Comparing technical success and clinical outcomes of macrocatheter versus microcatheter in genicular artery embolization for knee osteoarthritis

Purpose The purpose of this study was to evaluate the comparative effectiveness and safety of using macrocatheters versus microcatheters for genicular artery embolization (GAE) in the management of knee osteoarthritis (OA). The primary outcomes were technical success and adverse events during and immediately after the procedure. The secondary outcome was the clinical outcome over the follow-up period. Materials and methods In our retrospective analysis, we included 79 patients undergoing GAE for OA. Patients were categorized based on the catheter type used: microcatheter through macrocatheter or directly through macrocatheter. Key parameters, including technical success, adverse events, procedure duration, radiation exposure, and clinical outcomes (VAS and WOMAC scores), were assessed at 1st, 3rd, and 6th-month intervals. Results Technical success stood at 100 % for the microcatheter group, with a slight reduction for the macrocatheter group at 91 % (p = 0.069). Procedure and fluoroscopy durations were significantly shorter in the macrocatheter group (p < 0.001). Additionally, the macrocatheter group demonstrated a marked reduction in radiation dose, with notably decreased air kerma values. Clinical outcomes, including VAS and WOMAC scores at the predefined intervals, revealed no significant disparities between the two cohorts. Conclusion In GAE procedures utilizing a temporary embolic agent (imipenem/cilastatin), initiating the intervention with a macrocatheter can be deemed cost-effective, safe and advantageous for patients with less complex vascular anatomy, as it significantly reduces procedural and fluoroscopy times, thereby minimizing radiation exposure. Conversely, in patients with intricate vascular pathways, transitioning to a microcatheter enhances technical success.