Cryoablation Research Articles (Page 1)

Radiofrequency (RF) ablation has long been the standard treatment for atrioventricular nodal reentrant tachycardia (AVNRT) in children. However, cryoablation (CA) has gained popularity due to its safety profile and acceptable long-term success rates. Comparative data on different CA catheter tip sizes in pediatric AVNRT are limited. To compare the acute and long-term outcomes of 6-mm vs. 8-mm tip CA catheters in pediatric patients undergoing AVNRT ablation. This retrospective single-center study included 129 pediatric patients (76 female, mean age 13±3.0years, mean weight 51.7±15.7kg) who underwent CA for AVNRT between January 2016 and December 2022. A 6-mm tip catheter was used in 64 patients and an 8-mm tip catheter in 65 patients. All procedures were performed using a three-dimensional electroanatomical mapping system (EAMS) (EnSite, Abbott/St. Jude Medical Inc., St. Paul, MN, USA), with minimal or no fluoroscopy in most cases. Acute success, recurrence rates, procedural parameters, and complications were compared between groups. Of the 129 patients, 126 (97.7%) had typical AVNRT and 3 (2.3%) had atypical AVNRT. The mean procedure time was 151.9±43min, with no significant difference between groups. Acute success rates were 100% in the 6-mm group and 98.5% in the 8-mm group (p>0.05). The mean number of cryolesions was 8.5±2.3 (6-mm) and 9.0±2.5 (8-mm) (p>0.05). Over a mean follow-up of 31.4±26 months, recurrences occurred in six patients (4.6%), all successfully re-ablated. Long-term success rates were 94.4% overall, with no significant difference between groups. No permanent complications occurred; transient AV block was observed in one patient (0.7%). Both 6-mm and 8-mm CA catheters achieve high acute success and low recurrence rates in pediatric AVNRT with similar safety profiles. Catheter tip size can be tailored to patient age and weight without compromising efficacy. Minimal fluoroscopy approaches can be applied safely in the majority of cases.

Background: Lumbar facet joint degeneration is a common source of chronic low back pain. Radiofrequency (RF) ablation is widely used, whereas cryoablation (CA) remains less extensively investigated. Evidence directly comparing the long-term outcomes of these two modalities is scarce, particularly beyond 12 months. Methods: This single-center retrospective cohort study analyzed patients with lumbar facet joint degeneration who underwent RF (n = 97) or CA (n = 83). Clinical data were retrieved from institutional records. Pain intensity (VAS), functional outcomes (ODI and RMDQ), and quality-of-life measures (EQ-5D and SF-36) were assessed at baseline and at 1, 3, 6, 12, 18, and 24 months. The primary outcome was change in ODI; secondary outcomes included VAS, RMDQ, quality of life, and complications. Clinically meaningful improvement was defined according to Minimal Clinically Important Difference (MCID) and Patient Acceptable Symptom State (PASS) thresholds. Results: Both RF and CA significantly improved pain and function compared with baseline. RF demonstrated superior reductions in ODI and VAS at 12 and 18 months (p < 0.05); however, by 24 months, treatment effects had diminished, and no significant differences remained (p > 0.05). Quality-of-life improvements plateaued after 18 months in both groups. Minor complications occurred in 9.3% of RF cases and 6.0% of CA cases; no major adverse events were observed. Conclusions: RF provided earlier and more pronounced benefits in pain and function up to 18 months, whereas both RF and CA showed reduced but comparable effectiveness at 24 months. These findings support RF as a preferred interventional option for robust short- to mid-term outcomes, with CA serving as a safe long-term alternative. However, the single-center retrospective design and potential observer bias limit generalizability. Future multicenter prospective studies are warranted.

ObjectivesCalcaneal spur is an important cause of chronic pain that is resistant to conservative treatments and reduces quality of life. Nerve ablation techniques are widely used in chronic pain. This study aimed to investigate the short- and long-term effects of radiofrequency thermocoagulation (RFT) and intralesional cryoablation (CA) on pain management, functional limitation, and ankle function in patients with calcaneal spurs.Materials and MethodsThis study included 71 patients aged between 28 and 52 years (body mass index, 22.3–31.1) who were receiving chronic pain treatment. The patients were evaluated pre- and postoperatively using the visual analog scale, functional limitation, activity limitation, and American Orthopedic Foot and Ankle Society score.ResultsVAS was measured as 1.2 ± 0.1 in the RFT group and 1.3 ± 0.2 in the CA group at 6 months. RFT yielded faster and more effective results in pain management and short-term functional improvement (p=0.00002), whereas CA was superior to the former in terms of ankle function in the long term (p=0.0001).ConclusionRFT and CA have different advantages. Thus, personalized treatment should be provided to each patient. Although our study was conducted retrospectively, prospective studies are needed to support our findings.

Background and aim The rapid evolution of catheter ablation technologies has introduced variability in clinical outcomes, procedural efficiency, and costs. This study aimed to evaluate the economic costs and clinical outcomes associated with radiofrequency ablation (RFA), cryoablation (CRYO), and pulsed field ablation (PFA) for the treatment of paroxysmal atrial fibrillation (AF). Methods A cost-consequence analytical model was developed to assess the economic impact and clinical outcomes of three treatment alternatives for adult patients with paroxysmal AF, from the hospital’s perspective, in the short (index hospitalization) and medium-term (1 year). Real-world data were collected across three European specialty centers (Czech Republic, Italy, and Spain). The collected data captured procedural durations (including pre-procedural, skin-to-skin, and post-procedural phases), resource consumption, and staff workload. Costs were retrieved from institutional economic databases and published cost repositories. Costs were expressed in Euro (2025). Medium-term outcomes (complications, reinterventions, hospitalizations, cardioversions) were sourced from literature. Results A total of N = 270 patients were included in the analysis. PFA was associated with consistency and predictable procedure duration compared to the other treatment alternatives. This efficiency may support increased capacity within the healthcare systems. PFA demonstrated cost saving of 10% compared to CRYO and 22% compared to RFA procedures, primarily driven by procedure time. Additionally, PFA showed a cost per responder of €2,406, versus €2,873 for CRYO (+19%) and €3,436 for RFA (+43%), reflecting both lower procedural costs and superior clinical outcomes. Conclusion These findings suggest that PFA technology may offer economic and operational advantages, including more efficient resource utilization, reduced procedural complexity and consumables use, compared to traditional ablation modalities. However, variations in hospital clinical practices may limit the generalizability of results.

BackgroundAblation is an effective alternative treatment option for early-stage non-small cell lung cancer (NSCLC) patients who are not candidates for surgery or who refuse surgery. Microwave ablation (MWA) and cryoablation (CA) are both minimally invasive treatment techniques widely used in NSCLC patients, and their safety and efficacy have been verified. This study aimed to compare the safety and efficacy of co-ablation (Co-A) and MWA in the treatment of subpleural stage I NSCLC.MethodsFrom December 2023 to December 2024, a retrospective analysis was conducted on 87 eligible patients (40 males, 47 females; mean age ± standard deviation: 72.03±9.07 years; age range, 31–88 years). Patients were divided into two groups based on the treatment method: a Co-A group and an MWA group. Recurrence-free survival (RFS) rates and complication rates were compared between the two groups.ResultsCo-A had a significantly longer mean operative time compared to MWA (28.26±7.56 vs. 6.37±2.01 min, P<0.001). Postoperative analgesic intervention was significantly lower in the Co-A group (30.4% vs. 45.4%, P=0.03). Mean follow-up time was similar between groups (7.04±2.01 vs. 7.27±2.49 months, P=0.69). RFS rates at study end were 95.7% in Co-A and 100.0% in MWA (P=0.26). Common complications—pneumothorax, transient hemoptysis, and pleural effusion—showed no significant differences in incidence between the two groups (P>0.05). However, pneumothorax requiring chest tube drainage was significantly higher in the Co-A group (34.8% vs. 7.8%, P=0.008).ConclusionsCompared with MWA, Co-A demonstrates no significant difference in efficacy or safety for treating patients with subpleural stage I NSCLC, but is associated with reduced perioperative pain and a longer operative duration.

Pulsed-field ablation versus cryoballoon ablation in patients with persistent atrial fibrillation.

ObjectivesTo evaluate the outcomes of partial gland ablation (PGA) according to prostate cancer (PCa) visibility on magnetic resonance imaging (MRI).Subjects and MethodsConsecutive patients with localized PCa diagnosed by MRI‐informed prostate biopsy (PBx), who underwent hemi‐gland Cryoablation (CRYO) or hemi‐gland High‐Intensity Focused Ultrasound (HIFU), were identified from a multicentric database. High‐visibility was defined as Prostate Imaging–Reporting and Data System (PIRADS) ≥ 4. The primary endpoint was treatment failure (TF), defined as Grade Group (GG) ≥ 2 on follow‐up PBx (FU‐PBx), any whole‐gland treatment, systemic therapy, metastases or PCa‐specific mortality. Kaplan–Meier and Cox regression analyses were performed. Statistically significant if p < 0.05.ResultsA total of 156 patients met the inclusion criteria being 96 (62%) high‐visibility and 59 (38%) low‐visibility groups on baseline MRI. The baseline characteristics were as follows: median age 65yo, prostate‐specific antigen (PSA) 6.0 ng/ml, 22% with PIRADS 1–2, 16% with PIRADS 3, 44% with PIRADS 4 and 17% with PIRADS 5. The 3‐year free‐survival rates for high‐visible vs low‐visible were: TF 57% vs 83% (p = 0.002); biochemical failure (PSA nadir + 2 ng/ml) 81% vs 72% (p = 0.5); GG ≥ 2 on FU‐PBx 57% vs 85% (p < 0.001); and Radical Treatment 87% vs 85% (p = 0.9), respectively. After adjusting for confounders, the independent predictors for TF were PSA density, PSA reduction and high visibility (hazard ratio 4.83, 95% confidence interval 1.81–12.90).ConclusionMRI visibility is an independent prognosticator for outcomes following focal therapy for prostate cancer. Patients with higher MRI visibility (PIRADS ≥4) are at an increased risk of treatment failure.

The objective of this study was to systematically review the literature-reported outcomes of CRYO compared to standard of care without CRYO (non-CRYO) after PEx repair. Surgical repair of pectus excavatum (PEx) via the Nuss or Ravitch procedures is associated with substantial postoperative pain. Intercostal nerve cryoablation (CRYO) performed during the primary surgical repair has been adopted as a non-opioid modality for pain management. A literature search was conducted in PubMed, Embase, and using additional online approaches to identify comparative studies of patients undergoing the Nuss or Ravitch procedure for PEx repair with CRYO versus non-CRYO between years 2014-24. Meta-analysis was performed to quantitatively evaluate primary outcomes of hospital length of stay (LOS) and opioid consumption. Secondary outcomes were hospital costs and complications, summarized qualitatively. Of 178 studies, 32 comparative studies encompassing 13,103 patients were included; 28% (n=3,620) received CRYO. Random effects meta-analyses demonstrated a significantly shortened LOS by 1.8 days (95% confidence interval [CI]: -2.12, -1.42) and a significant reduction in inpatient and outpatient opioid consumption with CRYO by 186 morphine mg equivalents (MME) (95% CI: -262.26, -109.08) and 147 MME (95% CI: -255.72, -38.26), respectively. Complications with CRYO were either decreased or similar between groups and resolved over time. Hospital costs were similar. This systematic review suggests CRYO during PEx repair is associated with a significantly shorter hospital LOS, as well as decreased opioid consumption both in the hospital and after discharge. Complications were infrequent and time-limited.

Thermal Ablation Modalities That Best Compete with Partial Nephrectomy for T1A and T1B Renal Cell Carcinoma: A Network Meta-Analysis.

Cosmetic outcome and patient satisfaction following percutaneous thermal ablation of early-stage breast cancer; results of an open label randomized phase 2 trial.

SABR Versus Radiofrequency Ablation and Cryoablation for Primary Renal Cell Carcinoma: An Economic Evaluation of the FASTRACK II Trial.

To assess the efficacy and safety of cone beam CT guided percutaneous cryoablation (CBCT guided PCA) for the treatment of cT1a renal tumors by evaluating oncological outcomes and postoperative complication risk, in comparison to conventional CTguided PCA and laparoscopic cryoablation (LCA) using long-term follow-up data from a single-center cohort. A retrospective analysis of 3 cryoablation (CA) techniques was conducted at our institution from December 2006 to February 2023. A total of 77 (32.6%) patients underwent CBCT guided PCA, 34 (14.4%) received CT guided PCA, and 125 (53%) were treated with LCA. Primary outcomes included recurrence-free survival (RFS) and overall complication rate (OCR). RFS was calculated using the Kaplan-Meier method. Univariate and multivariate Cox proportional hazards analyses assessed the impact of specific baseline characteristics on recurrence risk. 19 (8.1%) patients exhibited local disease recurrence during follow-up. Recurrence occurred in 7 (9.1%), 4 (11.8%), and 8 (6.4%) patients in the CBCT guided PCA, CT guided PCA, and LCA group, respectively (P = .549). The overall RFS was 90.1%, 88.2%, and 93.6% for CBCT guided PCA, CT guided PCA, and LCA, respectively. RFS did not differ significantly between the 3 groups (Log-rank for trend: P = .083). No significant difference in overall recurrence (OCR) was observed among the groups (P = .200). CBCT guided PCA shows higher overall RFS in comparison to CT guided PCA and thereby is an effective and safe alternative for the treatment of small renal masses.

Safety, workflow, and efficacy of atrial fibrillation ablation in women: pulsed field vs conventional thermal ablation

Outcomes of atrial fibrillation ablation in patients with chronic kidney disease

To assess the prognostic factors for clinical and radiological responses to percutaneous image-guided cryoablation (CA) in treating venous malformation (VM) and fibro-adipose vascular anomaly (FAVA). Fifty-five patients (12 males, 43 females; median age: 30 years) with symptomatic lesions (median VAS pain score: 70; median initial volume: 12.2 mm³) underwent CA between 2012 and 2023. CA was a first-line treatment in 23 patients (42%) and second-line in 32 (58%). Lesions were Goyal grade 1 in 24 cases (43%) and located on extremities in 44 (80%). Technical efficacy was assessed using MRI and applying RECIST criteria, while clinical efficacy was based on changes in VAS pain scores. Prognostic factors for residual pain were analyzed using univariable and multivariable analyses. With a median follow-up of 13 months, technical success was achieved in all cases, and 20% of patients underwent multiple sessions. Technical efficacy was observed in 69% of cases, with 33% achieving complete response and 36% partial response (mean volume reduction: 47%). Clinical efficacy was reached in 72% of cases. Univariable analysis linked residual pain to sex (female, p = 0.013), initial pain level (p = 0.014), Goyal grade (p = 0.029), and residual volume (p = 0.012). Multivariable analysis revealed that grade (p = 0.035), post-therapeutic volume (p = 0.048), and completeness of treatment (p = 0.029) were statistically significant predictors. Cryoablation is an effective management strategy for venous malformation and FAVA, with residual volume emerging as a significant indicator of clinical success. Question Venous malformations (VA) and fibro-adipose vascular anomalies (FAVA) often cause chronic pain, with limited effective treatment options. Identifying predictors of pain relief following cryoablation could optimize patient outcomes. Findings Cryoablation achieved 72% pain relief for VA and FAVA. High lesion grade, treatment completeness, and residual volume were significantly associated with residual pain. Clinical relevance Cryoablation provides an effective, minimally invasive treatment for VA and FAVA, achieving significant pain relief while identifying predictors to optimize patient selection and outcomes.

To report the pain relief and procedure-related outcomes of percutaneous cryoablation (CA) of painful endometriosis deposits in unusual anatomic locations. A retrospective search of institutional radiological information system identified a total of 15 patients (median age 35.5years; interquartile ranges-IQR 33-38). Patients and lesions specific data as well as procedural and follow-up information were collected, analyzed, and presented using descriptive statistical methods. A total of 16 painful target lesions situated in the umbilicus (7/16; 43.8%), diaphragm (4/16; 25.0%), inguinal canal (3/16; 18.8%), and within the muscular layers of the uterus (i.e., adenomyosis; 2/16; 12.4%) underwent CA. The median of the largest diameter of the target lesions was 19mm (IQR 13-22.3). Primary and secondary rates of complete pain relief were achieved in 86.7% (13/15 patients) and 93.3% (14/15 patients; one patient receiving additional CA for recurring pain) of patients, respectively. Each lesion underwent one single intervention, thus accounting for a total of 16 CA procedures. Eleven interventions were carried out under general anesthesia (11/16; 68.8%), with combination of ultrasound and cross-sectional imaging (CT or MRI) being the most used modality for image guidance (10/16; 62.5%). Nearly all interventions (15/16; 93.8%) required adjunctive protective measures with hydrodissection (13/16; 81.3%) and combination of hydrodissection and cutaneous protection with warm saline filled gloves (9/16; 56.3%) being the two most common protective measures. Two (2/16; 12.5%) complications were noted. Percutaneous CA of painful endometriosis deposits in unusual anatomic locations seems highly effective and safe.

We sought to assess and compare the effectiveness and safety of cryoablation (CA) and microwave ablation (MWA) in treating paravertebral metastases of VX2 in rabbits. A rabbit VX2 paravertebral metastases model was established under computed tomography (CT) guidance, with a modeling success rate of 88.23% (60/68). Sixty successfully modeled rabbits were randomly allocated into the MWA group (n = 30) and CA group (n = 30). A comparative analysis between the CA and MWA groups included assessments of the complete ablation rate, operation time, post-ablation pain, and complication rate. The complete ablation rate in the CA group (86.67%) was higher than that in the MWA group (63.33%) (P < 0.05), and the operation time in the CA group was notably longer than that in the MWA group (P < 0.05). The BRPS ( Bristol Rabbit Pain Scale)scores in both groups decreased at 5 time points after treatment, the post-treatment points scores in the CA group were lower than those in the MWA group (P < 0.001). At a follow-up of 21 days postoperatively, the complication rate in the CA group (10.00%) was significantly lower than that in the MWA group (33.33%) (P < 0.05), with 6 rabbits in the MWA group experiencing severe complications. Compared to MWA, CA for paravertebral metastases demonstrates higher efficacy and safety.

Intermediate-Term Oncologic Outcomes of Partial Nephrectomy vs Cryoablation in Renal Tumors > 3 cm: A Propensity Score-Matched Analysis.

Atrial fibrillation (AF) has become the most common arrhythmia of clinical importance. A well-established and recommended therapeutic option for AF is the balloon-based cryoablation (CBA) method. There are still no sensitive biomarkers for AF prediction and cryoablation effectiveness assessment, therefore in our prospective study, we examined the plasma content of apolipoproteins (Apo) and sphingolipids, as well as the distribution of selected sphingolipids among lipoprotein fractions. The study included 33 patients with AF on admission and 24 h after cryoablation therapy, while 20 healthy volunteers were recruited to the control group. Plasma Apo concentrations were determined using a multiplex assay kit measuring fluorescence signal, whereas the high-performance liquid chromatography (HPLC) method was applied to assess the total plasma sphingolipid levels as well as their content in isolated lipoprotein fractions. Our results showed that cryoballoon ablation in AF patients markedly reduced the level of almost all Apo compared to the individuals from the control and Pre-CBA groups (Apo-A1: -25.9% and -20.0%, Apo-A2: -19.9% and -17.3%, Apo-B: -26.8% and -14.4%, Apo-C1: -20.3% and -13.4%, Apo-D: -15.9% and -22.2%, Apo-E: -18.3% and -14.3%, and Apo-J: -36.4% and -21.5%, p < 0.05, respectively). Importantly, the area under the curve of Apo-J (AUC 0.81; 95% CI, 0.71-0.92) indicates that it might be a useful biomarker of cryotherapy success in AF patients. Moreover, we also observed a pronounced increase in sphinganine (Sa; +33.5%), sphingosine (So; +24.6%), sphinganine-1-phosphate (Sa1P; +34.3%), and sphingosine-1-phosphate (So1P; +22.3%) concentrations in the Pre-CBA group in comparison with controls. This is the first study that evaluates such a broad panel of Apo and sphingolipids in patients with AF undergoing the CBA procedure, however, to confirm whether any of these parameters could be a clinically useful biomarker for predicting AF or assessing the effectiveness of treatment, further research will be necessary due to limitations of the study.

Background: Scoring metrics are important to compare outcomes of different percutaneous treatments for small renal masses (RMs). The concept of trifecta (no complications, kidney function preservation, and absence of local recurrence) has been recently introduced in percutaneous thermal ablation of RM. In this context, previous studies have shown that cryoablation (CA) and microwave ablation (MWA) have similar outcomes. We aimed to validate the trifecta in CA and MWA and factors associated with treatment success. Materials and Methods: A retrospective comparative analysis of two cohorts was carried out on 190 consecutive patients with RMs treated using percutaneous CA or MWA. Nephrometry scores described RM complexity. Postoperative complications were categorized according to the Clavien-Dindo system. Glomerular filtration rate (GFR) at the last follow-up was calculated through the chronic kidney disease-epidemiology collaboration (EPI) formula, whereas detection of contrast enhancement during follow-up defined local recurrence. Last, trifecta was defined by the combination of no major (Clavien >2) complications, estimation of GFR (eGFR) decline <10%, and absence of local recurrence. Descriptive statistics and logistic regression models tested the association between predictors and trifecta achievement. Factors associated with recurrence were compared by the log-rank test. Results: Of 175 patients, 121 (69.1%) and 54 (30.8%) patients underwent CA and MWA, respectively. Median (interquartile range [IQR]) age and RM diameter were 75 years (66-80) and 2.4 cm (1.8-3.0). The CA group had a lower preoperative GFR but also had a lower rate of comorbidities (both p = 0.01). Other demographics and tumor characteristics were comparable between groups. In the CA and MWA groups, major complications occurred after 1.6% and 4.8% of procedures (p = 0.33), whereas an eGFR decline >10% was found in 31.5% and 38.8% of cases (p = 0.40), respectively. Similarly, in the CA and MWA groups, at a median follow-up of 21 (8-39) and 24 (9.5-36) months, local recurrence was observed after 10 (8.3%) and 5 (9.3%) cases (p = 0.78), trifecta was accomplished after 72 (59.5%) and 32 (59.3%; p = 1.00) procedures, respectively. Of note, recurrence-free survival (RFS) was comparable among groups (p = 0.57). Moreover, trifecta achievement was comparable when stratifying for demographics and tumor characteristics in the whole cohort and in the CA group (p > 0.05). Conversely, logistic regression showed a lower odds ratio (OR) of trifecta for lesions close to renal collecting system treated by MWA, even when accounting for maximum diameter and preoperative GFR (OR 0.21, confidence interval 0.60-0.72, p = 0.010). Of note, this factor was also associated with a significantly lower RFS (log-rank p = 0.002). Conclusions: Both percutaneous CA and MWA of RM can safely accomplish good oncological outcomes while preserving renal function. Approximately 6 out of 10 patients achieved trifecta after each procedure. Patient selection should account for tumor proximity to the collecting system, as this factor seems to impact the outcomes of MWA.