title: Feasibility of catheter-directed intraluminal irreversible electroporation of porcine ureter and acute outcomes in response to increasing energy delivery.
abstract: OBJECTIVE
  To evaluate the feasibility of focal intraluminal irreversible electroporation (IRE) in the ureter with a novel electrode catheter and to study the treatment effects in response to increasing pulse strength.
  
  
  METHODS
  Five IRE treatment settings were each evaluated twice for the ablation of normal ureter in 5 Yorkshire pigs (n = 1-4 ablations per animal; total of 10 ablations) with the use of a prototype device under ultrasound and fluoroscopic guidance. Animals received unilateral or bilateral treatment, limited to a maximum of 2 ablations in any 1 ureter. Treatment was delivered with increasing pulse strength (from 1,000 V to 3,000 V in increments of 500 V) while keeping the pulse duration (100 μs) and number of pulses (n = 90) constant. Ureter patency was assessed with antegrade ureteropyelography immediately following treatment. Animals were euthanized within 4 hours after treatment, and treated urinary tract was harvested for histopathologic analysis with hematoxylin and eosin and Masson trichrome stains.
  
  
  RESULTS
  IRE was successfully performed in all animals, without evidence of ureteral perforation. Hematoxylin and eosin analysis of IRE treatments demonstrated full-thickness ablation at higher field strengths (mucosa to the adventitia). Masson trichrome stains showed preservation of connective tissue at all field strengths.
  
  
  CONCLUSIONS
  Intraluminal catheter-directed IRE ablation is feasible and produces full-thickness ablation of normal ureters. There was no evidence of lumen perforation even at the maximum voltages evaluated.
authors.affiliation: Department of Radiology, Interventional Radiology Service, Memorial Sloan-Kettering Cancer Center, New York, New York. Electronic address: srimaths@mskcc.org.
authors.forename: Govindarajan
authors.initials: G
authors.lastname: Srimathveeravalli
authors.affiliation: Department of Radiology, Interventional Radiology Service, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Mikhail
authors.initials: M
authors.lastname: Silk
authors.affiliation: Department of Radiology, Medical University of Graz, Graz, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Wimmer
authors.affiliation: Tri-Institutional Laboratory of Comparative Pathology, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, and The Rockefeller University, New York, New York.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Monette
authors.affiliation: Department of Surgery, Division of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Simon
authors.initials: S
authors.lastname: Kimm
authors.affiliation: Department of Radiology, Interventional Radiology Service, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Majid
authors.initials: M
authors.lastname: Maybody
authors.affiliation: Department of Radiology, Interventional Radiology Service, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Solomon
authors.affiliation: Department of Surgery, Division of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Coleman
authors.affiliation: Department of Radiology, Interventional Radiology Service, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Jeremy C
authors.initials: JC
authors.lastname: Durack
mesh_terms: D000818:Animals; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D057785:Catheters; D018274:Electroporation / Q000295:instrumentation; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D008839:Microelectrodes; D023421:Models, Animal; D009336:Necrosis; D015641:Radiography, Interventional; D013552:Swine; D014513:Ureter / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*