Apparatus and methods for renal denervation ablation
A catheter device for renal denervation ablation includes a flexible catheter shaft having an electrically insulating expandable member in its distal portion with at least one electrode located proximal to the member, at least one electrode located distal to the member, and with openings in the distal shaft with at least one opening proximal to the proximal electrode and one opening distal to the distal electrode of said electrode pair, said openings connected through an inner lumen in the catheter that provides a path for blood to flow through the expandable member. In one embodiment, the device comprises a flexible catheter shaft with a multiplicity of recessed paired electrodes disposed in recessed spaces in its distal portion, such that an electrically conducting portion of each electrode is exposed to the exterior of the catheter within a recessed space, and with an electrical insulator separating the electrodes of each pair.
1. An apparatus, comprising:
a flexible catheter shaft disposable in a vessel, the catheter shaft having an electrically insulating expandable member coupled thereto such that the expandable member surrounds a portion of the catheter shaft, the expandable member configured to transition into an expanded configuration to center the portion of the catheter shaft in the vessel, the portion of the catheter shaft defining a lumen, the catheter shaft defining:
a first opening and a second opening each in fluid communication with the lumen such that the first opening, the second opening, and the lumen establish a pathway through the expandable member; and
a recess, the expandable member disposed proximal to the recess; and
an electrode pair having a bipolar configuration for generating an electric field that causes irreversible electroporation of tissue surrounding the vessel, the electrode pair being disposed below a surface of the catheter shaft in the recess, the electrodes of the electrode pair disposed on opposite sides of an insulator disposed in the recess, each electrode of the electrode pair coupled to a respective electrical lead for the bipolar configuration.
2. The apparatus of claim 1 , wherein the recess has a depth from about 0.5 mm to about 1.5 mm from the surface of the catheter shaft.
3. The apparatus of claim 1 , wherein a ratio of the depth of the recess from the surface of the catheter shaft to a diameter of the catheter shaft is in the range from about 0.1 to about 0.45.
4. The apparatus of claim 1 , wherein the recess has a length in the range from about 0.5 mm to about 5 mm and a width in the range from about 0.2 mm to about 2 mm.
5. The apparatus of claim 1 , wherein each electrode of the electrode pair has an ellipsoid shape.
6. The apparatus of claim 1 , wherein the recess has an ellipsoid shape.
7. The apparatus of claim 1 , wherein the respective electrical leads coupled to the electrode pair are disposed at least partially within the catheter shaft.
8. The apparatus of claim 1 , wherein each respective electrical lead coupled to each electrode of the electrode pair includes an insulation layer having a thickness and a dielectric strength configured to withstand a voltage of at least about 500 Volts without dielectric breakdown.
9. The apparatus of claim 1 , wherein:
the lumen is a first lumen;
the expandable member is configured to be filled with a fluid to transition between a collapsed configuration and the expanded configuration; and
the catheter shaft defining a second lumen in fluid communication with the expandable member, the second lumen configured to be fluidically isolated from the first lumen.
10. The apparatus of claim 1 , wherein the diameter of the expandable member in the expanded configuration is from about 2 mm to about 6 mm.
11. The apparatus of claim 1 , wherein the expandable member includes polyurethane.
12. The apparatus of claim 1 , wherein the recess is a first recess, the electrode pair is a first electrode pair, and the insulator is a first insulator, the apparatus further comprising a second electrode pair disposed in a second recess, each electrode of the second electrode pair separated from the other electrode of the electrode pair by a second insulator,
the expandable member disposed between the first recess and the second recess.
13. The apparatus of claim 12 , wherein the second electrode pair has a bipolar configuration.
14. A system, comprising:
a voltage pulse generator;
a medical device coupled to the voltage pulse generator, the medical device including:
a catheter shaft disposable in a vessel, the catheter shaft defining a lumen, a first opening, and a second opening, the first opening and the second opening each in fluid communication with the lumen;
a plurality of ablation electrodes configured to be polarized to generate an electric field that causes irreversible electroporation of tissue surrounding the vessel, an ablation electrode pair of the plurality of ablation electrodes having a bipolar configuration and disposed below a surface of the catheter shaft in a recess, the electrodes of the ablation electrode pair disposed on opposite sides of an insulator disposed in the recess, each electrode of the ablation electrode pair coupled to a respective electrical lead for the bipolar configuration; and
an electrically insulated inflatable balloon, the catheter shaft passing through the balloon, the first opening and the second opening being disposed further from the balloon than the plurality of ablation electrodes,
the lumen, the first opening, and the second opening collectively configured to enable electric current to flow through the lumen when the plurality of ablation electrodes are polarized; and
a controller coupled to the pulse generator, the controller configured to trigger the pulse generator to generate voltage pulses for polarizing the plurality of ablation electrodes, the pulse generator configured to apply the voltage pulses to the plurality of ablation electrodes.
15. The system of claim 14 , wherein the voltage pulses have an amplitude of at least about 500 Volts.
16. The system of claim 14 , wherein the voltage pulses include a train of multiple pulses, each pulse having a pulse width of at least about 10 nanoseconds.
17. The system of claim 14 , wherein one of the first opening and the second opening is proximal to the balloon, and the other of the first opening and the second opening is distal to the balloon.
18. The system of claim 14 , wherein at least one of the ablation electrodes of the plurality of ablation electrodes includes a biocompatible metal.
19. The system of claim 14 , wherein each electrical lead includes an insulation layer having a thickness and a dielectric strength configured to withstand a voltage of at least about 2000 Volts without dielectric breakdown.
20. The system of claim 14 , wherein the catheter shaft is formed from a material that includes one or more of Teflon, polyurethane, Nylon, PEEK, and polyethylene.
21. The system of claim 14 , wherein the inflatable balloon includes polyurethane.
22. The system of claim 14 , wherein at least one of the ablation electrodes of the plurality of ablation electrodes includes a ring with a ring width in the range between approximately 1 mm and approximately 6 mm.
23. The system of claim 14 , wherein the controller is configured to record impedance data from at least a pair of the ablation electrodes.
24. A system, comprising:
a voltage pulse generator;
a medical device coupled to the voltage pulse generator, the medical device including:
an electrically insulated balloon inflatable to contact a tissue surface;
a catheter shaft extending through the balloon, the catheter shaft defining a lumen, a first opening, and a second opening, the first opening and the second opening each in fluid communication with the lumen;
a plurality of ablation electrodes, an ablation electrode pair of the plurality of ablation electrodes disposed at one or more of a proximal end and a distal end of the expandable member, the ablation electrode pair having a bipolar configuration and disposed below a surface of the catheter shaft in a recess, the electrodes of the ablation electrode pair disposed on opposite sides of an insulator disposed in the recess, each electrode of the ablation electrode pair coupled to a respective electrical lead for the bipolar configuration; and
a controller coupled to the voltage pulse generator, the controller configured to (1) trigger the pulse generator to generate voltage pulses and (2) apply the voltage pulses to the plurality of ablation electrodes such that the plurality of ablation electrodes generates a pulsed electric field including a portion that traverses the tissue surface and causes irreversible electroporation of surrounding tissue.
25. The system of claim 24 , wherein the first opening and the second opening are disposed further from the balloon than the plurality of ablation electrodes.