Minimally invasive segmental artery coil embolization for spinal cord ischemia prevention prior to fenestrated/branched endovascular aortic repair
Bibliographic record
Abstract
OBJECTIVE: To report our institutional experience with minimally invasive segmental artery coil embolization (MISACE) before fenestrated/branched endovascular aortic repair (F/BEVAR) and to compare post-F/BEVAR outcomes between patients treated in the MISACE era and those treated earlier without MISACE. METHODS: MISACE was implemented at our institution beginning in 2018 as part of a multidisciplinary spinal protection strategy. Patients who underwent F/BEVAR with prior MISACE between March 2018 and September 2023 (MISACE group, n = 42) were retrospectively compared with patients treated before MISACE implementation (non-MISACE group, n = 50; November 2007 to February 2018). Extent IV aortic repair coverage in the non-MISACE cohort was excluded. The primary end point was in-hospital spinal cord ischemia (SCI) after F/BEVAR. Univariate and multivariable logistic regression were used to assess factors associated with SCI. RESULTS: Patients in the MISACE cohort were younger (70 ± 9.0 vs 75.1 ± 5.8 years, P = .003) and more frequently had aortic dissections (36% vs 12%, P = .014), but there were no significant differences in previous aortic surgery (64% vs 50%, P = .17) or presentation with extent I-III aneurysms (76.2% vs 80%, P = .66). MISACE was performed in a single session in 95.2% of patients, targeting a median of 3 [2, 4] vessels, with a median interval of 72 [35, 110] days before F/BEVAR. There were no differences in the rates of thoracic endovascular repair staging (50% vs 36%, P = .25), F/BEVAR technical success (88% vs 80%, P = .45), or extent I-III aortic repair coverage (83.3% vs 96%, P = .074). SCI occurred less frequently in the MISACE cohort (9.5% vs 30%, P = .016). There were no significant differences in in-hospital mortality (7.1% vs 12%, P = .5); however, the median length of hospital stay was significantly shorter in the MISACE cohort (7 [5, 12] vs 11 [7, 20] days, P = .022). On univariate analysis, MISACE was associated with reduced odds of SCI (odds ratio: 0.25, 95% confidence interval: 0.07-0.75; P = .013). However, on multivariable analysis, only prior aortic surgery remained independently associated with reduced SCI (odds ratio: 0.29, 95% confidence interval: 0.09-0.89; P = .036). CONCLUSIONS: MISACE is a technically feasible and safe spinal protection adjunct to F/BEVAR, with no added procedural or neurologic risk. Although associated with lower SCI rates on univariate analysis, its independent effect was not statistically significant after adjustment. Prospective randomized data are needed to clarify the role of MISACE in spinal cord protection.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".