<h3>INTRODUCTION</h3> Spinal cord ischemia (SCI) is a rare but serious complication of TEVAR. A number of measures including spinal drain (SD) placement have been proposed to reduce the risk of SCI in TEVARs performed for aneurysms. However, there is no specific data on potential benefits of SD placement in aortic dissection (AD). We aimed to assess the impact of preoperative SD placement on preventing SCI during TEVARs performed for AD. <h3>Methods</h3> We included all TEVAR cases performed for AD in VQI from 2012 to 2021. Patients with connective tissue disease, open conversion, rupture, proximal disease > zone 5, or SCI on presentation were excluded. One-to-one propensity score matching was used to balance patients on 37 dimensions by the nearest neighbor principle to compare patients based on preoperative SD placement. The primary outcome was SCI. Secondary outcomes included 30-day and 90-day mortality, perioperative complications, and 90-day re-intervention. <h3>RESULTS</h3> A total of 2970 TEVARs were performed for AD with 1373 (44.9%) undergoing preoperative SD placement. Propensity matching produced 924 well-matched pairs. In the matched cohort, SD placement was not associated with significant reduction in temporary SCI (2.7 vs. 1.9%, p=0.28). However, SD placement was associated with significant reduction of the risk of permanent SCI at discharge (1.4% vs. 2.7%, p=0.049). SD was also associated with lower risk of 30-day mortality (3.6% vs 6.0%, p=0.016) and longer length of stay but not perioperative complication or 90-day mortality or 90-day re-intervention. <h3>CONCLUSION</h3> Our study suggests that preoperative SD placement in patients undergoing TEVAR for AD is beneficial in reducing the risk of permanent SCI without increasing risks of perioperative complications. Further prospective studies are necessary to confirm these findings.