Methods and apparatus for pulsed electric field neuromodulation via an intra-to-extravascular approach
Methods and apparatus are provided for pulsed electric field (PEF) neuromodulation via an intra-to-extravascular approach, e.g., to effectuate irreversible electroporation or electrofusion, necrosis and/or inducement of apoptosis, alteration of gene expression, changes in cytokine upregulation and other conditions in target neural fibers. In some embodiments, an apparatus includes an intravascular catheter having one or more electrodes configured for intra-to-extravascular placement across a wall of patient's vessel into proximity with target neural fibers. With the electrode(s) passing from an intravascular position to an extravascular position prior to delivery of the PEF, a magnitude of applied voltage or energy delivered via the electrode(s) and necessary to achieve desired neuromodulation may be reduced relative to an intravascular PEF system having one or more electrodes positioned solely intravascularly. The methods and apparatus may, for example, be used to modulate one or more target neural fibers that contribute to renal function.
1. An apparatus for neuromodulation of a human patient, the apparatus comprising:
a catheter defining a lumen extending along the catheter to a lumen outlet; and
a neuromodulation assembly movable relative to the catheter within the lumen, the neuromodulation assembly comprising an outer member and a neuromodulation element,
wherein the outer member is configured to extend, in a treatment configuration of the apparatus while the catheter and the outer member are positioned in an interior of a blood vessel, through the lumen outlet at least to a wall of the blood vessel, and
wherein an end portion of the neuromodulation element is configured to, in the treatment configuration of the apparatus, extend beyond an end of the outer member and the lumen outlet, and through the wall of the blood vessel.
2. The apparatus of claim 1 , wherein the apparatus is further configured to transform between the treatment configuration and a delivery configuration that is different from the treatment configuration.
3. The apparatus of claim 2 , wherein the neuromodulation assembly is configured to transform between a retracted state in the delivery configuration and an expanded state in the treatment configuration.
4. The apparatus of claim 2 , wherein in the delivery configuration, the outer member and the neuromodulation element are each configured to be spaced from the wall of the blood vessel.
5. The apparatus of claim 2 , wherein the outer member is a cannula, and wherein the cannula is disposed within the catheter in the delivery configuration.
6. The apparatus of claim 5 , wherein the cannula is configured to extend through the wall of the blood vessel in the treatment configuration.
7. The apparatus of claim 1 , wherein the outer member is a cannula.
8. The apparatus of claim 7 , wherein the cannula is configured to extend through the wall of the blood vessel in the treatment configuration.
9. The apparatus of claim 8 , wherein an end portion of the neuromodulation element comprises an electrode configured to be disposed extravascularly in the treatment configuration.
10. The apparatus of claim 7 , wherein the neuromodulation element is adapted to be movable through a cannula lumen defined by the cannula.
11. The apparatus of claim 7 , wherein an end portion of the neuromodulation element comprises an electrode configured to be disposed extravascularly in the treatment configuration.
12. The apparatus of claim 1 , wherein the outer member is a housing.
13. The apparatus of claim 12 , wherein the housing is configured to extend to and contact the wall of the blood vessel in the treatment configuration.
14. The apparatus of claim 13 , wherein the housing is adapted to move in a direction of the wall of the blood vessel when the apparatus is transitioned from a delivery configuration to the treatment configuration.
15. The apparatus of claim 13 , wherein the neuromodulation element comprises a needle electrode.
16. The apparatus of claim 15 , wherein the needle electrode is adapted to be movable relative to the housing.
17. The apparatus of claim 12 , wherein the neuromodulation element is adapted to be movable relative to the housing.
18. The apparatus of claim 17 , wherein the neuromodulation element comprises a needle electrode.
19. The apparatus of claim 1 , wherein the neuromodulation assembly comprises a plurality of outer members and a plurality of neuromodulation elements.
20. The apparatus of claim 1 , wherein the neuromodulation assembly comprises three outer members and three neuromodulation elements, and wherein the outer members are spaced about 120 degrees apart around a circumference of the catheter.