Irreversible electroporation and thermal ablation of tumors in the liver, lung, kidney and bone: What are the differences?

2017 ◽  
Vol 98 (9) ◽  
pp. 609-617 ◽  
Author(s):  
L.G.P.H. Vroomen ◽  
E.N. Petre ◽  
F.H. Cornelis ◽  
S.B. Solomon ◽  
G. Srimathveeravalli
Keyword(s):  
Thermal Ablation ◽  
Irreversible Electroporation

In Vivo Validation of Irreversible Electroporation Electric Field Threshold for Prostate Tissue

2013 ◽  
Author(s):  
Robert E. Neal ◽  
Helen Kavnoudias ◽  
Franklin Rosenfeldt ◽  
Ruchong Ou ◽  
James Marron ◽  
...  
Keyword(s):  
Thermal Ablation ◽  
Conventional Treatment ◽  
Irreversible Electroporation ◽  
Blood Perfusion ◽  
Complete Regression ◽  
Safety Study ◽  
Electric Pulses ◽  
Transmembrane Potentials ◽  
Focal Ablation

Irreversible electroporation (IRE) is a non-thermal focal ablation technique that uses needle electrodes to deliver a series of brief (100μs duration) electric pulses into the targeted region. These alter cellular transmembrane potentials, destabilizing the membranes in a manner that kills the cells while sparing major vasculature and other sensitive structures. IRE can therefore be used in regions ineligible for surgical resection or thermal ablation. Treatments result in rapid lesion creation and resolution [1], are unaffected by the blood perfusion “heat sink”, can be planned with numerical modeling [2], and its effects can be readily monitored with various imaging modalities [3]. Therapeutic ire has proven effective in the treatment of experimental [4] and clinical tumors. A human safety study attained complete regression in 46 of 69 tumors ineligible or unresponsive to conventional treatment [5], and veterinary case studies convey its utility in large difficult tumors [6, 7].

scholarly journals Careful treatment planning enables safe ablation of liver tumors adjacent to major blood vessels by percutaneous irreversible electroporation (IRE)

2015 ◽  
Vol 49 (3) ◽  
pp. 234-241 ◽  
Author(s):  
Bor Kos ◽  
Peter Voigt ◽  
Damijan Miklavcic ◽  
Michael Moche
Keyword(s):  
Electric Field ◽  
Blood Vessels ◽  
Treatment Planning ◽  
Hepatic Vein ◽  
Thermal Ablation ◽  
Pulse Generator ◽  
Liver Tumors ◽  
Irreversible Electroporation ◽  
Distance Ratio ◽  
Contrast Enhanced Ct

AbstractBackground.Irreversible electroporation (IRE) is a tissue ablation method, which relies on the phenomenon of electroporation. When cells are exposed to a sufficiently electric field, the plasma membrane is disrupted and cells undergo an apoptotic or necrotic cell death. Although heating effects are known IRE is considered as non-thermal ablation technique and is currently applied to treat tumors in locations where thermal ablation techniques are contraindicated.Materials and methods.The manufacturer of the only commercially available pulse generator for IRE recommends a voltage-to-distance ratio of 1500 to 1700 V/cm for treating tumors in the liver. However, major blood vessels can influence the electric field distribution. We present a method for treatment planning of IRE which takes the influence of blood vessels on the electric field into account; this is illustrated on a treatment of 48-year-old patient with a metastasis near the remaining hepatic vein after a right side hemi-hepatectomy.Results.Output of the numerical treatment planning method shows that a 19.9 cm3irreversible electroporation lesion was generated and the whole tumor was covered with at least 900 V/cm. This compares well with the volume of the hypodense lesion seen in contrast enhanced CT images taken after the IRE treatment. A significant temperature raise occurs near the electrodes. However, the hepatic vein remains open after the treatment without evidence of tumor recurrence after 6 months.Conclusions.Treatment planning using accurate computer models was recognized as important for electrochemotherapy and irreversible electroporation. An important finding of this study was, that the surface of the electrodes heat up significantly. Therefore the clinical user should generally avoid placing the electrodes less than 4 mm away from risk structures when following recommendations of the manufacturer.

scholarly journals MP100-13 IRREVERSIBLE ELECTROPORATION FOR RENAL MASSES NOT AMENABLE TO THERMAL ABLATION IN NON-SURGICAL CANDIDATES: MID-TERM CLINICAL FOLLOW-UP

2017 ◽  
Vol 197 (4S) ◽  
Author(s):  
Robert Medairos ◽  
Wei Phin Tan ◽  
Kelsey Gallo ◽  
Kalyan Latchamsetty ◽  
Jordan Tasse ◽  
...  
Keyword(s):  
Thermal Ablation ◽  
Irreversible Electroporation ◽  
Renal Masses

scholarly journals Irreversible Electroporation of the Pancreas

2019 ◽  
Vol 36 (03) ◽  
pp. 213-220 ◽  
Author(s):  
Gabriel Chan ◽  
Uei Pua
Keyword(s):  
Cell Death ◽  
Thermal Ablation ◽  
Irreversible Electroporation ◽  
Current Evidence ◽  
Thermal Methods ◽  
Induce Cell Death ◽  
Close Proximity ◽  
Recent Method ◽  
Vascular Structures ◽  
Biliary Ducts

AbstractIrreversible electroporation (IRE) is a relatively recent method of ablation. In contrast to many ablation devices that use thermal methods to induce cell death, IRE employs the use of an electric field to cause irreversible permeability of the cell membrane, thus inducing apoptosis. Since its use in the pancreas was first described in 2012, IRE has become established as part of the armamentarium of ablation devices currently available. The crucial advantage of IRE compared with other devices employing thermal ablation is the safety around vital structures such as vessels and ducts. This is especially important in the pancreas due to the close proximity of multiple major vascular structures, biliary ducts, and adjacent gastrointestinal organs. This article will explore the current evidence regarding the use of IRE in the pancreas.

Imaging Guided Percutaneous Irreversible Electroporation: Ultrasound and Immunohistological Correlation

2007 ◽  
Vol 6 (4) ◽  
pp. 287-293 ◽  
Author(s):  
Edward W. Lee ◽  
Christopher T. Loh ◽  
Stephen T. Kee
Keyword(s):  
Cell Death ◽  
Real Time ◽  
Thermal Ablation ◽  
Apoptotic Cell ◽  
Irreversible Electroporation ◽  
Apoptotic Cell Death ◽  
Real Time Monitoring ◽  
Apoptotic Marker ◽  
Swine Liver ◽  
Mean Size

Preliminary results of percutaneous irreversible electroporation (PIE) on swine liver as a novel non-thermal ablation are presented. The goal of this study was to evaluate the feasibility of using irreversible electroporation in more clinically applicable manner, a percutaneous method, and to investigate a possible role of apoptosis in PIE-induced cell death. We performed PIE on four swine livers under real-time ultrasound guidance. The lesions created by PIE were imaged with ultrasound and were correlated with histology data, including pro-apoptotic marker. A total of 11 lesions were created with a mean size of 16.8 cm3 in 8.4 ± 1.8 minutes. Real-time monitoring was performed and a correlation of (+) 2 ± 3.2 mm in measurement comparison between ultrasound and gross pathologic measurements was demonstrated. Complete hepatic cell death without structural destruction, unaffected by heat-sink effect, and with a sharp demarcation between the ablated zone and the non-ablated zone were observed. Immunohistological analysis confirmed complete apoptotic cell death by PIE on Von Kossa, BAX, and H&E staining. In summary, PIE can provide a novel and unique ablative method with real-time monitoring capability, ultra-short procedure time, non-thermal ablation, and well-controlled and focused apoptotic cell death.

scholarly journals Similar complication rates for irreversible electroporation and thermal ablation in patients with hepatocellular tumors

2019 ◽  
Vol 53 (1) ◽  
pp. 116-122 ◽  
Author(s):  
Niklas Verloh ◽  
Isabel Jensch ◽  
Lukas Lürken ◽  
Michael Haimerl ◽  
Marco Dollinger ◽  
...  
Keyword(s):  
Adverse Events ◽  
Thermal Ablation ◽  
Liver Tumors ◽  
Irreversible Electroporation ◽  
Percutaneous Ablation ◽  
Complication Rates ◽  
Significant Difference ◽  
Malignant Liver Tumors ◽  
Malignant Liver ◽  
Grade Iii

Abstract Background To compare the frequency of adverse events of thermal microwave (MWA) and radiofrequency ablation (RFA) with non-thermal irreversible electroporation (IRE) in percutaneous ablation of hepatocellular carcinoma (HCC). Patients and methods We retrospectively analyzed 117 MWA/RFA and 47 IRE procedures (one tumor treated per procedure; 144 men and 20 women; median age, 66 years) regarding adverse events, duration of hospital and intensive care unit (ICU) stays and occurrence of a post-ablation syndrome. Complications were classified according to the Clavien & Dindo classification system. Results 70.1% of the RFA/MWA and 63.8% of the IRE procedures were performed without complications. Grade I and II complications (any deviation from the normal postinterventional course, e.g., analgesics) occurred in 26.5% (31/117) of MWA/RFA and 34.0% (16/47) of IRE procedures. Grade III and IV (major) complications occurred in 2.6% (3/117) of MWA/RFA and 2.1% (1/47) of IRE procedures. There was no significant difference in the frequency of complications (p = 0.864), duration of hospital and ICU stay and the occurrence of a post-ablation syndrome between the two groups. Conclusions Our results suggest that thermal (MWA and RFA) and non-thermal IRE ablation of malignant liver tumors have comparable complication rates despite the higher number of punctures and the lack of track cauterization in IRE.

Pulsed field ablation – new perspective in atrial fibrillation therapy

2021 ◽  
Vol 1 (58) ◽  
pp. 4-7
Author(s):  
Adam Wojtaszczyk ◽  
Paweł Ptaszyński ◽  
Krzysztof Kaczmarek
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Trials ◽  
High Voltage ◽  
Gold Standard ◽  
Thermal Ablation ◽  
Irreversible Electroporation ◽  
Preclinical Studies ◽  
High Efficacy ◽  
New Perspective

Atrial fibrillation (AF) is one of the most important problems in cardiology. Thermal ablation therapies are “gold standard” to treat symptomatic patients. Despite the improvements, both success rate and safety are limited by their thermal nature. Pulsed filed ablation is a new non-thermal ablation method. It is based on the phenomenon of unrecoverable permeabilization of cell membranes caused by pulses of high voltage (irreversible electroporation). Several preclinical studies suggest its safety. Clinical trials published so far have showed high efficacy. Further studies especially with longer follow-up period are needed.

Sign in / Sign up

Export Citation Format

Share Document