Neuromodulation cryotherapeutic devices and associated systems and methods
Neuromodulation cryotherapeutic devices and associated systems and methods are disclosed herein. A cryotherapeutic device configured in accordance with a particular embodiment includes an elongated shaft and a cooling assembly at distal portion of the shaft. The shaft can be configured to locate the distal portion intravascularly at a treatment site within or otherwise proximate a renal artery. The cryotherapeutic device can further include a supply lumen configured to carry liquid refrigerant toward the cooling assembly. The cooling assembly can include an applicator in fluid communication with the supply lumen and configured to deliver cryotherapeutic cooling to nerves proximate the target site when in a deployed state.
1. A cryotherapeutic device, comprising;
an elongated shaft having a distal portion configured to be located intravascularly at a treatment site in a renal artery or ostium;
a supply lumen extending along a length of the shaft, the supply lumen being configured to receive liquid refrigerant;
a cooling assembly at the distal portion of the shaft, the cooling assembly having a delivery state and a deployed state, the cooling assembly including
an elongated support member extending along a length of the cooling assembly,
an orifice in fluid communication with the supply lumen, and
an applicator configured to cause therapeutically-effective cryogenic renal-nerve modulation when the cooling assembly is in the deployed state and when the cooling assembly receives refrigerant from the supply lumen, the applicator having a balloon that defines a chamber, the balloon having
a heat-transfer portion in fluid communication with the orifice, the heat-transfer portion being non-circumferential at longitudinal segments disposed along the length of the cooling assembly and being spaced apart from the support member when the cooling assembly is in the deployed state, and
an attachment portion attached to the support member; and
an occlusion member spaced apart proximally from the applicator, the occlusion member having a collapsed state, an expanded state, and a cross-sectional dimension that fully occludes the renal artery or ostium proximal to the treatment site when the occlusion member is in the expanded state.
2. The cryotherapeutic device of claim 1 , wherein:
the chamber is a first chamber;
the balloon is a first balloon; and
the occlusion member includes a second balloon defining a second chamber fluidly connected to the first chamber.
3. The cryotherapeutic device of claim 2 , further comprising an exhaust passage extending along the shaft, wherein the second chamber is fluidly connected to the exhaust passage.
4. The cryotherapeutic device of claim 2 , wherein:
the first chamber has a first refrigerant residence time when the cooling assembly is in deployed state;
the second chamber has a second refrigerant residence time when the occlusion member is in the expanded state; and
the first refrigerant residence time is less than the second refrigerant residence time.
5. The cryotherapeutic device of claim 1 , further comprising a filler lumen extending along the shaft, wherein:
the filler lumen is fluidly connected to the occlusion member; and
the occlusion member is fluidly separate from the supply lumen.
6. The cryotherapeutic device of claim 1 , wherein:
the balloon is a first balloon;
the occlusion member includes a second balloon; and
the second balloon is compliant.
7. The cryotherapeutic device of claim 1 , further comprising a handle, wherein:
the shaft has a proximal portion at the handle; and
the shaft includes
a control lumen, and
an elongated control member within the control lumen and operably coupled to the distal portion of the shaft and to the handle such that increasing or decreasing tension of the control member controls deflection of the distal portion of the shaft distal to the occlusion member.
8. The cryotherapeutic device of claim 1 , wherein the balloon is helical and wrapped around the support member.
9. The cryotherapeutic device of claim 1 , wherein;
the ballon has a shape when the cooling assembly is in the deployed state, the shape including a plurality of recessed portions and a non-recessed area around the plurality of recessed portions, the non-recessed area at least partially defining the heat-transfer portion of the cooling assembly; and
the heat-transfer portion of the cooling assembly is non-circumferential at longitudinal segments disposing along a length of the applicator.
10. The cryotherapeutic device of claim 9 , wherein the shape of the balloon when the cooling assembly in the deployed state is cylindrical.
11. The cryotherapeutic device of claim 1 , wherein:
the balloon has a shape when the cooling assembly is in deployed state, the shape including a plurality of protrusions and a non-protruding area around the plurality of protrusions, the plurality of protrusions at least partially defining the heat-transfer portion of the cooling assembly; and
the heat-transfer portion of the cooling assembly is non-circumferential at longitudinal segments disposed along a length of the applicator.
12. The cryotherapeutic device of claim 1 , wherein:
the balloon has a helical recessed portion and a helical non-recessed portion; and
the helical non-recessed portion at least partially defines the heat-transfer portion.
13. A cryotherapeutic device, comprising:
an elongated shaft having a distal portion configured to be located intravascularly at a treatment site in a renal artery or ostium;
a supply lumen extending along a length of the shaft, the supply lumen being configured to receive liquid refrigerant;
a cooling assembly at the distal portion of the shaft, the cooling assembly having a delivery state and a developed state, the cooling assembly including
an orifice in fluid coomunication with the supply lumen, and
an applicator configured to cause therapeutically-effective cryogenic renal-nerve modulation when the cooling assembly is in the deployed state and when the cooling assembly receives refrigerant from the supply lumen, the applicator having a heat-transfer portion in fluid communication with the orifice,
wherein
the balloon is elongated and has a proximal portion, a distal portion, and a middle portion therebetween,
the balloon has a first wall portion with a concave curvature along a length of the balloon and a second wall portion having a non-concave curvature along the length of the balloon when the cooling assembly is in the deployed state,
the middle portion of the balloon is configured to contact the renal artery or ostium along the second wall potion and not the first wall portion when the cooling assembly is in the deployed state,
the second wall portion of the balloon at the middle portion of the balloon at least partially defines the heat-transfer portion of the applicator, and
the heat-transfer portion of the applicator is non-circumferential at longitudinal segments disposed along a length of the applicator; and
an occlusion member spaced apart proximally from the applicator, the occlusion member having a collapsed state, an expanded state, and a cross-sectional dimension that fully occludes the renal artery or ostium proximal of the treatment site when the occlusion member is in the expanded state.
14. The cryotherapeutic device of claim 13 , wherein:
the first wall portion has a first thickness; and
the second wall portion has a second thickness less than the first thickness.
15. A cryotherapeutic device, comprising:
an elongated shaft having a distal portion configured to be located intravascularly at a treatment site in a renal artery or ostium;
a supply lumen extending along a length of the shaft, the supply lumen being configured to receive liquid refrigerant;
a cooling assembly at the distal portion of the shaft, the cooling assembly having a delivery state and a deployed state, the cooling including
an elongated shaping member extending along a length of the cooling assembly,
a shaping member having a linear configuration when the cooling assembly is in the delivery state and a curvilinear configuration when the cooling assembly is in the deployed state,
an orifice in fluid communication with the supply lumen, and
an applicator configured to cause therapeutically-effective cryogenic renal-nerve modulation when the cooling assembly is in the deployed state and when the cooling assembly receives refrigerant from the supply lumen, the applicator having a balloon that defines a chamber, the balloon having a heat-transfer portion in fluid communication with the orifice, the balloon having a shape when the cooling assembly is in the deployed state that at least partially corresponds to the curvilinear configuration of the shaping member; and
an occlusion member spaced apart proximally from the applicator, the occlusion member having a collapsed state, an expanded state, and a cross-sectional dimension that fully occludes the renal artery or ostium proximal to the treatment site when the occlusion member is in the expanded state.
16. The cryotherapeutic device of claim 15 , wherein the shape of the balloon when the cooling assembly is in the deployed state is helical.
17. The cryotherapeutic device of claim 15 , wherein the shape of the balloon when the cooling assembly is in the deployed state is serpentine.
18. A cryotherapeutic device, comprising:
an elongated shaft having a distal portion configured to be located intravsacularly at a treatment site in a renal artery or ostium;
a supply lumen extending along a length of the shaft, the supply lumen being configured to receive liquid refrigerant;
an elongated shaping member longitudinally movable relative to the shaft;
a cooling assembly at the distal portion of the shaft, the cooling assembly having
a delivery state and a deployed state, the cooling assembly including
an orifice in fluid communication with the supply lumen, and
an applicator configured to cause therapeutically-effective cryogenic renal-nerve modulation when the cooling assembly is in the deployed state and when the cooling assembly receives refrigerant from the supply lumen, the applicator having
a first elongated balloon with a heat-transfer portion in fluid communication with the orifice, the first balloon having a proximal portion, a distal portion, and a middle portion therebetween,
a second elongated balloon having a proximal portion, a distal portion, and middle portion, therebetween,
wherein
the distal portion of the first and second balloons are attached to the shaping member such that retracting the shaping member relative to the shaft causes the first and second balloons to curve along a length of the cooling assembly, and the middle portions of the first and second balloons to laterally move away from the shaping member,
the middle portion of the first balloon has an outer side with a non-concave curvature along the length of the cooling assembly when the cooling assembly is in the deployed state,
the middle portion of the second balloon has an outer side with a non-concave curvature along the length of the cooling assembly when the cooling assembly is in the deployed state,
the outer sides of the middle portions of the first and second balloons at least partially define the heat-transfer portion, and
the heat-transfer portion is non-circumferential at longitudinal segments along the length of the cooling assembly; and
an occlusion member spaced apart proximally from the applicator, the occlusion member having a collapsed state, an expanded state, and a cross-sectional dimension that fully occludes the renal artery or ostium proximal to the treatment site when the occlusion member is in the expanded state.
19. The cryotherapeutic device of claim 13 , wherein:
the chamber is a first chamber;
the balloon is a first balloon; and
the occlusion member includes a second balloon defining a second chamber fluidly connected to the first chamber.
20. The cryotherapeutic device of claim 19 , further comprising an exhaust passage extending along the shaft, wherein the second chamber is fluidly connected to the exhaust passage.
21. The cryotherapeutic device of claim 19 , wherein:
the first chamber has a first refrigerant residence time when the cooling assembly is in the deployed state;
the second chamber has a second refrigerant residence time when the occlusion member is in the expanded state; and
the first refrigerant residence time is less than the second refrigerant residence time.
22. The cryotherapeutic device of claim 13 , further comprising a filler lumen extending along the shaft, wherein:
the filler lumen is fluidly connected to the occlusion member; and
the occlusion member is fluidly separate from the supply lumen.
23. The cryotherapeutic device of claim 13 , wherein:
the balloon is a first balloon;
the occlusion member includes a second balloon; and
the second balloon is compliant.
24. The cryotherapeutic device of claim 15 , wherein:
the chamber is a first chamber;
the balloon is a first balloon; and
the occlusion member includes a second balloon defining a second chamber fluidly connected to the first chamber.
25. The cryotherapeutic device of claim 24 , further comprising an exhaust passage extending along the shaft, wherein the second chamber is fluidly connected to the exhaust passage.
26. The cryotherapeutic device of claim 24 , wherein:
the first chamber has a first refrigerant residence time when the cooling assembly is in the deployed state;
the second chamber has a second refrigerant residence time when the occlusion member is in the expanded state; and
the first refrigerant residence time is less than the second refrigerant residence time.
27. The cryotherapeutic device of claim 15 , further comprising a filler lumen extending along the shaft, wherein:
the filler lumen is fluidly connected to the occlusion member; and
the occlusion member is fluidly separate from the supply lumen.
28. The cryotherapeutic device of claim 15 , wherein:
the balloon is a first balloon;
the occlusion member includes a second balloon; and
the second balloon is compliant.
29. The cryotherapeutic device of claim 18 , wherein:
the chamber is a first chamber;
the balloon is a first balloon; and
the occlusion member includes a second balloon defining a second chamber fluidly connected to the first chamber.
30. The cryotherapeutic device of claim 29 , further comprising an exhaust passage extending along the shaft, wherein the second chamber is fluidly connected to the exhaust passage.
31. The cryotherapeutic device of claim 29 , wherein:
the first chamber has a first refrigerant residence time when the cooling assembly is in the deployed state;
the second chamber has a second refrigerant residence time when the occlusion member is in the expanded state; and
the first refrigerant residence time is less than the second refrigerant residence time.
32. The cryotherapeutic device of claim 18 , further comprising a filler lumen extending along the shaft, wherein:
the filler lumen is fluidly connected to the occlusion member; and
the occlusion member is fluidly separate from the supply lumen.