SYSTEMS FOR HEATINDUCED RENALE NEURO MODULATION

SYSTEMS TO THE AUFLOSEN OF GERINSELN

Apparatus and method for removing occlusive material within blood vessels

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.

Methods and apparatus for inducing controlled renal neuromodulation

Methods and apparatus are provided for inducing, monitoring and controlling renal neuromodulation using a pulsed electric field to effectuate electroporation or electrofusion. In some embodiments, tissue impedance, conductance or conductivity may be monitored to determine the effects of pulsed electric field therapy, e.g., to determine an extent of electroporation and its degree of irreversibility. Pulsed electric field electroporation of tissue causes a decrease in tissue impedance and an increase in tissue conductivity. If induced electroporation is reversible, upon cessation of the pulsed electric field, tissue impedance and conductivity should approximate baseline levels; however, if electroporation is irreversible, impedance and conductivity changes should persist. Thus, monitoring of impedance or conductivity may be utilized to determine the onset of electroporation and to determine the type or extent of electroporation. Furthermore, monitoring data may be used in one or more manual ...

GER�T F�R THE RENALE NEURO MODULATION

EXPAND-CASH SCHERKATHETER FOR THE DISTANCE OF THROMBUS AND LOCKING MATERIAL

Apparatus and methods for clot dissolution

Clot disruption and dissolution are achieved using a catheter having the ability to infuse a thrombolytic agent, aspirate clot and fluid, and allow passage of a guidewire. Optionally, the catheter may also include a mechanical agitator for further disrupt clot in the presence of the thrombolytic agent. A flow resistor in the catheter provides for infusion and/or aspiration to be concentrated primarily at a clot treatment area in a blood vessel while also providing optional infusion and/or aspiration distal to the treatment area. In some embodiments, infusion, aspiration and guidewire passage occur through a common lumen. The thrombolytic agent, such as tPA, streptokinase, or urokinase, is directly released into the clot at the point where the agitator is engaging the clot. In this way, the thrombolytic activity of the agent is enhanced and the dissolution of the clot is improved.

Methods and apparatus for intravasculary-induced neuromodulation or denervation

Methods and apparatus are provided for intravascularly-induced neuromodulation or denervation. Neuromodulation may be achieved via direct and/or via indirect application of energy or neuromodulatory agents to target neural matter, or to vascular structures that support the target neural matter. In some embodiments, parameters of the target neural matter, of non-target tissue, or of the apparatus may be monitored via one or more sensors for controlling the neuromodulation or denervation. Such monitoring data optionally may be utilized for feedback control of the neuromodulation or denervation.

SYSTEMS FOR HEATINDUCED RENALE NEURO MODULATION

METHODS AND APPARATUS FOR PULSED ELECTRIC FIELD 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 ...

APPARATUS AND METHODS FOR CLOT DISSOLUTION

Methods and apparatus for performing a non-continuous circumferential treatment to a body lumen

Methods and apparatus are provided for non-continuous circumferential treatment of a body lumen. Apparatus may be positioned within a body lumen of a patient and may deliver energy at a first lengthwise and angular position to create a less-than-full circumferential treatment zone at the first position. The apparatus also may deliver energy at one or more additional lengthwise and angular positions within the body lumen to create less-than-full circumferential treatment zone(s) at the one or more additional positions that are offset lengthwise and angularly from the first treatment zone. Superimposition of the first treatment zone and the one or more additional treatment zones defines a non-continuous circumferential treatment zone without formation of a continuous circumferential lesion. Various embodiments of methods and apparatus for achieving such non-continuous circumferential treatment are provided.

METHODS AND APPARATUS FOR INDUCING CONTROLLED RENAL NEUROMODULATION

Methods and apparatus are provided for inducing, monitoring and controlling renal neuromodulation using a pulsed electric field to effectuate electroporation or electrofusion. In some embodiments, tissue impedance, conductance or conductivity may be monitored to determine the effects of pulsed electric field therapy, e.g., to determine an extent of electroporation and its degree of irreversibility. Pulsed electric field electroporation of tissue causes a decrease in tissue impedance and an increase in tissue conductivity. If induced electroporation is reversible, upon cessation of the pulsed electric field, tissue impedance and conductivity should approximate baseline levels; however, if electroporation is irreversible, impedance and conductivity changes should persist. Thus, monitoring of impedance or conductivity may be utilized to determine the onset of electroporation and to determine the type or extent of electroporation. Furthermore, monitoring data may be used in one or more manual ...

METHODS AND APPARATUS FOR BILATERAL RENAL NEUROMODULATION

METHODS FOR INTRAVASCULARLY-INDUCED NEUROMODULATION

Methods and apparatus are provided for intravascularly-induced neuromodulation using a pulsed electric field, e.g., to effectuate irreversible electroporation or electrofusion, necrosis and/or inducement of apoptosis, alteration of gene expression, changes in cytokine upregulation, etc., in target neural fibers. In some embodiments, the intravascular PEF system comprises a catheter having a pair of bipolar electrodes for delivering the PEF, with a first electrode positioned on a first side of an impedance-altering element and a second electrode positioned on an opposing side of the impedance-altering element. A length of the electrodes, as well as a separation distance between the first and second electrodes, may be specified such that, with the impedance-altering element deployed in a manner that locally increases impedance within a patient's vessel, e.g., with the impedance-altering element deployed into contact with the vessel wall at a treatment site within the patient's vasculature ...

Devices for percutaneous remote endarterectomy

The present invention provides devices, systems, methods and kits for the percutaneous removal of unwanted tissue or obstructive matter from body cavities or lumens, particularly from the vasculature. Blood vessels, including the coronary, peripheral and neurovascular circulation, which are narrowed or blocked by atheromatous material or plaque are often treated with traditional endarterectomy procedures. The present invention allows the benefits of such a procedure with an intraluminal approach, particularly a percutaneous approach. Generally, the present invention provides a set of catheters or tools which are percutaneously introduceable to the site of the blockage or occlusion. The tools dissect or cut through the innermost tissue layer of the lumen to an underlying tissue layer. The innermost tissue layer is then stripped away from the underlying layer with the occlusive material thereattached. The detached tissue layer and occlusive material is then removed from the lumen; this may include additional cutting, maceration and removal through mechanical aspiration. In any case, the resulting lumen is free of obstruction.

Apparatus and method for removing occlusive material within blood vessels

An apparatus for treating an occlusive region of a blood vessel includes a catheter including a first lumen extending from an end port to a first side port, and a second lumen extending from a proximal end of the catheter to a second side port. A balloon is mounted on the catheter between the first and second side ports. During use, a guidewire is placed into an occlusive region, and the guidewire is backloaded through the first and second lumens. The catheter is advanced over the guidewire, and the balloon is expanded to isolate the occlusive region. The guidewire is removed, and an agitator is advanced through the second lumen. After the agitator is agitated to dislodge occlusive material from the occlusive region, the agitator is removed, and the loose occlusive material is aspirated via the second side port.

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.

Apparatus and methods for capturing particulate material within blood vessels

SYSTEMS AND METHODS FOR CLOT DISRUPTION AND RETRIEVAL

Occlusive material, notably thrombus or clot, can block body cavities. Treatment requires disrupting, collecting and removing the material. A catheter for removing occlusive material from a body lumen is provided that has a catheter body having a proximal end, a distal end, and a lumen therethrough, a radially expansible positioning cage near the distal end of the catheter body, and a radially expansible macerator configured to break up occlusive material within the cage and draw the material into the catheter body lumen. The macerator includes a shaped wire having a spiral geometry.

Systems and methods for clot disruption and retrieval

METHODS AND APPARATUS FOR MULTI-VESSEL RENAL NEUROMODULATION

Methods and apparatus are provided for multi-vessel neurornodulation, e.g ., via a pulsed electric field. Such multi-vessel neurornodulation may effec tuate irreversible electroporation or electrofusion, necrosis and/or inducem ent of apoptosis, alteration of gene expression, action potential attenuatio n or blockade, changes in cytokine up- regulation and other conditions in ta rget neural fibers. In some embodiments, the multi-vessel neuromodulation is applied to neural fibers that contribute to renal function. Such multi-vess el neuromodulation optionally may be performed bilaterally.

Apparatus and methods for clot dissolution

METHODS AND APPARATUS FOR PULSED ELECTRIC FIELD NEUROMODULATION VIA AN INTRA-TO-EXTRAVASCULAR APPROACH

Methods for thermal modulation of nerves contributing to renal function

Methods and apparatus are provided for treatment of heart arrhythmia via renal neuromodulation. Such neuromodulation may effectuate irreversible electroporation or electrofusion, ablation, 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, such neuromodulation is achieved through application of an electric field. In some embodiments, such neuromodulation is achieved through application of neuromodulatory agents, of thermal energy and/or of high intensity focused ultrasound. In some embodiments, such neuromodulation is performed in a bilateral fashion.

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 extravascular delivery of pulsed electric fields to achieve such neuromodulation.

Systems and methods for clot disruption and retrieval

Methods and apparatus for multi-vessel renal neuromodulation

Methods and apparatus are provided for multi-vessel neuromodulation, e.g., via a pulsed electric field. Such multi-vessel 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, the multi-vessel neuromodulation is applied to neural fibers that contribute to renal function. Such multi-vessel neuromodulation optionally may be performed bilaterally.

APPARATUS AND METHOD FOR REMOVING OCCLUSIVE MATERIAL WITHIN BLOOD VESSELS

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.

METHODS AND APPARATUS FOR THERMALLY-INDUCED RENAL NEUROMODULATION

Methods and apparatus are provided for thermally-induced renal neuromodulation. Thermally-induced renal neuromodulation may be achieved via direct and/or via indirect application of thermal energy to heat or cool neural fibers that contribute to renal function, or of vascular structures that feed or perfuse the neural fibers. In some embodiments, parameters of the neural fibers, of non-target tissue, or of the thermal energy delivery element, may be monitored via one or more sensors for controlling the thermally-induced neuromodulation. In some embodiments, protective elements may be provided to reduce a degree of thermal damage induced in the non-target tissues. In some embodiments, thermally-induced renal neuromodulation is achieved via delivery of a pulsed thermal therapy.

Systems and methods for clot disruption and retrieval

Thrombectomy and other treatments are achieved using a catheter having a positioning cage and a macerator within the positioning cage. The catheter is introduced to a target body lumen, typically a blood vessel, and a positioning cage deployed at a treatment site. The macerator is then operated to disrupt thrombus, clot, or other occlusive materials at the treatment site, and the catheter is used to collect and remove the disruptive materials from the body lumen. In particular examples, the macerator may be radially expansible and optionally rotated and/or axially translated within the positioning cage to effect disruption of the occlusive material.

Apparatuses 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 extravascular delivery of pulsed electric fields to achieve such neuromodulation. 165-. (canceled)66. An apparatus for renal neuromodulation , the apparatus comprising:a probe configured for insertion in proximity to renal nerves along a renal artery or renal vein; an anchoring mechanism having—', 'a first collar;', 'a second collar located distally relative to the first collar; and', 'an expandable member connected to the first and second collars,', 'wherein the expandable member is reversibly transformable from a collapsed configuration to an expanded configuration by moving at least one of the first and second collars toward the other to reduce the distance between the collars; and, 'a catheter configured to move through the probe, wherein the catheter comprises'}a plurality of electrodes at the expandable member, wherein the electrodes are configured to deliver an electric field to the renal nerves.67. The apparatus of wherein the probe is configured for percutaneous placement adjacent to the renal artery or renal vein.68. The apparatus of wherein the probe is configured for insertion in proximity to the renal nerves along the renal artery or renal vein under guidance claim 66 , and wherein the guidance is chosen from the group consisting of visual claim 66 , computed tomographic claim 66 , radiographic claim 66 , ultrasonic claim 66 , angiographic claim 66 , laparoscopic claim 66 , and combinations thereof.69. The apparatus of wherein the expandable member comprises ...

Methods and apparatus for inducing controlled renal neuromodulation

Methods and apparatus are provided for inducing, monitoring and controlling renal neuromodulation using a pulsed electric field to effectuate electroporation or electrofusion. In some embodiments, tissue impedance, conductance or conductivity may be monitored to determine the effects of pulsed electric field therapy, e.g., to determine an extent of electroporation and its degree of irreversibility. Pulsed electric field electroporation of tissue causes a decrease in tissue impedance and an increase in tissue conductivity. If induced electroporation is reversible, upon cessation of the pulsed electric field, tissue impedance and conductivity should approximate baseline levels; however, if electroporation is irreversible, impedance and conductivity changes should persist. Thus, monitoring of impedance or conductivity may be utilized to determine the onset of electroporation and to determine the type or extent of electroporation. Furthermore, monitoring data may be used in one or more manual ...

Devices and methods for controlling expandable prostheses during deployment

A catheter for delivering a prosthesis to a treatment site in a body lumen comprises an elongate flexible member and a sheath slidably disposed thereover. A plurality of self-expanding tubular prostheses are carried in axially spaced apart locations along the elongate member, within the sheath. The prostheses may be selectively interlocked with one another and are constrained by the sheath in a radially contracted configuration. The prostheses are separately releasable from the sheath when the sheath is retracted relative to the elongate member. The catheter also has a pusher member slidably disposed along the elongate member within the sheath. The pusher is adapted to move past the prostheses in a first direction without displacing the prostheses, while in a second direction the pusher engages a selected prosthesis so as to move the prosthesis with the pusher to interlock the selected prosthesis with a second prosthesis.

Methods and apparatus for renal neuromodulation

Methods and apparatus for pulsed electric field 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 ...

GERÄT FÜR DIE RENALE NEUROMODULATION

Methods and apparatus for renal neuromodulation

APPARATUSES FOR MONOPOLAR RENAL NEUROMODULATION

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. 1. An apparatus for performing renal neuromodulation of a patient , the apparatus comprising:an electric field generator;a device configured for percutaneous placement proximate a renal vasculature of the patient, the device comprising a monopolar electrode electrically coupled to the electric field generator; anda ground electrode configured for electrical coupling to an exterior of the patient,wherein the apparatus is configured for delivery of an electric field between the monopolar electrode and the ground electrode to modulate a neural fiber that contributes to renal function while the device is located proximate the renal vasculature.2. The apparatus of wherein the monopolar electrode is configured for placement at a position chosen from the group consisting of within the renal vasculature claim 1 , adjacent to the renal vasculature claim 1 , external to the renal vasculature claim 1 , external to the renal vasculature via a laparoscopic approach claim 1 , external to the renal vasculature via an intra-to-extravascular approach and combinations thereof.3. The apparatus of wherein the device is configured for intravascular placement claim 1 , the device further comprising an expandable element configured for expansion from a collapsed delivery configuration to an expanded deployed configuration within the renal vasculature of the patient.4. The apparatus of wherein the expandable element is ...

Methods for inhibiting renal nerve activity

Methods and apparatus are provided for thermally-induced renal neuromodulation. Thermally-induced renal neuromodulation may be achieved via direct and/or via indirect application of thermal energy to heat or cool neural fibers that contribute to renal function, or of vascular structures that feed or perfuse the neural fibers. In some embodiments, parameters of the neural fibers, of non-target tissue, or of the thermal energy delivery element, may be monitored via one or more sensors for controlling the thermally-induced neuromodulation. In some embodiments, protective elements may be provided to reduce a degree of thermal damage induced in the non-target tissues.

METHODS FOR THERMAL MODULATION OF NERVES CONTRIBUTING TO RENAL FUNCTION

Methods and apparatus are provided for treatment of heart arrhythmia via renal neuromodulation. Such neuromodulation may effectuate irreversible electroporation or electrofusion, ablation, 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, such neuromodulation is achieved through application of an electric field. In some embodiments, such neuromodulation is achieved through application of neuromodulatory agents, of thermal energy and/or of high intensity focused ultrasound. In some embodiments, such neuromodulation is performed in a bilateral fashion.

ULTRASOUND APPARATUSES FOR THERMALLY-INDUCED RENAL NEUROMODULATION

Methods and apparatus are provided for thermally-induced renal neuromodulation. Thermally-induced renal neuromodulation may be achieved via direct and/or via indirect application of thermal energy to heat or cool neural fibers that contribute to renal function, or of vascular structures that feed or perfuse the neural fibers. In some embodiments, parameters of the neural fibers, of non-target tissue, or of the thermal energy delivery element, may be monitored via one or more sensors for controlling the thermally-induced neuromodulation. In some embodiments, protective elements may be provided to reduce a degree of thermal damage induced in the non-target tissues.

Apparatuses for thermally-induced renal neuromodulation

Methods and apparatus are provided for thermally-induced renal neuromodulation. Thermally-induced renal neuromodulation may be achieved via direct and/or via indirect application of thermal energy to heat or cool neural fibers that contribute to renal function, or of vascular structures that feed or perfuse the neural fibers. In some embodiments, parameters of the neural fibers, of non-target tissue, or of the thermal energy delivery element, may be monitored via one or more sensors for controlling the thermally-induced neuromodulation. In some embodiments, protective elements may be provided to reduce a degree of thermal damage induced in the non-target tissues.

Apparatus and methods for clot dissolution

Clot disruption and dissolution are achieved using a catheter having the ability to infuse a thrombolytic agent, aspirate clot and fluid, and allow passage of a guidewire. Optionally, the catheter may also include a mechanical agitator for further disrupt clot in the presence of the thrombolytic agent. A flow resistor in the catheter provides for infusion and/or aspiration to be concentrated primarily at a clot treatment area in a blood vessel while also providing optional infusion and/or aspiration distal to the treatment area. In some embodiments, infusion, aspiration and guidewire passage occur through a common lumen. The thrombolytic agent, such as tPA, streptokinase, or urokinase, is directly released into the clot at the point where the agitator is engaging the clot. In this way, the thrombolytic activity of the agent is enhanced and the dissolution of the clot is improved.

METHODS FOR RENAL NEUROMODULATION

Methods and apparatus are provided for treating hypertension, e.g., via a pulsed electric field, via a stimulation electric field, via localized drug delivery, via high frequency ultrasound, via thermal techniques, etc. Such 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, neuromodulation is applied to neural fibers that contribute to renal function. In some embodiments, such neuromodulation is performed in a bilateral fashion. Bilateral renal neuromodulation may provide enhanced therapeutic effect in some patients as compared to renal neuromodulation performed unilaterally, i.e., as compared to renal neuromodulation performed on neural tissue innervating a single kidney. 1. A method for treating hypertension , the method comprising:modulating a function of a neural fiber that contributes to renal function of a kidney of a patient,wherein modulating the function of the neural fiber further comprises modulating the function without completely physically severing the neural fiber.2. The method of claim 1 , wherein modulating the function of the neural fiber further comprises modulating the function of the neural fiber via an electric field.3. The method of claim 2 , wherein modulating the function of the neural fiber via an electric field further comprises exposing the neural fiber to a pulsed electric field.4. The method of claim 2 , wherein modulating the function of the neural fiber via an electric field further comprises exposing the neural fiber to a stimulation electric field.5. The method of claim 1 , wherein modulating the function of the neural fiber further comprises delivering a neuromodulatory agent to the neural fiber.6. The method of claim 1 , wherein modulating the function of the neural fiber further comprises at ...

APPARATUS AND METHODS FOR CLOT DISSOLUTION

Clot disruption and dissolution are achieved using a catheter having the ability to infuse a thrombolytic agent, aspirate clot and fluid, and allow passage of a guidewire. Optionally, the catheter may also include a mechanical agitator for further disrupt clot in the presence of the thrombolytic agent. A flow resistor in the catheter provides for infusion and/or aspiration to be concentrated primarily at a clot treatment area in a blood vessel while also providing optional infusion and/or aspiration distal to the treatment area. In some embodiments, infusion, aspiration and guidewire passage occur through a common lumen. The thrombolytic agent, such as tPA, streptokinase, or urokinase, is directly released into the clot at the point where the agitator is engaging the clot. In this way, the thrombolytic activity of the agent is enhanced and the dissolution of the clot is improved.

Methods and apparatus for thermally-induced renal neuromodulation

Methods and apparatus are provided for thermally-induced renal neuromodulation. Thermally-induced renal neuromodulation may be achieved via direct and/or via indirect application of thermal energy to heat or cool neural fibers that contribute to renal function, or of vascular structures that feed or perfuse the neural fibers. In some embodiments, parameters of the neural fibers, of non-target tissue, or of the thermal energy delivery element, may be monitored via one or more sensors for controlling the thermally-induced neuromodulation. In some embodiments, protective elements may be provided to reduce a degree of thermal damage induced in the non-target tissues. In some embodiments, thermally-induced renal neuromodulation is achieved via delivery of a pulsed thermal therapy.

METHODS AND APPARATUS FOR INTRAVASCULARLY-INDUCED NEUROMODULATION

Methods and apparatus are provided for intravascularly-induced neuromodulation using a pulsed electric field, e.g., to effectuate irreversible electroporation or electrofusion, necrosis and/or inducement of apoptosis, alteration of gene expression, changes in cytokine upregulation, etc., in target neural fibers. In some embodiments, the intravascular PEF system comprises a catheter having a pair of bipolar electrodes for delivering the PEF, with a first electrode positioned on a first side of an impedance-altering element and a second electrode positioned on an opposing side of the impedance-altering element. A length of the electrodes, as well as a separation distance between the first and second electrodes, may be specified such that, with the impedance-altering element deployed in a manner that locally increases impedance within a patient's vessel, e.g., with the impedance-altering element deployed into contact with the vessel wall at a treatment site within the patient's vasculature, a magnitude of applied voltage delivered across the bipolar electrodes necessary to achieve desired neuromodulation is reduced relative to an intravascular PEF system having similarly spaced electrodes but no (or an undeployed) impedance-altering element. In a preferred embodiment, the impedance-altering element comprises an inflatable balloon configured to locally increase impedance within a patient's vasculature. The methods and apparatus of the present invention may be used to modulate a neural fiber that contributes to renal function. 1. Apparatus for intravascularly-induced neuromodulation , the apparatus comprising:a pulsed electric field generator; andan intravascular catheter comprising an impedance-altering element and a pair of bipolar electrodes positioned on either side of the impedance-altering element, the electrodes being electrically coupled to the pulsed electric field generator, wherein (a) the apparatus is configured for intravascular delivery of a pulsed electric ...

Systems and methods for clot disruption and retrieval

Thrombectomy and other treatments are achieved using a catheter having a positioning cage and a macerator within the positioning cage. The catheter is introduced to a target body lumen, typically a blood vessel, and a positioning cage deployed at a treatment site. The macerator is then operated to disrupt thrombus, clot, or other occlusive materials at the treatment site, and the catheter is used to collect and remove the disruptive materials from the body lumen. In particular examples, the macerator may be radially expansible and optionally rotated and/or axially translated within the positioning cage to effect disruption of the occlusive material.

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.

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 extravascular delivery of pulsed electric fields to achieve neuromodulation.

Devices and methods for controlling expandable prostheses during deployment

A catheter for delivering a prosthesis to a treatment site in a body lumen comprises an elongate flexible member and a sheath slidably disposed thereover. A plurality of self-expanding tubular prostheses are carried in axially spaced apart locations along the elongate member, within the sheath. The prostheses may be selectively interlocked with one another and are constrained by the sheath in a radially contracted configuration. The prostheses are separately releasable from the sheath when the sheath is retracted relative to the elongate member. The catheter also has a pusher member slidably disposed along the elongate member within the sheath. The pusher is adapted to move past the prostheses in a first direction without displacing the prostheses, while in a second direction the pusher engages a selected prosthesis so as to move the prosthesis with the pusher to interlock the selected prosthesis with a second prosthesis.

Methods and systems for thermally-induced renal neuromodulation

Methods and system are provided for thermally-induced renal neuromodulation. Thermally-induced renal neuromodulation may be achieved via direct and/or via indirect application of thermal energy to heat or cool neural fibers that contribute to renal function, or of vascular structures that feed or perfuse the neural fibers. In some embodiments, parameters of the neural fibers, of non-target tissue, or of the thermal energy delivery element, may be monitored via one or more sensors for controlling the thermally-induced neuromodulation. In some embodiments, protective elements may be provided to reduce a degree of thermal damage induced in the non-target tissues. In some embodiments, thermally-induced renal neuromodulation is achieved via delivery of a pulsed thermal therapy.

Apparatus and methods for clot dissolution

Clot disruption and dissolution are achieved using a catheter having the ability to infuse a thrombolytic agent, agitate the clot and agent, and aspirate broken-up clot from the blood vessel. A flow resistor in the catheter provides for infusion and/or aspiration to be concentrated primarily at a clot treatment area in a blood vessel while also providing optional infusion and/or aspiration distal to the treatment area. In some embodiments, infusion, aspiration and guidewire passage occur through a common lumen. The thrombolytic agent, such as tPA, streptokinase, or urokinase, is directly released into the clot at the point where the agitator is engaging the clot. In this way, the thrombolytic activity of the agent is enhanced and the dissolution of the clot is improved.

Methods and apparatus for intravasculary-induced neuromodulation

Methods and apparatus are provided for intravascularly-induced neuromodulation or denervation. Neuromodulation may be achieved via direct and/or via indirect application of energy or neuromodulatory agents to target neural matter, or to vascular structures that support the target neural matter. In some embodiments, parameters of the target neural matter, of non-target tissue, or of the apparatus may be monitored via one or more sensors for controlling the neuromodulation or denervation. Such monitoring data optionally may be utilized for feedback control of the neuromodulation or denervation.

DEVICES AND METHODS FOR CONTROLLING EXPANDABLE PROSTHESES DURING DEPLOYMENT

A catheter for delivering a prosthesis to a treatment site in a body lumen comprises an elongate flexible member and a sheath slidably disposed thereover. A plurality of sell-expanding tubular prostheses are carried in axially spaced apart locations along the elongate member, within the sheath. The prostheses may be selectively interlocked with one another and are constrained by the sheath in a radially contracted configuration. The prostheses are separately releasable from the sheath when the sheath is retracted relative to the elongate member. The catheter also has a pusher member slidably disposed along the elongate member within the sheath. The pusher is adapted to move past the prostheses in a first direction without displacing the prostheses, while in a second direction the pusher engages a selected prosthesis so as to move the prosthesis with the pusher to interlock the selected prosthesis with a second prosthesis. 1. A catheter for delivering a prosthesis to a treatment site in a body lumen , the catheter comprising:an elongate flexible member having a proximal end and a distal end;a sheath slidably disposed over the elongate flexible member;a plurality of self-expanding tubular prostheses carried in axially spaced-apart locations along the elongate flexible member and within the sheath, the plurality of self-expanding tubular prostheses adapted to be selectively interlocked with one another and constrained by the sheath in a radially contracted configuration, the prostheses being separately releasable from the sheath as the sheath is retracted relative to the elongate flexible member; anda pusher member slidably disposed along the elongate flexible member within the sheath, the pusher member adapted to move past the prostheses in a first direction, while in a second direction the pusher member engages a selected prosthesis so as to move the prosthesis with the pusher member to interlock the selected prosthesis with a second prosthesis.2. The catheter of ...

Methods and apparatus for performing a non-continuous circumferential treatment of a body lumen

Methods and apparatus are provided for non-continuous circumferential treatment of a body lumen. Apparatus may be positioned within a body lumen of a patient and may deliver energy at a first lengthwise and angular position to create a less-than-full circumferential treatment zone at the first position. The apparatus also may deliver energy at one or more additional lengthwise and angular positions within the body lumen to create less-than-full circumferential treatment zone(s) at the one or more additional positions that are offset lengthwise and angularly from the first treatment zone. Superimposition of the first treatment zone and the one or more additional treatment zones defines a non-continuous circumferential treatment zone without formation of a continuous circumferential lesion. Various embodiments of methods and apparatus for achieving such non-continuous circumferential treatment are provided.

APPARATUSES 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.

Methods and apparatus for thermally-induced renal neuromodulation

Methods and apparatus are provided for thermally-induced renal neuromodulation. Thermally-induced renal neuromodulation may be achieved via direct and/or via indirect application of thermal energy to heat or cool neural fibers that contribute to renal function, or of vascular structures that feed or perfuse the neural fibers. In some embodiments, parameters of the neural fibers, of non-target tissue, or of the thermal energy delivery element, may be monitored via one or more sensors for controlling the thermally-induced neuromodulation. In some embodiments, protective elements may be provided to reduce a degree of thermal damage induced in the non-target tissues.

APPARATUS FOR RENAL NEUROMODULATION

PROBLEM TO BE SOLVED: To provide methods and apparatus for renal neuromodulation using a pulsed electric field to effectuate electroporation or electrofusion. SOLUTION: 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. COPYRIGHT: (C)2012,JPO&INPIT ...

Systeme für wärmeinduzierte renale Neuromodulation

Devices and methods for controlling expandable prosthesis during develoyment

Prosthesis delivery devices and methods are provided that enable precise control of prosthesis position during deployment. The prosthesis delivery devices may carry multiple prostheses and include deployment mechanisms for delivery of a selectable number of prostheses. Control mechanisms are provided in the prosthesis delivery devices that control either or both of the axial and rotational positions of the prostheses during deployment. This enables the deployment of multiple prostheses at a target site with precision and predictability, eliminating excessive spacing or overlap between prostheses. In particular embodiments, the prostheses of the invention are deployed in stenotic lesions in coronary or peripheral arteries, or in other vascular locations.

METHODS AND APPARATUS FOR MULTI-VESSEL RENAL NEUROMODULATION

Methods and apparatus are provided for multi-vessel neuromodulation, e.g., via a pulsed electric field. Such multi-vessel 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, the multi-vessel neuromodulation is applied to neural fibers that contribute to renal function. Such multi-vessel neuromodulation optionally may be performed bilaterally.

METHODS AND APPARATUS FOR PULSED ELECTRIC FIELD 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 ...

Methods and apparatus for inducing, monitoring and controlling renal neuromodulation

Methods and apparatus are provided for inducing, monitoring and controlling renal neuromodulation using a pulsed electric field to effectuate electroporation or electrofusion. In some embodiments, tissue impedance, conductance or conductivity may be monitored to determine the effects of pulsed electric field therapy, e.g., to determine an extent of electroporation and its degree of irreversibility. Pulsed electric field electroporation of tissue causes a decrease in tissue impedance and an increase in tissue conductivity. If induced electroporation is reversible, upon cessation of the pulsed electric field, tissue impedance and conductivity should approximate baseline levels; however, if electroporation is irreversible, impedance and conductivity changes should persist. Thus, monitoring of impedance or conductivity may be utilized to determine the onset of electroporation and to determine the type or extent of electroporation. Furthermore, monitoring data may be used in one or more manual ...

Systems and methods for selective denervation of heart dysrhythmias

Methods and apparatus are provided for selective denervation of conduction pathways in the heart for the treatment of dysrhythmias, including one or more ablation or electroporation catheters having electrodes for stimulating, targeting, and ablating fat pad tissue and other cardiac tissue to selectively denervate heart tissue.

Apparatus for performing a non-continuous circumferential treatment of a body lumen

Methods and apparatus are provided for non-continuous circumferential treatment of a body lumen. Apparatus may be positioned within a body lumen of a patient and may deliver energy at a first lengthwise and angular position to create a less-than-full circumferential treatment zone at the first position. The apparatus also may deliver energy at one or more additional lengthwise and angular positions within the body lumen to create less-than-full circumferential treatment zone(s) at the one or more additional positions that are offset lengthwise and angularly from the first treatment zone. Superimposition of the first treatment zone and the one or more additional treatment zones defines a non-continuous circumferential treatment zone without formation of a continuous circumferential lesion. Various embodiments of methods and apparatus for achieving such non-continuous circumferential treatment are provided.

APPARATUSES FOR THERMALLY-INDUCED RENAL NEUROMODULATION

Methods and apparatus are provided for thermally-induced renal neuromodulation. Thermally-induced renal neuromodulation may be achieved via direct and/or via indirect application of thermal energy to heat or cool neural fibers that contribute to renal function, or of vascular structures that feed or perfuse the neural fibers. In some embodiments, parameters of the neural fibers, of non-target tissue, or of the thermal energy delivery element, may be monitored via one or more sensors for controlling the thermally-induced neuromodulation. In some embodiments, protective elements may be provided to reduce a degree of thermal damage induced in the non-target tissues.

Apparatus for performing a non-continuous circumferential treatment to a body lumen

Methods and apparatus are provided for non-continuous circumferential treatment of a body lumen. Apparatus may be positioned within a body lumen of a patient and may deliver energy at a first lengthwise and angular position to create a less-than-full circumferential treatment zone at the first position. The apparatus also may deliver energy at one or more additional lengthwise and angular positions within the body lumen to create less-than-full circumferential treatment zone(s) at the one or more additional positions that are offset lengthwise and angularly from the first treatment zone. Superimposition of the first treatment zone and the one or more additional treatment zones defines a non-continuous circumferential treatment zone without formation of a continuous circumferential lesion. Various embodiments of methods and apparatus for achieving such non-continuous circumferential treatment are provided.

Methods for treating heart arrhythmia

Methods and apparatus are provided for treatment of heart arrhythmia via renal neuromodulation. Such neuromodulation may effectuate irreversible electroporation or electrofusion, ablation, 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, such neuromodulation is achieved through application of an electric field. In some embodiments, such neuromodulation is achieved through application of neuromodulatory agents, of thermal energy and/or of high intensity focused ultrasound. In some embodiments, such neuromodulation is performed in a bilateral fashion.

Systems and methods for clot disruption and retrieval

Thrombectomy and other treatments are achieved using a catheter having a positioning cage and a macerator within the positioning cage. The catheter is introduced to a target body lumen, typically a blood vessel, and a positioning cage deployed at a treatment site. The macerator is then operated to disrupt thrombus, clot, or other occlusive materials at the treatment site, and the catheter is used to collect and remove the disruptive materials from the body lumen. In particular examples, the macerator may be radially expansible and optionally rotated and/or axially translated within the positioning cage to effect disruption of the occlusive material.

APPARATUS FOR RENAL NEUROMODULATION

PROBLEM TO BE SOLVED: To provide an apparatus for treating congestive heart failure, renal failure, hypertension, and/or other heart or kidney diseases with renal neuromodulation and/or renal denervation. SOLUTION: An apparatus for renal neuromodulation includes: a catheter 210 configured for intravascular placement within a renal artery or renal vein in a subject, and provided with an extendable distal basket formed from a plurality of struts or members; and a plurality of electrodes 212 disposed along the struts or members of the basket, and adapted to be positioned into contact with the wall of the renal artery or renal vein. The electrodes are configured to deliver an electric field across the wall of the renal vessel to target renal nerves to achieve renal denervation. COPYRIGHT: (C)2012,JPO&INPIT ...

APPARATUS AND METHODS FOR CLOT DISSOLUTION

Clot disruption and dissolution are achieved using a catheter having the ability to infuse a thrombolytic agent, aspirate clot and fluid, and allow passage of a guidewire. Optionally, the catheter may also include a mechanical agitator for further disrupt clot in the presence of the thrombolytic agent. A flow resistor in the catheter provides for infusion and/or aspiration to be concentrated primarily at a clot treatment area in a blood vessel while also providing optional infusion and/or aspiration distal to the treatment area. In some embodiments, infusion, aspiration and guidewire passage occur through a common lumen. The thrombolytic agent, such as tPA, streptokinase, or urokinase, is directly released into the clot at the point where the agitator is engaging the clot. In this way, the thrombolytic activity of the agent is enhanced and the dissolution of the clot is improved.

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.

Devices and methods for controlling expandable prostheses during deployment

Prosthesis delivery devices and methods are provided that enable precise control of prosthesis position during deployment. The prosthesis delivery devices may carry multiple prostheses and include deployment mechanisms for delivery of a selectable number of prostheses. Control mechanisms are provided in the prosthesis delivery devices that control either or both of the axial and rotational positions of the prostheses during deployment. This enables the deployment of multiple prostheses at a target site with precision and predictability, eliminating excessive spacing or overlap between prostheses. In particular embodiments, the prostheses of the invention are deployed in stenotic lesions in coronary or peripheral arteries, or in other vascular locations.

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 extravascular delivery of pulsed electric fields to achieve such neuromodulation.

APPARATUSES FOR BILATERAL RENAL NEUROMODULATION

Methods and apparatus are provided for bilateral renal neuromodulation, e.g., via a pulsed electric field, via a stimulation electric field, via localized drug delivery, via high frequency ultrasound, via thermal techniques, etc. Such 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, neuromodulation is applied to neural fibers that contribute to renal function. In some embodiments, such neuromodulation is performed in a bilateral fashion. Bilateral renal neuromodulation may provide enhanced therapeutic effect in some patients as compared to renal neuromodulation performed unilaterally, i.e., as compared to renal neuromodulation performed on neural tissue innervating a single kidney. 117-. (canceled)18. An apparatus for bilateral renal neuromodulation via an intravascular approach , the apparatus comprising:a first field applicator configured to be positioned proximate to at least a first neural fiber that contributes to right renal function of a human patient;a second field applicator configured to be positioned proximate to at least a second neural fiber that contributes to left renal function while the first field applicator is positioned proximate to the first neural fiber; anda field generator external to the patient and coupled to the first and second field applicators,wherein the field generator is configured to provide a first signal to the first field applicator and a second signal to the second field applicator.19. The apparatus of claim 18 , wherein the first field applicator and the second field applicator comprise intravascular field applicators configured for placement within renal vasculature of the patient.20. (canceled)21. The apparatus of claim 18 , wherein the first field applicator and the second field ...

Ultrasound apparatuses for thermally-induced renal neuromodulation

Methods and apparatus are provided for thermally-induced renal neuromodulation. Thermally-induced renal neuromodulation may be achieved via direct and/or via indirect application of thermal energy to heat or cool neural fibers that contribute to renal function, or of vascular structures that feed or perfuse the neural fibers. In some embodiments, parameters of the neural fibers, of non-target tissue, or of the thermal energy delivery element, may be monitored via one or more sensors for controlling the thermally-induced neuromodulation. In some embodiments, protective elements may be provided to reduce a degree of thermal damage induced in the non-target tissues.

ULTRASOUND APPARATUSES FOR THERMALLY-INDUCED RENAL NEUROMODULATION AND ASSOCIATED SYSTEMS AND METHODS

Methods and apparatus are provided for thermally-induced renal neuromodulation. Thermally-induced renal neuromodulation may be achieved via direct and/or via indirect application of thermal energy to heat or cool neural fibers that contribute to renal function, or of vascular structures that feed or perfuse the neural fibers. In some embodiments, parameters of the neural fibers, of non-target tissue, or of the thermal energy delivery element, may be monitored via one or more sensors for controlling the thermally-induced neuromodulation. In some embodiments, protective elements may be provided to reduce a degree of thermal damage induced in the non-target tissues. 1. An ultrasound apparatus for thermally-induced renal neuromodulation , the apparatus comprising:a catheter configured for intravascular placement within a renal blood vessel of a human patient; andone or more ultrasound transducers positioned along the catheter, wherein the one or more ultrasound transducers are configured to transmit ultrasound waves to renal neural fibers outside of the vessel to achieve thermal renal neuromodulation via heating.2. The apparatus of claim 1 , further comprising an inflatable balloon proximate to the one or more ultrasound transducers claim 1 , wherein the apparatus is configured to vary between a reduced delivery and retrieval configuration and an expanded deployed configuration.3. The apparatus of wherein the one or more ultrasound transducers are positioned within the inflatable balloon.4. The apparatus of wherein the one or more ultrasound transducers are attached directly to the inflatable balloon.5. The apparatus of wherein the inflatable balloon comprises an acoustically transmissive portion through which the ultrasound waves passes.6. The apparatus of wherein the inflatable balloon comprises an acoustically reflective portion for reflecting the ultrasound waves.7. The apparatus of wherein calibrated expansion of the inflatable balloon dynamically varies a focal ...

Methods and apparatus for thermally-induced renal neuromodulation

Methods and apparatus are provided for thermally-induced renal neuromodulation. Thermally-induced renal neuromodulation may be achieved via direct and/or via indirect application of thermal energy to heat or cool neural fibers that contribute to renal function, or of vascular structures that feed or perfuse the neural fibers. In some embodiments, parameters of the neural fibers, of non-target tissue, or of the thermal energy delivery element, may be monitored via one or more sensors for controlling the thermally-induced neuromodulation. In some embodiments, protective elements may be provided to reduce a degree of thermal damage induced in the non-target tissues. In some embodiments, thermally-induced renal neuromodulation is achieved via delivery of a pulsed thermal therapy.

Methods and apparatus for pulsed electric field 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 ...

METHODS AND APPARATUS FOR PERFORMING A NON-CONTINUOUS CIRCUMFERENTIAL TREATMENT OF A BODY LUMEN

Methods and apparatus are provided for non-continuous circumferential treatment of a body lumen. Apparatus may be positioned within a body lumen of a patient and may deliver energy at a first lengthwise and angular position to create a less-than-full circumferential treatment zone at the first position. The apparatus also may deliver energy at one or more additional lengthwise and angular positions within the body lumen to create less-than-full circumferential treatment zone(s) at the one or more additional positions that are offset lengthwise and angularly from the first treatment zone. Superimposition of the first treatment zone and the one or more additional treatment zones defines a non-continuous circumferential treatment zone without formation of a continuous circumferential lesion. Various embodiments of methods and apparatus for achieving such non-continuous circumferential treatment are provided.

APPARATUS FOR THERMAL MODULATION OF NERVES CONTRIBUTING TO RENAL FUNCTION

Methods and apparatus are provided for treatment of heart arrhythmia via renal neuromodulation. Such neuromodulation may effectuate irreversible electroporation or electrofusion, ablation, 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, such neuromodulation is achieved through application of an electric field. In some embodiments, such neuromodulation is achieved through application of neuromodulatory agents, of thermal energy and/or of high intensity focused ultrasound. In some embodiments, such neuromodulation is performed in a bilateral fashion.

Methods and apparatus for performing a non-continuous circumferential treatment of a body lumen

Methods and apparatus are provided for non-continuous circumferential treatment of a body lumen. Apparatus may be positioned within a body lumen of a patient and may deliver energy at a first lengthwise and angular position to create a less-than-full circumferential treatment zone at the first position. The apparatus also may deliver energy at one or more additional lengthwise and angular positions within the body lumen to create less-than-full circumferential treatment zone(s) at the one or more additional positions that are offset lengthwise and angularly from the first treatment zone. Superimposition of the first treatment zone and the one or more additional treatment zones defines a non-continuous circumferential treatment zone without formation of a continuous circumferential lesion. Various embodiments of methods and apparatus for achieving such non-continuous circumferential treatment are provided.

METHODS AND APPARATUS FOR THERMALLY-INDUCED RENAL NEUROMODULATION

Methods and apparatus are provided for thermally-induced renal neuromodulation. Thermally-induced renal neuromodulation may be achieved via direct and/or via indirect application of thermal energy to heat or cool neural fibers that contribute to renal function, or of vascular structures that feed or perfuse the neural fibers, In some embodiments, parameters of the neural fibers, of non-target tissue, or of the thermal energy delivery element, may be monitored via one or more sensors for controlling the thermally-induced neuromodulation. In some embodiments, protective elements may be provided to reduce a degree of thermal damage induced in the non-target tissues.

Methods for catheter-based renal denervation

Methods and apparatus are provided for treating end-stage renal disease, e.g., via a pulsed electric field, via a stimulation electric field, via localized drug delivery, via high frequency ultrasound, via thermal techniques, etc. Such 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, neuromodulation is applied to neural fibers that contribute to renal function. In some embodiments, such neuromodulation is performed in a bilateral fashion. Bilateral renal neuromodulation may provide enhanced therapeutic effect in some patients as compared to renal neuromodulation performed unilaterally, i.e., as compared to renal neuromodulation performed on neural tissue innervating a single kidney.

METHODS FOR INHIBITING RENAL NERVE ACTIVITY VIA AN INTRA-TO-EXTRAVASCULAR APPROACH

Methods and apparatus are provided for thermally-induced renal neuromodulation. Thermally-induced renal neuromodulation may be achieved via direct and/or via indirect application of thermal energy to heat or cool neural fibers that contribute to renal function, or of vascular structures that feed or perfuse the neural fibers. In some embodiments, parameters of the neural fibers, of non-target tissue, or of the thermal energy delivery element, may be monitored via one or more sensors for controlling the thermally-induced neuromodulation. In some embodiments, protective elements may be provided to reduce a degree of thermal damage induced in the non-target tissues. 130-. (canceled)31. A method for renal denervation via an intra-to-extravascular approach , the method comprising:positioning an intravascular catheter within a renal blood vessel proximate to renal nerves, wherein the catheter comprises an infusion needle extending from a distal section of the catheter;passing a portion of the infusion needle through at least a portion of a wall of the renal blood vessel to position the infusion needle at an extravascular location adjacent to the renal nerves via an intra-to-extravascular approach; anddelivering a fluid via the infusion needle to at least partially inhibit neural signaling along the renal nerves.32. The method of wherein delivering a fluid via the infusion needle comprises delivering a neuromodulatory agent to the renal nerves.33. The method of wherein delivering a neuromodulatory agent to the renal nerves comprises delivering phenol.34. The method of wherein delivering a neuromodulatory agent to the renal nerves comprises delivering a neurotoxin.35. The method of wherein delivering a neuromodulatory agent to the renal nerves comprises delivering botulinum toxin.36. The method of wherein delivering a fluid via the infusion needle comprises delivering a thermal fluid to the renal nerves.37. The method of wherein delivering a thermal fluid to the renal ...

APPARATUS FOR PERFORMING A NON-CONTINUOUS CIRCUMFERENTIAL TREATMENT OF A BODY LUMEN

Methods and apparatus are provided for non-continuous circumferential treatment of a body lumen. Apparatus may be positioned within a body lumen of a patient and may deliver energy at a first lengthwise and angular position to create a less-than-full circumferential treatment zone at the first position. The apparatus also may deliver energy at one or more additional lengthwise and angular positions within the body lumen to create less-than-full circumferential treatment zone(s) at the one or more additional positions that are offset lengthwise and angularly from the first treatment zone. Superimposition of the first treatment zone and the one or more additional treatment zones defines a non-continuous circumferential treatment zone without formation of a continuous circumferential lesion. Various embodiments of methods and apparatus for achieving such non-continuous circumferential treatment are provided.

Methods and apparatus for bilateral renal neuromodulation

Methods and apparatus are provided for bilateral renal neuromodulation, e.g., via a pulsed electric field, via a stimulation electric field, via localized drug delivery, via high frequency ultrasound, via thermal techniques, etc. Such 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, neuromodulation is applied to neural fibers that contribute to renal function. In some embodiments, such neuromodulation is performed in a bilateral fashion. Bilateral renal neuromodulation may provide enhanced therapeutic effect in some patients as compared to renal neuromodulation performed unilaterally, i.e., as compared to renal neuromodulation performed on neural tissue innervating a single kidney.

Ultrasound apparatuses for thermally-induced renal neuromodulation and associated systems and methods

Methods and apparatus are provided for thermally-induced renal neuromodulation. Thermally-induced renal neuromodulation may be achieved via direct and/or via indirect application of thermal energy to heat or cool neural fibers that contribute to renal function, or of vascular structures that feed or perfuse the neural fibers. In some embodiments, parameters of the neural fibers, of non-target tissue, or of the thermal energy delivery element, may be monitored via one or more sensors for controlling the thermally-induced neuromodulation. In some embodiments, protective elements may be provided to reduce a degree of thermal damage induced in the non-target tissues.

Methods for monitoring 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.

Methods for multi-vessel renal neuromodulation

Methods and apparatus are provided for multi-vessel neuromodulation, e.g., via a pulsed electric field. Such multi-vessel 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, the multi-vessel neuromodulation is applied to neural fibers that contribute to renal function. Such multi-vessel neuromodulation optionally may be performed bilaterally.

Methods and apparatus for performing a non-continuous circumferential treatment of a body lumen

Methods and apparatus are provided for non-continuous circumferential treatment of a body lumen. Apparatus may be positioned within a body lumen of a patient and may deliver energy at a first lengthwise and angular position to create a less-than-full circumferential treatment zone at the first position. The apparatus also may deliver energy at one or more additional lengthwise and angular positions within the body lumen to create less-than-full circumferential treatment zone(s) at the one or more additional positions that are offset lengthwise and angularly from the first treatment zone. Superimposition of the first treatment zone and the one or more additional treatment zones defines a non-continuous circumferential treatment zone without formation of a continuous circumferential lesion. Various embodiments of methods and apparatus for achieving such non-continuous circumferential treatment are provided.

APPARATUSES FOR RENAL NEUROMODULATION AND ASSOCIATED SYSTEMS AND METHODS

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. An apparatus for renal neuromodulation , the apparatus comprising:a catheter having a distal portion configured for percutaneous placement within a renal blood vessel of a human patient;an expandable balloon at the distal portion of the catheter, wherein the expandable balloon is selectively transformable between a low-profile, delivery configuration and a deployed configuration sized to fit within the renal blood vessel, and wherein the expandable balloon comprises a weeping balloon for infusion of a selected agent therefrom; anda helical conductor arranged about the expandable balloon such that, when the balloon is in the deployed configuration, the helical conductor is configured to deliver energy through an inner wall of the renal blood vessel to neural fibers that innervate a kidney of the patient to reduce renal sympathetic nerve activity.2. The apparatus of wherein claim 1 , in the deployed configuration claim 1 , the balloon is sized to occlude the renal blood vessel.3. The apparatus of wherein the energy from the helical conductor is sufficient to cause at least partial renal denervation.4. The apparatus of wherein the energy from the helical conductor is sufficient to cause at least partial ablation of at least one neural fiber.5. The apparatus of wherein the helical conductor is configured to physically contact the inner wall of the renal blood vessel.6. The ...

METHODS FOR MONITORING 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.

DEVICES AND METHODS FOR CONTROLLING EXPANDABLE PROSTHESES DURING DEPLOYMENT

Prosthesis delivery devices and methods are provided that enable precise control of prosthesis position during deployment. The prosthesis delivery devices may carry multiple prostheses and include deployment mechanisms for delivery of a selectable number of prostheses. Control mechanisms are provided in the prosthesis delivery devices that control either or both of the axial and rotational positions of the prostheses during deployment. This enables the deployment of multiple prostheses at a target site with precision and predictability, eliminating excessive spacing or overlap between prostheses. In particular embodiments, the prostheses of the invention are deployed in stenotic lesions in coronary or peripheral arteries, or in other vascular locations.

Apparatus and methods for capturing particulate material within blood vessels

An apparatus includes a jet housing including an inlet and an outlet, and a nozzle within the jet housing for injecting fluid towards the outlet. A filter element is disposed on the inlet, the filter element including openings for preventing particulate larger than a predetermined size from entering the inlet. The jet housing is positioned within a blood vessel, and fluid is injected from the nozzle towards the outlet to create a vacuum at the inlet, thereby causing fluid downstream of the outlet to flow retrograde through the vessel around the jet housing into the inlet. The filter element prevents particulate from entering the inlet, thereby effectively capturing the particulate, which may be aspirated. Alternatively, a filter element is used to filter particulate during a procedure. The filter element everts from a tubular to an everted configuration for capturing particulate.

Methods and apparatus for pulsed electric field 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 ...

MECHANICAL PUMP FOR REMOVAL OF FRAGMENTED MATTER AND METHODS OF MANUFACTURE AND USE

Material transport catheters and methods for their use rely on rotation of an impeller within a catheter body and a clearing element for preventing buildup of materials at the opening of the catheter body. The impeller preferably comprises an inner tube or shaft having a helical rotor formed over an outer surface thereof. The clearing element may comprise a free end of a structure near the distal end of the catheter body for disrupting clot, wherein the free end of the structure extends into the distal opening of the catheter body to break up materials as the impeller is rotated. Alternatively, the clearing element may comprise a cutting member disposed at the distal opening of the catheter body. 1. (canceled)2. A mechanical pump for use in a medical device comprising:an elongate hollow, flexible inner tube having a proximal end, a distal end, and a central lumen;a first coiled rotor element having a distal end and a proximal end disposed over an outer surface of the inner tube; anda jacket securing the coiled rotor element to the outer surface of the inner tube.3. The mechanical pump of claim 1 , wherein the inner tube has an outer diameter in the range from 0.5 mm to 5 mm claim 1 , and the coiled rotor has a pitch in the range from 1 to 50 turns/cm.4. The mechanical pump of claim 1 , further comprising a second coiled rotor element disposed within the central lumen of the inner tube.5. The mechanical pump of claim 3 , wherein the first and second coiled rotors are counterwound.6. The mechanical pump of claim 3 , wherein the first and second coiled rotors are co-wound.7. The mechanical pump of claim 5 , wherein a distal portion of the coiled rotor is unattached to the inner tube to provide a whip element as the pump is rotated.8. The mechanical pump of claim 1 , wherein the inner tube comprises a braided tube claim 1 , a mesh tube claim 1 , a coil claim 1 , a stacked coil claim 1 , or a coil-reinforced polymer tube.9. The mechanical pump of claim 7 , wherein the ...

APPARATUSES 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 extravascular delivery of pulsed electric fields to achieve such neuromodulation. 1. An apparatus for renal neuromodulation , the apparatus comprising:an electric field generator; andan electrode configured for extravascular placement proximate a renal nerve in a patient,wherein the electrode is electrically coupled to the electric field generator, and wherein the electrode is configured to deliver an electric field to the renal nerve while the electrode is located proximate the renal nerve.2. The apparatus of claim 1 , wherein the electrode is configured for placement adjacent to a renal vasculature.3. The apparatus of claim 2 , wherein the electrode is configured for percutaneous placement adjacent to the renal vasculature.4. The apparatus of claim 2 , wherein the electrode is configured to be arranged in (a) a reduced delivery configuration for placement adjacent to the renal vasculature and (b) an expanded treatment configuration for delivering the electric field to the renal nerve.5. The apparatus of claim 4 , wherein the electrode is configured to at least partially encircle the renal vasculature in the expanded treatment configuration.6. The apparatus of claim 1 , wherein the electrode is configured to at least partially encircle a renal artery of the patient.7. The apparatus of claim 2 , wherein the electrode is configured for placement in an annular space between renal fascia and renal vasculature.8. The apparatus of claim 2 , wherein the apparatus is configured ...

MECHANICAL PUMP FOR REMOVAL OF FRAGMENTED MATTER AND METHODS OF MANUFACTURE AND USE

Material transport catheters and methods for their use rely on rotation of an impeller within a catheter body and a clearing element for preventing buildup of materials at the opening of the catheter body. The impeller preferably comprises an inner tube or shaft having a helical rotor fainted over an outer surface thereof. The clearing element may comprise a free end of a structure near the distal end of the catheter body for disrupting clot, wherein the free end of the structure extends into the distal opening of the catheter body to break up materials as the impeller is rotated. Alternatively, the clearing element may comprise a cutting member disposed at the distal opening of the catheter body. 1. Apparatus for transporting material between a target site in a lumen of a body and a location external to the body , the apparatus comprising:an impeller including an elongate flexible tube defining a lumen, a coiled rotor element disposed over an outer surface of the tube, and a jacket securing the coiled rotor element to the outer surface of the tube;means for introducing the impeller to the target site; andmeans for rotating the coiled rotor element within the body lumen to advance the material proximally away from the target site.2. The apparatus of claim 1 , the impeller further comprising a macerator attached at a distal end of the coiled rotor element claim 1 , wherein rotating the coiled rotor element further comprises rotating the macerator.3. The apparatus of claim 1 , the impeller further comprising a clearing element comprising a cutting disk attached to the coiled rotor element.4. The apparatus of claim 1 , wherein a distal portion of the coiled rotor element is unattached to the tube to provide a whip element as the coiled rotor element is rotated.5. The apparatus of claim 1 , wherein the tube has an outer diameter in the range from 0.5 mm to 5 mm claim 1 , and the coiled rotor element has a pitch in the range from 1 to 50 turns/cm.6. The apparatus of ...

APPARATUSES FOR RENAL NEUROMODULATION AND ASSOCIATED SYSTEMS AND METHODS

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. An apparatus for renal neuromodulation , the apparatus comprising:a catheter configured for intravascular placement within a renal blood vessel of a human patient,wherein the catheter comprises an expandable distal basket formed from a plurality of elongate members and configured to allow blood to flow therethrough; anda plurality of electrodes arranged along the members of the basket and adapted to be positioned into contact with a wall of the renal blood vessel, wherein at least two of the electrodes are at different longitudinal positions along the basket,wherein the electrodes are configured to deliver an electric field across the wall to target renal nerves to achieve renal denervation.2. The apparatus of wherein the expandable basket is fabricated from a plurality of shape-memory wires or ribbons.3. The apparatus of wherein the members of the expandable basket are formed from an electrically conductive material coated with a dielectric material.4. The apparatus of wherein the expandable basket is formed from a slotted and/or laser cut hypotube.5. The apparatus of wherein the basket is collapsible for delivery to the renal blood vessel within a sheath claim 1 , and further wherein the basket is configured to self-expand into contact with the wall of the renal blood vessel upon removal from the sheath.6. The apparatus of wherein the electrodes are configured to be ...

METHODS FOR THERMALLY-INDUCED RENAL NEUROMODULATION

Methods and apparatus are provided for thermally-induced renal neuromodulation. Thermally-induced renal neuromodulation may be achieved via direct and/or via indirect application of thermal energy to heat or cool neural fibers that contribute to renal function, or of vascular structures that feed or perfuse the neural fibers. In some embodiments, parameters of the neural fibers, of non-target tissue, or of the thermal energy delivery element, may be monitored via one or more sensors for controlling the thermally-induced neuromodulation. In some embodiments, protective elements may be provided to reduce a degree of thermal damage induced in the non-target tissues. 1. A method for thermally-induced renal neuromodulation of a human patient , the method comprising:delivering a renal neuromodulation device to a vicinity of a neural fiber that contributes to renal function of the patient; andthermally inducing modulation of a function of the neural fiber with the renal neuromodulation device such that the neural fiber is thermally altered.2. The method of wherein thermally inducing modulation of a function of the neural fiber further comprises directly applying thermal energy to the neural fiber.3. The method of wherein thermally inducing modulation of a function of the neural fiber further comprises indirectly applying thermal energy to the neural fiber.4. The method of wherein thermally inducing modulation of a function of the neural fiber further comprises delivering a thermal electric field to the neural fiber via at least one electrode.5. The method of wherein:delivering a renal neuromodulation device to a vicinity of the neural fiber further comprises intravascularly delivering the renal neuromodulation device; anddelivering a thermal electric field to the neural fiber via at least one electrode further comprises delivering the thermal electric field via at least one wall-contacting electrode.6. The method of claim 1 , further comprising monitoring a parameter of (a ...

METHODS FOR THERMALLY-INDUCED RENAL NEUROMODULATION

Methods and apparatus are provided for thermally-induced renal neuromodulation. Thermally-induced renal neuromodulation may be achieved via direct and/or via indirect application of thermal energy to heat or cool neural fibers that contribute to renal function, or of vascular structures that feed or perfuse the neural fibers. In some embodiments, parameters of the neural fibers, of non-target tissue, or of the thermal energy delivery element, may be monitored via one or more sensors for controlling the thermally-induced neuromodulation. In some embodiments, protective elements may be provided to reduce a degree of thermal damage induced in the non-target tissues. 1. A method of treating a human patient diagnosed with a cardio-renal disease or disorder , the method comprising:intravascularly delivering a device to a vicinity of a neural fiber associated with renal function of the patient; andthermally inhibiting neural communication along the neural fiber with the device.2. The method of wherein thermally inhibiting neural communication along the neural fiber with the device comprises thermally inhibiting afferent neural communication along the neural fiber with the device.3. The method of wherein thermally inhibiting neural communication along the neural fiber with the device comprises thermally inhibiting efferent neural communication along the neural fiber with the device.4. The method of wherein intravascularly delivering a device to a vicinity of a neural fiber associated with renal function comprises intravascularly delivering the device via a renal blood vessel to a position proximate to the neural fiber.5. The method of wherein intravascularly delivering the device via a blood vessel to a position proximate to the neural fiber comprises intravascularly positioning the device in contact with a wall of the blood vessel proximate to the neural fiber.6. The method of wherein thermally inhibiting neural communication along the neural fiber with the device ...

METHODS FOR THERMALLY-INDUCED RENAL NEUROMODULATION

Methods and apparatus are provided for thermally-induced renal neuromodulation. Thermally-induced renal neuromodulation may be achieved via direct and/or via indirect application of thermal energy to heat or cool neural fibers that contribute to renal function, or of vascular structures that feed or perfuse the neural fibers. In some embodiments, parameters of the neural fibers, of non-target tissue, or of the thermal energy delivery element, may be monitored via one or more sensors for controlling the thermally-induced neuromodulation. In some embodiments, protective elements may be provided to reduce a degree of thermal damage induced in the non-target tissues. 1. A method for thermally-induced neuromodulation of a human patient , the method comprising:intravascularly delivering a device to a vicinity of a neural fiber that contributes to renal function of the patient; andthermally inducing modulation of a function of the neural fiber with the device.2. The method of wherein intravascularly delivering a device to a vicinity of a neural fiber that contributes to renal function comprises intravascularly delivering the device via a renal blood vessel to a position proximate the neural fiber.3. The method of wherein intravascularly delivering a device to a vicinity of a neural fiber that contributes to renal function comprises:intravascularly delivering the device in a low profile delivery configuration to a position within a renal blood vessel of the patient and proximate the neural fiber; andtransforming the device from the delivery configuration to a deployed configuration within the renal blood vessel before thermally inducing modulation.4. The method of claim 3 , further comprising:transforming the device from the deployed configuration to the low profile configuration after thermally inducing modulation of a function of the neural fiber; andremoving the device from the patient.5. The method of wherein the device comprises an expandable wire basket carrying ...

Methods and Apparatus for Treating Contrast Nephropathy

Methods and apparatus are provided for treating contrast nephropathy, e.g., via a pulsed electric field, via a stimulation electric field, via localized drug delivery, via high frequency ultrasound, via thermal techniques, etc. Such neuromodulation may effectuate irreversible electroporation of 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, neuromodulation is applied to neural fibers that contribute to renal function. In some embodiments, such neuromodulation is performed in a bilateral fashion. Bilateral renal neuromodulation may provide enhanced therapeutic effect in some patients as compared to renal neuromodulation performed unilaterally, i.e., as compared to renal neuromodulation performed on neural tissue innervating a single kidney. 120-. (canceled)21. A method for catheter-based renal neuromodulation , the method comprising: 'wherein the first therapeutic element comprises a first expandable balloon sized and shaped for the first renal blood vessel, and wherein the first expandable balloon comprises a plurality of first electrodes arranged thereon,', 'positioning a first catheter having a first therapeutic element in a low profile delivery configuration within a first renal blood vessel of a human patient and proximate to neural fibers innervating a first kidney of the patient,'}transforming the first therapeutic element from the delivery configuration to a treatment configuration such that the first electrodes on the first expandable balloon are in contact with an inner wall of the first renal blood vessel;thermally inhibiting neural communication along the neural fibers innervating the first kidney via thermal radio frequency (RF) energy from the first electrodes; 'wherein the second therapeutic element comprises a second expandable balloon sized and shaped for the second ...

Mechanical pump for removal of fragmented matter and methods of manufacture and use

Material transport catheters and methods for their use rely on rotation of an impeller within a catheter body and a clearing element for preventing buildup of materials at the opening of the catheter body. The impeller preferably comprises an inner tube or shaft having a helical rotor formed over an outer surface thereof. The clearing element may comprise a free end of a structure near the distal end of the catheter body for disrupting clot, wherein the free end of the structure extends into the distal opening of the catheter body to break up materials as the impeller is rotated. Alternatively, the clearing element may comprise a cutting member disposed at the distal opening of the catheter body.

Mechanical pump for removal of fragmented matter and methods of manufacture and use

Material transport catheters and methods for their use rely on rotation of an impeller within a catheter body and a clearing element for preventing buildup of materials at the opening of the catheter body. The impeller preferably comprises an inner tube or shaft having a helical rotor fainted over an outer surface thereof. The clearing element may comprise a free end of a structure near the distal end of the catheter body for disrupting clot, wherein the free end of the structure extends into the distal opening of the catheter body to break up materials as the impeller is rotated. Alternatively, the clearing element may comprise a cutting member disposed at the distal opening of the catheter body.

Mechanical pump for removal of fragmented matter and methods of manufacture and use

Material transport catheters and methods for their use rely on rotation of an impeller within a catheter body and a clearing element for preventing buildup of materials at the opening of the catheter body. The impeller preferably comprises an inner tube or shaft having a helical rotor formed over an outer surface thereof. The clearing element may comprise a free end of a structure near the distal end of the catheter body for disrupting clot, wherein the free end of the structure extends into the distal opening of the catheter body to break up materials as the impeller is rotated. Alternatively, the clearing element may comprise a cutting member disposed at the distal opening of the catheter body.

Measurement confirmation devices and methods for fluoroscopically directed surgery

The present invention provides methods and apparatus for measuring and/or marking the internal features of a patient body when those features are viewed under fluoroscopy or another medical imaging modality. Although suitable for the physiological measurement of many body lumens, including the intestines, the urethra, and the like, the present invention will find its most immediate use in the measurement of vascular lesions, particularly vascular aneurysms adjacent the aortoiliac junction and other bifurcations. The positions and bend angles of such branching body lumens can be accurately mapped on a panel which remains outside the patient body. By imaging the patient through the panel, and by providing markings on the panel which give a bright contrast when imaged, the panel provides a guide that highlights the length, position, and geometry of the luminal lesion. The guide may be tailored for the specific bifurcated prosthesis to be deployed, and can also graphically illustrate the safe and effective range of target positions in which to deploy the prosthesis.

Methods and apparatus for intravascularly-induced neuromodulation

Methods and apparatus are provided for intravascularly-induced neuromodulation using a pulsed electric field, e.g., to effectuate irreversible electroporation or electrofusion, necrosis and/or inducement of apoptosis, alteration of gene expression, changes in cytokine upregulation, etc., in target neural fibers. In some embodiments, the intravascular PEF system comprises a catheter having a pair of bipolar electrodes for delivering the PEF, with a first electrode positioned on a first side of an impedance-altering element and a second electrode positioned on an opposing side of the impedance-altering element. A length of the electrodes, as well as a separation distance between the first and second electrodes, may be specified such that, with the impedance-altering element deployed in a manner that locally increases impedance within a patient's vessel, e.g., with the impedance-altering element deployed into contact with the vessel wall at a treatment site within the patient's vasculature, a magnitude of applied voltage delivered across the bipolar electrodes necessary to achieve desired neuromodulation is reduced relative to an intravascular PEF system having similarly spaced electrodes but no (or an undeployed) impedance-altering element. In a preferred embodiment, the impedance-altering element comprises an inflatable balloon configured to locally increase impedance within a patient's vasculature. The methods and apparatus of the present invention may be used to modulate a neural fiber that contributes to renal function.

Methods and apparatus for thermally-induced renal neuromodulation

Methods and apparatus are provided for thermally-induced renal neuromodulation. Thermally-induced renal neuromodulation may be achieved via direct and/or via indirect application of thermal energy to heat or cool neural fibers that contribute to renal function, or of vascular structures that feed or perfuse the neural fibers. In some embodiments, parameters of the neural fibers, of non-target tissue, or of the thermal energy delivery element, may be monitored via one or more sensors for controlling the thermally-induced neuromodulation. In some embodiments, protective elements may be provided to reduce a degree of thermal damage induced in the non-target tissues. In some embodiments, thermally-induced renal neuromodulation is achieved via delivery of a pulsed thermal therapy.

Methods for treating heart arrhythmia

Methods and apparatus are provided for treatment of heart arrhythmia via renal neuromodulation. Such neuromodulation may effectuate irreversible electroporation or electrofusion, ablation, 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, such neuromodulation is achieved through application of an electric field. In some embodiments, such neuromodulation is achieved through application of neuromodulatory agents, of thermal energy and/or of high intensity focused ultrasound. In some embodiments, such neuromodulation is performed in a bilateral fashion.

Methods and apparatus for thermally-induced renal neuromodulation

Methods and apparatus are provided for thermally-induced renal neuromodulation. Thermally-induced renal neuromodulation may be achieved via direct and/or via indirect application of thermal energy to heat or cool neural fibers that contribute to renal function, or of vascular structures that feed or perfuse the neural fibers. In some embodiments, parameters of the neural fibers, of non-target tissue, or of the thermal energy delivery element, may be monitored via one or more sensors for controlling the thermally-induced neuromodulation. In some embodiments, protective elements may be provided to reduce a degree of thermal damage induced in the non-target tissues.

Methods and device for percutaneous remote endarterectomy

The present invention provides devices, systems, methods and kits for the percutaneous removal of unwanted tissue or obstructive matter from body cavities or lumens, particularly from the vasculature. Blood vessels, including the coronary, peripheral and neurovascular circulation, which are narrowed or blocked by atheromatous material or plaque are often treated with traditional endarterectomy procedures. The present invention allows the benefits of such a procedure with an intraluminal approach, particularly a percutaneous approach. Generally, the present invention provides a set of catheters or tools which are percutaneously introduceable to the site of the blockage or occlusion. The tools dissect or cut through the innermost tissue layer of the lumen to an underlying tissue layer. The innermost tissue layer is then stripped away from the underlying layer with the occlusive material thereattached. The detached tissue layer and occlusive material is then removed from the lumen; this may include additional cutting, maceration and removal through mechanical aspiration. In any case, the resulting lumen is free of obstruction.

Methods and apparatus for renal neuromodulation

Methods and apparatus (232) 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 extravascular delivery of pulsed electric fields to achieve neuromodulation.

Methods and apparatus for bilateral renal neuromodulation

Methods and apparatus are provided for bilateral renal neuromodulation, e.g., via a pulsed electric field, via a stimulation electric field, via localized drug delivery, via high frequency ultrasound, via thermal techniques, etc. Such 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, neuromodulation is applied to neural fibers that contribute to renal function. In some embodiments, such neuromodulation is performed in a bilateral fashion. Bilateral renal neuromodulation may provide enhanced therapeutic effect in some patients as compared to renal neuromodulation performed unilaterally, i.e., as compared to renal neuromodulation performed on neural tissue innervating a single kidney.

Methods and device for percutaneous remote endarterectomy

EXTENSIBLE SCHERKATHETER FOR REMOVING THROMBUS AND CLOSING MATERIAL

Methods and apparatus for bilateral renal neuromodulation

Methods and apparatus are provided for bilateral renal neuromodulation, e.g., via a pulsed electric field, via a stimulation electric field, via localized drug delivery, via high frequency ultrasound, via thermal techniques, etc. Such 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, neuromodulation is applied to neural fibers that contribute to renal function. In some embodiments, such neuromodulation is performed in a bilateral fashion. Bilateral renal neuromodulation may provide enhanced therapeutic effect in some patients as compared to renal neuromodulation performed unilaterally, i.e., as compared to renal neuromodulation performed on neural tissue innervating a single kidney.

Apparatus and methods for clot dissolution

Clot disruption and dissolution are achieved using a catheter (300) having the ability to infuse a thrombolytic agent, agitate the clot and agent, and aspirate broken-up clot from the blood vessel. A flow resistor (310) in the catheter provides for infusion and/or aspiration to be concentrated primarily at a clot treatment area in a blood vessel while also providing optional infusion and/or aspiration distal to the treatment area. In some embodiments, infusion, aspiration and guidewire (716) passage occur through a common lumen. The thrombolytic agent, such as tPA, streptokinase, or urokinase, is directly released into the clot at the point where the agitator (30) is engaging the clot. In this way, the thrombolytic activity of the agent is enhanced and the dissolution of the clot is improved.

Expansible shearing catheters for thrombus and occlusive material removal

Devices, methods, kits, and methods remove obstructive material from the vasculature and other body lumens. Expansible baskets may be used as cooperating radially expansible shearing members. Helically oriented struts of each basket may wind in a uniform circumferential direction. The struts can be independently flexible, allowing the shearing members to flex axially together. The inner basket may be rotatably driven and may use an axial pump extending proximally from the shearing members and/or a distal penetrator for advancing into an occlusion which inhibits guidewire access. The struts may slide substantially continuously across each other, and may be sufficiently aggressive for highly effective thrombectomy. A rotationally static and axially flexible outer basket may provide a safe, limited atherectomy treatment.

Systems and methods for clot dissolution

Clot disruption and dissolution are achieved using a catheter (12) having both an agitator (30) and the ability to deliver a thrombolytic agent. The catheter (12) is introduced to a target region with a blood vessel and the agitator (30) manipulated to engage and disrupt a region of clot therein. The thrombolytic agent, such as tPA, streptokinase, or urokinase, is directly released into the clot at the point where the agitator (30) is engaging the clot. In this way, the thrombolytic activity of the agent is enhanced and the dissolution of the clot is improved.

Methods and apparatus for treating end-stage renal disease

Methods and apparatus are provided for treating end-stage renal disease, e.g., via a pulsed electric field, via a stimulation electric field, via localized drug delivery, via high frequency ultrasound, via thermal techniques, etc. Such 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, neuromodulation is applied to neural fibers that contribute to renal function. In some embodiments, such neuromodulation is performed in a bilateral fashion. Bilateral renal neuromodulation may provide enhanced therapeutic effect in some patients as compared to renal neuromodulation performed unilaterally, i.e., as compared to renal neuromodulation performed on neural tissue innervating a single kidney.

Expansible shearing catheters for thrombus and occlusive material removal

Methods for reducing hollow organ volume

Methods for treating heart arrhythmia

Methods and apparatus are provided for treatment of heart arrhythmia via renal neuromodulation. Such neuromodulation may effectuate irreversible electroporation or electrofusion, ablation, 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, such neuromodulation is achieved through application of an electric field. In some embodiments, such neuromodulation is achieved through application of neuromodulatory agents, of thermal energy and/or of high intensity focused ultrasound. In some embodiments, such neuromodulation is performed in a bilateral fashion.

Methods and devices for reducing hollow organ volume

Methods and devices for providing a minimally-invasive placement of a mechanical structure for reducing the volume of a hollow body organ. Intragastric bands may be secured within the hollow body organ and then reduced in diameter to form a stricture within the hollow body organ. The strictures may be placed anywhere within the hollow body organ, and more than one stricture may be formed within the hollow body organ.

Apparatuses 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.

Apparatus for bilateral renal neuromodulation

Expansible shearing catheters for thrombus and occlusive material removal

Devices (10, 130), methods, kits, and methods remove obstructive material (O) from the vascular (W) and other body lumens (BV). Expansible baskets (18, 20) may be used as cooperating radially expansible shearing members. Helically oriented struts (30) of each basket (18 or 20) may wind in a uniform circumferential direction. The struts (30) can be independently flexible, allowing the shearing members (18, 20) to flex axially together. The inner basket (18) may be rotatably driven and may use an axial pump (141') extending proximally from the shearing members (18, 20) and/or a distal penetrator (122) for advancing into an occlusion (O) which inhibits guidewire (GW) access. The struts (30) may slide substantially continuously across each other, and may be sufficiently aggressive for highly effective thrombectomy. A rotationally static and axially flexible outer basket (20) may provide a safe, limited atherectomy treatment.

Methods and apparatus for treating contrast nephropathy

Methods and apparatus are provided for treating contrast nephropathy, e.g., via a pulsed electric field, via a stimulation electric field, via localized drug delivery, via high frequency ultrasound, via thermal techniques, etc. Such 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, neuromodulation is applied to neural fibers that contribute to renal function. In some embodiments, such neuromodulation is performed in a bilateral fashion. Bilateral renal neuromodulation may provide enhanced therapeutic effect in some patients as compared to renal neuromodulation performed unilaterally, i.e., as compared to renal neuromodulation performed on neural tissue innervating a single kidney.

Methods and apparatus for performing a non-continuous circumferential treatment to a body lumen

Methods and apparatus are provided for non-continuous circumferential treatment of a body lumen. Apparatus may be positioned within a body lumen of a patient and may deliver energy at a first lengthwise and angular position to create a less-than-full circumferential treatment zone at the first position. The apparatus also may deliver energy at one or more additional lengthwise and angular positions within the body lumen to create less-than-full circumferential treatment zone(s) at the one or more additional positions that are offset lengthwise and angularly from the first treatment zone. Superimposition of the first treatment zone and the one or more additional treatment zones defines a non-continuous circumferential treatment zone without formation of a continuous circumferential lesion. Various embodiments of methods and apparatus for achieving such non-continuous circumferential treatment are provided.

Systems and methods for clot disruption and retrieval

Occlusive material, notably thrombus or clot, can block body cavities. Treatment requires disrupting, collecting and removing the material. A catheter for removing occlusive material from a body lumen is provided that has a catheter body having a proximal end, a distal end, and a lumen therethrough, a radially expansible positioning cage near the distal end of the catheter body, and a radially expansible macerator configured to break up occlusive material within the cage and draw the material into the catheter body lumen. The macerator includes a shaped wire having a spiral geometry.

Methods and apparatus for multi-vessel renal neuromodulation

Methods and apparatus are provided for multi-vessel neuromodulation, e.g., via a pulsed electric field. Such multi-vessel 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, the multi-vessel neuromodulation is applied to neural fibers that contribute to renal function. Such multi-vessel neuromodulation optionally may be performed bilaterally.

Apparatus for pulsed electric field 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.

Methods and apparatus for intravascularly-induced neuromodulation or denervation

Methods and apparatus are provided for intravascularly-induced neuromodulation or denervation. Neuromodulation may be achieved via direct and/or via indirect application of energy or neuromodulatory agents to target neural matter, or to vascular structures that support the target neural matter. In some embodiments, parameters of the target neural matter, of non-target tissue, or of the apparatus may be monitored via one or more sensors for controlling the neuromodulation or denervation. Such monitoring data optionally may be utilized for feedback control of the neuromodulation or denervation.

Methods and device for percutaneous remote endarterectomy

The present invention provides devices, systems, methods and kits for the percutaneous removal of unwanted tissue or obstructive matter from body cavities or lumens, particularly from the vasculature. Blood vessels, including the coronary, peripheral and neurovascular circulation, which are narrowed or blocked by atheromatous material or plaque are often treated with traditional endarterectomy procedures. The present invention allows the benefits of such a procedure with an intraluminal approach, particularly a percutaneous approach. Generally, the present invention provides a set of catheters or tools which are percutaneously introduceable to the site of the blockage or occlusion. The tools dissect or cut through the innermost tissue layer of the lumen to an underlying tissue layer. The innermost tissue layer is then stripped away from the underlying layer with the occlusive material thereattached. The detached tissue layer and occlusive material is then removed from the lumen; this may include additional cutting, maceration and removal through mechanical aspiration. In any case, the resulting lumen is free of obstruction.

Clot dissolution systems

Un aparato para destruir coágulos a lo largo de una longitud luminal predeterminada de un vaso sanguíneo,comprendiendo dicho aparato:un cuerpo (12) de catéter que tiene un extremo proximal y un extremo distal que comprende un agitador (30)mecánico giratorio y/o desplazable axialmente cerca del extremo distal del cuerpo (12) del catéter para laagitación mecánica del coágulo a lo largo de la longitud predeterminada en el vaso sanguíneo;medios de distribución (40) cerca del extremo distal del cuerpo del catéter para distribuir un agente a lo largode la longitud predeterminada del vaso sanguíneo, siendo el agitador (30) no lineal;una unidad 14 de accionamiento motriz para hacer girar y/o trasladar axialmente el agitador mecánico, elaparato caracterizado porque el agitador está dispuesto dentro de una funda que proporciona los medios dedistribución como una pluralidad de puertos u orificios de distribución de fluido repartidos a lo largo de lalongitud no lineal del agitador. An apparatus for destroying clots along a predetermined luminal length of a blood vessel, said apparatus comprising: a catheter body (12) having a proximal end and a distal end comprising a rotating mechanical stirrer (30) and / or axially movable near the distal end of the body (12) of the catheter for mechanical clotting of the clot along the predetermined length in the blood vessel; distribution means (40) near the distal end of the catheter body to distribute an agent at along the predetermined length of the blood vessel, the agitator (30) being nonlinear; a drive unit 14 for driving and / or axially moving the mechanical agitator, the device characterized in that the agitator is disposed within a sheath that provides the means distribution as a plurality of ports or fluid distribution ports distributed along the nonlinear length of the agitator.

Methods for treating heart arrhythmia

Methods and apparatus are provided for treatment of heart arrhythmia via renal neuromodulation. Such neuromodulation may effectuate irreversible electroporation or electrofusion, ablation, 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, such neuromodulation is achieved through application of an electric field. In some embodiments, such neuromodulation is achieved through application of neuromodulatory agents, of thermal energy and/or of high intensity focused ultrasound. In some embodiments, such neuromodulation is performed in a bilateral fashion.

Methods and systems for thermally-induced renal neuromodulation

Methods and system are provided for thermally-induced renal neuromodulation. Thermally-induced renal neuromodulatoin may be achieved via direct and/or via indirect application of thermal energy to heat or cool neural fibers that contribute to renal function, or of vascular structures that feel or perfuse the neural fibers. In some embodiments, parameters of the neural fibers, of non-target tissue, or of the thermal energy delivery element, may be monitored via one or more sensors for controlling the thermally-induced neuromodulation. In some embodiments, protective elements may be provided to reduce a degree of thermal damage induced in the non-target tissues. In some embodiments, thermally-induced renal neuromodulation is achieved via delivery of a pulsed thermal therapy.

Methods and apparatus for performing a non-continuous circumferential treatment to a body lumen

Methods and apparatus are provided for discontinuous circumferential treatment of a body lumen. Apparatus may be positioned within a body lumen of a patient and may deliver energy at a first lengthwise and angular position to create a less-than-full circumferential treatment zone at the first position. The apparatus also may deliver energy at one or more additional lengthwise and angular positions within the body lumen to create less-than-full circumferential treatment zone(s) at the one or more additional positions that are offset lengthwise and angularly from the first treatment zone. Superimposition of the first treatment zone and the one or more additional treatment zones defines a discontinuous circumferential treatment zone without formation of a continuous circumferential lesion. Various embodiments of methods and apparatus for achieving such discontinuous circumferential treatment are provided.

Methods for reducing hollow organ volume

Methods and devices for providing a minimally-invasive placement of a mechanical structure for reducing the volume of a hollow body organ. Anchors maybe secured within the hollow body organ and then cinched together using a tensioning member to form a stricture within the hollow body organ. In another embodiment a tensioning member may be threaded along the hollow body organ and t hen c inched f o r educe t he volume. T he strictures may b e p laced anywhere within the hollow body organ, and more than one stricture may be formed within the hollow body organ.

Methods and devices for reducing hollow organ volume

Published without an Abstract

Apparatus and methods for clot dissolution

Clot disruption and dissolution are achieved using a catheter (300) having the ability to infuse a thrombolytic agent, agitate the clot and agent, and aspirate broken-up clot from the blood vessel. A flow resistor (310) in the catheter provides for infusion and/or aspiration to be concentrated primarily at a clot treatment area in a blood vessel while also providing optional infusion and/or aspiration distal to the treatment area. In some embodiments, infusion, aspiration and guidewire (716) passage occur through a common lumen. The thrombolytic agent, such as tPA, streptokinase, or urokinase, is directly released into the clot at the point where the agitator (30) is engaging the clot. In this way, the thrombolytic activity of the agent is enhanced and the dissolution of the clot is improved.

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.

Systeme für wärmeinduzierte renale neuromodulation

Systeme für wärmeinduzierte renale neuromodulation

Gerät für die renale neuromodulation

Ausweitbare scherkatheter zur entfernung von thrombus und verschliessendem material

Systeme zum auflosen von gerinseln

Apparatus and method for removing occlusive material within blood vessels

An apparatus for treating an occlusive region of a blood vessel includes a catheter (10) including a first lumen (24) extending from an end port (26) to a first side port (28), and a second lumen (34) extending from a proximal end of the catheter to a second side port (36). A balloon (40) is mounted on the catheter (10) between the first and second side ports. During use, a guidewire (5) is placed into an occlusive region, and the guidewire (5) is backloaded through the first and second lumens. The catheter is advanced over the guidewire, and the balloon is expanded to isolate the occlusive region. The guidewire is removed, and an agitator (62) is advanced through the second lumen. After the agitator is agitated to dislodge occlusive material from the occlusive region, the agitator is removed, and the loose occlusive material is aspirated via the second side port.

Versetzter endoluminaler stent

Systems and methods for treating obesity