Abstract
BackgroundSpinal cord ischemic injury remains a serious complication of open surgical and endovascular aortic procedures. Simvastatin has been reported to be associated with neuroprotective effect after spinal cord ischemia-reperfusion (IR) injury. The aim of this study was to determine the therapeutic efficacy of starting simvastatin after spinal cord IR injury in a rat model.MethodsIn adult Sprague-Dawley rats, spinal cord ischemia was induced using a balloon-tipped catheter placed in the descending thoracic aorta. The animals were then randomly divided into 4 groups: group A (control); group B (0.5 mg/kg simvastatin); group C (1 mg/kg simvastatin); and group D (10 mg/kg simvastatin). Simvastatin was administered orally upon reperfusion for 5 days. Neurological function of the hind limbs was evaluated for 7 days after reperfusion and recorded using a motor deficit score (MDS) (0: normal, 5: complete paraplegia). The number of normal motor neurons within the anterior horns of the spinal cord was counted after final MDS evaluation. Then, the spinal cord was harvested for histopathological examination.ResultsGroup D showed a significantly lower MDS than the other groups at post-reperfusion day 1 and this trend was sustained throughout the study period. Additionally, a greater number of normal motor neurons was observed in group D than in other groups (group D 21.2 [3.2] vs. group A: 15.8 [4.2]; group B 15.4 [3.4]; and group C 15.5 [3.7]; P = 0.002).ConclusionsThe results of the current study suggest that 10 mg/kg can significantly improve neurologic outcome by attenuating neurologic injury and restoring normal motor neurons after spinal cord IR injury.
Highlights
Spinal cord ischemic injury remains a serious complication of open surgical and endovascular aortic procedures
At post-reperfusion day 1, Group D presented a significantly lower motor deficit score (MDS) compared with groups A, B, and C (3.0 [1.0] for group A, 3.5 [1.0] for group B, 4.0 [1.0] for group C and 3.0 [0] for group D; P = 0.006); this trend was sustained throughout the study period
We showed that this simvastatin treatment after IR injury significantly improves the neurological outcome, as demonstrated by MDS and the number of normal motor neurons in a rat spinal cord ischemia model
Summary
Spinal cord ischemic injury remains a serious complication of open surgical and endovascular aortic procedures. Spinal cord ischemia remains to be the most impressive and devastating complication following thoracoabdominal aortic aneurysm (TAAR) surgery. The precise pathophysiology of spinal cord ischemia after TAAR surgery is unclear and probably multifactorial, including intercostal artery occlusion, spinal cord hypoperfusion during aortic occlusion, or spinal cord reperfusion [4]. To date, a variety of surgical techniques have focused on maximizing spinal cord perfusion, oxygen delivery, and reducing oxygen consumption to minimize risk of spinal cord ischemia. These methods include systemic cooling or regional spinal. Intravenous high dose methylprednisolone remains a widespread option for acute spinal cord ischemia despite its limited efficacy and safety profile [6]
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