A Comparison of Histotripsy and Percutaneous Cryoablation in a Chronic Healthy Swine Kidney Model

Allison B Couillard; Annie M Zlevor; Timothy J Ziemlewicz; Meridith A Kisting; Emily Knott; Annika E Rossebo; Jim White; Meghan G Lubner; Lori Mankowski Gettle; J Louis Hinshaw; Lu Mao; William Stoffregen; John F Swietlik; Erica Knavel-Koepsel; Lindsay Stratchko; E Jason Abel; Zhen Xu; Fred T Lee Jr; Paul F Laeseke

doi:10.1016/j.jvir.2023.07.014

A Comparison of Histotripsy and Percutaneous Cryoablation in a Chronic Healthy Swine Kidney Model

J Vasc Interv Radiol. 2023 Nov;34(11):1986-1996. doi: 10.1016/j.jvir.2023.07.014. Epub 2023 Jul 20.

Authors

Allison B Couillard¹, Annie M Zlevor², Timothy J Ziemlewicz², Meridith A Kisting², Emily Knott³, Annika E Rossebo², Jim White², Meghan G Lubner², Lori Mankowski Gettle², J Louis Hinshaw⁴, Lu Mao⁵, William Stoffregen⁶, John F Swietlik², Erica Knavel-Koepsel², Lindsay Stratchko², E Jason Abel⁴, Zhen Xu⁷, Fred T Lee Jr⁴, Paul F Laeseke⁸

Affiliations

¹ Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
² Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin.
³ Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio.
⁴ Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin; Department of Urology, University of Wisconsin-Madison, Madison, Wisconsin.
⁵ Department of Biostatistics, University of Wisconsin-Madison, Madison, Wisconsin.
⁶ Northstar Preclinical and Pathology Services, LLC, Lake Elmo, Minnesota.
⁷ Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan.
⁸ Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin; Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin. Electronic address: plaeseke@wisc.edu.

PMID: 37481064
DOI: 10.1016/j.jvir.2023.07.014

Abstract

Purpose: To compare the safety and efficacy of histotripsy with cryoablation in a chronic human-scale normal porcine kidney model.

Materials and methods: Eighteen female domestic swine were divided evenly into histotripsy and cryoablation treatment arms. A planned 2-3 cm diameter treatment was performed under ultrasound (histotripsy) or ultrasound and computed tomography (CT) guidance (cryoablation). Contrast-enhanced CT and serum blood analysis were performed immediately postprocedure and on day 7, with either immediate killing (n = 3) or continued survival to day 30 (n = 6), at which time contrast-enhanced CT, serum blood analysis, and necropsy were performed. Animal welfare, treatment zone appearance, procedure-related adverse events, and histopathology of the treatment zones and surrounding tissues were assessed.

Results: Histotripsy treatment zones (mean ±standard deviation diameters, 2.7 ± 0.12 × 2.4 ± 0.19 × 2.4 ± 0.26 cm; volume, 8.3 ± 1.9 cm³) were larger than cryoablation zones (mean diameters, 2.2 ± 0.19 × 1.9 ± 0.13 × 1.7 ± 0.19 cm; volume, 3.9 ± 0.8 cm³; P < .001). At 30 days, histotripsy and cryoablation treatment zone volumes decreased by 96% and 83% on CT, respectively (P < .001). Perirenal hematomas were present after 8 of 9 (89%) cryoablation (mean volume, 22.2 cm³) and 1 of 9 (11%, P < .001) histotripsy (volume, 0.4 cm³) procedures, with active arterial extravasation in 4 of 9 (44%) cryoablation and no histotripsy animals (P = .206). All 9 histotripsy animals and 5 of 9 (56%) cryoablation animals had collecting system debris (P = .042). Changes in serum creatinine were similar between the groups (P = .321).

Conclusions: Other than a higher rate of bleeding after cryoablation, the safety and early efficacy of histotripsy and cryoablation were comparable for creating treatment zones in a chronic normal porcine kidney model.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Animals
Cryosurgery* / adverse effects
Cryosurgery* / methods
Female
Gastrointestinal Hemorrhage / etiology
Humans
Kidney / pathology
Kidney Neoplasms* / pathology
Swine
Tomography, X-Ray Computed
Treatment Outcome