公开(公告)号：US10258791B2

公开(公告)日：2019-04-16

申请号：US13458877

申请日：2012-04-27

申请人： Neil C. Barman ,  Robert J. Beetel ,  Benjamin J. Clark ,  Andrew Wu ,  Maria G. Aboytes ,  Denise Zarins

发明人： Neil C. Barman ,  Robert J. Beetel ,  Benjamin J. Clark ,  Andrew Wu ,  Maria G. Aboytes ,  Denise Zarins

IPC分类号： A61B18/14 ,  A61N1/05 ,  A61N1/36

摘要： Catheter assemblies for neuromodulation proximate a renal artery bifurcation and associated systems and methods are disclosed herein. A catheter assembly configured in accordance with a particular embodiment of the present technology can include a shaft having a proximal portion, a distal portion, and two therapeutic arms extending from the distal portion. The shaft can be configured to deliver the distal portion to a treatment site proximate a branch point or bifurcation in a renal blood vessel. The therapeutic arms can include energy delivery elements that are configured to deliver the therapeutically-effective energy to renal nerves proximate the branch point.

公开(公告)号：US09364280B2

公开(公告)日：2016-06-14

申请号：US14574262

申请日：2014-12-17

申请人： Denise Zarins ,  Benjamin J. Clark ,  Nicolas Zadno ,  Hanson Gifford, III ,  Erik Thai

发明人： Denise Zarins ,  Benjamin J. Clark ,  Nicolas Zadno ,  Hanson Gifford, III ,  Erik Thai

IPC分类号： A61N1/05 ,  A61B18/14 ,  A61N1/32 ,  A61N1/36 ,  A61B18/12 ,  A61M5/14 ,  A61B18/00

CPC分类号： A61B18/1477 ,  A61B18/1206 ,  A61B2018/0022 ,  A61B2018/00267 ,  A61B2018/00404 ,  A61B2018/00434 ,  A61B2018/00505 ,  A61B2018/00613 ,  A61B2018/126 ,  A61M5/14 ,  A61M37/00 ,  A61N1/05 ,  A61N1/0514 ,  A61N1/0551 ,  A61N1/321 ,  A61N1/327 ,  A61N1/36007

摘要： 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.

公开(公告)号：US09066720B2

公开(公告)日：2015-06-30

申请号：US13281269

申请日：2011-10-25

申请人： Sowmya Ballakur ,  Robert Beetel ,  Paul Friedrichs ,  Andrew Wu ,  Denise Zarins ,  David Herzfeld ,  Mark S. Leung

发明人： Sowmya Ballakur ,  Robert Beetel ,  Paul Friedrichs ,  Andrew Wu ,  Denise Zarins ,  David Herzfeld ,  Mark S. Leung

IPC分类号： A61B18/10 ,  A61B18/12 ,  A61B18/14 ,  A61B17/00 ,  A61B18/00

CPC分类号： A61B18/1206 ,  A61B18/10 ,  A61B18/1492 ,  A61B2017/00075 ,  A61B2018/00404 ,  A61B2018/00434 ,  A61B2018/00505 ,  A61B2018/00511 ,  A61B2018/00577 ,  A61B2018/00642 ,  A61B2018/00648 ,  A61B2018/00672 ,  A61B2018/00678 ,  A61B2018/00702 ,  A61B2018/00761 ,  A61B2018/00791 ,  A61B2018/00797 ,  A61B2018/00815 ,  A61B2018/00821 ,  A61B2018/00863 ,  A61B2018/00875 ,  A61F7/12 ,  A61F2007/0093 ,  A61F2007/126

摘要： The present disclosure relates to devices, systems and methods for evaluating the success of a treatment applied to tissue in a patient, such as a radio frequency ablative treatment used to neuromodulate nerves associated with the renal artery. A system monitors parameters or values generated during the course of a treatment. Feedback provided to an operator is based on the monitored values and relates to an assessment of the likelihood that a completed treatment was technically successful. In other embodiments, parameters or values generated during the course of an incomplete treatment (such as due to high temperature or high impedance conditions) may be evaluated to provide additional instructions or feedback to an operator.

摘要翻译： 本公开涉及用于评估应用于患者组织的治疗成功的装置，系统和方法，例如用于神经调节与肾动脉相关的神经的射频消融治疗。 系统监视在治疗过程中产生的参数或值。 提供给运营商的反馈是基于监测值，并且涉及对完成的处理在技术上成功的可能性的评估。 在其他实施例中，可以评估在不完全处理过程中产生的参数或值（例如由于高温或高阻抗条件），以向操作者提供额外的指令或反馈。

公开(公告)号：US20140114305A1

公开(公告)日：2014-04-24

申请号：US14094330

申请日：2013-12-02

申请人： Denise Zarins ,  Andrew Wu ,  Hanson Gifford, III ,  Mark Deem ,  Mark Gelfand ,  Howard R. Levin

发明人： Denise Zarins ,  Andrew Wu ,  Hanson Gifford, III ,  Mark Deem ,  Mark Gelfand ,  Howard R. Levin

IPC分类号： A61B18/14 ,  A61N1/32

CPC分类号： A61B18/1492 ,  A61B2018/00404 ,  A61B2018/00434 ,  A61B2018/00505 ,  A61B2018/00511 ,  A61B2018/00577 ,  A61B2018/00642 ,  A61F7/123 ,  A61F2007/126 ,  A61M5/14276 ,  A61M5/1723 ,  A61M2210/1082 ,  A61N1/28 ,  A61N1/32 ,  A61N1/326 ,  A61N1/36007 ,  A61N1/36017 ,  A61N1/36114 ,  A61N1/36117 ,  A61N1/3627 ,  A61N1/403 ,  A61N5/045 ,  A61N7/02 ,  A61N2007/003

摘要： 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.

摘要翻译： 提供了用于热诱导的肾神经调节的方法和装置。 热诱导的肾神经调节可以通过直接和/或通过间接施加热能来加热或冷却有助于肾功能的神经纤维或者供给或灌注神经纤维的血管结构来实现。 在一些实施例中，神经纤维，非目标组织或热能递送元件的参数可以经由一个或多个传感器来监测，以控制热诱导的神经调节。 在一些实施方案中，可以提供保护元件以减少在非靶组织中诱导的热损伤程度。 在一些实施方案中，热诱导的肾神经调节通过脉冲热疗法的递送来实现。

公开(公告)号：US20140107539A1

公开(公告)日：2014-04-17

申请号：US14081634

申请日：2013-11-15

申请人： Denise Zarins ,  Hanson Gifford, III

发明人： Denise Zarins ,  Hanson Gifford, III

IPC分类号： A61B18/14 ,  A61N7/02 ,  A61F7/00 ,  A61M5/00 ,  A61N1/05

CPC分类号： A61M25/0084 ,  A61B17/3478 ,  A61B18/04 ,  A61B18/1492 ,  A61B2018/0022 ,  A61B2018/00434 ,  A61B2018/00511 ,  A61B2018/00577 ,  A61F7/007 ,  A61K38/4893 ,  A61M5/00 ,  A61M2025/0085 ,  A61M2202/0007 ,  A61M2210/1082 ,  A61N1/05 ,  A61N1/0551 ,  A61N1/32 ,  A61N1/36017 ,  A61N1/36114 ,  A61N7/02 ,  C12Y304/24069

摘要： 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.

摘要翻译： 提供了通过肾脏神经调节治疗心律失常的方法和装置。 这种神经调节可以实现不可逆的电穿孔或电融合，消融，坏死和/或诱导凋亡，基因表达的改变，动作电位衰减或阻断，细胞因子上调和靶神经纤维中的其他条件的变化。 在一些实施例中，通过施加电场来实现这种神经调节。 在一些实施方案中，通过应用神经调节剂，热能和/或高强度聚焦超声来实现这种神经调节。 在一些实施方案中，这种神经调节以双向方式进行。

公开(公告)号：US20140018880A1

公开(公告)日：2014-01-16

申请号：US13958450

申请日：2013-08-02

申请人： Denise Zarins ,  Hanson Gifford, III ,  Mark Deem ,  Howard R. Levin ,  Mark Gelfand ,  Nicolas Zadno

发明人： Denise Zarins ,  Hanson Gifford, III ,  Mark Deem ,  Howard R. Levin ,  Mark Gelfand ,  Nicolas Zadno

IPC分类号： A61N1/36

CPC分类号： A61B18/1492 ,  A61B18/12 ,  A61B18/1206 ,  A61B18/1482 ,  A61B18/16 ,  A61B2017/00154 ,  A61B2018/00059 ,  A61B2018/00214 ,  A61B2018/0022 ,  A61B2018/00261 ,  A61B2018/00267 ,  A61B2018/00279 ,  A61B2018/00404 ,  A61B2018/00434 ,  A61B2018/00511 ,  A61B2018/00577 ,  A61B2018/00613 ,  A61B2018/00642 ,  A61B2018/00648 ,  A61B2018/00791 ,  A61B2018/00875 ,  A61B2018/124 ,  A61B2018/1253 ,  A61B2018/1435 ,  A61B2018/1467 ,  A61B2018/1472 ,  A61N1/05 ,  A61N1/0551 ,  A61N1/327 ,  A61N1/36017 ,  A61N1/36117 ,  A61N1/36139 ,  H05K999/99

摘要： 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.

摘要翻译： 提供了用于单极神经调节的方法和装置，例如通过脉冲电场。 这种单极神经调节可能会导致不可逆的电穿孔或电融合，坏死和/或诱导凋亡，基因表达的改变，动作电位减弱或阻断，细胞因子上调的变化和靶神经纤维中的其他条件。 在一些实施方案中，单极神经调节被应用于有助于肾功能的神经纤维。 在一些实施方案中，这种单极神经调节是双侧进行的。

公开(公告)号：US20120143293A1

公开(公告)日：2012-06-07

申请号：US13281395

申请日：2011-10-25

申请人： Kevin Mauch ,  Mario Alvarado ,  Robert Beetel ,  William Chang ,  Justin Goshgarian ,  Leonila Rivera ,  Sukyoung Shin ,  Michele Silver ,  Sina Som ,  Andrew Wu ,  Denise Zarins ,  Juanita Sanchez-Cole ,  Maria G. Aboytes

发明人： Kevin Mauch ,  Mario Alvarado ,  Robert Beetel ,  William Chang ,  Justin Goshgarian ,  Leonila Rivera ,  Sukyoung Shin ,  Michele Silver ,  Sina Som ,  Andrew Wu ,  Denise Zarins ,  Juanita Sanchez-Cole ,  Maria G. Aboytes

IPC分类号： A61N1/18 ,  A61F7/12

CPC分类号： A61B18/1492 ,  A61B2018/00023 ,  A61B2018/00404 ,  A61B2018/00434 ,  A61B2018/00505 ,  A61B2018/00511 ,  A61B2018/00577 ,  A61B2018/1435 ,  A61B2018/1467 ,  A61M25/0041 ,  A61M25/0074 ,  A61M25/0133 ,  A61M25/0138 ,  A61M25/0147

摘要： Catheter apparatuses, systems, and methods for achieving renal neuromodulation by intravascular access are disclosed herein. One aspect of the present technology, for example, is directed to a treatment device having a multi-electrode array configured to be delivered to a renal blood vessel. The array is selectively transformable between a delivery or low-profile state (e.g., a generally straight shape) and a deployed state (e.g., a radially expanded, generally helical shape). The multi-electrode array is sized and shaped so that the electrodes or energy delivery elements contact an interior wall of the renal blood vessel when the array is in the deployed (e.g., helical) state. The electrodes or energy delivery elements are configured for direct and/or indirect application of thermal and/or electrical energy to heat or otherwise electrically modulate neural fibers that contribute to renal function or of vascular structures that feed or perfuse the neural fibers.

公开(公告)号：US20120136418A1

公开(公告)日：2012-05-31

申请号：US13279328

申请日：2011-10-23

申请人： Naomi Buckley ,  Benjamin J. Clark ,  Michael Cummins ,  Danny Donovan ,  Luke Hughes ,  Brian Kelly ,  Gary Kelly ,  Grace Kelly ,  John Kelly ,  Seamus Ledwith ,  Gwenda McMullin ,  Karun D. Naga ,  Stephen Nash ,  Eric Ryba ,  Fiachra Sweeney ,  Vincenzo Tilotta ,  Roman Turovskiy ,  Lana Woolley ,  Denise Zarins ,  Mark Gelfand ,  Mark S. Leung ,  Barry Mullins

发明人： Naomi Buckley ,  Benjamin J. Clark ,  Michael Cummins ,  Danny Donovan ,  Luke Hughes ,  Brian Kelly ,  Gary Kelly ,  Grace Kelly ,  John Kelly ,  Seamus Ledwith ,  Gwenda McMullin ,  Karun D. Naga ,  Stephen Nash ,  Eric Ryba ,  Fiachra Sweeney ,  Vincenzo Tilotta ,  Roman Turovskiy ,  Lana Woolley ,  Denise Zarins ,  Mark Gelfand ,  Mark S. Leung ,  Barry Mullins

IPC分类号： A61F7/12

CPC分类号： A61B18/02 ,  A61B2018/00214 ,  A61B2018/00232 ,  A61B2018/00255 ,  A61B2018/00404 ,  A61B2018/00434 ,  A61B2018/00511 ,  A61B2018/0212

摘要： Neuromodulation cryotherapeutic devices and associated systems and methods are disclosed herein. A cryotherapeutic device configured in accordance with a particular embodiment of the present technology can include an elongated shaft having distal portion and a supply lumen along at least a portion of the shaft. The shaft can be configured to locate the distal portion intravascularly at a treatment site proximate a renal artery or renal ostium. The supply lumen can be configured to receive a liquid refrigerant. The cryotherapeutic device can further include a cooling assembly at the distal portion of the shaft. The cooling assembly can include an applicator in fluid communication with the supply lumen and configured to deliver cryotherapeutic cooling to nerves proximate the target site when the cooling assembly is in a deployed state.

摘要翻译： 本文公开了神经调节冷冻治疗装置及相关系统和方法。 根据本技术的特定实施例配置的冷冻治疗装置可以包括细长轴，其具有沿轴的至少一部分的远侧部分和供应内腔。 轴可以被配置为将远端部分血管内定位在肾动脉或肾口附近的治疗部位。 供应内腔可被配置为接收液体制冷剂。 冷冻治疗装置还可以包括在轴的远端处的冷却组件。 冷却组件可以包括与供应内腔流体连通的施加器，并且构造成当冷却组件处于展开状态时，将冷冻治疗冷却递送到靠近目标部位的神经。

公开(公告)号：US20120089047A1

公开(公告)日：2012-04-12

申请号：US13204504

申请日：2011-08-05

申请人： Eric Ryba ,  Naomi Buckley ,  Benjamin J. Clark ,  Danny Donovan ,  Luke Hughes ,  Brian Kelly ,  Gwenda McMullin ,  Karun D. Naga ,  Stephen Nash ,  Roman Turovskiy ,  Lana Wooley ,  Denise Zarins ,  Mark Gelfand ,  Mark Leung

发明人： Eric Ryba ,  Naomi Buckley ,  Benjamin J. Clark ,  Danny Donovan ,  Luke Hughes ,  Brian Kelly ,  Gwenda McMullin ,  Karun D. Naga ,  Stephen Nash ,  Roman Turovskiy ,  Lana Wooley ,  Denise Zarins ,  Mark Gelfand ,  Mark Leung

IPC分类号： A61B18/02 ,  A61B5/05 ,  A61B5/00

CPC分类号： A61B18/02 ,  A61B2018/0022 ,  A61B2018/0212 ,  A61B2018/0262 ,  A61B2018/0268

摘要： Catheter apparatuses, systems, and methods for cryogenically modulating neural structures of the renal plexus by intravascular access are disclosed herein. One aspect of the present application, for example, is directed to apparatuses, systems, and methods that incorporate a catheter treatment device comprising an elongated shaft. The elongated shaft is sized and configured to deliver a cryo-applicator to a renal artery via an intravascular path. Cryogenic renal neuromodulation may be achieved via application of cryogenic temperatures to modulate neural fibers that contribute to renal function, or of vascular structures that feed or perfuse the neural fibers.

摘要翻译： 本文公开了通过血管内通路低血压调节肾丛神经结构的导管装置，系统和方法。 本申请的一个方面，例如，涉及包括细长轴的导管治疗装置的装置，系统和方法。 细长轴的尺寸和构造适于通过血管内途径将低温涂敷器递送至肾动脉。 低温肾神经调节可以通过应用低温温度来实现，以调节有助于肾功能的神经纤维，或者供给或灌注神经纤维的血管结构。

公开(公告)号：US20100168731A1

公开(公告)日：2010-07-01

申请号：US12545648

申请日：2009-08-21

申请人： Andrew Wu ,  Benjamin J. Clark ,  Denise Zarins ,  Erik Thai

发明人： Andrew Wu ,  Benjamin J. Clark ,  Denise Zarins ,  Erik Thai

IPC分类号： A61B18/18

CPC分类号： A61B18/1492 ,  A61B18/02 ,  A61B18/1206 ,  A61B18/18 ,  A61B18/24 ,  A61B90/39 ,  A61B2017/003 ,  A61B2018/00172 ,  A61B2018/00404 ,  A61B2018/00434 ,  A61B2018/00511 ,  A61B2018/00577 ,  A61B2018/00648 ,  A61B2018/00791 ,  A61B2018/00875 ,  A61M25/0141 ,  A61N2007/003

摘要： Apparatus, systems, and methods for achieving thermally-induced renal neuromodulation by intravascular access are disclosed herein. One aspect of the present application, for example, is directed to apparatuses, systems, and methods that incorporate a treatment device comprising an elongated shaft. The elongated shaft is sized and configured to deliver a thermal element to a renal artery via an intravascular path. 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.

摘要翻译： 本文公开了通过血管内通路实现热诱导的肾神经调节的装置，系统和方法。 本申请的一个方面，例如，涉及包含细长轴的治疗装置的装置，系统和方法。 细长轴的尺寸和构造适于通过血管内路径将热元件输送到肾动脉。 热诱导的肾神经调节可以通过直接和/或通过间接施加热能来加热或冷却有助于肾功能的神经纤维或者供给或灌注神经纤维的血管结构来实现。