La Radiologia medica · 2026
Multi-site efficacy and safety of transarterial microembolization with imipenem/cilastatin for refractory musculoskeletal pain: a single-centre analysis of hip, knee and shoulder (FIRE-NEM study).
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Discalzi Andrea, Brino Jacopo, Nardelli Floriana, Mancini Andrea, Pasinato Elettra, Pettirossi Vittorio, Audisio Giulia, Viglione Margherita, Albarello Thaira, Ficara Bruno, d'Amelio Andrea, Bellato Enrico, Doriguzzi Breatta Andrea, Fonio Paolo
Аннотация
PURPOSE: To report the early safety, feasibility and clinical efficacy of transarterial microembolization (TAME) with imipenem/cilastatin (IPM/CS) for refractory musculoskeletal (MSK) pain.
MATERIALS AND METHODS: We performed a retrospective analysis of prospectively collected data from 42 patients who underwent 50 TAME procedures between December 2024 and March 2026 for refractory chronic MSK pain. Districts treated were hip (n = 24), knee (n = 15) and shoulder (n = 11). Pain (NRS) and functional scores (WOMAC, KOOS, Quick-DASH and Oxford Shoulder Score) were assessed at baseline, 1, 3 and 6 months. Technical success was defined as complete embolization of all arteries responsible for hypervascular blush. Clinical success was defined as the minimum clinically important difference (MCID), set at ≥ 2-point reduction on NRS or ≥ 10-point improvement on functional scores; substantial clinical benefit (SCB) was defined as ≥ 30% improvement on the relevant functional score from baseline. Inter-district pain reduction and functional score improvement were compared. Complications were graded according to the modified CIRSE classification.
RESULTS: Technical success was 100%. Median NRS decreased from 9.0 (IQR: 8.0-10.0) at baseline to 6.0 (4.0-7.8) at 1 month, 6.0 (3.0-8.0) at 3 months and 6.0 (3.5-7.0) at 6 months (all p < 0.0001 vs. baseline). MCID for pain was reached in 72.0% of procedures at three months and sustained in 71.4% at six months; MCID for functional scores was 82.0% and 85.7%, respectively. SCB was reached in 72.0% at three months and 77.1% at six months. Pain reduction did not differ significantly across hip, knee and shoulder (p = 0.118), although the subgroup sizes do not allow equivalence to be established. Three minor (CIRSE grade 1-2) access-site complications occurred; no skin ischaemia, nerve injury or osteonecrosis were observed.
CONCLUSION: TAME with IPM/CS appeared to be safe and to provide clinically meaningful early pain relief in patients with refractory MSK pain across multiple districts.
LEVEL OF EVIDENCE: Oxford Centre for Evidence-Based Medicine Level 4.
MATERIALS AND METHODS: We performed a retrospective analysis of prospectively collected data from 42 patients who underwent 50 TAME procedures between December 2024 and March 2026 for refractory chronic MSK pain. Districts treated were hip (n = 24), knee (n = 15) and shoulder (n = 11). Pain (NRS) and functional scores (WOMAC, KOOS, Quick-DASH and Oxford Shoulder Score) were assessed at baseline, 1, 3 and 6 months. Technical success was defined as complete embolization of all arteries responsible for hypervascular blush. Clinical success was defined as the minimum clinically important difference (MCID), set at ≥ 2-point reduction on NRS or ≥ 10-point improvement on functional scores; substantial clinical benefit (SCB) was defined as ≥ 30% improvement on the relevant functional score from baseline. Inter-district pain reduction and functional score improvement were compared. Complications were graded according to the modified CIRSE classification.
RESULTS: Technical success was 100%. Median NRS decreased from 9.0 (IQR: 8.0-10.0) at baseline to 6.0 (4.0-7.8) at 1 month, 6.0 (3.0-8.0) at 3 months and 6.0 (3.5-7.0) at 6 months (all p < 0.0001 vs. baseline). MCID for pain was reached in 72.0% of procedures at three months and sustained in 71.4% at six months; MCID for functional scores was 82.0% and 85.7%, respectively. SCB was reached in 72.0% at three months and 77.1% at six months. Pain reduction did not differ significantly across hip, knee and shoulder (p = 0.118), although the subgroup sizes do not allow equivalence to be established. Three minor (CIRSE grade 1-2) access-site complications occurred; no skin ischaemia, nerve injury or osteonecrosis were observed.
CONCLUSION: TAME with IPM/CS appeared to be safe and to provide clinically meaningful early pain relief in patients with refractory MSK pain across multiple districts.
LEVEL OF EVIDENCE: Oxford Centre for Evidence-Based Medicine Level 4.