Methods and apparatus for performing renal neuromodulation via catheter apparatuses having inflatable balloons
Methods and apparatus are provided for non-continuous circumferential treatment of a body lumen. Apparatus may be positioned within a body lumen of a patient and may deliver energy at a first lengthwise and angular position to create a less-than-full circumferential treatment zone at the first position. The apparatus also may deliver energy at one or more additional lengthwise and angular positions within the body lumen to create less-than-full circumferential treatment zone(s) at the one or more additional positions that are offset lengthwise and angularly from the first treatment zone. Superimposition of the first treatment zone and the one or more additional treatment zones defines a non-continuous circumferential treatment zone without formation of a continuous circumferential lesion. Various embodiments of methods and apparatus for achieving such non-continuous circumferential treatment are provided.
1. A method of performing renal neuromodulation, the method comprising:
intravascularly positioning a catheter in a reduced profile delivery configuration within a renal blood vessel and proximate to a renal nerve of a human patient;
transforming the catheter from the delivery configuration to a treatment configuration, wherein a distal balloon is expanded to place a plurality of electrodes arranged thereabout in a staggered configuration proximate to the renal nerve,
wherein the plurality of electrodes comprises (a) a first electrode having a first pair of bipolar contacts and (b) a second electrode having a second pair of bipolar contacts; and
modulating the renal nerve by—
selectively energizing the first electrode to produce a first treatment zone along the renal blood vessel, and
selectively energizing the second electrode to produce a second treatment zone along the renal blood vessel.
2. The method of claim 1 wherein selectively energizing the first and second electrodes to produce the first and second treatment zones, respectively, occurs without repositioning the catheter.
3. The method of claim 1 wherein intravascularly positioning the catheter comprises delivering the catheter over a guidewire.
4. The method of claim 1 wherein the first and second electrodes are staggered such that the first treatment zone and the second treatment zone do not overlap.
5. The method of claim 1 wherein selectively energizing the first electrode to produce the first treatment zone and selectively energizing the second electrode to produce the second treatment zone occur in sequence.
6. The method of claim 1 wherein selectively energizing the first electrode to produce the first treatment zone and selectively energizing the second electrode to produce the second treatment zone occur concurrently.
7. The method of claim 1 wherein the first electrode and the second electrode are parts of a flex circuit on a surface of the balloon.
8. The method of claim 7 wherein the flex circuit terminates proximally of a distal end portion of the balloon.
9. The method of claim 1 wherein the balloon is configured to bring the first electrode and the second electrode into apposition with an inner wall of the renal blood vessel when the catheter is in the deployed configuration.
10. The method of claim 1 wherein the balloon is configured to block fluid flow within the renal blood vessel during energy delivery.
11. The method of claim 1 wherein the plurality of electrodes further comprises a third electrode having a third pair of bipolar contacts and a fourth electrode having a fourth pair of bipolar contacts, and wherein modulating the renal nerve further comprises:
selectively energizing the third electrode to produce a third treatment zone along the renal blood vessel; and
selectively energizing the fourth electrode to produce a fourth treatment zone along the renal blood vessel,
wherein each of the plurality of electrodes is configured to deliver thermal energy to less than a full circumference of the renal blood vessel.
12. The method of claim 1 , further comprising monitoring a parameter of the balloon, electrodes, and/or tissue proximate the renal nerve within the patient during therapy.
13. The method of claim 12 wherein monitoring a parameter comprises monitoring temperature of the balloon, electrodes, and/or tissue, and wherein the method further comprises maintaining a desired temperature throughout therapy.
14. The method of claim 12 , further comprising altering treatment in response to the monitored parameter.
15. The method of claim 14 wherein altering treatment comprises deactivating an electrode that the monitored parameter indicates is not in apposition with an inner wall of the renal blood vessel.
16. The method of claim 1 wherein modulating the renal nerve comprises ablating the renal nerve of the patient via thermal energy from the first and second electrodes.
17. The method of claim 1 wherein modulating the renal nerve comprises partially ablating the renal nerve of the patient via thermal energy from the first and second electrodes.
18. The method of claim 1 wherein modulating the renal nerve comprises at least partially blocking neural traffic to and/or from a kidney of the patient.
19. The method of claim 1 , further comprising repositioning the catheter and distal balloon within the renal blood vessel of the patient after producing the first and second treatment zones, and wherein, after repositioning, the method further comprises selectively energizing the first and second electrodes to produce third and fourth treatment zones, respectively, along the renal blood vessel.
20. The method of claim 1 wherein intravascularly positioning a catheter within a renal blood vessel comprises positioning the catheter within a renal artery of the patient.
21. A method of performing renal neuromodulation, the method comprising:
intravascularly delivering a catheter over a guidewire in a low profile delivery configuration to a vicinity of a renal nerve of a human patient;
transforming the catheter from the delivery configuration to a treatment configuration, wherein a distal balloon is expanded to place a plurality of electrodes arranged thereabout in a staggered configuration into contact with an inner wall of a renal blood vessel of the patient, and wherein each electrode comprises a pair of bipolar contacts;
selectively energizing a first electrode to produce a first treatment zone along the renal blood vessel; and
selectively energizing a second electrode to produce a second treatment zone along the renal blood vessel,
wherein selectively energizing the first and second electrodes modulates the renal nerve to reduce renal sympathetic nerve activity of the patient.
22. The method of claim 21 wherein the first and second electrodes are staggered such that the first treatment zone and second treatment zone do not overlap.
23. The method of claim 21 wherein the first and second electrodes are staggered such that the first treatment zone and second treatment zone overlap.
24. The method of claim 21 wherein selectively energizing the first electrode and selectively energizing the second electrode occur simultaneously.
25. The method of claim 21 wherein, when the catheter is in the treatment configuration, the balloon occludes the renal blood vessel.
26. The method of claim 21 wherein modulating the renal nerve to reduce renal sympathetic nerve activity comprises thermally modulating afferent and efferent renal nerves of the patient.