Safety and Efficacy of Embolization with Microspheres in Chronic Refractory Inflammatory Shoulder Pain: A Pilot Monocentric Study on 15 Patients

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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“…Numerous investigations have described abnormal hypervascularity in patients with SAC, notably within the capsule, using enhanced MRI 5,33,34 , surgical observation 1,2,22,34 , and histologic examination 4,22 . In the studies included in our review, angiography showed neovessels in 89% of the patients, which suggest hypervascularization plays an important role in the pathogenesis of adhesive capsulitis.…”

“…Outcome measures systems were variable in the different studies included, yet pain, which was the primary outcome in most of the studies, was reported using the VAS in all of them. Some studies included variables like night-time pain, pain at rest or during activity 22 . Figure 2 illustrates pain reduction after TAE.…”

Safety and Efficacy of Prestige Coils for Embolization of Vascular Abnormalities: The Embo-Prestige Study

“…Prestige coils seem more adequate for small vessels and allow the use of small microcatheters, potentially due to the miniaturized electric detachment system. This may be of use with the generalization of the embolization technique in other and newly-spreading indications such as prostatic artery [16] or shoulder embolization [17] in which use of a microcatheter is essential in the small arteries implicated in these pathologies. Prestige coils were found to be flexible, but packing was not very tight in our study, as compared to a previous study by Hongo et al which highlighted the packing density provided by hydrocoils [10].…”

Recent Progress in Advanced Hydrogel‐Based Embolic Agents: From Rational Design Strategies to Improved Endovascular Embolization

“…These embolic agents are developed in different forms, including foams, sponges, and microspheres, which seek to block the selective blood vessels depending on different diseases and a wide range of target vessel sizes. Despite the extensive applications of particulate embolization in clinical trials, there still exist some major limitations, such as ease of aggregation, [12] off-target embolization, [13,14] and collateral circulation. [15,16] These may result in reduced embolization efficacy and even lead to treatment failure.…”