Selective transarterial microembolization for chronic musculoskeletal pain: early and durable outcomes from a prospective cardiology-led endovascular registry

Background Chronic musculoskeletal pain is increasingly recognized as a vascular-driven inflammatory condition characterized by pathological neovascularization that sustains nociceptive signaling and limits response to conventional therapy. Selective transarterial microembolization (TAME) enables targeted catheter-based interruption of these pathological microvessels; however, standardized dosing strategies and real-world safety data from cardiology catheterization laboratories remain limited. Purpose To evaluate the feasibility, safety, and durability of catheter-based selective transarterial microembolization using imipenem/cilastatin in an ongoing prospective endovascular cohort. Methods We conducted a prospective, single-center registry including 100 patients (113 joints) with chronic refractory musculoskeletal pain and angiographically confirmed pathological hypervascularity. TAME was performed using transradial, transfemoral, or transpedal access with a 4-Fr diagnostic catheter and a 1.7-Fr microcatheter. Imipenem/cilastatin was administered until angiographic transient stasis (TIMI 1–2 flow) was achieved. Joint-specific dosing, procedural safety outcomes, pain severity assessed by visual analogue scale (VAS), and health-related quality of life assessed by EQ-5D were prospectively collected. Results Selective transarterial microembolization was technically successful in all procedures with no major ischemic or neurologic complications. Mean VAS scores decreased rapidly within 2 weeks and continued to improve through 24 weeks, accompanied by sustained improvement in EQ-5D among patients with available follow-up, demonstrating early and durable clinical benefit. Conclusion Selective transarterial microembolization provides a safe and reproducible endovascular therapy for chronic musculoskeletal pain, delivering rapid pain relief with durable improvement in quality of life and supporting an expanded role for peripheral endovascular intervention among cardiovascular specialists.