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Originally published March 19, 2025
Last updated March 21, 2025
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Thoracoabdominal aortic aneurysms (TAAAs) can be complex, difficult aneurysms to treat. Current endovascular technology has reduced the overall complication rates compared to previous open surgical treatment for TAAAs. However, the risk of spinal cord stroke and paraplegia remains a significant challenge. When treating high-risk aneurysms, the spinal cord stroke risk can be as high as 15%, with one half of that 15% unable to walk after treatment of their aneurysm.
“The Achilles’ heel of minimally invasive, complex aortic aneurysm repair is spinal cord stroke,” says Sukgu M. Han, MD, chief of vascular surgery at Keck Medicine of USC and co-director of the USC Comprehensive Aortic Center. “In patients with extensive aneurysms affecting most of their aorta, one of the most serious complications of aortic aneurysm repair is that circulation to their spinal cord gets blocked, which can result in a spinal cord stroke.”
The USC Neuro Revascularization Center (“USC NRV Center”) has pioneered a novel strategy to reduce the risk of spinal cord stroke in patients. Han, Joseph Carey, MD, and Jonathan Russin, MD, comprise the leadership of the USC NRV Center, which has been focused on solutions for spinal cord stroke in TAAA patients. Carey is a recognized expert in revascularization techniques and is continually evolving the opportunities for spinal cord bypass. “The core of the mission of microvascular reconstruction is to innovate at the frontlines of the most challenging surgical problems. We believe the best opportunities for innovation occur in the interstices between specialties,” Carey says.
Merging multidisciplinary expertise
Russin and Carey had a history of collaborating on cerebral revascularization treatments to preserve blood flow in patients with brain aneurysms, moyamoya disease, carotid occlusion and atherosclerosis disease. As the USC NRV Center grew and Han joined the leadership team, there was an immediacy to addressing the problem of spinal cord stroke. “Once we began working with Dr. Han, we were able to expand our potential to positively impact patients with TAAAs,” Russin says.
“The strength of the USC NRV Center is that it is not the typical assembly line format for multidisciplinary collaboration where each specialty contributes their own expertise to a particular problem,” Russin adds. “Our team works in parallel to create new and innovative approaches to problems. Rather than piecing together standard surgical treatments to look ‘multidisciplinary,’ the USC NRV Center brings experts together to create something new: novel strategies to tackle the most challenging problems.”
First-of-its-kind bypass shows promise
The USC NRV Center has published several articles related to its work on preventing spinal cord stroke for TAAA patients, which can be found in the peer-reviewed literature. The strategy is simple and aims to identify the blood flow to the spinal cord prior to TAAA treatment and to keep these arteries open. The default is to use endovascular grafts to maintain blood flow to the spinal cord. However, when this is not possible, the USC NRV Center team has created a new bypass procedure to preserve blood flow to the spinal cord.
“Current protocols to reduce the risk of spinal cord stroke have been stagnant for many years,” Han says. “This is a novel, preventative approach that we hope will significantly improve the outcomes for our patients.”
This strategy has been adopted as slightly modified techniques by other institutions, including as described in a publication from the University of Maryland. “Prevention is always preferable to a responsive strategy, and the fact that other institutions are looking to build on our work is a testament to the innovation of Dr. Han, Dr. Carey and our entire USC NRV Center,” Russin says.
The USC NRV Center has been a recognized leader in revascularization across surgical subspecialties. Its team has been recognized with invitations to present its work nationally and internationally at neurosurgical, plastic surgery and vascular conferences. The USC NRV Center has been awarded funding from the NIH and has been honored with a $1.25 million donation from the Alfred E. Mann Charities.
“Our goal is to eliminate spinal cord stroke as a complication of TAAA treatment,” Russin says. “We believe that this strategy is promising, but we will not take it for granted, and we will continue to innovate, even at the expense of our own ideas, in order to solve problems for our patients.”
