Apparatus for renal neuromodulation via an intra-to-extravascular approach
Methods and apparatus are provided for pulsed electric field 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, the ITEV PEF system comprises 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 of the present invention may, for example, be used to modulate one or more target neural fibers that contribute to renal function.
1. A renal neuromodulation apparatus, comprising:
an elongated element configured to be intravascularly positioned within a blood vessel of a human patient;
an electrode at a distal region of the elongated element and electrically coupleable to an electric field generator external to the patient,
wherein the electrode comprises an intravascular region associated with the elongated element and an extravascular region adapted to be passed through a wall of the blood vessel; and
an expansion element associated with the electrode and configured to move the electrode between—
a low-profile arrangement in which the extravascular region of the electrode is within the blood vessel, and
a treatment arrangement in which the extravascular region of the electrode is located at an extravascular location for extravascular delivery of an electric field.
2. The renal neuromodulation apparatus of claim 1 wherein the expansion element comprises an inflatable balloon.
3. The renal neuromodulation apparatus of claim 1 wherein the expansion element comprises an expandable cage or basket.
4. The renal neuromodulation apparatus of claim 1 wherein the expansion element comprises a self-expanding basket or cage.
5. The renal neuromodulation apparatus of claim 1 wherein the extravascular region of the electrode comprises a sharpened point for penetrating the wall of the blood vessel.
6. The renal neuromodulation apparatus of claim 1 wherein the electrode comprises a bipolar electrode pair having a first electrode element and a second electrode element.
7. The renal neuromodulation apparatus of claim 6 wherein, in the treatment arrangement, the first electrode element and the second electrode element are angularly aligned and longitudinally spaced apart from one another.
8. The renal neuromodulation apparatus of claim 6 wherein the bipolar electrode pair is a first bipolar electrode pair, and wherein the apparatus further comprises a second bipolar electrode pair angularly offset from the first bipolar electrode pair, and further wherein the second bipolar electrode pair comprises a third electrode element and a fourth electrode element.
9. The renal neuromodulation apparatus of claim 1 wherein the elongated element is configured to be intravascularly positioned within the blood vessel via a guide wire.
10. The renal neuromodulation apparatus of claim 1 wherein the electrode is configured for infusion of an agent before, during, and/or after delivery of the electric field.
11. The renal neuromodulation apparatus of claim 10 wherein the agent is adapted to enhance a neuromodulatory effect of the electric field.
12. The renal neuromodulation apparatus of claim 10 wherein the agent comprises saline.
13. The renal neuromodulation apparatus of claim 10 wherein the agent is adapted to provide a protective effect for non-target tissue during delivery of the electric field.
14. The renal neuromodulation apparatus of claim 1 wherein the electrode is configured for monopolar delivery of the electric field.
15. The renal neuromodulation apparatus of claim 1 wherein the elongated element, electrode, and expansion element are sized and shaped for intravascular positioning within a renal artery of the patient.
16. The renal neuromodulation apparatus of claim 1 wherein the electric field is a pulsed electric field.
17. The renal neuromodulation apparatus of claim 1 wherein the elongated element is configured to be intravascularly positioned within a renal artery of the patient, and wherein the electrode is sized such that, when in the treatment arrangement, the extravascular region of the electrode is within adventitia of the renal artery.
18. The renal neuromodulation apparatus of claim 1 wherein the elongated element is configured to be intravascularly positioned within a renal artery of the patient, and wherein the extravascular region is adapted to deliver the electric field to one or more renal nerves of the patient to achieve renal denervation.