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van Zadelhoff TA, Kubo T, Shibuya M, Miyazaki K, Nakata M, Sugihara E, Oei EHG, Okuno Y. Comparative Safety of 3 Temporary Embolic Agents in Transcatheter Arterial Embolization for Degenerative, Inflammatory, and Overuse Joint Disorders. J Vasc Interv Radiol 2025; 36:979-987.e1. [PMID: 40032077 DOI: 10.1016/j.jvir.2025.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 02/11/2025] [Accepted: 02/23/2025] [Indexed: 03/05/2025] Open
Abstract
PURPOSE To evaluate the safety and degree of pain relief of 3 rapidly biodegraded embolic materials, including imipenem (IPM)/cilastatin sodium (CS), quick-soluble gelatin sponge particles (QS-GSPs), and resorbable microsphere (RMs), in transcatheter arterial embolization (TAE) for degenerative, inflammatory, and overuse joint disorders. MATERIALS AND METHODS Consecutive 431 patients, 527 joints with refractory overuse injuries, knee osteoarthritis, frozen shoulder, symptomatic rotator cuff tear, synovitis of the foot joints, and persistent pain after knee joint arthroplasty who underwent TAE between March 2020 and May 2023 were included in this retrospective study. IPM/CS, QS-GSPs, and RMs were used in 140 patients (176 TAEs), 136 patients (163 TAEs), and 155 patients (182 TAEs), respectively. Adverse events were monitored immediately after the procedure. Changes in pain numeric rating scale (NRS) score were evaluated at 1, 3, and 6 months after TAE. RESULTS No severe adverse events were observed. Increased pain at the site of embolization after the procedure lasting more than 7 days occurred in 7.1%, 22.1%, and 5.8% of patients with IPM/CS, QS-GSPs, and RMs, respectively, more commonly in the elbow joint. The NRS score improved from the baseline to 1, 3, and 6 months with IPM/CS (6.9 [SD ± 1.3] vs 4.4 [SD ± 2.2], 3.6 [SD ± 2.3], and 3.1 [SD ± 2.4], respectively; all P < .0001), QS-GSPs (6.4 [SD ± 1.5] vs 4.3 [SD ± 2.1], 3.6 [SD ± 2.2], and 3.0 [SD ± 2.1], respectively; all P < .0001), and RMs (7.0 [SD ± 1.3] vs 4.4 [SD ± 2.2], 3.2 [SD ± 2.1], and 2.3 [SD ± 1.8], respectively; all P < .0001). CONCLUSIONS IPM/CS, QS-GSPs, and RMs demonstrated acceptable safety profiles and effectively alleviated pain in TAE for degenerative, inflammatory, and overuse joint disorders.
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Affiliation(s)
- Tijmen A van Zadelhoff
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Takatoshi Kubo
- Department of Radiology, The University of Tokyo Hospital, Bunkyo, Tokyo, Japan
| | - Masahiko Shibuya
- Musculoskeletal Intervention Center, Okuno Clinic, Minato, Tokyo, Japan
| | - Koichi Miyazaki
- Musculoskeletal Intervention Center, Okuno Clinic, Minato, Tokyo, Japan
| | - Masaya Nakata
- Musculoskeletal Intervention Center, Okuno Clinic, Minato, Tokyo, Japan
| | - Eiji Sugihara
- Musculoskeletal Intervention Center, Okuno Clinic, Minato, Tokyo, Japan; Department of Radiology, Tokyo Medical University, Shinjuku, Tokyo, Japan
| | - Edwin H G Oei
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Yuji Okuno
- Musculoskeletal Intervention Center, Okuno Clinic, Minato, Tokyo, Japan.
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Liang KW, Lin HY, Hsu KL, Kuan FC, Gean CY, Wang CK, Su WR, Wang B. Clinical and Radiological Outcomes of Transarterial Embolization for Adhesive Capsulitis. Korean J Radiol 2025; 26:230-238. [PMID: 39999964 PMCID: PMC11865901 DOI: 10.3348/kjr.2024.0883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Revised: 12/24/2024] [Accepted: 12/24/2024] [Indexed: 02/27/2025] Open
Abstract
OBJECTIVE To assess the effect of transarterial embolization (TAE) for adhesive capsulitis (AC) by evaluating clinical outcomes and changes in inflammation using magnetic resonance imaging (MRI). MATERIALS AND METHODS Patients who had undergone TAE between August 2020 and August 2023 for AC refractory to conservative treatments without any invasive procedures for more than 3 months, and had undergone baseline and 3-month post-AC follow-up contrast-enhanced MRI evaluations, were included. A suspension mixture of 500 mg imipenem/cilastatin in 10 mL of iodinated contrast agent was used for TAE. MRI results were analyzed to assess periarticular capsule/ligament inflammation. Clinical assessments included pain scores using the numeric rating scale (NRS) and functional scores using the quick disabilities of the arm, shoulder, and hand (Quick DASH) questionnaire. RESULTS Twenty-five patients (female:male, 14:11; age, 54.9 ± 7.1 years) were included. Significant reductions in average NRS pain scores as well as improvements in Quick DASH scores and range of motion, including anterior flexion and abduction, were observed at 1, 3, and 6 months after TAE (all P < 0.001). MRI analyses revealed that TAE significantly decreased the grades of axillary recess capsule enhancement, rotator interval (RI) capsule T2 signal intensity, and RI capsule enhancement (all P ≤ 0.004). CONCLUSION TAE may be an effective and safe therapeutic approach for AC refractory to conservative treatments, alleviating pain and supporting functional recovery. The observed MRI findings suggest that the effectiveness of TAE for AC may be attributed to the reduction of inflammation and the elimination of angiogenesis.
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Affiliation(s)
- Keng-Wei Liang
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Hsuan Yin Lin
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Kai-Lan Hsu
- Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Fa-Chuan Kuan
- Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chia-Yu Gean
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Interventional Medicine Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Kuo Wang
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Interventional Medicine Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Ren Su
- Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Skeleton Materials and Bio-Compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Musculoskeletal Research Center, Innovation Headquarter, National Cheng Kung University, Tainan, Taiwan
| | - Bow Wang
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Interventional Medicine Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Nakamura H, Yamamoto A, Watanabe H, Hayashida M, Higaki A, Kanki A, Fukunaga T, Maruhisa T, Fukukura Y, Tamada T. Microembolization Effects of Imipenem/Cilastatin In Vivo Depicted by Monochromatic Synchrotron X-Ray Microangiography. J Vasc Interv Radiol 2025; 36:340-346. [PMID: 39481468 DOI: 10.1016/j.jvir.2024.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 10/11/2024] [Accepted: 10/22/2024] [Indexed: 11/02/2024] Open
Abstract
PURPOSE To elucidate the characteristics of imipenem (IPM)/cilastatin (CS) as an embolic material in microvessels in vivo. MATERIALS AND METHODS Three healthy rabbits were injected subcutaneously in 1 auricle with picibanil (OK-432) in advance to create an inflammation-induced neovascular model. Microangiography was performed using monochromatic X-rays obtained from a large synchrotron radiation facility (SuperPhoton ring-8 GeV, SPring-8). All rabbits underwent pre-embolic microangiography under anesthesia. Embolization from the central branch of the auricular artery was then performed using a mixture of IPM/CS (0.2 g) + nonionic contrast medium (2 mL). Microangiography was performed immediately after and at 10, 20, 30, 40, 50, 60, 70, 80, and 90 minutes after embolization. The diameter of embolized vessels was measured from the images immediately after embolization. Recanalization times were evaluated from immediately after embolization to 90 minutes after embolization, and they were compared between normal sites and sites where inflammation was induced. RESULTS The mean diameter of the embolized vessels immediately after embolization evaluated at the normal site was 267 μm (SD ± 58.35; range, 174-363 μm). Evaluation of postembolic recanalization showed that vessels in the normal sites recanalized after a mean of 70 minutes (range, 50-70 minutes), whereas vessels at the sites of inflammation did not recanalize in observations up to 90 minutes after embolization. CONCLUSIONS Microangiography using monochromatic X-rays produced from large synchrotron radiation showed that vessels larger than the IPM/CS particles were initially occluded, but the embolic effect resolved in normal vessels within 70 minutes and persisted in inflamed vessels. IPM/CS may thus exert a selective embolic effect on inflammation-related neovasculature.
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Affiliation(s)
- Hiroki Nakamura
- Department of Radiology, Kawasaki Medical School, Kurashiki City, Okayama, Japan.
| | - Akira Yamamoto
- Department of Radiology, Kawasaki Medical School, Kurashiki City, Okayama, Japan
| | - Hiroyuki Watanabe
- Department of Radiology, Kawasaki Medical School, Kurashiki City, Okayama, Japan
| | - Minoru Hayashida
- Department of Radiology, Kawasaki Medical School, Kurashiki City, Okayama, Japan
| | - Atushi Higaki
- Department of Radiology, Kawasaki Medical School, Kurashiki City, Okayama, Japan
| | - Akihiko Kanki
- Department of Radiology, Kawasaki Medical School, Kurashiki City, Okayama, Japan
| | - Takeshi Fukunaga
- Department of Radiology, Kawasaki Medical School, Kurashiki City, Okayama, Japan
| | - Takuma Maruhisa
- Department of Radiology, Kawasaki Medical School, Kurashiki City, Okayama, Japan
| | - Yoshihiko Fukukura
- Department of Radiology, Kawasaki Medical School, Kurashiki City, Okayama, Japan
| | - Tsutomu Tamada
- Department of Radiology, Kawasaki Medical School, Kurashiki City, Okayama, Japan
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Sajan A, Epelboym Y, Martínez AF, Little M, Talaie R, Isaacson A. Transarterial Embolization for Musculoskeletal Pain Management: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2025; 224:e2431626. [PMID: 39475196 DOI: 10.2214/ajr.24.31626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2024]
Abstract
Musculoskeletal embolization has emerged in recent years as a treatment of chronic joint pain, as the inflammatory cascade responsible for such pain has become better understood. Studies have shown a complex interplay between joint inflammation and synovial hypervascularity that causes growth of new unmyelinated nerve fibers responsible for pain. Embolization targets joint hypervascularity to disrupt the inflammatory cycle and provide pain relief. The standard treatment algorithm for chronic joint pain is well established and entails escalating therapeutic options that include exercise, self-management programs, analgesic medications, intraarticular injections, and finally surgical replacement or release. Genicular artery embolization (GAE), targeting abnormal vasculature around the knee joint, is the most studied musculoskeletal embolization procedure, reflecting the high worldwide prevalence and increasing incidence of knee osteoarthritis (OA). GAE is now supported by multiple prospective studies, including randomized controlled trials comparing GAE versus sham treatment. Embolization has also extended outside of the knee joint to include the shoulder (treatment of adhesive capsulitis or secondary stiff shoulder), elbow (medial or lateral epicondylitis), hip (OA, great trochanteric pain syndrome), and ankle (plantar fasciitis). This AJR Expert Panel Narrative Review discusses the current status of transarterial embolization for musculoskeletal pain management, focusing on treatment of knee OA and chronic shoulder pain.
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Affiliation(s)
- Abin Sajan
- Department of Radiology, Columbia University Herbert Irving Comprehensive Cancer Center, 822 W 168th St, New York, NY 10032
| | - Yan Epelboym
- Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | | | - Mark Little
- Department of Radiology, Berkshire Health Limited, Reading, England
| | - Reza Talaie
- Department of Radiology, University of Minnesota Medical School, Minneapolis, MN
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Sasaki T, Shibuya M, Miyazaki K, Nakata M, Kawabe A, Nakasone T, Sakai N, Okuno Y. Clinical results of ultrasound-guided intra-arterial embolization targeting abnormal neovessels for plantar fasciitis: 66 cases with up to 4 years of follow-up. Foot Ankle Surg 2025; 31:105-110. [PMID: 39089905 DOI: 10.1016/j.fas.2024.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 07/05/2024] [Accepted: 07/26/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Plantar fasciitis (PF) is the most common cause of chronic heel pain, affecting young and older patients. METHODS This retrospective study included patients with PF refractory to conservative treatment who underwent intra-arterial embolization of abnormal neovessels. All patients received temporary embolic material through a needle percutaneously inserted into the posterior tibial artery. The numeric rating scale (NRS) pain score, American Orthopaedic Foot and Ankle Society (AOFAS) score, and procedure-related adverse events were evaluated. RESULTS Between January 2020 and February 2022, 66 patients with PF were treated with intra-arterial embolization without major adverse events. The NRS pain score improved significantly, and the AOFAS score increased from 65.8 pre-treatment to 92.8 at 1 year post-treatment. The treatment effect was maintained until the final follow-up (mean duration: 30.9 months). CONCLUSIONS Ultrasound-guided intraarterial embolization using temporary embolic material may be effective for PF. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Takahide Sasaki
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8509, Japan; Musculoskeletal Intervention Center, Okuno Clinic Kobe, B1 Fl, 1-2-1, Sannomiyacho, Chuo-ku, Kobe City, Hyogo 650-0021, Japan
| | - Masahiko Shibuya
- Musculoskeletal Intervention Center, Okuno Clinic Kobe, B1 Fl, 1-2-1, Sannomiyacho, Chuo-ku, Kobe City, Hyogo 650-0021, Japan
| | - Koichi Miyazaki
- Musculoskeletal Intervention Center, Okuno Clinic Osaka, 3rd Fl Shinsaibashi Front Bldg., 3-5-11, Minamifunaba, Chuo-ku, Osaka City, Osaka 542-0081, Japan
| | - Masaya Nakata
- Musculoskeletal Intervention Center, Okuno Clinic Tokyo, 4th Fl Ginrei Bldg., 7-8-4, Roppongi, Minato-ku, Tokyo 106-0032, Japan
| | - Atsuhiko Kawabe
- Musculoskeletal Intervention Center, Okuno Clinic Tokyo, 4th Fl Ginrei Bldg., 7-8-4, Roppongi, Minato-ku, Tokyo 106-0032, Japan
| | - Takashi Nakasone
- Musculoskeletal Intervention Center, Okuno Clinic Tokyo, 4th Fl Ginrei Bldg., 7-8-4, Roppongi, Minato-ku, Tokyo 106-0032, Japan
| | - Nobuaki Sakai
- Musculoskeletal Intervention Center, Okuno Clinic Tokyo, 4th Fl Ginrei Bldg., 7-8-4, Roppongi, Minato-ku, Tokyo 106-0032, Japan
| | - Yuji Okuno
- Musculoskeletal Intervention Center, Okuno Clinic Tokyo, 4th Fl Ginrei Bldg., 7-8-4, Roppongi, Minato-ku, Tokyo 106-0032, Japan.
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Papalexis N, Peta G, Carta M, Quarchioni S, Di Carlo M, Miceli M, Facchini G. How Arterial Embolization Is Transforming Treatment of Oncologic and Degenerative Musculoskeletal Disease. Curr Oncol 2024; 31:7523-7554. [PMID: 39727678 DOI: 10.3390/curroncol31120555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2024] [Revised: 11/18/2024] [Accepted: 11/20/2024] [Indexed: 12/28/2024] Open
Abstract
BACKGROUND Arterial embolization is a minimally invasive treatment that occludes blood vessels supplying pathological tissue. Developed to control bleeding without surgery, it has evolved over decades and is now applied in musculoskeletal oncology as a preoperative treatment, palliative care, or standalone therapy for select tumors. Recently, its use has expanded globally in treating chronic pain syndromes and osteoarthritis. MATERIALS AND METHODS We reviewed the literature on arterial embolization in various musculoskeletal conditions. The focus was on established oncologic indications for primary and metastatic bone or soft tissue tumors, and emerging evidence on degenerative diseases like osteoarthritis, inflammatory musculoskeletal pathology, and intractable pain. Emphasis was placed on leading studies regarding efficacy, complications, and recurrence rates. DISCUSSION Arterial embolization has progressed from bleeding control to a versatile therapeutic option in musculoskeletal medicine. It offers symptom relief, reduces tumor size, and improves quality of life. Applications include oncologic interventions and management of degenerative and inflammatory conditions. Despite its benefits, variations in complications and recurrence rates highlight the need for standardized protocols and further research. CONCLUSIONS Arterial embolization is a safe and effective minimally invasive tool in the multidisciplinary management of a wide range of musculoskeletal pathologies. Ongoing research is crucial to understand long-term efficacy, optimize protocols, and broaden its applications.
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Affiliation(s)
- Nicolas Papalexis
- Department of Diagnostic and Interventional Radiology, IRCCS-Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Giuliano Peta
- Department of Diagnostic and Interventional Radiology, IRCCS-Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Michela Carta
- Department of Diagnostic and Interventional Radiology, IRCCS-Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Simone Quarchioni
- Department of Diagnostic and Interventional Radiology, IRCCS-Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Maddalena Di Carlo
- Department of Diagnostic and Interventional Radiology, IRCCS-Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Marco Miceli
- Department of Diagnostic and Interventional Radiology, IRCCS-Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Giancarlo Facchini
- Department of Diagnostic and Interventional Radiology, IRCCS-Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
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Pan CY, Liang KW, Chen TR, Wang CK, Liao WY, Lu YH, Hsiung YC, Liu YS, Wang B. Added value of pre-procedural magnetic resonance angiography in transarterial embolization for refractory musculoskeletal pain. Front Med (Lausanne) 2024; 11:1471504. [PMID: 39568746 PMCID: PMC11576317 DOI: 10.3389/fmed.2024.1471504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2024] [Accepted: 10/16/2024] [Indexed: 11/22/2024] Open
Abstract
Background Transarterial microembolization (TAME) is a minimally invasive treatment for chronic musculoskeletal disorders. Identifying angiogenesis and the supplying vessels of the target joint is important but challenging. Although magnetic resonance imaging (MRI) is commonly used to diagnose musculoskeletal diseases, it typically excludes vascular imaging. Dynamic contrast-enhanced magnetic resonance angiography (DCE-MRA) has the ability to visualize lesion angiogenesis, identify supplying vessels, and evaluate the vasculature anatomy. We propose that incorporating DCE-MRA into pre-procedural assessments can help identify the culprit vessels, arterial anatomy, and variant assessment of the target joint before TAME. Materials and methods We investigated six cases, each presenting pain in different body parts: shoulder adhesive capsulitis, trapezius myalgia, combined tennis and golf elbow, knee osteoarthritis, refractory knee pain after osteotomy, and plantar fasciitis. All patients underwent MRI with DCE-MRA before undergoing TAME. DCE-MRA was performed using either 1.5 T or 3 T MRI scanners, employing 3D-TRICKS or 4D-TRAK XD techniques. The numerical rating scale for pain was evaluated at one, three, and six months after the procedure, and any adverse events were recorded over the entire six-month follow-up period. Results Pre-procedural DCE-MRA helped to visualize angiogenesis at the lesion site in all patients and identify the supplying vessels, arterial vasculature anatomy, and branching variants. These findings corroborated the subsequent digital subtraction angiography (DSA) findings obtained during TAME. All patients experienced pain reduction and functional improvement after TAME without any complications. The average pain score reduced significantly after TAME treatment (p < 0.05). Two patients underwent a second MRI and DCE-MRA at the six-month follow-up and showed a significant reduction in angiogenesis. Conclusion DCE-MRA offers a valuable pre-procedural assessment tool for TAME procedures by facilitating the visualization of angiogenesis at the lesion site, supplying vessels, and arterial anatomic variants, including the variable orifice of the supplying branches. This information can potentially improve patient selection and pre-procedural planning, leading to better outcomes and reduced risk of complications.
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Affiliation(s)
- Chiao-Yun Pan
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Keng-Wei Liang
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ting-Rong Chen
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Kuo Wang
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Interventional Medicine Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wen-Ying Liao
- Department of Biotechnology and Bioindustry Sciences, National Cheng Kung University, Tainan, Taiwan
| | - Ying-Hung Lu
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Cheng Hsiung
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Sheng Liu
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Bow Wang
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Interventional Medicine Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Li KW, Liang KW, Liao WY, Wang CK, Liu YS, Yang TH, Wu CH, Wang B. Nitroglycerin (NTG) Infusion for Intraprocedural Vasospasm in Transarterial Microembolization (TAME): A Case Series. Life (Basel) 2024; 14:1413. [PMID: 39598211 PMCID: PMC11595508 DOI: 10.3390/life14111413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2024] [Revised: 10/21/2024] [Accepted: 10/31/2024] [Indexed: 11/29/2024] Open
Abstract
Transarterial microembolization (TAME) is an innovative approach to treating chronic musculoskeletal pain. During the procedure, intraprocedural vasospasm, presenting juxta-catheter stenosis, and poor distal artery perfusion and flow through the anastomosis commonly pose challenges. Difficulty of the catheter reaching the target vessel and restricted drug delivery are possible consequences. To address these issues, transcatheter nitroglycerin (NTG) infusion at the extremity's small-sized artery has been introduced. We investigated patients who underwent the TAME procedure wherein NTG was employed and sourced from two institutional settings. Transcatheter NTG infusion was administered in seven instances of chronic musculoskeletal pain manifesting with intraprocedural vasospasm during TAME procedures. Patient profiles, preprocedural imaging, fluoroscopic findings, adverse events, and Numerical Rating Scale (NRS) scores were evaluated. As a result, all seven cases experiencing intraprocedural vasospasm exhibited rapid responses to transcatheter NTG infusion. Angiography conducted pre- and post-infusion demonstrated increased vessel size, resolved proximal catheter stenosis, and improved distal perfusion. One case presented an adverse effect of self-limited transient hypotension. The NRS scores decreased following the procedure. Transcatheter NTG infusion at the extremity's small-sized muscular artery can be an effective technique for resolving intraprocedural vasospasm in TAME procedures, irrespective of the target diseases and approach vessels.
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Affiliation(s)
- Kuan-Wei Li
- Department of Medical Imaging, National Cheng Kung University, Tainan 704, Taiwan; (K.-W.L.); (C.-K.W.); (Y.-S.L.)
| | - Keng-Wei Liang
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung 402, Taiwan;
- School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
| | - Wen-Ying Liao
- Department of Biotechnology and Bioindustry Sciences, National Cheng Kung University, Tainan 704, Taiwan;
| | - Chien-Kuo Wang
- Department of Medical Imaging, National Cheng Kung University, Tainan 704, Taiwan; (K.-W.L.); (C.-K.W.); (Y.-S.L.)
| | - Yi-Sheng Liu
- Department of Medical Imaging, National Cheng Kung University, Tainan 704, Taiwan; (K.-W.L.); (C.-K.W.); (Y.-S.L.)
| | - Tai-Hua Yang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan 704, Taiwan;
- Department of Orthopedic Surgery, National Cheng Kung University Hospital, Tainan 704, Taiwan
- Medical Device Innovation Center, National Cheng Kung University, Tainan 704, Taiwan
| | - Chun-Hsin Wu
- Department of Internal Medicine, Division of Allergy, Immunology, and Rheumatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
| | - Bow Wang
- Department of Medical Imaging, National Cheng Kung University, Tainan 704, Taiwan; (K.-W.L.); (C.-K.W.); (Y.-S.L.)
- Interventional Medicine Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
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Kubo T, Shibuya M, Miyazaki K, Tsuji Y, Nakata M, Kawabe A, Nakasone T, Sakai N, Okuno Y. Transcatheter Arterial Embolization for Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Retrospective Study of 44 Patients. Cardiovasc Intervent Radiol 2024; 47:1348-1355. [PMID: 39191997 DOI: 10.1007/s00270-024-03842-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 08/16/2024] [Indexed: 08/29/2024]
Abstract
PURPOSE To investigate the preliminary treatment outcomes of transcatheter arterial embolization (TAE) for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). MATERIALS AND METHODS This retrospective study included patients with refractory CP/CPPS who underwent TAE between April 2022 and February 2023. All patients had persistent pelvic pain for at least 3 months, a total score of at least 15 on the NIH-Chronic Prostatitis Symptom Index (NIH-CPSI), and lacked evidence of infection. All procedures were performed by injecting imipenem/cilastatin sodium (IPM/CS) from bilateral prostatic arteries ± internal pudendal arteries. NIH-CPSI, pain numeric rating scale (NRS), and complications were evaluated at 1, 3, and 6 months after the initial TAE and at the final follow-up. RESULTS Out of 48 patients, 44 were included in this study, with four excluded because of loss of follow-up. No severe procedure-related complications were observed. Pretreatment and post-treatment evaluations at 1, 3, and 6 months after the initial TAE and at the final follow-up (mean 16.6 months) revealed a decrease in the mean NIH-CPSI scores from 27 ± 6 to 21 ± 8, 20 ± 9, 17 ± 9, and 18 ± 9, respectively (all P < 0.001). Pain NRS scores were also decreased from 7.0 ± 1.6 to 4.8 ± 2.5, 4.1 ± 2.6, 3.7 ± 2.4, and 3.4 ± 2.3, respectively (all P < 0.001). The proportions of clinical success, defined as a reduction of at least 6 points from baseline in the NIH-CPSI, at 6 months after TAE and at the final follow-up were 70 and 64%, respectively. CONCLUSIONS This study provides evidence of the feasibility of TAE using IPM/CS for CP/CPPS, suggesting both symptomatic improvement and safety.
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Affiliation(s)
- Takatoshi Kubo
- Department of Radiology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
- Department of Interventional Radiology, Okuno Clinic Tokyo, 4th Fl Ginrei Bldg., 7-8-4, Roppongi, Minato-Ku, Tokyo, 106-0032, Japan
| | - Masahiko Shibuya
- Department of Interventional Radiology, Okuno Clinic Kobe, B1 Fl, 1-2-1, Sannomiyacho, Chuo-Ku, Kobe City, Hyogo, 650-0021, Japan
| | - Koichi Miyazaki
- Department of Interventional Radiology, Okuno Clinic Osaka, 3Rd Fl Shinsaibashi Front Bldg., 3-5-11, Minamifunaba, Chuo-Ku, Osaka, 542-0081, Japan
| | - Yusuke Tsuji
- Department of Interventional Radiology, Okuno Clinic Tokyo, 4th Fl Ginrei Bldg., 7-8-4, Roppongi, Minato-Ku, Tokyo, 106-0032, Japan
| | - Masaya Nakata
- Department of Interventional Radiology, Okuno Clinic Tokyo, 4th Fl Ginrei Bldg., 7-8-4, Roppongi, Minato-Ku, Tokyo, 106-0032, Japan
| | - Atsuhiko Kawabe
- Department of Interventional Radiology, Okuno Clinic Tokyo, 4th Fl Ginrei Bldg., 7-8-4, Roppongi, Minato-Ku, Tokyo, 106-0032, Japan
| | - Takashi Nakasone
- Department of Interventional Radiology, Okuno Clinic Tokyo, 4th Fl Ginrei Bldg., 7-8-4, Roppongi, Minato-Ku, Tokyo, 106-0032, Japan
| | - Nobuaki Sakai
- Department of Interventional Radiology, Okuno Clinic Tokyo, 4th Fl Ginrei Bldg., 7-8-4, Roppongi, Minato-Ku, Tokyo, 106-0032, Japan
| | - Yuji Okuno
- Department of Interventional Radiology, Okuno Clinic Tokyo, 4th Fl Ginrei Bldg., 7-8-4, Roppongi, Minato-Ku, Tokyo, 106-0032, Japan.
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Lin HY, Liang KW, Wang B, Lee CC. Challenges and complications and their management of the transarterial microembolization for chronic musculoskeletal pain. Eur Radiol 2024; 34:3260-3270. [PMID: 37853172 DOI: 10.1007/s00330-023-10328-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/05/2023] [Accepted: 10/02/2023] [Indexed: 10/20/2023]
Abstract
Transarterial microembolization (TAME) is an increasingly well-known novel and minimally invasive treatment option for painful chronic musculoskeletal diseases that is gaining popularity. Although the safety and effectiveness of TAME have been established, limited knowledge of intraarticular and musculocutaneous arterial anatomy may lead to challenges and complications. This article aims to present cases illustrating these challenges and complications, based on multicenter experiences and a comprehensive literature review. Furthermore, the article also provides preventive tips, solutions, and follow-up strategies to reduce the learning curve for interventional radiologists and facilitate familiarity with post-TAME follow-up images for diagnostic radiologists. CLINICAL RELEVANCE STATEMENT: This article illustrates the intra- and post-interventional complications of transarterial microembolization (TAME) through detailed pictorial reviews, including how to distinguish them from normal angiographic findings. It provides strategies for their prevention, management, and follow-up, which can further improve clinical outcomes. KEY POINTS: • Transarterial microembolization for chronic musculoskeletal pain may result in intrainterventional challenges (IIC) and postinterventional complications (PIC), and their importance may be underestimated. • The intrainterventional challenges include microarterial perforation, arterial dissection, and catheter tip fracture, whereas postinterventional complications include tissue ischemia-related complications, puncture site hemorrhage, and arterial injury. • Being familiar with the intrainterventional challenges and postinterventional complications may help minimize the procedure risk and improve outcomes.
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Affiliation(s)
- Hsuan-Yin Lin
- Department of Radiology, Taichung Veterans General Hospital, No.1650 Taiwan Boulevard Sect. 4, Taichung, Taiwan, 40705, Republic of China.
| | - Keng-Wei Liang
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, 402, Taiwan.
- School of Medicine, Chung Shan Medical University, Taichung, 402, Taiwan.
| | - Bow Wang
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 704, Taiwan
| | - Cheng-Chun Lee
- Department of Medical Imaging, Tungs' Taichung Metroharbor Hospital, Taichung, 435, Taiwan
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Lanciego C, Puentes-Gutierrez A, Sánchez-Casado M, Cifuentes-Garcia I, Fernández-Tamayo A, Dominguez-Paillacho D, Ciampi-Dopazo JJ, Marquina-Valero MA. Transarterial Embolization for Adhesive Capsulitis of the Shoulder: Midterm Outcomes on Function and Pain Relief. J Vasc Interv Radiol 2024; 35:550-557. [PMID: 38199458 DOI: 10.1016/j.jvir.2023.12.572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/27/2023] [Accepted: 12/30/2023] [Indexed: 01/12/2024] Open
Abstract
PURPOSE To determine the safety and potential effectiveness of transarterial embolization for adhesive capsulitis of the shoulder. MATERIALS AND METHODS This prospective study analyzed consecutive adult patients with adhesive capsulitis referred for embolization between January 2018 and May 2023 after a poor response to treatment (symptoms and limitation of motion in ≥2 axes; ≤120° flexion, ≤50° external rotation and/or internal rotation with the shoulder abducted 90°) persisting for >3 months after having completed ≥6 weeks of analgesics and physical therapy. Different types of pain and mobility were measured before embolization and 1, 3, and 6 months after embolization. Overall upper limb function (Quick Disabilities of Arm, Shoulder, and Hand) and patient satisfaction were measured before and 6 months after embolization. Long-term follow-up comprised telephone interviews and clinical history reviews. RESULTS A total of 20 patients (12 [60%] women; median age, 50.7; interquartile ranges [IQR], 45‒55 years) were included; 6 (30%) had diabetes and 15 (75%) were off work. Median duration of symptoms before embolization was 39.4 weeks (IQR, 28‒49 weeks), and median duration of rehabilitation therapy was 12.8 weeks (IQR, 8‒16 weeks). Six months after embolization, significant improvements were observed in nocturnal pain (P = .003), pain on moving (P = .001), external rotation (P < .001), internal rotation (P < .001), active flexion (P < .001), passive flexion (P = .03), active abduction (P < .001), passive abduction (P < .001), and overall function (P < .001). Despite objective improvements, patient satisfaction was nearly unchanged. Only 1 patient experienced a mild adverse event. CONCLUSION Transarterial embolization is safe and potentially effective in treating adhesive capsulitis of the shoulder refractory to conventional treatment. Clinical improvements were maintained in the mid to long term.
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Affiliation(s)
- Carlos Lanciego
- Interventional Radiology Unit, Radiology Department, Complejo Hospitalario Universitario de Toledo, Toledo, Spain.
| | - Ana Puentes-Gutierrez
- Rehabilitation and Physical Medicine Department, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | - Marcelino Sánchez-Casado
- Biostatistics Unit, Intensive Care Department, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | - Irene Cifuentes-Garcia
- Interventional Radiology Unit, Radiology Department, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | - Ana Fernández-Tamayo
- Interventional Radiology Unit, Radiology Department, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | - David Dominguez-Paillacho
- Interventional Radiology Unit, Radiology Department, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | - Juan J Ciampi-Dopazo
- Interventional Radiology Unit, Radiology Department, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | - Maria A Marquina-Valero
- Rehabilitation and Physical Medicine Department, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
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Piechowiak R, Sajan A, Isaacson A, Lerner J, Bagla S. Angiographic Analysis of Anatomical Variants in Adhesive Capsulitis Embolization. Cardiovasc Intervent Radiol 2023:10.1007/s00270-023-03427-9. [PMID: 37041388 DOI: 10.1007/s00270-023-03427-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/23/2023] [Indexed: 04/13/2023]
Abstract
PURPOSE To analyze the complex shoulder vasculature and identify potential challenges during adhesive capsulitis embolization (ACE). MATERIALS AND METHODS Two interventional radiologists evaluated angiographic findings from 21 ACE procedures. The suprascapular artery (SSA), thoracoacromial artery (TAA), coracoid branch (CB), circumflex scapular artery (CSA), and anterior/posterior circumflex humeral artery (ACHA/PCHA) were assessed for their presence, course, diameter within 1 cm of origin, angle to the proximal parent vessel, and distance from the clavicle. RESULTS 83 arteries were embolized: CB (20.5%), TAA (19.3%), PCHA (19.3%), ACHA (16.9%), CSA (14.5%), and SSA (9.6%). The CSA had the largest diameter (4.3 mm), while CB had the smallest diameter (1.0 mm). An acute angle to the parent vessel was noted with the SSA, TAA, ACHA, and PCHA. A common origin for CSA and PCHA was noted in 2 patients. A common origin for TAA and SSA was also noted in one patient. The CB appears perpendicular to the axillary artery and courses vertically toward the coracoid process. The TAA branches off the axillary artery and courses along the medial border of the pectoralis minor. The PCHA and ACHA originate from the axillary artery. The CSA is located on the medial side of axillary artery. The SSA originates from the thyrocervical trunk and courses laterally toward the superior border of the scapula. CONCLUSION An anatomical-technical guide is provided to help interventional radiologists during ACE to treat adhesive capsulitis.
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Affiliation(s)
- Rachel Piechowiak
- Prostate Centers USA, 1801 Robert Fulton Dr Suite 510, Reston, VA, 20191, USA
| | - Abin Sajan
- Columbia University Irving Medical Center, 622 W 168th St, New York, NY, 10032, USA
| | - Ari Isaacson
- Prostate Centers USA, 9400 Brier Creek Pkwy Suite 202, Raleigh, NC, 27617, USA
| | - Jade Lerner
- St George's University School of Medicine, University Centre Grenada, West Indies, Grenada.
| | - Sandeep Bagla
- Prostate Centers USA, 2755 Hartland Rd #110, Falls Church, VA, 22043, USA
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