Genicular Artery Embolization: Embolic Material and Imaging Review

Abstract

Osteoarthritis (OA) of the knee is a degenerative condition impacting numerous individuals globally. Genicular artery embolization (GAE) has emerged as an effective minimally invasive therapy for managing medically refractory OA-related pain in patients who are not eligible for surgery. This intervention works by disrupting the inflammatory and neoangiogenic pathways that contribute to pain. The efficacy of GAE has been demonstrated in various clinical trials, yielding promising results. This review aims to explore recent advancements in the embolic materials used during GAE, examining their properties and potential benefits. Additionally, it will describe the use of pre-, intra-, and postprocedural imaging—particularly magnetic resonance imaging and other modalities—to optimize GAE outcomes.

Keywords

interventional radiology - osteoarthritis - geniculate artery embolization - embolization - magnetic resonance imaging

Publikationsverlauf

Artikel online veröffentlicht:
19. August 2024

• References

• 1 Dillon CF, Rasch EK, Gu Q, Hirsch R. Prevalence of knee osteoarthritis in the United States: arthritis data from the Third National Health and Nutrition Examination Survey 1991-94. J Rheumatol 2006; 33 (11) 2271-2279
• 2 Brown GA. AAOS clinical practice guideline: treatment of osteoarthritis of the knee: evidence-based guideline, 2nd edition. J Am Acad Orthop Surg 2013; 21 (09) 577-579
• 3 Deyle GD, Allen CS, Allison SC. et al. Physical therapy versus glucocorticoid injection for osteoarthritis of the knee. N Engl J Med 2020; 382 (15) 1420-1429
• 4 Jevsevar D, Donnelly P, Brown GA, Cummins DS. Viscosupplementation for osteoarthritis of the knee: a systematic review of the evidence. J Bone Joint Surg Am 2015; 97 (24) 2047-2060
• 5 Kompel AJ, Roemer FW, Murakami AM, Diaz LE, Crema MD, Guermazi A. Intra-articular corticosteroid injections in the hip and knee: perhaps not as safe as we thought?. Radiology 2019; 293 (03) 656-663
• 6 Genicular Artery Embolization for Symptomatic Knee Osteoarthritis • APPLIED RADIOLOGY. Accessed May 15, 2024. https://appliedradiology.com/Articles/genicular-artery-embolization-for-symptomatic-knee-osteoarthritis
• 7 Mathis DT, Lohrer L, Amsler F, Hirschmann MT. Reasons for failure in primary total knee arthroplasty - an analysis of prospectively collected registry data. J Orthop 2020; 23: 60-66
• 8 Bonnet CS, Walsh DA. Osteoarthritis, angiogenesis and inflammation. Rheumatology (Oxford) 2005; 44 (01) 7-16
• 9 Ashraf S, Mapp PI, Walsh DA. Contributions of angiogenesis to inflammation, joint damage, and pain in a rat model of osteoarthritis. Arthritis Rheum 2011; 63 (09) 2700-2710
• 10 Taslakian B, Swilling D, Attur M. et al. Genicular artery embolization for treatment of knee osteoarthritis: interim analysis of a prospective pilot trial including effect on serum osteoarthritis-associated biomarkers. J Vasc Interv Radiol 2023; 34 (12) 2180-2189.e3
• 11 Okuno Y, Korchi AM, Shinjo T, Kato S. Transcatheter arterial embolization as a treatment for medial knee pain in patients with mild to moderate osteoarthritis. Cardiovasc Intervent Radiol 2015; 38 (02) 336-343
• 12 Okuno Y, Korchi AM, Shinjo T, Kato S, Kaneko T. Midterm clinical outcomes and MR imaging changes after transcatheter arterial embolization as a treatment for mild to moderate radiographic knee osteoarthritis resistant to conservative treatment. J Vasc Interv Radiol 2017; 28 (07) 995-1002
• 13 Landers S, Hely R, Page R. et al. Genicular artery embolization to improve pain and function in early-stage knee osteoarthritis-24-month pilot study results. J Vasc Interv Radiol 2020; 31 (09) 1453-1458
• 14 Bagla S, Piechowiak R, Hartman T, Orlando J, Del Gaizo D, Isaacson A. Genicular artery embolization for the treatment of knee pain secondary to osteoarthritis. J Vasc Interv Radiol 2020; 31 (07) 1096-1102
• 15 Little MW, Gibson M, Briggs J. et al. Genicular artEry embolizatioN in patiEnts with oSteoarthrItiS of the Knee (GENESIS) using permanent microspheres: interim analysis. Cardiovasc Intervent Radiol 2021; 44 (06) 931-940
• 16 Bagla S, Piechowiak R, Sajan A, Orlando J, Hartman T, Isaacson A. Multicenter randomized sham controlled study of genicular artery embolization for knee pain secondary to osteoarthritis. J Vasc Interv Radiol 2022; 33 (01) 2-10.e2
• 17 Sapoval M, Querub C, Pereira H. et al. Genicular artery embolization for knee osteoarthritis: results of the LipioJoint-1 trial. Diagn Interv Imaging 2024; 105 (04) 144-150
• 18 Kim KY, Kim GW. The efficacy of transcatheter arterial embolization for knee pain on patients with knee osteoarthritis: a case series. J Back Musculoskeletal Rehabil 2022; 35 (04) 743-748
• 19 Lee SH, Hwang JH, Kim DH. et al. Clinical outcomes of transcatheter arterial embolisation for chronic knee pain: mild-to-moderate versus severe knee osteoarthritis. Cardiovasc Intervent Radiol 2019; 42 (11) 1530-1536
• 20 Genicular Artery Embolization: Building Evidence and Practice. Endovascular Today. Accessed May 16, 2024 at: https://evtoday.com/articles/2024-feb/genicular-artery-embolization-building-evidence-and-practice
• 21 Min J, Park SW, Hwang JH. et al. Evaluating the safety and effectiveness of quick-soluble gelatin sponge particles for genicular artery embolization for chronic knee pain associated with osteoarthritis. J Vasc Interv Radiol 2023; 34 (11) 1868-1874
• 22 Miyayama S, Yamakado K, Anai H. et al. Guidelines on the use of gelatin sponge particles in embolotherapy. Jpn J Radiol 2014; 32 (04) 242-250
• 23 Padia SA, Genshaft S, Blumstein G. et al. Genicular artery embolization for the treatment of symptomatic knee osteoarthritis. JBJS Open Access 2021; 6 (04) e21
• 24 Casadaban LC, Mandell JC, Epelboym Y. Genicular artery embolization for osteoarthritis related knee pain: a systematic review and qualitative analysis of clinical outcomes. Cardiovasc Intervent Radiol 2021; 44 (01) 1-9
• 25 Torkian P, Golzarian J, Chalian M. et al. Osteoarthritis-related knee pain treated with genicular artery embolization: a systematic review and meta-analysis. Orthop J Sports Med 2021 ;9(7):23259671211021356
• 26 Bhatia S, Jalaeian H, Kumar J. et al. Two-year outcomes comparing Embosphere® microspheres versus Imipenem Cilastatin for genicular artery embolization in patients with moderate to severe knee osteoarthritis. Knee 2023; 41: 38-47
• 27 Correa MP, Motta-Leal-Filho JM, Lugokeski R, Mezzomo M, Leite LR. GAUCHO - Trial Genicular Artery Embolization using imipenem/cilastatin vs. microsphere for knee osteoarthritis: a randomized controlled trial. Cardiovasc Intervent Radiol 2022; 45 (07) 903-910
• 28 Hayashi D, Roemer FW, Guermazi A. Imaging for osteoarthritis. Ann Phys Rehabil Med 2016; 59 (03) 161-169
• 29 Roemer FW, Eckstein F, Hayashi D, Guermazi A. The role of imaging in osteoarthritis. Best Pract Res Clin Rheumatol 2014; 28 (01) 31-60
• 30 Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis 1957; 16 (04) 494-502
• 31 Sterbis E, Casadaban L. Genicular artery embolization technique. Tech Vasc Interv Radiol 2023; 26 (01) 100878
• 32 Callese T, Cusumano L, Sparks H. et al. Abstract no. 367 early intervention in knee osteoarthritis with genicular artery embolization is associated with improved clinical outcomes. J Vasc Interv Radiol 2024; 35 (03) S163-S164
• 33 Choi JW, Ro DH, Chae HD. et al. The value of preprocedural MR imaging in genicular artery embolization for patients with osteoarthritic knee pain. J Vasc Interv Radiol 2020; 31 (12) 2043-2050
• 34 Peterfy CG, Guermazi A, Zaim S. et al. Whole-Organ Magnetic Resonance Imaging Score (WORMS) of the knee in osteoarthritis. Osteoarthritis Cartilage 2004; 12 (03) 177-190
• 35 Guermazi A, Roemer FW, Hayashi D. et al. Assessment of synovitis with contrast-enhanced MRI using a whole-joint semiquantitative scoring system in people with, or at high risk of, knee osteoarthritis: the MOST study. Ann Rheum Dis 2011; 70 (05) 805-811
• 36 Worrell S, Lindquester W, Ghodadra A. Abstract no. 365 Objective improvement in knee function following genicular artery embolization correlates with MRI-based texture feature of the infrapatellar fat pad. J Vasc Interv Radiol 2024; 35 (03) S163
• 37 Badar W, Yu Q, Wallace S. et al. Abstract No. 369 correlation of synovitis on pre-procedural MRI to perfusion on intra-procedural DSA during GAE. J Vasc Interv Radiol 2024; 35 (03) S164-S165
• 38 van Zadelhoff TA, Moelker A, Bierma-Zeinstra SMA, Bos PK, Krestin GP, Oei EHG. Genicular artery embolization as a novel treatment for mild to moderate knee osteoarthritis: protocol design of a randomized sham-controlled clinical trial. Trials 2022; 23 (01) 24
• 39 Merit Medical Systems, Inc.. Multicenter, PrOspective, Randomized, Controlled Trial Comparing GenIcular Artery EmbOlization Using Embosphere Microspheres to Corticosteroid iNjections for the Treatment of Symptomatic Knee Osteoarthritis: MOTION Study. clinicaltrials.gov; 2024 . Accessed December 31, 2023 at: https://clinicaltrials.gov/study/NCT05818150
• 40 Bagla S, Piechowiak R, Sajan A, Orlando J, Canario DAH, Isaacson A. Angiographic analysis of the anatomical variants in genicular artery embolization. J Clin Interv Radiol ISVIR 2022; 6 (01) 18-22
• 41 Badar W, Anitescu M, Ross B, Wallace S, Uy-Palmer R, Ahmed O. Quantifying change in perfusion after genicular artery embolization with parametric analysis of intraprocedural digital subtraction angiograms. J Vasc Interv Radiol 2023; 34 (12) 2190-2196
• 42 Donaldson C, O'Neill AH, Slater LA, Chong W, Lai LT, Chandra RV. Feasibility of real-time angiographic perfusion imaging in the treatment of cerebral vasospasm. Intervent Neurol 2017; 6 (3-4) 163-169
• 43 Thurner A, Augustin AM, Bley TA, Kickuth R. 2D-perfusion angiography for intra-procedural endovascular treatment response assessment in chronic mesenteric ischemia: a feasibility study. BMC Med Imaging 2022; 22 (01) 90
• 44 Callese TE, Cusumano L, Redwood KD. et al. Classification of genicular artery anatomic variants using intraoperative cone-beam computed tomography. Cardiovasc Intervent Radiol 2023; 46 (05) 628-634
• 45 Mirakhur A, Bakshi DR. Contrast-enhanced ultrasonography during genicular artery embolization. Cardiovasc Intervent Radiol 2021; 44 (11) 1830-1832