Intrahepatic Radiofrequency Ablation Versus Electrochemical Treatment Ex Vivo

Magnetic Resonance–Monitored Coaxial Electrochemical Ablation—Preliminary Evaluation of Technical Feasibility

“…EChT is a nonthermal ablation technique that causes tissue necrosis by generating extreme pH changes at the anode and cathode resulting in protein denaturation (8,9,11). The main electrochemical reactions at the anode are decomposition of water and oxidation of chloride ions resulting in free hydrogen ions and a strongly acidic microenvironment resulting in coagulative necrosis (24):…”

“…EChT is a nonthermal percutaneous ablation technique that uses DC electricity to cause tumor necrosis by generating a strongly acidic microenvironment at the anode and strongly alkaline microenvironment at the cathode (5)(6)(7). Studies showed no effect on systemic pH; necrosis was due primarily to pH-mediated protein denaturation and secondarily to disruption of cell membranes and coagulation of local capillaries (8)(9)(10)(11)(12). Although thermal ablation relies on heat dispersion, which is susceptible to perivascular heat sink, the acids and bases of EChT penetrate into the surrounding tissues via diffusion and electrically driven migration (13,14).…”

“…Although thermal ablation relies on heat dispersion, which is susceptible to perivascular heat sink, the acids and bases of EChT penetrate into the surrounding tissues via diffusion and electrically driven migration (13,14). This feature results in a sharp ablation margin regardless of traversing vessels (11,12). The primary considerations for ablation size and rate for EChT is the level of current and electrode distance (11,12,(15)(16)(17)(18).…”

“…This feature results in a sharp ablation margin regardless of traversing vessels (11,12). The primary considerations for ablation size and rate for EChT is the level of current and electrode distance (11,12,(15)(16)(17)(18). Additionally, magnetic resonance (MR)-compatible electrodes can be used in EChT. EChT has been used to treat lung, gastrointestinal, and soft tissue tumors with minimal local discomfort and morbidity (19,20).…”

“…Reported 5-year survival was 39% for lung, 15% for primary liver, and 50% for breast carcinomas (13). However, EChT has not gained widespread clinical use in Western countries because of the lack of standardized treatment algorithms, the paucity of published clinical trials, and because ablations are time-consuming and difficult to contour with traditional EChT (11)(12)(13)19,20). We propose a novel approach to EChT using a coaxial configuration of the electrodes consisting of a central platinum anode with a peripheral nitinol cathode cage.…”