 10.1177/1538574418814612] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: Despite advances in perioperative critical care and surgical technique, spinal cord ischemia remains a devastating complication of thoracic and thoracoabdominal aortic aneurysm repair. Biochemical markers present in peripheral blood and cerebrospinal fluid (CSF) may be useful in assessing spinal cord injury. We systematically analyze and report the role of all reported biochemical markers that have been used in assessing and diagnosing spinal cord ischemia in thoracic and thoracoabdominal aortic aneurysm repair. Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used for this review. Published literature was searched to identify all studies reporting on the use of biochemical markers in thoracoabdominal aortic aneurysm repair in the assessment of spinal cord ischemia. Marker-specific and patient-specific data were extracted from all studies and where possible, subgroup analysis was performed on marker-specific data sets. Results: Fourteen studies of 321 patients undergoing thoracic and thoracoabdominal aortic aneurysm repair were eligible for further analysis. Seven distinct biochemical markers were used in both CSF and blood samples: S100B proteins (S100B), neurone-specific enolase, lactate dehydrogenase, glial fibrillary acidic protein (GFAp), neurofilament triplet protein (NFL) and Tau protein, and glucose. There was substantial evidence demonstrating the heightened levels of S100, NFL, and GFAp in CSF in patients with spinal cord ischemia. There is however, wide variability in the correlation of the same 6 biochemical markers in peripheral blood and spinal cord ischemia. Conclusions: In patients with spinal cord injury, dramatic rises occur with S100B, NFL, and GFAp in CSF. However, further work is needed if biochemical markers are to impact on the future of thoracoabdominal aortic aneurysm repair.
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Affiliation(s)
- Andrew M. T. L. Choong
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore
- Cardiovascular Research Institute, National University of Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Vascular Surgery, National University Heart Centre, Singapore
| | - Ian J. Y. Wee
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mark Almond
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore
| | - Masafumi Muratani
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore
- Department of Genome Biology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Ferenc Kovari
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore
- Department of Anaesthetics and Intensive Care, North Middlesex University Hospital, London, United Kingdom
| | - Rita Russai
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore
- Department of Anaesthetics, London North West Healthcare NHS Trust, Middlesex, United Kingdom
| | - Michael P. Jenkins
- Imperial Vascular Unit, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
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S-100 β and Antioxidant Capacity in Cerebrospinal Fluid during and after Thoracic Endovascular Aortic Repair. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2017; 2017:6875195. [PMID: 28740858 PMCID: PMC5504939 DOI: 10.1155/2017/6875195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 05/10/2017] [Accepted: 05/31/2017] [Indexed: 11/27/2022]
Abstract
Background Thoracic Endovascular Aortic Repair (TEVAR) has substantially decreased the mortality and major complications from aortic surgery. However, neurological complications such as spinal cord ischemia may still occur after TEVAR. S-100β is a biomarker of central nervous system injury, and oxidant injury plays an important role in neurological injury. In this pilot study, we examined the trends of S-100β and antioxidant capacity in the CSF during and after TEVAR. Methods We recruited 10 patients who underwent elective TEVAR. CSF samples were collected through a lumbar catheter at the following time points: before the start of surgery (T0) and immediately (T1) and 24 (T2) and 48 hours (T3) after the deployment of the aortic stent. S-100β and CSF antioxidant capacity were analyzed with the use of commercially available kits. Results We observed that the level of S-100β in all of the subjects at 24 hours after the deployment of the aortic stent (T2) increased. However, the levels of S-100β at T1 and T3 were comparable to the baseline value. The antioxidant capacity remained unchanged. No patient had a clinical neurologic complication. Conclusions Our observations may indicate biochemical/subclinical central nervous system injury attributable to the deployment of the aortic stent.
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Merisson E, Mattsson N, Zetterberg H, Blennow K, Pikwer A, Mehmedagic I, Acosta S, Åkeson J. Total-tau and neurofilament light in CSF reflect spinal cord ischaemia after endovascular aortic repair. Neurochem Int 2016; 93:1-5. [DOI: 10.1016/j.neuint.2015.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 11/27/2015] [Accepted: 12/02/2015] [Indexed: 01/16/2023]
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Panthee N, Ono M. Spinal cord injury following thoracic and thoracoabdominal aortic repairs. Asian Cardiovasc Thorac Ann 2015; 23:235-246. [DOI: 10.1177/0218492314548901] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Objective To discuss the currently available approaches to prevent spinal cord injury during thoracic and thoracoabdominal aortic repairs. Methods We carried out a PubMed search up to 2013 using the Medical Subject Headings: “aortic aneurysm/surgery” and “spinal cord ischemia”; “aortic aneurysm, thoracic/surgery” and “spinal cord ischemia”; “aneurysm/surgery” and “spinal cord ischemia/cerebrospinal fluid”; “aortic aneurysm/surgery” and “paraplegia”. All 190 original articles satisfying our inclusion criteria were analyzed for incidence, predictors, and other pertinent variables related to spinal cord injury, and we compared the results in recent publications with those in earlier reports. Results The mean age of the 38,491 patients was 65.3 ± 4.9 years. The overall incidence of paraplegia and/or paraparesis was 7.1% ± 6.1% (range 0%–32%). The incidence of spinal cord injury before 2000, from 2001 to 2007, and 2008–2013 was 9.0% ± 6.7%, 7.0% ± 6.1%, and 5.9% ± 5.2%, respectively ( p = 0.019). Various predictors of spinal cord injury were identified, extent of disease being the most common. Modification of surgical techniques, use of adjuncts, and better understanding of spinal cord perfusion physiology were attributed to the decrease in postoperative spinal cord injury in recent years. Conclusions Spinal cord injury after thoracic and thoracoabdominal aortic repair poses a real challenge to cardiovascular surgeons. However, with evolving surgical strategies, identification of predictors, and use of various adjuncts over the years, the incidence of spinal cord injury after thoracic/thoracoabdominal aortic repair has declined. Embracing a multimodality approach offers a good insight into combating this grave complication.
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Affiliation(s)
- Nirmal Panthee
- Department of Cardiac Surgery, University of Tokyo, Tokyo, Japan
| | - Minoru Ono
- Department of Cardiac Surgery, University of Tokyo, Tokyo, Japan
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Feezor RJ, Lee WA. Strategies for Detection and Prevention of Spinal Cord Ischemia during TEVAR. Semin Vasc Surg 2009; 22:187-92. [DOI: 10.1053/j.semvascsurg.2009.07.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Schlösser FJ, Verhagen HJ, Lin PH, Verhoeven EL, van Herwaarden JA, Moll FL, Muhs BE. TEVAR following prior abdominal aortic aneurysm surgery: Increased risk of neurological deficit. J Vasc Surg 2009; 49:308-14; discussion 314. [DOI: 10.1016/j.jvs.2008.07.093] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2008] [Revised: 07/16/2008] [Accepted: 07/16/2008] [Indexed: 11/26/2022]
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Pouw MH, Hosman AJF, van Middendorp JJ, Verbeek MM, Vos PE, van de Meent H. Biomarkers in spinal cord injury. Spinal Cord 2009; 47:519-25. [PMID: 19153591 DOI: 10.1038/sc.2008.176] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
STUDY DESIGN Literature review. OBJECTIVES In traumatic spinal cord injury (SCI), much effort has been put into the evaluation of SCI severity and the prediction of recovery potential. An accurate prediction of the initial damage of the spinal cord that differentiates between the severities of SCI however, may help physicians in choosing a particular neuroprotective treatment in the acute phase. Neurochemical biomarkers may possibly fulfil these requirements. The aim of this review was to describe (1) the current status of neurochemical biomarkers in SCI; (2) their potential diagnostic role in SCI. METHODS MEDLINE was searched from 1966 to 2008 to identify publications concerning biomarkers in traumatic SCI. RESULTS The biomarkers S-100beta, neuron-specific enolase, neurofilament light chain, and Glial fibrillary acidic protein are significantly increased in cases of (experimental) spinal cord injury. Furthermore, increased serum concentrations of S-100beta have been correlated with an unfavourable functional outcome. Although biomarkers in SCI show promising results, considerations and shortcomings, such as polytrauma, haemolysis, extracerebral sources, and poor resuscitation, must be studied in greater detail before biomarkers can be utilised in the clinical care of SCI. CONCLUSIONS Quantitative standards for determining the extent of SCI during the acute phase must be developed and validated. Even though increased concentrations of neurochemical biomarkers have been identified in patients with SCI, these do not yet provide a sensitive prognostic tool. Considering the limited availability of sensitive prognostic tools, neurochemical biomarkers of SCI should be evaluated and validated in future clinical trials.
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Affiliation(s)
- M H Pouw
- Department of Orthopedic Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Khaladj N, Teebken O, Hagl C, Wilhelmi M, Tschan C, Weissenborn K, Lichtinghagen R, Hoy L, Haverich A, Pichlmaier M. The Role of Cerebrospinal Fluid S100 and Lactate to Predict Clinically Evident Spinal Cord Ischaemia in Thoraco-abdominal Aortic Surgery. Eur J Vasc Endovasc Surg 2008; 36:11-9. [PMID: 18313337 DOI: 10.1016/j.ejvs.2008.01.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2007] [Accepted: 01/04/2008] [Indexed: 11/25/2022]
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