Methods and apparatus for renal neuromodulation
Methods and apparatus are provided for renal neuromodulation using a pulsed electric field to effectuate electroporation or electrofusion. It is expected that renal neuromodulation (e.g., denervation) may, among other things, reduce expansion of an acute myocardial infarction, reduce or prevent the onset of morphological changes that are affiliated with congestive heart failure, and/or be efficacious in the treatment of end stage renal disease. Embodiments of the present invention are configured for percutaneous intravascular delivery of pulsed electric fields to achieve such neuromodulation.
1. A method comprising:
intravascularly advancing an elongate shaft of a catheter to renal vasculature of a patient;
locating a distal portion of the elongate shaft of the catheter within a renal vessel of the patient, wherein the distal portion carries at least one neuromodulation element, and wherein each neuromodulation element comprises a corresponding needle port and a corresponding needle;
imaging at least one radiopaque marker associated with the distal portion of the elongate shaft;
orienting the needle port of the at least one neuromodulation element based on the imaging of the at least one radiopaque marker;
after orienting the needle port based on the imaging, extending the corresponding needle of each of the at least one neuromodulation element to penetrate a wall of the renal vessel; and
modulating nerve tissue within an anatomical region extending about the renal vessel via the neuromodulation element.
2. The method of claim 1 , wherein modulating nerve tissue within the anatomical region comprises infusing a drug through the corresponding needle of each of the at least one neuromodulation element.
3. The method of claim 2 , wherein infusing the drug through the corresponding needle of each of the at least one neuromodulation element comprises infusing the drug through the corresponding needle of each of the at least one neuromodulation element to renal fascia.
4. The method of claim 1 , wherein locating the distal portion of the elongate shaft within the renal vessel of the patient comprises locating the distal portion of the elongate shaft within a renal artery of the patient.
5. The method of claim 1 , further comprising, prior to extending the corresponding needle of each of the at least one neuromodulation element, expanding a centering element associated with the distal portion of the elongate shaft to stabilize the distal portion within the renal vessel.
6. The method of claim 1 , further comprising, prior to extending the corresponding needle of each of the at least one neuromodulation element, expanding a plurality of centering elements associated with the distal portion of the elongate shaft to stabilize the distal portion within the renal vessel.
7. The method of claim 1 , wherein locating the distal portion of the elongate shaft within the renal vessel of the patient comprises locating the distal portion within a renal vein of the patient.
8. The method of claim 1 , wherein extending the corresponding needle of each of the at least one neuromodulation element to penetrate the wall of the renal vessel comprises extending the corresponding needle so the corresponding needles enter needle enters into renal fascia.
9. The method of claim 1 , wherein intravascularly advancing the elongate shaft of the catheter to the renal vasculature of the patient comprises percutaneously introducing the elongate shaft of the catheter into the renal vasculature of the patient.
10. The method of claim 1 , wherein modulating nerve tissue within the anatomical region results in a therapeutically beneficial reduction in clinical symptoms of hypertension in the patient.
11. The method of claim 1 , wherein modulating nerve tissue within the anatomical region comprises systemically reduces sympathetic tone in the patient.
12. A method comprising:
intravascularly advancing an elongate shaft of a catheter to a first renal vessel associated with a first kidney of a patient;
locating a distal portion of the elongate shaft of the catheter within the first renal vessel, wherein the distal portion carries at least one neuromodulation element, and wherein each neuromodulation element comprises a corresponding needle port and a corresponding needle;
imaging at least one radiopaque marker associated with the distal portion of the elongate shaft;
extending the corresponding needle of a neuromodulation element of the at least one neuromodulation element to penetrate a wall of the first renal vessel; and
modulating nerve tissue within a first anatomical region extending about the first renal vessel via the neuromodulation element;
intravascularly advancing the elongate shaft to a second renal vessel associated with a second kidney of a patient;
locating the distal portion of the elongate shaft within the second renal vessel;
imaging the at least one radiopaque marker associated with the distal portion of the elongate shaft;
extending the corresponding needle of a neuromodulation element of the at least one neuromodulation element to penetrate a wall of the second renal vessel; and
modulating nerve tissue within a second anatomical region extending about the second renal vessel via the neuromodulation element.
13. The method of claim 12 , wherein modulating nerve tissue within the first anatomical region and modulating nerve tissue within the second anatomical region comprise infusing a drug through the corresponding needles.
14. The method of claim 13 , wherein infusing the drug through the corresponding needles comprises infusing the drug through the corresponding needles to renal fascia.
15. The method of claim 12 , wherein locating the distal portion of the elongate shaft within the second renal vessel of the patient comprises locating the distal portion within a renal artery of the patient.
16. The method of claim 12 , further comprising, prior to extending the corresponding needle to penetrate the wall of the second renal vessel, expanding a centering element associated with the distal portion of the elongate shaft to stabilize the distal portion within the second renal vessel.
17. The method of claim 12 , further comprising, prior to extending the corresponding needle to penetrate the wall of the second renal vessel, expanding a plurality of centering element elements associated with the distal portion of the elongate shaft to stabilize the distal portion within the second renal vessel.
18. The method of claim 12 , wherein locating the distal portion of the elongate shaft within the second renal vessel of the patient comprises locating the distal portion within a renal vein of the patient.
19. The method of claim 12 , wherein extending the corresponding needle to penetrate the wall of the second renal vessel comprises extending the corresponding needle so the corresponding needle enter into renal fascia.
20. The method of claim 12 , wherein modulating nerve tissue within the first anatomical region and modulating nerve tissue within the second anatomical region results in a therapeutically beneficial reduction in clinical symptoms of hypertension in the patient.
21. The method of claim 12 , wherein modulating nerve tissue within the first anatomical region and modulating nerve tissue within the second anatomical region comprises systemically reducing sympathetic tone in the patient.