Microwave Ablation of Adrenal Tumors in Patients With Continuous Intra-Arterial Blood Pressure Monitoring Without Prior Alpha-Adrenergic Blockade: Safety and Efficacy

Cardiovasc Intervent Radiol. 2020 Sep;43(9):1384-1391. doi: 10.1007/s00270-020-02547-w. Epub 2020 Jun 11.


Purpose: Evaluate the safety and efficacy of adrenal microwave ablation performed with continuous intra-arterial blood pressure monitoring (IABPM) and without alpha-adrenergic blockade (AAB) as pretreatment.

Material and methods: A single-center, retrospective review of all percutaneous adrenal microwave ablation performed between 2011 and 2018. Microwave ablation was completed on 11 patients, with a total of 15 adrenal tumors with a mean size of 3.3 cm (1.4-6.9 cm) treated metastatic RCC, HCC, esophageal carcinoma, adrenal adenoma. Cases were performed without prior AAB, but with continuous IABPM and rapid intervention using short-acting antihypertensive medications.

Results: There were no post-procedural episodes of hypertension, no neurological or cardiovascular complications, and no SIR moderate or worse adverse event complications. Mean intraprocedural maximum systolic blood pressure (SBP) was 211 mmHg (range: 132-288), with an average increase in SBP of 100 mmHg (range: 23-180). A hypertensive crisis (SBP ≥ 180 and/or DBP ≥ 120) occurred in 9 of the 15 procedures (60%) with a mean length of 3.0 min (range: 1-12). The technical success rate was 100% (15/15 procedures). The mean follow-up time was 2.4 years (range: 0.9-7.7 years), with primary and secondary efficacy rates of 77% and 87%, respectively, and an overall survival of 82%.

Conclusion: In this single-center retrospective study, microwave ablation of adrenal tumors without AAB was safe and effective when performed with continuous arterial line monitoring of vital signs and the use of short-acting, rapid-onset antihypertensive medications.

Level of evidence: Level 4, Case Series.

Keywords: Ablation; Adrenal ablation; Interventional oncology.

MeSH terms

  • Ablation Techniques / methods*
  • Adrenal Gland Neoplasms / diagnosis
  • Adrenal Gland Neoplasms / physiopathology
  • Adrenal Gland Neoplasms / therapy*
  • Adrenergic alpha-Antagonists / therapeutic use*
  • Adult
  • Aged
  • Arterial Pressure / physiology*
  • Blood Pressure Determination / methods*
  • Female
  • Humans
  • Male
  • Microwaves / therapeutic use*
  • Middle Aged
  • Retrospective Studies
  • Treatment Outcome


  • Adrenergic alpha-Antagonists