Genicular Artery Embolization Relieves Chronic Knee Pain Caused By Osteoarthritis

A process performed nether mild sedation successful little than 2 hours by an interventional radiologist relieves chronic knee symptom caused by osteoarthritis, an NYU Langone Health study shows.

As they gradually break down, knee joints successful people pinch osteoarthritis are known to go inflamed, which triggers nan maturation of mini humor vessels (angiogenesis) and accrued humor travel to joints. The study procedure, called genicular artery embolization, kept this abnormal humor travel from ferrying successful immune cells that origin nan inflammation and related pain. 

For nan caller study, nan researchers delivered chemic beads (biocompatible hydrogels) done an image-guided integrative conduit to artifact humor travel successful immoderate of a half-dozen arteries feeding nan synovium lining successful nan knee. More than 60 percent of nan 25 men and women who had nan process astatine its accommodation successful Manhattan knowledgeable important improvements 1 twelvemonth later.

Results of nan study published online Aug. 12 successful nan Journal of Vascular Interventional Radiology.

"Our study shows that genicular artery embolization is simply a safe and effective, minimally invasive curen for those pinch mean to terrible symptomatic knee symptom tied to osteoarthritis," said study co-investigator and interventional radiologist Ryan Hickey, MD. "This activity besides provides grounds that genicular artery embolization is offering much than conscionable symptom alleviation and could beryllium modifying nan diseases process itself."

"This process is peculiarly suited to those patients who are either not yet fresh for knee replacement room aliases for whom room is not an action because of property aliases different consequence factors, specified arsenic obesity, uncontrolled glucosuria aliases bosom disease, aliases smoking," added Hickey, an subordinate professor successful nan Department of Radiology astatine NYU Grossman School of Medicine, wherever he besides serves arsenic conception main of vascular and interventional radiology.

He says location is urgent request for alternative, less-invasive treatments for osteoarthritis. An estimated 24 cardinal cases of osteoarthritis successful a knee are diagnosed each twelvemonth successful nan United States, a number he expects only to turn pinch nan aging population.

Among nan study's different cardinal results were significant, one-year postsurgical declines (on mean 12%) successful humor levels of vascular endothelial maturation factor (VEGF), a macromolecule that is needed to stimulate nan statement of caller humor vessels. Past investigation has besides linked VEGF to different structural changes successful nan knee from osteoarthritis. Another macromolecule biomarker, interleukin 1 receptor agonist (IL-1Ra) showed a akin alteration (15%). IL-1Ra is known for its domiciled successful countering inflammation. Tests of a half-dozen different immune molecules progressive successful inflammation were inconclusive.

Our investigation suggests that declines successful vascular endothelial maturation facet could service arsenic a valuable biomarker aliases chemic trace for determining occurrence pinch genicular artery embolization, offering a much-needed nonsubjective benchmark by which to measurement its effectiveness."

Bedros Taslakian, MD, MA., study main interrogator and lead author

"Our study findings besides bespeak that genicular artery embolization may, if further larger objective tests beryllium successful, slow down nan progression of osteoarthritis by watching important decreases successful signaling proteins, specifically vascular endothelial maturation facet and interleukin 1 receptor agonist, 1 twelvemonth aft nan procedure," said Taslakian. Formerly an subordinate professor successful nan Department of Radiology astatine NYU Grossman School of Medicine, Taslakian is now vice chair for investigation successful nan Department of Interventional Radiology astatine nan University of Miami Miller School of Medicine successful Florida.

The improvements seen successful nan 25 patients successful nan existent study were captured by modular diligent study scores for knee pain, stiffness, and nan expertise to bend, guidelines up, aliases locomotion up and down stairs freely. While subjective surveys are useful successful monitoring illness progression, Hickey says, independent humor tests for illustration nan NGF measurement are much meticulous and convenient for patients for search mini declines aliases improvements complete time.

The NYU Langone squad has plans to further analyse precisely really embolization alleviates inflammation and leads to symptom relief.

Hickey besides says that much investigation is needed to found really agelong nan procedure's benefits past and which osteoarthritis patients are astir apt to benefit.

All study volunteers were diagnosed pinch mean to terrible osteoarthritis successful nan knee that had been unresponsive to first-line therapy. This includes knee injections of corticosteroids to trim inflammation; fluid aspiration (arthrocentesis) to region excess fluid from nan joint; and injections of platelet-rich plasma to repair damaged tissue; arsenic good arsenic physiotherapy. Study subordinate ages ranged from 50 years aged to 78 years old, pinch each having their embolization procedures performed betwixt January 2021 and January 2023.

As portion of nan procedure, interventional radiologists accessed each patient's arteries done a mini incision successful nan thigh, utilizing video x-ray to guideline nan catheter to nan precise knee artery selected earlier for embolization. Study participants were past monitored during regular checkups for astatine slightest 1 twelvemonth and crossed two-dozen measures of pain, knee stiffness, and their expertise to move about. Patients needed to execute a four-point quality connected a standard of 20 points to found a clinically important simplification successful pain. Side effects from nan procedure, nan researchers say, were minimal and constricted to acheronian tegument blemishes connected nan knee and mild symptom adjacent nan incision site.

Funding for nan study was provided by NYU Langone.

Besides Hickey and Taslakian, NYU Langone researchers progressive successful nan study are co-investigator Mukundan Attur, PhD; Erin Alai, MD; Jonathan Samuels, MD; William Macaulay, MD; Danibel Ramos, RN; Shu Liu, MD; and Elizabeth Morris, MD.