Midterm Clinical Outcomes and MR Imaging Changes after Transcatheter Arterial Embolization as a Treatment for Mild to Moderate Radiographic Knee Osteoarthritis Resistant to Conservative Treatment.

PURPOSE: To describe the safety and efficacy of transcatheter arterial embolization for mild to moderate radiographic knee osteoarthritis (OA) that is resistant to conservative treatment. MATERIALS AND METHODS: This prospective study included 72 patients (95 knees) with OA of Kellgren-Lawrence (KL) grade 1-3 and persisting moderate to severe pain that was resistant to conservative management who were treated with transcatheter arterial embolization between July 2012 and March 2016. Clinical outcomes were evaluated at 1, 4, and 6 months and then every 6 months for a maximum of 4 years. The Whole-Organ Magnetic Resonance Imaging Score (WORMS) was evaluated at baseline and at 2 years after embolization in 35 knees. RESULTS: Abnormal neovessels were identified in all cases. There were no major adverse events related to the procedures. Mean Western Ontario and McMaster Universities Osteoarthritis Index pain scores significantly decreased from baseline to 1, 4, 6, 12, and 24 months after treatment (12.1 vs 6.2, 4.4, 3.7, 3.0, and 2.6; all P < .001). The cumulative clinical success rates at 6 months and 3 years after embolization were 86.3% (95% confidence interval [CI], 78%-92%) and 79.8% (95% CI, 69%-87%), respectively. WORMS scores at 2 years after embolization in 35 knees showed significant improvement of synovitis vs baseline (P = .0016) and no osteonecrosis or other evidence indicating aggressive progression of degenerative changes. CONCLUSIONS: Transcatheter arterial embolization significantly improved pain symptoms and clinical function in patients with mild to moderate knee OA that was resistant to conservative treatment.

Ultrasonographic superb microvascular imaging for emergency surgery of intracerebral hemorrhage.

Ultrasonography (US) has been used as a reliable imaging modality, providing real-time information during neurosurgical operations. One recent innovative US technique, superb microvascular imaging (SMI), visualizes small vessels and flow, which are not detected with standard US with doppler. We apply SMI to intraoperative US monitoring in emergency surgery for intracerebral hemorrhage (ICH). Eleven consecutive patients with ICH underwent endoscopic emergency surgery under US monitoring with SMI. After performing a small craniotomy, US images were obtained using SMI, a fusion technique, and a contrast agent technique, with the probe on the brain surface during surgery. Fusion images were obtained with the probe on the head before craniotomy in some patients. Animated US images with SMI could differentiate hematoma containing no vessels from brain tissue, and flow images using SMI and contrast agent techniques clarified the borderlines. Animated fusion images of intraoperative US and preoperative CT provided information on the extent of hematoma and residual hematoma during emergency surgery. We made various fusion CT images showing intracranial hematoma with US probes and decided on the skin incision line before beginning surgery, as if we were using a neuronavigation system. US with SMI, contrast agent, and fusion techniques provide information on the extent of intracranial hematoma and residual hematoma with no vessels and no flow. Monitoring by US and fusion CT images is useful for ICH surgery as a next-generation neuronavigator.

Transcatheter arterial embolization as a treatment for medial knee pain in patients with mild to moderate osteoarthritis.

PURPOSE: Osteoarthritis is a common cause of pain and disability. Mild to moderate knee osteoarthritis that is resistant to nonsurgical options and not severe enough to warrant joint replacement represents a challenge in its management. On the basis of the hypothesis that neovessels and accompanying nerves are possible sources of pain, previous work demonstrated that transcatheter arterial embolization for chronic painful conditions resulted in excellent pain relief. We hypothesized that transcatheter arterial embolization can relieve pain associated with knee osteoarthritis. METHODS: Transcatheter arterial embolization for mild to moderate knee osteoarthritis using imipenem/cilastatin sodium or 75 µm calibrated Embozene microspheres as an embolic agent has been performed in 11 and three patients, respectively. We assessed adverse events and changes in Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores. RESULTS: Abnormal neovessels were identified within soft tissue surrounding knee joint in all cases by arteriography. No major adverse events were related to the procedures. Transcatheter arterial embolization rapidly improved WOMAC pain scores from 12.2 ± 1.9 to 3.3 ± 2.1 at 1 month after the procedure, with further improvement at 4 months (1.7 ± 2.2) and WOMAC total scores from 47.3 ± 5.8 to 11.6 ± 5.4 at 1 month, and to 6.3 ± 6.0 at 4 months. These improvements were maintained in most cases at the final follow-up examination at a mean of 12 ± 5 months (range 4-19 months). CONCLUSION: Transcatheter arterial embolization for mild to moderate knee osteoarthritis was feasible, rapidly relieved resistant pain, and restored knee function.