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

  • Interventional
  • Published:
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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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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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Funding

The authors state that this work has not received any funding.

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Author notes

  1. Jacques Chiras and Frédéric Clarençon contributed equally to this work.

Authors and Affiliations

  1. Department of Neuroradiology, Pitié-Salpêtrière Hospital, APHP, 47, Bd de l’Hôpital, 75013, Paris, France

    Sarah Fadili Hassani, Evelyne Cormier, Eimad Shotar, Jacques Chiras & Frédéric Clarençon

  2. Paris VI University, Pierre et Marie Curie, Paris, France

    Eimad Shotar, Jean-Philippe Spano, Jacques Chiras & Frédéric Clarençon

  3. Department of Anesthesiology, Pitié-Salpêtrière Hospital, Paris, France

    Mehdi Drir

  4. Department of Oncoly, Pitié-Salpêtrière Hospital, Paris, France

    Jean-Philippe Spano

  5. Department of Rheumatology, Pitié-Salpêtrière Hospital, Paris, France

    Laetitia Morardet

  6. Department of Cardiology, Pitié-Salpêtrière Hospital, Paris, France

    Jean-Philippe Collet

Authors
  1. Sarah Fadili Hassani
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Correspondence to Frédéric Clarençon.

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The scientific guarantor of this publication is Prof. Frédéric Clarençon.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was not required because French law states that no approval from a local IRB is necessary for retrospective analysis of patients' charts.

Methodology

• 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

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