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, comprising:
intravascularly advancing an elongate shaft of a catheter to a renal vasculature of a patient;
locating a first neuromodulation element of the catheter within a distal portion of a main renal artery directly connected to an aorta of the patient and extending distally toward a kidney of the patient;
locating a second neuromodulation element of the catheter within a branch vessel of the main renal artery distal to a bifurcation at a distal end of the main renal artery;
modulating nerve tissue within an anatomical region extending about the distal portion of the main renal artery via the first neuromodulation element; and
modulating nerve tissue within an anatomical region extending about the branch vessel via the second neuromodulation element.
2. The method of claim 1 wherein intravascularly advancing the elongate shaft of the catheter to the renal vasculature comprises delivering the catheter over a guidewire, and wherein the first neuromodulation element is an expandable helical electrode.
3. The method of claim 1 wherein intravascularly advancing the elongate shaft of the catheter to the renal vasculature comprises delivering the catheter within a sheath, and wherein the first neuromodulation element assumes a preformed spiral/helical configuration within the distal portion of the main renal artery when removed from the sheath.
4. The method of claim 1 wherein the second neuromodulation element is on the elongate shaft.
5. The method of claim 1 wherein the second neuromodulation element comprises at least one wire electrode, and wherein locating the second neuromodulation element of the catheter within the branch vessel comprises delivering the second neuromodulation element to the branch vessel in a low-profile state and transforming the second neuromodulation element to an expanded state within the branch vessel.
6. The method of claim 1 wherein the second neuromodulation element comprises multiple wire electrodes, and wherein locating the second neuromodulation element of the catheter within the branch vessel comprises locating a first wire electrode within a first branch vessel and a second wire electrode within a second, different branch vessel.
7. The method of claim 1 wherein the first neuromodulation element further comprises a balloon, and wherein locating the first neuromodulation element of the catheter within the distal portion of the main renal artery comprises inflating the balloon before modulating nerve tissue via the first neuromodulation element.
8. The method of claim 1 further comprising:
inflating a balloon before modulating nerve tissue via the second neuromodulation element.
9. The method of claim 1 wherein the main renal artery and the branch vessel are modulated simultaneously.
10. A method for treating a patient diagnosed with a measurable physiological parameter associated with systemic sympathetic overactivity or hyperactivity, the method comprising:
ablating renal nerves within an anatomical region extending about a branch renal vessel of the patient, wherein the branch renal vessel is located distal to a bifurcation in a main renal artery of the patient; and
ablating renal nerves within an anatomical region extending circumferentially around the main renal artery of the patient, wherein ablating the renal nerves results in a decrease in renal sympathetic neural activity in the patient.
11. The method of claim 10 wherein ablating the renal nerves results in a therapeutically beneficial reduction in clinical symptoms of hypertension in the patient.
12. The method of claim 10 wherein ablating the renal nerves comprises systemically reducing sympathetic tone in the patient.