“Inside Access” provides interviews and background on open access articles from the Journal of Interventional Radiology.
Cusumano, Lucas R. et al. Genicular Artery Embolization for Treatment of Symptomatic Knee Osteoarthritis: 2-Year Outcomes from a Prospective IDE Trial. JVIR. 2024;35(12):1768-1775
Listen to Dr. Cusumano discuss his research on the Kinked Wire.
Tell us about you, your team and your institution.
Reed Hutchinson Credit Photo: Reed Hutchinson
UCLA Health ID's 230725
Lucas R. Cusumano, MD: I was born and raised in New York, and I did my medical training there, and then went to the University of California, Los Angeles for my general surgery internship and integrated IR residency. I stayed on and have been at UCLA for seven and a half years.
Geniculate artery embolization is an important part of my practice and research focus. I feel very fortunate to be part of the GAE team at UCLA and my mentors here have been critical in my development as an IR. Overall, our mission on the GAE team and UCLA IR is to offer the most effective evidence-based treatments with a real emphasis on patient safety.
Why did you set out to research GAE for knee osteoarthritis?
LC: GAE is gaining increasing acceptance as a treatment for knee osteoarthritis. However, the long-term data is limited specifically for this treatment. As a result, the focus of our study was to present the 2-year follow up data for our GAE patients. Our 1-year data was previously published by Siddharth A. Padia, MD, FSIR, in 2021 in the Journal of Bone and Joint Surgery. Two important features of our study that are worth noting is first, we used a relatively high bar for clinical success, which was at least a 50 percent decrease in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores.
Second, we included patients with moderate to severe knee osteoarthritis judged on the Kellgren and Lawrence score that was two to four. We chose this because we thought it would more accurately represent the demographics seeking GAE treatments for pain relief for knee osteoarthritis.
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Angiograms before and after procedure.
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WOMAC scores.
What are the key takeaways from this research?
LC: We found that the clinical outcomes after GAE were sustained for most patients at 2 years if they respond to initial treatment. Of the patients who responded at 12 months, 72% had durable response at 24 months and 28% had a relapse of symptoms. Of all the patients we treated, 47% demonstrated clinical success at 24 months and importantly, there were no long-term adverse events after GAE procedures.
What do you feel would be the long- or short-term impact long of what you found?
LC: Short term, we expect our findings to build on the growing body of evidence regarding the effectiveness, safety and durability of GAE.
In the long term, we believe more patients and referring providers are now going to be seeking out GAE as a treatment option for knee-related osteoarthritis pain. We do hope that our results encourage other IRs to continue publishing their results and hopefully gain additional support for GAE as well as gain insight to how to further optimize our procedures.
How do you feel this will influence treatment practices or current clinical processes?
LC: From an IR perspective, when people find out about the screwing option, and knowing that this could potentially last up at least 2 years, I think there's a lot more excitement from patients versus something like a joint injection, which only lasts for a few months, weeks or days depending on patient factors. Some patients don't want surgery under any circumstances, which is why they prefer joint injections—so GAE is filling a very important gap for patients, and they seem very exciting about it, especially if the benefits could potentially last for years.
Hopefully this data is also inspiring confidence from other IRs that if you have an appropriate candidate and feel comfortable with the procedure, you can tell patients that you may have a years-long solution.
You have first-hand experience on this topic, from the patient perspective. How has that impacted your research?
LC: I've had two knee surgeries myself, and I’ve already had some early osteoarthritis and MSK issues. I feel like GAE is a procedure that I’ll need one day—which is one of the reasons why I’m personally so passionate about trying to get it working, and narrow down patient selection.
When you have a patient who is in agony, and you’re able to take that pain away so they can now care for their family or needs or even just go about their normal day without pain—that’s the reason why I went into medicine. It’s just really rewarding.
What are the next steps for research?
LC: We have a lot of things going on right now. We're continually following this cohort of patients to see how durable this procedure is. The GAE team also has a lot of other projects in this space, such as improving patient selection; Dr. Padia is currently finishing enrollment of a clinical trial which randomizes patients for GAE versus observation.
There's lots of questions that are still unanswered, and we're hoping that at least we can provide some of those answers. The whole point of this is to make sure that we're offering the most effective, safe procedure to our patients. We hope this ongoing research will provide some very important data for refining treatment strategies and optimizing outcomes for our patients.
Was there a particular mentor or colleague who was particularly instrumental in this effort?
LC: I would certainly say a lot of this initial effort has been from Dr. Padia. He laid the initial groundwork of getting GAE adopted at UCLA. He's been one of my mentors since the very beginning and hey gave me the opportunity to further this research and present our 2-year data.
I would not be where I am today without the mentors that I've had at UCLA; that's part of the reason why I stayed on as faculty. As a young faculty member, you think you're done learning when you're done with training, but it's not the case. I feel like I'm constantly learning. Having support from a mentor or other former attendings also allows us to push the envelope in different ways and start new programs.
