Renal nerve ablation using conductive fluid jet and RF energy

1. An apparatus, comprising:

a catheter comprising a flexible shaft having a proximal end, a distal end, a length, and a lumen arrangement extending between the proximal and distal ends, the length of the shaft sufficient to access a patient's renal artery relative to a percutaneous access location;

a pressurizable lumen of the lumen arrangement configured to receive a pressurized conductive fluid;

a nozzle fluidly coupled to a distal end of the pressurizable lumen, the nozzle configured to direct a jet of the pressurized conductive fluid at a wall of the renal artery to create or expand a hole through the artery wall and to fill the hole and at least some of perivascular space adjacent to the hole with the conductive fluid; and

at least one electrical conductor extending at least partially along the shaft and terminating proximate or at the distal end of the pressurizable lumen, the at least one electrical conductor configured to conduct radio frequency energy to the conductive fluid sufficient to ablate perivascular renal nerve tissue in contact with the conductive fluid;

wherein the pressurizable lumen comprises electrically conductive material that extends between the distal and proximal ends of the shaft.

2. The apparatus of claim 1 , wherein the conductive fluid has an impedance lower than that of renal artery tissue proximate the hole.

3. The apparatus of claim 1 , wherein at least the nozzle comprises electrically conductive material.

4. The apparatus of claim 1 , wherein at least a proximal portion of the pressurizable lumen comprises non-conductive material, the nozzle comprises an electrically conductive element.

5. The apparatus of claim 1 , comprising:

a conductive wire covered with an electrically insulating material and having an exposed tip portion, the tip portion configured to create a pilot hole through the artery wall;

wherein a relatively low pressure conductive fluid jet is configured to expand the pilot hole in the artery wall and dissect the perivascular space, and the radiofrequency energy is transferred to the conductive fluid via the tip of the conductive wire.

6. The apparatus of claim 1 , comprising a plurality of the pressurizable lumens fluidly coupled to a plurality of the nozzles, each of the pressurizable lumens individually pressurizable.

7. The apparatus of claim 1 , comprising a plurality of the pressurizable lumens fluidly coupled to a plurality of the nozzles, at least some of the pressurizable lumens fluidly coupled to a common pressurizable lumen and commonly pressurizable.

8. The apparatus of claim 1 , comprising:

a plurality of the pressurizable lumens fluidly coupled to a plurality of the nozzles; and

an expandable balloon or mesh provided at the distal end of the shaft and configured to position the nozzles against the artery wall and stabilize the position of the nozzles during ablation.

9. The apparatus of claim 1 , comprising:

a plurality of the pressurizable lumens fluidly coupled to a plurality of the nozzles;

an expandable balloon or mesh provided at the distal end of the shaft and configured to position the nozzles against the artery wall and stabilize the position of the nozzles during ablation; and

an external control unit fluidly coupled to the pressurizable lumens and configured to control the jets of the pressurized conductive fluid at the wall of the renal artery to concurrently ablate separate locations along and around the renal artery perivascular tissue.

10. The apparatus of claim 1 , comprising:

a plurality of the pressurizable lumens fluidly coupled to a plurality of the nozzles;

an expandable balloon or mesh provided at the distal end of the shaft and configured to position the nozzles against the artery wall and stabilize the position of the nozzles during ablation; and

an external control unit fluidly coupled to the pressurizable lumens and configured to control the jets of the pressurized conductive fluid at the wall of the renal artery to serially or sequentially ablate separate locations along and around the renal artery perivascular tissue.

11. The apparatus of claim 1 , wherein the conductive fluid is cooled to a temperature sufficient to provide cooling at a renal artery ablation site.

12. The apparatus of claim 1 , comprising a cooling arrangement separate from the pressurizable lumen and configured to provide cooling at a renal artery treatment site.

13. An apparatus, comprising:

a catheter dimensioned for advancement through a vessel of the body;

a pressurizable lumen of the catheter configured to receive a pressurized conductive fluid;

a nozzle fluidly coupled to a distal end of the pressurizable lumen, the nozzle configured to direct a jet of the pressurized conductive fluid at a wall of a target vessel to create or expand a hole through the target vessel and to fill the hole and at least some of the space adjacent to the hole with the conductive fluid; and

at least one electrical conductor extending at least partially along the catheter and terminating proximate or at the distal end of the pressurizable lumen, the at least one electrical conductor configured to conduct radio frequency energy to the conductive fluid sufficient to ablate target tissue in contact with the conductive fluid;

wherein the pressurizable lumen comprises electrically conductive material that extends between the distal and proximal ends of the shaft.

14. The apparatus of claim 13 , wherein at least a proximal portion of the pressurizable lumen comprises non-conductive material, the nozzle comprises electrically conductive material.

15. The apparatus of claim 13 , comprising:

a conductive wire covered with an electrically insulating material and having an exposed tip portion, the tip portion configured to create a pilot hole through the target vessel;

wherein a relatively low pressure conductive fluid jet is configured to expand the pilot hole in the target vessel wall, and the radiofrequency energy is transferred to the conductive fluid via the tip of the conductive wire.

16. A method, comprising:

advancing a catheter through a renal artery of the body to a target location proximate target tissue adjacent an outer wall of the renal artery, wherein the target tissue comprises perivascular renal nerve tissue;

creating a hole through the outer wall of the renal artery at the target location;

filling the hole and at least some of the space adjacent to the hole with conductive fluid via a lumen of the catheter; and

conducting radiofrequency energy along the catheter and to the conductive fluid filing filling the hole and the at least some of the space adjacent to the hole sufficient to ablate the target tissue.

17. The method of claim 16 , comprising:

creating a plurality of the holes through the renal artery at a plurality of one or both of circumferentially and axially spaced-apart target locations;

filling the holes and at least some of the space adjacent to the holes with the conductive fluid; and

conducting radiofrequency energy along the catheter and to the conductive fluid filling the holes and the at least some of the space adjacent to the holes sufficient to ablate the target tissue.

18. The method of claim 16 , further comprising:

prior to filling the hole, expanding the hole and dissecting perivascular space adjacent the hole using a low-pressure jet of conductive fluid.

19. The method of claim 16 , wherein the catheter comprises:

a flexible shaft having a proximal end, a distal end, a length, the length of the shaft sufficient to access the renal artery relative to a percutaneous access location;

a nozzle fluidly coupled to a distal end of the lumen, the nozzle being configured to direct a jet of the conductive fluid at the outer wall of the renal artery to create the hole through the outer wall and to fill the hole and at least some of the space adjacent to the hole with the conductive fluid; and

at least one electrical conductor extending at least partially along the shaft and terminating proximate or at the distal end of the lumen, the at least one electrical conductor configured to conduct radiofrequency energy to the conductive fluid sufficient to ablate perivascular renal nerve tissue in contact with the conductive fluid;

wherein the lumen comprises electrically conductive material that extends between the distal and proximal ends of the shaft.