Delayed bridging stent placement for rescue of spinal cord ischemia during complex endovascular repair of thoracoabdominal aortic aneurysms

Spinal cord ischemia remains a significant cause of patient morbidity in the repair of thoracoabdominal aortic aneurysms. We present a three-case series of delayed bridging stent placement in patients who had significant neuromonitoring changes during index aneurysm repair. To prevent spinal cord ischemia, we delayed placement of the final bridging stent in each case for 4 to 8 weeks. The final stent was then placed under local anesthesia with the patient moving their lower extremities throughout the procedure and a 10- to 15-minute balloon occlusion test to ensure adequate spinal perfusion. All patients tolerated the procedure well without evidence of spinal cord ischemia.