Delayed paraplegia after thoracic endovascular aortic repair (TEVAR) successfully reversed with midodrine – A case report

Introduction: Most existing management strategies for spinal cord ischaemia (SCI) after thoracic endovascular aortic repair (TEVAR) are invasive in nature, including intravenous vasopressors, cerebrospinal fluid drainage, and segmental artery embolization. Non-invasive pharmacological adjuncts have been described without established effectiveness. Clinical Case: This case report describes the use of midodrine, an alpha 1-adrenoreceptor agonist, as a rescue therapy adjunctive to phenylephrine to successfully reverse post-TEVAR delayed paraplegia in a 73-year-old patient with ruptured thoracic aortic aneurysm. The initial episode of paraplegia was completely reversed with lumbar drainage, while the second episode was effectively corrected with phenylephrine and subsequently midodrine alone. He had complete neurological recovery, and could mobilize independently. Conclusion: Midodrine is a safe and non-invasive treatment to increase spinal cord perfusion pressure, which could improve or even reverse symptoms of spinal cord ischemia in patients post-TEVAR.