Methods and devices for endovascular ablation of a splanchnic nerve
Systems, devices, and methods for transvascular ablation of target tissue are disclosed herein. The devices and methods may, in some examples, be used for splanchnic nerve ablation to increase splanchnic venous blood capacitance to treat at least one of heart failure and hypertension. For example, the devices disclosed herein may be advanced endovascularly to a target vessel in the region of a thoracic splanchnic nerve (TSN), such as a greater splanchnic nerve (GSN) or a TSN nerve root. Also disclosed are method of treating heart failure, such as HFpEF, by endovascularly ablating a thoracic splanchnic nerve to increase venous capacitance and reduce pulmonary blood pressure.
1. A device for endovascular vein puncture, comprising:
an elongate catheter extending along a longitudinal catheter axis and having a catheter proximal portion and a catheter distal portion;
a needle guide having a blunt needle guide distal end, wherein the needle guide is deployable from the catheter from a needle guide storage position to a needle guide working position, wherein in the needle guide working position, the needle guide distal end is radially spaced from the catheter, and in the needle guide storage position, the needle guide distal end is withdrawn towards the catheter relative to the needle guide working position;
a needle having a sharp puncturing end, wherein the needle is deployable from within the needle guide from a needle storage position to a puncturing position, wherein in the needle storage position, the sharp puncturing end is shy of the needle guide distal end, and in the puncturing position, the sharp puncturing end extends proud of the needle guide distal end; and
an ablation energy delivery device deployable from within the needle from an ablation energy delivery device storage position to an ablation energy delivery device treatment position, wherein the ablation energy delivery device has a blunt delivery device distal end,
wherein when in the needle guide working position, the puncturing position, and the ablation energy delivery device treatment position, the needle guide, the needle, and the ablation energy delivery device, respectively, are co-axial, and
wherein when in the ablation energy delivery device treatment position, the ablation energy delivery device has a straight configuration where it extends from the needle.
2. The device of claim 1 , wherein the ablation energy delivery device is at least one of a fluid delivery device, a thermal energy delivery device, a radiofrequency energy delivery device, a cryogenic energy delivery device, and an electrical energy delivery device.
3. The device of claim 1 , wherein in the ablation energy delivery device treatment position, the ablation energy delivery device distal end extends proud of the sharp puncturing end by a delivery distance that is greater than a needle puncturing distance.
4. The device of claim 3 , wherein the delivery distance is between about 3 mm and about 15 mm.
5. The device of claim 4 , wherein the delivery distance is between about 4 mm and about 6 mm.
6. The device of claim 1 , wherein:
the catheter has a catheter outer diameter,
in the puncturing position, the sharp puncturing end is spaced from the blunt needle guide distal end by a needle deployed distance that is less than the catheter outer diameter, and
in the needle guide working position, the blunt needle guide distal end is spaced from the catheter in the radial direction by a needle guide deployed distance that is less than the catheter outer diameter.
7. The device of claim 6 , wherein the needle deployed Distance is less than 2 mm.
8. The device of claim 7 , wherein the needle deployed distance is less than 1 mm.
9. The device of claim 6 , wherein the needle guide deployed distance is between about 0.5 mm and 6 mm.
10. The device of claim 9 , wherein the needle guide deployed distance is between about 0.5 mm and about 3 mm.
11. The device of claim 9 , wherein the needle guide deployed distance is between about 2 mm and about 6 mm.
12. The device of claim 6 , wherein the catheter diameter plus the needle guide deployed distance, when the needle guide is fully deployed, is equal to a distance in a range of 2 mm to 4 mm.
13. The device of claim 6 , wherein the catheter diameter plus the needle guide deployed distance, when the needle guide is fully deployed, is equal to a distance in a range of 3.5 mm to 6.5 mm.
14. The device of claim 1 , wherein the catheter comprises a circumferential outer surface and a first side port in the circumferential outer surface, and the needle guide is deployable from the first side port.
15. The device of claim 1 , wherein the catheter comprises a guidewire lumen extending therethrough, along the catheter axis, and the catheter distal portion has a guidewire exit port; and wherein the catheter comprises a distal end surface and a circumferential outer surface, and the guidewire exit port comprises a notch that is open at and between the distal end surface and the circumferential surface.
16. The device of claim 15 , wherein
the needle guide is deployable from the catheter at a first circumferential position on the catheter,
the notch is open at the circumferential surface at a notch circumferential position that is within 30 degrees of the first circumferential position, and
the notch circumferential position is aligned with the first circumferential position.
17. The device of claim 1 , further comprising:
a second needle guide deployable from the catheter; and
a second needle deployable from within the second needle guide,
wherein the needle guide is deployable from the catheter at a first longitudinal position on the catheter, and the second needle guide is deployable from the catheter at a second longitudinal position on the catheter, wherein the second longitudinal position is longitudinally spaced from the first longitudinal position along a longitudinal axis, and
wherein the needle guide is deployable from the catheter at a first circumferential position on the catheter, and the second needle guide is deployable from the catheter at a second circumferential position on the catheter, wherein the second circumferential position is circumferentially aligned with the first circumferential position.
18. The device of claim 17 , wherein the needle guide and the needle are longitudinally spaced apart from a notch at the distal end by a spacing of between 1.5 cm and about 2.5 cm, and wherein the second longitudinal position is spaced from the first longitudinal position by a spacing of between about 3 cm and about 5 cm.