Methods and apparatus for monopolar renal neuromodulation

Patent metadata

Field	Value
Publication number	US-10376312-B2
Application number	US-201816153376-A
Country	US
Kind code	B2
Filing date	Oct 5, 2018
Priority date	Apr 8, 2002
Publication date	Aug 13, 2019
Grant date	Aug 13, 2019

Abstract

Methods and apparatus are provided for monopolar neuromodulation, e.g., via a pulsed electric field. Such monopolar neuromodulation may effectuate irreversible electroporation or electrofusion, necrosis and/or inducement of apoptosis, alteration of gene expression, action potential attenuation or blockade, changes in cytokine up-regulation and other conditions in target neural fibers. In some embodiments, monopolar neuromodulation is applied to neural fibers that contribute to renal function. In some embodiments, such monopolar neuromodulation is performed bilaterally.

First claim

We claim:

1. A method, comprising:
intravascularly positioning a renal denervation catheter in a low-profile delivery arrangement within a renal blood vessel of a hypertensive human patient and adjacent to renal nerves innervating a kidney of the patient;
transforming the catheter from the low-profile delivery arrangement to an expanded arrangement at a treatment site within the renal blood vessel,
wherein, in the expanded arrangement, a plurality of energy delivery elements of the renal denervation catheter are positioned in contact with an inner wall of the renal blood vessel of the patient; and
delivering an electric field between the plurality of energy delivery elements and a ground pad coupled to an exterior of the patient,
wherein delivering the electric field comprises delivering a substantially uniform circumferential energy field about the renal blood vessel at the treatment site, and
wherein delivering the electric field attenuates neural communication along the renal nerves and results in a therapeutically beneficial reduction in blood pressure of the patient.

2. The method of claim 1 wherein the renal denervation catheter further comprises one or more monitoring elements located adjacent the plurality of energy delivery elements and configured to monitor a parameter of the renal denervation catheter and/or tissue within the patient before and during delivery of the electric field and altering delivery of the electric field in response to the monitored parameter.

3. The method of claim 2 wherein monitoring a parameter comprises monitoring temperature, power, and/or impedance.

4. The method of claim 1 wherein intravascularly positioning a renal denervation catheter within a renal blood vessel of a hypertensive human patient comprises intravascularly positioning the renal denervation catheter within a renal artery of the patient.

5. The method of claim 1 wherein intravascularly positioning a renal denervation catheter within a renal blood vessel of a hypertensive human patient comprises positioning the renal denervation catheter via a guide catheter.

6. The method of claim 1 wherein intravascularly positioning a renal denervation catheter within a renal blood vessel of a hypertensive human patient comprises intravascularly positioning the renal denervation catheter via a guide wire.

7. The method of claim 1 wherein delivering an electric field between the plurality of energy delivery elements and the ground pad coupled to the exterior of the patient causes ablation of the renal nerves.

8. The method of claim 1 wherein delivering an electric field between the plurality of energy delivery elements and the ground pad coupled to the exterior of the patient causes partial ablation of the renal nerves.

9. The method of claim 1 wherein delivering the electric field and attenuating neural communication along the renal nerves comprises reducing efferent neural activity across the renal nerves.

10. The method of claim 1 wherein delivering the electric field and attenuating neural communication along the renal nerves comprises reducing afferent neural activity across the renal nerves.

11. The method of claim 1 , further comprising removing the renal denervation catheter from the patient after delivering the electric field.

12. The method of claim 1 wherein delivering the electric field and attenuating neural communication along the renal nerves further results in a therapeutically beneficial reduction in sympathetic overactivity of the patient.

13. The method of claim 1 wherein the treatment site is a first treatment site and the electric field is a first electric field, and wherein the method further comprises:
repositioning the plurality of energy delivery elements at a second treatment site within the renal blood vessel after delivering the first electric field at the first treatment site; and
after repositioning, delivering a second electric field between the plurality of energy delivery elements and the ground pad at the second treatment site along the renal blood vessel.

14. The method of claim 1 wherein delivering an electric field between the plurality of energy delivery elements and the ground pad comprises delivering a radio frequency (RF) electric field.

Assignees

• Medtronic Ardian Luxembourg

Inventors

• Zarins Denise
• Gifford Iii Hanson
• Deem Mark
• Levin Howard R
• Gelfand Mark
• Zadno Nicolas

Classifications

• A61B2017/00154

  pulsed · CPC title

• A61B18/16

  Indifferent or passive electrodes for grounding · CPC title

• A61B2018/00214

  Expandable means emitting energy, e.g. by elements carried thereon · CPC title

• A61B2018/1472

  for use with liquid electrolyte, e.g. virtual electrodes · CPC title

• A61B18/1492 Primary

  having a flexible, catheter-like structure, e.g. for heart ablation (A61B18/1477 takes precedence) · CPC title