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Hydrodissection of the Retro-Sternal Space to Protect the Pericardium During Sternal Cryoablation

  • Technical Note
  • Non-Vascular Interventions
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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.

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Funding

This study was not supported by any funding.

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Authors and Affiliations

  1. Service D’Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, place de l’hopital, 67000, Strasbourg, France

    Pierre-Alexis Autrusseau, Julien Garnon, Pierre Auloge, Julia Weiss, Jean Caudrelier, Roberto Luigi Cazzato, Guillaume Koch & Afshin Gangi

  2. Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Road, Oxford, OX3 7LD, UK

    Danoob Dalili

  3. School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK

    Danoob Dalili

Authors
  1. Pierre-Alexis Autrusseau
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  2. Julien Garnon
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  3. Pierre Auloge
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  4. Julia Weiss
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  5. Danoob Dalili
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  6. Jean Caudrelier
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  7. Roberto Luigi Cazzato
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  8. Guillaume Koch
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  9. Afshin Gangi
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Corresponding author

Correspondence to Pierre-Alexis Autrusseau.

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Conflict of interest

Julien Garnon, MD: Proctor, Galil Medical Ltd. Afshin Gangi, MD, PhD: Proctor, Galil Medical Ltd. Other authors declare that they have no conflict of interest.

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Consent for publication was obtained for every individual person’s data (or their parent) included in the study.

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Informed consent was obtained from all individual participants (or their parent) included in the study.

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Autrusseau, PA., Garnon, J., Auloge, P. et al. Hydrodissection of the Retro-Sternal Space to Protect the Pericardium During Sternal Cryoablation. Cardiovasc Intervent Radiol 43, 1371–1377 (2020). https://doi.org/10.1007/s00270-020-02587-2

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  • DOI: https://doi.org/10.1007/s00270-020-02587-2

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