Thursday, 18 June 2026

Quality Ablation close to the heart: part I

3:17

A 71-year-old patient diagnosed with an HCC and portal hypertension in March 2026. Decision was made to treat the 2 lesions in segment II with microwave ablation guided by CAS-One IR. The system was chosen due to the challenging position of one lesion very close to the right ventricle. The planning and navigation helped ensure the optimum treatment to cover the lesion and the safety margins while keeping the treatment as safe as possible. AblaSure^® was able to confirm full coverage of both lesions, and the patient was discharged the next day with no complications.

Pre-operative MRI showing both lesions

Video of the planning of both lesions

Needle placement of the lesion close to the heart with 1mm lateral deviation - important due to the proximity to the right ventricle but also shows the deviation is irrelevant with respect to the ablation plan as no adjustments to parameters are needed.

AblaSureshowing excellent coverage of both lesions. The 100% tumor and 95% margin histogram is shown for the lesion touching the hepatic vein, reducing the margin coverage to 95%.

Name: Dr. Javier Armijo and Dr Marco Leyva Vásquez-Caicedo

Institution: Clinico San Carlos, Madrid, Spain

Patient age and sex: 71, Male

Initial condition and Imaging:

Patient initially diagnosed with chronic hepatopathy and portal hypertension due to alcohol abuse
HCC classified CHILD B8, MELD 13
In March 2026, MRI showed 2 lesions in segment II. One of 12mm LI-RADS 5, and one LI-RADS 4 of 10 mm. Other hypervascular lesions with no sign of washout in other lobes were classified as LR 3
MDT discussed surgery for the portal hypertension but decided on ablation for the lesions LR 4 and 5. Decision to use CAS-One IR due to the close proximity of the LR5 lesion from the right ventricle. The LR3 lesions will be monitored closely

Treatment:

Follow-up imaging 4 months post-ablation showed complete ablation of both lesions
No complications occurred, and the patient was discharged from the hospital the day after ablation
The 2 lesions in segment II were targeted with 2 different trajectories using the Medtronic Emprint^®microwave
The lesion under the right ventricle was treated with 75W and 8 minutes to reduce the risks of injuring the pericardium
The second lesion was treated at 100W for 10 minutes due to its proximity to the hepatic vein
AblaSure showed complete coverage of both lesions

Result and Conclusion

No complications occurred, and the patient was discharged from the hospital the day after ablation
Follow-up at 1-month confirmed complete ablation of both lesions

Dr. Marco Leyva Vásquez-Caicedo said of the case: "Thanks to the CAS-One IR system, it was possible to plan and execute the complex trajectory of both lesions with high precision and safety. This enabled a safe treatment, avoiding injury to lung and heart tissue, while maintaining a safe distance from the heart, something that would not have been possible with other techniques. The high precision guarantees optimal coverage of the lesions, achieving a complete tumor response."

Learn more about CAS-One IR.