Apparatus and method of assessing transvascular denervation
A catheter apparatus for assessing denervation comprises: an elongated catheter body; a deployable structure coupled to the catheter body, the deployable structure being deployable outwardly from and contractible inwardly toward the longitudinal axis of the catheter body; one or more ablation elements disposed on the deployable structure to move outwardly and inwardly with the deployable structure; one or more stimulation elements spaced from each other and disposed on the deployable structure to move with the deployable structure, the stimulation elements being powered to supply nerve stimulating signals to the vessel; and one or more recording elements spaced from each other and from the stimulation elements, the recording elements being disposed on the deployable structure to move with the deployable structure, the recording elements configured to record response of the vessel to the nerve stimulating signals.
1. A method of evaluating the intraprocedural success of a renal denervation procedure on a subject, the method comprising:
supplying, using a plurality of stimulation electrodes, first nerve-stimulating signals to multiple evenly distributed points about a circumference of a renal artery of the subject, the plurality of stimulation electrodes including at least one pair of stimulation electrodes that are longitudinally spaced from one another relative to the renal artery;
recording, using a plurality of recording electrodes, a response of the renal artery to the first nerve-stimulating signals to determine a baseline physiological response of the subject, the plurality of recording electrodes including at least one pair of recording electrodes that are circumferentially spaced from one another at the same longitudinal position relative to the renal artery;
performing a renal denervation procedure on the renal artery of the subject;
supplying second nerve-stimulating signals to the multiple points about the circumference of the renal artery of the subject to determine the physiological response of the subject; and
assessing denervation of the renal artery by comparing the baseline physiological response of the subj ect prior to renal denervation with the physiological response after renal denervation.
2. The method of claim 1 further comprising determining whether to perform additional renal denervation on the subject by using the compared physiological responses.
3. The method of claim 1 wherein the electrical stimulation of the renal artery and the renal denervation are performed using the same ablation catheter.
4. The method of claim 3 wherein the ablation catheter comprises at least four ablation electrodes and at least four electrical stimulation electrodes.
5. The method of claim 4 wherein the ablation catheter includes at least four splines and the ablation electrodes and the electrical stimulation electrodes are positioned and configured on the at least four splines.
6. The method of claim 3 wherein the ablation catheter is a balloon catheter.
7. The method of claim 3 wherein the ablation catheter comprises at least four ablation electrodes.
8. The method of claim 1 wherein the first and second nerve-stimulation signals are supplied using sequential electrical stimulation.
9. The method of claim 1 wherein the first and second nerve-stimulation signals are supplied using simultaneous electrical stimulation.
10. The method of claim 1 wherein the first and second nerve-stimulation signals are supplied using monopolar electrical stimulation.
11. The method of claim 1 wherein the first and second nerve-stimulation signals are supplied using bipolar electrical stimulation.
12. The method of claim 1 wherein the physiological response of the subject measured is blood pressure.
13. The method of claim 1 wherein the first and second nerve-stimulation signals are supplied using rectangular pulse waves.
14. The method of claim 1 wherein the first and second nerve-stimulation signals provide current in an amount of from about 1 milliamps to about 20 milliamps at a frequency of from about 0.5 Hertz to about 20 Hertz for a time period of from about 0.1 millisecond to about 1 milliseconds.
15. The method of claim 14 wherein the electrical stimulation provides current in an amount of from about 5 milliamps to about 10 milliamps at a frequency of from about 0.5 Hertz to about 20 Hertz for a time period of from about 0.2 millisecond to about 0.5 milliseconds.
16. The method of claim 1 wherein comparing the baseline physiological response of the subject prior to renal denervation with the physiological response after renal denervation comprises computing a ratio of the physiological response after renal denervation to the baseline physiological response of the subject prior to renal denervation.
17. The method of claim 1 wherein the plurality of stimulation electrodes and the plurality of recording electrodes are different sets of electrodes.
18. A method of determining the end point of a renal denervation procedure on a subject, the method comprising:
supplying, using a plurality of electrical stimulation electrodes on an ablation catheter, first nerve-stimulating signals to at least three circumferentially evenly spaced locations about a renal artery of the subject through electrical stimulation, the plurality of electrical stimulation electrodes including at least one pair of electrical stimulation electrodes that are longitudinally spaced from one another relative to the renal artery;
recording, using a plurality of recording electrodes on the ablation catheter, a response of the renal artery to the first nerve-stimulating signals to determine a baseline reading of the subject's blood pressure, the ablation catheter comprising at least three ablation electrodes and at least three electrical stimulation electrodes and configured to electrically contact the at least three circumferentially spaced locations about the renal artery, the plurality of recording electrodes including at least one pair of recording electrodes that are circumferentially spaced from one another at the same longitudinal position relative to the renal artery;
performing a renal denervation procedure on the renal artery of the subject using the ablation catheter;
supplying second nerve-stimulating signals to the at least three circumferentially spaced locations about the renal artery of the subject through electrical stimulation using the ablation catheter configured to electrically contact the at least three circumferentially spaced locations about the renal artery and determine the subject's blood pressure;
comparing the baseline blood pressure of the subject prior to renal denervation with the blood pressure after renal denervation; and
determining whether to perform an additional renal denervation procedure.
19. The method of claim 18 wherein the first and second nerve-stimulation signals provide current in an amount of from about 1 milliamps to about 20 milliamps at a frequency of from about 0.5 Hertz to about 20 Hertz for a time period of from about 0.1 millisecond to about 1 milliseconds.
20. The method of claim 18 wherein the first and second nerve-stimulation signals are supplied using bipolar electrical stimulation.