Genicular Artery Embolization for Knee Osteoarthritis: An Interventional Radiology Perspective on Pathophysiology, Imaging Biomarkers and Procedural Strategy

Genicular artery embolization (GAE) has emerged as a minimally invasive interventional radiology technique for the management of symptomatic knee osteoarthritis (OA), a highly prevalent condition associated with substantial functional impairment and socioeconomic burden. The rationale of GAE is based on superselective embolization of pathological periarticular neovascularization, aiming to modulate synovial inflammation, angiogenesis, and nociceptive signaling while preserving physiological joint perfusion. This narrative review provides an interventional radiology-oriented framework integrating pathophysiological mechanisms, imaging-based patient selection, and procedural strategy. Particular emphasis is placed on the vascular-inflammatory phenotype of OA, MRI-derived biomarkers of synovitis and hypervascularity, and technical aspects of embolization, including embolic agent selection and angiographic endpoints. A structured literature search was performed to identify relevant studies, including prospective trials and randomized controlled studies. Available evidence is critically discussed, with attention to clinical outcomes, safety profile, and current limitations. In addition, practical technical considerations and procedural pitfalls are summarized to provide a clinically applicable perspective. GAE represents a promising therapeutic option for selected patients with knee OA refractory to conservative management. However, further high-quality studies are required to define long-term durability, optimal patient selection, and standardized procedural strategies.