A 69-year-old patient presented with HCC in segment II and was initially treated with TACE. Residual tumor was seen at the 6-month follow-up, and it was decided to try ablation, with the aid of CAS-One IR due to the proximity to the patients heart. An additional lesion was later discovered in segment VII high in the liver dome, which was also treated with the help of CAS-One IR due to the previous positive experience. Both treatments were performed safely and effectively, with AblaSure showing treatment success.
Dr. Mauda-Havakuk stated that performing procedures with CAS-One IR felt significantly easier: `I felt light`, as it eliminates additional radiation during fluoroscopy, removing the need for lead protection. This not only alleviates discomfort from heavy lead aprons but also eliminates radiation exposure for physicians—a major advancement in these procedures.
Name: Dr. Michal Mauda-Havakuk & Rina Neeman
Institution: Tel Aviv Sourasky Medical Center - Ichilov
Patient age and sex: Male, 69y
Initial condition:
- The patient was diagnosed with primary HCC in segment II
- The lesion was initially treated with TACE, as anticoagulant therapies could not be discontinued due to recent cardiac stenting
- 6 months post TACE, residual viable tumor tissue was detected and once anticoagulant therapy could be safely paused, an ablation procedure was planned
- CAS-One IR was chosen due to the lesion’s proximity to the heart
- In March, another lesion was discovered in segment VII. A wait-and-see approach was initially adopted before confirming the need for treatment, and later the MDT decided for ablation
- Given the lesion’s location and prior successful experiences with CAS-One IR, Quality Ablation was selected as the preferred treatment method
Treatment:
- Both procedures were performed under general anesthesia with breath-hold techniques
- The first lesion was treated with the Medtronic Emprint needle, delivering 100W for 7 minutes
- The second lesion in segment VII was ablated at 110W for 8 minutes, followed by a pullback of 1.5 cm and an additional 8 minutes at 100W
- Due to the steep angle, the skin and liver capsule were pre-punctured with a stiff needle to prevent displacement
- One single push was applied for both lesions, with minimal (<2mm, <1mm) lateral displacement
Result:
- Post-procedure imaging performed one day after intervention was fused on CAS-One IR using AblaSure to assess treatment success
- Both lesions were successfully treated with no complications during the procedures
- The patient remained hospitalized overnight and was discharged the following day
- A follow-up CT/MRI is scheduled in one month
Learn more about the stereotactic navigation system CAS-One IR.
