Medium molecular weight pentastarch reduces reperfusion injury by decreasing capillary leak in an animal model of spinal cord ischemia

Purpose: The medium molecular weight fraction of pentastarch (HES-Px) has been shown to decrease reperfusion injury to myocardium and brain by reducing capillary leak. This study was undertaken to assess the effects of HES-Pz on neurologic function, microvascular permeability, and spinal cord infarction after temporary aortic crossclamping in a rabbit model. Methods: In 30 New Zealand White rabbits, a snare occlusion device was placed around the infrarenal aorta and tunneled into a subcutaneous position. Animals were allowed to recover for 48 hours and were randomized into three groups. In each group, the infrarenal aorta was occluded by tightening the snare in the awake animal for 21 minutes. Immediately after unclamping, animals received an intravenous infusion of 4% of their estimated blood volume of one of the following solutions: normal saline solution (NS; group 1); 6% standard hydroxyethyl starch (HES), molecular weight 10 to 3400 kD (group 2); and 6% HES-Pz, molecular weight 100 to 1000 kD (group 3). During 5 days of observation, neurologic recovery was graded by an independent observer using the Tarlov scale. Animals were then killed and their spinal cords harvested for histologic examination using hematoxylin-eosin and 2,3,5-triphenyltetrazolium chloride staining. In a separate group of animals (n = 15), the occurrence of spinal cord capillary permeability after NS, HES, and HES-Pz infusions was evaluated by spectrophotometric analysis of extravasated Evans blue. Results: Complete paraplegia and marked histologic evidence of spinal cord cellular injury were seen in 90% of group 1 (NS) and in 78% of group 2 (HES). Treatment with HES-Pz (group 3) resulted in full neurologic recovery in 89% of animals (p < 0.05) and a threefold reduction of extravasated Evans blue compared with controls P < 0.05). Conclusions:;These results indicate that microvascular hyperpermeability plays an important role in reperfusion injury to the spinal cord. Treatment with HES-Pe reduced the capillary permeability, neuron membrane injury, and incidence of paraplegia after reperfusion of ischemic spinal cord in a rabbit model.