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 for treatment of a human patient diagnosed with hypertension, the method comprising:
intravascularly positioning a catheter in a reduced profile delivery configuration within a renal blood vessel and at least partially adjacent to renal nerves of the patient;
transforming a distal basket of the catheter from the delivery configuration to a treatment configuration, wherein, in the treatment configuration, the distal basket is expanded to place a plurality of electrodes arranged thereabout into contact with an inner wall of the renal blood vessel of the patient;
selectively energizing a first bipolar electrode pair carried by a first strut of the basket and delivering a first bipolar energy field to the renal nerves; and
selectively energizing a second bipolar electrode pair carried by a second, different strut of the basket and delivering a second bipolar energy field to the renal nerves,
wherein delivering the first and second bipolar energy fields modulates neural function of the renal nerves.
2. The method of claim 1 wherein modulating neural function of the renal nerves results in a therapeutically beneficial reduction in blood pressure of the patient.
3. The method of claim 1 wherein selectively energizing the first bipolar electrode pair and selectively energizing the second bipolar electrode pair occurs simultaneously.
4. The method of claim 1 wherein intravascularly positioning a catheter in a reduced profile delivery configuration within a renal blood vessel comprises delivering the catheter over a guidewire.
5. The method of claim 1 , further comprising monitoring a parameter of the catheter and/or tissue within the patient before and during delivery of the first and second bipolar energy fields.
6. The method of claim 5 wherein monitoring a parameter comprises monitoring temperature, power, and/or impedance.
7. The method of claim 5 , further comprising altering delivery of at least one of the first and second bipolar energy fields in response to the monitored parameter.
8. The method of claim 1 wherein the catheter further comprises an insulating element carried by the basket.
9. The method of claim 8 wherein transforming the basket from the delivery configuration to a treatment configuration comprises blocking blood flow within the renal blood vessel via the insulating element.
10. The method of claim 8 wherein the insulating element comprises a balloon.
11. The method of claim 1 wherein delivering the first and second bipolar energy fields comprises thermally altering the renal nerves in a manner that reduces neural traffic to and from a kidney of the patient.
12. The method of claim 1 wherein delivering the first and second bipolar energy fields comprises ablating one or more renal nerves of the patient.
13. The method of claim 1 wherein delivering the first and second bipolar energy fields comprises partially ablating the renal nerves of the patient.
14. The method of claim 1 wherein delivering the first and second bipolar energy fields comprises at least partially blocking afferent and efferent neural traffic to and/or from a kidney of the patient.
15. A method for renal neuromodulation, the method comprising:
transluminally positioning an expandable basket of a renal denervation catheter at an intravascular location within a renal artery of a human patient and adjacent to neural fibers innervating a kidney of the patient;
transforming the expandable basket from a low-profile delivery configuration to an expanded treatment configuration,
wherein, in the treatment configuration, the basket is sized and shaped to place a first bipolar electrode pair carried by a first strut of the basket and a second bipolar electrode pair carried by a second, different strut of the basket in apposition with target tissue at or near the neural fibers; and
ablating the neural fibers innervating the kidney via radio frequency (RF) energy from the first and second bipolar electrode pairs.
16. The method of claim 15 wherein ablating the neural fibers innervating the kidney results in a therapeutically beneficial reduction in blood pressure of the patient.
17. The method of claim 15 , further comprising monitoring a parameter of the renal denervation catheter and/or tissue within the patient before and during delivery of the RF energy.
18. The method of claim 17 wherein monitoring a parameter comprises monitoring temperature, power, and/or impedance, and wherein the method further comprises altering delivery of the RF energy in response to the monitored parameter.
19. The method of claim 15 wherein transluminally positioning an expandable basket of a renal denervation catheter at an intravascular location within a renal artery comprises delivering the catheter over a guidewire.
20. The method of claim 15 wherein transluminally positioning an expandable basket of a renal denervation catheter at an intravascular location within a renal artery comprises delivering the expandable basket within a guide sheath, and wherein the method further comprises at least partially withdrawing the guide sheath and transforming the expandable basket from the low-profile delivery configuration to the expanded treatment configuration before ablating the neural fibers.
21. The method of claim 15 , further comprising removing the renal denervation catheter from the patient after ablating the neural fibers to conclude the procedure.
22. The method of claim 15 wherein ablating the neural fibers innervating the kidney comprises at least partially denervating the kidney of the patient.