January 09, 2020
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Genicular artery embolization reduced inflammation, pain secondary to knee OA

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Sandeep Bagla

Genicular artery embolization is safe and potentially efficacious in the treatment of knee pain secondary to osteoarthritis, according to data published in the Journal of Vascular and Interventional Radiology.

“The study is significant because it addresses the underlying cause of pain associated with osteoarthritis, which includes an inflammatory process called synovitis,” Sandeep Bagla, MD, of the Vascular Institute of Virginia and the University of North Carolina-Chapel Hill, told Healio Rheumatology. “The synovitis early on in osteoarthritis leads to an increase in proinflammatory factors, one of which increases the amount of vascularity within the synovium and regional cartilage. It is this increase in vascularity which is the target of genicular artery embolization.”

This was the first study of its kind in the United States examining the use of genicular artery embolization (GAE) for extended knee-pain treatment in patients with OA, according to a press release. The minimally invasive procedure, which is currently only available in clinical trials, uses a spaghetti-sized catheter to block the flow of blood to certain parts of the knee that can be the source of OA-related pain. The catheter is directed through the arteries to the knee using X-ray and iodinated contrast, and spherical particles are injected to create a blockage once the appropriate knee arteries are identified.

Patients are under moderate sedation during this procedure and are discharged the same day with no physical therapy required, the researchers noted.

 
Genicular artery embolization is safe and potentially efficacious in the treatment of knee pain secondary to OA, according to data.
Source: Adobe

To evaluate the efficacy and safety of GAE in knee pain secondary to OA, Bagla and colleagues conducted a prospective study of 20 patients recruited from two sites. Participants included nine men and 11 women, aged 49 to 84 years, with radiographic knee OA and moderate-to-severe pain refractory to conservative therapy.

All patients underwent GAE with 75-m or 100-m spherical particles, and assessed using MRI at baseline and 1-month follow-up. The researchers also used the Visual Analogue Scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) to assess participants at baseline as well as at 1, 3 and 6 months. Adverse events were recorded at all follow-ups.

According to the researchers, embolization of at least one genicular artery was successfully achieved in all 20 participants. Mean VAS scores improved from 76 mm ± 14 at baseline to 29 mm ± 27 at the 6-month follow-up (P < .01), and mean WOMAC scores improved from 61 ± 12 at baseline to 29 ± 27 during the same period (P < .01). Self-limiting skin discoloration occurred in 65% patients, while 10% demonstrated plantar sensory paresthesia that resolved within 14 days.

According to the press release, the researchers are currently performing a randomized control trial comparing GAE to a placebo procedure.

“This pilot study demonstrated that genicular artery embolization can work to decrease inflammation and pain related to knee osteoarthritis,” Bagla said. “This can potentially offer many millions of patients treatment for their knee pain when they are not yet quite ready for knee replacement surgery or not good operative candidates.”

“The procedure is performed on an outpatient basis and takes approximately one hour and does not require any open incisions,” he added. “We completed enrollment in a second study which is a randomized clinical trial of a sham procedure vs. genicular artery embolization and we will be publishing these results shortly as well. It is our hope that we can demonstrate a role for this novel procedure in the setting of pain to potentially reduce the amount of pain medications taken by patients, disability and pain associated with a widely prevalent condition.” – by Jason Laday

Disclosure: Bagla reports consulting fees from Boston Scientific, Medtronic, Terumo and Merit Medical. Please see the study for all other authors’ relevant financial disclosures.