Remote ischemic preconditioning protects the spinal cord against ischemic insult: An experimental study in a porcine model.

Abstract

Surgical repair of thoracoabdominal aneurysm jeopardizes the vascularization of the spinal cord, and therefore, despite improvement in surgical techniques, still carries the risk of paraplegia. This study aimed to demonstrate the possible protective effects of remote ischemic preconditioning (RIPC) on the preservation of spinal cord function after segmental artery (SA) occlusion. Twenty piglets were randomized into the RIPC group (n = 10) and the control group (n = 10). The RIPC group underwent transient left hind limb ischemia before systematic left subclavian artery and SA occlusion at the level of the diaphragm. Motor-evoked potential (MEP) monitoring was performed from the hind limbs. Afterward, the thoracic and lumbar spinal cords were harvested and analyzed. The elevation of the MEP amplitude after RIPC was statistically significant, whereas amplitude was consistently decreased in the control group. Additionally, the onset latency was significantly shorter after RIPC during SA occlusion. The control group reached a 50% decrease of MEP amplitude in the right hind limb sooner than did the experimental group. Remote ischemic preconditioning preserves spinal cord function after left subclavian artery and SA occlusion, as indicated by the MEP amplitudes.