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Preoperative Spinal Arterial Supply Mapping Using Non-Selective Cone Beam Computed Tomography before Complex Aortic
Baptiste Bonnet1, Hicham Kobeiter1,2,3, Lorenzo Pescatori1
1Service D'imagerie Médicale Diagnostique et Interventionnelle, DMU FIxIT, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), F-94010 Creteil, France.
Journal of Clinical Medicine
|February 10, 2024
Summary
Pre-operative spinal arterial mapping using non-selective cone beam CT (CBCT) can identify the Adamkiewicz artery (AKA). This method shows promise in predicting spinal cord ischemia (SCI) risk after complex aortic repair.
Area of Science:
- Vascular Surgery
- Radiology
- Medical Imaging
Background:
- Spinal cord ischemia (SCI) is a risk following complex aortic repair.
- Accurate pre-operative spinal arterial mapping is essential for risk assessment.
- Identifying the Adamkiewicz artery (AKA) is key for understanding spinal cord perfusion.
Purpose of the Study:
- To evaluate the utility of non-selective cone beam computed tomography (CBCT) for pre-operative spinal arterial mapping.
- To assess the identification of the Adamkiewicz artery (AKA) using CBCT.
- To correlate AKA detection with the incidence of postoperative spinal cord ischemia (SCI).
Main Methods:
- Non-selective dual-phase CBCT was performed in 21 patients undergoing aortic repair.
- Intra-aortic contrast injection was used for imaging.
- Image fusion with pre-interventional CT angiography aided AKA origin assessment.
- CBCT findings were compared with postoperative SCI incidence.
Main Results:
- The Adamkiewicz artery (AKA) was detected in 67% of patients via CBCT.
- AKA was predominantly identified originating from T7 to L1 intercostal and lumbar arteries.
- Spinal cord ischemia (SCI) occurred in 14% of patients; none occurred when AKA was not detected (p < 0.01).
Conclusions:
- Non-selective aortic CBCT is a safe and feasible method for spinal arterial mapping.
- This technique shows potential in predicting post-surgical spinal cord ischemia (SCI) risk.
- CBCT offers promising insights for personalized surgical planning in complex aortic repair.
