Ethanol Ablation Research Articles

Comparison of efficacy and safety of different minimally invasive therapies for thyroid nodules: A network meta-analysis.

This study aimed to compare efficacy and safety of minimally invasive therapies such as radiofrequency ablation (RFA), microwave ablation (MWA), ethanol ablation (EA), and laser ablation (LA) for thyroid nodules through network meta-analysis (NMA). This study searched PubMed, Web of Science, Embase, and The Cochrane Library databases to collect randomized controlled trials (RCTs) or cohort studies comparing efficacy and safety of different minimally invasive therapies for thyroid nodules. Newcastle-Ottawa Scale (NOS) was implemented to assess quality of included cohort studies, and Cochrane risk of bias assessment tool was utilized to evaluate quality of included RCTs. Eligible studies contained at least one of the following clinical outcome measures: volume reduction rate (VRR), symptom score, cosmetic score, nodule regrowth rate, and complication rate. STATA software was utilized for NMA. Sixteen eligible studies (4 RCTs, 11 retrospective cohort studies, 1 prospective cohort study) involved 4094 patients. NMA results revealed that RFA group had the highest VRR at 1 months and 12 months. There were no significant differences in symptom scores and cosmetic scores among all treatment methods, with the lowest symptom scores and cosmetic scores in RFA group. LA group had a significantly higher nodule regrowth rate than RFA and MWA groups, with the lowest in RFA group. There were no significant differences in complication rate among all treatment methods. RFA had the highest VRR for thyroid nodules, and it excelled in symptom scores, cosmetic scores, and nodule regrowth rates.

Can Ethanol Ablation Achieve Durable Control of Neck Nodal Recurrences in Adults With Stage I Papillary Thyroid Cancer?

Results of ethanol ablation (EA) for controlling neck nodal metastases (NNM) in adult patients with papillary thyroid carcinoma (APTC) beyond 6 months have rarely been reported. We now describe outcome results in controlling 71 NNM in 40 node-positive stage I APTC patients followed for 66 to 269 months. All 40 patients were managed with bilateral thyroidectomy and radioiodine therapy and followed with neck ultrasound (US) for >48 months after EA. Cumulative radioiodine doses ranged from 30 to 550 mCi; pre-EA 27 patients (67%) had 36 additional neck surgeries. Cytologic diagnosis of PTC in 71 NNM selected for EA was confirmed by US-guided biopsy. EA technique and follow-up protocol were as previously described. The 40 patients had 1 to 4 NNM; 67/71 NNM (94%) received 2 to 4 ethanol injections (total median volume 0.8 cc). All ablated 71 NNM shrank (mean volume reduction of 93%); nodal hypervascularity was eliminated. Thirty-eight NNM (54%) with initial volumes of 12-1404 mm3 (median 164) disappeared on neck sonography. Thirty-three hypovascular foci from ablated NNM (pre-EA volume range 31-636 mm3; median 147) were still identifiable with volume reductions of 45% to 97% observed (median 81%). There were no complications and no postprocedure hoarseness. Final results were considered to be ideal or near ideal in 55% and satisfactory in 45%. There was no evidence of tumor regrowth after EA. Our results demonstrate that for patients with American Joint Committee on Cancer stage I APTC, who do not wish further surgery or radioiodine, and are uncomfortable with active surveillance, EA can achieve durable control of recurrent NNM.

Differential Pacing Maneuver From the Vein of Marshall.

Bidirectional mitral isthmus (MI) block is conventionally verified by differential pacing from the coronary sinus (CS) and its sequence change. This study aimed to evaluate the ability of differential pacing from the vein of Marshall (VOM) to detect epicardial MI connections. Radiofrequency and VOM ethanol MI ablation were performed with a VOM electrode catheter inserted to the septal side of the ablation line. MI block was verified using conventional CS pacing. To perform differential VOM pacing analysis, initial pacing was delivered from a distal VOM bipole closer to the block line, and then from a proximal VOM bipole. The intervals from pacing stimulus during different VOM pacing sites to the electrogram recorded through the CS catheter on the opposite side of the line were compared. When the interval during distal VOM pacing was longer than that during proximal VOM pacing, it indicated a VOM connection block; however, if the former interval was shorter, the connection through the VOM was considered persistent. Overall, 50 patients were evaluated. According to CS pacing, MI ablation was incomplete in 9 patients, in whom the analysis indicated persistent VOM connection. Among 41 patients with complete MI block, confirmed by CS finding, in 30 (73%) patients, the interval during distal VOM pacing was longer than that during proximal VOM pacing by 11±5 ms. However, in 11 patients (27%) the former interval was revealed to be shorter than the latter by 16±8 ms, indicating residual VOM connection. Conduction time across the line was significantly shorter in 11 patients than in the other 30 (166±21 versus 197±36 ms; P<0.01). Ten successful reevaluated analyses after VOM ethanol and further radiofrequency ablation of the connection indicated VOM block achievement. Differential VOM pacing maneuver reflects the VOM conduction status. This maneuver can uncover residual epicardial connections that are missing with CS pacing.

Thyroid Ethanol and Radiofrequency Ablation: A Call for Patient-Friendly Online Resources

Introduction: The multiple treatment options available to patients with thyroid nodules can generate uncertainty and confusion. Radiofrequency ablation (RFA) and ethanol ablation (EA) are two alternative modalities to manage thyroid nodules. As patients more frequently utilize online resources to guide their decision-making, the quality of such resources must be evaluated. The goal of this study was to assess the quality of online patient materials relating to RFA and EA compared to standard thyroidectomy. Methods: The terms “thyroidectomy,” “thyroid radiofrequency ablation,” and “thyroid ethanol ablation” were searched on Google. Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), and Patient Education Materials Assessment Tool (PEMAT) understandability and actionability were calculated for each website. Statistical analysis was conducted on SPSS Statistics. Google trends were used to determine search interest for each term (May 2016 – May 2021). Results: Of the 77 websites that met our inclusion criteria (30 thyroidectomy sites, 30 RFA sites, and 17 EA sites), the average FRE, FKGL, and SMOG scores of the RFA websites were significantly worse than those of the thyroidectomy websites (p < 0.05). The FKGL and SMOG scores of the EA websites were significantly worse than those of the thyroidectomy websites (p < 0.05). The average understandability and actionability scores for thyroidectomy websites were significantly higher than those of RFA and EA websites (p < 0.05). Conclusion: Ablation websites have lower search interest, readability, validity, understandability, and actionability scores in comparison to traditional thyroidectomy websites. Our findings emphasize the need to consider readability and PEMAT scores when developing online educational resources for ablative alternatives to thyroidectomy to allow for greater patient accessibility.

Ventricular Tachycardia Catheter Ablation: Retrospective Analysis and Prospective Outlooks-A Comprehensive Review.

Ventricular tachycardia is a potentially life-threatening arrhythmia associated with an overall high morbi-mortality, particularly in patients with structural heart disease. Despite their pivotal role in preventing sudden cardiac death, implantable cardioverter-defibrillators, although a guideline-based class I recommendation, are unable to prevent arrhythmic episodes and significantly alter the quality of life by delivering recurrent therapies. From open-heart surgical ablation to the currently widely used percutaneous approach, catheter ablation is a safe and effective procedure able to target the responsible re-entry myocardial circuit from both the endocardium and the epicardium. There are four main mapping strategies, activation, entrainment, pace, and substrate mapping, each of them with their own advantages and limitations. The contemporary guideline-based recommendations for VT ablation primarily apply to patients experiencing antiarrhythmic drug ineffectiveness or those intolerant to the pharmacological treatment. Although highly effective in most cases of scar-related VTs, the traditional approach may sometimes be insufficient, especially in patients with nonischemic cardiomyopathies, where circuits may be unmappable using the classic techniques. Alternative methods have been proposed, such as stereotactic arrhythmia radioablation or radiotherapy ablation, surgical ablation, needle ablation, transarterial coronary ethanol ablation, and retrograde coronary venous ethanol ablation, with promising results. Further studies are needed in order to prove the overall efficacy of these methods in comparison to standard radiofrequency delivery. Nevertheless, as the field of cardiac electrophysiology continues to evolve, it is important to acknowledge the role of artificial intelligence in both the pre-procedural planning and the intervention itself.

Ethanol ablation of papillary thyroid carcinoma nodal metastases: Long-term outcomes

BackgroundPercutaneous ethanol ablation has emerged as a treatment for recurrent papillary thyroid carcinoma in the lateral neck after compartment-oriented therapeutic lymphadenectomy. However, the safety and utility of percutaneous ethanol ablation as a primary treatment modality for lateral neck metastases remains undefined. We aimed to investigate long-term outcomes of percutaneous ethanol ablation of lateral neck papillary thyroid carcinoma recurrence both with and without prior lymphadenectomy. MethodsWe conducted a retrospective study of patients with lateral neck papillary thyroid carcinoma treated with percutaneous ethanol ablation from 2013 to 2018. Patient characteristics, disease volume, morbidity, and recurrence (development of new lymphadenopathy within a percutaneous ethanol ablation-treated nodal compartment) were assessed. ResultsWe identified 117 patients who underwent percutaneous ethanol ablation for papillary thyroid carcinoma lateral neck metastases—67 (57%) had a prior lateral neck dissection. Median follow-up after percutaneous ethanol ablation was 5.5 years (interquartile range 3.1–7.5). On average, 1.4 lymph nodes (range: 1–6) were treated. Three patients (3%) developed transient nerve-related complications after percutaneous ethanol ablation. Of 15 patients who underwent lateral neck dissection after percutaneous ethanol ablation (including patients undergoing repeat lateral neck dissection), dissection was “difficult” in 8 (53%) (7 of whom had previously undergone lateral neck dissection), and 4 (27%) developed complications (transient nerve dysfunction = 3, lymphatic leak = 1). Thirty-three patients (28%) developed recurrent papillary thyroid carcinoma. No difference in recurrence was seen between patients who did or did not undergo pre-percutaneous ethanol ablation lateral neck dissection (no pre-percutaneous ethanol ablation lateral neck dissection: 24%, pre-percutaneous ethanol ablation lateral neck dissection, 31%; hazard ratio = 1.27, 95% confidence interval 0.62–2.58; P = .514). ConclusionPercutaneous ethanol ablation may be a safe primary treatment modality for papillary thyroid carcinoma lateral neck nodal recurrence in selected patients with low-volume nodal disease.

Endoscopic ultrasound-guided ethanol ablation versus surgical resection of insulinomas.

Insulinoma is a rare tumor of the pancreas that can lead to hypoglycemia. To date, the standard therapy is surgical resection. After the first case report of successful endoscopic ultrasound-guided (EUS) ethanol injection 16 years ago, the need for establishing an alternative treatment method remains unchanged given the high morbidity rates of surgery and its unsuitability in some patients. Here, we provide retrospective data from 33 insulinoma patients that were treated at our center between 2010 and 2021. Of these, 9 patients were treated with EUS-guided ethanol injection and 24 underwent pancreatic surgery. The ethanol group was older (ethanol: mean ± SE 67.8±11.2 years vs. surgery: 52.3±15.7, p=0.014) with a higher Charlson Comorbidity Index (3.0 (1.0;4.0) vs. 1.0 (0.0;2.0), p=0.008). The lowest glucose values were similar between groups before (ethanol: 2.09±0.17 mmol/l vs. surgery: 1.81±0.08, p=0.158) and after (4.95±0.74 vs. 5.41±0.28, p=0.581) the respective treatments. Complications occurred more frequently in the surgery group (11 % vs. 54 %, p=0.026). One patient after prior partial pancreatectomy died postoperatively. The hospitalization time was significantly shorter in the ethanol group (4.78±0.78 days vs. 19.88±4.07, p<0.001). EUS-guided ethanol injection can be similarly effective for the treatment of hyperinsulinemic hypoglycemia compared with pancreatic surgery but seems to be associated with less severe complications. This implies the need for prospective randomized trials in insulinoma patients with a low risk for malignancy.

The Comparison of Efficacy and Safety between Radiofrequency Ablation Alone and Ethanol Ablation Followed by Radiofrequency Ablation in the Treatment of Mixed Cystic and Solid Thyroid Nodule.

To compare the efficacy and safety of radiofrequency ablation (RFA) and ethanol ablation (EA) followed by RFA in treating mixed cystic and solid thyroid nodules. We included 243 nodules from 243 patients who underwent RFA for mixed cystic and solid benign nodules. The nodules were divided into two groups (RFA alone and EA + RFA). We evaluated volume reduction rate (VRR), therapeutic success rate, improvement in symptomatic and cosmetic issues, complications, and adverse effects. The RFA group included 204 patients, and the EA + RFA group included 39 patients. The long-term success rates in the RFA only and EA + RFA groups were 90.2% and 97.4%, respectively. The mean VRR at the last follow-up in the RFA and EA + RFA groups were 81.6% and 87.2%, respectively. Therapeutic results were similar in both groups at the last follow-up. Cosmetic and symptomatic problems markedly improved in both groups. No major complications were observed. Both RFA alone and EA + RA are safe and effective methods for treating mixed cystic and solid thyroid nodules, although EA + RFA is slightly more effective.

Are Non-Ethanol Based Ablation Therapies Better Than Ethanol Ablation for Pancreatic Cysts?: A Systematic Review and Meta-Analysis

Background: Endoscopic Ultrasound (EUS) guided Ethanol Ablation of the pancreatic cyst has been used as an alternative for surgery in recent years. In this meta-analysis, we compare the outcomes of pancreatic cyst ablation with ethanol-based ablation therapy versus non-ethanol-based ablation therapies. Methods: Selection Criteria included pancreatic cyst ablations with EUS-guided ethanol and non-ethanol ablation. Data was collected and extracted from Medline, Pubmed, and Ovid journals. Statistical analysis used Fixed and random effects models to calculate the pooled proportions.

Hypoxia and hypotension following industrial-grade anhydrous ethanol ablation of the vein of Marshall in the treatment of atrial fibrillation: a case report

Hypoxia and hypotension following industrial-grade anhydrous ethanol ablation of the vein of Marshall in the treatment of atrial fibrillation: a case report

Ethanol Ablation of Refractory Premature Ventricular Complex Originating from a Left Ventricular Summit Communicating Vein after Radiofrequency Catheter Ablation Failed in a Dilated Cardiomyopathy Patient.

During follow-up of a 60-year-old patient with dilated cardiomyopathy, a Holter electrocardiogram revealed monomorphic premature ventricular complexes (PVCs) accounting for 21-30% of total beats. Oral beta-blockers led to no improvement in PVC burden. The first radiofrequency catheter ablation attempt identified the PVC arising from the left ventricle summit communicating vein (CV) but failed to eliminate the PVC's origin. The second ablation attempt with selective infusions of 100% ethanol into the summit CV resulted in immediate termination of PVCs. The post-ablation course was uneventful. Echocardiography showed an improved ejection fraction, and a repeated Holter electrocardiogram showed no recurrence of PVCs during follow-up. Ethics The RCVEA procedures were approved by the Takagi Hospital Ethical Committee and were performed under an institutional review board-approved protocol. (Kouhou-kai Ethical Committee, ID: KR168) Fundings This work was supported by the Takagi Hospital Cardiology Research Grant. The authors declare no competing interests. Acknowledgements: We thank the patient, the patient's family, and the medical staff of Takagi Hospital for their valuable cooperation and kind support. Consent Written informed consent was obtained from the patient for the publication of this case report and accompanying images.

Giant Multicyst Neck Lymphangioma in Adult with Single Session Ethanol Ablation Treatment: Rare Case Report

Introduction: Neck lymphangioma is a benign congenital malformation that occurs frequently in children, and is rare in adults. They are usually found in the head and neck region and are often considered a metastatic lesion rather than a primary neoplasia. Most lymphangiomas are acquired at birth which is about 60%, and by the age of 2 years about 80% to 90% are present. The most common location of the abnormality is the submandibular region followed by the parotid gland.&#x0D; Case Presentation: A 22-year-old man with complaints of lumps on the right side of the neck that has been getting bigger since 5 months ago. The lump initially appeared the size of a tennis ball, then quickly grew to the size of a watermelon within a month. Physical examination revealed a mass in the right colli region, cystic, fixed, multiple masses of varying size. The core biopsy examination showed the results of lymphangioma. The patient was treated with Ethanol Ablation.&#x0D; Discussion: Neck lymphangiomas that are clinically more circumscribed than cavernous lymphangioma. On physical examination, they are soft, with varying sizes and shapes, and will typically grow if not surgically excised. MRI can be useful in determining the extent of anatomical involvement of cystic or cavernous lymphangiomas. Treatment of neck lymphoma is mainly surgical resection. Resection surgery can be associated with complications like lymphatic leaks, fistula formation, chronic wounds, neck on account of mucosal oedema, enlargement of internal lymphangiomas, and loss of neural innervation to the pharynx or tongue. Radiofrequency ablation is a safe, viable alternative and effective debulking treatment of neck lymphangioma.&#x0D; Conclusion: We recommend ethanol ablation is a safe, viable alternative and effective debulking treatment of neck lymphangioma and thermal damage to surrounding tissues. This paper constitutes the first report of successful treatment of airway obstruction due to neck lymphangioma.

Acute impact of the vein of marshall ethanol infusion on newly-formed lesion and mitral line block in persistent atrial fibrillation ablation

Abstract Catheter ablation in persistent atrial fibrillation (PeAF) has limited success. Strategies beyond pulmonary veins isolation failed to demonstrate improvement of long-term rhythm maintenance. The vein of Marshall (VoM) is a promising therapeutic target because it contains triggers and autonomic parasympathetic and sympathetic activity implicated in arrhythmogenesis of AF. Moreover, as the VoM colocalizes with the trajectory of the "mitral isthmus", alcohol infusion into the vein facilitates bidirectional block across the line eliminating protected epicardial connections (1,2). Purpose We evaluated acute impact on lesion formation post-VOM-ETHO and the mitral line block validation after an approach including VOM-ETHO, pulmonary vein isolation (PVI), roof-line, mitral line (ML) and cavo-tricuspid isthmus line in a population of PeAF patients (Figure 1). We aimed also to report procedural outcomes after a short follow-up period. Methods After a detailed electroanatomical map of the left atrium (LA) (filter at 0.05-0.5 mV if the patient was in sinus rhythm or 0.05-0.3 mV in the case of AF), we thus proceeded with the VoM-ETHO using the technique previously described (3,4). LA map was thus repeated to assess the extension of the newly-formed low voltage area (LVA). According to the newly-formed LVAs, mitral isthmus ablation was completed endocardially. PVI, roof-line and cavo-tricuspid isthmus line were performed to complete the ablation setting. Bidirectional block across line was then validated during pacing from left atrial appendage. In case of persistence of conduction through the mitral line due to epicardial gaps, additional ablations were applied in the "anchored wall" or in the "free-wall" of the great cardiac vein (GCV). Results Twenty-one PeAF patients (67±6 years; 67% male) underwent ablation. The medium value of basal LA-LVAs was 3.1±63.8 cmq and the newly-formed LVAs after the VoM-ETHO procedure was 12.35±67.28 cmq. All patients had bidirectional block validated across the roof-line. Bidirectional block of the ML was achieved in 19/21 patients: in 12/21 patients after endocardial line only and in 9/21 after epicardial gaps ablations into the coronary sinus. The ML procedural time was 11.3±65.9 minutes. No major complications occurred. One patient had mild pericardial effusion due to VoM perforation with a spontaneous resolution. After a short follow-up period (6±63 months), no relapse of AF was observed in 19/21 (90%) patients. 12/21 patients were free from antiarrhythmic drugs (AADs). Interestingly, recurrences happened in patients in whom bidirectional block of the mitral line was not achieved. Conclusions VoM ethanol ablation added to PVI and linear lesions in the context of a methodical and anatomical approach seems to have promising results in PeAF patients. This strategy seems to be safe and reproducible. A favourable outcome depended on the interventional setting completion and the procedural end-points validation is crucial.

In Vivo Evaluation of Safety and Efficacy of Ethyl Cellulose-Ethanol Tissue Ablation in a Swine Cervix Model.

Current therapies for treating cervical dysplasia are often inaccessible in low and middle-income countries (LMICs), highlighting the need for novel low-cost therapies that can be delivered at the point of care. Ethanol ablation is a low-cost therapy designed to treat locoregional cancers, which we augmented into an ethyl cellulose (EC)-ethanol gel formulation to enhance its efficacy. Here, we evaluated whether EC-ethanol ablation is able to safely achieve an ablation zone comparable to thermocoagulation, a commonly used therapy for cervical dysplasia. The study was performed in 20 female Yorkshire pigs treated with either a single 500 µL injection of EC-ethanol into the 12 o'clock position of the cervix or a single application of thermocoagulation at 100 °C for 20 s. The average temperature, heart rate, respiratory rate, and blood oxygen remained within normal ranges throughout the EC-ethanol procedure and were similar to the thermocoagulation group. No major side effects were observed. The reproductive tracts were excised after 24 h to examine ablation zones. Comparable depths of necrosis were seen for EC-ethanol (18.6 ± 1.6 mm) and thermocoagulation (19.7 ± 4.1 mm). The volumes of necrosis induced by a single injection of EC-ethanol (626.2 ± 122.8 µL) were comparable to the necrotic volumes induced by thermocoagulation in the top half of the cervices (664.6 ± 168.5 µL). This suggests that two EC-ethanol injections could be performed (e.g., at the 12 and 6 o'clock positions) to achieve comparable total necrotic volumes to thermocoagulation and safely and effectively treat women with cervical dysplasia in LMICs. This is the first study to systematically evaluate EC-ethanol ablation in a large animal model and compare its safety and efficacy to thermocoagulation, a commonly used ablative therapy for cervical dysplasia.

Ethanol Ablation for Benign Insulinoma: Intraoperative and Endoscopic Approaches

IntroductionEthanol ablation can be utilized to manage insulinoma. We aimed to analyze our outcomes of endoscopic ultrasound (EUS) and intraoperative ultrasound (IOUS) guided Ethanol ablation of insulinoma. MethodsA single institution retrospective review of adults undergoing Ethanol ablation of benign pancreatic insulinoma (2007-2022) was performed. Outcomes were categorized as resolution of hypoglycemia, improvement, or no change at last follow-up. ResultsA total of 16 patients underwent Ethanol ablation of benign insulinoma (N = 8 EUS, N = 8 IOUS): median age was 68 y, 8 (50%) were females, and 2 (12.5%) were associated with multiple endocrine neoplasia type-1. Median insulinoma size was 12 (range 7, 25) mm. Ethanol ablation was preferred over resection to avoid pancreaticoduodenectomy when it was not possible to enucleate the tumor in 10 (62.5%) patients while the rest underwent ablation due to being poor surgical candidates or because of a history of previous pancreatic resection. The median follow-up (interquartile range) was 43 (19.5, 81.5) mo. Resolution of hypoglycemia occurred in 11 patients (5 EUS, 6 IOUS), while the rest (3 EUS, 2 IOUS) experienced improvement in the severity and frequency of hypoglycemia. A single patient underwent resection following a previous ablation for symptomatic hypoglycemia 5 y after EUS guided ablation. ConclusionsEthanol ablation provides an alternative therapeutic option for patients with insulinoma. Both EUS and IOUS guided approaches are associated with a favorable resolution rate although EUS guided ablation may require multiple procedures to optimize outcomes.

SAT457 Ethanol Ablation For The Treatment Of Cystic Thyroid Nodules: The First Ecuadorian Prospective Cohort

Abstract Disclosure: A.P. Solis Pazmiño: None. F. Carrion: None. J. Mesias: None. E. Pilatuna: None. R. Godoy: None. C. Garcia: None. Introduction: Percutaneous ethanol injection (PEI) has been adopted to treat benign cystic nodules in the last decade. For this study, we aimed to investigate the change in nodule volumes and cosmetic scores before and after EA in benign thyroid nodules and the effectiveness of treatment. Method: This prospective study, conducted at ITECC, included adults who underwent PEI for benign thyroid nodules (TN) with cystic content, between February 2021 and October 2022. The technique first consists of providing anesthesia using 10 ml of 2% solution. lidocaine. We then injected 75% ethanol into 1/3 of the volume of the TN. Nodule size and volume, thyroid function, and complications were evaluated before and after UPEA. Initial volume and change in TN volume were calculated with the ATA calculator and the independent-samples T-test. Results: A total of 13 patients with purely cystic single nodules with non-functioning and graded as Bethesda II were included. The mean age at the time of PEI was 52.46 years, and most of the patients were female (76.9%), euthyroid (77%), and symptomatic (69%). The median largest diameter of the thyroid cyst was 4.0 cm (interquartile range [IQR], 3.2 -4.5 cm; range, 1.7-5.9 cm); the median volume pre-PEI was 15.06 mL (IQR, 3.63-22.07 mL; range, 0.6-44.8 mL). The median amount of cystic fluid drained before PEI was 20 mL, and the median amount of ethanol administered was 3,85 mL (IQR, 3-5.25 mL; range, 1.5-6 mL). After a month’s follow-up, of 10 patients with available imaging on follow-up, 8 (80%) had a 50% or greater reduction in nodule volume. The median volume post-PEI was 1.5 (IQR, 0.6-8.1) ml decrease, 80.44% [IQR, 31.88%-95%]). We did not have any adverse effects. Prior to ablation, there were 46% of patients with cosmetic problems and symptomatic scores. At the 12-month follow-up, the overall cosmetic score improved from 2 to 0 (p&amp;lt; 0.001), as well as the overall symptomatic score improved from 3.2 to 0.5. Conclusions: Percutaneous ethanol injection seems to be a safe and effective alternative to surgical resection for patients with purely or predominantly cystic thyroid nodules and compressive symptoms who decline surgery or are not good surgical candidates. ITECC is the first center in Ecuador to perform this procedure, having encouraging results with a considerable reduction in TN in the first month with symptomatic relief and improvement in cosmetic score. Presentation: Saturday, June 17, 2023

Unilateral chemical ablation of the adrenal gland lowers blood pressure and alleviates target organ damage in spontaneously hypertensive rats.

Spontaneously hypertensive rats (SHR) and Wistar-Kyoto rats (WKY) were subjected to unilateral adrenal ablation with injection of ethanol or a sham procedure. Blood pressure was monitored for 24 weeks. Adrenal ablation significantly lowered systolic and diastolic blood pressure of SHR but not WKY from 4 to 24 weeks after the procedure. Unilateral debulking of the adrenal gland using ethanol ablation is a promising therapeutic strategy for treating hypertension.

S1952 Successful Management of Insulinoma by Computed Tomography Guided Ethanol Ablation

S1952 Successful Management of Insulinoma by Computed Tomography Guided Ethanol Ablation

How to ablate the septo-pulmonary bundle: a case-based review of percutaneous ablation strategies to achieve roof line block.

Electrical conduction through cardiac muscle fibres separated from the main myocardial wall by layers of interposed adipose tissue are notoriously difficult to target by endocardial ablation alone. They are a recognised important cause for procedural failure due to the difficulties of delivering sufficient energy via the endocardial radiofrequency catheter to reach the outer epicardial layer without risking adverse events of the otherwise thin walled atria. Left atrial ablations for atrial fibrillation (AF) and tachycardia are commonly affected by the presence of several epicardial structures, with the septo-pulmonary bundle (SPB), Bachmann's bundle, and the ligament of Marshall all posing substantial challenges for endocardial procedures. Delivery of a transmural lesion set is essential for sustained pulmonary vein isolation and for conduction block across linear atrial lines which in turn has been described to translate into a reduced AF/atrial tachycardia recurrence rate. To overcome the limitations of endocardial-only approaches, surgical ablation techniques for epicardial or combined hybrid endo-epicardial ablations have been described to successfully target these connections. Yet, these techniques confer an increase in procedure complexity, duration, cost, and morbidity. Alternatively, coronary venous system ethanol ablation has been successfully employed by sub-selecting the vein of Marshall to facilitate mitral isthmus line block, although this approach is naturally limited to this area by the coronary venous anatomy. Increased awareness of the pathophysiological relevance of these epicardial structures and their intracardiac conduction patterns in the era of high-resolution 3D electro-anatomical mapping technology has allowed greater understanding of their contribution to the persistence of AF as well as failure to achieve transmural block by traditional ablation approaches. This might translate into novel catheter ablation strategies with procedural success rates comparable to surgical 'cut-and-sew' techniques. This review aims to give an overview of percutaneous catheter ablation strategies to target the SPB, an important cause of failed block across the roof line and isolation of the left atrial posterior wall and/or the pulmonary veins. Existing and investigational technologies will be discussed and an outlook of future approaches provided.

Venous anatomy of the left ventricular summit region: Insights from high-speed rotational retrograde angiography.

Mapping and ablation through the coronary venous system (CVS) have shown potential for ventricular arrhythmias originating from the left ventricular summit (LVS). Multielectrode catheters and balloons are frequently used for mapping and venous ethanol ablation (VEA). However, there is limited data on the venous size and drainage condition in the LVS region. This study aimed to investigate the morphology, angiographic size, and drainage condition of LV summit veins via high-speed rotational angiography (RA). We measured and analyzed the size of the great cardiac vein (GCV), the anterior interventricular vein (AIV), veins near to the LVS, and other main tributaries of CVS in 102 patients undergoing electrophysiology study. Rotational retrograde angiography of LVS was successfully performed in 81 patients. The diameter of GCV at the level of the Vieussens valve and the distal end of GCV (junction of GCV-AIV) was larger in males than females (6.8 ± 1.1 vs. 5.6 ± 1.2 mm, p < .001; 5.2 ± 0.9 vs. 4.6 ± 0.8, p = .002, respectively) while no significant gender differences were observed in other tributaries. The LV summit veins presented downward drainage direction in half of the patients, indicating potential anatomic adjacency with His bundle. Left anterior oblique (LAO) 45° projection might provide the practical and optimal view of the LV summit veins. The coronary veins of the LVS region present various anatomical morphologies and ostium sizes. We provide a systematic description and angiographic size spectrum of CVS. RA could facilitate assessing the feature of CVS comprehensively.