TITLE:
Latest Advances in Research on Spinal Cord Ischemia after Endovascular Repair of Type B Aortic Dissection
AUTHORS:
Chaohui Huang, Shiguan Luo, Weining Xu
KEYWORDS:
B-Type Aortic Dissection, Thoracic Endovascular Aortic Repair, Spinal Cord Ischemia, Treatment, Prevention
JOURNAL NAME:
Journal of Biosciences and Medicines,
Vol.14 No.8,
August
31,
2026
ABSTRACT: Stanford type B aortic dissection (TBAD) is a severe aortic emergency, with a sudden onset and rapid progression, which is a major threat to patient survival. Over the past decades, thoracic endovascular aortic repair (TEVAR) has become the main treatment for TBAD, because there were continuous improvements in endovascular devices, and the clinical decision-making has evolved, resulting in significant benefits both in short and long term survival. Even though there are these gains, spinal cord ischemia (SCI) after TEVAR—though it’s rare—still a dreaded complication, which often causes permanent neurological deficits, making functional recovery and long-term quality of life significantly worse. Recent innovations in imaging, intraoperative neurophysiologic monitoring, and perioperative organ-sparing measures have been instrumental in fostering a better understanding of SCI in the context of TBAD. From a mechanistic viewpoint, there are three main factors that interact to either initiate or aggravate the spinal cord hypoperfusion. These factors include anatomical variations, technical variables that arise during the procedure, and patient-specific comorbidities. For diagnosis, combing a thorough neurologic examination with advanced imaging techniques (like diffusion-weighted MRI) and electrophysiologic studies (such as somatosensory and motor evoked potentials) has made detection more sensitive and timely. Management approaches encompass pharmacotherapy, surgical revascularization, and structured rehabilitation, each having its own rationale and patient selection criteria. Prevention is based on a rigorous preoperative risk evaluation, precise stent-graft sizing and positioning, and close postoperative hemodynamics and neurologic surveillance. This review has a distinctive feature, that it systematically categorizes the level of evidence supporting each recommendation, clearly distinguishing data from TBAD and TEVAR populations from those derived from thoracoabdominal aneurysm repairs, open surgery, or spinal injuries of non-aortic origin. Moreover, the review gives explicit time-based definitions (like immediate vs. delayed) and outcome-based classifications (transient vs. permanent) for SCI. It redefines the diagnostic imaging algorithm and emergency response pathway, and provides a balanced assessment of the predictive utility of various risk factors and clinical signs. By combing these up-to-date findings, the review provides clinicians with practical, evidence-based guidance to personalize therapy, reduce the frequency of SCI, and improve patient outcomes.