Key result
Rescue CSF drainage and permissive hypertension completely resolves delayed spinal cord ischemia after TEVAR.
Why the study?
Spinal cord ischemia is a serious complication of thoracic endovascular aortic repair, and several proposed treatment options remain the subject of ongoing research.
Does late cerebrospinal fluid drainage combined with permissive hypertension resolve delayed spinal cord ischemia in a patient following thoracic endovascular aortic repair?
Case Report (n=1)
No
Does late cerebrospinal fluid drainage combined with permissive hypertension resolve delayed spinal cord ischemia in a patient following thoracic endovascular aortic repair?
This case report demonstrates that late rescue therapy combining permissive hypertension and cerebrospinal fluid drainage initiated on the fourth postoperative day can lead to complete neurological recovery in delayed spinal cord ischemia after thoracic endovascular aortic repair, even without typical MRI findings.
Answers are grounded in this paper and cite their sources.
Supports delayed CSF drainage with permissive hypertension for post-TEVAR spinal ischemia; leaves open need for prospective trials.
We present the case of a male sexagenarian who developed atypical and progressive neurological deficits four days after thoracic endovascular aortic repair.Spinal cord ischemia is a serious complication of this procedure for which several treatment options have been proposed and are the subject of ongoing research.Despite absent typical findings on magnetic resonance imaging (MRI) and it being the fourth postoperative day, we decided in favor of combining permissive hypertension and the insertion of a spinal catheter as rescue therapy.The neurological deficit was completely resolved, and the patient made a full recovery.This case report highlights the importance of identifying spinal cord ischemia and that even late treatment beginning on the fourth postoperative day may lead to recovery.Postoperative clinical onset of lower limb neurology in high-risk surgery should be treated as spinal cord ischemia until proven otherwise.
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Buhlmann et al. (2026) conducted a case report in Delayed spinal cord ischemia after thoracic endovascular aortic repair (TEVAR) for a penetrating aortic ulcer (n=1). Rescue cerebrospinal fluid drainage and permissive hypertension was evaluated on Resolution of postoperative neurological deficits (motor and sensory). Rescue cerebrospinal fluid drainage and permissive hypertension initiated on postoperative day 4 completely resolved delayed spinal cord ischemia within 4 days after TEVAR.
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