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Awad H, Tili E, Nuovo G, Kelani H, Ramadan ME, Williams J, Binzel K, Rajan J, Mast D, Efanov AA, Rasul KB, Moore S, Basso M, Mikhail A, Eltobgy M, Malbrue RA, Bourekas E, Oglesbee M, Bergdall V, Knopp M, Michaille JJ, El-Sayed H. Endovascular repair and open repair surgery of thoraco-abdominal aortic aneurysms cause drastically different types of spinal cord injury. Sci Rep 2021; 11:7834. [PMID: 33837260 PMCID: PMC8035135 DOI: 10.1038/s41598-021-87324-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 03/22/2021] [Indexed: 01/26/2023] Open
Abstract
Both endovascular repair (EVR) and open repair (OR) surgery of thoraco-abdominal aortic aneurysms cause spinal cord (SC) injury that can lead to paraparesis or paraplegia. It has been assumed that mechanisms responsible for SC damage after EVR are similar to those after OR. This pilot study compared the pathophysiology of SC injury after EVR versus OR using a newly developed EVR dog model. An increasing number of stents similar to those used in patients were inserted in the aorta of three dogs to ensure thoracic or thoracic plus lumbar coverage. The aorta of OR dogs was cross-clamped for 45 min. Behavior assessment demonstrated unique patterns of proprioceptive ataxia and evolving paraparesis in EVR versus irreversible paraplegia in OR. MRI showed posterior signal in lumbar SC after EVR versus central cord edema after OR. Histopathology showed white matter edema in L3-L5 localized to the dorsal column medial lemniscus area associated with loss of myelin basic protein but not neurons after EVR, versus massive neuronal loss in the gray matter in L3-L5 after OR. Metabolome analysis demonstrates a distinctive chemical fingerprint of cellular processes in both interventions. Our results call for the development of new therapeutics tailored to these distinct pathophysiologic findings.
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Affiliation(s)
- Hamdy Awad
- Department of Anesthesiology, Wexner Medical Center, College of Medicine, The Ohio State University, 410 W. 10th Ave, Columbus, OH, 43210, USA.
| | - Esmerina Tili
- Department of Anesthesiology, Wexner Medical Center, College of Medicine, The Ohio State University, 410 W. 10th Ave, Columbus, OH, 43210, USA
- Department of Cancer Biology and Genetics, College of Medicine, Wexner Medical Center, The Ohio State University, 460 W 10th Ave, Columbus, OH, 43210, USA
| | - Gerard Nuovo
- Phylogeny, 1476 Manning Pkwy, Powell, OH, 43065, USA
| | - Hesham Kelani
- Department of Anesthesiology, Wexner Medical Center, College of Medicine, The Ohio State University, 410 W. 10th Ave, Columbus, OH, 43210, USA
| | | | - Jim Williams
- Phylogeny, 1476 Manning Pkwy, Powell, OH, 43065, USA
| | - Katherine Binzel
- Department of Radiology, Wexner Medical Center, College of Medicine, The Ohio State University, 410 W. 10th Ave, Columbus, OH, 43210, USA
| | - Jayanth Rajan
- Department of Anesthesiology, Wexner Medical Center, College of Medicine, The Ohio State University, 410 W. 10th Ave, Columbus, OH, 43210, USA
| | - David Mast
- ECMO Coordinator, Wexner Medical Center, The Ohio State University, Columbus, OH, 43210, USA
| | - Alexander A Efanov
- Department of Anesthesiology, Wexner Medical Center, College of Medicine, The Ohio State University, 410 W. 10th Ave, Columbus, OH, 43210, USA
| | - Kareem B Rasul
- Department of Anesthesiology and Perioperative Medicine, University Hospitals, Cleveland, OH, 44106, USA
| | - Sarah Moore
- Department of Veterinary Clinical Sciences, The Ohio State University, 601 Vernon Tharp St., Columbus, OH, 43210, USA
| | - Michele Basso
- School of Health and Rehabilitation Sciences, The Ohio State University, 106A Atwell Hall, 453 W. 10th Ave., Columbus, OH, 43210, USA
| | - Adel Mikhail
- Phylogeny, 1476 Manning Pkwy, Powell, OH, 43065, USA
| | - Mostafa Eltobgy
- Department of Anesthesiology, Wexner Medical Center, College of Medicine, The Ohio State University, 410 W. 10th Ave, Columbus, OH, 43210, USA
| | - Raphael A Malbrue
- Department of Veterinary Preventive Medicine, University Laboratory Animal Resources, The Ohio State University, 111 Wiseman Hall, 400 West 12th Avenue, Columbus, OH, 43210, USA
| | - Eric Bourekas
- Department of Radiology, Wexner Medical Center, College of Medicine, The Ohio State University, 410 W. 10th Ave, Columbus, OH, 43210, USA
| | - Michael Oglesbee
- Department of Veterinary Biosciences, The Ohio State University, 205 Goss Laboratory, 1925 Coffey Rd, Columbus, OH, 43210, USA
| | - Valerie Bergdall
- Department of Veterinary Preventive Medicine, University Laboratory Animal Resources, The Ohio State University, 111 Wiseman Hall, 400 West 12th Avenue, Columbus, OH, 43210, USA
| | - Michael Knopp
- Department of Radiology, Wexner Medical Center, College of Medicine, The Ohio State University, 410 W. 10th Ave, Columbus, OH, 43210, USA
| | - Jean-Jacques Michaille
- Department of Cancer Biology and Genetics, College of Medicine, Wexner Medical Center, The Ohio State University, 460 W 10th Ave, Columbus, OH, 43210, USA
- BioPerox-IL, Faculté des Sciences Gabriel, Université de Bourgogne-Franche Comté, 6 Bd. Gabriel, 21000, Dijon, France
| | - Hosam El-Sayed
- Department of Surgery, Division of Vascular and Endovascular Surgery, Eastern Virginia Medical School, 600 Gresham Dr, Norfolk, VA, 23507, USA
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