The improvement of irreversible electroporation therapy using saline-irrigated electrodes: a theoretical study

Irreversible electroporation: treatment effect is susceptible to local environment and tissue properties

PURPOSE

To study the effects of the surrounding electrical microenvironment and local tissue parameters on the electrical parameters and outcome of irreversible electroporation (IRE) ablation in porcine muscle, kidney, and liver tissue.

MATERIALS AND METHODS

Animal Care and Use Committee approval was obtained, and National Institutes of Health guidelines were followed. IRE ablation (n = 90) was applied in muscle (n = 44), kidney (n = 28), and liver (n = 18) tissue in 18 pigs. Two electrodes with tip exposure of 1.5-2 cm were used at varying voltages (1500-3000 V), pulse repetitions (n = 70-100), pulse length (70-100 µsec), and electrode spacing (1.5-2 cm). In muscle tissue, electrodes were placed exactly parallel, in plane, or perpendicular to paraspinal muscle fibers; in kidney tissue, in the cortex or adjacent to the renal medulla; and in liver tissue, with and without metallic or plastic plates placed 1-2 cm from electrodes. Ablation zones were determined at gross pathologic (90-120 minutes after IRE) and immunohistopathologic examination (6 hours after) for apoptosis and heat-shock protein markers. Multivariate analysis of variance with multiple comparisons and/or paired t tests and regression analysis were used for analysis.

RESULTS

Mean (± standard deviation) ablation zones in muscle were 6.2 cm ± 0.3 × 4.2 cm ± 0.3 for parallel electrodes and 4.2 cm ± 0.8 × 3.0 cm ± 0.5 for in-plane application. Perpendicular orientation resulted in a cross-shaped zone. Orientation significantly affected IRE current applied (28.5-31.7A for parallel, 29.5-39.7A for perpendicular; P = .003). For kidney cortex, ovoid zones of 1.5 cm ± 0.1 × 0.5 cm ± 0.0 to 2.5 cm ± 0.1 × 1.3 cm ± 0.1 were seen. Placement of electrodes less than 5 mm from the medullary pyramids resulted in treatment effect arcing into the collecting system. For liver tissue, symmetric 2.7 cm ± 0.2 × 1.4 cm ± 0.3 coagulation areas were seen without the metallic plate but asymmetric coagulation was seen with the metallic plate.

CONCLUSION

IRE treatment zones are sensitive to varying electrical conductivity in tissues. Electrode location, orientation, and heterogeneities in local environment must be considered in planning ablation treatment. Online supplemental material is available for this article.

Electrode activation sequencing employing conductivity changes in irreversible electroporation tissue ablation

Irreversible electroporation (IRE) uses high-voltage pulses applied to tissue, which cause dielectric breakdown of cell membranes resulting in cell death. IRE is a promising technique for ablation of nonresectable tumors because it can be configured to spare critical structures such as blood vessels. A consequence of pulse application is an increase in tissue electrical conductivity due to current pathways being opened in cell membranes. We propose a novel IRE method introducing electrode switching and pulse sequencing in which tissue conductivity is first increased using preparatory pulses in order to form high-conductivity zones, which then helps provide higher electric field intensity within the targeted tissue as subsequent pulses are applied, and hence, enhances the efficiency and selectivity of the IRE treatment. We demonstrate the potential of this method using computational models on simple geometries.