[MP-21] Late onset paraplegia caused by stent induced new tear (SINE) 7 months after thoracic endovascular aortic repair (TEVAR) for the treatment of Stanford B aortic dissection.
Clinical history
A 68-year-old man was transported to our hospital with the sudden onset chest pain. Contrast-enhanced computed tomography (CE-CT) revealed an acute Stanford B aortic dissection. The false lumen extended from the proximal descending aorta to right common iliac artery, the entry of the false lumen existed from Th6 to Th8 level of the descending aorta, and the Adamkiewicz artery branched from right 9th costal artery. The patient was treated conservatively first. However, TEVAR was performed 5 months after the onset, because the diameter of the descending aorta enlarged from 32mm to 40mm for 3months.Stent graft was implanted from the distal aortic arch to Th10 level of the descending aorta. CE-CT after TEVAR showed that the entry of the false lumen was closed by the stentgraft, the false lumen was thrombosed in the rage of stentgraft implantation, and right 9th costal artery was patent.
Result
The patient was discharged without any complication. However, incomplete paraplegia appeared suddenly 7 months after TEVAR. The symptoms were sensory disorder below Th7 level, motor impairment in left dominant bilateral legs, and urinary retension. CE-CT showed that SINE appeared just beneath the distal edge of the stentgraft and the intimal flap, which was destabilized by SINE, obstructed the entry of right 9th costal artery. The symptoms gradually improved with conservative medical therapy, and the patient was able to walk with the use of walking flame.
Take home points
SINE could be the cause of spinal ischemia.
A 68-year-old man was transported to our hospital with the sudden onset chest pain. Contrast-enhanced computed tomography (CE-CT) revealed an acute Stanford B aortic dissection. The false lumen extended from the proximal descending aorta to right common iliac artery, the entry of the false lumen existed from Th6 to Th8 level of the descending aorta, and the Adamkiewicz artery branched from right 9th costal artery. The patient was treated conservatively first. However, TEVAR was performed 5 months after the onset, because the diameter of the descending aorta enlarged from 32mm to 40mm for 3months.Stent graft was implanted from the distal aortic arch to Th10 level of the descending aorta. CE-CT after TEVAR showed that the entry of the false lumen was closed by the stentgraft, the false lumen was thrombosed in the rage of stentgraft implantation, and right 9th costal artery was patent.
Result
The patient was discharged without any complication. However, incomplete paraplegia appeared suddenly 7 months after TEVAR. The symptoms were sensory disorder below Th7 level, motor impairment in left dominant bilateral legs, and urinary retension. CE-CT showed that SINE appeared just beneath the distal edge of the stentgraft and the intimal flap, which was destabilized by SINE, obstructed the entry of right 9th costal artery. The symptoms gradually improved with conservative medical therapy, and the patient was able to walk with the use of walking flame.
Take home points
SINE could be the cause of spinal ischemia.