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Yuan X, Feng S, Xiao W, Li J, He Y, Zhou F, Liu X. Rat shoulder contracture models: Techniques, evaluation, pathophysiology, and applications in developing treatment interventions. Heliyon 2024; 10:e37936. [PMID: 39381200 PMCID: PMC11458964 DOI: 10.1016/j.heliyon.2024.e37936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 08/21/2024] [Accepted: 09/13/2024] [Indexed: 10/10/2024] Open
Abstract
Studies on the pathophysiology of shoulder contracture and development of interventions have greatly benefited from the use of animal models. This narrative review comprehensively analyzes research on established rat model of shoulder contracture and new treatment approaches. This review evaluated existing literature on the available techniques for inducing contracture models, assessed these models, conducted pathological analyses, and explored their application in developing new treatment interventions. Our review highlights the usefulness of different rat shoulder contracture models, including external immobilization, internal immobilization, and intra-articular injection models, each with varying levels of success. Pathological analyses have demonstrated similarities to the human condition. The effective models have been instrumental in developing new treatment interventions, including recombinant human relaxin-2, platelet-rich plasma, collagenase clostridium histolyticum, and peroxisome proliferator-activated receptor-γ agonists. Therefore, rat shoulder contracture models serve as valuable tools for researchers to establish an effective animal model foundation for investigating the etiology and potential treatment.
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Affiliation(s)
- Xiangnan Yuan
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Shengwen Feng
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Wanan Xiao
- Department of Orthopaedics, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Jianjun Li
- Department of Orthopaedics, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Yu He
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Fenghua Zhou
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Xueyong Liu
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
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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 2024:10.1007/s00270-024-03842-6. [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] [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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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 2024:S1268-7731(24)00160-7. [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] [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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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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Okuno Y. Transarterial Embolization for Refractory Overuse Sports Injury: Pictorial Case Reports. Cardiovasc Intervent Radiol 2023; 46:1525-1537. [PMID: 37433909 DOI: 10.1007/s00270-023-03496-w] [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: 10/31/2022] [Accepted: 06/18/2023] [Indexed: 07/13/2023]
Abstract
Transarterial embolization for the treatment of chronic musculoskeletal diseases is gaining increasing interest in the field of interventional radiology. Overuse sports injury is defined as an injury occurring in the absence of a single, identifiable traumatic cause. In the treatment of this condition, there is a need for reliable results and a quick return to activity. Minimally invasive treatments with short periods of missed practice are required. Intra-arterial embolization has the potential to meet this need. In this article, we describe cases of embolization for refractory overuse sports injuries including patellar tendinopathy, pes anserine, plantar fasciitis, triangular fibrocartilage complex injury, hamstring injury, infrapatellar fat pad inflammation, Achilles tendinopathy, delayed union metatarsal bone fracture, lumbar spondylolysis, and repetitive hamstrings strain.
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Affiliation(s)
- Yuji Okuno
- Musculoskeletal Intervention Center, Okuno Clinic, 4th Fl Ginrei Bldg., 7-8-4, Roppongi, Minato-ku, Tokyo, 106-0032, Japan.
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Min J, Park SW, Hwang JH, Lee JK, Lee DW, Kwon YW, Shin KC. 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; 34:1868-1874. [PMID: 37473861 DOI: 10.1016/j.jvir.2023.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 06/19/2023] [Accepted: 07/10/2023] [Indexed: 07/22/2023] Open
Abstract
PURPOSE To evaluate the effectiveness and safety of genicular artery embolization (GAE) using quick-soluble gelatin sponge particles (QS-GSPs) to alleviate chronic knee pain associated with osteoarthritis. MATERIALS AND METHODS This retrospective study included 71 patients (97 procedures, including 26 patients for both knees) who underwent GAE to treat osteoarthritic knee pain between August 2019 and January 2022. QS-GSPs were used for all the procedures. Technical success was defined as the embolization of at least 1 feeding artery. Clinical outcomes were evaluated using a 10-point visual analog scale (VAS). Clinical success was defined as a decrease in the VAS score of >50%. RESULTS The technical success rate was 100% (97 of 97). The mean VAS scores at baseline, immediately after TAE, and at 1 day, 1 week, 1 month, 3 months, and 6 months after TAE were 6.3, 4.3, 5.0, 3.0, 2.9, 2.9, and 2.8, respectively. The clinical success rate was 72% (70 of 97 patients) at 6 months. No major adverse events were reported, and temporary skin color change (50.5%, 49 of 97) and hematoma at the puncture site (10.3%, 10 of 97) were observed. CONCLUSIONS GAE using QS-GSPs had a high technical success rate and was considered safe. Clinical outcomes using QS-GSPs were comparable with those of existing materials.
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Affiliation(s)
- Jeeyoung Min
- Department of Radiology, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Sang Woo Park
- Department of Radiology, Konkuk University Medical Center, Seoul, Republic of Korea.
| | - Jin Ho Hwang
- Department of Radiology, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Joon Kyu Lee
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Dhong Won Lee
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Yong Wonn Kwon
- Department of Interventional Radiology, Cheil Orthopedic Hospital, Seoul, Republic of Korea
| | - Kyu Cheol Shin
- Department of Interventional Radiology, Cheil Orthopedic Hospital, Seoul, Republic of Korea
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Kubo T, Miyazaki K, Shibuya M, Sugihara E, Nakata M, Okuno Y. Intra-Arterial Injection of Temporary Embolic Material Through a Needle Inserted into the Radial or Ulnar Artery for Distal and Proximal Interphalangeal Joint Osteoarthritis: A Retrospective Study of 92 Patients. Cardiovasc Intervent Radiol 2023; 46:1375-1382. [PMID: 37524895 DOI: 10.1007/s00270-023-03514-x] [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: 02/16/2023] [Accepted: 07/06/2023] [Indexed: 08/02/2023]
Abstract
PURPOSE To assess the efficacy and safety of intra-arterial injection of imipenem/cilastatin sodium (IPM/CS) via a needle placed into the radial artery or ulnar artery (RA/UA) for distal interphalangeal and proximal interphalangeal joint osteoarthritis (DIP/PIP-OA). MATERIALS AND METHODS This is a retrospective single-arm cohort study. Ninety-two patients [92% women, mean (SD) age 55(8.3) years] with a primary DIP/PIP-OA meet the American College of Rheumatology criteria for hand osteoarthritis with pain ≥ 4 on the 0-10 numeric rating scale (NRS) were enrolled. All procedures were performed by injecting IPM/CS through a 24-gauge needle percutaneously inserted into the RA/UA. Two procedures were planned; the second procedure was scheduled 1-2 months after the first. NRS, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, Patient Global Impression of Change (PGIC) scale, and procedure-related adverse events were evaluated. RESULTS Technical success, defined as injection of IPM/CS into the RA/UA, was achieved in all patients. Clinical success, defined as a reduction of 2 points or more in the NRS at 12 months, was 77% (95% confidence interval 68-85%). The NRS improved from the baseline to 3, 6, and 12 months (7.8 ± 1.6 vs. 3.8 ± 2.6, 3.9 ± 2.7, and 4.0 ± 2.8, respectively, all p < 0.001). The QuickDASH score improved from the baseline to 12 months (27 ± 15 vs. 19 ± 17, p < 0.001) respectively. No major adverse events were observed. CONCLUSIONS Intra-arterial injection of IPM/CS is a feasible treatment option for DIP/PIP-OA.
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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
- Musculoskeletal Intervention Center, Okuno Clinic Tokyo, 4th Fl Ginrei Bldg., 7-8-4, Roppongi, Minato-ku, Tokyo, 106-0032, 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
| | - Masahiko Shibuya
- Musculoskeletal Intervention Center, Okuno Clinic Kobe, B1 Fl, 1-2-1, Sannomiyacho, Chuo-ku, Kobe City, Hyogo, 650-0021, Japan
| | - Eiji Sugihara
- Musculoskeletal Intervention Center, Okuno Clinic Tokyo, 4th Fl Ginrei Bldg., 7-8-4, Roppongi, Minato-ku, Tokyo, 106-0032, Japan
| | - Masaya Nakata
- 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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Gill SD, Hely R, Hely A, Harrison B, Page RS, Landers S. Outcomes after Genicular Artery Embolization Vary According to the Radiographic Severity of Osteoarthritis: Results from a Prospective Single-Center Study. J Vasc Interv Radiol 2023; 34:1734-1739. [PMID: 37331590 DOI: 10.1016/j.jvir.2023.06.016] [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: 01/07/2023] [Revised: 06/05/2023] [Accepted: 06/09/2023] [Indexed: 06/20/2023] Open
Abstract
This prospective single-center study compared outcomes after genicular artery embolization (GAE) in people with mild radiographic knee osteoarthritis (OA) (n = 11) versus moderate to severe radiographic knee OA (n = 22). The mild OA group was older and had experienced symptoms for less time (P < .05). All participants underwent complete embolization of neovessels from genicular arteries. The primary outcome was the proportion of responders at 6 months according to predetermined improvements in pain, function, and/or global change. Results indicated that a higher proportion of participants (n = 9, 81.8%) with mild OA fulfilled responder criteria after treatment compared with people with moderate to severe OA (n = 8, 36.4%) (P = .014). Secondary outcomes for pain, quality of life, and global change were also better in the mild OA group (P < .05). No serious adverse events occurred, including the absence of osteonecrosis on magnetic resonance imaging. The study demonstrated that outcomes after GAE varied according to the severity of baseline radiographic OA.
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Affiliation(s)
- Stephen D Gill
- Barwon Medical Imaging, Barwon Health, Geelong, Victoria, Australia; GIRADI Research Institute, Geelong, Victoria, Australia; School of Medicine, Deakin University, Waurn Ponds, Victoria, Australia; Barwon Centre for Orthopaedic Research & Education, St John of God and Geelong Hospitals, Geelong, Victoria, Australia
| | - Rachael Hely
- Barwon Medical Imaging, Barwon Health, Geelong, Victoria, Australia; GIRADI Research Institute, Geelong, Victoria, Australia
| | - Andrew Hely
- Barwon Medical Imaging, Barwon Health, Geelong, Victoria, Australia; GIRADI Research Institute, Geelong, Victoria, Australia; Integral Diagnostics, Geelong, Victoria, Australia
| | - Benjamin Harrison
- Barwon Medical Imaging, Barwon Health, Geelong, Victoria, Australia; GIRADI Research Institute, Geelong, Victoria, Australia
| | - Richard S Page
- School of Medicine, Deakin University, Waurn Ponds, Victoria, Australia; Barwon Centre for Orthopaedic Research & Education, St John of God and Geelong Hospitals, Geelong, Victoria, Australia
| | - Steve Landers
- GIRADI Research Institute, Geelong, Victoria, Australia; Clinical Precision, Geelong, Victoria, Australia.
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Landers S, Hely R, Hely A, Harrison B, Page RS, Maister N, Gwini SM, Gill SD. Genicular artery embolization for early-stage knee osteoarthritis: results from a triple-blind single-centre randomized controlled trial. Bone Jt Open 2023; 4:158-167. [PMID: 37051829 PMCID: PMC10032233 DOI: 10.1302/2633-1462.43.bjo-2022-0161.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
This study investigated the effects of transcatheter arterial embolization (TAE) on pain, function, and quality of life in people with early-stage symptomatic knee osteoarthritis (OA) compared to a sham procedure. A total of 59 participants with symptomatic Kellgren-Lawrence grade 2 knee OA were randomly allocated to TAE or a sham procedure. The intervention group underwent TAE of one or more genicular arteries. The control group received a blinded sham procedure. The primary outcome was knee pain at 12 months according to the Knee injury and Osteoarthritis Outcome Score (KOOS) pain scale. Secondary outcomes included self-reported function and quality of life (KOOS, EuroQol five-dimension five-level questionnaire (EQ-5D-5L)), self-reported Global Change, six-minute walk test, 30-second chair stand test, and adverse events. Subgroup analyses compared participants who received complete embolization of all genicular arteries (as distinct from embolization of some arteries) (n = 17) with the control group (n = 29) for KOOS and Global Change scores at 12 months. Continuous variables were analyzed with quantile regression, adjusting for baseline scores. Dichotomized variables were analyzed with chi-squared tests. Overall, 58 participants provided questionnaire data at 12 months. No significant differences were found for the primary and secondary outcomes, with both groups improving following the procedure. At 12 months, KOOS pain scores improved by 41.3% and 29.4% in the intervention and control groups, respectively. No adverse events occurred. Subgroup analysis indicated that the complete embolization group had significantly better KOOS Sports and Recreation, KOOS Quality of Life, and Global Change scores than the control group; 76.5% of participants who received complete embolization reporting being moderately or much better compared to 37.9% of the control group. TAE might produce benefits above placebo, but only when complete embolization of all genicular arteries is performed. Further comparative studies are required before definitive conclusions regarding the effectiveness of TAE can be made. Level of evidence: I.
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Affiliation(s)
- Steve Landers
- Barwon Medical Imaging, University Health Geelong, Geelong, Australia
- GIRADI Research Institute, Geelong, Australia
| | - Rachael Hely
- Barwon Medical Imaging, University Health Geelong, Geelong, Australia
- GIRADI Research Institute, Geelong, Australia
| | - Andrew Hely
- Barwon Medical Imaging, University Health Geelong, Geelong, Australia
- GIRADI Research Institute, Geelong, Australia
| | - Benjamin Harrison
- Barwon Medical Imaging, University Health Geelong, Geelong, Australia
- GIRADI Research Institute, Geelong, Australia
| | - Richard S Page
- Department of Orthopaedics, Barwon Health, Geelong, Australia
- Barwon Centre for Orthopaedic Research and Education (B-CORE), School of Medicine, Deakin University & St John of God Hospital, Geelong, Australia
| | - Nick Maister
- Department of Orthopaedics, Barwon Health, Geelong, Australia
| | | | - Stephen D Gill
- Barwon Medical Imaging, University Health Geelong, Geelong, Australia
- GIRADI Research Institute, Geelong, Australia
- Barwon Centre for Orthopaedic Research and Education (B-CORE), School of Medicine, Deakin University & St John of God Hospital, Geelong, Australia
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11
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Frozen Shoulder. Tech Vasc Interv Radiol 2023; 26:100882. [PMID: 36889844 DOI: 10.1016/j.tvir.2022.100882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Adhesive capsulitis (AC) develops spontaneously without a known cause and is a common cause of painful shoulder. The natural history of AC can last until 36 months and it is classically considered a self-limiting entity, however there is a high rate of refractory cases to conventional treatment with residual deficits during years. There is no consensus on the therapeutic guidelines to be followed in patients with AC. Several authors have pointed out the relevance of hypervascularization of the capsule in the pathophysiology of AC, that is why the objective of transarterial embolization (TAE) is to decrease the abnormal vascularization responsible for the inflammatory-fibrotic state that occurs in AC. TAE has now emerged as a therapeutic option in refractory patients. We describe the most important technical aspects of TAE and review the current literature on arterial embolization as a treatment for AC.
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12
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Finas M, Frandon J, Gremen E, Horteur C, Benassayag M, Lateur G, Pailhe R, Ferretti G, Bellier A, Ghelfi J. A Retrospective Comparison of the Efficacy of Embolization with Imipenem/Cilastatin and Microspheres in the Management of Chronic Shoulder Pain. Cardiovasc Intervent Radiol 2023:10.1007/s00270-023-03385-2. [PMID: 36826491 DOI: 10.1007/s00270-023-03385-2] [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: 09/21/2022] [Accepted: 01/31/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE To compare the efficacy of embolization with imipenem/cilastatin and microspheres in chronic shoulder pain. METHODS This retrospective study included 29 patients who underwent embolization for chronic shoulder pain between June 2017 and March 2022 with calibrated MSs from 100 to 250 µm or IMP/CS. The main objective was the clinical success evaluated by the Minimum Clinically Important Difference (MCID) at 3 months after the procedure, validated if the patient responded yes to 2 questions: (1) Is the pain less severe than before the procedure? (2) Are you satisfied with the procedure? The decrease in visual analogue pain scale scores and the safety of the procedure were evaluated. RESULTS Embolization was achieved in all patients. In the MS group, 4/15 patients (26.7%) experienced clinical success at 3 months according to MCID versus 10/14 patients (71.4%) in the IMP/CS group (p = 0.02). The mean VAS decreases were respectively - 28.6% ± 34.6 in the MS group and - 36.8% ± 27.8 in the IMP/CS group at 1 month (p = 0.50), - 29.9% ± 29.0 and - 39.6% ± 23.0 at 3 months (p = 0.33) and - 30.6% ± 32.8 and - 46.6% ± 28.4 at 6 months after the procedure (p = 0.26). Eleven patients (73.3%) in the MS group and 3 patients (21.4%) in the IMP/CS group had complications (p = 0.01). Among them, 2/15 patients (13.3%) had transient skin ischaemia in the MS group. CONCLUSION Embolization with IMP/CS may be more effective and safer than MSs in the management of chronic shoulder pain.
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Affiliation(s)
- Mathieu Finas
- University of Grenoble-Alpes, Grenoble, France.,Department of Radiology, Grenoble-Alpes University Hospital, Grenoble, France
| | - Julien Frandon
- Department of Radiology, Nimes University Hospital, Nimes, France
| | - Emeric Gremen
- University of Grenoble-Alpes, Grenoble, France.,Department of Radiology, Grenoble-Alpes University Hospital, Grenoble, France
| | - Clément Horteur
- University of Grenoble-Alpes, Grenoble, France.,Department of Orthopaedic Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Michaël Benassayag
- Department of Orthopaedic Surgery, Medipôle de Savoie Hospital, Challes-les-Eaux, France
| | - Gabriel Lateur
- Department of Orthopaedic Surgery Department, Albertville Hospital, Albertville, France
| | - Régis Pailhe
- University of Grenoble-Alpes, Grenoble, France.,Department of Orthopaedic Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Gilbert Ferretti
- University of Grenoble-Alpes, Grenoble, France.,Department of Radiology, Grenoble-Alpes University Hospital, Grenoble, France
| | - Alexandre Bellier
- University of Grenoble-Alpes, Grenoble, France.,Clinical Research Department, Grenoble-Alpes University Hospital, Grenoble, France
| | - Julien Ghelfi
- University of Grenoble-Alpes, Grenoble, France. .,Department of Radiology, Grenoble-Alpes University Hospital, Grenoble, France. .,Institute for Advanced Biosciences, INSERM U1209, CNRS UMR 5309, University of Grenoble-Alpes, Grenoble, France.
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13
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Wang B, Liang KW, Chen CH, Wang CK. Transcatheter Arterial Embolization for Alleviating Chronic Musculoskeletal Pain and Improving Physical Function: A Narrative Review. Diagnostics (Basel) 2022; 13:134. [PMID: 36611426 PMCID: PMC9818587 DOI: 10.3390/diagnostics13010134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/08/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023] Open
Abstract
Chronic musculoskeletal pain imposes immense suffering and diminishes the quality of life for millions of patients worldwide; the pain persists despite the use of standard conservative treatments. Increases in our understanding of the pathophysiological mechanisms underlying musculoskeletal disorders indicate the involvement of inappropriate angiogenesis. Accordingly, the resulting neovessels are the target of emerging treatments for chronic musculoskeletal pain, including transarterial embolization. The use of this noninvasive procedure to treat pain refractory to standard therapy in a variety of musculoskeletal conditions is the focus of numerous recent investigations. Here, we describe the pathophysiological indications for the use of transarterial embolization and summarize the findings of studies investigating its use in a variety of histopathological conditions and anatomical sites.
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Affiliation(s)
- Bow Wang
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - 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
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
| | - Chia-Hui Chen
- Department of Medical Imaging and Radiological Sciences, I-Shou University, Kaohsiung City 824, Taiwan
| | - Chien-Kuo Wang
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
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14
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Transarterial Embolization of Neovascularity for Refractory Nighttime Shoulder Pain: A Multicenter, Open-Label, Feasibility Trial. J Vasc Interv Radiol 2022; 33:1468-1475.e8. [PMID: 35995121 DOI: 10.1016/j.jvir.2022.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 07/08/2022] [Accepted: 08/12/2022] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To assess the feasibility of transarterial embolization (TAE) for recalcitrant nighttime shoulder pain in a multicentric study. MATERIALS AND METHODS This prospective, open-label, feasibility trial included 100 patients treated at 5 institutions. TAE was performed in 76 patients with adhesive capsulitis (AC) and 24 patients with symptomatic rotator cuff tears (sRCTs). The ipsilateral radial artery was punctured, and imipenem/cilastatin sodium was infused as an embolic agent. Adverse events, 10 point pain numerical rating scale (NRS), range of motion (ROM) of the shoulder joint, and quality of life (via the EuroQol-5D [EQ-5D]) were evaluated. RESULTS All patients exhibited neovascularity on baseline angiography, and all TAE procedures were performed successfully. No patient experienced a major adverse event. The mean nighttime pain NRS scores at baseline and 1, 3, and 6 months after TAE were 6.4 ± 2.2, 3.4 ± 2.6, 2.3 ± 2.5, and 1.6 ± 2.2, respectively (for all, P < .001). The mean ROM of anterior elevation at baseline and 1, 3, and 6 months after TAE were 97° ± 29°, 119° ± 28°, 135° ± 27°, and 151° ± 17°, respectively (for all, P < .001). The mean EQ-5D scores at baseline and 1, 3, and 6 months after TAE were 0.63 ± 0.17, 0.73 ± 0.16, 0.80 ± 0.17, and 0.84 ± 0.17, respectively (for all, P < .001). There was no significant difference in the clinical success rate between the AC and sRCT groups. CONCLUSIONS TAE for nighttime shoulder pain caused by AC and sRCTs was feasible with sufficient safety and efficacy.
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15
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Shintaku T, Inui S, Ikegami H, Yoshizawa S, Ishii H, Sakamoto M, Musha Y, Okuno Y, Kuji I. Alteration of chronic inflammatory status by transarterial embolization in frozen shoulder evaluated by 18-fluorine-fluoro-2-deoxyglucose positron-emission tomography/computed tomography. J Shoulder Elbow Surg 2022; 32:e227-e234. [PMID: 36435485 DOI: 10.1016/j.jse.2022.10.021] [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: 05/11/2022] [Revised: 09/30/2022] [Accepted: 10/20/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Frozen shoulder (FS) is speculated to have an inflammatory etiology. On angiography, abnormal angiogenesis is observed around the affected shoulder, suggesting a possible source of inflammation and pain. The effectiveness and safety of transarterial embolization (TAE) targeting abnormally proliferating blood vessels have been reported. This study investigated changes in chronic inflammatory and hypoxic status before and after TAE in FS by 19-fluorine-fluoro-2-deoxyglucose (FDG) positron-emission tomography/computed tomography as a possible mechanism of the therapeutic response to TAE. METHODS Fifteen patients with unilateral FS, persistent for more than 6 months, who were refractory to conservative treatments, underwent TAE using the temporary embolic agent imipenem/cilastatin. Patients underwent positron-emission tomography/computed tomography with FDG (as a biomarker of inflammation) before and 8 weeks after TAE. Regional uptake was evaluated by the maximum standardized uptake value. The lesion-side-to-(contralateral-) normal-side uptake ratio was also calculated. Pain and functional scales, range-of-motion, and laboratory tests, including white blood cell, C-reactive protein, interleukin 6, vascular endothelial growth factor, and tumor necrosis factor α were evaluated. RESULTS On FDG-PET, the average maximum standardized uptake value of the lesion-side was significantly greater than that of the normal-side (maximum standardized uptake value before TAE: 3.11 ± 1.25 vs 1.95 ± 1.15, P = .0001; 8-weeks post-TAE: 2.36 ± 0.74 vs 1.78 ± 0.69, P = .0002). The mean lesion-side-to-(contralateral-) normal-side uptake ratios before TAE (1.71 ± 0.60) decreased after TAE (1.37 ± 0.29, P = .011). The decrease of FDG uptake (-21.1 ± 12.2%) showed a significant correlation with the change in the pain scale score (r = -0.56, P = .039) and extension score (r = -0.59, P = .026). CONCLUSION Chronic inflammation in FS, as demonstrated by FDG uptake, was decreased after TAE. Thus, chronic inflammation is likely to be an underlying mechanism that should be targeted for symptomatic improvement of frozen shoulder.
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Affiliation(s)
- Takanori Shintaku
- Department of Orthopaedics Surgery, Toho University Ohashi Medical Center, Meguro-ku, Tokyo, Japan; Musculoskeletal Intervention Center, Edogawa Hospital, Edogawa-ku, Tokyo, Japan; Department of Orthopaedic Surgery, Toho University Graduate School of Medicine, Ota-ku, Tokyo, Japan
| | - Shohei Inui
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Hiroyasu Ikegami
- Department of Orthopaedics Surgery, Toho University Ohashi Medical Center, Meguro-ku, Tokyo, Japan
| | - Shu Yoshizawa
- Department of Orthopaedics Surgery, Toho University Ohashi Medical Center, Meguro-ku, Tokyo, Japan; Department of Orthopaedic Surgery, Toho University Graduate School of Medicine, Ota-ku, Tokyo, Japan
| | - Hideaki Ishii
- Department of Orthopaedics Surgery, Toho University Ohashi Medical Center, Meguro-ku, Tokyo, Japan
| | - Misato Sakamoto
- Department of Orthopaedics Surgery, Toho University Ohashi Medical Center, Meguro-ku, Tokyo, Japan; Department of Orthopaedic Surgery, Toho University Graduate School of Medicine, Ota-ku, Tokyo, Japan
| | - Yoshiro Musha
- Department of Orthopaedics Surgery, Toho University Ohashi Medical Center, Meguro-ku, Tokyo, Japan
| | - Yuji Okuno
- Musculoskeletal Intervention Center, Edogawa Hospital, Edogawa-ku, Tokyo, Japan; Musculoskeletal Intervention Center, Okuno Clinic, Minato-ku, Tokyo, Japan; Department of Radiology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
| | - Ichiei Kuji
- Department of Nuclear Medicine, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
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16
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Feasibility of Neovessel Embolization in a Large Animal Model of Tendinopathy: Safety and Efficacy of Various Embolization Agents. J Pers Med 2022; 12:jpm12091530. [PMID: 36143314 PMCID: PMC9501590 DOI: 10.3390/jpm12091530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/12/2022] [Accepted: 09/15/2022] [Indexed: 11/17/2022] Open
Abstract
Targeting neovessels in chronic tendinopathies has emerged as a new therapeutic approach and several embolization agents have been reported. The aim of this study was to investigate the feasibility of embolization with different agents in a porcine model of patellar tendinopathy and evaluate their safety and efficacy. Eight 3-month-old male piglets underwent percutaneous injection of collagenase type I to induce patellar tendinopathies (n = 16 tendons). They were divided into four groups (2 piglets, 4 tendons/group): the control group, 50–100 µm microspheres group, 100–300 µm microspheres group, and the Imipenem/Cilastatin (IMP/CS) group. Angiography and embolization were performed for each patellar tendon on day 7 (D7). The neovessels were evaluated visually with an angiography on day 14. The pathological analysis assessed the efficacy (Bonar score, number of neovessels/mm2) and safety (off-target persistent cutaneous ischemic modifications and presence of off-target embolization agents). The technical success was 92%, with a failed embolization for one tendon due to an arterial dissection. Neoangiogenesis was significantly less important in the embolized groups compared to the control group angiographies (p = 0.04) but not with respect to histology (Bonar score p = 0.15, neovessels p = 0.07). Off-target cutaneous embolization was more frequently depicted in the histology of the 50–100 µm microspheres group (p = 0.02). Embolization of this animal model with induced patellar tendinopathy was technically feasible with different agents and allowed assessing the safety and efficacy of neovessel destruction. Particles smaller than 100 µm seemed to be associated with more complications.
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17
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Gremen E, Frandon J, Lateur G, Finas M, Rodière M, Horteur C, Benassayag M, Thony F, Pailhe R, Ghelfi J. Safety and Efficacy of Embolization with Microspheres in Chronic Refractory Inflammatory Shoulder Pain: A Pilot Monocentric Study on 15 Patients. Biomedicines 2022; 10:biomedicines10040744. [PMID: 35453492 PMCID: PMC9028229 DOI: 10.3390/biomedicines10040744] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/15/2022] [Accepted: 03/21/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose: Musculoskeletal (MSK) embolization is emerging in tendinopathy treatment. The objective of this study was to assess the efficacy and safety of MSK embolization with microspheres in the treatment of chronic shoulder pain. Patients and methods: This retrospective monocentric study included patients with chronic shoulder pain resistant to 6 months or more of conventional therapies who were treated with MSK embolization between 2017 and 2021. Embolization was performed using calibrated 100–250 µm microspheres. Clinical success was defined as pain reduction, i.e., a decrease in the visual analogue scale (VAS) pain score of ≥50% at 3 months after MSK embolization as compared to baseline. Adverse events were collected. Results: Fifteen patients (11 women, 4 men) were included, with a median age of 50.3 years (IQR: 46.7–54.5). The median duration of symptoms was 26.6 months (20.6–39.8). The median VAS pain scores were 7.0 (7.0–8.0) at baseline, 6.0 (3.5–7.0) at 1 month, 5.0 (4.5–6.5) and 5.0 (3.0–7.4) at 3 months and 6 months (p = 0.002). Three patients (20%) reported clinical success at 3 months. Three patients experienced minor complications after embolization (paresthesia, n = 2; transient osteo-medullary edema, n = 1) and two patients had moderate complications (transient skin ischemia). Conclusion: MSK embolization with microspheres for treatment of refractory chronic shoulder pain showed moderate results in terms of clinical success and safety.
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Affiliation(s)
- Emeric Gremen
- Faculty of Medecine, Grenoble-Alpes University, 38043 Grenoble, France; (E.G.); (R.P.)
- Radiology Department, Grenoble Alpes University Hospital, 38043 Grenoble, France; (M.F.); (M.R.); (F.T.)
| | - Julien Frandon
- Radiology Department, Nimes University Hospital, University of Montpellier, 30900 Nimes, France;
| | - Gabriel Lateur
- Orthopaedic and Traumatology Surgery Department, Albertville Hospital, 73200 Albertville, France;
| | - Mathieu Finas
- Radiology Department, Grenoble Alpes University Hospital, 38043 Grenoble, France; (M.F.); (M.R.); (F.T.)
| | - Mathieu Rodière
- Radiology Department, Grenoble Alpes University Hospital, 38043 Grenoble, France; (M.F.); (M.R.); (F.T.)
| | - Clément Horteur
- Department of Orthopaedic Surgery, Grenoble Alpes University Hospital, 38043 Grenoble, France;
| | - Michaël Benassayag
- Orthopaedic Surgery Department, Medipôle de Savoie Hospital, 73190 Challes-les-Eaux, France;
| | - Frédéric Thony
- Radiology Department, Grenoble Alpes University Hospital, 38043 Grenoble, France; (M.F.); (M.R.); (F.T.)
| | - Régis Pailhe
- Faculty of Medecine, Grenoble-Alpes University, 38043 Grenoble, France; (E.G.); (R.P.)
- Department of Orthopaedic Surgery, Grenoble Alpes University Hospital, 38043 Grenoble, France;
| | - Julien Ghelfi
- Faculty of Medecine, Grenoble-Alpes University, 38043 Grenoble, France; (E.G.); (R.P.)
- Radiology Department, Grenoble Alpes University Hospital, 38043 Grenoble, France; (M.F.); (M.R.); (F.T.)
- Institute of Advanced Biosciences, INSERM U1209, CNRS UMR 5309, 38043 Grenoble, France
- Correspondence: ; Tel.: +33-4-76-76-89-09
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18
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Ghelfi J, Bacle M, Stephanov O, de Forges H, Soulairol I, Roger P, Ferretti GR, Beregi JP, Frandon J. Collagenase-Induced Patellar Tendinopathy with Neovascularization: First Results towards a Piglet Model of Musculoskeletal Embolization. Biomedicines 2021; 10:biomedicines10010002. [PMID: 35052682 PMCID: PMC8773136 DOI: 10.3390/biomedicines10010002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Therapeutic strategies targeting neovessels responsible for musculoskeletal chronic pain have emerged, including neovessels embolization. Our study aimed to develop a large animal model of patellar tendinopathy with neovascularization. Methods: Nine 3-month-old male piglets (18 patellar tendons) received percutaneous injections of increasing doses of collagenase (0 to 50 mg) at day 0 (D0). Tendinopathy was evaluated by ultrasound (D7 and D14). Neovascularization was evaluated visually and on angiographies. Bonar score was used for histological analysis (D14). Correlations were evaluated using Spearman’s rank (Rs) test. Results: Research protocol was well tolerated. All tendons were enlarged with a median increase of 31.58% [25–40.28] at D7 (p = 0.244) at D7 and 57.52% [48.41–91.45] at D14 (p = 0.065). Tendons with collagenase injection had more hypoechoic changes, with one tendon rupture (p = 0.012). Neovascularization was reported above 5 mg collagenase (p < 0.01) at D7 and D14 with dose-related neovessels induction (Rs = 0.8, p < 0.001). The Bonar score increased above 5 mg collagenase, correlated with the dose (Rs = 0.666, p = 0.003). Conclusions: The study shows the feasibility, safety and reproducibility of this new large animal model of patellar tendinopathy with neovascularization after collagenase injection. It will allow studying new treatments on direct embolization of neovessels by endovascular approach.
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Affiliation(s)
- Julien Ghelfi
- Service de Radiologie Diagnostique et Interventionnelle, CHU Grenoble Alpes, 38043 Grenoble, France; (J.G.); (G.R.F.)
- Department of Medical Imaging, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes, 30000 Nimes, France; (H.d.F.); (J.-P.B.)
| | - Marylène Bacle
- Faculty of Medicine, Montpellier Nîmes University, RAM-PTNIM, 30000 Nimes, France;
| | - Olivier Stephanov
- Anatomopathology Department, Grenoble University Hospital, 38043 Grenoble, France;
| | - Hélène de Forges
- Department of Medical Imaging, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes, 30000 Nimes, France; (H.d.F.); (J.-P.B.)
| | - Ian Soulairol
- Department of Pharmacy, Nîmes University Hospital, 30000 Nimes, France;
- ICGM, University of Montpellier, CNRS, ENSCM, 34090 Montpellier, France
| | - Pascal Roger
- Anatomopathology Department, Nimes University Hospital, University of Montpellier, 30000 Nimes, France;
| | - Gilbert R. Ferretti
- Service de Radiologie Diagnostique et Interventionnelle, CHU Grenoble Alpes, 38043 Grenoble, France; (J.G.); (G.R.F.)
| | - Jean-Paul Beregi
- Department of Medical Imaging, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes, 30000 Nimes, France; (H.d.F.); (J.-P.B.)
| | - Julien Frandon
- Department of Medical Imaging, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes, 30000 Nimes, France; (H.d.F.); (J.-P.B.)
- Correspondence: ; Tel.: +33-4-66-68-67-22
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19
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Fujiwara K, Inui S, Shibuya M, Sugihara E, Miyazaki K, Sakugawa T, Okuno Y. 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; 44:1964-1970. [PMID: 34668999 DOI: 10.1007/s00270-021-02976-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/27/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the safety and 2-year follow-up clinical outcomes of transcatheter arterial embolization (TAE) using imipenem/cilastatin sodium for chronic low back pain resistant to conservative treatment. MATERIALS AND METHODS A retrospective review identified 14 patients who underwent TAE for chronic low back pain between October 2017 and August 2018. Patients with low back pain related to the facet or sacroiliac joint, lasting ≥ 6 months, refractory to ≥ 3 months of conservative treatment were eligible for TAE. Each patient received embolization of feeding arteries of painful regions. The changes in brief pain inventory (BPI) scores, adverse events, and the Oswestry Disability Index (ODI) were evaluated at baseline and 1, 3, and 24 months after TAE. Clinical success was defined as BPI maximum pain intensity decrease of ≥ 2 and ODI decrease of ≥ 10 points from baseline. RESULTS Follow-up data were available in 13 and 11 patients, at 3 and 24 months after embolization, respectively. Intention-to-treat clinical success was obtained in 11/14 (79%) of patients at 3 months and 8/14 (57%) of patients at 24 months after TAE. Mean BPI maximum pain intensity and ODI scores decreased significantly from baseline to 1, 3, and 24 months after treatment (7.6 vs.. 4.3, 3.4, and 4.1; 40.8 vs 21.5, 20.0, and 23.8, respectively; all P < 0.01). No major adverse events were associated with the procedures. CONCLUSION TAE is one possible treatment option for patients with chronic low back pain refractory to conservative treatment.
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Affiliation(s)
- Keishi Fujiwara
- Musculoskeletal Intervention Center, Okuno Clinic, 4th Fl Ginrei Bldg., 7-8-4, Roppongi, Minato-ku, Tokyo, 106-0032, Japan
| | - Shohei Inui
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan
| | - Masahiko Shibuya
- Musculoskeletal Intervention Center, Okuno Clinic, 4th Fl Ginrei Bldg., 7-8-4, Roppongi, Minato-ku, Tokyo, 106-0032, Japan
| | - Eiji Sugihara
- Musculoskeletal Intervention Center, Okuno Clinic, 4th Fl Ginrei Bldg., 7-8-4, Roppongi, Minato-ku, Tokyo, 106-0032, Japan
| | - Koichi Miyazaki
- Musculoskeletal Intervention Center, Okuno Clinic, 4th Fl Ginrei Bldg., 7-8-4, Roppongi, Minato-ku, Tokyo, 106-0032, Japan
| | - Takayuki Sakugawa
- Musculoskeletal Intervention Center, Okuno Clinic, 4th Fl Ginrei Bldg., 7-8-4, Roppongi, Minato-ku, Tokyo, 106-0032, Japan
| | - Yuji Okuno
- Musculoskeletal Intervention Center, Okuno Clinic, 4th Fl Ginrei Bldg., 7-8-4, Roppongi, Minato-ku, Tokyo, 106-0032, Japan.
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20
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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. J Vasc Interv Radiol 2021; 32:1341-1347. [PMID: 34242776 DOI: 10.1016/j.jvir.2021.06.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/23/2021] [Accepted: 06/27/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of intra-arterial infusion of temporary embolic material with/without radiographic monitoring via a needle placed into the radial artery to occlude abnormal neovessels for trapeziometacarpal osteoarthritis. MATERIALS AND METHODS Thirty-one patients having Eaton stage II or III osteoarthritis, with a symptom duration longer than 6 months, resistant to conservative therapy for at least 3 months were prospectively enrolled. All procedures were performed by infusing imipenem/cilastatin sodium through a 24-gauge needle that was percutaneously inserted into the radial artery. Seven patients underwent the procedure with fluoroscopy, and 21 patients underwent the procedure without fluoroscopy. The mean Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, numerical rating scale (NRS), and Patient Global Impression of Change (PGIC) scale were evaluated before and at 2, 6, and 24 months after the first procedure. RESULTS Technical success was 100%. The mean procedure time (from the beginning of local anesthesia to the removal of needle) was 2.9 minutes ± 1.6. The QuickDASH score improved from the baseline to 2, 6, and 24 months (49.2 ± 11.2 vs 22.1 ± 11.2, 20.9 ± 16.6, and 19.5 ± 16.1, respectively, all P <.001). The NRS improved from the baseline to 2, 6, and 24 months (7.2 ± 1.1 vs 3.1 ± 1.8, 2.8 ± 2, and 2.5 ± 2.1, respectively, all P <.001). Improvement on PGIC was observed in 84%, 81%, and 77% of patients at 2, 6, and 24 months, respectively. No major adverse events were encountered. CONCLUSIONS Intra-arterial infusion of temporary embolic material is a feasible treatment option for trapeziometacarpal osteoarthritis.
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Affiliation(s)
- Shohei Inui
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shu Yoshizawa
- Department of Orthopedic Surgery, School of Medicine, Toho University, Tokyo, Japan; Musculoskeletal Intervention Center, Edogawa Hospital, Tokyo, Japan
| | - Takanori Shintaku
- Department of Orthopedic Surgery, School of Medicine, Toho University, Tokyo, Japan
| | - Takao Kaneko
- Department of Orthopedic Surgery, School of Medicine, Toho University, Tokyo, Japan
| | - Hiroyasu Ikegami
- Department of Orthopedic Surgery, School of Medicine, Toho University, Tokyo, Japan
| | - Yuji Okuno
- Musculoskeletal Intervention Center, Edogawa Hospital, Tokyo, Japan; Musculoskeletal Intervention Center, Okuno Clinic, Tokyo, Japan.
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21
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Koucheki R, Dowling KI, Patel NR, Matsuura N, Mafeld S. Characteristics of Imipenem/Cilastatin: Considerations for Musculoskeletal Embolotherapy. J Vasc Interv Radiol 2021; 32:1040-1043.e1. [PMID: 34210475 DOI: 10.1016/j.jvir.2021.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/02/2021] [Accepted: 04/04/2021] [Indexed: 10/21/2022] Open
Affiliation(s)
- Robert Koucheki
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Kierdra I Dowling
- Department of Materials Science and Engineering, University of Toronto, Toronto, Canada
| | - Neeral R Patel
- Division of Interventional Radiology, University Health Network, Toronto, Ontario, Canada
| | - Naomi Matsuura
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada; Department of Materials Science and Engineering, University of Toronto, Toronto, Canada; Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Sebastian Mafeld
- Division of Interventional Radiology, University Health Network, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Canada.
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