Motor evoked potential-guided segmental artery revascularization during open thoracoabdominal aortic aneurysm surgery after coil embolization as a part of the minimally invasive staged segmental artery coil embolization concept

Sacrifice of the segmental arteries during thoracoabdominal aortic repair carries the risk of spinal cord injury. Staged embolization of segmental arteries has been discussed as an option for preconditioning the spinal cord vascular network. In the present case, periprocedural monitoring of motor-evoked potentials detected spinal cord ischemia after aortic cross-clamping, although embolization of eight segmental arteries had been performed in advance. Implantation of an intercostal artery bypass restored spinal cord perfusion and normalized the motor-evoked potentials. Thus, the preconditioning strategy to stimulate creation of a spinal cord collateral network as an adjunctive method to prevent paraplegia is not perfect.