Hydrodissection of the Retro-Sternal Space to Protect the Pericardium During Sternal Cryoablation
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TECHNICAL NOTE
NON-VASCULAR INTERVENTIONS
Hydrodissection of the Retro-Sternal Space to Protect the Pericardium During Sternal Cryoablation Pierre-Alexis Autrusseau1 • Julien Garnon1 • Pierre Auloge1 • Julia Weiss1 • Danoob Dalili2,3 • Jean Caudrelier1 • Roberto Luigi Cazzato1 • Guillaume Koch1 Afshin Gangi1
•
Received: 23 April 2020 / Accepted: 26 June 2020 Ó Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2020
Abstract Purpose To report the retro-sternal space hydrodissection technique used to displace the heart and the pericardium posteriorly for thermoprotection ahead of sternal cryoablation (CA). Methods and materials Between May 2015 and March 2020, hydrodissection of the retro-sternal space was performed in 5 consecutive patients (5 female; mean age 55.2 ± 9.3 years, range 41–65) who underwent percutaneous image-guided cryoablation of the sternum. The number of needles required, the implemented approach, volume of injectate to achieve hydrodissection, hydrodissection procedure time, distance between the lesion and the pericardium before and after hydrodissection, distance between the ice-ball and the pericardium, technical success and complications were retrospectively assessed. Results Technical success, defined as the completion of a full dual freeze protocol without contact between the ice-
ball and the pericardium, was achieved in all cases (5/5, 100%). One to two needles were used to perform hydrodissection via a perpendicular (3/5) or an anterior oblique approach (2/5) and a mean hydrodissection procedure time of 10.4 ± 2.6 min (range 8–14). Minimum distance between the lesion and the pericardium increased from mean 5.8 ± 3.8 mm (range 0–10) before hydrodissection to a mean 22.2 ± 5.8 mm (range 18–32) after, with a mean distance between the final ice-ball and the pericardium of 11.6 ± 8.7 mm (range 7–27). A mean of 198 ± 79.8 mL (range 90–290) of iodinated contrast was injected. There were no immediate, short- or medium-term complication noted. Conclusion Hydrodissection of the retro-sternal space is a feasible technique for sternal cryoablation in order to protect the pericardium from freezing for sternal cryoablation.
& Pierre-Alexis Autrusseau [email protected]
Guillaume Koch [email protected] Afshin Gangi [email protected]
Julien Garnon [email protected] Pierre Auloge [email protected] Julia Weiss [email protected]
1
Service D’Imagerie Interventionnelle, Hoˆpitaux Universitaires de Strasbourg, 1, place de l’hopital, 67000 Strasbourg, France
2
Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Road, Oxford OX3 7LD, UK
3
School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
Danoob Dalili [email protected] Jean Caudrelier [email protected] Roberto Luigi Cazzato [email protected]
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