Apparatus and method of assessing transvascular denervation
A catheter apparatus for assessing denervation comprises: an elongated catheter body; a deployable structure coupled to the catheter body, the deployable structure being deployable outwardly from and contractible inwardly toward the longitudinal axis of the catheter body; one or more ablation elements disposed on the deployable structure to move outwardly and inwardly with the deployable structure; one or more stimulation elements spaced from each other and disposed on the deployable structure to move with the deployable structure, the stimulation elements being powered to supply nerve stimulating signals to the vessel; and one or more recording elements spaced from each other and from the stimulation elements, the recording elements being disposed on the deployable structure to move with the deployable structure, the recording elements configured to record response of the vessel to the nerve stimulating signals.
1. A catheter apparatus for assessing denervation comprising:
an elongated catheter body having a proximal end and a distal end and a longitudinal axis extending in a longitudinal direction between the distal end and the proximal end;
a deployable structure coupled to the catheter body, the deployable structure being deployable outwardly from the longitudinal axis and contractible inwardly toward the longitudinal axis of the catheter body, the deployable structure comprising a deployable sleeve having a semi-compliant outer shell and a non-compliant inner shell, wherein the semi-compliant outer shell is configured to stretch outwardly from the longitudinal axis away from the non-compliant inner shell in a deployed arrangement of the deployable structure, wherein at least a portion of the catheter body is disposed inside the deployable sleeve;
one or more ablation elements disposed on the deployable sleeve to move outwardly and inwardly with the deployable sleeve, the one or more ablation elements being powered to apply ablation energy to a vessel of a patient;
one or more stimulation elements disposed on the deployable sleeve to move outwardly and inwardly with the deployable sleeve, the one or more stimulation elements being powered to supply nerve stimulating signals to the vessel; and
one or more recording elements spaced from the one or more stimulation elements, the one or more recording elements being disposed on the deployable sleeve to move outwardly and inwardly with the deployable sleeve and being configured to record evoked electrical responses of the vessel in response to the nerve stimulating signals.
2. The catheter ablation apparatus of claim 1 ,
wherein the one or more stimulation elements are proximal relative to the one or more recording elements.
3. The catheter apparatus of claim 1 ,
wherein a most distal ablation element of the one or more ablation elements is no more distal than at least one of the one or more stimulation elements and a most proximal ablation element of the one or more ablation elements is no more proximal than at least one of the one or more recording elements.
4. The catheter apparatus of claim 1 ,
wherein at least one of the one or more ablation elements is also a stimulation element or a recording element.
5. The catheter apparatus of claim 1 ,
wherein the one or more recording elements are spaced from one of the one or more stimulation elements by one of a longitudinal spacing, a lateral spacing, or a combined longitudinal and lateral spacing.
6. The catheter apparatus of claim 1 ,
wherein the one or more recording elements are configured to record the evoked electrical responses of the vessel in response to the nerve stimulating signals by direct contact with a luminal wall of the vessel.
7. The catheter apparatus of claim 1 ,
wherein the deployable sleeve comprises an electrically insulative material.
8. The catheter apparatus of claim 1 ,
wherein the portion of the catheter body disposed inside the deployable sleeve includes a plurality of holes for fluid to pass therethrough to facilitate pushing the deployable sleeve radially outwardly relative to the catheter body in the deployed arrangement.
9. The catheter apparatus of claim 8 , further comprising:
a plurality of draw strings extending from inside the portion of the catheter body disposed inside the deployable sleeve through the plurality of holes to the deployable sleeve to draw the deployable sleeve radially inwardly relative to the catheter body in an undeployed arrangement.
10. The catheter apparatus of claim 1 ,
wherein the deployable structure is contractible to a contracted arrangement and is deployable to the deployed arrangement, and wherein the deployable structure includes an anti-occlusion feature to permit fluid flow in the vessel between a proximal end and a distal end of the deployable structure in the deployed arrangement.
11. A catheter apparatus for assessing denervation comprising:
an elongated catheter body having a proximal end and a distal end and a longitudinal axis extending in a longitudinal direction between the distal end and the proximal end, a portion of the catheter body including a plurality of holes;
a structure coupled to the catheter body, the structure comprising a deployable sleeve, wherein at least a portion of the catheter body is disposed inside the deployable sleeve;
one or more ablation elements disposed on the deployable sleeve and being powered to apply ablation energy to a vessel;
one or more stimulation elements disposed on the deployable sleeve, the one or more stimulation elements being powered to supply nerve stimulating signals to the vessel;
one or more recording elements spaced from each other and from the one or more stimulation elements, the one or more recording elements being disposed on the deployable sleeve and being configured to record evoked electrical responses of the vessel in response to the nerve stimulating signals; and
wherein the portion of the catheter body disposed inside the deployable sleeve is configured to facilitate deployment of the deployable sleeve outwardly from the longitudinal axis of the catheter body to move the one or more ablation elements, the one or more stimulation elements, and the one or more recording elements outwardly to a deployed arrangement, and wherein the structure comprises a plurality of draw strings extending from inside the portion of the catheter body disposed inside the deployable sleeve through the plurality of holes to the deployable sleeve to draw the deployable sleeve radially inwardly relative to the catheter body in an undeployed arrangement.
12. The catheter apparatus of claim 11 ,
wherein at least one of the one or more ablation elements is also a stimulation element or a recording element.
13. The catheter apparatus of claim 11 ,
wherein a most distal ablation element of the one or more ablation elements is no more distal than at least one of the one or more stimulation elements and a most proximal ablation element of the one or more ablation elements is no more proximal than at least one of the one or more recording elements.
14. The catheter apparatus of claim 11 ,
wherein the one or more recording elements are configured to record evoked electrical responses of the vessel in response to the nerve stimulating signals by direct contact with a luminal wall of the vessel.
15. The catheter apparatus of claim 11 ,
wherein the deployable sleeve comprises an electrically insulative material.
16. The catheter apparatus of claim 11 ,
wherein the structure is contractible to the undeployed arrangement and is deployable to the deployed arrangement, and wherein the structure includes an anti-occlusion feature to permit fluid flow in the vessel between a proximal end and a distal end of the structure in the deployed arrangement.
17. The catheter apparatus of claim 16 ,
wherein the anti-occlusion feature comprises a plurality of rib channels connecting a lumen of the portion of the catheter disposed inside the deployable sleeve to an enclosed interior of the deployable sleeve between an outer shell of the deployable sleeve and an inner shell of the deployable sleeve.
18. The catheter apparatus of claim 17 ,
wherein the outer shell of the deployable sleeve is semi-compliant, and wherein the inner shell of the deployable sleeve is noncompliant.