European Conference on Embolotherapy

June 1-4 | Vienna, Austria

Mastering embolization

June 1-4 | Vienna, Austria

Mastering embolization

June 1-4 | Vienna, Austria

Mastering embolization

June 1-4 | Vienna, Austria

June 1-4 | Vienna, Austria

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ProgrammeHighlight topicsKnee embolization: current evidence and ongoing trials

Knee embolization: current evidence and ongoing trials

 

Three reasons to watch my lecture on demand

  1. Sham-controlled RCT data has shown superiority of GAE over a sham procedure following complete embolization
  2. Resorbable embolic technology is increasing within the field of MSK embolotherapy
  3. IRs need to consider the whole patient when managing MSK conditions and gain education on disease specific management

Prof Mark Little
Speaker bio | Watch lecture
 

Musculoskeletal embolotherapy continues to move at pace. From the initial potential shown by Dr Yuji Okuno’s pioneering work [1], there is now data from two published randomized sham-controlled trials elucidating the role of genicular artery embolization [GAE] in the treatment of knee OA [2,3].

Research into GAE for knee OA remains the most widely studied MSK embolotherapy. It is becoming clear that complete embolization of a diseased territory is important for clinical success [3]. Research has shown the anatomical complexity encountered during GAE, with frequent anastomoses between vessels posing a risk of non-target embolization [4]. Systematic review and meta-analysis has shown GAE to be safe, with potential mid-term efficacy [5]. Future trials will provide more data on GAE against a sham procedure, further addressing the placebo effect [6]. Data should also concentrate on imaging, biomarkers, and neuropsychological correlates for clinical success. The GENESIS and GENESIS 2 studies both included functional MRI neuroimaging and neuropsychometric testing [6,7]. The GENESIS 1 long term data is now complete showing sustained significant clinical success of GAE in patients with mild to moderate knee OA at 2-years. Furthermore, a correlation between patient catastrophising and clinical outcome was found. The consideration of chronic pain and patient-specific neuropsychological phenotypes will potentially have a significant role in understanding patient selection and clinical outcome for MSK embolotherapy.

Aside from GAE, emerging data has shown potential for embolization as a treatment for patients with plantar fasciitis, adhesive capsulitis, lumbar back pain, as well as osteoarthritis of the fingers, to name but a few [8–11].  The pathophysiology, anatomy and embolization endpoint need careful consideration to perform safe and effective embolotherapy. A significant area of development within MSK embolization is within resorbable embolics. Resorbable embolic technology has several advantages over permanent particles, particularly in end-organ territories such as the hands and feet, where permanent embolics would pose too great a risk of non-target embolization.

As interventional radiology transitions to become a stand-alone clinical specialty, we need to gain a complete understanding of the MSK conditions we treat. Providing patient-centred management that considers other treatment options, limitations of embolization, and patient expectations are important. Understanding the role of biomechanics on pain and clinical outcome is essential. Collaborating with orthopaedic and rheumatology colleagues is needed to gain knowledge and access to physiotherapy and orthotics; both of which can optimize outcome following embolization. Furthermore, some patients will fail to respond to embolization. IRs need a robust mechanism of being able to send patients back to orthopaedics and rheumatology for other options that are in our patients’ best interests.

 

Mark Little

Royal Berkshire NHS Foundation Trust, Reading/UK


Prof Little is a consultant interventional radiologist, and research lead at the University Department of Radiology, Royal Berkshire NHS Foundation Trust, UK. Prof Little has established a large embolotherapy research group alongside his busy clinical practice and was awarded the NIHR research rising star award 2018, and CVIR Editors Medal 2022. Prof Little led the first European study investigating Genicular Artery Embolisation [GAE] in the treatment of knee OA [GENESIS]. He is currently leading the GENESIS 2 trial, a randomized sham-controlled trial investigating GAE. He was UK CI for PROstate, an international study investigating long term outcomes of PAE. In 2021, his research group opened a trial investigating the neuro-psychological factors correlating with failure to adhere to a day-case UAE pathway. He is current specialist advisor on the NICE interventional procedures programme, is a member of the CVIR editorial board, member of Next Research board, and is chair of the BSIR research committee. He has been invited to give over 50 lectures worldwide, and peer reviews for numerous journals including JVIR, CVIR, and The Lancet.

 

References

  1. Okuno Y, Matsumura N, Oguro S. Transcatheter arterial embolization using imipenem/cilastatin sodium for tendinopathy and enthesopathy refractory to nonsurgical management. J Vasc Interv Radiol. 2013 Jun;24[6]:787–92.
  2. 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 Jan;33[1]:2-10.e2.
  3. Landers S, Hely R, Hely A, Harrison B, Page RS, Maister N, et al. Genicular artery embolization for early-stage knee osteoarthritis: results from a triple-blind single-centre randomized controlled trial. Bone Jt Open. 2023 Mar 10;4[3]:158–67.
  4. O’Grady A, Welsh L, Gibson M, Briggs J, Speirs A, Little M. Cadaveric and Angiographic Anatomical Considerations in the Genicular Arterial System: Implications for Genicular Artery Embolisation in Patients with Knee Osteoarthritis. Cardiovasc Intervent Radiol. 2022 Jan 1;45[1]:80–90.
  5. Taslakian B, Miller LE, Mabud TS, Macaulay W, Samuels J, Attur M, et al. Genicular artery embolization for treatment of knee osteoarthritis pain: Systematic review and meta-analysis. Osteoarthr Cartil Open. 2023 Jun;5[2]:100342.
  6. Little MW, Harrison R, MacGill S, Speirs A, Briggs JH, Tayton E, et al. Genicular Artery Embolisation in Patients with Osteoarthritis of the Knee [GENESIS 2]: Protocol for a Double-Blind Randomised Sham-Controlled Trial. Cardiovasc Intervent Radiol. 2023 Jun 19;
  7. Little MW, Gibson M, Briggs J, Speirs A, Yoong P, Ariyanayagam T, et al. Genicular artEry embolizatioN in patiEnts with oSteoarthrItiS of the Knee [GENESIS] Using Permanent Microspheres: Interim Analysis. Cardiovasc Intervent Radiol. 2021 Jan 20;
  8. Okuno Y, Matsumura N, Oguro S. Transcatheter arterial embolization using imipenem/cilastatin sodium for tendinopathy and enthesopathy refractory to nonsurgical management. J Vasc Interv Radiol. 2013 Jun;24[6]:787–92.
  9. Shibuya M, Sugihara E, Miyazaki K, Fujiwara K, Sakugawa T, Okuno Y. Intra-arterial Infusion of Temporary Embolic Material in a Patient with Plantar Fasciitis: A Case Report. Cardiovasc Intervent Radiol. 2021 Jul 6;
  10. Inui S, Yoshizawa S, Shintaku T, Kaneko T, Ikegami H, Okuno Y. Intra-Arterial Infusion of Imipenem/Cilastatin Sodium through a Needle Inserted into the Radial Artery as a New Treatment for Refractory Trapeziometacarpal Osteoarthritis. Journal of Vascular and Interventional Radiology. 2021 Sep 1;32[9]:1341–7.
  11. Fujiwara K, Inui S, Shibuya M, Sugihara E, Miyazaki K, Sakugawa T, et al. Transcatheter Arterial Embolization Using Imipenem/Cilastatin Sodium for Chronic Low Back Pain Resistant to Conservative Treatment: A Pilot Study with 2-Year Follow-Up. Cardiovasc Intervent Radiol. 2021 Dec;44[12]:1964–70.