Abstract
Objective
To evaluate the incidence and risk factors for ICE during a PV.
Materials and methods
Single-center retrospective analysis of 1512 consecutive patients who underwent 1854 PV procedures for osteoporotic (34 %), malignant (39.9 %) or other cause (26.1 %) of vertebral compression fractures (VCFs)/spine tumor lesions. Only thoracic or lumbar PVs were included. PVs were performed with polymethylmethacrylate (PMMA) low-viscosity bone cement under fluoroscopic guidance. Chest imaging (X-ray or CT) was performed the same day after PV in patients with high clinical suspicion of ICE. All post-procedural chest-imaging examinations were reviewed, and all ICEs were agreed upon in consensus by two radiologists.
Results
ICEs were detected in 72 patients (92 cement embolisms). In 86.1 % of the cases, concomitant pulmonary artery cement leakage was detected. Symptomatic ICEs were observed in six cases (8.3% of all ICEs; 0.32% of all PV procedures). No ICE led to death or permanent sequelae. Multiple levels treated during the same PV session were associated with a higher ICE rate [OR: 3.59, 95% CI: (1.98-6.51); p < 0.001]; the use of flat panel technology with a lower ICE occurrence [OR: 0.51, 95% CI: (0.32-0.83); p = 0.007].
Conclusion
Intracardiac cement embolism after PV has a low incidence (3.9 % in our study). Symptomatic complications related to ICE are rare (0.3%); none was responsible for clinical sequelae in our series.
Key Points
• The incidence of intracardiac cement embolism (ICE) during PVP is low (3.9%).
• Having a high number of treated vertebrae during the same session is a significant risk factor for ICE.
• Symptomatic intracardiac cement embolisms have a low incidence (8.3% of patients with ICE).
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Abbreviations
- AP:
-
Anteroposterior
- ICE:
-
Intracardiac cement embolism
- IV:
-
Intravenous
- PCE:
-
Pulmonary cement embolism
- PMMA:
-
Polymethylmethacrylate
- PV:
-
Percutaneous vertebroplasty
- RA:
-
Right atrium
- RAA:
-
Right atrial appendage
- RV:
-
Right ventricle
- VCF:
-
Vertebral compression fracture
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The scientific guarantor of this publication is Prof. Frédéric Clarençon.
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• retrospective
• observational
• performed at one institution
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Fadili Hassani, S., Cormier, E., Shotar, E. et al. Intracardiac cement embolism during percutaneous vertebroplasty: incidence, risk factors and clinical management. Eur Radiol 29, 663–673 (2019). https://doi.org/10.1007/s00330-018-5647-0
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DOI: https://doi.org/10.1007/s00330-018-5647-0