Abstract
Purpose Irreversible Electroporation (IRE) is a non-thermal ablation technique that has been shown to preserve the extracellular matrix within an ablation zone, maintaining patency of luminal structures such as blood vessels and bile ducts. Preservation of luminal architecture may enable IRE ablation of malignant transitional cells in the bladder, ureter or renal pelvis. Due to a lack of catheter based IRE devices, there is little known about intraluminal IRE ablation. We investigated the feasibility, safety and efficacy of catheter-mounted IRE ablation in normal porcine ureters. Materials and Methods We performed image-guided catheter-mounted intraluminal IRE ablation on normal porcine ureters in an acute study on five animals. Catheters were used to create transmural circumferential lesions in each animal followed by post-ablation fluoroscopic and contrast enhanced CT imaging to assess ureteral patency. Mathematical models were used to select parameters to achieve transmural ablation and predict the ablation zone diameter. These models were analyzed with respect to histopathologic findings in the ablated regions. Results IRE was successfully performed in all animals with preservation of luminal diameter and urine flow in the immediate post-ablation period. The extent of ureter ablation assessed histopathologically (radial and longitudinal distance) confirmed the utility of mathematical modeling for prediction and selection of treatment parameters. Early signs of injury in the ablated region include hyperemia, coagulative necrosis, and complete sloughing of epithelial layers with sharp boundaries between treated and untreated regions. Conclusion Transmural intraluminal IRE can be performed using a catheter-mounted device with acute preservation of ureteric architecture and function. Intraluminal IRE holds promise for treatment of predominantly intraluminal malignancies such as transitional cell carcinoma.
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