Pilot Study: Geniculate Artery Embolization in Knee Osteoarthrosis.

NCT ID: NCT04113681

Last Updated: 2021-03-08

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

40 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-02-14

Study Completion Date

2021-12-31

Brief Summary

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Geniculate Artery Embolization (GAE) has recently been described and studied as a palliative treatment for osteoarthrosis-related knee pain in patients un-eligible for surgical intervention. This treatment is based on the hypothesis that hypervascularization and associated increased nerve proliferation are possible sources of chronic pain following the morphological changes of osteoarthrosis. A large animal model has shown digital subtraction arteriography to be well correlated to both the histological findings of synovial inflammation and synovial contrast enhancement on magnetic resonance imaging. This embolization technique has also been applied to other regions of the musculoskeletal system including the elbow and the shoulder.

Detailed Description

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Primary Objective Confirm the efficacy and the effectiveness of geniculate artery embolization for pain control in knee osteoarthrosis.

Secondary Objective Evaluate the effectiveness of geniculate artery embolization for pain control in specific population: young patients between 18 and 50 years old with advanced osteoarthritis (KL grade 3 or 4) for whom an orthopedic surgeon has deemed a total knee arthroplasty is not an appropriate therapy, and whom have failed conservative management for at least 6 months.

Investigators propose a prospective pilot study on 40 patients with osteoarthrosis.

Conditions

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Osteoarthritis, Knee

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Patients will be stratified into two groups:

* Group 1: Patients between 18-50 years old with KL grade 3-4
* Group 2: Patients age 50 years old and over with KL grade 1-4
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Geniculate Artery Embolization Arm

Single-arm prospective study of geniculate artery embolization for symptomatic knee osteoarthritis

Group Type EXPERIMENTAL

Geniculate Artery Embolization

Intervention Type PROCEDURE

1. Conscious sedation : midazolam and fentanyl
2. Local anesthesia : Lidocaine 2% subcutaneous
3. Retrograde or anterograde common femoral artery access - 4Fr introducer
4. Sub-therapeutic anticoagulation (heparin 2000 IU IA)
5. Lower extremity arteriography
6. Selective and supra-selective catheterization of geniculate arteries supplying painful region of the knee
7. If abnormal arterial blushes are demonstrated selective and supra-selective embolization will be performed with Embozene microspheres (100 microns to 200 microns) - cold saline or ice-packs sac to be applied to overlying skin if significant cutaneous arteries are demonstrated at angiography.
8. Angiographic end-points: embolization of abnormal blush while preserving the parent vessel
9. Arteriotomy closure (manual compression or closure device)

Interventions

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Geniculate Artery Embolization

1. Conscious sedation : midazolam and fentanyl
2. Local anesthesia : Lidocaine 2% subcutaneous
3. Retrograde or anterograde common femoral artery access - 4Fr introducer
4. Sub-therapeutic anticoagulation (heparin 2000 IU IA)
5. Lower extremity arteriography
6. Selective and supra-selective catheterization of geniculate arteries supplying painful region of the knee
7. If abnormal arterial blushes are demonstrated selective and supra-selective embolization will be performed with Embozene microspheres (100 microns to 200 microns) - cold saline or ice-packs sac to be applied to overlying skin if significant cutaneous arteries are demonstrated at angiography.
8. Angiographic end-points: embolization of abnormal blush while preserving the parent vessel
9. Arteriotomy closure (manual compression or closure device)

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* 18 years and older
* Moderate to severe knee pain (visual analog scale (VAS) \> 70 mm)
* Pain refractory to at least 6 months of conservative therapies (anti-inflammatory drugs, or physical therapy, or muscle strengthening, or intra-articular injections)
* Localized pain on physical examination
* Kellgren-Lawrence (KL) Score on knee X-Ray
* Patients 50 years old and over : grade 1, 2, 3 or 4
* 18-50 years old: KL grade 3 or 4

Exclusion Criteria

* Current local infection
* Life expectancy less than 6 months
* Known advanced atherosclerosis
* Rheumatoid or infectious arthritis
* Prior knee surgery
* Uncorrectable coagulopathy including international normalized ratio (INR) \> 1.5 or platelets \< 50,000
* Iodine allergy
* Renal dysfunction as defined by GFR \< 60ml/min obtained within the past 30 days.
* Diabetic patient
* Previous embolization of the geniculate arteries during the last year
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Maisonneuve-Rosemont Hospital

OTHER

Sponsor Role lead

Responsible Party

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Alexandre Cengarle-Samak

Interventional radiologist

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Alexandre Cengarle-Samak, MD

Role: PRINCIPAL_INVESTIGATOR

CIUSSS de l'Est-de-l'Ile-de-Montreal

Locations

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CIUSSS de l'Est-de-l'Île-de-Montréal, Installation Hopital Maisonneuve-Rosemont

Montreal, Quebec, Canada

Site Status RECRUITING

Countries

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Canada

Central Contacts

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Alexandre Cengarle-Samak, MD

Role: CONTACT

514-252-3400

Pascal Andre Vendittoli, MD

Role: CONTACT

514-252-3400

Facility Contacts

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Alexandre Cengarle-Samak, MD

Role: primary

514-252-3400

Pascal Andre Vendittoli, MD

Role: backup

514-252-3400

References

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van Baardewijk LJ, Hoogeveen YL, van der Geest ICM, Schultze Kool LJ. Embolization of the Geniculate Arteries Is an Effective Treatment of Recurrent Hemarthrosis Following Total Knee Arthroplasty That Can Be Safely Repeated. J Arthroplasty. 2018 Apr;33(4):1177-1180.e1. doi: 10.1016/j.arth.2017.11.002. Epub 2017 Nov 24.

Reference Type BACKGROUND
PMID: 29224993 (View on PubMed)

Bagla S, Rholl KS, van Breda A, Sterling KM, van Breda A. Geniculate artery embolization in the management of spontaneous recurrent hemarthrosis of the knee: case series. J Vasc Interv Radiol. 2013 Mar;24(3):439-42. doi: 10.1016/j.jvir.2012.11.011.

Reference Type BACKGROUND
PMID: 23433418 (View on PubMed)

Okuno Y, Korchi AM, Shinjo T, Kato S, Kaneko T. 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. J Vasc Interv Radiol. 2017 Jul;28(7):995-1002. doi: 10.1016/j.jvir.2017.02.033. Epub 2017 Mar 30.

Reference Type BACKGROUND
PMID: 28365171 (View on PubMed)

Okuno Y, Korchi AM, Shinjo T, Kato S. Transcatheter arterial embolization as a treatment for medial knee pain in patients with mild to moderate osteoarthritis. Cardiovasc Intervent Radiol. 2015 Apr;38(2):336-43. doi: 10.1007/s00270-014-0944-8. Epub 2014 Jul 4.

Reference Type BACKGROUND
PMID: 24993956 (View on PubMed)

Iwamoto W, Okuno Y, Matsumura N, Kaneko T, Ikegami H. Transcatheter arterial embolization of abnormal vessels as a treatment for lateral epicondylitis refractory to conservative treatment: a pilot study with a 2-year follow-up. J Shoulder Elbow Surg. 2017 Aug;26(8):1335-1341. doi: 10.1016/j.jse.2017.03.026.

Reference Type BACKGROUND
PMID: 28734535 (View on PubMed)

Okuno Y, Iwamoto W, Matsumura N, Oguro S, Yasumoto T, Kaneko T, Ikegami H. Clinical Outcomes of Transcatheter Arterial Embolization for Adhesive Capsulitis Resistant to Conservative Treatment. J Vasc Interv Radiol. 2017 Feb;28(2):161-167.e1. doi: 10.1016/j.jvir.2016.09.028. Epub 2016 Dec 19.

Reference Type BACKGROUND
PMID: 28007330 (View on PubMed)

Okuno Y, Oguro S, Iwamoto W, Miyamoto T, Ikegami H, Matsumura N. Short-term results of transcatheter arterial embolization for abnormal neovessels in patients with adhesive capsulitis: a pilot study. J Shoulder Elbow Surg. 2014 Sep;23(9):e199-206. doi: 10.1016/j.jse.2013.12.014. Epub 2014 Mar 4.

Reference Type BACKGROUND
PMID: 24618195 (View on PubMed)

Other Identifiers

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Geniculate embolization.

Identifier Type: -

Identifier Source: org_study_id

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