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27.07.2018 | Interventional

Intracardiac cement embolism during percutaneous vertebroplasty: incidence, risk factors and clinical management

verfasst von: Sarah Fadili Hassani, Evelyne Cormier, Eimad Shotar, Mehdi Drir, Jean-Philippe Spano, Laetitia Morardet, Jean-Philippe Collet, Jacques Chiras, Frédéric Clarençon

Erschienen in: European Radiology | Ausgabe 2/2019

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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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Titel: Intracardiac cement embolism during percutaneous vertebroplasty: incidence, risk factors and clinical management
verfasst von: Sarah Fadili Hassani
Evelyne Cormier
Eimad Shotar
Mehdi Drir
Jean-Philippe Spano
Laetitia Morardet
Jean-Philippe Collet
Jacques Chiras
Frédéric Clarençon
Publikationsdatum: 27.07.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 2/2019
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-018-5647-0

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Intracardiac cement embolism during percutaneous vertebroplasty: incidence, risk factors and clinical management