CN202654226U - Cryotherapy equipment for neuroregulation and related system - Google Patents

Abstract

The utility model discloses cryotherapy equipment for neuroregulation and a related system. The cryotherapy equipment configured according to a special embodiment of the technology comprises a rod with a far side part and a supply cavity along at least part of the rod. The rod can be configured in a way that the far side part is placed in a manner close to a treatment part of the renal artery or nephrostome in the blood vessel. The supply cavity can be configured to receive a liquid refrigerant. The cryotherapy equipment further comprises a cooling assembly located at the far side part of the rod. The cooling assembly comprises an applicator in liquid communication with the supply cavity. The applicator is configured to transfer cryogenic cooling to nerves near a target part when the cooling assembly is in an unfolded state.

Description

Neuroregulation cold therapy equipment and related system

Technical field

Present technique relates generally to cold therapy equipment.Particularly, some embodiment are cold therapy equipment and related system and the method for neuroregulation in the blood vessel.

Background technology

Sympathetic nervous system (SNS) is the imperious health control system that is mainly that substantially is associated with stress.Tissue in almost each tract of the fiber domination human body of SNS, and can affect characteristics such as pupil diameter, intestinal peristalsis promoting and voided volume.It is this that to be adjusted in the holder inner equilibrium or to make health be environmental factors to be made have adaptability to use in the fast reaction.But the chronic activation of SNS is the untoward reaction that can promote PD.Especially the overactivity of kidney SNS is regarded as the state (for example heart failure) of hypertensive complicated Pathophysiology, volume load and the inducement likely of carrying out property nephropathy in experiment and human body.Kidney norepinephrine (NE) flood rate of the increase of for example, tracer dilution is verified primary hypertension patient.

The heart-kidney sympathetic nerve is hyperfunction can be particularly remarkable in heart failure patient.For example, the NE that often occurs from heart and kidney to polyplasmia of these patients overflows.The SNS activation that has improved has chronic and characteristics end-stage renal disease substantially.Among the nephrotic, the above plasmal NE level of intermediate value has been proved to be the omen of cardiovascular disease and several causes of the death late.Like this too to the patient who suffers from diabetes or radiographic contrast nephropathy.Evidence shows, is the main cause that causes and keep the output of maincenter sympathetic nerve to raise from the sensation input signal of pathological changes kidney.

The kidney sympathetic nerve ends at blood vessel, juxtaglomerular apparatus and renal tubules.The orthosympathetic stimulation of kidney can cause increase, the sodium (Na of renin release ⁺) minimizing of re-absorbed increase and renal blood flow.These neuroregulation part of renal function is stimulated significantly by the morbid state institute take the sympathetic nerve that improves as feature, and probably promotes hyperpietic's hypertension.The kidney sympathetic activities stimulates reducing of the renal blood flow cause and glomerular filtration rate, is likely the basis of the heart-kidney syndrome (be renal insufficiency, it is the carrying out property syndrome of chronic heart failure) middle kidney afunction.The pharmacology strategy that is used for the consequence of prevention sympathetic stimulation comprises maincenter sympathetic nerve medicine, beta-blocker (being intended to reduce renin release), angiotensin converting enzyme inhibitor and receptor blocking agent (being intended to stop the action of Angiotensin II and the aldosterone activation that comes with renin release), and diuretic (being intended to tackle the retention of sodium and water of kidney sympathetic nerve mediation).Yet there is significant limitation in these medicine strategies, comprise limited curative effect, compliance problem, side effect, reach other.Therefore, public health has urgent demand to the therapeutic strategy that replaces.

The utility model content

Cold therapy equipment provided by the utility model comprises:

Bar with elongation of distal part and distal part, described bar are configured to place among renal artery or the nephrostome described distal part or near therapentic part, and described portions of proximal is configured to outside vascular system;

Be positioned at the sub-cooled assembly of the described distal part of described bar;

Main supply along at least a portion of described bar is answered the chamber, and it has first and second portion, and wherein said main supply answers the described second portion in chamber near described sub-cooled assembly; And

Precooler, it has the container that is configured to receive liquid refrigerant stream, the diverter in the described container, along pre-cooled dose of passage and the pre-cooling expansion chambers in described container of the periphery of described diverter, described pre-cooling expansion chambers has the proximal part of being determined by described diverter, wherein said diverter has and is connected to the main channel that described main supply is answered the described first in chamber, arrive described main supply and answer the chamber so that the part of liquid refrigerant flows through described main channel, and another part of liquid refrigerant flows through described precooling agent passage and enters described pre-cooling expansion chambers.

According to an aspect of the present utility model, in the described cold therapy equipment, described container has inner surface and described diverter is not fixed to described inner surface.

According to an aspect of the present utility model, in the described cold therapy equipment, described container has inner surface and described supply chamber is not fixed to described inner surface.

According to an aspect of the present utility model, described cold therapy equipment comprises determines that described main supply answers the main supply in chamber to answer conduit, and described main supply answers conduit to have the outer surface of at least a portion of determining described peripheral channel.

According to an aspect of the present utility model, described cold therapy equipment further comprises determines that described main supply answers the main supply in chamber to answer conduit, described main supply answers conduit to have outer surface, wherein said chamber has inner surface, and described diverter is fixed to described main supply and answers conduit on the outer surface between described pre-cold supply chamber and the described fore-cooling room, and wherein said diverter has been determined at least a portion of described precooling agent passage.

According to an aspect of the present utility model, in the described cold therapy equipment, described main supply answers conduit to have mean outside diameter in described fore-cooling room, and wherein said diverter is the part that described main supply is answered conduit, and has the external diameter larger than described mean outside diameter.

According to an aspect of the present utility model, in the described cold therapy equipment, described container has inner surface, and described pre-cooling passage is included in the gap of the bending between described diverter and the described inner surface.

According to an aspect of the present utility model, in the described cold therapy equipment, described container has inner surface, and described precooling agent passage is included in the annular gap between described diverter and the described inner surface.

According to an aspect of the present utility model, in the described cold therapy equipment, described pre-cooling expansion chambers has greater than about 10 centimetres length.

According to an aspect of the present utility model, described cold therapy equipment further comprises along the passing away of at least a portion of described bar, wherein said precooler comprise and described passing away between the outlet of fluid connection.

Detail and some embodiment of present technique have been introduced below with reference to Fig. 1-59B.Although a lot of embodiment are for equipment, system and method in the blood vessel that is used for regulating in the blood vessel of kidney nerve that uses the cold therapy means, other outside described herein use and other embodiment also within the scope of present technique.In addition, some other embodiment of present technique can have and different configuration described herein, parts or process.Therefore, those of ordinary skills correspondingly understand, and present technique can have other embodiment that comprises additional element, or present technique can have and do not possess the some features that illustrate and introduce referring to Fig. 1-59B.

As for the term in this description " far-end " and " near-end ", except as otherwise noted, this term can refer to that part on cold therapy equipment and/or the relevant delivery device is with respect to the relative position of the position in operator and/or the blood vessel.For example, near-end can refer to more close equipment the operator the position or enter the otch of vascular system, far-end can refer to from the farther position of the operator of equipment or guard system is from the farther position of otch along the pulse.

The kidney neuroregulation

The kidney neuroregulation is part or all of anergy or other the effective damage that makes the neurocyte that kidney innervates.This anergy can be long-term (for example, permanent or lasting several months, several years or many decades) or in short-term (for example, continuing several minutes, a few hours, a couple of days or several weeks).The kidney neuroregulation is hoped effectively to treat some clinical symptoms, these clinical settings strengthen particularly take whole sympathetic activity, and the kidney sympathetic activity strengthens as characteristics, for example, improper fluid retention, the heart-kidney syndrome and the sudden death of hypertension, metabolism syndrome, insulin resistant, diabetes, left ventricular hypertrophy, chronic and end-stage renal disease, heart failure.The minimizing of the nerve signal that imports into helps systematicness to reduce sympathetic tone/drive, and the kidney neuroregulation is treated and the hyperfunction relevant several symptoms of whole body sympathetic nerve helping.The kidney neuroregulation may be conducive to various organs by sympathetic innervation and body structure.For example, maincenter sympathetic nerve drive reduces and can reduction torment the insulin resistant of suffering from metabolic syndrome and type ii diabetes patient.In addition, osteoporosis can cause by sympathetic nerve, and benefits from the downward modulation of the sympathetic nerve drive of following the kidney neuroregulation.Relevant patient's anatomy and physiology's more detailed description below are provided.

Many technology can be used for making such as the neurocyte that kidney is innervated anergy partially or completely.For example, cryotherapy comprises by the mode of regulating function of nervous system and cools off tissue on the target site.The mechanism of freezing tissue damage comprises, for example, and directly cell damage (for example, necrosis), blood vessel injury (for example, make cell lack nutrient substance by the damage supply vessels and dead) and with follow-up apoptotic inferior fatal low temperature.Be exposed to the cell death that refrigated cooling can cause acute cell death (for example, after exposure at once) and/or postpone (for example, during organizing between frost free period and follow-up transition pays close attention to).Some embodiment of present technique comprise being in or cooling off near the structure of the inner surface of renal artery wall, thereby nearest (for example, being close to) tissue are reached the cooling of the kidney sympathetic nerve place degree of depth.For example, the cooling degree of cooling structure causes effectively low the kidney warming-neuroregulation in treatment.The orthosympathetic at least a portion of kidney is fully cooled off the conduction that is hoped to slow down or may the block nerves signal, to produce the long-term or permanent minimizing of kidney sympathetic activity.

Cold therapy has certain characteristics, and these characteristics are conducive to endovascular kidney neuroregulation.For example, cools tissue can provide analgesic effect rapidly, so that cold therapy does not have the bright erosion of high temperature to organize so misery.Therefore, compare with the heat erosion treatment operation of burning, cold therapy in operation process for to make the patient keep comfortable required analgesic less.In addition, ease the pain and relaxed patient's motion, thereby improved the success of operative doctor and reduced postoperative complication.Cold therapy can not cause significant collagen protein to tighten substantially yet, so cold therapy is generally not relevant with angiostenosis.

Cold therapy is operated in substantially so that cold therapy applicator (applicator) adheres to the temperature of moistening tissue.This has promoted stable, the continuous contact of making peace in the therapeutic process, thereby is useful.The common condition for the treatment of can make it to become attractive characteristics, and for example, patient can move in therapeutic process, and the conduit related with applicator can move, and/or breathing can cause the rising of kidney and descends and movable kidney tremulous pulse thus.In addition, blood flow is beaten, and can cause arteriorenal beating.In shorter renal artery, the interior location of blood vessel that more difficult realization is stable, the adhesion related with frozen cooling also can be favourable.

Description of drawings

A lot of aspect disclosed by the invention can be understood better with reference to the following drawings.Parts among the figure needn't be proportional.On the contrary, focus on and clearly demonstrate on the principle disclosed by the invention.In addition, the parts in some view can be shown transparent, and this only is to describe for clear, but not shows that the parts that illustrate must be transparent.

Fig. 1 shows the cold therapy system according to an embodiment of present technique.

Fig. 2 A is amplification sectional view, and it shows the embodiment according to the distal portions of the bar that is in sending state (for example, the configuration of low profile or contraction) of an embodiment of present technique and cooling package.

Fig. 2 B is the sectional view of the amplification of (for example, the configuration of expansion) when being in deployed condition of the cooling package among Fig. 2 A.

Fig. 2 C and 2D are side cross-sectional view and the end section figure that shows according to the amplification of the cooling package of another embodiment configuration of present technique.

Fig. 2 E is according to the near-end of the cold therapy equipment of the another embodiment configuration of present technique and the amplification sectional view of distal portions.

Fig. 3 A shows the cold therapy system that uses according to an embodiment of present technique to be come the kidney nerve is carried out freezing adjusting, and wherein each figure notation is: 1-kidney, path in the 2-renal artery, 3-blood vessel, 4-iliac artery, 5-aorta, 6-femoral artery.

Fig. 3 B shows the block diagram that the kidney nerve is carried out the method for freezing adjusting according to any embodiment of present technique.

Fig. 4 A and 4B are the sectional view according to the amplification of the cold therapy equipment with stepped distal portions of several embodiment configurations of present technique.

Fig. 5 A is the part schematic diagram according to the cold therapy system of another embodiment configuration of present technique.

Fig. 5 B is the sectional view according to the amplification of the distal portions of the bar that is in deployed condition of an embodiment of present technique and cooling package.

Fig. 6 A is the plane graph that shows according to the pre-cooling assembly of embodiment configuration of present technique.

Fig. 6 B is the sectional view that shows the pre-cooling assembly among Fig. 6 A.

Fig. 7 is the sectional view that shows according to the pre-cooling assembly with valve of embodiment configuration of present technique.

Fig. 8 A is the sectional view with the pre-cooling assembly that flows separator that illustrates according to an embodiment configuration of present technique.

Fig. 8 B is the sectional view that the pre-cooling assembly among Fig. 8 A is shown.

Fig. 9 A is the sectional view that illustrates according to the pre-cooling assembly with stream separator of another embodiment configuration of present technique.

Fig. 9 B is the sectional view that shows the pre-cooling assembly among Fig. 9 A.

Figure 10 be show according to embodiment configuration of present technique in handle round the part schematic diagram of the tubular element of the pre-cooling assembly of outlet coiling.

Figure 11 be show according to embodiment configuration of present technique in handle near the part schematic diagram of the tubular element of the pre-cooling assembly of outlet coiling.

Figure 12 is the sectional view that shows according to the cooling package of the supply pipe with the distal portions that comprises inclination of embodiment configuration of present technique.

Figure 13 is the sectional view that shows according to the cooling package with supply pipe of embodiment configuration of present technique, and wherein supply pipe has the spiral part that is wrapped in around the passing away.

Figure 14 is the sectional view that shows according to the cooling package with supply pipe of embodiment configuration of present technique, and wherein supply pipe has the spiral part that is wrapped in around the passing away.

Figure 15 A is the sectional view that shows according to the cooling package with interior balloon of embodiment configuration of present technique, wherein in balloon have interior balloon aperture.

Figure 15 B is the sectional view that shows cooling package among Figure 15 A.

Figure 16 A is the sectional view that shows according to the cooling package with interior balloon and outer balloon of embodiment configuration of present technique, wherein in balloon have interior balloon aperture, outer ball has the spiral part of rising.

Figure 16 B is the sectional view that shows the cooling package among Figure 16 A.

Figure 17 A is the sectional view that shows according to the cooling package of the heat insulating component with prolongation of embodiment configuration of present technique.

Figure 17 B is the sectional view that shows the cooling package among Figure 17 A.

Figure 18 A is the sectional view that shows according to the cooling package of the heat insulating component with prolongation of another embodiment configuration of present technique.

Figure 18 B is the sectional view that shows the cooling package among Figure 18 A.

Figure 19 A is the profile diagram that shows according to the cooling package with spiral type heat insulating component of embodiment configuration of present technique.

Figure 19 B and 19C are the sectional view that shows cooling package among Figure 19 A.

Figure 20 A is the profile diagram that shows according to the cooling package with the double-helical heat insulating component that is similar to mutual winding of embodiment configuration of present technique.

Figure 20 B and 20C are the sectional view that shows the cooling package among Figure 20 A.

Figure 21 A is the sectional view that shows according to the cooling package of the heat insulating component with the prolongation that can move in balloon of another embodiment configuration of present technique.

Figure 21 B is the sectional view that shows the cooling package among Figure 21 A.

Figure 21 C shows cooling package among Figure 21 A is in sending state in sending cover sectional view.

Figure 22 A is the sectional view that shows according to the cooling package of the heat insulating component with the prolongation that can move in balloon of embodiment configuration of present technique.

Figure 22 B is the sectional view that shows the cooling package among Figure 22 A.

Figure 23 A is the profile diagram that shows according to the cooling package with a plurality of part circumference balloons of embodiment configuration of present technique.

Figure 23 B is the isometric view that shows the cooling package among Figure 23 A.

Figure 24 A is the profile diagram that shows according to the cooling package with a plurality of part circumference balloons of another embodiment configuration of present technique.

Figure 24 B is the isometric view that shows the cooling package among Figure 24 A.

Figure 25 is the profile diagram that shows according to the cooling package with helical groove of embodiment configuration of present technique.

Figure 26 is the profile diagram that shows according to the cooling package of the spaced recess of tool of embodiment configuration of present technique.

Figure 27 A is the profile diagram that shows according to the cooling package of the spaced recess of tool of another embodiment configuration of present technique.

Figure 27 B is the sectional view that shows the cooling package among Figure 27 A.

Figure 27 C is the isometric view that shows the cooling package among Figure 27 A.

Figure 28 is the profile diagram that shows according to the cooling package of the spaced recess of tool of embodiment configuration of present technique.

Figure 29 is the profile diagram that shows according to the cooling package with the helical form balloon that is wrapped in passing away of embodiment configuration of present technique.

Figure 30 is the profile diagram with the cooling package that is wrapped in the helical form balloon of supplying the chamber that shows according to an embodiment configuration of present technique.

Figure 31 is the profile diagram with the cooling package that is wrapped in the helical form balloon of supplying the chamber that shows according to another embodiment configuration of present technique.

Figure 32 A is the profile diagram that shows according to the cooling package with shaped component of embodiment configuration of present technique, and wherein shaped component has shape memory.

Figure 32 B is the sectional view that shows the cooling package among Figure 32 A.

Figure 33 A is the profile diagram that shows according to the cooling package with crooked along its length balloon of embodiment configuration of present technique.

Figure 33 B and 33C are the sectional view that shows the cooling package among Figure 33 A.

Figure 33 D is the sectional view that shows the cooling package among Figure 33 A, and wherein cooling package is in sending state in sending cover.

Figure 34 is the sectional view that shows according to the cooling package with crooked along its length balloon of embodiment configuration of present technique.

Figure 35 A is the profile diagram that shows according to the cooling package with balloon of embodiment configuration of present technique, and wherein balloon has confined length part.

Figure 35 B is the sectional view that shows the cooling package among Figure 35 A.

Figure 36 is the profile diagram that shows according to the cooling package with balloon of another embodiment configuration of present technique, and wherein balloon has confined length part.

Figure 37 is the profile diagram that shows according to the cooling package with ring-type balloon of embodiment configuration of present technique.

Figure 38 A is the profile diagram that shows according to the cooling package of the balloon with a plurality of elongations of embodiment configuration of present technique.

Figure 38 B is the sectional view that shows the cooling package among Figure 38 A.

Figure 39 A is the profile diagram that shows according to the cooling package of the balloon with a plurality of elongations of another embodiment configuration of present technique.

Figure 39 B and 39C are the sectional view that shows the cooling package among Figure 39 A.

Figure 40 is the sectional view that shows according to the cooling package of the balloon with a plurality of elongations of another embodiment configuration of present technique.

Figure 41 is the profile diagram that shows according to the cooling package with a plurality of helical form balloons of embodiment configuration of present technique.

Figure 42 is the profile diagram that shows according to the cooling package with a plurality of helical form balloons of another embodiment configuration of present technique.

Figure 43 A is the profile diagram that shows according to the cooling package of the balloon with a plurality of elongations that are connected in shaped component of embodiment configuration of present technique.

Figure 43 B is the sectional view that shows the cooling package among Figure 43 A.

Figure 43 C is the profile diagram that shows the cooling package among Figure 43 A, and wherein shaped component is retracted.

Figure 44 A is the profile diagram that shows according to the cooling package of the balloon with a plurality of elongations that are connected in shaped component of embodiment configuration of present technique.

Figure 44 B is the sectional view that shows the cooling package among Figure 44 A.

Figure 44 C is the profile diagram that shows the cooling package among Figure 44 A, and wherein shaped component is retracted.

Figure 45 A is the profile diagram that shows according to the cooling package of the balloon with a plurality of heteroid elongations of embodiment configuration of present technique.

Figure 45 B is the sectional view that shows the cooling package among Figure 45 A, and wherein cooling package extends to the first sectional dimension.

Figure 45 B-1 is the sectional view that shows the amplification of the division among Figure 45 B.

Figure 45 C is the sectional view that shows the cooling package among Figure 45 A, and wherein cooling package extends to the second sectional dimension greater than the first sectional dimension.

Figure 46 is the profile diagram that shows according to the cooling package of the balloon with a plurality of heteroid elongations of another embodiment configuration of present technique.

Figure 46-1 is the sectional view that shows the amplification of the division shown in Figure 46.

Figure 47 is the profile diagram that shows according to the cooling package with the main balloon of helical form of embodiment configuration of present technique, and wherein main balloon wraps up less important balloon.

Figure 48 A is the profile diagram that shows according to the cooling package with the main balloon of helical form in less important balloon of embodiment configuration of present technique.

Figure 48 B is the sectional view that shows the cooling package among Figure 48 A.

Figure 49 is the profile diagram that shows according to the cooling package with the main balloon of helical form that twines less important balloon of another embodiment configuration of present technique.

Figure 50 is the profile diagram that shows according to the cooling package with the main balloon of helical form that twines less important balloon of another embodiment configuration of present technique.

Figure 51 is the profile diagram that shows according to the cooling package with the main balloon of helical form that twines less important balloon of another embodiment configuration of present technique.

Figure 52 A is the profile diagram that shows according to the distal portions of the cold therapy equipment that comprises cooling package and obstruction component of embodiment configuration of present technique.

Figure 52 B is the sectional view that shows the distal portions among Figure 52 A.

Figure 53 is the sectional view that shows according to the distal portions of the cold therapy equipment that comprises cooling package and obstruction component of another embodiment configuration of present technique.

Figure 54 is the sectional view that shows according to the cooling package of embodiment configuration of present technique, and this cooling package can need not the circulation that phase transformation namely is used for cold-producing medium.

Figure 55 is the sectional view that shows according to the cooling package of another embodiment configuration of present technique, and this cooling package can need not the circulation that phase transformation namely is used for cold-producing medium.

Figure 56 is that sympathetic nervous system (SNS) and brain are the conceptual illustration how to communicate with health by sympathetic nerve, and wherein each figure notation is: 7-eyes, 8-lachrymal gland, the 9-submaxillary gland, 10-sublingual gland, the 11-parotid gland, the 12-heart, 13-larynx trachea and bronchus, 14-lung, the 15-stomach, 16-small intestinal, 17-abdominal vascular, the 18-liver, 19 gallbladders, 20 bile ducts, 21-pancreas, 22-adrenal medulla, 1-kidney, the 23-colon, 24-rectum, 25-bladder, 26-sexual organ and external genitalia, 27-ciliary ganglion, 28-ganglion pterygoplatinum, the 29-maxillary ganglion, 30-otoganglion, 31-carotid artery and clump, the 32-ganglia coeliaca, the 33-greater splanchnic nerve, 34-internal organs pin is neural, 35-dorsal mesentery neuroganglion, 36-mesenterium ventrale neuroganglion, 37-sympathetic chain, the 38-pelvic nerve, the upper cervical ganglia of 39-, cervical ganglia among the 40-, cervical ganglia under the 41-, the 42-midbrain, 43-bone marrow, 44-spinal cord.

Figure 57 be make that left kidney innervates to form around the amplification internal anatomy of the nerve of the kidney clump (plexus) of left renal artery, wherein each figure notation is: 45-aortic nerve joint, the 46-large artery trunks, the intrathoracic visceral never of 47-, the 48-adrenal gland, 2-renal artery (RA), 1-kidney, 49-kidney clump (RP), the 50-ureter.

Figure 58 A and 58B are respectively internal anatomy and the conceptual illustration of human body, have described nerve between brain and the kidney and have imported into and spread out of, and wherein each figure notation is: the 51-brain, the 52-spinal cord, 53-Renal efferent nerve signal, 2a '-left renal vein, the left kidney of 1a-, the right kidney of 1b-, 2b '-vena renalis dextra, 54-kidney nervus centripetalis signal, the 12-heart, 55-CNS is integrated, 56-kidney nervus centripetalis, 57-Renal efferent nerve; Among Figure 58 B, I represents that smooth muscle flesh is moving, vasoconstriction, arteriosclerosis; II represents hypertrophy, arrhythmia, ischemia, heart failure; III represents renal ischemia, and stroke volume descends, and adenosine rises; IV represents the sodium retention rising, RAAS, and the sympathetic gain of system, sodium retention is risen, hypervolemia, wall hardness, the RBF of reduction descends, and albuminuria rises, and BNP resists rising.

Figure 59 A and 59B are respectively the arterial vessel of human body and the internal anatomy of vein vascular, wherein Figure 59 A represents arteries, and each figure notation is: 12-heart, 2a-left renal artery, the left kidney of 1a-, 4a-left ilium tremulous pulse, 6a-left femoral artery, 6b-right femoral artery, 4b-ILR tremulous pulse, the 46-large artery trunks, the right kidney of 1b-, 2b-right renal artery; Figure 59 B represents vein blood vessel, and each figure notation is: the 12-heart, and 2a '-left renal vein, the left kidney of 1a-, 4a '-left ilium vein, 6a '-left femoral vein, 6b '-right femoral vein, 4b '-ILR vein, 46 '-postcava, the right kidney of 1b-, 2b '-vena renalis dextra.

The specific embodiment

The selected embodiment of kidney refrigeration system

Fig. 1 figure has released the cold therapy system 100 according to some embodiment configurations of present technique.Cold therapy system 100 can comprise operation bench 102 and freezing equipment 120.In the embodiment shown in fig. 1, operation bench 102 comprise in supply container 104, the supply container 104 cold-producing medium 106 and with supply container 104 between become fluid to be communicated with supply control valve 108.Supply container 104 can be disposable container or comprise the larger container that deal is enough to carry out the cold-producing medium 106 of Repeated Operation.For instance, larger supply container can be the cylinder that can refill.Supply container 104 is configured to preserve cold-producing medium 106 with required pressure.For example, in one embodiment, liquid N ₂O is included in the supply container 104 with 750 pound per square inches (psi) or higher pressure, so it is fluid state at ambient temperature at least substantially.In other embodiments, cold-producing medium 106 can comprise carbon dioxide, hydrofluorocarbon (" HFC ", for example Freon

R-410A, etc.) and/or other suitable compressed or concentrated cold-producing medium, this cold-producing medium can be remained on take sufficiently high pressure in the supply container 104 so that this cold-producing medium 106 keeps at least substantially being fluid state (for example, being about 210psi for R-410A) at ambient temperature.

Supply control valve 108 is coupled to the supply line 110 that is configured to cold-producing medium 106 is transported to freezing equipment 120.Supply control valve 108 can be by artificial or automatic operation.Operation bench 102 can comprise pump 111 alternatively, for example vacuum pump or direct current (DC) power pump and/or back-pressure control valve 113, and it is coupled to the discharge line 115 that is configured to receive from the discarded cold-producing medium 117 of freezing equipment 120.Pump 111 can reduce the back-pressure of the cold-producing medium of vaporization, and, in conjunction with the supply flowing velocity, improve refrigeration work consumption.In other embodiments, the cold-producing medium 117 of expansion can be vented to environmental stress.

Operation bench 102 may further include optional controller 118, controller 118 operation supply control valve 108 and back-pressure control valves 113.Controller 118 for instance, can be processor or the special circuit of realizing for the computerized algorithm of automatically performing the operation.Operation bench 102 can also comprise optional reception user input and/or the user interface of information is provided and/or be used for monitoring the circuit of optional sensor (for example, pressure or temperature) to the user, if there is in freezing equipment 120.In one embodiment, controller 118 operation back-pressure control valves 113 are controlled the negative pressure amount that is applied to the discarded cold-producing medium 117 that returns from freezing equipment 120.This back-pressure of having regulated the cold-producing medium of vaporizing is with the temperature in the control cold therapy equipment 120.In another embodiment, supply control valve 108 and/or back-pressure control valve 113 can be used for strengthening the back-pressure of discarded cold-producing medium 117.The back-pressure that increases discarded cold-producing medium 117 can improve the boiling point of cold-producing medium.For example, at N ₂In the example of O, back-pressure is elevated to 2 atmospheric a little increase meetings so that boiling point from approximately-88 ℃ rising to approximately-75 ℃, is elevated to 3 atmospheric pressure with back-pressure and makes the elevation of boiling point to approximately-65 ℃ from 1 atmospheric pressure.

In certain embodiments, cold therapy system 100 also can carry out pre-cooling to cold-producing medium 106, thereby before cold-producing medium 106 arrives cooling system, for cold-producing medium 106 provides more powerful refrigeration work consumption.For instance, system 100 can comprise the precooler 119 (being shown dotted line) in the operation bench 102.In other embodiments, system 100 can comprise along the precooler of supply line 110, and it is positioned at the handle at the proximal end region place of system 100, or is positioned at other place of being coupled to freezing equipment 120.

Freezing equipment 120 comprises bar 122, and bar 122 has proximal part 124, is positioned at the handle 125 of the proximal end region of this proximal part 124, and the distal portions 126 that distad extends with respect to proximal part 124.Freezing equipment 120 may further include the cooling package 130 on the distal portions 126 of bar 122.Bar 122 is configured to described distal portions 126 is positioned at treatment position near near (for example, therein or it) renal artery or nephrostome in blood vessel, and cooling package 130 is configured to provide medicable freezing kidney-neuroregulation.

Fig. 2 A (for example is in sending state for showing, low profile or collapsed configuration) the distal portions 126 of bar 122 and the sectional view of the amplification of cooling package 130, Fig. 2 B is the sectional view of the amplification of the cooling package 130 that is in deployed condition (for example, the configuration of expansion).In the embodiment shown in Fig. 2 A, the distal portions 126 of bar 122 can comprise the first district 127a, and the Second Region 127b (being separated by broken broken line) that caves inward with respect to the first district 127a.The first district 127a and Second Region 127b can be divided by ladder 128, and ladder 128 is notch (for example, being configured to cooperate annular or other circumferential groove of another member) for example.The first district 127a correspondingly can have the first external dimensions or the first sectional dimension (for example, area or diameter), and Second Region 127b can have the second external dimensions or the second sectional dimension less than first size.Bar 122 can be sized to be installed in the sheath 150 of 8Fr or less (for example, the lead sheath of 6Fr) to adapt to little renal artery.

Freezing equipment 120 can also comprise along the supply pipe of at least a portion of bar 122 or chamber 132 and discharge pipe or chamber 134.Supply chamber 132 can be for being configured under high pressure cold-producing medium be remained on the tubule of fluid state.The internal diameter in supply chamber 132 is selected to be fluid state so that arrive at least a portion of the cold-producing medium of cooling package 130 at far-end 135 places in supply chamber 132.Discharge side 134 can be outer tube, and supply chamber 132 can be along at least distal portions 126 extensions of bar 126 in discharge side 134.To be described in further detail ground as following, some embodiment of freezing equipment 120 may further include the one or more sensors 138 that are coupled to controller 118 (Fig. 1) by lead-in wire 139, for example temperature sensor or pressure transducer.In some embodiment, cold therapy system 100 can be configured to the suitable calibration of test sensors 138 before cold therapy.For example, cold therapy system 100 can its begin one start circulation time automatically with temperature sensor measurement to measurement temperature and room temperature compare, whether work well with the inspection temperature sensor.

The embodiment of the cooling package 130 shown in Fig. 2 A and the 2B can have applicator 140, it comprise balloon or other type definition be configured to the expandable members of the expansion chambers of complete closed renal artery or nephrostome.Balloon 142 can be relatively short (for example, 10mm or shorter) (for example to adapt to arteriorenal length and bending, between the 4-6cm), and can in the expansion configuration, have enough large diameter so that it is enough to touch the major part (for example, diameter is between 3-10mm) on arteriorenal interior week.In following other embodiments, balloon can be configured to only partly seal renal artery or nephrostome.Balloon 142 can comprise the combination of flexible material, non-flexible material and/or flexible and non-flexible material.In various embodiments, for example, balloon 142 can be by polyurethane and/or other flexible or half flexible material make, these materials can expand and the blood vessel of showing the complete closed various sizes with blood vessel wall one (for example, vessel diameter is from about 3mm to about 10mm, or in application-specific from about 4mm to about 8mm).In other embodiments, balloon 142 can be made by nylon and/or other non-flexible material, and its size is determined to adapt to the blood vessel in the concrete size range.For example, the nylon balloon of inflexibility can be sized to adapt to and have approximately 3mm to the about blood vessel of 6mm internal diameter, and the size of larger inflexibility nylon balloon can be determined to adapt to and has the approximately blood vessel of 7mm to 10mm internal diameter.

In Fig. 2 A and the illustrated embodiment of 2B, the distal portions of balloon 142 is not connected to supporting mechanism's (for example, supply chamber 132 and/or other support), and can therefore be pressed down mould and/or otherwise form and have continuous distal portions.The continuous distal portions of balloon 142 provides mild surface, contacts blood vessel wall to avoid tearing, pierce through and/or injured blood vessel wall otherwise with this surface.In addition, the cooling package 130 shown in Fig. 2 B can have the shorter overall length of balloon that connects than far-end, and it can be conducive to location cooling package 130 in shorter blood vessel (for example, length is 6cm or shorter renal artery).

Cooling package 130 may further include with expansion chambers between the aperture 144 that is communicated with of fluid.In one embodiment, aperture 144 can be determined by the far-end of the capillary tube 146 in the far-end 135 that is inserted into supply chamber 132.Mode is supplied the opening at far-end 135 places in chamber 132 and can be determined the aperture as an alternative.The diameter in capillary tube 146 and/or aperture 144 can be less than supply chamber 132, to hinder near the flowing of the cold-producing medium of expansion chambers, increases thus the pressure drop of the cold-producing medium 106 that enters expansion chambers and converges cooling capacity at cooling package 130 places.In other embodiments, supply chamber 132 can have substantially invariable internal diameter (for example, 0.008 inch (0.203mm), 0.009 inch (0.023mm), 0.010 inch (0.254mm) etc.), so the minimum equal diameters with supplying chamber 132 of the diameter in aperture 144.Cold therapy equipment 120 may further include in handle 125 (Fig. 1) and/or the operation bench 102 (Fig. 1) extra hardware (for example, valve, flow velocity and pressure gauge, Deng) and/or software, pass through the flow velocity of the cold-producing medium 106 in supply chamber 132 in order to control, and the distal portions 126 of refrigeration work consumption to bar 122 converged.

The size in aperture 144 can be determined with respect to area and/or the length of the discharge side 134 at distal portions 126 places of bar 122, so that enough cold-producing medium flow velocitys to be provided, in expansion chambers, produce enough pressure drops, and allow to discharge fully discarded cold-producing medium 117 by discharge side 134.In one embodiment, the diameter in aperture 144 can be about 0.003 inch (0.076mm) or larger, for example approximately 0.004 inch (0.101mm) to approximately 0.009 inch (0.229mm).In different embodiment, the ratio of the sectional area in the internal diameter of discharge side 132 and/or sectional area and/or aperture 144 can be greatly between 4: 1 to 10: 1.For example, the internal diameter of discharge side 132 can be at approximately 0.030 inch (0.762mm) and approximately between 0.050 inch (1.27mm), and the diameter in aperture 144 be approximately 0.003 inch (0.0762mm) to about 0.008 inch ((0.203mm; For example, 0.004 inch (0.101mm)).In other embodiments, discharge side 134 and aperture 144 can have other suitable size.In a further embodiment, bar 122 (for example can comprise the extra chamber that extends through the there or equipment, pressure induction cavity, extra fluid passage, etc.) and the ratio of the occupied total sectional dimension of the sectional dimension of discharge side 132 and other member in supply chamber and/or the bar 122 can be approximated to be 4: 1 and 10: 1.

Can also control by changing supply chamber 132 and capillary tube 146 length relative to each other the flow velocity of coolant 106.For example, in certain embodiments, the length of capillary tube 146 can be at most 1/3 of supply chamber 132 length.In various embodiments, the length of capillary tube 146 can be between 2 inches (5.08cm) and 30 inches (76.2cm) and the size in supply chamber 132 can correspondingly determine.In other embodiments, capillary tube 146 is shorter or longer than supply chamber 132, and/or capillary tube 146 can be omitted.

When sending in the configuration shown in Fig. 2 A, cooling package 130 is passed to the target site T in the blood vessel V in blood vessel.With reference to Fig. 2 B, cooling package 130 and sheath 150 are then relatively moved so that cooling package 130 surpasses sheath 150 to remote extension.For example, can draw sheath 150 and/or push away cooling package 130 to far-end to near-end.In operation, cold-producing medium 106 by aperture 144, and enters the expansion chambers that is defined by balloon 142 by supply chamber 132.When cold-producing medium 106 by aperture 144, its expansion enters gas phase (gaseous phase), makes thus balloon expansion and causes significant hypothermal in the expansion chambers.The part of the tissue at contact target T place can be conduction of heat scope 149 or heat conduction area on the applicator 140, and its cold-producing medium 106 in expansion chambers causes medicable freezing kidney-neuroregulation.Discarded cold-producing medium 117 passes discharge side 134 at proximal direction.In various embodiments, the length of bar 122 can be minimized to reduce to flow through the loss (for example, frictional dissipation) of the cold-producing medium of supplying chamber 132 and discharge side 134, improves thus the efficient of refrigeration work consumption and cooling package 130.For instance, the discharge that the extra frictional dissipation meeting that is caused by longer discharge side suppresses to discard cold-producing medium 117, and pressure and temperature in the balloon 142 that raises thus.Therefore, bar 122 can be configured to have overall length less than 90cm (for example, 80cm to 85cm, 70cm to 80cm, etc.).In other embodiments, bar 122 can be longer and/or be comprised that extra feature is to strengthen the refrigeration work consumption of cooling package 130.

The embodiment complete closed of the cooling package 130 shown in Fig. 2 A and the 2B blood vessel V, and produce the treatment of full circle week at target site T and (also be, the continuous scope blood vessel V that is cooled whole interior Zhou Yanshen planar, this plane is horizontal or vertical with respect to the length direction of the blood vessel V on the T of position).Fully sealing blood vessels V has limited the heating of blood to heat conduction scope 149, so that the cooling capacity of cold-producing medium more effectively acts on target T.Although the kidney blood vessel is closed with the ischemia that may cause kidney excessively for a long time, have been found that renal blood flow can enough be carried out fully freezing (for example, 2-5 minute) to target T by the time of complete closed.Controller 118 (Fig. 1) can be programmed with electronics or mechanical timer and come time (for example, 2-5 minute) of valve being controlled to limit flow of refrigerant.Mode as an alternative, timer can be integrated in the handle 125 (Fig. 1) or other parts of cold therapy equipment 120.If exist, sensor 138 can provide feedback to regulate or control system 100 to controller 118.In certain embodiments, may need the control algolithm full automation, but in other embodiments, the treatment user input of carrying out.In a further embodiment, the flowing time of cold-producing medium can be limited by the capacity of the cold-producing medium in the supply container 104.As hereinafter introducing more in detail, in other embodiments, cooling package 130 can be configured to partly seal blood flow.

In various embodiments, sensor 138 can be the thermocouple on the outer surface that places balloon 142, and is configured to provide the real time temperature reading of the external temperature of balloon 142.Therefore, can pass through controller 118 (for example, using the software control circulation) and regulate cold therapy system 100, so that it based on real-time outer balloon temperature and predetermined treatment temperature (for example,-40 ℃ ,-60 ℃, etc.) between difference come the output of oblique ascension or oblique deascension cooling power.For example, can respond the temperature that records comes at the stages of cold therapy valve (for example, supply control valve 108 and/or back-pressure control valve 113) to be opened or closed to regulate cooling power output.In other embodiments, can usage ratio control to regulate cooling power output, wherein the flow velocity of the conveying pressure of cold-producing medium 106 and/or vacuum pump 111 can respond the outer balloon temperature that records and change.Therefore, the external heat galvanic couple allows cold therapy system 100 that the variable of the cooling that affect target site T is compensated, and above-mentioned variable is the variation, the variation that the blood flow that flows through tremulous pulse changes and/or flow through near the blood flow of other blood vessel of renal artery of artery diameter for example.

Fig. 2 C-2E is the sectional view according to the amplification of the distal portions 126 of the cold therapy equipment 120 of other embodiment configurations of present technique.With reference to Fig. 2 C, the distal portions 152 of balloon 142 can be connected to distal connector 162 by heat bonding, binding agent and/or other suitable connection mechanism.Distal connector 162 can have shown in Fig. 2 C crooked, the tip of bullet shaped, but or be configured to be provided for tip by the antisitic defect of vascular system guiding.

In illustrated embodiment, cold therapy equipment 120 further comprises guidewire lumen 133a, and wire 133b can pass through vascular system by the distal portions that this guidewire lumen 133a is received with guide rod 122.In the illustrated embodiment of Fig. 2 C, on line in (OTW) configuration, guidewire lumen 133a from the proximal open that is positioned at adapter 201 of bar 122 (for example, at handle shown in Figure 1 125 places) extend through whole bar 122 to the distal openings of crossing bar 122, and in the illustrated embodiment of Fig. 2 E, in exchange (RX) configured fast, guidewire lumen 133a only extended through the part of bar 122.Although the near-end of guidewire lumen 133a extends through the sidewall of bar 122 at distal portions 126 in Fig. 2 E, in other embodiments, the near-end of guidewire lumen 133a all can approach at the near-end of bar 122 and any position between the far-end.Guidewire lumen 133a shown in Fig. 2 C-2E or its distortion can be included among each embodiment that this paper introduces so that the guiding in vascular system.It is 545 that suitable OTW and RX conductor configurations are disclosed in the patent No. of submitting on October 27th, 1994,134 United States Patent (USP), the patent No. that submit to May 23 nineteen ninety-five is 5,782,760 United States Patent (USP), the publication number of submitting to August 23 calendar year 2001 is that 2003/0040769 United States Patent (USP) is open, and the publication number of submitting on October 17th, 2006 be 2008/0171979 United States Patent (USP) open in, wherein each its integral body is incorporated the application by reference into.

The embodiment that Fig. 3 A figure has released with system 100 comes low temperature to regulate the kidney nerve.Cold therapy equipment 120 provides the entrance that leads to the kidney clump by path P in the blood vessel that leads to corresponding renal artery RA.As shown in the figure, one section of the proximal part 124 of bar 122 is exposed to outside the patient body.By the proximal part 124 of path P in blood vessel with external control lever 122, the care-giver can (for example pass through the interior path P of crooked blood vessel by catch bar 122, by femoral artery or radial artery) and remote control distal portions 126 (for example, with the actuator in the handle 125).For example, bar 122 may further include one or more backguys or other guiding device passes through vascular system to be used for guiding distal portions 126.Image-guided, for example computed tomography (CT), radiography, intravascular ultrasonic imaging (IVUS), optical coherence tomography (OCT) or other suitable guiding form, or its combination, the operation that can be used for helping the care-giver.After cooling applicator 140 suitably places renal artery RA or nephrostome, can use operation bench 102 (Fig. 1), handle 125 (Fig. 1), and/or other device expands or launches cooling applicator 140, until the inwall of applicator 140 contact renal artery RA.To be used to organize to bring out the neuroregulation effect of the one or more needs on the adjacent domain of regional area on the renal artery and kidney clump from the autotelic application of the refrigerating capacity of applicator 140, described kidney clump is positioned among the described arteriorenal tunica adventitia of artery, adjacent with described arteriorenal tunica adventitia of artery, or very approaching with described arteriorenal tunica adventitia of artery.The autotelic application of neuroregulation effect can realize along the neuroregulation of all or part kidney clump.

The neuroregulation effect substantially be applicator 140, applicator 140 at least in part with blood vessel wall between contact, the quantity (for example, by the one or more cooling cycles that add thermoperiod and separate) of idle hours, the cooling cycle of applicator and the function that passes through the blood flow of blood vessel when cooling off.The cooling effect that needs can comprise applicator is cooled off so that the temperature of target neural fiber is lower than required threshold value to realize low temperature alteration (cryo alteration) or to melt (ablation).For example, the refrigerant gas in the applicator 140 can be cooled to approximately-88 ℃ to about-60 ℃ temperature, perhaps in other embodiments, the temperature of the gas in the applicator 140 can for-80 ℃ to approximately-40 ℃.

In each embodiment, neuroregulation effect volume can occur in 100 seconds that chilled applicator 140 put in one or more cooling cycles renal artery RA or kidney clump (for example, 90 seconds, 75 seconds, 60 seconds, 30 seconds etc.).In one embodiment, this process can comprise two by the cooling cycle that adds thermoperiod and separate, but in other embodiments, the quilt that this process can have more than two adds the cooling cycle that thermoperiod separates.The length of cooling cycle can be identical or different, and for example each was from about 10 seconds to about 90 seconds.The length that adds thermoperiod can be enough to partly or entirely dissolve the material that freezes on the cooling contact surface.In some embodiment, the length that adds thermoperiod can be from approximately 5 seconds to approximately 90 seconds.Between cooling cycle each adds thermoperiod can continue identical time or different time.Cooling cycle can pre-determine and be programmed for algorithm with the length that adds thermoperiod, and perhaps this system can comprise the automatic control algorithm that uses feedback control loop, and this feedback control loop is based on temperature on the balloon exterior face and/or balloon interior and/or pressure.For example, control algolithm can estimate that the material that freezes fully melts based on pressure and/or temperature survey, thereby stops adding thermoperiod and beginning to cool down the cycle.The quantity and the length that depend on the cooling cycle, from (for example launching cooling package 130, shown in Fig. 2 B) can shorter than 5 minutes (for example, short than 3 minutes) to the total operating time that cooling package is recovered to sending state (for example, shown in Fig. 2 A).After two renal artery RA all handle, from cooling package 130 being deployed in the first renal artery RA, to reorientation, expansion in the second renal artery and regain cooling package 130, can less than 12 minutes (for example, 10 minutes, 6 minutes, etc.).In certain embodiments, can be by applicator 140 being set to the whole circumference (for example, along same plane or along laterally spaced parallel plane) around renal artery RA, and in single application, carry out neuroregulation to shorten operating time.In other embodiments, applicator 140 can act on the whole circumference that is less than renal artery RA and/or act on more than in one the application.

Fig. 3 B is that figure has released with according to described above with reference to Fig. 1-3A or come low temperature to regulate the block diagram of the method 300 of kidney nerve according to the system 100 of another following suitable embodiment of present technique.In the lump with reference to Fig. 1-3B, method 300 can be included in renal artery or the nephrostome (frame 305) and cooling package 130 is set to sending state (for example, shown in Fig. 2 A) in blood vessel.Cold therapy equipment 120 and/or the part on it (for example, cooling package 130) can be inserted into guide catheter (for example, the sheath shown in Fig. 2 A-2C 150) so that the endovascular delivery of described cooling package 130.In certain embodiments, for example, cold therapy equipment 120 can be configured to be installed in 8FR or the less guide catheter (for example, 7Fr, 6Fr, etc.) with near little external perihaemal canal.Enter the above, OTW or RX wire also can be used for controlling and promote the control to bar 122 and cooling package 130.

Method 300 may further include cold therapy equipment 120 is connected to operation bench 102 (frame 310), and the expansible assembly (for example, balloon 142) that partly or entirely makes cooling package 130 expands to determine whether cooling package 130 is in the tram (frame 315 and 320) on the target site.Can through supply chamber 132 by from the cold-producing medium of the supply container 104 at operation bench 102 places and/or from described distensible assembly between other suitable fluid (for example, air) of the second fluid supply bin that is communicated with of fluid make described expandable members expansion.If cooling package 130 is not in the desired position, at least some pressure in the expandable members can be released (frame 325).In certain embodiments, for example, can disconnect by making cold therapy equipment 120 and operation bench 102, and described expandable members manually be exitted through the proximal part of bar 122 with syringe, thereby expansible assembly is exitted up hill and dale.In other embodiments, cold therapy equipment 120 can keep being connected in operation bench 102, and syringe can connect along the length direction of bar 122, and (for example, piston injector) is next exits to this expandable members.In a further embodiment, the controller 118 at operation bench 102 places can comprise the algorithm of partly or entirely exitting for to described expandable members.In embodiment further, can cooling package 130 be positioned target site with the impenetrable labelling of ray and/or sign.

In case cooling package 130 suitably places the first renal artery or its nephrostome, can operate the cooling that operation bench 102 starts cooling package 130 places, the part or all of denervation (frame 330) of kidney nerve to cause kidney regulated in described cooling.Sub-cooled can be along one or more positions one or more cycles of effect of the circumference of the first renal artery or the first nephrostome and/or length (for example, to 30 seconds increments, 60 seconds increments, 90 seconds increments, etc.).In certain embodiments, for example, can use two cycles of 90 seconds.In each embodiment, expandable members can keep all or part of expansion between the cooling cycle position of cooling package 130 is remained on target site.

After first arteriorenal kidney-neuroregulation, method 300 may further include and makes the expandable members venting and cooling package 130 is recovered to sending state (frame 335).Can be by cold therapy equipment 120 be separated and the equipment connection that detaches that syringe or other is suitable manually described expandable members 120 exits to the near-end of bar 122 from operation bench 102.In other embodiments, syringe can connect along the length of bar 122 and cold therapy equipment 120 not separated from operation bench 102, and perhaps expandable members can be by automatically venting (for example, via controller 118).In certain embodiments, after expandable members was deflated, cooling package 130 may be withdrawn in the guide catheter.Alternatively, cooling package 130 can be in reorientation and is stored in aseptic position (for example, in saline) time temporarily and is removed from guide catheter.

Then, cooling package 130 can be positioned to (frame 340) in the second renal artery or the second nephrostome, and expandable members can be expanded to the position (frame 345) of consolidating cooling package 130.In the embodiment that selects, contrast medium can be distally given to send above cooling package 130 and fluoroscopy and/or other imaging technique that is fit to and can be used to locate the second renal artery.If necessary, supply container 104 in the used operation bench 102 can heavily be filled out or be removed and (for example be replaced with new supply container, disposable cold-producing medium cylinder), come to provide enough cold-producing mediums for the kidney-neuroregulation at the second renal artery or the second nephrostome place.Those operation bench 102 in the repositioning process of cooling package 130 by the embodiment that separates from cold therapy equipment 120, operation bench 102 can be reconnected to cold therapy equipment 120, cools off to finish the kidney-neuroregulation (frame 350) at the second renal artery or the second nephrostome place so that method 300 continues application of cold temperature.

In other embodiments, each step of method 300 can be modified, omits and/or add extra step.For example, operation bench 102 can be opened and load and be in the outer supply container 104 of sterile field that carries out cold therapy, and places sterile bag or shell, so that it can be brought in this sterile field.If supply container 104 must be reloaded or heavily fill out in the cold therapy process, operation bench 102 can be removed from sterile field, reloads, and is put back on (for example, in sterile bag or shell) in the sterile field again.In other embodiments, empty supply container 104 can remove and throws aside around the sterile bag or shell of operation bench 102 from operation bench 102, new supply container can be connected to operation bench 102 in described sterile bag or shell, so operation bench 102 does not leave sterile field in therapeutic process.In a further embodiment, operation bench 102 can remain on the outer also operated from a distance of sterile field.

Fig. 4 A is the sectional view according to the amplification of the distal portions 426 of the cold therapy equipment 420 of another embodiment configuration of present technique.This cold therapy equipment 420 comprise with above with reference to the basic similarly feature of the feature of the described cold therapy equipment 120 of Fig. 1-3B.For example, cold therapy equipment 420 comprises the bar 122 of elongation, and extend along at least a portion of bar 122 in supply and eliminating chamber 132 and 134, and cooling package 130 is positioned at the distal portions 426 of bar 102.Cooling package 130 comprises expandable members, the expandable members that is fit to of balloon 142 or other for example, and it has determined at least a portion of expansion chambers and has received via aperture 144 at least substantially to be the cold-producing medium 106 of gas phase.

In illustrated embodiment, the distal portions 452 that the far-end 135 in supply chamber 132 is coupled to balloon 142 to provide extra support and/or control for cooling package 130, and aperture 144 is the opening (for example, being not far-end 135 or the end capillaceous that is in supply chamber 132) of arranging along the length in supply chamber 132.Can use binding agent (for example, thermal), securing member and/or the adhesion mechanism that other is fit to known in the art that the distal portions 452 of supply chamber 132 and balloon 142 is linked together.In other embodiments, supply chamber 132 can end at expansion chambers or wherein, and/or cold therapy equipment 420 may further include the support member (not shown), and this support member extends to the distal portions 452 of balloon 142 at least from bar 122.

Shown in Fig. 4 A, cold therapy equipment 420 may further include the adapter 454 of the proximal part that is positioned at balloon 142, and it can be connected the top of the distal portions 426 of bar 122, and thus balloon 142 is coupled to bar 122.Adapter 454 can be by the proximal part of balloon 142 (for example, the cervical region of balloon 142) definition, shown in Fig. 4 A, described proximal part and described expansible part one, perhaps, described adapter 454 can be for being independent of and being different from the parts of balloon 142, for example the axle collar or other keeper that is fit to.Adapter 454 can be thermally bonded, binding agent, chain surface (for example, line), friction is fixing, the attachment mechanism that interlock is fixed, suction and/or other are fit to is connected to the distal portions 426 of bar 122, and perhaps adapter 454 can be integrally formed with distal portions 426.

In illustrated embodiment, adapter 4545 is placed close to ladder 128 and above the second area 127b of the distal portions 426 of bar 122.Shown in Fig. 4 A, the first area 127a of distal portions 426 can have the first outer cross section size or diameter OD ₁And second area 127b can have the second outer cross section size or diameter OD ₂, it is less than the first outer cross section size OD ₁The external dimensions of distal portions 426 reduces to have formed caving inward with respect to first area 127a ladder 128 places, the proximal part of the expansible part of at least a portion of described adapter 454 and described balloon 142 can be arranged in described depression, reduces thus the profile of the distal portions of bar 122.In certain embodiments, the size of ladder 128 can be determined so that the outer surface 455 of first area 127a is at least basically concordant with the outer surface 457 of adapter 454.Therefore, the external diameter OD of second area 127b ₂Can equal the external diameter OD of first area 127a ₁Deduct the thickness of 2 times adapter 454.In other embodiments, the external diameter OD of second area 127b ₂Can be greater than or less than 2 times of adapter 454 thickness.

In the embodiment that selects, adapter 454 is not expansible, so when cooling package 130 moved to deployed condition (for example, shown in Fig. 4 A), adapter 454 remained in the depression and/or substantially and flushes with the outer surface 455 of first area 127a.In other embodiments, adapter 454 can be distensible and when cooling package 130 moves to deployed condition increasing section long-pending.

In the embodiment shown in Fig. 4 A, discharge side (for example, determined by the inner surface of bar 122) sectional area also reduce at the transition position of first area 127a and second area 127b, so the distal portions 426 of bar 122 has the first inner section size or diameter ID at first area 127a place ₁And at less the second inner section size or the diameter ID at second area 127b place ₂Cause the pressure in the expansion chambers to raise for fear of the insufficient discharge by neck formula discharge side 134, second area 127b can only place the distal-most end near the bar 122 of expansion chambers, and discarded cold-producing medium 117 density are the highest there.For example, second area 127b can have 4cm or shorter length (for example, 2cm, 1cm, etc.).Discarded cold-producing medium 117 is also discharged by the less inner diameter, ID 2 of second area 127b and is not subjected to excessive restriction, because second area 127b can be quite short along the length of the longitudinal axis of bar 122.For example, the length of second area 127b can minimize, with abundant matching connector 454.Therefore, the less discharge chamber 134 at second area 127b place can mainly transport highdensity discarded cold-producing medium 117, and it is driven can reduce in discarded cold-producing medium 117 density the time and send the larger discharge side 134 that is positioned at first area 127a to, be convenient to thus the second less inner diameter, ID via second area 127b ₂Suitably aerofluxus.

In operation, the second area 127b that caves inward can reduce bar 122 distal portions 426 profile and/or 454 roughly level and smooth transition is provided from bar 122 to adapter, and can not jeopardize the discharge characteristic of discharge side 134.The distal portions 426 of the low profile of bar 122 also helps fluid contrast medium between bar 122 and the sheath 150 from proximal part 124 (Fig. 1) the sending to distal portions 426 of bar 122, described contrast medium at sending state (for example, shown in Fig. 2 A) in around cooling package 130 the target in the vascular system is carried out imaging and location (for example, use fluoroscopy).Shown in Fig. 4 A, for example, the second area 127b of depression provides around one or more paths or the channel C of the distal portions 426 of bar 122, and it enough surmounts cooling package 130 in order to send the comparison agent to far-end greatly, and the adapter that can not be highlighted or balloon retardance.In certain embodiments, can be at the first and second corresponding regional 127a and the first external diameter OD of 127b ₁With the second external diameter OD ₂Difference be that contrast medium forms enough channel C during less than 0.01 inch (0.254mm).In other embodiments, the external dimensions OD of the first and second regional 127a and 127b ₁And OD ₂Difference can be greater or lesser.After using in kidney-neuroregulation process, the first renal artery can surmount cooling package 130 and locates by send contrast medium through channel C to far-end under sending state.After the kidney-neuroregulation at the first renal artery place, cooling package 130 can be retracted to sending state from deployed condition, wherein can send extra contrast medium to far-end through channel C and surmount cooling package 130 to locate the second renal artery.

In other embodiments, the distal portions 426 of bar 122 does not comprise the discharge side 134 that progressively lowers shown in Fig. 4 A, and the ground that replaces can have substantially unified sectional dimension.Such discharge side can adapt to guidewire lumen (for example, shown in Fig. 2 C-2E) relatively like a cork, thereby wire can extend by this guidewire lumen cooling package 130 is positioned at target site T in the blood vessel V.In this embodiment, after wire is contracted, can send the contrast medium that carries out imaging for to target site (for example, two renal artery) to far-end through guidewire lumen.

Fig. 4 B is the sectional view according to the amplification of the distal portions 456 of the cold therapy equipment 460 of another embodiment configuration of present technique.Described cold therapy equipment 460 comprises and above is combined the basic similarly feature of feature of the described cold therapy equipment 460 of Fig. 4 A.For example, the distal portions 456 of bar 122 has ladder 128, and the second area 127b that described ladder 128 is less with first area 127a and divides and comes.But in the embodiment shown in Fig. 4 B, second area 127b is by being determined from bar 122 outstanding independent pipes 459.Be similar to the progressively inside part of the bar 122 shown in Fig. 4 A, pipe 459 is at the sectional areas of second area 127b reduction discharge side 134.

Shown in Fig. 4 B, cold therapy equipment 460 may further include the proximal connector 458 that balloon 142 is connected to the distal portions 456 of bar 122.Unlike the adapter 456 shown in Fig. 4 A that substantially is arranged in the depression that is formed by ladder 128, the proximal connector 458 shown in Fig. 4 B extends to the outer surface 455 of first area 127a above second area 127b.By above the 127a of first area, extending proximal connector 456, increased the surface area that can be used for balloon 142 is connected to the distal portions 456 of bar 122.Therefore, can shorten the length of second area 127b so that the competent neck shape discharge side 134 (for example, shown in Fig. 4 A and 4B) that passes through comes discharging refrigerant 117.

In certain embodiments, proximal connector 458 is unaugmentable, then its launch and sending state under all keep basic low profile and against the outer surface 455 of first area 127a.This can reduce or prevent that proximal connector 458 from when configuration retract being hooked sheath 150 from launching configuration to sending at it.In other embodiments, at least one part of proximal connector 458 can be expanded, but is configured to keep when cooling package 130 is in sending state the low profile of distal portions 456.Therefore, cold therapy equipment 460 with the proximal connector 458 that extends can provide low profile roughly at little external perihaemal canal (for example to come, renal artery) in cooling package 130 at endovascular delivery to target site and/or one or more channel C can be provided, the fluid contrast medium can be sent to far-end by this channel C surmounts cooling package 130.

Further illustrate such as Fig. 4 B, cold therapy equipment 460 also comprises distal connector 462, it keeps the distal portions 452 of balloon 142 and the support member 433 that extends through balloon 142, and this support member 433 supports balloon 142 in described sending state and deployed condition.Distal connector 462 can also be connected to (for example, passing through thermal) from it to the atraumatic tip 464 of remote extension or integrally formed with it.Atraumatic tip 464 can be extended approximately 0.5cm to 5cm (for example, approximately 1-2cm) from distal connector 462, and has at approximately 0.010 inch (0.254mm) to the about external diameter between 0.050 inch (1.27mm).In one embodiment, for example, atraumatic tip 464 can have the approximately length of 2cm and the external diameter (for example, 0.038 inch (0.965mm)) of at least 0.035 inch (0.889mm).In other embodiments, atraumatic tip 464 can have other suitable length and/or external diameter.Atraumatic tip 464 can be used as fixed guide with convenient guiding by vascular system.In some embodiment, the angle of atraumatic tip 464 and/or direction of rotation can be adjusted by control line 467 (for example, backguy), and this control line 467 extends through at least a portion of bar 122.User can control control line 467 twist deflection or otherwise mobile atraumatic tip 464 be directed to target site T with the distal portions 456 with bar 122.In other embodiments, atraumatic tip 464 can be definite by the distal portion branch of wire (for example, the wire 133b shown in Fig. 2 C), and this wire extends through bar 122 and crosses distal connector 462.

Atraumatic tip 464 can be by essentially smooth and submissive material or support structure, so that when cold therapy equipment 460 is controlled vascular system, therefore atraumatic tip 464 can contact and depart from blood vessel wall lightly, and avoids running through and/or blood vessel that otherwise wound is passed guiding therein by atraumatic tip 464.For example, atraumatic tip 464 can be made by the coil (for example, platinum coil) of the softness on nuclear or the line (for example, stainless steel wire).In each embodiment, described line can be configured to retreat to gradually from the proximal part 469a of atraumatic tip 464 the distal portions 469b of atraumatic tip 464.Taper, for example, can be circular and (for example have approximately the external diameter between 0.005 inch (0.127mm) and 0.015 inch (0.381mm) at proximal part 469a, 0.009 inch (0.229mm)), and can be flattened to the thickness (0.127mm that has between approximately 0.001 inch (0.025mm) and 0.005 inch towards distal portions 469, for example, 0.003 inch (0.076mm)).In the embodiment that selects, about length of 1/3 to 1/2 of the atraumatic tip 464 that begins from proximal extremity makes described line flat.In other embodiments, described atraumatic tip 464 can have the cross section of circular taper or non-taper from start to finish.In some embodiment, atraumatic tip 464 (for example, twine the coil of described line) at least a portion can be by platinum and/or other radiopaque material (for example, platinum/iridium alloy) make, the cold therapy equipment 460 of its imaging technique known in the art easy to use is guided through vascular system.In aspect some of present technique, balloon 142 can also comprise that radiopaque labelling of being positioned at its proximal part and distal portions and/or radiopaque sign (for example, being made by radiopaque ink) further are beneficial to guiding and launch.In other embodiments, atraumatic tip 464 can by other can be deflectable and flexible material and structure make, for example macromolecular material is (such as Pebax

Polymer, nylon etc.), macromolecular material tinsel (for example, stainless steel silk), and/or other suitable material.

In the illustrated embodiment of Fig. 4 B, atraumatic tip 464 is by molding and/or otherwise form curve or sloping portion.Atraumatic tip 464 by plastic material (for example, rustless steel, platinum, etc.) make, atraumatic tip 464 can form and/or be restructured as required flexibility.In other embodiments, atraumatic tip 464 can be in advance by can not being pre-formed by shaping material, so it has nonadjustable, fixing curve.The described curve of atraumatic tip 464 can further help the guiding of vascular system.For example, described curve can help with cooling package 130 remain on required sequential in (for example, renal artery) and prevent that its side from propping up (side braches).

Pressure in the cold therapy system monitors

Fig. 5 A is that Fig. 5 B is the amplification sectional view of the distal portions of the system 500 among Fig. 5 A according to the part schematic diagram of the cold therapy system 500 of another embodiment configuration of present technique.The feature that cold therapy system 500 comprises can be similar to the feature of the above cold therapy system 100 of introducing in conjunction with Fig. 1-3B substantially.With reference to Fig. 5 A, for example, cold therapy system 500 can comprise cold therapy equipment 520 and operation bench 502.Operation bench 502 can comprise cold-producing medium supply container 504 and the supply control valve 508 that is coupled to supply circuit 510, and supply circuit 510 is configured to cold-producing medium 506 is transported to cold therapy equipment 520.Operation bench 502 can also comprise pump 511 and/or back-pressure control valve 513 alternatively, and it is coupled to the pumping-out line 515 that is configured to receive from cold therapy equipment 520 cold-producing medium 517 of vaporization.Controller 518 can operationally be coupled to supply control valve 508 and/or back-pressure control valve 513, regulates the cold-producing medium stream by cold therapy equipment 520.In illustrated embodiment, cold therapy equipment 520 comprises bar 522, be positioned at the handle 525 of proximal end region of proximal part of bar 522 and the distal portions 526 of freezing assembly 530 with remote area of the distal portions 526 that is positioned at bar 522.

Such as Fig. 5 A ground is shown further, operation bench 502 (for example may further include pressure transducer or sensor 570, Omega Engineering of Stanmford, the PX209-100G5V pressure transducer that CT produces), it is coupled to the pressure in the part (for example, expansion chambers) that pressure circuit 571 monitors cooling package 530 in refrigerating process.In different embodiment, pressure transducer 570 can be coupled to controller 518 and be used as feedback mechanism with control supply control valve 508 and/or back-pressure control valve 513, and the pressure that senses corresponding to cooling package 530 places is thus regulated and gone to and/or from the cold-producing medium stream of cooling package 530.For example, pressure transducer 570 can be configured to point out to be higher than the pressure of subscribing threshold value (for example, being within the scope of burst pressure of expansion chambers).As response, controller 518 can by close at least in part supply control valve 508 and/or by reduce in the pumping-out line 515 back-pressure (for example, use vacuum pump 511) increase the refrigerant flow from cooling package 530, reduce or stop refrigerant flow.In other embodiments, pressure transducer 570 can be directly coupled to supply control valve 508 and/or back-pressure control valve 513 come control valve 508 automatically and 513 in response to the pressure that senses open and/or closed.In some embodiment, cold therapy system 500 can be configured to confirm that pressure transducer 570 was suitably calibrated before freezing.For example, when system 500 energising, system 500 can be automatically by the function that relatively checks pressure transducer 570 from reading and the environmental stress of pressure transducer 570.

Referring now to Fig. 5 B, the remote area of cold therapy equipment 520 can comprise the feature similar with the feature of the cold therapy equipment 120 of introducing above with reference to Fig. 2 A-2E.For example, cold therapy equipment 520 comprises the supply chamber 132 of being coupled to supply circuit 510 (Fig. 5 A), be coupled to the discharge side 134 of pumping-out line 515 (Fig. 5 A), and the applicator 140 that comprises the expandable members of the balloon 142 of determining expansion chambers or other types.

Illustrated such as Fig. 5 B, cold therapy equipment 520 may further include pressure and monitors chamber 572, and it is coupled to pressure transducer 570 (Fig. 5 A) via pressure circuit 571 (Fig. 5 A).Pressure monitor chamber 572 can extend through bar 522 and have with expansion chambers (for example, being determined by balloon 142) between the distal openings 574 that is communicated with of fluid.The size in pressure supervision chamber 572 (for example, sectional area, internal diameter and/or external diameter) thus can be enough come pressure readings in the sensing expansion chambers with enough accuracies greatly, but enough little of to reduce or eliminate and the interference between flowing of cold-producing medium by discharge side 134.For example, supply chamber 132 and pressure monitor that chamber 572 can (for example together have the first sectional dimension, the first sectional area) and discharge side 134 (for example can have the second sectional dimension, the second sectional area), then the ratio of the second sectional dimension and the first sectional dimension between 4: 1 to 10: 1.In certain embodiments, pressure monitors that chamber 572 can have and is not more than 0.03 inch (0.762mm; For example, 0.015 inch (0.381mm), 0.010 inch (0.762mm) etc.) internal diameter, and external diameter is not more than 0.060 inch (1.52mm; For example, 0.02 inch (0.508mm), 0.015 inch (0.381mm), etc.), and the size of discharge chamber 134 can correspondingly be adjusted.In the illustrated embodiment of Fig. 5 B institute, pressure monitors that chamber 572 ended at bar 522 at external diameter before the second area 127b of distal portions 520 place's indentation.This configuration can be used in such embodiments, the internal diameter indentation of its king-rod 522 (for example, shown in Fig. 4 A and 4B) thus be not limited in the discharging of cold-producing medium 517 of the expansion at less second area 127b place.In other embodiments, pressure monitors that the opening 574 in chamber 572 can be in balloon 542 or therein.

Thereby pressure monitors that chamber 572 can also have sufficiently long length and in blood vessel opening 574 is positioned at target site T renal artery or the nephrostome of femoral artery or radial artery (for example, through) with cooling package 530.For example, pressure monitors that chamber 572 can have the length identical with the whole length of bar 522 (for example, at least 48 inches (122cm)).In other embodiments, pressure monitors that chamber 572 can have different length and/or size that other is fit to.For example, pressure monitors that chamber 572 can have the first length and the pressure circuit 571 that is connected thereto (for example can have the second length, 48 inches (122cm), 30 inches (76cm), 12 inches (30cm), etc.), thereby pressure is monitored that chamber 572 extends to pressure transducer 570, allow thus with operation bench 502 in the cold therapy process as for desired position (for example, on the table).

In cold therapy, pressure monitors that chamber 572 and pressure transducer 570 (Fig. 5 A) can be configured to provide the signal of the pressure change in the indication expansion chambers.For example, pressure transducer 570 can be configured to point out to be in the threshold value pressure under the burst pressure of balloon 142, thereby reduces the probability that balloon breaks in the cold therapy process.Balloon 142 can have at least part of burst pressure that depends on the manufactured materials of balloon 142.Flexible material (for example, polyurethane), for example, generally have the burst pressure lower than non-flexible material (for example, nylon) (for example, 80psi, 100psi, 200psi, etc.), the burst pressure of non-flexible material is 300psi or higher.Pressure transducer 570 can be configured to monitoring threshold pressure, and this threshold value pressure can equal to be positioned at the pressure values under the burst pressure, and it provides the sufficient response time before balloon 142 breaks pressure change to be made a response.In other embodiments, pressure transducer 570 can be configured to (for example, 20-60psi) provide indication in addition the time when balloon 142 is operated in its required operating pressure.

Time-delay between the pressure at opening 574 places in the pressure supervision chamber 572 of expansion chambers and the pressure readings at pressure transducer 570 places can depend on that pressure monitors the volume in chamber 572.Therefore, pressure monitors that the volume in chamber 572 can have the abundant response time (for example, before balloon 142 breaks) of the pressure change in the expansion chambers being made appropriate reaction.In certain embodiments, for example, pressure transducer 570 has the response time less than 1.5 seconds, for example, less than 1 second response time, 0.2 second, 0.1 second, or 15 milliseconds.For the accuracy that improves pressure readings and the response time that reduces pressure transducer 570, pressure monitors that the length in chamber 572 can be shortened, and the pressure before being connected to pressure transducer 570 monitors that the obvious increase of the volume in chamber 572 can be reduced.For example, the pressure circuit 571 of the proximal part 524 (for example, being positioned at handle 525) (Fig. 5 A) that is positioned at bar 522 can be coupled in pressure supervision chamber 572, and pressure circuit 571 can have the sectional area that is similar to pressure supervision chamber 572.In other embodiments, pressure transducer 570 can (for example be coupled at handle 525 places in pressure supervision chamber 572, omit pressure circuit 571), with the total length of the pressure pipe that shortens to pressure transducer 570, electric wire can be coupled to pressure transducer 570 and pass the signal to operation bench 502.

To returning with reference to Fig. 5 A and 5B, in certain embodiments, pressure transducer 570 can be coupled to by using assembling (fitting) or adapter 576 (for example, quick connect adapter) in pressure circuit 571 and/or pressure supervision chamber 572.In the illustrated embodiment of Fig. 5 A, for example, adapter 576 comprises interior storage or passage 578, and it is connected to pressure transducer 570 with pressure circuit 571 with the fluid mode of communicating.Passage 578 can have fully little volume, then unlikely destruction from pressure circuit 571 to pressure transducer 570 pressure difference, and strengthen the accuracy of pressure measurement.For example, in one embodiment, passage 578 can have the internal volume that is not more than 0.1cc.In other embodiments, passage 578 can have larger internal volume.In a further embodiment, adapter 576 can monitor pressure that chamber 572 is coupled to bar 522 or other near the locational pressure line 571 of bar 522 proximal parts 524.Therefore adapter 576 allows pressure to monitor that chamber 572 and/or pressure circuit 571 come to separate from pressure transducer 570 after cold therapy, pressure transducer 570 (for example can be stored so that pressure supervision chamber 572 can be thrown aside, with handle 525 and/operation bench 502) for the usefulness of follow-up cold therapy, and can not destroy the accuracy of the pressure readings at pressure transducer 570 places.

To returning with reference to Fig. 5 B, in various other embodiment, cold therapy equipment 520 may further include the extra gas supply chamber 579 of being coupled to supply container 504 (Fig. 5 A), perhaps other transmit the gas supply container of additional gas to expansion chambers, and regulate thus the temperature of applicator 140.For example, gas supply chamber 579 can be before sending cold-producing medium 506 via aperture 144 or simultaneously with cold-producing medium 506 (for example, nitrous oxide) and/or other pressurization or uninflated gas (for example, air) is delivered in the balloon 142, to increase the pressure (for example, from about 5psi to about 60psi) in the balloon 142.Extra gas in the balloon 142 has reduced the pressure drop of the cold-producing medium 506 in the expansion chambers, and has improved thus the temperature in the balloon 142.Therefore, gas supply chamber 579 can be used to begin, limit and/or postpone enter expansion chambers extra gas (for example, use valve), and the temperature of regulating balloon 142, and need not in the operation bench 502 complex component (for example, pressure regulator, sub-refrigerator, etc.) pressure drop in the balloon 142 changed.Additionally, when independent gas container (for example is coupled in gas supply chamber 579, gas supply), gas supply chamber 579 can be used to before sending to cold-producing medium 506 ground such as balloon 142 with gas send balloon 142 to, monitor the position of the applicator 142 on the target site T.

In a further embodiment, pressure regulator is (not shown, for example, air relief valve) can be added to the cold-producing medium 517 that limits vaporization on the discharge side 134 leaves balloon 142 and/or is limited in the discharge side 134, until the pressure in the balloon 142 is predetermined value (for example, when using pressure to monitor that chamber 572 senses).In embodiment further, coolant treatment equipment 520 can comprise the pressure regulator for discharge side 134 and gas supply chamber 579, so the pressure in the balloon 142 can be conditioned in the cold therapy process.

Pre-cooling in the cold therapy system

In low the kidney warming neuroregulation, the refrigerant volume that can be used for cooling can be limited.Therefore, the cooling capacity of increase cold-producing medium is useful.Be to make in the cooling package before the cold-producing medium expansion cold-producing medium is carried out the example that pre-cooling is the process of a cooling capacity that can increase cold-producing medium.Even when cooling mainly occurs by phase transformation, before phase transformation, use colder cold-producing medium can improve the amount of cooling.In addition, if supply pipe is to exchange with discharge pipe heat, reducing the temperature of the cold-producing medium in the supply pipe can cool off the cold-producing medium waste gas of discharging the Central Shanxi Plain, and it can reduce the back-pressure in the cooling package that is associated, and the thus further cooling at the cooling package place of wild phase association.Pre-cooling can reduce the required refrigerant volume of the kidney warming neuroregulation, and it can allow in vascular system to use less and bar more flexibly.Pre-cooling can also relax with the cold therapy system in the going down of cooling capacity of other part relation, for example heat insulating component in the applicator and the coaxial screw pipe valve (in-line solenoid valve) that in operation process, dispels the heat.

The cold-producing medium of the pressurization of using in low the kidney warming neuroregulation generally at room temperature provides (for example, from the room temperature Dewar flask) from the vascular system outside.When the cold-producing medium of pressurization when advancing in vascular system along supply pipe, its can through and warm blood and the heat exchange between the tissue temperature that raises.For example, when vascular system (for example, about 37 ℃) by being in body temperature of the cold-producing medium of the pressurization that provides in about room temperature (for example, about 23 ℃), the temperature of the cold-producing medium of pressurization can be elevated to approximately 25 ℃ to 37 ℃ before arriving cooling package.Cold therapy equipment according to the some embodiment configuration of present technique can comprise the pre-cooling assembly, and it is configured to before expansion in the cooling package of cold-producing medium in association of pressurization it be carried out pre-cooling.For example,, the cold-producing medium of pressurization has the temperature that is lower than body temperature (for example, be lower than 20 ℃ or be lower than 10 ℃) before the expansion thereby can being cooled in the cooling package of association.Such pre-cooling assembly can be configured to outside vascular system, and/or the cold-producing medium supply identical with related cooling package use.In the some embodiment according to the present technique configuration, pre-cooling helps cold-producing medium is maintained liquid state until it arrives the subcooled cooling package of needs.For example, with by the vaporization that is associated of heating near the cold-producing medium of the part of the cold therapy equipment of cooling package can be lowered.In this joint, term " closely " or " far " can refer to the position with respect to the cryogen source of pressurization.For example, closely can refer to the position of the cryogen source of more close pressurization, and far can refer to further from the position of the cryogen source of pressurization.

Fig. 6 A-6B figure has released cold therapy equipment 600, and it comprises pre-cooling assembly 602, determines the bar 604 of the elongation of passing away, and the concentrator between pre-cooling assembly and the bar 606.Pre-cooling assembly 602 comprises flexible tubular element 608, and it extends in concentrator 606 and is configured to be connected between the adapter 610 of cryogen source (not shown) of pressurization.Described concentrator 606 can comprise the main connector 612 that is connected to bar 604, leads to the outlet 614 of atmosphere, is connected to the first branch 616 of tubular element 608, and the second branch 618 that is connected to control line conduit 620.In some embodiment, concentrator 606 can comprise one or more extra branches, for example comprise with the fluid connection mode be connected to the near-end syringe adapter pipe (for example, the near-end syringe adapter, it comprise be configured to by the broken barrier film of the acupuncture of syringe) branch.For instance, such structure is favourable near the introducing contrast medium cooling package in vascular system and/or for introducing packing material in the filling chamber of the cooling package in vascular system.Packing material will be described in further detail.

Refer again to Fig. 6 A-6B, two control lines 621 (Fig. 6 B) can extend from control line conduit 620, by concentrator 606, enter bar 604.Concentrator 606 can determine that be straight main discharge stream via outlet 614 to the basic of atmosphere from bar 604.Tubular element 608 comprises the tubulose proximal part 622 that is positioned at adapter 610 and the tubular distal 624 that is positioned at the first branch 616.As being clearly shown that among Fig. 6 B, tubulose proximal part 622 can comprise the first plug the 626 and second plug 628, and adapter 610 can comprise the opening 630 near the second plug 628.Adapter 610 can comprise various suitable structures to be connected to the cryogen source of pressurization, for example screw device, compressor or thorn line apparatus.

In the illustrated embodiment of Fig. 6 B, equipment 600 comprises has determined that main supply answers the main supply pipe 632 in chamber, and pre-cooling assembly 602 comprises the pre-cooling supply pipe 634 of having determined pre-cold supply chamber.Main supply pipe 632 and pre-cooling supply pipe 634 can be respectively comprise at the second plug 628 places that main supply answers proximal openings 636 and pre-cold supply proximal openings 638.Main supply answers proximal openings 636 and pre-cold supply proximal openings 638 in the fluid connection mode main supply pipe 632 and pre-cooling supply pipe 634 to be connected respectively to the passage of being determined by opening 630.From the second plug 628, main supply pipe 632 and pre-cooling supply pipe 634 extend through tubulose proximal part 622 and fill in 626 by first.Tubular distal 624 has been determined the pre-cooling expansion chambers, and it extends to the main stream of discharging from the first plug 626.Pre-cooling supply pipe 634 extends slightly by the first plug 626 and end at pre-cooling distal openings 640 in the pre-cooling expansion chambers.Therefore with between the stream by pre-cooling supply pipe 634 the pre-cooling expansion chambers becomes fluid connection, extends to the main stream of discharging so stream is discharged in pre-cooling from pre-cooling distal openings 640.Main supply pipe 632 extends through the pre-cooling expansion chambers, by concentrator 606 and enter bar 604.The part of answering proximal openings 636 to extend to bar from main supply of main supply pipe 632 is the first of main supply pipe 632.The second portion (not shown) of main supply pipe 632 is approximately the cooling package (not shown) that is configured in vascular system.

The cold-producing medium that makes pressurization enters the pre-cooling expansion chambers from 634 expansions of pre-cooling supply pipe can cool off the pre-cooling expansion chambers, and cools off thus the liquid refrigerant in main supply pipe 632 and the main supply pipe.If pre-cooling (is for example carried out in the place away from the inlet point of vascular system, if the cold-producing medium of pressurization was cooled at the operation bench place before being sent to the inlet point that enters vascular system), can cause the cold-producing medium through pressurization of pre-cooling is carried out unfavorable heating from the heat of atmosphere.Orientate the pre-cooling expansion chambers as close concentrator and can reduce this unfavorable heating.Can have enough length with the heat exchange between the cold-producing medium of the pressurization in the part of the cold-producing medium that allows the expansion in the pre-cooling expansion chambers and the main supply pipe in the pre-cooling expansion chambers according to the pre-cooling assembly of the some embodiment configuration of present technique.For example, can have greater than the about length of 10cm according to the fore-cooling room of the some embodiment configuration of present technique, for example greater than about 15cm, or greater than about 25cm.Have from about 20cm to the about length of 30cm according to the fore-cooling room of the some embodiment configuration of present technique.

After main supply pipe 632 is cooled off, can join from being expelled to atmosphere among the stream of passing away and from outlet 614 from the cold-producing medium of pre-cooling expansion chambers.Fig. 6 B shows the first arrow 642, and the flow direction that it has been indicated by the cold-producing medium of outlet 614 also shows the second arrow 644, and it has indicated the flow direction by the cold-producing medium of pre-cooling expansion chambers.The flow direction of the cold-producing medium by outlet 614 generally aligns with passing away.On the contrary, the flow direction alignment of the flow direction of the cold-producing medium by pre-cooling expansion chambers discord passing away or the cold-producing medium by outlet 614.

Fig. 7 figure has released the part of the cold therapy equipment 700 of the cold therapy equipment 600 that is similar among Fig. 6 A-6B, and difference is between pre-cooling expansion chambers that equipment 700 has and the passing away not fluid connection.Cold therapy equipment 700 for example, comprises pre-cooling assembly 702, comprising between the interior section that makes pre-cooling expansion chambers and bar 604 and the concentrator 606 not the valve 704 of fluid connection and the 3rd the plug 706.Main supply pipe 632 extends through the 3rd plug 706 and enters bar 604.

Arrow 708 has been indicated when valve 704 is opened the flow direction by the cold-producing medium of pre-cooling expansion chambers.But when valve 704 cut out, the pressure in the pre-cooling expansion chambers can increase until itself and pre-cooling supply pipe 634 balances, thus so that stop by the mobile of pre-cooling supply pipe.By this way, open and close valve 704 and can open and close pre-cooling.Partly opening valve 704 can regulate the pressure in the pre-cooling expansion chambers and regulate thus by the cold-producing medium stream of pre-cooling supply pipe 634 and the precooling temperature of association.For example, actuator 710 can be operatively attached to valve 704 and is configured to receive the signal of self processor 712.The signal that processor 712 can be configured to receive from user interface 714 and/or sensor 716 instructs actuator 710 to open or close valve fully or step by step.Sensor 716 for example, can be the temperature sensor of the cooling package of association.In one embodiment, temperature sensor can be to processor 712 transmitted signals, so that by valve 704 (a) if the cooling package that detects or be higher than required value near the temperature of the tissue of cooling package, open and increase pre-cooling, perhaps (b) if cooling package or be lower than required value near the temperature that detects of the tissue of cooling package close and reduce pre-cooling.

Fig. 8 A-8B figure has released the part according to the cold therapy equipment 800 with precooler 802 of another embodiment configuration of present technique.The first plug 626 that forms pre-cooling assembly 602 (Fig. 6 A-6B) near the interior section of tubular element 608 may be challenging.Get the first plug 626 and pre-cooling supply pipe 634 (Fig. 6 B) and the ground in generation, precooler 802 can comprise diverter, and it is connected to main supply pipe.For example, precooler 802 can comprise the diverter 804 that is connected to main supply pipe 806 and have container proximal part 810 and the container 808 of container distal portions 812.In this embodiment, diverter 804 is divided into container proximal part 810 and container distal portions 812 with container 802.Container proximal part 810 has been determined near-end chamber between opening 630 and the diverter 804 or the supply chamber of merging, and container distal portions 812 has been determined the pre-cooling expansion chambers.Be clearly shown that such as Fig. 8 B, diverter 804 has been determined to be connected to the main channel 814 of main supply pipe 804 and along the pre-cooling passage 816 of diverter 804 peripheries with the fluid mode of communicating.

Continuation is with reference to Fig. 8 B, and the size of described pre-cooling passage 816 is determined to cause enough pressure drops to expand cold-producing medium and cool off the pre-cooling expansion chambers.Diverter 804 comprises tubular sections 818 and diverter plug 820.Diverter plug 820 is positioned between the inner surface of the outer surface of main supply pipe 806 and container 808.Tubular sections 818 can be selected to have the outer sectional dimension (for example, diameter) of the interior sectional dimension (for example, diameter) that is slightly less than container 808.Diverter 820 can comprise, for example, cohesive material is configured to the outer surface of main supply pipe 806 is incorporated into the inner surface of container 808.

In one embodiment, in diverter 804 floating sound of sighing the containers 808 (for example, it is not to be fixed in the container 808), so pre-cooling passage 816 is the annular spaces between the inner surface of diverter 804 and container 808.In other embodiments, diverter can have different configurations.For example, diverter can be fixed to container and the pre-cooling passage can center on the only part of the periphery of diverter, and for example curved portion extends through diverter.In other again embodiment, diverter can be connected to container around the whole periphery of container, and the opening that diverter inwardly can comprise and separate the periphery of diverter.For example, diverter can comprise inside opening, is configured to make the cold-producing medium expansion to enter the pre-cooling expansion chambers.

Fig. 9 A-9B figure has released and the cold therapy equipment 800 similar cold therapy equipment 900 shown in Fig. 8 A-8B, and difference is to have different diverters and the configuration of main supply pipe.Cold therapy equipment 900 comprises main supply pipe 902 and precooler 904, and precooler 904 comprises the diverter 906 that is connected to main supply pipe 902.Precooler 904 can also comprise container proximal part 910 with the opposite side that is positioned at diverter 906 and the container 908 of container distal portions 912.In this embodiment, diverter 906 do not comprise tubular sections and can by, for example, material (for example, rubber, polymer, metal or other material) cylindrical block construct, this cylindrical block has the hole, and described main supply pipe 902 is connected by bolt by described hole or otherwise installs.Be clearly shown that such as Fig. 9 B, diverter 906 can be determined along the pre-cooling passage 914 of diverter 906 peripheries.Main supply pipe 902 can extend through diverter 906 and can be connected to the inner surface of the container proximal part 910 of close opening 630.The approached part that main supply pipe 906 is connected to container proximal part 910 vertically moves in the time of can helping to prevent that diverter and main supply pipe 902 are in high pressure in the near-end chamber.

Pre-cooling assembly according to the some embodiment configuration of present technique can be arranged as compact configuration.For example, at least one part of such pre-cooling assembly can be in the handle of cold therapy equipment.Figure 10 figure has released and has comprised the pre-cooling assembly 1002 that is arranged in handle 1006 and the cold therapy equipment 1000 of concentrator 1004.Pre-cooling assembly 1002 comprises flexible tubular element 1008, and it extends from concentrator 1004, by the bottom 1010 of handle 1008, arrives adapter 1012, and adapter 1012 is configured to be connected to the cryogen source (not shown) of pressurization.Concentrator 1004 can comprise the outlet 1014 of elongation, and it extends through bottom 1010, and control line conduit 1016 can extend through bottom 1010 from concentrator 1014.In one embodiment, tubular element 1008 is coiled in around the outlet 1014.Handle 1006 can also be by heat insulation, to prevent heat loss arrival wherein and to improve pre-cold efficiency.

Figure 11 shows the cold therapy equipment 1100 that has in handle and have the replacement scheme configuration on every side.Cold therapy equipment 1100 comprises pre-cooling assembly 1102 and the concentrator 1104 that is arranged in handle 1106.Pre-cooling assembly 1102 comprises flexible tubular element 1108, and it extends and pass through the bottom 1110 of handle 1106 from concentrator 1104.Concentrator 1104 can comprise the outlet 1112 of the elongation that extends through bottom 1110, and control line conduit 1114 can extend through bottom 1110 from concentrator 1104.In one embodiment, tubular element 1108 comprises the helical form part 1116 of separating with outlet 1112.Handle 1106 can also be by heat insulation, to prevent heat loss arrival wherein and to improve pre-cold efficiency.

The cold therapy part of appliance

After the above-mentioned explanation of having understood according to the cold therapy equipment of the some embodiment configuration of present technique, the below is introduced with reference to Figure 12-55 pair of various cooling package, obstruction component and other cold therapy part of appliance.Will be understood that, the specific features of the cold therapy part of appliance of hereinafter introducing and/or following cold therapy part of appliance can with cold therapy equipment 100 couplings described in Fig. 1, be used in the handheld device independent or self-supporting, or with other system's coupling that is fit to.For ease of reference, run through the disclosure, identical reference number is used to refer to for similar or analogous parts or feature, but the use of same reference numbers is not hinting that or not is identical that these parts are appreciated that.Really, in many examples as herein described, the part that indicates same numbers distinguishes in structure and/or function.

Some embodiment of following cold therapy part of appliance can be configured to be conducive to the one or more therapeutic purposes relevant with the refreshing neuroregulation of low temperature.For example, some embodiment of following applicator are configured to apply sub-cooled in the local or overall therapeutic modality of needs.Required topical therapeutic mode can comprise, for example, circumferentially cools off partly on one or more vertical paragraph of renal artery or nephrostome.Required overall therapeutic modality can be included in the combination of the topical therapeutic mode for the treatment of site.For example, required overall therapeutic modality can be perpendicular to the part side face on the plane of renal artery or nephrostome or all-round therapeutic modality.In order to be beneficial to required local or overall therapeutic modality, can have hot transmitting portions more than one, for example main hot transmitting portions and less important hot transmitting portions according to the applicator of some embodiment configurations of present technique.When the cooling package that comprises such applicator operated in deployed condition, the hot transmitting portions of the master of applicator can have the heat transfer rate that is enough to cause medicable low the kidney warming neuroregulation.The less important hot transmitting portions of applicator is in operation and can has lower heat transfer rate, for example, is not enough to bring the heat transfer rate of medicable low the kidney warming neuroregulation.Main and secondary wants the location of hot transmitting portions can be corresponding to required local or overall therapeutic modality.

Some embodiment of following applicator comprise that configuration affects the feature that main and secondary is wanted the location of hot transmitting portions.Such feature can comprise, for example, with following relevant feature: (a) convective heat transfer of the difference in the applicator, (b) conductive heat transfer of the difference by applicator, and/or (c) applicator with in the renal artery of therapentic part or contacting or the interval of the difference between the nephrostome.The feature relevant with the convective heat transfer of difference can comprise, for example, is configured to optionally guide to the different piece of applicator cold-producing medium supply pipe and the aperture of the expansion of cold-producing medium.The feature relevant with the conductive heat transfer of difference by applicator can comprise, for example, extra balloon (for example, non-cooling balloon and the balloon with low cooling level), the formation of difference (for example, low heat conductivity and high thermal conductivity material), the thickness of difference (for example, and heat insulation structural (for example, in the balloon or be connected to the heat insulating component of the elongation on the balloon wall) the balloon wall thickness).The feature relevant with the contact of difference between applicator and renal artery or the nephrostome or interval can comprise, for example, extra balloon, and the characteristic of complicated balloon, for example shape (for example, helical form, shaped form, longitudinal asymmetric and radial asymmetrical), surface differences (for example, depression, groove, projection and outstanding), and the expansion of difference (for example, the limited expansion of part).

Some embodiment of following applicator also configure to be convenient to determining of size, sending and carry out determining of size in the expansion that is suitable for renal artery with different size and/or nephrostome provide medicable treatment (for example, low profile) sectional dimension of reducing for example.For example, some embodiment of following applicator comprise balloon, and described balloon subsides when relevant cooling package is in sending state at least in part, and expand at least in part when relevant cooling package is in deployed condition.Determine that with size relevant feature comprises, for example, balloon consists of (for example, flexibility or non-flexible material), extra balloon and the characteristic of complicated balloon, for example shape (for example, flexibility and inflexibility shape).Non-flexible material (for example, polyethylene terephthalate) can have flexibility (for example elasticity), for example, and from approximately 0% to approximately 30%.Flexible material (for example, polyurethane or other thermoplastic elastomer (TPE)) can have flexibility, for example, and from 30% to 500%.Non-flexible material generally has the intensity higher than flexible material (for example, higher pressure rating).Some embodiment of following applicator can be configured to be beneficial to the required inaccessible level of renal artery and/or nephrostome.For example, some embodiment of following applicator are configured to the part occlusive, thereby in the situation that do not stop blood flow to cross therapentic part to apply the medicable cooling of kidney neuroregulation at therapentic part.Comprise with the inaccessible relevant feature of part, for example, the characteristic of complicated balloon, for example expansion (for example, the limited expansion of part) of shape (for example, helical form, shaped form, vertically asymmetric and radially asymmetric) and difference.Entirely shut, for example complete or cross renal artery or nephrostome near complete prevention blood flow, for some treatment, need.Comprise with the relevant feature of entirely shutting, for example, any and size are determined relevant suitable feature.As mentioned below, cold therapy equipment according to the some embodiment configuration of present technique can comprise obstruction component, the for example expandable members of freezing assembly (for example, determining the balloon of expansion chambers) or independently obstruction component (for example, near cooling package).Obstruction component can provide inaccessible with incompatible the combination with the feature that is associated with applicator of any suitable applicator as herein described.

Can comprise by the structure that helps the one or more therapeutic purposes relevant with low the kidney warming neuroregulation near the freezing and/or liquid blood of applicator according to the cooling package of present technique configuration.Can affect such as heat transmission, size and the factor such as inaccessible near the freezing and/or liquid blood of applicator.For example, thus some embodiment can configure near the blood that comes the freezing applicator causes all or part of obturation.In these examples, medicable cooling occurs by the freezing blood of one deck (for example, a layer thickness is less than about 0.8mm, 1mm, or the frozen blood of 1.2mm).Balloon can be configured to so that frozen blood is formed between the hot transmitting portions of the master of balloon and renal artery or the nephrostome, and the thickness of wherein said frozen blood is so that by this thickness medicable cooling can occur.Above-mentioned layer for example, can help to determine size or required inaccessible level.In addition, balloon can be configured to so that form frozen blood between less important hot transmitting portions and renal artery or nephrostome, and the thickness of wherein said frozen blood is so that medicable cooling can't occur (for example, greater than about 0.8mm by described thickness, 1mm, or the thickness of 1.2mm).Such balloon can comprise, for example, and part depression or nonpitting and other suitable structures described in detail below.

Convective heat transfer

Figure 12-16B figure has released some embodiment of cold therapy equipment, and this cold therapy equipment can affect treatment with the convective heat transfer of difference.The feature relevant with convective heat transfer in the applicator can be conducive to one or more therapeutic purposes of low the kidney warming neuroregulation, and example is local or overall therapeutic modality as required.Such feature can comprise, for example, is configured to optionally guide to the different piece of applicator cold-producing medium supply pipe and the aperture of the expansion of cold-producing medium.

Figure 12 figure has released the part of cold therapy equipment 1200.This cold therapy equipment 1200 comprises the cooling package 1202 of doing 1206 distal portions 1204 that is positioned at elongation, and it has determined passing away.As mentioned above, this distal portions 1204 can have ladder 1208 and cooling package 1202 can comprise the applicator 1210 with a plurality of hot transmitting portions (being expressed as respectively 1211a-d).Applicator 1210 can also comprise the balloon 1212 with far-end neck 1214, and balloon 1212 has determined to be configured to produce and send subcooled expansion chambers.Equipment 1200 may further include the guiding elements 1216a of elongation, determines first supply pipe 1218 in the first supply chamber, and the second supply pipe 1220 of determining the second supply chamber.Guiding elements 1216a can determine guidewire lumen, and this guidewire lumen is finalized to hold wire 1216b, ground is described in detail in detail in as mentioned.The guiding elements of setting forth in conjunction with other cold therapy part of appliance as herein described can be configured similarly, although for illustrated clearness, related wire is not shown generally.In illustrated embodiment, guiding elements 1216a has straight end and extends to far-end neck 1214.Mode as an alternative, guiding elements 1216a can comprise round terminal and/or extend across the end of far-end neck 1214.Similarly, in other cold therapy part of appliance as herein described, leaving the guiding elements of distal portions of balloon and/or illustrated certain section of supply pipe can have various suitable shapes (for example, antisitic defect shape) and can extend various distances with respect to the far-end neck of balloon.

The first supply pipe 1218 can comprise the first beveled distal end part 1222, and cooling package 1202 can comprise the first aperture 1224 that is positioned at the first beveled distal end part 1222 places.Similarly, the second supply pipe 1220 can comprise the second beveled distal end part 1226, and described cooling package can comprise the second aperture 1228 that is positioned at the second beveled distal end part 1226 places.Figure release embodiment described the first and second beveled distal end parts 1222,1226 along or roughly longitudinally and radially separate along the length of cooling package 1202.In some other embodiment, the first and second beveled distal end parts 1222 and 1226 have identical vertical and/or radial position, or other configurations.When cooling package 1202 was in deployed condition, cold-producing medium can flow through respectively the first and second supply pipes 1218,1220, flow through the first and second beveled distal end parts 1222,1226, flowed out respectively the first and second apertures 1224,1228.The first and second beveled distal end parts 1222,1226 can be respectively with the cold-producing medium guiding thermotropism transmitting portions 1211a and the 1211d that expand.As a result of, when cold-producing medium flows out the first and second apertures 1224,1228, hot transmitting portions 1211a and 1211d can have the overall situation higher and than the special convective heat transfer speed of other hot transmitting portions of applicator 1210.This variation of heat transfer rate can be corresponding to the required type of cooling, for example in some or all vertical part side face types of cooling on the section of applicator 1210.The difference of heat transfer rate can change according to the distance of interior-heat transmitting portions 1211a and 1211d.Functional significant difference on the heat transfer rate can be separated hot transmitting portions 1211a and hot transmitting portions 1211c, and wherein hot transmitting portions 1211c faces toward hot transmitting portions 1211a with circumference substantially.Similarly, the functional significant difference on the heat transfer rate can be separated hot transmitting portions 1211d and hot transmitting portions 1211b, and wherein hot transmitting portions 1211d faces toward hot transmitting portions 1211b with circumference substantially.In some embodiment, the heat transfer rate that hot transmitting portions 1211a and 1211d have is enough to cause medicable kidney neuroregulation, and the heat transfer rate of hot transmitting portions 1211b and 1211c is not enough to cause medicable kidney neuroregulation.

For example, the first and second supply pipes 1218,1220 can be configured in the approximately expansion of the angle guiding cold-producing medium of 45 degree of the length that departs from applicator 1210 or cooling package 1202.In some other embodiment, one or more supply pipes are configured to guiding cold-producing medium with respect to approximately 15 degree of the length of applicator or cooling package to the about angles of 90 degree, for example, and from about 30 degree to about 45 degree, or from about 30 degree to about 40 degree.In addition, the first supply pipe 1218 can be in the angle different from the second supply pipe 1220.According to the fore-and-aft distance in the first aperture 1224 of the cooling package of the some embodiment configuration of present technique and the second aperture 1228 can for, for example, from about 1mm to about 20mm, for example from about 2mm to about 15mm, or from about 3mm to about 10mm.

As a kind of alternative, can comprise having supply pipe or chamber crooked and/or the helical form part according to the cooling package of the some embodiment configuration of present technique.Figure 13 figure has released the cold therapy equipment 1300 of the cooling package 1302 of the distal portions 1304 that comprises the bar 1306 that is positioned at elongation, and it has determined the passing away opened in distal portions 1304 ends.Described distal portions 1304 can have ladder 1307, and cooling package 1302 can comprise the applicator 1308 with the first hot transmitting portions 1309 and second hot transmitting portions 1310.The first and second hot transmitting portions 1309, the 1310th, elongation and around the length radial separation of cooling package 1302.Applicator 1308 can also have balloon 1311, and it determines to be configured to produce and transmit subcooled expansion chambers.Equipment 1300 may further include the guiding elements 1312 of elongation and the supply pipe 1313 that extends along the length of bar 1306.In balloon 1311, supply pipe 1313 can comprise the helical form part 1314 (for example, distal portions 1304 can be determined the axis of helical form part 1314) of leaving distal portions 1304 and twining distal portions 1304.Cooling package 1302 can comprise along a plurality of apertures of helical form part 1314 lateral spacings (being labeled as respectively 1316a-e).In illustrated embodiment, if helical form part 1314 is straightened, aperture 1316a-e is radially aligned roughly.In this embodiment, the shape of helical form part 1314 is so that aperture 1316a-e points to different radial direction.In other embodiments, helical form part 1314 can have the aperture 1316a-e on varying number and/or the direction.

It is straight time more close balloons 1311 that helical form part 1314 is positioned as aperture 1316a-e such as fruit supply pipe 1312.This can be so that cold-producing medium leaves aperture 1316a-e at faster speed, contact 1311, and be increased in convection current amount of cooling water on the corresponding hot transmitting portions of balloon 1311.This also provides cold-producing medium has been contacted the size at balloon 1311 places and the more control at interval first.In the time of can being included in cooling package and being in deployed condition according to the cooling package of the some embodiment configuration of present technique, (for example surpass approximately 0.01mm apart from the center longitudinal axis of cooling package, greater than about 0.1mm, greater than about 0.5mm, or greater than about 1mm) the aperture.For example, the aperture in some embodiment is when cooling package is in deployed condition, and the distance between the center longitudinal axis of cooling package can be at about 0.01mm to approximately between the 4mm, or at about 0.1mm to approximately between the 2mm.Similarly, in the time of can being included in cooling package and being in deployed condition according to the cooling package of the some embodiment configuration of present technique, and the distance between the balloon is less than the approximately aperture of 4mm (for example, be less than approximately 2mm, be less than approximately 1mm, or be less than approximately 0.5mm).For example, the aperture in some embodiment can be when cooling package be in deployed condition, and the distance between the balloon at about 0.1mm to approximately between the 4mm, or at about 0.5mm to approximately between the 2mm.In addition, cooling package according to the some embodiment configuration of present technique can comprise the aperture, its be placed so that the distance between the central longitudinal axis of cooling package and the aperture be not more than again longitudinal axis between the inner surface of balloon at aperture place perpendicular to the distance in the plane of central longitudinal axis 20% (for example, be not less than 25%, 40% or 60%).

In illustrated embodiment, aperture 1316a, 1316c, 1316e point to the first half of balloon 1311 substantially, and aperture 1316b, 1316d point to the Lower Half of balloon 1311 substantially.When cooling package 1302 was in deployed condition, the cold-producing medium that flows through aperture 1316a, 1316c and 1316e produced the first hot transmitting portions 1309, and the cold-producing medium that flows through aperture 1316b, 1316d produces the second hot transmitting portions 1310.As the result of flow of refrigerant, it is higher and with respect to the special convective heat transfer speed of other hot transmitting portions of applicator 1308 that the first and second hot transmitting portions 1309,1310 can have the overall situation.This variation of heat transfer rate can be corresponding to the required type of cooling, for example the part side face type of cooling on the part or all of length section of applicator 1308.In some embodiment, the first and second hot transmitting portions 1309,1310 heat transfer rates that have are enough to cause medicable kidney neuroregulation, and the part described heat transfer rate that have of applicator 1308 between the first and second hot transmitting portions 1309,1310 is not enough to produce medicable kidney neuroregulation.

Figure 14 figure has released a part that mainly is different from the cold therapy equipment 1400 of the equipment 1300 among Figure 13 aspect discharging configuration.Equipment 1400 comprises the cold therapy equipment 1400 of cooling package 1402 of the distal portions 1404 of the bar 1406 that is positioned at the elongation of determining passing away.Distal portions 1404 can have ladder 1407, a plurality of outlet openings 1408, and circular distal 1409.Cooling package 1402 can comprise the applicator 1410 that is positioned at balloon 1411, and balloon 1411 has far-end neck 1412 and can determine to be configured to produce and transmit subcooled expansion chambers.Equipment 1400 may further include the supply pipe 1413 that extends into balloon 1411 along the length of doing 1406.In balloon 1411, supply pipe 1413 can comprise the helical form part 1414 (for example, distal portions 1404 can be determined the axis of helical form part 1414) of leaving distal portions 1404 and twining distal portions 1404.The spiral winding of helical form part 1414 can be between outlet opening 1408.Cooling package 1402 can comprise along a plurality of apertures of helical form part 1414 lateral spacings (being labeled as respectively 1416a-e).In illustrated embodiment, distal portions 1404 is the narrow diameter that does not generally extend across to allow helical form part 1414 coiling distal portions 1404 near the bar 1406 of distal portions 1404 enough.Therefore, the cooling package 1402 under the deployed condition can be configured to be fixed in the delivery sheath, and the size of delivery sheath is determined according to bar 1406.Described a plurality of outlet opening 1408 can promote delivery flow and alleviate any flow restriction with the Size dependence of distal portions 1404.Therefore, as mentioned above, the relatively high density of cold-producing medium that enters the expansion of expanding channel can allow the size downward modulation of distal portions and can not cause necessarily the unsuitable rising of back-pressure.

Be similar to the aperture 1316a-e of the equipment 1300 among Figure 13, figure releases aperture 1416a-d among the embodiment along helical form part 1414 interval on side direction.But different from the aperture 1316a-e of equipment 1300 among Figure 13 is, figure releases aperture 1416a-d among the embodiment and is configured to guide in the radial direction cold-producing medium in the difference around the length of cooling package 1402.Particularly, aperture 1416a-d is configured to guide cold-producing medium on the directions that space increment diametrically is approximately 90 degree.The size of aperture 1416a-d be determined to so that corresponding hot transmitting portions have greater than approximately 90 the degree angles of circumference.As a result of, generally be entirely circumference corresponding to the outstanding periphery of the hot transmitting portions of aperture 1416a-d, and be the part circumference specific vertical section of cooling package 1402.

Such as ground as described in reference Figure 13, main cold-producing medium extended region is determined can help convective heat transfer near balloon.It is next so that the cold therapy equipment 1500 of the main more close balloon of cold-producing medium extended region that Figure 15 A-15B figure has released same configuration.This equipment 1500 comprises the cooling package 1502 at distal portions 1504 places of the bar 1506 that is positioned at the elongation of having determined passing away.Distal portions 1504 can have ladder 1507, and cooling package 1502 can comprise the applicator 1508 with outer balloon 1510, and this outer balloon 1510 can determine to be configured to produce and transmit subcooled expansion chambers.Equipment 1500 may further include supply pipe 1512 and interior balloon 1514.Supply pipe 1512 has circular distal 1516 and can extend and pass through along the length of bar 1506 distal portions of outer balloon 1510.Interior balloon 1514 extends around the part of supply pipe 1512 in the balloon 1510 outside.In some other embodiment according to the present technique configuration, supply pipe 1512 terminates in the interior allotter, interior balloon 1514 for example, and/or can comprise that the equipment of guiding elements, this guiding elements can extend through interior balloon 1514 and the distal portions by outer balloon.Referring again to the embodiment of the equipment 1500 shown in Figure 15 A-15B, the part that supply pipe 1512 is positioned at balloon 1514 can comprise supply pipe aperture 1518.Be distributed as helical form layout or other suitable interior balloon aperture 1520 of arranging on the cooling package 1502 includable balloons 1514.Interior balloon aperture 1520 can for, for example, the cut hole on the interior balloon 1514.When cooling package 1502 was in sending state, outer balloon 1510 and interior balloon 1514 can subside to be fixed in the delivery sheath at least in part.

When cooling package 1502 was in sending state, cold-producing medium can flow from supply pipe 1512, by supply pipe aperture 1518, and enters interior balloon 1514.Thereby liquid phase transformation to gaseous state does not occur in the supply pipe aperture 1518 enough large major part (for example, the great majority of liquid refrigerant) that allows cold-producing medium to enter interior balloon 1514 and liquid refrigerant.For example, under deployed condition, the absolute vapour pressure of cold-producing medium in the outer interior balloon 1514 of supply pipe 1512 can be approximately 40% to approximately 100% of the absolute vapour pressure of cold-producing medium in the part of supply pipe in interior balloon 1514, for example approximately 20% to approximately 100%, or approximately 33% to approximately 100%.The the first clear passage area that equals total clear passage area in interior balloon aperture 1520 can be less than the second clear passage area, and wherein the second clear passage area equals total clear passage area in supply pipe aperture 1518.The size in interior balloon aperture 1520 and/or quantity can be selected to control the first clear passage area.Similarly, the size in supply pipe aperture 1518 and/or quantity also can be selected to control the second clear passage area.From interior balloon 1514, cold-producing medium can extend through interior balloon 1520 with the one or more corresponding hot transmitting portions of cooling applicator 1508.Particularly, interior balloon aperture 1520 can be configured to cool off the hot transmitting portions that is generally the spiral dress.

Figure 16 A-16B figure released from Figure 15 A in cooling package 1500 different cold therapy equipment 1600 on the balloon outside.This equipment 1600 comprises cooling package 1602, and cooling package 1602 comprises the applicator 1604 of the outer balloon 1606 of helical form part 1608 with rising and female 1610.The inner surface of the helical form part 1608 that raises can be configured to hold the cold-producing medium from the expansion in interior balloon aperture 1520, and the shape of the inner surface of the helical form part 1608 that raises can help the convection current cooling is focused on the helical form part 1608 of rising.Female 1610 renal artery or the nephrostome contact that generally is configured to get along well.The helical form part 1606 that the convection current cooling that strengthens is focused on rising can promote cooling effectiveness and cool position selectivity.The helical form part 1608 that raises can be corresponding to the hot transmitting portions with heat transfer rate higher than other hot transmitting portions of applicator 1604, for example corresponding to the hot transmitting portions of female 1610.For example, be in operation, corresponding your heat transfer rate of hot transmitting portions of helical form part that raises is enough to produce medicable kidney neuroregulation, and the heat transfer rate of another hot transmitting portions of applicator the hot transmitting portions of the part 1610 that raises (for example, corresponding to) is not enough to produce medicable kidney neuroregulation.

Conductive heat transfer

Figure 17-22B figure has released the some embodiment that affect the cold therapy equipment for the treatment of with the conductive heat transfer of difference.The feature that is associated with conductive heat transfer by applicator can help one or more therapeutic purposes of low the kidney warming neuroregulation, and example is local or overall therapeutic modality as required.In some embodiment, this equipment is controlled conduction with heat insulating component.The feature relevant with the conductive heat transfer of difference by applicator can comprise, for example, extra balloon (for example, non-cooling balloon and the balloon with low cooling level), the formation of difference (for example, low heat conductivity and high thermal conductivity material), the thickness of difference (for example, and heat insulation structural (for example, balloon interior or be connected to the heat insulating component of the elongation on the balloon wall) the balloon wall thickness).

Figure 17 A-17B figure has released the part of cold therapy equipment 1700 of the cooling package of the distal portions 1704 that comprises the bar 1706 that is positioned at the elongation of determining passing away.Distal portions 1704 can have ladder 1707, and freezing assembly 1702 can comprise having the applicator 1708 that is configured to renal artery or dark mouthful of balloon 1710 that contacts.Applicator 1708 may further include the heat insulating component 1711 of a plurality of elongations, and the length of these heat insulating components is in substantially parallel relationship to the length of cooling package 1702 and around the side face of cooling package 1702 interval diametrically.Balloon 1710 can determine to be configured to produce and transmit subcooled expansion chambers.Equipment 1700 may further include supply pipe 1712, and its length along bar 1706 is extended and entered balloon 1710, and cooling package 1702 can comprise the aperture 1714 of the end that is positioned at supply pipe 1712.In operation, when cooling package 1702 was in deployed condition, heat insulating component 1711 can reduce the conductivity cooling that closes on part by balloon 1710.For example, the thermal conduction rate of the part of balloon 1710 between heat insulating component 1711 can be enough to produce medicable kidney neuroregulation, and the part of balloon at heat insulating component 1711 places can have lower heat transfer rate, for example is not enough to produce the heat transfer rate of medicable kidney neuroregulation.Heat insulating component 1711 can for elongation and substantially continuously along the length of the each several part of applicator 1708.Therefore, at cooling package 1702 vertical section of the hot transmitting portions of the part between the heat insulating component 1711, generally be on-circular corresponding to balloon 1710.

Heat insulating component 1711 can comprise main material, and the heat conductivity of this main material is less than or equal to the heat conductivity of the main material of balloon 1710.In some embodiment, heat insulating component 1711 can have the formation different from balloon 1710, and is connected to the inner surface of balloon 1710.Some other embodiment can be included in and consist of upper and balloon 1710 similar (for example, identical) or different heat insulating components 1711.Suitable main material according to the heat insulating component of the some embodiment configuration of present technique comprises heat insulation foam of polymers (for example, polyurethane foam).In some embodiment, heat insulating component 1711 can form or be connected to balloon 1710 with balloon 1710.

Figure 18 A-18B figure has released the part of the cold therapy equipment 1800 of the equipment 1700 that is similar among Figure 17 A-17B, and its difference is the configuration of heat insulating component.The heat insulation attribute of heat insulating component under sending state according to the some embodiment configuration of present technique can be different from deployed condition.For example, heat insulating component can be configured to be filled material under deployed condition and is full of.Equipment 1800 comprises the cooling package 1802 with applicator 1804, and applicator 1804 has the balloon 1806 that can determine to be configured to produce and transmit subcooled expansion chambers.Applicator 1804 also comprises a plurality of heat insulating components 1808.Equipment 1800 may further include fills pipe 1810, and heat insulating component 1808 can be configured to be full of via filling pipe 1810 under deployed condition.In illustrated embodiment, fill pipe 1810 and comprise major part 1812 and four branches 1814, wherein each branch is connected in the heat insulating component 1808 one in the mode of fluid connection with major part.Heat insulating component 1808 and fill that on-liquid is communicated with between the expansion chambers in pipe 1810 and the balloon 1806.

Fill pipe 1810 and have the packing material source (not shown) reception packing material that is configured to outside vascular system.Filling pipe 1810 and heat insulating component 1808 can be configured under sending state fully substantially, or partly to subside.This helps to allow to import liquid packing material under sending state and does not need to discharge substituted gas.Some other embodiment can comprise general not collapsible filling pipe, and the heat insulating component that is configured to receive from such filling pipe substituted gas.Proximal part according to the filling pipe of the some embodiment configuration of present technique can be connected in the mode of fluid connection the tucker mouth, the tucker mouth that for example comprises syringe adapter, the syringe adapter that for example comprises barrier film, described diaphragm configuration is punctured by the pin of the syringe of involved packing material.Such tucker mouth can be configured to, for example, before packing material passes through, during and/or reduce afterwards passing through of (for example, preventing) air.But in some embodiment, air can become suitable packing material.Comprise that according to the cold therapy equipment of some embodiment (comprising these embodiment as herein described) of present technique configuration other parts of filling pipe also can be configured similarly.Be suitable for comprising liquid (for example, saline), gas (for example, air), bio-inert material, and radiopaque material (for example inner, contrast medium) with packing material according to the cold therapy equipment coupling of the some embodiment configuration of present technique.

Although 4 heat insulating components have been shown among Figure 17 A-18B, according to any heat insulating component of right quantity of the cooling package of the some embodiment configuration of present technique, for example at least one or more heat insulating components.In addition, can be independent component substantially according to the heat insulating component of the some embodiment configuration of present technique, or the various piece of discrete component, and can have various suitable shapes.

Figure 19 A-19C figure has released the part of cold therapy equipment 1900.With reference to Figure 19 A, equipment 1900 can comprise the cooling package 1902 of the distal portions 1904 of the bar 1906 that is in the elongation of having determined passing away.Distal portions 1904 can have ladder 1907, and cooling package 1902 can be included in the applicator 1908 in the balloon 1910, and balloon 1910 has determined to be configured to produce and transmit subcooled extended cavity.Equipment 1900 may further include the supply pipe 1912 that extends into balloon 1910 along the length of bar 1906, and cooling package 1902 can comprise the aperture 1914 of the end that is positioned at supply pipe 1912.Equipment 1900 may further include helical form heat insulating component 1916, for instance, this heat insulating component 1916 can be the thicker part of balloon 1910, its inner surface place at balloon 1910 has additional thickness and (also is, the outer surface of balloon 1910 can be level and smooth substantially, or even is level and smooth near helical form heat insulating component 1916 places and helical form heat insulating component 1916).In operation, when cooling package 1902 is in deployed condition, helical form heat insulating component 1916 can having than the hot transmitting portions of the lower heat transfer rate of the other parts of applicator 1908 corresponding to applicator 1908.For example, the heat transfer rate away from the part of helical form heat insulating component 1916 of applicator 1908 can be enough to produce medicable kidney neuroregulation in operation, and the heat transfer rate of the part that is in helical form heat insulating component 1916 places of applicator 1908 can be not enough to produce medicable kidney neuroregulation.Figure 19 B and 19C are the sectional view of the applicator 1908 on different longitudinal position.Shown in Figure 19 B and 19C, the side face position of helical form heat insulating component 1916 changes along the length of cooling package 1902, so balloon 1910 is being on-circular away from the part of helical form heat insulating component 1916 on vertical section of the length of cooling package 1902 substantially.

Figure 20 A-20C figure has released the cold therapy equipment 2000 of the equipment 1900 that is similar among Figure 19 A-19C, and difference is the shape of heat insulating component.With reference to Figure 20 A, equipment 2000 comprises cooling package 2002, and cooling package 2002 comprises the applicator 2004 with balloon 2006, and described balloon 2006 has determined to be configured to produce and send subcooled expansion chambers.Applicator 2004 also comprises the double-helical heat insulating component 2008 (for example, the right-handed helix of winding and left hand helix) that substantially is similar to winding.Applicator 2004 is kept apart hot transmitting portions and the heat insulating component 2008 of applicator 2004 substantially in the hot transmitting portions at heat insulating component 2008 places.Heat insulating component 2008 can be configured to subside with balloon 2006 when cooling package 2002 moves between sending state and deployed condition and/or expand.For example, if balloon 2006 generally is flexible and inflexibility, heat insulating component 2008 can or be generally flexible and flexibility or inflexibility.If balloon 2006 is generally flexible, heat insulating component 2008 can be generally flexible, thereby extends flexibly and contact in conjunction with balloon 2006.The illustrated heat insulating component 1716 of Figure 17 A-18B, 1808, and the illustrated helical form heat insulating component 1916 of Figure 19 A-19B can configure similarly with respect to corresponding balloon 1710,1806 and 1910.In some embodiment of present technique, heat insulating component has in approximately 50% and the about coefficient of elasticity between 150% of the coefficient of elasticity of corresponding balloon, for example approximately between 20% and 140%, or approximately 33% and approximately between 130%.

Heat insulating component according to the extra embodiment configuration of present technique can completely or partially be connected to corresponding balloon, and perhaps in other embodiments, heat insulating component is free of attachment to balloon.When heat insulating component only partly was connected to or is free of attachment to corresponding balloon, the expansion of corresponding balloon and/or contraction phase were independent of heat insulating component over the ground.Figure 21 A-21C figure has released the part of cold therapy equipment 2100 of the cooling package 2102 at distal portions 2104 places that comprise the bar 2106 that is positioned at the elongation of determining passing away.Described distal portions 2104 can have ladder 2107 and circular edge 2108.Cooling package 2102 can comprise the applicator 2109 with balloon 2110, and balloon 2110 has far-end neck 2111 and can determine to be configured to produce and transmit subcooled expansion chambers.Equipment 2100 may further include the guiding elements 2112 of elongation and the supply pipe 2114 that extends into balloon 2110 along the length of bar 2106.Cooling package 2102 can comprise the aperture 2116 that is positioned at the supply pipe end.In illustrated embodiment, guiding elements 2112 extends through far-end neck 2111.Applicator 2109 further comprises the heat insulating component 2118 of the first elongation, and the heat insulating component 2120 of the second elongation.The heat insulating component 2118,2120 of the first and second elongations is free of attachment to balloon 2110.The ground that replaces, the heat insulating components 2118,2120 of the first and second elongations are connected to the inner surface of distal portions 2104.

When cooling package 2102 was in deployed condition, the first and second heat insulating components 2118,2120 can move with respect to balloon 2110 in response to gravity.The first and second heat insulating components 2118,2120 can be mobile above circular edge 2108 when they are placed in the balloon.Shown in Figure 21 A, the first and second heat insulating components 2118,2120 can settling than lower part along balloon 2110.The first and second heat insulating components 2118,2120 have the sectional area that is similar to round triangle (rounded triangles) shown in Figure 21 B.In other embodiments, similarly heat insulating component can have different sectional areas.The circle triangular-section is long-pending can be particularly advantageous in contact area between the inner surface of the side that increases unconnected heat insulating component substantially and balloon, and prevents that the unconnected a plurality of heat insulating components of cardinal principle are overlapped.With reference to Figure 21 C, equipment 2100 is shown in delivery sheath 2122 and is in sending state.Shown in Figure 21 C, the first and second heat insulating components 2118,2120 can subside with balloon 2110 under sending state.

Figure 22 A-22B figure has released the cold therapy equipment 2200 of the equipment 2100 that is similar among Figure 21 A-21C, and difference is the configuration of heat insulating component.Equipment 2200 comprises cooling package 2202, and cooling package 2202 comprises the applicator 2204 with balloon 2206, and balloon can determine to be configured to produce and send subcooled expansion chambers.Applicator 2204 also comprises heat insulating component 2208 and second heat insulating component 2210 of the first elongation.This equipment 2200 may further include fills pipe 2212, and the first and second heat insulating components 2208,2210 can be configured to fill via filling pipe 2212 under deployed condition.Fill pipe 2212 and can comprise concentrator 2214, fill pipe 2212 and branch into the first and second heat insulating components 2208,2210 at concentrator 2214 places.The heat insulating component 1808 of the equipment 1800 shown in reference Figure 18 A-18B is described, the first and second heat insulating components 2208,2210 and fill pipe 2212 can and balloon 2206 between do not have fluid connection.Fill pipe 2212 and can have the proximal part (not shown), be configured to receive the packing material from the vascular system outside.Filling pipe the 2212 and first and second heat insulating components 2208,2210 can be configured to when cooling package 2202 is in sending state fully, mostly or partly subside.

Cooling package according to the some embodiment configuration of present technique can comprise one or more heat insulating components, and these heat insulating components have various suitable shapes and produce around the variety of way of the hot transmitting portions of applicator.For example, can selection mode, so that thereby the continuous hot transmitting portions of the cardinal principle at heat insulating component place can enough be concentrated cooling (for example, so that can not stride across the hot transmitting portions at heat insulating component place for the medicable cooling cardinal principle of kidney neuroregulation) to the kidney neuroregulation greatly effective in curely.Additionally or the ground that replaces, for example, mode can be selected so that with the hot transmitting portions at heat insulating component interval enough greatly to realize the medicable cooling of kidney neuroregulation.Heat is transmitted and to be proportional to area, if the hot transmitting portions of therefore separating with heat insulating component is too little, the total amount of heat by hot transmitting portions transmission can be not enough to produce the medicable cooling of kidney neuroregulation.

Complicated balloon

Figure 23 A-37 figure has released some embodiment of cold therapy equipment, this cold therapy equipment comprises complicated balloon, complicated balloon can be conducive to the one or more therapeutic purposes relevant with low the kidney warming neuroregulation, example as required local or overall therapeutic modality, size is determined and the part obturation.Complicated balloon can have various suitable characteristics, for example shape (for example, helical form, shaped form, vertically asymmetric and radially asymmetric), surface differences (for example, depression, groove, outstanding and projection) and the expansion (for example, the limited expansion of part) of difference.

Figure 23 A-23B figure has released cold therapy equipment 2300, and it comprises the cooling package 2302 of the distal portions 2304 of the bar 2306 that is positioned at the elongation of having determined passing away.Described distal portions 2304 can have ladder 2307, first row outlet 2308, second row outlet 2309, and circular distal 2310.Cooling package 2302 can comprise applicator 2311, and applicator 2311 has the first balloon 2312 of having determined the first expansion chambers and the second balloon 2313 of having determined the second expansion chambers.The first balloon 2312 and the second balloon 2313 are connected to respectively passing away by first row outlet 2308 and second row outlet 2309 fluid connection.Equipment 2300 may further include the supply pipe 2314 that extends along the length of bar 2306, and cooling package 2302 may further include the first aperture 2316 and the second aperture 2318.Align with first row outlet 2308 in the first aperture 2316, so that cold-producing medium enters the first balloon 2312 by first row outlet 2308 expansions, and align with second row outlet 2309 in the second aperture 2318, so that cold-producing medium exports 2309 expansions and enters the second balloon 2313 by second row.

The first and second balloons 2312,2313 are separated mutually along the length of cooling package 2302, and are configured to lateral spread and pass along the arc of the different part circumference of the length of cooling package 2302.When cooling package 2302 is in deployed condition, the first balloon 2312 can be configured to contact with first's circumferential section of the inner surface of renal artery or nephrostome, and the second balloon 2313 can be configured to contact with the second portion circumferential section of the inner surface of renal artery or nephrostome.The first and second part circumferential sections can have outstanding perpendicular to the merging of the complete circumference on the plane of renal artery or nephrostome.Therefore, when treatment require on vertical section the cooling of part circumference and fully during the overall type of cooling of circumference, cooling package 2302 can be configured to be conducive to such treatment, and need to not reorientate cooling package 2302 in therapeutic process.

When the first and second balloons 2312,2313 during all in deployed condition, they can drive each other towards the relative side of cardinal principle of the inner surface of renal artery or nephrostome.For example, distal portions 2304 can be between the first and second balloons 2312,2313 transmission power and bar 2306 distal portions is remained substantially the length that is parallel to renal artery or nephrostome near the part of distal portions.In this or other operation, cooling package 2302 can be configured to (also namely, deficiency entirely shut renal artery or nephrostome) of non-obturation.For example, the percentage ratio that cooling package 2302 can be configured to allow the normal blood flow amount is by renal artery or nephrostome (for example, the normal blood flow amount at least about 1%, at least about 10%, or at least about 25%).

Figure 24 A-24B figure has released mainly in a part of discharging the cold therapy equipment 2400 that configures the equipment 2300 shown in Figure 23 A-23B that is different from.Equipment 2400 comprises cooling package 2402, and it is positioned at the distal portions 2404 of the bar 2406 of the elongation of having determined passing away.Distal portions 2404 can have ladder 2407, first row outlet 2408, second row outlet 2409, and circular distal 2410.Cooling package 2402 can comprise having the first balloon 2412 of having determined the first expansion chambers and the applicator 2411 of having determined the second balloon 2413 of the second expansion chambers.The first balloon 2412 and the second balloon 2413 liquid communication ground are connected to passing away by first count outlet 2408 and second row outlet 2409 respectively.Equipment 2400 may further include the supply pipe 2414 with the first lateral branching 2416 and second lateral branching 2418 that extends along the length of bar 2406.Cooling package 2402 may further include be positioned at the first lateral branching 2416 ends to the first aperture 2420 that the first balloon 2412 is opened, and it is terminal and to the second aperture 2422 that the second balloon 2413 is opened to be positioned at the second lateral branching 2418.Be different from the equipment 2300 shown in Figure 23 A-23B, equipment 2400 comprise on the side face opposite side of distal portions 2404 be used for the first and second balloons 2412,2413 cold-producing medium supply and cold-producing medium are discharged.The first and second balloons 2412, the 2413 vertically section extensions of complete side face around distal portions 2404, but be connected to distal portions 2404 and be finalized near asymmetrically expansion distal portions 2404.

Can comprise part circumference balloon with the cooling package 2302 shown in Figure 23 A-24B, 2402 varying numbers according to the cooling package of the some embodiment configuration of present technique.For example, in some embodiment, cooling package 2302 can comprise the first balloon 2312 or the second balloon 2313, but not comprises both.Similarly, cooling package 2402 can comprise the first balloon 2412 or the second balloon 2413 but not comprise both.Cooling package 2302 shown in Figure 23 A-24B, 2402 can also comprise more balloon, for example 3 or 4 balloons in the separation that vertically and directly makes progress.In addition, the size of balloon can change.For example, in some embodiment, first and second balloons 2312,2313 of cooling package 2302, or first and second balloons 2412,2413 of cooling package 2402 can be configured to provide the overall type of cooling of part side face.

Can comprise applicator with balloon according to the cooling package of the some embodiment configuration of present technique, wherein balloon has multiple suitable surface characteristic, for example be configured to be convenient to separately the part circumference cooling on vertical section, or itself and the combination of the overall type of cooling of full circumferences.Figure 25 figure has released the part of cold therapy equipment 2500 of the cooling package 2502 at distal portions 2504 places that comprise the bar 2506 that is positioned at the elongation of having determined passing away.Described distal portions 2504 can have ladder 2507, and cooling package 2502 can be included in the applicator 2508 in the balloon 2510, and wherein balloon has been determined expansion chambers and had far-end neck 2511, helical form depression 2512 and lands 2513.Equipment 2500 may further include the guiding elements that extends through far-end neck 1,511 2514 of elongation, and the supply pipe 2516 that extends and enter balloon 2510 along the length of bar 2506.Cooling package 2502 may further include the aperture 2518 of the far-end that is positioned at supply pipe 2516.When cooling package 2502 was in sending state, helical form depression 2512 can be corresponding to the hot transmitting portions that has the heat transfer rate lower than the part away from helical form depression 2512 of applicator 2508 on the applicator 2508.

Interval between the renal artery of helical form depression 2512 and treatment site or the inner surface of nephrostome can make between the part of renal artery or the most close helical form depression 2512 of nephrostome and the cryogenic temperature in the balloon 2510 heat isolate.For example, the blood that freeze or liquid state in this interval can provide the heat isolation.Helical form depression 2512 can with respect to the degree of depth of lands 2513, for example, corresponding to the thickness of material (for example, liquid state or the blood that freezes), wherein said thickness is enough to heat isolation between the sub-cooled in the part of renal artery or nephrostome and the balloon 2510.For example, the described degree of depth can be at about 0.2mm and approximately between the 2mm, for example at about 0.3mm and approximately between the 1.5mm.The female of the balloon of cold therapy part of appliance as herein described in some other embodiment can have with respect to the lands of balloon the similar degree of depth.

Figure 26 figure has released the part of another embodiment of cold therapy equipment 2600 of the cooling package 2602 of the distal portions 2604 that comprises the bar 2606 that is positioned at the elongation that has formed passing away.Distal portions 2604 can have ladder 2607, and freezing assembly 2602 can comprise the applicator 2608 with balloon 2610, and balloon 2610 has been determined expansion chambers and had far-end neck 2611, a plurality of depression 2612 and lands 2613.Female 2612 can be arranged as the helical form mode around the side face of balloon 2610.Cooling package 2602 may further include the guiding elements 2614 of elongation, and it extends through far-end neck 2611.Equipment 2600 can also comprise supply pipe 2616, and it extends and enter balloon 2610 along length of bar 2606.Cooling package 2602 may further include the aperture 2618 of the far-end that is positioned at supply pipe 2616.When cooling package 2602 was in deployed condition, helical form depression 2512 and lands 2513 that depression 2612 and lands 2613 can be similar to equipment shown in Figure 25 2500 worked.

Figure 27 A-27C figure has released the part of the cold therapy equipment 270 of the equipment 2600 that is similar among Figure 26, but equipment 2700 is configured to compare in renal artery or nephrostome more not inaccessible with the equipment 2600 among Figure 26.Equipment 2700 comprises the cooling package 2702 of the distal portions 2704 of the bar 2706 that is positioned at the elongation of having determined passing away.Distal portions 2704 can have ladder 2707, and cooling package 2702 can comprise the applicator 2708 that is arranged in balloon 2710, and balloon 2710 has been determined expansion chambers and had near-end branch 2711, tubular body portion 2712, far-end branch 2713, a plurality of depression 2714 and lands 2716.Described a plurality of depression 2714 can be arranged as around the helical form mode of balloon 2710 side faces.When cooling package 2702 was in deployed condition, depression 2612 and lands 2613 that depression 2714 and lands 2716 can be similar to equipment shown in Figure 26 2600 worked.Near-end branch 2711 can be configured to fluid connection ground tubular body portion 2712 is connected to passing away.Equipment 2700 may further include the guiding elements 2718 of elongation, it can extend and be connected to far-end branch 2713 along the length of bar 2706, and the supply pipe 2720 that extends along the length of bar 2706, it is by one in the near-end branch 2711 and enter tubular body portion 2712.Near-end branch 2711 can be configured to tubular body portion 2712 is separated with guiding elements 2718 with far-end branch 2713.Cooling package 2702 may further include the aperture 2722 of the far-end that is positioned at supply pipe 2720.

When cooling package 2702 is in deployed condition, cooling package 2702 can be determined outer surface and the flow path between the balloon 2710 (for example, blood flow paths) of guiding elements 2718.For example, described flow path can extend around near-end branch 2711, by described tubular body portion 2712 (for example, between the inner surface of guiding elements 2718 and tubular body portion 2712), and around far-end branch 2713.Shown in Figure 27 B, described tubular body portion 2712 can comprise the heat insulation interior part 2724 around flow path.Described heat insulation interior part 2724 can be configured at least in part that the sub-cooled in the liquid on the flow path and the tubular body portion 2712 is isolated.In illustrated embodiment, heat insulation interior part 2724 can be the part than the larger thickness of other parts of balloon 2710 of having of balloon 2710.In some other embodiment, part 2724 has the formation different from the other parts of balloon 2710 in the heat isolation, and/or comprises one or more independently heat insulation structurals.Mode as an alternative, balloon 2710 can comprise the tubular body portion 2712 with interior part, the thermal insulation of wherein said interior part is not better than the other parts of balloon 2710.

Figure 28 figure has released the part of the cold therapy equipment 2800 of the equipment 2600 that is similar among Figure 26, the difference configuration with lands that is to cave in.Equipment 2800 comprises the cooling package 2802 with applicator 2804, and applicator 2804 has the balloon 2806 that can determine expansion chambers.Balloon 2806 comprises a plurality of outstanding 2808 and non-protuberance 2810.Outstanding 2808 can be arranged as the helical form mode or around other modes that are fit to of the side face of balloon 2806.When cooling package 2802 was in sending state, non-ledge 2810 can be corresponding to the hot transmitting portions of having of applicator 2804 heat transfer rate lower than the part of applicator at outstanding 2808 places.The renal artery of non-protuberance 2810 and treatment site or the interval between the nephrostome can be with the part of close non-protuberance is isolated with the cryogenic temperature in the balloon 2806 on renal artery or the nephrostome.For example, in this interval freeze or liquid blood heat isolation can be provided.

Have difform balloon and can be conducive to the therapeutic purposes relevant with low the kidney warming neuroregulation.For example, spiral-shaped be beneficial to required part or the overall situation therapeutic modality.Figure 29 figure has released the part of the cold therapy equipment 2900 that comprises cooling package 2902, and cooling package 2902 is positioned at distal portions 2904 places of the bar 2906 of the elongation of having determined passing away.Distal portions 2904 can have ladder 2907, portal 2908 and outlet 2909.Cooling package 2902 can comprise the applicator 2910 with spiral balloon 2911, and balloon 2911 has been determined expansion chambers and had balloon proximal part 2912 and balloon distal portions 2914.Balloon proximal part 2912 has by 2908 less important (minor) liquid with between passing away of portalling and is connected.Balloon distal portions 2914 is connected to around the outer surface of the distal portions 2904 of outlet opening 2909, thus spiral balloon 2911 is connected to passing away in the fluid connection mode.Spiral balloon 2911 is wrapped in (for example, distal portions 2904 can be determined the central axis of spiral balloon 2911) around the distal portions 2904.Equipment 2900 may further include supply pipe 2916, and supply pipe 2916 has been determined the supply chamber and had the main part 2918 of extending along the length of bar 2906 and by 2908 distal portions 2920 that leave the inclination of bar 2906 that portal.Cooling package 2902 can also comprise the aperture 2922 of the far-end of the distal portions 2920 that is positioned at inclination.Supply pipe 2916 and aperture 2922 can be configured to the expansion of cold-producing medium is advanced proximal part 2912 in cardinal principle corresponding to the direction guiding in vertical orientation of balloon proximal part 2912.When cooling package 2902 was in deployed condition, cold-producing medium can flow to balloon distal portions 2914 from balloon proximal part 2912, then flowed along passing away to near-end.After arriving balloon distal portions 2914, cold-producing medium can use up part, major part or whole of its sub-cooled ability.

Figure 30 figure has released a part that mainly is different from the cold therapy equipment 3000 of the equipment 2900 among Figure 29 in the flow of refrigerant direction.Equipment 3000 comprises the cooling package 3002 of the distal portions 3004 of the bar 3006 that is positioned at the elongation of determining passing away.Distal portions 3004 can have ladder 3007, and cooling package 3002 can comprise the applicator 3008 with spiral balloon 3014, and balloon 3014 has been determined expansion chambers and had balloon proximal part 3016 and balloon distal portions 3018.Balloon proximal part 3016 can be connected to the outer surface of distal portions 3004 near the far-end of distal portions 3004, the mode with fluid connection is connected to passing away with spiral balloon 3014 thus.Equipment 3000 may further include the supply pipe 3019 with crooked distal portions 3020.Spiral balloon 3014 can be wrapped in (for example, supply pipe 3019 can be determined the central axis of spiral balloon 3014) around the supply pipe 3019.Supply pipe 3019 can extend along the length of bar 3006, extends rod, extends balloon proximal part 3016, along the central axis of spiral balloon 3014, and enters balloon distal portions 3018.Balloon distal portions 3016 is can be near supply pipe 3019 sealed and be connected at least in part crooked distal portions 3020.Cooling package 3002 may further include the aperture 3021 that supply pipe 3019 is connected to balloon distal portions 3018 in the mode of fluid connection.Supply pipe 3019 and aperture 3021 can be configured to enter balloon distal portions 3018 in the direction guiding cold-producing medium expansion corresponding to vertical orientation of balloon distal portions 3018 substantially.When cooling package 3002 was in deployed condition, cold-producing medium can be from balloon distal portions 3018 to the balloon proximal part 3016 flows, and flows along passing away.

Figure 31 figure has released the part of the cold therapy equipment 3100 of the equipment 3000 that is similar among Figure 30, and its difference is the shape of spiral balloon.Equipment 3100 comprises the cooling package 3102 of the distal portion 3104 of the bar 3106 that is positioned at the elongation of having determined passing away.Distal portions 3104 can have ladder 3108, and cooling package 3102 can comprise the applicator 3110 with spiral balloon 3112, and balloon 3112 has been determined expansion chambers and had balloon proximal part 3114 and balloon distal portions 3116.Balloon proximal part 3114 can be connected to the outer surface of distal portions 3104 near the far-end of distal portions 3104, the mode with fluid connection is connected to passing away with spiral balloon 3112 thus.Equipment 3100 may further include the supply pipe 3117 of the distal portions 3118 with inclination.Spiral balloon 3112 can be wrapped in supply pipe 3117 on every side but separate with supply pipe 3117 diametrically.Supply pipe 3117 can extend along the length of bar 3106, extends rod 3106, extends balloon proximal part 3114, along the central axis of spiral balloon 3112, and enters balloon distal portions 3116.Balloon distal portions 3116 can be sealed near supply pipe 3117.Cooling package may further include the aperture 3119 that supply pipe 3117 is connected to balloon distal portions 3116 in the mode of fluid connection.When cooling package 3102 was in deployed condition, cold-producing medium can be from balloon distal portions 3116 to the balloon proximal part 3114 flows, and flows along passing away.The wider screw diameter of spiral balloon 3112 can be conducive to the part obturation.For example, when cooling package 3102 was in deployed condition, cooling package 3102 can be determined outer surface and the flow path between the spiral balloon 3112 (for example, blood flow paths) of supply pipe 3117.

Figure 32 A-32B figure has released the part that can have corresponding to the cold therapy equipment 3200 of the complicated shape of standard element, and standard element for example has the standard element of shape memory.As mentioned above, can be from least part of the subsiding when corresponding cooling package is in sending state according to the balloon in the cold therapy equipment of the some embodiment configuration of present technique, mobile is at least part of expansion when cooling component is in deployed condition.After expansion under deployed condition, complicated balloon can have predetermined shape (global shape of for example, incorporating balloon by molding or alternate manner into) or corresponding to the shape of independent stereotyped structure.Cold therapy equipment 3200 shown in Figure 32 A-32B comprises the cooling package 3202 of the distal portions 3204 of the bar 3206 that is positioned at the elongation of determining passing away.Distal portions 3204 can have ladder 3207, and cooling package 3202 can comprise applicator 3208.Equipment 3200 may further include the standard element 3210 of elongation and has the supply pipe 3212 of the distal portions 3214 of inclination.Applicator 3208 can comprise the balloon 3216 with distal seal 3217.Balloon 3216 can extend around the standard element 3210 of elongation and can determine expansion chambers.Distal seal 3217 can be the smooth part of balloon 3216, is sealed to together at the wall of this part place balloon 3216 (for example, with hot mode and/or use binding agent).The end of closing that can have other type according to the balloon of the some embodiment configuration of present technique.As mentioned above, balloon can be closed near the structure of for example guiding elements and/or supply pipe.Balloon can also be closed near valve.In addition, balloon can have the complete far-end of closing.For example, balloon can be by molding (for example, dip mold) for having the complete far-end of closing.

Standard element 3210 can be configured to have linear configurations substantially and have curved configuration when cooling package 3202 is in sending state when cooling package 3202 is in deployed condition.Cooling package 3202 can also comprise the aperture 3218 of the far-end of the distal portions 3214 that is positioned at inclination.Supply pipe 3212 and aperture 3218 can be configured to the expansion of cold-producing medium substantially corresponding to the direction guiding air inlet ball 3216 near vertical orientation of the balloon 3216 in aperture 3218.Shown in Figure 32 A, the shape of balloon 3216 under deployed condition is at least in part corresponding to the curved configuration of standard element 3210.Illustrated curved configuration is roughly helical form, but also can be other shapes, the circuitous shape of for example wriggling.Standard element 3210 can have shape memory (for example, one-way shape memory or bidirectional shape memory) and can comprise shape-memory material, for example Nitinol (for example, Nitinol (nitinol)).Shape memory can allow standard element 3210 and balloon 3216 to move into the configuration (for example, crooked, curve, spiral or the circuitous configuration of wriggling) of preliminary election under deployed condition.Configuration can be selected, and for example, allows applicator 3208 to apply therapeutic modality required part or overall.Similarly, spiral-shaped and other shape shown in Figure 32 A can be selected to be provided at the inaccessible grade on the therapentic part, and for example part is inaccessible but not entirely shut.Shape-memory material can lose its part or all of typing attribute when being exposed to cryogenic temperature.Cooling package 3202 according to the some embodiment configuration of present technique can comprise balloon 3216, and balloon 3216 is in the preconfigured that moves into before the sub-cooled or in initial sub-cooled process corresponding to the shape of standard element 3210.When sub-cooled causes standard element to lose its part or all of typing attribute, freezing bonding (cryo-adhesion) between balloon 3216 and the exterior material (for example, blood and/or tissue) can finish so that balloon 3216 remains to freezing bonding at least with its preconfigured.

In the illustrated embodiment of Figure 32 A-32B, standard element 3210 substantially is shown and is centered close in the balloon, and also, balloon 3216 is substantially uniformly around standard element 3210 expansions.Mode as an alternative, standard element 3210 can have the different position in balloon 3216 when cooling package 3202 is in deployed condition.For example, standard element 3210 can be near the inner surface of balloon 3216.When the wall of standard element 3210 and balloon 3216 was separated, balloon 3216 can disperse renal artery or nephrostome applied pressure.Shown in Figure 32 A, standard element 3210 can extend through distal seal 3217.Mode as an alternative, standard element 3210 can be free of attachment to balloon 3216 and/or end at the part of the close distal seal 3217 of balloon 3216.In addition, the distal portions of standard element 3210 can be configured to when cooling package 3202 is in deployed condition away from renal artery or nephrostome.In certain embodiments, balloon 3216 is configured to substantially not need inner supporting structure around standard element 3210 expansions uniformly.Mode as an alternative, balloon 3216 can comprise the internal structure (for example net) that extends across balloon 3216 internal diameters, this standard element 3210 can link to each other with the position at balloon 3216 inner surface intervals with internal structure again.This internal structure is the interval of different balloons (for example, discussing such as reference Figure 45 A-46) for example.In certain embodiments, cooling package comprises the structure of extending along the central axis of the balloon 3216 under the deployed condition.For example, distal portions 3204 can extend along the central axis of the balloon 3216 under the deployed condition and balloon 3216 and standard element 3210 can be connected to the lateral openings of distal portions 3204.As another example, distal portions 3204 can comprise the prolongation that reduces along the diameter of the central axis extension of balloon 3216, and another opening that balloon 3216 is connected to passing away in the mode of fluid connection that separates with the prolongation of reduced.The structure of extending along the central axis of balloon 3216 can comprise chamber (for example, being configured to hold the chamber of wire or control line), protector (for example, filter) and/or monitoring arrangement (for example, thermal coupling or pressure converter).

Equipment 3200 can also be modified for non-cold therapy and use.For example, supply pipe 3212 can be removed and equipment 3200 can be applied to benefit from therapentic part do not entirely shut other use.The kidney neuroregulation use and and during other uses, what balloon 3216 can the right and wrong obturation under deployed condition, for example, can form blood flow paths along the central axis of balloon 3216.In some non-cold therapies were used, distal portions 3204 can be supported a structure, and this structure is configured to treat (for example, thrombectomy) in blood vessel, and balloon 3216 is fixed to blood vessel wall with equipment 3200.In these or other embodiment, balloon 3216 can advantageously maintain endovascular center with distal portions 3204.

Figure 33 A-33D figure has released the part that can have the cold therapy equipment 3300 of predetermined curved shape in launching configuration.Equipment 3300 comprises the cooling package 3302 at distal portions 3304 places of the bar 3306 that is positioned at the elongation of having determined passing away.Distal portions 3304 can have ladder 3307, and cooling package 3302 can comprise the applicator 3308 with the balloon 3310 that can determine expansion chambers.Balloon 3310 can have balloon proximal part 3312, balloon mid portion 3314 and balloon distal portions 3316.Equipment 3300 further comprises the supply pipe 3318 that extends along bar 3306, and cooling package 3302 can have far-end and the aperture in balloon proximal part 3,312 3320 that is in supply pipe 3318.When cooling package 3302 is in deployed condition lower time, balloon 3310 is crooked and have first wall 3322 (being shown the bottom of balloon in Figure 33 A) of the depression of being generally and be generally nonpitting (for example, convex surface) second wall 3324 (being shown the top of balloon in Figure 33 A) along its length direction.

Balloon proximal part 3312, balloon mid portion 3314, and balloon distal portions 3316 can be configured to contact the part circumferential surface sections of renal artery or nephrostome.For example, balloon mid portion 3314 can be configured to when cooling package 3302 is in deployed condition, generally along the second wall 3324 and substantially not along the first wall 3322 contact renal artery or nephrostomes.Balloon proximal part 3312 and balloon distal portions 3316 for example, can be configured to when cooling package is in deployed condition generally along the first wall 3322 and substantially not along the second wall 3324 contact renal artery or nephrostomes.Because this uneven way of contact, the shape of the bending of balloon 3310 can help required local or overall therapeutic modality.

As being clear that in Figure 33 B-33C, balloon 3310 can be included in balloon mid portion 3314 places and reduce part 3326 along the elasticity of the first wall 3322.In illustrated embodiment, described elasticity reduces part 3326 can be the thicker part of balloon 3310.Shown in Figure 33 D, balloon 3310 can partly subside when cooling package 3302 is in sending state, in order to be fit to be in the delivery sheath 3328.When cooling package 3302 was in sending state, elasticity reduces part 3326 can keep some curvatures.Mode as an alternative, elasticity reduces part 3326 and can be roughly smooth.When cooling package 3302 is in deployed condition, be different from the part that elasticity reduces part 3326 on the balloon 3310, especially the part along the second wall 3324 at balloon mid portion 3314 places of balloon 3310, can be configured to expansion (for example, flexibly expansion) and reduce the larger degree of part 3326 for elasticity.In some embodiment, it is flexible that elasticity reduces being roughly along the part of the second wall 3324 at balloon mid portion 3314 places of that part 3326 is roughly inflexibility and balloon 3310.When cooling package 3302 is in deployed condition, reduce the bending that the related restriction of part 3326 can help balloon 3310 with elasticity.When cooling package 3302 is in deployed condition, elasticity reduces part 3326 and can be configured to respect to renal artery or nephrostome depression, and around having the hot transmitting portions that is enough to cause the heat transfer rate that the kidney of therapeutic effect neuroregulation is arranged.Except reducing elasticity, the thickness that elasticity reduces part 3326 can lower its heat conductivity, and this can promote cooling effectiveness and/or further be conducive to required local or whole therapeutic modalities.

Figure 34 figure has released the part of the cold therapy equipment 3400 of the equipment 3300 that is similar among Figure 33 A-33D, and its difference is the distinguishing support configuration of tool.Equipment 3400 comprises the cooling package 3402 with applicator 3404, and applicator 3404 comprises the balloon 3406 of determining expansion chambers.Cooling package 3402 also comprises the support member 3408 of elongation, and it has crooked far-end 3410.The support member 3408 of elongation and other support member as herein described can help balloon to move with cooling package when corresponding cooling package moves between sending state and deployed condition.For example, the support member 3408 of elongation can help prevent balloon 3406 to block in therapeutic process or reverse.Alternatively, the support member of elongation can be connected to the distal portions of corresponding balloon.This for, for example, balloon is maintained can be useful in the extended configuration.

Figure 35 A-35B figure has released cold therapy equipment 3500, and wherein the interaction with guiding elements causes complicated balloon at least in part.In some other embodiment, complicated balloon is at least in part by finalizing the design with the interaction of other cold therapy part of appliance (for example, bar or supply pipe).The illustrated equipment 3500 of Figure 35 A-35B comprises the cooling package 3502 of the distal portions 3504 of the bar 3506 that is in the elongation of determining passing away.Equipment 3500 can comprise guiding elements 3508 and the supply pipe 3512 of elongation, and cooling package can comprise the aperture 3514 of the far-end that is positioned at supply pipe 3512.Cooling package may further include the applicator 3510 in balloon 3516, the far-end integral neck 3522 that balloon 3516 can be determined expansion chambers and have balloon proximal part 3518, is connected to the near-end integral neck of distal portions 3504 and is connected to guiding elements 3508.Balloon 3516 can also have restricted longitudinal component 3524 (Figure 35 B) and distensible longitudinal component 3526 (Figure 35 B).Limited longitudinal component 3524 can be connected to guiding elements 3508 at least in part.For example, from far-end integral neck 3522 to balloon proximal part 3518, the inner surface of balloon 3516 can be connected to guiding elements 3508.Distensible longitudinal component 3526 can be when cooling package 3502 be in deployed condition and guiding elements 3508 isolated.The limited shape of the part of balloon 3516 can be used for helping required local or overall therapeutic modality.In addition, limited longitudinal component 3524 can be determined at least a portion of longitudinal flow path (for example, blood flow paths).For example, this is conducive to the inaccessible level of therapentic part, and for example part is inaccessible but not all inaccessible.

Figure 36 figure has released the cold therapy equipment 3600 of the cold therapy equipment 3500 that is similar among Figure 35 A-35B, and difference is to have the different connected mode between balloon and the guiding elements.Figure 36 can regard substituting of Figure 35 B as, and to scheme to release different embodiment, wherein all elements of the cold therapy equipment 3500 shown in Figure 35 A-35B are similar except being shown in Figure 36 than different those elements of Figure 35 B.Cold therapy equipment 3600 comprises guiding elements 3602 and the balloon 3604 of elongation, balloon 3604 have interval diametrically restricted longitudinal component 3506 and radially with the longitudinal component 3508 of the expansion at that interval.Although Figure 36 shows the longitudinal component 3608 of two limited longitudinal components 3606 and two expansions, the longitudinal component 3608 of the limited longitudinal component 3606 of greater number and/or expansion can form by for example balloon 3604 being connected to guiding elements 3602 at the radial section place of the varying number of guiding elements 3602.In addition, the distribution of the longitudinal component 3608 of limited longitudinal component 3606 and expansion can be symmetrical or asymmetrical (for example, along the axis that is parallel to the length of guiding elements 3602).

Figure 37 figure has released the part of the cold therapy equipment 3700 that comprises annular balloon.Equipment 3700 comprises the cooling package 3702 of the distal portions 3704 of the bar 3706 that is positioned at the elongation of determining passing away, and supply pipe 3708.Cooling package 3702 comprises the aperture 3710 of the far-end that is positioned at supply pipe 3708, and the applicator 3712 with balloon 3714, and wherein balloon 3714 has the first balloon section 3716 and the second balloon section 3718.The first balloon section 3716 has the first proximal part 3720 and the first distal portions 3722.The second balloon section 3718 has the second proximal part 3724 and the second distal portions 3726.The first balloon distal portions 3722 is connected to the second distal portions 3726 in the mode of fluid connection.When cooling package 3702 was in deployed condition, cold-producing medium can flow to the first distal portions 3722 from the first proximal part 3720, again to the second distal portions 3726.After arriving the second distal portions 3726, cold-producing medium can have been used up its sub-cooled ability partly, mostly or fully.Therefore, the second balloon section 3718 can Main Function ejects the cold-producing medium from the first distal portions 3722, and has hot transmitting portions, and the heat transfer rate of this hot transmitting portions is lower than the heat transfer rate of the hot transmitting portions of the first balloon section 3716.In some alternate embodiments, the first balloon section 3716 and the second balloon section 3718 are balloons independently, have the connection of fluid connection at its far-end.In another embodiment, the first and second balloon sections can be the part of folding single balloon.Be similar to following non-cooling balloon, the second balloon section 3718 can be thermally isolated from the part of the renal artery for the treatment of site or nephrostome the cryogenic temperature in the first balloon section 3716.For example, this can be useful for helping required local or overall therapeutic modality.

A plurality of balloons

Figure 38-51 figure has released some embodiment of the freezing equipment that comprises a plurality of balloons, described a plurality of balloon can help the one or more therapeutic purposes relevant with low the kidney warming neuroregulation, example as required local or overall therapeutic modality, size is determined and entirely shut.In the cold therapy equipment that the some embodiment according to present technique configure, main balloon is configured to produce or to the medicable cooling of kidney neuroregulation (for example transmits, comprise main hot transmitting portions), main balloon can with inferior balloon coupling, inferior balloon is configured to prevent or be suppressed at the medicable chilling temperature on the selected location.In some embodiment, inferior balloon comprises time hot transmitting portions.For instance, inferior balloon can be that warm up, heat insulation, non-cooling or have lower cooling level.Mode as an alternative, some embodiment comprise a plurality of balloons, comprising main hot transmitting portions and have or do not have inferior balloon.

Figure 38 A-38B figure has released the part of the cold therapy equipment 3800 that can have a plurality of main balloons.Equipment 3800 comprises the cooling package 3802 of the distal portions 3804 of the bar 3806 that is positioned at the elongation of determining passing away.Distal portions 3804 can have ladder 3807, and equipment 3800 can comprise guiding elements 3808 and the supply pipe 3810 of elongation.Cooling package 3802 can comprise the aperture 3811 of the far-end that is positioned at supply pipe 3810, and the applicator 3812 with balloon 3814 of elongation, and wherein balloon 3814 places parallel with the length of cooling package 3802 substantially.Balloon 3814 has shared proximal part 3816 and otherwise distributes at side face around guiding elements 3808.Aperture 3811 is arranged in shared proximal part 3816, and balloon 3814, in conjunction with the proximal part 3816 of sharing, can determine expansion chambers.When cooling package 3802 is in deployed condition, from cold-producing medium can enter shared proximal part 3816 and circulation has caused balloon balloon 3814 expansion and the cooling of supply pipe 3810 expansions.Cold-producing medium can also leave balloon 3814 by the proximal part 3816 of sharing and flow along passing away to far-end.Balloon 3814 can be configured to contact the part (for example, the longitudinal component of separation) of the separation of the renal artery that is positioned at therapentic part or nephrostome.This can help required local or overall therapeutic modality.In addition, the space between the balloon 3814 can be determined around at least a portion in the longitudinal flow path (for example, blood flow paths) of balloon 3814.This can help, for example, the inaccessible level of therapentic part, for example part is inaccessible but not entirely shut.

Figure 39 A-39C figure has released the part of the cold therapy equipment 3900 that can have a plurality of balloons, and wherein a plurality of balloons have different cooling levels.Equipment 3900 comprises the cooling package 3902 of the distal portions 3904 of the bar 3906 that is positioned at elongation, the guiding elements 3907 of elongation, and a plurality of supply pipe (being expressed as respectively 3908a-d).Cooling package 3902 can comprise a plurality of apertures (being expressed as respectively 3910a-d) of the far-end that is positioned at supply pipe 3908a-d, and the applicator 3912 that comprises the balloon (being expressed as respectively 3914a-d in Figure 39 A and 39C) of a plurality of elongations.Balloon 3914a-d centers on guiding elements 3907 in the side face distribution and comprises separately the near-end neck 3916 (Figure 39 A) that can balloon 3914a-d be connected in the fluid connection mode passing away.Aperture 3910a, 3910d have the clear passage area larger than aperture 3910b, 3910c.Similarly, supply pipe 3908a, 3908d have the clear passage area less than supply pipe 3908b, 3908d.Balloon 3914a-d substantially size equates and has an inside and outside surface area that substantially equates.Ratio between the aperture of balloon 3914a, 3914d and/or supply pipe clear passage area and the interior surface area can be greater than balloon 3914b and 3914c.This can cause balloon 3914a, 3914d with respect to the cooling of the difference of balloon 3914b, 3914c.For example, balloon 3914a, 3914d can be configured to the gaseous refrigerant that circulating temperature is lower than balloon 3914b, 3914c.Mode ground additionally or as an alternative, balloon 3914a, 3914d can be configured to the large body surface area limited cooling of cooling package 3902 when being in deployed condition, and balloon 3914b, 3914c are configured to the large cryogen limited cooling of cooling package 3902 when being in deployed condition.Near zone the tissue pointed for medicable kidney neuroregulation (for example provides certain cooling, low-level cooling, for example be not enough to carry out the refreshing neuroregulation of low temperature) can be useful, for example, reduce the heat that obtains from the surrounding tissue in medicable kidney neuroregulation zone pointed.Can also help required local or overall therapeutic modality and/or the required inaccessible level on the therapentic part to the use of a plurality of balloons, for example, part is inaccessible but not entirely shut.

Figure 40 figure has released the cold therapy equipment 4000 of the cold therapy equipment 3900 that is similar among Figure 39 A-39C, and its difference is to have the mechanism of different difference coolings.Figure 40 can regard substituting of Figure 39 B as, and to scheme to release independently embodiment, wherein all elements of the cold therapy equipment 3900 shown in Figure 39 A-39C are similar except being shown in Figure 40 than different those elements of Figure 39 B.Cold therapy equipment 4000 comprises bar 4002, and bar 4002 has the inwall 4004 of passing away that bar 4002 is divided into the separation of fluid connection, and lays respectively at the supply pipe 4006 in the passing away.Supply pipe 4006 has substantially identical size, also has the aperture (not shown), and described aperture has substantially identical size.Cold therapy equipment 4000 also comprise with passing away between a plurality of pressure regulators (being expressed as respectively 4008a-d) of being communicated with of fluid.Pressure regulator 4008a-d can be configured to be positioned at outside the vascular system.Back-pressure in the adjusting passing away can cause the temperature change in the corresponding balloon (not shown).For example, pressure regulator 4008a, 4008d can keep the first back-pressure in corresponding passing away and the balloon, and pressure regulator 4008b, 4008c can keep in corresponding passing away and the balloon second, different back-pressure.In this way, can realize being similar to reference to the similar difference cooling of equipment 3900 described difference coolings shown in Figure 39 A-39C.

Figure 41 figure has released the part of the cold therapy equipment 4100 that can have a plurality of spiral balloons.Equipment 4100 comprises the cooling package 4101 at distal portions 4102 places of the bar 4103 that is positioned at the elongation of having determined passing away, supply pipe 4104, and fill pipe 4105.Cooling package 4101 can comprise the first supply aperture 4106, the second supply aperture 4107 and the filling aperture 4108 that is positioned at the far-end of filling pipe 4105.Cooling package 4101 also comprises the applicator 4109 with a plurality of spiral balloons.In one embodiment, applicator 4109 comprise the first spiral balloon 4110 with the first distal portions 4112 and first proximal part 4114, the second spiral balloon 4116 with the second distal portions 4118 and second proximal part 4120 (release be shown dot-dash for ease of figure) and triple helical balloon 4122 with the 3rd distal portions 4124 and the 3rd proximal part 4126.First and second the supply apertures 4106,4107 can be connected respectively to communicatively the first distal portions 4112 and the 3rd distal portions 4124 by fluid, and first and triple helical balloon 4110,4112 can determine expansion chambers.The second balloon proximal part 4120 is connected to filling aperture 4108 with can being centered on 4107 sealings of filling pipe and fluid connection and the second spiral balloon 4116 can be determined filled chamber.When cooling package 4101 was in deployed condition, the second spiral balloon 4116 can be configured to be full of via filling pipe 4105.Cold-producing medium can be expanded and enter the first distal portions 4112 and the 3rd distal portions 4124, and first and triple helical balloon 4110,4122 main cooling under the spiral way of spiral way independently or merging can be provided.The second spiral balloon 4116 can with the part of renal artery or nephrostome with first and triple helical balloon 4110,4122 sub-cooled isolated.For instance, this is useful to helping required local or overall therapeutic modality.In addition, at least a portion of longitudinal flow path (for example, blood flow paths) can be determined in the inner space between supply pipe 4004 and first, second and the triple helical balloon 4110,4116,4112.For instance, this is useful to the inaccessible level that helps therapentic part, for example is that part is inaccessible but not all inaccessible.

Figure 42 figure has released the cold therapy equipment 4200 of the equipment 4100 that is similar among Figure 41, but the supply after in the spiral balloon, having change and discharge configuration.Equipment 4200 comprises the cooling package 4202 at distal portions 4203 places of the bar 4204 that is positioned at the elongation of determining passing away, guiding elements 4205 and the supply pipe 4206 of elongation.Cooling package 4202 can comprise the supply aperture 4207 that is positioned at supply pipe 4206 far-ends and the applicator 4208 with a plurality of spiral balloons.In one embodiment, applicator 4208 comprise the first spiral balloon 4210 with the first distal portions 4212 and first proximal part 4214, the second spiral balloon 4216 with the second distal portions 4218 and second proximal part 4220 (release be shown dot-dash for ease of figure) and triple helical balloon 4222 with the 3rd distal portions 4224 and the 3rd proximal part 4226.The first distal portions 4212 and the 3rd distal portions 4224 fluids are communicatively connected to the other side and the second distal portions 4218.The first proximal part 4214 and the 3rd proximal part 4226 fluids are communicatively connected to passing away.When cooling package 4202 was in deployed condition, cold-producing medium can be expanded and enter the second proximal part 4220, and the second spiral balloon 4216 can provide the main cooling in the spiral way.First and triple helical balloon 4210,4222 can receive from the discarded cold-producing medium of the second distal portions 4218 and can the part of renal artery or nephrostome is isolated with the sub-cooled in the second spiral balloon 4216.With respect to the cold therapy equipment 4200 shown in Figure 41, equipment 4100 needs still less cooling and/or be useful during the greater distance between the zone of main cooling.In some other embodiment, varying number warm, heat insulation, non-cooling or the spiral balloon with low cooling level twine with various layouts, wherein the spiral balloon is configured to provide main cooling, for example helps required local or overall therapeutic modality.

Figure 43 A-43C figure has released the part of the cold therapy equipment 4300 that can comprise the balloon that can move with respect to the other parts of cooling package.Equipment 4300 comprises the cooling package 4301 at distal portions 4302 places of the bar 4303 that is positioned at the elongation of determining passing away, and standard element 4304, the first supply pipe 4305 and second supply pipe 4306 of elongation.Distal portions 4302 can have ladder 4307, and cooling package 4301 can comprise the first aperture 4308 of the distal portions that is positioned at the first supply pipe 4305, and the second aperture 4309 that is positioned at the far-end of the second supply pipe 4306.Cooling package 4301 further comprises applicator 4310, the balloon 4312 that applicator 4310 has the balloon 4311 of the first elongation of having determined the first expansion chambers and determined the second elongation of the second expansion chambers.The first balloon 4311 has the first proximal part 4314, the first mid portion 4315 and the first distal portions 4316.The second balloon 4312 has the second proximal part 4318, the first mid portion 4319 and the first distal portions 4320.The first and second balloons 4311,4312 have the most close standard element 4304 inboard 4322 and with the inboard 4322 relative outsides 4324.The first distal portions 4316 and the second distal portions 4320 are connected to standard element 4304.In some embodiment, standard element 4304 has also been determined guidance cavity, and wire can pass by this guidance cavity.

Shown in Figure 43 C, when cooling package 4301 was in deployed condition, regaining standard element 4304 with respect to bar 4303 can be so that the first mid portion 4315 and the second mid portion 4319 laterally moves away standard element 4304.The part of the part of the first mid portion 4315 and/or the second mid portion 4319 can be weakened (for example, by folding, heat treatment so that its fragility and/or attenuation) or otherwise be configured to determine preferential bending direction.Shown in Figure 43 C, after standard element 4304 is retracted in the inboard 4322 of the first mid portion 4315 that its length direction caves in and the second mid portion 4319, when the outside 4324 of the first mid portion 4315 and the second mid portion 4319 generally along its length depression.For instance, the controlled deflection of balloon determines that with the lower risk that applies excessive expansion pressure to renal artery or nephrostome size is particularly favourable to helping.That be roughly inflexibility when one or more balloons of applicator and/or can't expand to realize that size is determined by flexibility the time, controlled deflection be particularly favourable.

Figure 44 A-44C figure released with Figure 43 A-43B in the part of cold therapy equipment 4300 similar cold therapy equipment 4400, but have greater number elongation balloon and comprise time balloon.Equipment 4400 comprises the having ladder 4405 and determined the distal portions 4402 of passing away of bar 4404 of elongation, is positioned at the cooling package 4406 of distal portions 4402, and the standard element 4408 of elongation.Standard element 4304 can for rigidity maybe can determine a chamber, guidance cavity for example, wire can pass by guidance cavity.Equipment 4400 further comprises the first supply pipe 4410, the second supply pipes, 4414, the three supply pipe (not shown) and fills pipe 4416.Cooling package 4406 can comprise the first supply aperture 4418 of the far-end that is positioned at the first supply pipe 4410, be positioned at the second aperture 4420 of the far-end of the second supply pipe 4414, be positioned at the 3rd aperture (not shown) of far-end of the 3rd supply pipe and the tucker aperture 4422 that is positioned at the far-end of filling pipe 4416.Cooling package 4406 also comprises applicator 4424, applicator 4424 has the balloon 4426 of the first elongation of having determined the first expansion chambers, determine the balloon 4428 of the second elongation of the second expansion chambers, determined the 3rd balloon 4430 (Figure 44 B) that extends of the 3rd expansion chambers and the 4th balloon 4432 that extends of definite filled chamber.Be connected to first, second, and third supply aperture 4418,4,420 first, second, third balloon 4426,4428,4430 fluid connections.Be connected near tucker aperture 4422 and sealed filling pipe 4416 the 4th balloon fluid connection.The first, second, third and the 4th balloon 4426,4428,4430,4432 is connected to standard element 4408, so, shown in Figure 44 C, when cooling package 4406 is in deployed condition, regain standard element 4408 so that applicator 4424 lateral spreads with respect to bar 4404.First, second, and third balloon 4426,4428 and 4430 can have hot transmitting portions, and the heat transfer rate of this hot transmitting portions enough produces medicable kidney neuroregulation.First, second, and third balloon 4426,4428,4430 can be configured to provide main cooling.The 4th balloon 4432 can be inferior balloon.In some other embodiment, the main balloon that is with or without time balloon of varying number can be included in the cold therapy equipment 4400 shown in the cold therapy equipment 4300 shown in Figure 43 A-43B and Figure 44 A-44C similarly in the configuration.Except size was determined, these configurations can help other therapeutic purposes, and example is local or overall therapeutic modality as required.

Figure 45 A-45B figure has released a part that comprises the cold therapy equipment 4500 that can have the different main balloons that consist of and time balloon.Equipment 4500 comprises the cooling package 4502 of the distal portions 4504 of the bar 4506 that is positioned at the elongation of having determined passing away, supply pipe 4508, and fill pipe 4509.Cooling package 4502 can comprise the supply aperture 4510 of the far-end that is positioned at supply pipe 4508, is positioned at the tucker aperture 4514 of the far-end of filling pipe 4509.Cooling package 4502 also comprises applicator 4516, and applicator 4516 has the first balloon of having determined expansion chambers and can determine the second balloon 4520 of filled chamber.The first balloon 4518 have be arranged in distal portions 4504 with the first balloon 4508 fluid connections be connected to the near-end neck 4522 of passing away.The second balloon is being connected to filling aperture 4514 with filling sealed near the pipe 4509 and fluid connection.When cooling package 4502 is in deployed condition, the first balloon 4518 can be configured to send main cooling and the second balloon 4520 can be inferior balloon.

In some embodiment, the first balloon 4518 has level of flexibility and/or the elasticity lower than the second balloon 4520.For example, first balloon 4518 can be roughly inflexibility, and the second balloon can be roughly flexible.In addition, the first balloon 4518 can be for flexibility for the second balloon of inflexibility.Non-flexible material has higher intensity (for example, higher pressure rating) than flexible material usually.Because of this and/or other reason, flexible material can be suitable for being configured to directly receiving from the aperture cold-producing medium of expansion and/or dispensing to the medicable cooling of kidney neuroregulation substantially.The flexible material of cardinal principle can also be suitable for being expanded to different sizes and adapt to renal artery and the nephrostome with different cross section size.Equipment 4500 shown in Figure 45 A-45B and some other cold therapy equipment as herein described can be configured to utilize the two different qualities of inflexibility and flexible material.Figure 45 B and 45C are the sectional view of equipment 4500, and wherein the size of equipment 4500 is determined to adapt in the renal artery or nephrostome that is in the different cross section size.The first balloon 4518 has identical size substantially in Figure 45 B and Figure 45 C.But the second balloon 4520 is expanded to than degree larger in Figure 45 B in Figure 45 C flexibly.Even the expansion that is roughly inflexibility of the first balloon 4518, the expansion variable, flexibility of the second balloon 4520 can move to the first balloon with the inner surface of renal artery or nephrostome and contact.The flexibility expansion of the second balloon 4520 can carefully be controlled to prevent to occur on renal artery or the nephrostome excessive expansionary force by filling pipe 4509.

Amplification among Figure 45 B-1 shows the spacer 4524 that comprises non-flexible material layer 4526 and flexible material layer 4528.Non-flexible material layer 4526 can be the part of the second balloon 4520 for the part flexible material layer 4528 of the first balloon 4518.In one embodiment, the first balloon 4518 can connect together at spacer 4524 places with the second balloon 4520, but in other embodiments, the first and second balloons 4518 and 4520 are free of attachment to together.

Figure 46 figure has released the cold therapy equipment 4600 of the cold therapy equipment 4500 that is similar among Figure 45 A-45C, but has different spacers.Figure 46 can regard substituting of Figure 45 B as, and to scheme to release independently embodiment, wherein all elements of the cold therapy equipment 4500 shown in Figure 45 A-45C are similar except being shown in Figure 46 than different those elements of Figure 45 B.Cold therapy equipment 4600 comprises the first balloon 4602, the second balloon 4604 and the volume spacer 4606 between the first balloon 4602 and the second balloon 4604.Shown in the amplification among Figure 46-1, spacer 4606 comprises monolayer, and described monolayer can be the inflexibility layer of the first balloon.In another embodiment, spacer 4606 can be included as the monolayer of the flexible layer of the second balloon 4604.For structure equipment 4600, submissive balloon part (for example substantially, incomplete balloon) can be connected to substantially not flexible balloon, to form substantially submissive balloon, it has at least part of by the determined chamber of the not flexible balloon of described cardinal principle, in the cross section, as shown in figure 46, the first balloon 4602 can be roughly the balloon of D type, and the second balloon 4604 can be roughly the balloon of C type, and it is connected to the balloon that is roughly the D type.

Can comprise that according to the cold therapy equipment of the some embodiment configuration of present technique spiral lives balloon and non-helical balloon.Figure 47 figure has released the cold therapy equipment 4700 that comprises cooling package 4702, and wherein cooling package 4702 is positioned at distal portions 4704 places of the bar 4706 of the elongation of having determined passing away.Equipment 4700 also comprises supply pipe 4707.Cooling package 4702 comprises applicator 4708, and applicator 4708 has helical form the first balloon 4710, and balloon 4710 has the first proximal part 4712 and the first distal portions 4714 and determines expansion chambers.Supply pipe 4707 can be expanded and enter the first proximal part 4712, and cooling package 4702 can have the aperture 4718 that is positioned at the far-end of supply pipe 4707 in the first proximal part 4712.The first proximal part 4712 is sealed near supply pipe 4707.Cooling package 4702 further comprises the second balloon 4720, and it has the second proximal part 4722 and the second distal portions 4724 and has determined the discharge chamber.The second distal portions 4724 can be connected to the first distal portions 4714 fluid connection, and the first balloon 4710 can be wrapped in around the second balloon 4720.The second proximal part 4722 can be connected to passing away fluid connection.When cooling package 4702 was in deployed condition, cold-producing medium can flow to the first distal portions 4714 from the first proximal part 4712, then flowed through the second balloon 4720 to near-end again.Back-pressure from cold-producing medium can be so that the second balloon 4720 be expanded (for example, flexibly expansion), and the screw diameter of the first balloon 4710 that this can be increases.For instance, this determines it is favourable for size.Additionally, the spiral-shaped of the first balloon 4710 can be useful for required local or overall therapeutic modality.

Figure 48 A-48B figure has released the part of the cold therapy equipment 4800 with the different spiral master balloon of configuration and non-helical balloon.Equipment 4800 comprises the cooling package 4802 at distal portions 4804 places of the bar 4806 that is positioned at the elongation of having determined passing away.Distal portions 4804 can have ladder, and cooling package 4802 can comprise applicator 4808, and applicator 4808 has helical form the first balloon 4810 of having determined expansion chambers and having comprised the first proximal part 4812 and the first distal portions 4814.Equipment 4800 can also comprise supply pipe 4816, and it extends into the first proximal part 4812, and cooling package 4802 can have the aperture 4818 of the far-end that is positioned at the first proximal part 4812 endogenous supply pipes 4816.The first proximal part 4812 is sealed near supply pipe 4816.Cooling package 4802 may further include the second balloon 4820, and it has the near-end neck 4822 of the integral body that is connected to distal portions 4804.The second balloon 4820 can determine to discharge the chamber, discharges the chamber and is configured to expand (for example, flexible expansion) in response to the back-pressure of the cold-producing medium of discharging from the first balloon 4810.The first balloon 4810 can be connected to the inner surface of the second balloon 4820.The expansion of the second balloon 4820 (for example, flexible expansion) can be so that the screw diameter of the first balloon 4810 increases, so the part of the bending of the first balloon 4810 moves to the inner surface of more close renal artery or nephrostome.For instance, it is useful the first balloon 4810 being placed among the second balloon 4820 for the redundancy capacity that cold-producing medium is provided in vascular system.

Figure 49 figure has released the part of the cold therapy equipment 4900 that comprises spiral master balloon and non-helical balloon in another configuration.Equipment 4900 comprises the cooling package 4902 at distal portions 4904 places of the bar 4905 that is positioned at the elongation of having determined passing away.Distal portions 4904 can have ladder 4906 and a plurality of outlet opening 4907.Cooling package 4902 can comprise applicator 4908, applicator 4908 has helical form the first balloon 4910. equipment 4900 of having determined expansion chambers and having had the first proximal part 4912 and the first distal portions 4914 can also comprise the supply pipe 4916 that extends into the first proximal part 4912, and cooling package 4902 can have the aperture 4918 of the far-end that is positioned at supply pipe 4916.The first proximal part 4912 can be by near sealing supply pipe 4916.Cooling package 4902 may further include the second balloon 4920, and it places near the distal portions 4904 and has the whole near-end neck 4922 that is connected to distal portions 4904.The first balloon 4910 can be wrapped in around the second balloon 4920 and the first distal portions 4914 can be connected to the distal portions 4904 in the second balloon 4920 distally fluid connection.When cooling package 4902 is in deployed condition, the second balloon 4920 can be configured to receive passively cold-producing medium from passing away by outlet opening 4907, and can be configured to the back-pressure that produces in response to the cold-producing medium of being discharged by the first balloon 4910 and expand (such as, flexibly expansion).The expansion of the second balloon 4920 (for example, flexibly expansion) can be so that the screw diameter of the first balloon 4910 increases, and this is so that the part of the first balloon 4910 (for example, crooked part) moves to the inner surface of more close renal artery or nephrostome.

Figure 50 figure has released the part of the cold therapy equipment 5000 in another configuration that comprises helical form master balloon and non-helical balloon.Equipment 5000 comprises the cooling package 5002 at distal portions 5003 places of the bar that is positioned at the elongation of having determined passing away, fills pipe 5004, is positioned at the filling aperture 5005 of the far-end of filling pipe 5004, and supply pipe 5006.Cooling package 5002 comprises the supply aperture 5007 of the far-end that is positioned at supply pipe 5006.Supply pipe 5006 can comprise turning 5008, and elbow for example is near supply aperture 5007.Cooling package 5002 further comprises applicator 5009, and it has helical form the first balloon 5010 of having determined expansion chambers and having had the first proximal part 5011 and the first distal portions 5012.Cooling package 5002 can also comprise the second balloon 5014, and it has the second proximal part 5016 and the second distal portions 5018.The second proximal part 5016 can be connected to fluid connection fills near aperture 5005 and sealed filling pipe 5004.The second distal portions 5018 can by near supply pipe 5006 sealing, but with supply pipe 5024 and the first balloon 5010 between be communicated with without fluid.The first balloon 5010 can claim that around the second balloon 5014 and be configured to receive cold-producing medium from supply pipe 5006, and cold-producing medium is entered passing away by 5011 dischargings of the first proximal part.The second balloon 5014 can be configured to receive packing material from filling pipe 5004, and expansion (for example, expand flexibly) cause that the screw diameter of the first balloon 5010 increases, this is so that the part of the first balloon 5010 (for example, sweep) moves to the inner surface of more close renal artery or nephrostome.

Figure 51 figure has released the part of the cold therapy equipment 5100 that comprises helical form master balloon and non-helical shape time balloon in another configuration.Equipment 5100 comprises the cooling package 5101 at distal portions 5102 places of the bar 5103 that is positioned at the elongation of having determined passing away, supply pipe 5106, and fill pipe 5108.Distal portions 5102 can have ladder 5104 and portal 5106.Cooling package 5101 can comprise the supply aperture 5107 of the far-end that is positioned at supply pipe 5106, and the filling aperture 5109 that is positioned at the far-end of filling pipe 5108.Cooling package 5101 may further include applicator 5110, and it has helical form the first balloon 5111, and it has been determined expansion chambers and has had the first proximal part 5112 and the first distal portions 5114.Supply pipe 5106 can 5105 extend and extends into the first proximal part 5112 from portalling, and the first proximal part 5112 can be sealed near supply pipe 5106.Cooling package 5101 may further include the second balloon 5116 around distal portions 5102, and it has the whole near-end neck 5118 that is connected to distal portions 5102.The second balloon 5116 can be configured to from (for example filling pipe 5108 reception packing materials and expansion, flexibly expansion) so that the screw diameter of the first balloon 5111 increases, this is so that the part of the first balloon 5111 (for example, sweep) moves to the inner surface of more close renal artery or nephrostome.

Near-end time balloon

Near-end master balloon and time balloon can be opened along the length direction longitudinal subdivision such as the part of the described cold therapy equipment of the several embodiment of the present invention.For example, inferior balloon can be the part of obstruction component, and described obstruction component is configured to inaccessible renal artery and/or nephrostome.Accompanying drawing 52A-53 shows several specific embodiments of the cold therapy equipment that comprises near-end time balloon.

Accompanying drawing 52A-52B shows cold therapy equipment 5200 parts that comprise a cooling package 5202 and obstruction component 5204, and described cooling package 5202 and obstruction component 5204 are opened along bar 5206 longitudinal subdivisions of the elongation of a definite passing away.Described bar 5206 has one first to be dwindled gradually part 5208 and dwindles gradually that 5209, one second of cooling package outlets on the part 5208 are dwindled part 5210 gradually and in the second obstruction component outlet 5211 of dwindling gradually on the part 5210 described first.Described cooling package 5202 and described obstruction component 5204 can be arranged at respectively described first and dwindle gradually part 5208 and second and dwindle gradually on the part 5210.Described cold therapy equipment 5200 can comprise a supply pipe 5212, and described cooling package 5202 can have at the end of described supply pipe 5212 aperture 5213.Described cooling package 5202 also can comprise one with the applicator 5214 of the first balloon 5215, to determine an extended cavity.Described supply pipe 5212 can tilt away to go forward side by side into the first balloon 5215 from described bar 5206.Described obstruction component 5204 can comprise second balloon 5216 of having determined an inaccessible chamber.Described the second balloon 5216 can be configured to passively and receives cold-producing medium from passing away by obstruction component outlet 5211, and can be configured to expansion with the rear portion pressure of response from the cold-producing medium of described cooling package 5202 discharges.Described cooling package 5202 and described obstruction component 5204 are can sending state at least part of detachable, and illustrate with expansion state and deployed condition respectively in accompanying drawing 52A-52B.Under described expansion state, described obstruction component 5204 can have a cross section size that is configured to abundant inaccessible renal artery and/or nephrostome.

Shown in accompanying drawing 52B, described device 5200 can comprise the control member 5220 of control member 5218, the second elongations of the first elongation further, with the control valve 5222 of the first far-end branch 5224 and the second far-end branch 5226.Described bar 5206 can comprise the first far-end junction point 5228, the second far-end junction points 5230 further, and dwindles gradually part 5208 and second first and dwindle gradually flexible portion 5232 between the part 5210.The control member 5218 of described the first elongation can extend along described control valve 5222 and the first far-end branch 5224, and is attached to described the first far-end junction point 5228.The control member 5220 of described the second elongation can extend along described control valve 5222 and the second far-end branch 5226, and is attached to the second far-end junction point 5230.Described equipment 5200 can be configured to, but the deflection of the increase of described the first control member 5218 and/or the second control member 5220 or minimizing tension force control valve 5206.Described pipe 5206 can flexible portion 5232 to blood vessel wall against or mouthful the first balloon position be flexible.Except abundant occluding vascular or mouth, replace described abundant occluding vascular or mouthful, described obstruction component 5204 can be configured to expansion state supporting described pipe 5206 among a renal artery or nephrostome, so that resetting of controlled described cooling package 5202 to be provided among described renal artery or nephrostome.For example, described cooling package 5202 can be reset to excite neural adjustment of medicable freezing kidney in the different piece of renal artery and/or nephrostome.

Accompanying drawing 53 shows cold therapy equipment 5300, and it is similar to the cold therapy equipment 5200 shown in the accompanying drawing 53A-53B, but described equipment 5300 has extra far-end cooling configuration and different supply and control configurations.Described equipment 5300 comprises that the cooling package 5302 and the obstruction component 5304. described pipes 5306 that vertically separate along the pipe 5306 of the elongation of a definite passing away have far-end junction point 5307 and the distal tip 5308 of determining a far-end extended cavity.Described cooling package 5302 comprises having applicator 5310, and described applicator 5310 is determined the first balloon 5312 of an extended cavity, and described obstruction component 5304 has the second balloon 5314, described the second balloon 5314 definite inaccessible chambeies that separate with passing away.Described equipment 5300 further comprises a filling pipe 5316 that extends described the second balloon 5314, supply pipe 5318 with the side branches 5320 that extends described the first balloon 5312 comprises that with the beveled distal end part 5322. described obstruction components 5304 that extend described distal tip 5308 is filled an aperture 5324, and packing material can be supplied to described the second balloon 5314 by it.Cooling package 5302 further comprises the first supply aperture 5326, and it is configured to guide cold-producing medium to expand in the first balloon, and described cooling package 5302 further comprises the second supply aperture 5328, and it is configured to guide cold-producing medium to expand in distal tip 5308.

Equipment 5300 further comprises control member 5330 and the control valve 5332 of elongation.Described control member 5330 can and be attached to far-end junction point 5307 along described control valve 5332 extensions.Described equipment 5300 can be configured to, but the deflection of the tension force control valve 5306 of the increase of described control member 5330 or minimizing.Except abundant occluding vascular or mouth, or replace described abundant occluding vascular or mouth, obstruction component 5304 can be configured to expansion state with stay pipe 5306 within renal artery or nephrostome, to provide the controlled of described cooling package 5302 to reset at renal artery or nephrostome.For example, described cooling package 5302 can reset, to excite the medicable low the kidney warming neuroregulation in the different piece of renal artery and/or nephrostome.

Substitute the type of cooling

According to the chiller that the described cooling package of several specific embodiments of the present invention has deployed condition, it does not relate to the cold-producing medium evaporation.For example, this embodiment can comprise that cooling package is configured to, and liquid or the postcritical cold-producing medium of circulation under chilling temperature passes the main hot transmitting portions of applicator to cause convection current and conductive cooling.In above-mentioned applicator, the flow impedance of supply can be generally equal to the flow impedance of discharge.For example, the cross section in supply chamber can be generally equal to the cross section of passing away.In certain embodiments, cold therapy equipment has and do not need to be configured to phase transformation to propagate the cooling package of cold-producing medium, can have to help be supplied to cooling package and/or the cold-producing medium of cold-producing medium to discharge the feature of described cooling package.For example, can comprise the first pump for increasing the pressure of the cold-producing medium that flows to cooling package, and/or vacuum source (that is, the second pump) is used for reducing the pressure of the cold-producing medium that flows out cooling package.Except described the first pump or alternately, cold-producing medium can be from a pressurized source supply.Based on the consideration of operation, that is, cold-producing medium viscosity and the flow impedance of the supply of cold therapy equipment, discharge and hot transmitting portions can be selected, to excite the cold-producing medium of different in flow rate.Described flow velocity can be selected, and for example, meets heat transfer speed fully to excite medicable low the kidney warming neuroregulation.

Figure 54 shows the part of cold therapy equipment 5400, and it can be configured to the convective heat transfer that does not need the cold-producing medium phase transformation.Described equipment 5400 comprises the cooling package 5402 on the distal portions 5404 of pipe 5406 of the elongation of determining passing away.Cooling package 5402 comprises one with the applicator 5408 of balloon 5410, and it has determined a flowing lumen.Described equipment 5400 comprises that also the length along described pipe 5406 extends the supply pipe 5412 among the described balloon 5410, and cooling package 5402 comprises the aperture 5414 on the far-end of supply pipe 5412.In several embodiment, described supply pipe 5412 is quite large, and is configured to the transport liquid cold-producing medium, and aperture 5414 is not to be configured to cause that pressure drop is with vaporized refrigerant fully.When cooling package 5402 during in deployed condition, balloon 5410 can be configured at least one substantial liquid line and has been full of cold-producing medium.Cold-producing medium can be supplied to passing away from supply pipe 5412.Accompanying drawing 54 comprises the arrow 5416 of the direction of indicating the cold-producing medium that passes balloon 5410.Described cold-producing medium can be the have low-freezing liquid of (that is, ethyl group ethanol), and can transport under cryogenic temperature and pass supply pipe 5412.Convective heat transfer between coolant and the balloon 5410 can be cooled off renal artery or nephrostome, and medicable kidney is neural to be adjusted to excite.

Accompanying drawing 55 shows the part of cold therapy equipment 5500, and it also configures in order not need the convective heat transfer of cold-producing medium phase transformation.Described equipment 5500 is included in the cooling package 5502 on the distal portions 5504 of pipe 5506 of elongation, and bar 5506 comprises the bar spacer 5508 that bar 5506 is divided into the second longitudinal component 5512 of the first longitudinal component 5510 of determining the supply chamber and definite passing away.Cooling package 5502 comprises the applicator 5514 with balloon 5516, and balloon 5516 comprises the balloon spacer 5518 of having determined the U-shaped chamber in the balloon 5516.Balloon 5516 can be configured to make the liquid refrigerant circulation from the first longitudinal component 5510, by the U-shaped chamber, and enters the second longitudinal component 5512.Figure 55 comprises the arrow 5520 of the direction when pointing out that flow of refrigerant is passed through balloon 5516.

In some embodiment, the cooling package supercritical liq (for example, supercritical nitrogen or water) that is configured to circulate.Supercritical liq can provide sufficient cooling and not undergo phase transition, but usually must maintain under the relatively high pressure.The cooling package of supercritical liq of being configured to circulate can comprise that supply, heat with high pressure grade transmits and discharge structure.For example, such cooling package can comprise not expansible applicator (for example, having metallic walls).Such applicator can move the diverse location that contacts renal artery or nephrostome in therapeutic process.

Extra embodiment

Above-mentioned and in Fig. 1-5B and 12-55 illustrated cold therapy equipment can be changed to form extra embodiment according to the present technique configuration.For example, among Figure 17 A-17B illustrated cold therapy equipment 1700 and above-mentioned and in Fig. 1-5B and 12-55 illustrated other cold therapy equipment that does not have guiding elements can comprise near or the guiding elements that extends of distal portions by balloon.Similarly, above-mentioned and in Fig. 1-5B and 12-55 illustrated cold therapy equipment can comprise the control member that is configured to containing control (for example, backguy).Control line can be used to, and for example, controls (for example, deflection, inclination, location or guiding) cooling package, applicator or other cold therapy part of appliance from the vascular system outside.

Above-mentioned and in Fig. 1-5B and 12-55 illustrated cold therapy equipment comprise the balloon with various features.In some instances, producing consideration and other factors perhaps makes some adjustment be required more or less.For example, some material may more adapt to pressing operation than molded operation, and vice versa.Similarly, some balloon use some production process more easily to form than other production process of use.For example, have the balloon of the far-end of complete sealing, in some instances, can be difficult to form with compacting.Above-mentioned and in Fig. 1-5B and 12-55 the balloon in the illustrated cold therapy part of appliance and balloon feature can change or exchange according to these factors.For example, far-end neck (for example, the far-end neck of sealing) can by above-mentioned and in Fig. 1-5B and 12-55 the far-end of the integrally closed in the illustrated balloon replace.So this is favourable for the more compatible compacting production process of balloon.

The feature of above-mentioned cold therapy part of appliance can also be exchanged to form other embodiment of present technique.For example, the interior balloon 1514 of the cooling package 1502 among Figure 15 A can merge in the cooling package 1902 shown in Figure 19 A-19C.As another example, first supply pipe 1218 with first beveled distal end part 1222 of cold therapy equipment 1200 shown in Figure 12 can and the cooling package shown in Figure 17 A-17B 1702 in, the first beveled distal end part 1222 is configured to guide cold-producing medium in the expansion of 1711 of heat insulating components.

Relevant anatomy and physiology

Sympathetic nervous system (SNS) is a branch of autonomic nervous system and the Nervous system parasympathetic nervous system of unifying.It is movable (being called sympatheticotonia) and become more movable during stress time in foundation level all the time.Be similar to neural other parts, sympathetic nervous system operates by the neuron of a series of interconnection.Sympathetic neuron usually is regarded as the part of peripheral nervous system (PNS), although many in central nervous system (CNS).The sympathetic neuron of spinal cord (it is the part of CNS) is communicated by letter with sympathetic neuron on every side via a series of sympathetic ganglion.In neuroganglion, sympathetic neuron engaged around the spinal cord sympathetic neuron was incited somebody to action by synapse.Therefore, the spinal cord sympathetic neuron is called presynaptic (or before joint) neuron, sympathetic neuron is called postsynaptic (or behind joint) neuron on every side simultaneously.

Synapse place in sympathetic ganglion, SPN discharges acetylcholine, and namely the chemical messenger of the nicotine receptor on the neuron is excited behind binding and the envoy.In response to this stimulation, postganglionic neuron mainly discharges noradrenalin (element on the new kidney).The excitement that prolongs can cause that epinephrine is from medulliadrenal release.

In case be released, element and epinephrine are bundled in adrenoreceptor on the surrounding tissue on the new kidney.Be tied to adrenoreceptor and cause neuron and hormone reaction.Physiological performance comprises platycoria, heart rate increase, sporadic vomiting and hypertension.Because the binding of the cholinoceptor of boerhaave'a glands, also seeing perspires increases.

Sympathetic nervous system is responsible for constant mechanism in the many bodies in the organs of living beings is regulated up and down.From the fiber of SNS the tissue in each tract is almost innervated, to such as pupil diameter, internal organs power diversified every provide at least some regulatory function the same as urinary volume.This reaction be also referred to as human body sympathetic-adrenal gland reaction, because sympathetic fiber (but also all other sympathetic fibers are arranged) is secreted acetylcholine before ending at the joint in the adrenal medulla, this activates adrenergic secretion and secretes noradrenalin (element on the new kidney) in less degree.Therefore, directly via regulating Main Function this reaction on cardiovascular system by sympathetic nervous system and the pulse that indirectly transmits via the catecholamine from adrenal medulla secretion.

Scientific research is considered as automatic regulating system with SNS usually, and operates in the situation that does not have the consciously intervention of thought.Some theory of evolution theoretician proposes sympathetic nervous system and operates to keep survival in the organism in early days, because sympathetic nervous system is responsible for making human body in advance along getting action ready.In this pre-prepd moment of example before wakeing up, wherein the sympathetic nerve effluent increases to prepare to move by the light of nature.

1. sympathetic chain

Shown in Figure 56, SNS provides the neutral net that allows brain to communicate by letter with health.Sympathetic nerve stems from spinal column inside, towards intermedio-lateral cell column (or intermedio-lateral cell column), begins at the first pereonite place of spinal cord, and thinks and extend to second or the third lumbar vertebra section.Because its cell begins in the breast of spinal cord and waist, is to have breast waist effluent so SNS is said into.These neural aixs cylinders are left spinal cord by front/root.(pass through near the sense organ neuroganglion, it enters front of spinal nerves there at spine for it.Yet, being different from the somatic nerve domination, it is separated by near (it is the aorta bifurcation) ganglionic white rami junctional complex before the spinal column that is connected near spinal column other (it is the spinal column) or extends by spinal column rapidly.

In order to arrive Target organ and gland, the aixs cylinder very long distance of should advancing in vivo, and for this reason, many aixs cylinders by the synapse transmission with its message relay to the second cell.The dendron that the end leap space of aixs cylinder, synapse are connected to the second cell.The first cell (presynaptic cell) transsynaptic gap sends neurotransmitter, and it activates the second cell (postsynaptic cell) there.Then this message be carried to the final destination.

In other ingredient of SNS and peripheral nervous system, produce these synapses being called ganglionic position.The cell that sends its fiber is called cell before the joint, and its fiber leaves ganglionic cell and is called cell behind the joint.As previously mentioned, cell is positioned between the first breast (T1) section and third lumbar vertebra (L3) section of spinal cord before the joint of SNS.Cell makes its cyton be sent to Target organ or gland in neuroganglion and with its aixs cylinder behind the joint.

Neuroganglion not only comprises sympathetic trunk, and comprises cervical ganglia (upward, neutralization is lower) (it is sent to head and chest manifold with sympathetic fiber) and abdominal cavity and mesentery neuroganglion (it is sent to internal organs with sympathetic fiber).

2. The innervation of kidney

Shown in Figure 57, by with kidney clump RP that renal artery is associated nearly kidney being innervated.Kidney clump RP is around renal artery and is embedded into the interior autonomic plexuses of arteriorenal adventitia.Kidney clump RP extends until it arrives the entity place of kidney along renal artery.The fiber that kidney clump RP is contributed to some extent stem from ganglia coeliaca, superior mesenteric ganglion, aortic nerve joint and aorta from.The kidney clump RP that is also referred to as the kidney nerve mainly forms part by sympathetic nerve and forms.The parasympathetic innervation that does not have (or considerably less at least) kidney.

The preganglionic neuron cyton is arranged in the intermedio-lateral cell column of spinal cord.Aixs cylinder is passed spinal column paraganglion (it does not form synapse) and is become little visceral nerve, minimum visceral nerve, the first lumbar splanchnic nerves, the second lumbar splanchnic nerves before the joint, and marches to ganglia coeliaca, superior mesenteric ganglion and aortic nerve joint.The postganglionic neuron cyton is left ganglia coeliaca, superior mesenteric ganglion and aortic nerve joint and is arrived kidney clump RP and be distributed to the kidney blood vessel.

3. The kidney sympathetic activity

Message is passed through SNS in bidirectional flow.Spread out of the variation that message can side by side trigger the different piece of human body.For example, sympathetic nervous system can cardioacceleration; Widen bronchial; Reduce the motion (motion) of large internal organs; Vasoconstrictive; Increase the wriggling in the esophagus; Cause pupil dilation, piloerection (goose pimples) and diaphoresis (perspiration); And raising blood pressure.Import message into the various organs of signal from human body and sensation receptor are carried to other organ and particularly brain.

Hypertension, heart failure and chronic nephropathy are several in the numerous disease state that causes of the long-term excitement by SNS, especially kidney sympathetic nervous system.The long-term excitement of SNS is the inadaptable reaction that drives the progress of these morbid states.The drug control of renin angiotensin aldosterone system has been the method for poor efficiency for reducing for a long time hyperactive of SNS but a little.

As mentioned above, experimentally with human body in, the kidney sympathetic nervous system has been identified as the main contributions person of the complicated pathophysiology of hypertension, volume overload (for example heart failure) state and carrying out property nephropathy.The research of adopting the radiotracer dilution process to measure plain overflow on the new kidney from kidney to blood plasma demonstrates element (NE) relief flow rate on the new kidney of kidney of increase in having the patient body of essential hypertension, particularly in the hypertension object of youth, this is consistent with the NE overflow from heart that increases, distribute unanimously with the hematodinamics of usually seeing in the hypertension in early days, and it is characterized in that the heart rate, cardiac output and the renal vascular resistance that increase.Present known essential hypertension generally is neuronic, usually is attended by obvious sympathetic nervous system hyperkinesia.

The excitement of heart kidney sympathetic activity is in heart failure even more obvious, as in this patient population as indicated in from heart and kidney to the excessive increase of the NE overflow of blood plasma.Idea is consistent therewith is to have kidney sympathetic activation in the patient body of congestive heart failure to the up-to-date proof of the strong negative predictive value of full cause mortality rate and heart transplantation, and it is irrelevant with overall sympathetic activity, glomerular filtration rate and left ventricular ejection fraction.These treatment regimeies of find supporting to be designed to reduce the kidney sympathetic stimulation have the potentiality of the survival that improves the patient with heart failure.

Chronic and feature end-stage renal disease all is the sympathetic activation strengthened.In having the patient body of crooked nephropathy, the blood plasma level of element has been proved to be full cause of the death silk screen and because of the dead omen of cardiovascular disease on the new kidney more than the intermediate value.Like this equally for the patient who stands patient of diabetes or radiographic contrast nephropathy.There is very convictive proof, the sensation input signal that its proposition stems from the disease kidney is the initiation of flowing out of the maincenter sympathetic nerve that improves and the main contributions person of maintenance in this patient population, this has promoted the generation of the well-known negative consequence that chronic sympathetic activity is excessive, such as hypertension, left ventricular hypertrophy, ventricular arrhythmia, sudden cardiac death, insulin resistant, diabetes and metabolic syndrome.

(i) The kidney sympathetic activities is movable

Sympathetic nerve to kidney stops in blood vessel, juxtaglomerular apparatus and renal tubules.The orthosympathetic stimulation of kidney causes that the renin release of increase, the sodium of increase (Na+) heavily absorb and the minimizing of renal blood flow.These ingredients of the neuroregulation of renal function are being stimulated under the morbid state of feature considerably take the sympatheticotonia that improves, and clearly the hypertension in the hypertension human body are contributed to some extent.May be the basis of the renal function loss in the Cardiorenal syndrome owing to the kidney sympathetic activities stimulates the renal blood flow cause and the reduction of glomerular filtration rate, Cardiorenal syndrome is the gradually complicated renal dysfunction as chronic heart failure, has usually the clinical course that rises and falls along with patient's clinical state and treatment.Obstruct kidney to spread out of the tactful central action sympathetic nerve of pharmacology medicine, beta-blocker (intention reduces renin release), angiotensin converting enzyme inhibitor and receptor blocking agent (intention stops the action as the result's of renin release Angiotensin II and aldosterone activation) and the diuretic (intention antagonism kidney sympathetic nerve sympathetic nerve mediation sodium and water keep) of the consequence of sympathetic stimulation.Yet current pharmacology's strategy has obvious restriction, comprises limited effectiveness, accordance problem, side effect etc.

(ii) Kidney sensation nervus centripetalis is movable

Kidney channel is communicated by letter with the overall structure among the central nervous system by kidney sensation nervus centripetalis.A plurality of forms of " injury of kidney " can cause the activation of sensation input signal.For example, renal ischaemia, stroke volume or renal blood flow reduce or abundant adenosinase can trigger the activation that nervus centripetalis is communicated by letter.Shown in Figure 58 A and 58B, this imports communication into may be from kidney to brain, perhaps may be to another kidney (via the central nervous system) from a kidney.These input signals are integrated by central authorities, and the sympathetic nerve that can cause increasing outflows.Kidney is pointed in this sympathetic nerve excitation, thereby activates RAAS and cause renin secretion, sodium retention, capacity and the blood-vascular system disease that increases.The maincenter sympathetic activity excessively also affects by sympathetic nerve and makes other organ and the body structure that innervates, and such as heart and peripheral vessels, causes the described adverse effect of sympathetic activation, and its many aspects are also contributed to some extent to increased blood pressure.

Therefore, physiology suggestion (i) has the minimizing that the denervation that spreads out of orthosympathetic tissue will reduce unsuitable renin release, salt retention and renal blood flow, and (ii) has the denervation of importing sensorineural tissue into and will contribute by the system that its direct impact on posterior hypothalamus also contralateral kidney reduces hypertension and the Other diseases that is associated with the maincenter sympatheticotonia that increases.Except the maincenter effect of easing stress that imports the kidney denervation into, can anticipate that various other makes the minimizing of the expectation that the maincenter sympathetic nerve of the organ (such as heart and blood vessel) that innervates flows out sympatheticly.

B. The additional clinical benefit of kidney denervation

Provide as mentioned, the kidney denervation is valuable in the treatment with totally and particularly a plurality of clinical diseases of kidney sympathetic activity of increasing probably, inappropriate fluid maintenance, Cardiorenal syndrome and sudden death in described kidney sympathetic activity such as hypertension, metabolic syndrome, insulin resistant, diabetes, left ventricular hypertrophy, chronic end-stage renal disease, the heart failure.Because the minimizing of nervus centripetalis signal reduces to some extent contribution to the systematicness of sympatheticotonia/excitement, so the kidney neuromodulation also may be useful when treating with the hyperfunction Other diseases that is associated of systemic sympathetic nerve.Therefore, the kidney denervation can also intend to make other organ and the body structure that innervates by sympathetic nerve, is included in those that identify among Figure 56.For example, as previously discussed, the minimizing of maincenter sympathetic drive can reduce the insulin resistant that torments patient with metabolic syndrome and type ii diabetes.In addition, have osteoporotic patient can be sympathetic ground excited, and may benefit from the downward adjusting of the sympathetic drive of following the kidney denervation.

C. realize entering in the arteriorenal blood vessel

According to present technique, can be by entering to realize the neuromodulation of left and/or right kidney clump RP (it is associated with a left side and/or right renal artery nearly) in the blood vessel.Shown in Figure 59 A, carry the blood that is moved by the contraction of heart by aorta from the left ventricle of heart.Aorta drops in left and the right renal artery by breast and branch.Below renal artery, aorta is at left and ILR tremulous pulse punishment fork.Left and ILR descends by left and right lower limb respectively and adds a left side and right femoral artery.

Shown in Figure 59 B, blood collecting is in vein and be back in the heart, by femoral vein to iliac vein and in the postcava.Postcava is branched off into a left side and vena renalis dextra.On renal veins, postcava rises with the right atrium pumping blood to heart.From right atrium, blood is pumped out in the lung by right ventricle, and it is combined with oxygen there.The blood of being combined with oxygen is transported to left atrium from lung.The blood of being combined with oxygen is carried from left atrium by left ventricle and is got back to aorta.

As described in detail later, just place, the bottom of the femoral triangle below the mid point of inguinal ligament enters and conduit is inserted femoral artery.Can insert conduit by this entry site, via skin enter femoral artery and lead to iliac artery and aorta in, enter a left side or right renal artery.This comprises provides path in the blood vessel that each renal artery and/or other renovascular minimally-invasive are entered.

Wrist, upper arm and shoulder zone are for other position that conduit is introduced Arterial system.In the selection situation, can utilize the conduit of radius, buttocks or axillary artery to insert.The shadowgraph technique of Application standard can make the conduit of introducing via these inlet points pass subclavian artery (or under the clavicle on the right side and brachiocephalic artery) in the left side, by aortic arch, along descending aorta downwards and enter renal artery.

D. renovascular character and characteristic

Since according to present technique by entering to realize the neuromodulation of left and/or right kidney clump RP in the blood vessel, so renovascular character and characteristic can impose restriction and/or provide the information about this design to the design of equipment, system and method.In these character and the characteristic some crossed over patient crowd and/or the leap time becomes described morbid state such as hypertension, chronic nephropathy, angiopathy, end-stage renal disease, insulin resistant, diabetes, metabolic syndrome etc. in specific patient body and in response to morbid state.Explain such as this paper, these shapes and characteristic can have meaning to the program of endovascular device and the effectiveness of particular design.Interested character can comprise for example material/machinery, space, hydrodynamics/hematodinamics and/or macroscopic property.

As discussed previously, can make conduit advance to a left side or right renal artery via skin via path in the minimally-invasive blood vessel.Yet, it may be challenging that the minimally-invasive renal artery enters, for example, because compare with some other tremulous pulse that is used by convention conduit to enter to compare, renal artery usually is extremely tortuous, may have relatively little diameter and/or may have relatively short length.In addition, atherosclerosis of renal artery is common in many patients, especially has those of cardiovascular disease.The renal artery dissection feature can also be explained for different patients aobvious different, further makes minimally-invasive enter complicated.For example aspect relevant flexibility, diameter, length and/or the atheromatous plaque burden and divide from aorta at renal artery and can see between significant patient aspect the deflecting angle of out branch and changing.When minimally-invasive when entering renal artery, be used for realizing the equipment of kidney neuromodulation, these and other aspect that system and method should be considered the renal artery dissection feature and the patient crowd's of leap variation thereof via access in the blood vessel.

Except renal artery is entered the complicated, the details of kidney anatomical features also makes the stable establishment complicated that contacts between neuromodulation equipment and surface, arteriorenal chamber or the wall.When neuromodulation equipment comprised energy delivery element (such as electrode), it was important that the energy delivery element applies for predictability with consistent location between the tube wall and contact force.Yet navigation is subject to the obstruction of the flexibility of the interior tight quarters of renal artery and tremulous pulse.In addition, moving patients, breathing and/or Cardiac cycle may cause that renal artery is with respect to aortal remarkable movement, and Cardiac cycle can make renal artery diastole (namely impelling the wall of tremulous pulse to beat) momently, further makes the establishment complicated of stable contact.

Even after entering renal artery and promoting stable contact the between the wall surface of neuromodulation equipment and tremulous pulse, must modulate safely nerve around the adventitia neutralization of tremulous pulse via neuromodulation equipment.When given during with potential clinical complication that this type for the treatment of is associated, it is significant effectively applying thermal therapeutical in the renal artery.For example, arteriorenal inner membrance and medium are very easy to be subject to the hot injury.As discussing in more detail hereinafter, lumen of vessels inner membrance-dielectric thickness of membrance separation outside it is meaned that the targeted kidney nerve can be apart from several millimeters on the wall surface of tremulous pulse.Should be with enough energy delivery to the targeted kidney nerve with neural in the situation modulated targeted kidney that does not make tube wall superheated and mummification.The potential clinical complication of another that is associated with superheated is from the thrombosis of solidifying blood flow that flows through tremulous pulse.Consider that this thrombosis can cause renal infarction, thereby kidney is caused irreversible damage, should use modestly the thermal therapeutical that carries out in the renal artery.Those of hot transferring power that therefore, be present in the fluid machinery of the complexity in the renal artery and thermodynamic condition during treating, particularly may affect treatment site may be important when applying energy (for example, heat energy) in renal artery.

The position for the treatment of neuromodulation equipment should be configured to allow the capable of regulating of energy delivery element in renal artery to locate and reorientate, because also may affect clinical efficacy.For example, consider that the kidney nerve can be circumferentially spaced apart around the renal artery, applying fully circumferentially in the renal artery, treatment may be interesting.Yet, may be caused that by continuous circumferential treatment the wholecircle scar can produce the risk of the renal artery stenosis of raising, thereby negate any other treatment benefit of kidney neuromodulation.Therefore, more complicated scar may be expected to reorientating of a plurality for the treatment of positions along formation and/or the neuromodulation equipment of arteriorenal vertical dimension via network structure as herein described.Yet, it should be noted to produce the risk that the benefit of circumferentially ablating can surpass renal artery stenosis, perhaps can alleviate this risk with some embodiment or in some patient, and to produce circumferential ablation can be target.In addition, renal artery is tortuous especially or wherein exist away from the distal branch blood vessel of renal artery master blood vessel so that in the challenging situation of some locational treatment therein, the variable location of neuromodulation equipment and reorientate and can prove useful.The manipulation of device in renal artery also should be considered the mechanical damage that applied at renal artery by device.Device in tremulous pulse such as can causing mechanical damage owing to inserting, handling, overcome the motion that causes such as crooked, such as cutting, perforation, corroding inner membrance or breaking-up internal elastic membrane.

Can be interim inaccessible in short time in minimum or uncomplicated situation by arteriorenal blood flow.Yet the obturation of plenty of time should avoid preventing from causing the damage to kidney, such as ischemia.If avoiding together inaccessible or inaccessible is of value to embodiment to make the inaccessible persistent period for example be confined to be no more than 2-5 minute may be useful.

Get involved based on (1) renal artery, (2) treat the consistent and stable placement that member abuts tube wall, (3) treatment of leap tube wall effectively applies, (4) therapeutic equipment is positioned and reorientates to have allowed potentially a plurality for the treatment of positions, and (5) avoid or limit the above-mentioned challenge of the persistent period of blood flow obturation, may interested renovascular various independences and accessory charactor for example comprise (a) blood vessel diameter, length of vessel, inner membrance-dielectric thickness, coefficient of friction and flexibility; (b) diastolic dimension of tube wall, consistency and elasticity modulus; (c) peak value heart contraction and diastole blood flow rate in latter stage, average heart contraction-diastole Maximum velocity and average/maximum blood flow rate of measuring volume; (d) heat conductivity of the specific heat capacity of blood and/or tube wall, blood and/or tube wall and/and the thermal convection current of blood flow by tube wall therapentic part and/or radiant heat transfer; (e) and by breathing, moving patients and/or blood flow pulsation cause with respect to aortal renal artery motion; (f) and renal artery with respect to aortal deflecting angle.To these character be described in more detail with respect to renal artery.Yet according to the equipment that is used for realizing the kidney neuromodulation, system and method, arteriorenal this type of character can also instruct and/or the constrained designs characteristic.

As mentioned above, be positioned the geometry that the interior equipment of renal artery should meet tremulous pulse.Renal artery blood vessel diameter DRA is usually in the scope of about 2～10mm, and the DRA of most patients is about 6mm from about 4mm to about 8mm average out to.Renal artery length of vessel LRA (between its mouth and its far-end branch at aorta/renal artery junction point) is usually in the scope at about 5～70mm, and very large a part of patient is in the scope of about 20～50mm.Because the targeted kidney clump is embedded in the arteriorenal adventitia, so compound inner membrance-dielectric thickness IMT (namely from the surface, chamber of tremulous pulse to the radially outward distance of the adventitia that comprises the target nerve structure) also is significant, and usually in the scope of about 0.5～2.5 mm, on average be about 1.5mm.Although the treatment of certain depth is important for arriving target neural fiber, treatment should be excessively not dark (for example, apart from arteriorenal inwall＞5mm) to avoid non-destination organization and the anatomical structure such as renal veins.

May interested arteriorenal additional character be by the degree with respect to aortal kidney motion of breathing and/or the blood flow pulsation causes.The kidney that is positioned at the patient of arteriorenal far-end can move nearly 4 along with breathing drift to cranium side ".This can give significant motion to the renal artery that connects aorta and kidney, thus from neuromodulation equipment requirements hardness and flexible peculiar balance with contacting during breath cycle between maintenance thermal therapeutical element and the tube wall.In addition, renal artery may be obviously different between patient from deflecting angle between the aorta, and can be for example because kidney motion and in the patient body, dynamically changing.Deflecting angle usually can be in about 30 ° of-135 ° of scopes.

Above-described embodiment of cold therapy equipment be configured to by thigh approach, oar approach or other approach that is fit to come accurately the low temperature applicator to be placed among renal artery and/or the nephrostome or near.In arbitrary above-described embodiment of reference Fig. 1-55, it is that approximately 3mm is to about 8mm that single balloon can be configured to expand into diameter, and it is that approximately 3mm and arrives 8mm for 4mm to 8mm in some embodiment that a plurality of balloons can be configured to expand into diameter uniformly.In addition, in the described any embodiment of reference Fig. 1-55, balloon can be individually and/or is had uniformly approximately 8mm to the about length of 15mm, and is 10mm in certain embodiments.For example, some specific embodiments of the equipment among Fig. 1-55 can have the long balloon of 10mm, and it is configured to expand into diameter is that 4mm is to 8mm.Size with reference to the bar of the equipment in the described any embodiment of Fig. 1-55 can be confirmed as adapting in the 6Fr sheath, for example, and 4Fr bar size.

Example

1. cold therapy equipment comprises:

Bar with elongation of distal portions, wherein said bar be configured to described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of at least a portion of described bar, described supply chamber is configured to receive liquid refrigerant; And

Be positioned at the cooling package of the described distal portions of described bar, described cooling package has sending state and deployed condition, described cooling package comprises applicator, described applicator have at least and described supply chamber between the first hot transmitting portions and the second hot transmitting portions of fluid connection, in described deployed condition, the described first hot transmitting portions is configured in has the first heat transfer rate when described cooling package receives cold-producing medium under the described deployed condition, and the described second hot transmitting portions is configured to have second heat transfer rate lower than described the first heat transfer rate under the described deployed condition when described cooling package receives cold-producing medium, and the wherein said first hot transmitting portions along vertical section of the length of described cooling package is being non-side face.

2. the cold therapy equipment in the example 1, wherein said cooling package has central longitudinal axis and comprises for the aperture of cold-producing medium from wherein flowing through, described applicator comprises the balloon with inner surface, the described central longitudinal axis under the described deployed condition to the distance in described aperture be not less than under the described deployed condition from described central longitudinal axis to described inner surface described aperture perpendicular to approximately 20% of the distance in the plane of described central longitudinal axis.

3. the cold therapy equipment in the example 1, further comprise along the passing away of at least a portion of described bar, wherein said cooling package comprises for the aperture of cold-producing medium from wherein flowing through, described supply chamber has and comprises the spiral helicine part of being roughly of described aperture, described spiral helicine part is wrapped in around the described passing away, and described aperture is configured to guide cold-producing medium directly to expand towards the described first hot transmitting portions from described supply chamber.

4. the cold therapy equipment in the example 3, wherein said cooling package has central longitudinal axis, and surpasses approximately 0.1mm in aperture described in the described deployed condition and described central longitudinal axis interval.

5. the cold therapy equipment in the example 3, wherein said applicator comprises the balloon with inner surface, and described aperture about 1mm of the described inner surface of distance under described deployed condition.

6. the cold therapy equipment in the example 3, wherein said cooling package comprise that a plurality of cold-producing mediums can be from the aperture of wherein flowing through, and described a plurality of aperture is arranged on the different side face position of described spiral helicine part.

7. the cold therapy equipment in the example 1 further comprises the heat insulating component near described the second hot transmitting portions.

8. the cold therapy equipment in the example 7, wherein said applicator comprises the balloon with inner surface, the described second hot transmitting portions is the part of described balloon, and described heat insulating component is near described inner surface.

9. the cold therapy equipment in the example 8, the wherein said first and second hot transmitting portions are roughly helical form.

10. the cold therapy equipment in the example 7, wherein said applicator comprises balloon, the described first hot transmitting portions is the first with first average thickness of described balloon, the described second hot transmitting portions is the second portion with second average thickness of described balloon, and described the first average thickness is less than described the second average thickness.

11. the cold therapy equipment in the example 1 further comprises the heat insulating component of the first elongation and the heat insulating component of the second elongation, wherein---

Described applicator has the 3rd heat transfer rate under described deployed condition and described cooling package receives the cold-producing medium that is higher than described the second heat transfer rate,

Described applicator has the 4th heat transfer rate and described cooling package and receives and be lower than described first and the cold-producing medium of the 3rd heat transfer rate under described deployed condition,

Close the described second hot transmitting portions of described the first heat insulating component,

Close the described the 4th hot transmitting portions of described the second heat insulating component,

And

The described the 3rd hot transmitting portions along vertical section of the length of described cooling package is being non-side face alone or with the described first hot transmitting portions.

12. the cold therapy equipment in the example 11, wherein said the first and second heat insulating components have been determined the filling chamber, and described filling chamber is configured to receive packing material, and described filling chamber has subside configuration and expansion configuration.

13. the cold therapy equipment in the example 11, wherein said the first and second heat insulating components are in substantially parallel relationship to the length of described cooling package in described deployed condition.

14. the cold therapy equipment in the example 1 further comprises the heat insulating component of elongation, wherein said applicator comprises balloon, and at least a portion of described heat insulating component is not connected to described balloon and can be mobile in described balloon under the described deployed condition.

15. having, the cold therapy equipment in the example 14, wherein said heat insulating component is roughly leg-of-mutton sectional area.

16. the cold therapy equipment in the example 14, the described partial configuration of wherein said heat insulating component are to come in described balloon mobile in response to gravity under the described deployed condition.

17. the cold therapy equipment in the example 14, wherein said heat insulating component have determined to be configured to receive the filling chamber of packing material, and described filling chamber has subside configuration and expansion configuration.

18. the cold therapy equipment in the example 1, further comprise determined and described supply chamber between the interior balloon chamber of fluid connection, wherein said applicator comprises outer balloon, described interior balloon is in described outer balloon, described interior balloon comprises for the aperture of cold-producing medium from wherein flowing through, and described interior balloon has subside configuration and expansion configuration.

19. the cold therapy equipment in the example 18, the part in wherein said supply chamber extends through described interior balloon.

20. the cold therapy equipment in the example 18, wherein said interior balloon comprise the locational a plurality of apertures of different side faces that are arranged in around described interior balloon.

21. the cold therapy equipment in the example 20, wherein said a plurality of apertures are arranged as helical pattern.

22. the cold therapy equipment in the example 18, wherein said outer ball has female and lands, and the described first hot transmitting portions comprises described lands, and the described second hot transmitting portions comprises described female.

23. the cold therapy equipment in the example 22, wherein said lands is roughly helical form.

24. the cold therapy equipment in the example 18, wherein said outer balloon has been determined outer balloon chamber, total fluid connection connection between described interior balloon and the described outer balloon has the first clear passage area, described supply chamber is connected with total fluid connection between the described interior balloon chamber and has the second clear passage area, and described the first clear passage area is less than described the second clear passage area.

25. a cold therapy equipment comprises:

Bar with elongation of distal portions, wherein said bar be configured to described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Be positioned at the cooling package of the described distal portions of described bar, described cooling package has sending state and deployed condition, described cooling package has applicator and a plurality of for the aperture of cold-producing medium from wherein flowing through, wherein said a plurality of aperture is arranged about described applicator, cold-producing medium stream is directed to discrete zone in the described applicator, and described discrete zone provides non-side face whole sub-cooled pattern.

26. the cold therapy equipment in the example 25, further comprise the supply chamber that is configured to cold-producing medium is transported to along described bar described cooling package, extend in described applicator at least in part in wherein said supply chamber, and described a plurality of aperture is the separate hole of the part in the described supply chamber in the described applicator.

27. being linear pipe and described hole, the cold therapy equipment in the example 26, the described part in wherein said supply chamber is arranged on the different side face position in described supply chamber.

28. the cold therapy equipment in the example 26, the described part in wherein said supply chamber is serpentine pipe, and described hole is arranged as the Outboard Sections along described serpentine pipe.

29. the cold therapy equipment in the example 26, further comprise the first supply branch of inclination and the second supply branch of inclination, a far-end that is positioned at described the first supply chamber in wherein said a plurality of aperture, and another in described a plurality of aperture is positioned at the far-end of described the second supply branch, and described the first and second supply branches separate in the vertical along the length of described cooling package.

30. the cold therapy equipment in the example 29, further comprise the first supply chamber and the second supply chamber, wherein the first and second supply chambeies are configured to along described bar cold-producing medium is transported to described cooling package, described the first supply branch has determined the distal portions in described the first supply chamber, and described the second supply branch has determined the distal portions in described the second supply chamber.

31. a cold therapy equipment comprises:

Bar with elongation of distal portions, wherein said bar be configured to described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber has first-class impedance,motional and is configured to transport liquid and/or supercritical refrigerant;

Along the passing away of the described bar of at least a portion, described passing away has the second impedance,motional and is configured to transport liquid and/or supercritical refrigerant;

Be positioned at the cooling package of the described distal portions of described bar, described cooling package has sending state and deployed condition, described cooling package comprises the applicator with balloon, fluid connection between described balloon and described supply chamber and the described passing away, and wherein said first-class impedance,motional equals described second impedance,motional substantially.

32. a cold therapy equipment comprises:

Bar with elongation of distal portions, wherein said bar be configured to described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant; And

Be positioned at the cooling package of described distal portions, described cooling package has sending state and deployed condition, described cooling package comprises aperture and applicator, described applicator comprises the first balloon and the second balloon, fluid connection between described aperture and the described supply chamber, described the first balloon have and described aperture between the hot transmitting portions of fluid connection, wherein said the second balloon subsides under described sending state at least in part, wherein said hot transmitting portions has the heat transfer rate that is enough to cause medicable freezing kidney neuroregulation under the described deployed condition when described cooling package receives cold-producing medium, and wherein said hot transmitting portions along vertical section of the length of described cooling package is being non-side face.

33. a cold therapy equipment comprises:

Bar with elongation of distal portions, wherein said bar be configured to described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant; And

Be positioned at the cooling package of described distal portions, described cooling package has sending state and deployed condition, described cooling package comprises aperture and applicator, described applicator comprises the first balloon and the second balloon, fluid connection between described aperture and the described supply chamber, described the first balloon have and described aperture between the first hot transmitting portions of fluid connection, described the second balloon has the second hot transmitting portions, and described the second balloon subsides under described sending state at least in part, the second hot transmitting portions is not flexible as described substantially for the wherein said first hot transmitting portions, the wherein said first hot transmitting portions has the first heat transfer rate that is enough to cause medicable freezing kidney neuroregulation when described cooling package receives cold-producing medium under the described deployed condition, the wherein said second hot transmitting portions has second heat transfer rate lower than described the first heat transfer rate under the described deployed condition when described cooling package receives cold-producing medium, and the wherein said first hot transmitting portions along vertical section of the length of described cooling package is being non-side face.

34. the second balloon is not flexible as described for the cold therapy equipment in the example 33, wherein said the first balloon.

Be roughly flexible 35. the cold therapy equipment in the example 33, wherein said the first balloon are roughly the second balloon inflexibility and described.

36. the cold therapy equipment in the example 33, wherein:

Described the first balloon has the sectional area that is roughly the D type,

The described first hot transmitting portions is roughly inflexibility,

Described the second balloon has the sectional area joint area that is roughly the C type to the zone of the sectional area that is roughly the D type of described the first balloon, and

The described second hot transmitting portions is roughly flexible.

37. the cold therapy equipment in the example 33, wherein said applicator are distensible and are configured to renal artery or nephrostome with different cross section size fully inaccessible.

38. the cold therapy equipment in the example 33, wherein described the second balloon in described deployed condition is configured to heat isolation between the part of described therapentic part and described the first balloon.

39. the cold therapy equipment in the example 33, wherein said applicator comprises the spacer between described the first balloon and described the second balloon, described spacer is roughly inflexibility.

40. the cold therapy equipment in the example 33, wherein said the first balloon has been determined the first Room, described the second balloon has been determined the second Room, that liquid separates between described the first Room and described the second Room, described equipment further comprises the filling chamber along at least a portion of described bar, and described filling chamber is configured to described the second Room supply packing material.

41. the cold therapy equipment in the example 33, wherein-

Described cooling package has the first length,

Described the first balloon for elongation and have the second length,

Described the second balloon for elongation and have the 3rd length, and,

Described first, second, and third length is substantially parallel under described deployed condition.

42. a cold therapy equipment comprises:

Bar with elongation of distal portions, wherein said bar be configured to described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

The supply chamber of at least a portion of described bar, described supply chamber is configured to receive liquid refrigerant; With

Be positioned at the applicator of the described far-end of described bar, described applicator has sending state and deployed condition and comprises the first Room and the second Room, described the first Room have and described supply chamber between the first hot transmitting portions of being communicated with of fluid, and described the second Room has the second hot transmitting portions, the second hot transmitting portions is not flexible as described substantially for the wherein said first hot transmitting portions, the wherein said first hot transmitting portions has the first heat transfer rate that is enough to cause medicable freezing kidney neuroregulation when described cooling package receives cold-producing medium under the described deployed condition, the wherein said second hot transmitting portions has second heat transfer rate lower than described the first heat transfer rate under the described deployed condition when described cooling package receives cold-producing medium, and the wherein said first hot transmitting portions is extended in the plane perpendicular to described length around the complete side face of not enough described applicator.

43. a cold therapy equipment comprises:

Bar with elongation of distal portions, wherein said bar be configured to described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant; With

Be positioned at the cooling package of described distal portions, described cooling package has sending state and deployed condition, described cooling package comprises aperture and applicator, described applicator comprises the first balloon and the second balloon, fluid connection between described aperture and the described supply chamber, described the first balloon determine the first Room and have and described aperture between the first hot transmitting portions of fluid connection, described the second balloon is determined the second Room and is had the second hot transmitting portions, described the second balloon at least part of subsiding under described sending state, the wherein said first hot transmitting portions has the first heat transfer rate that is enough to cause medicable freezing kidney neuroregulation when described cooling package receives cold-producing medium under the described deployed condition, the wherein said second hot transmitting portions has second heat transfer rate lower than described the first heat transfer rate under the described deployed condition when described cooling package receives cold-producing medium, and the wherein said first hot transmitting portions along vertical section of the length of described cooling package is being non-side face;

Along the first passing away of the described bar of at least a portion, described the first passing away is configured to transport cold-producing medium from described the first Room; And

Along the second passing away of the described bar of at least a portion, described the second passing away be configured to from described the second Room transport cold-producing medium not with described the first passing away between fluid be communicated with.

44. the cold therapy equipment in the example 43 further comprises:

The first pressure regulator that is communicated with fluid between described the first passing away; And

And the second pressure regulator of fluid connection between described the second passing away.

45. the cold therapy equipment in the example 43, wherein-

Described the first balloon has the first internal surface area,

Described the second balloon has the second internal surface area,

Described aperture is the first aperture with first clear passage area,

Fluid connection between described the first Room and described the first aperture,

Described cooling package further comprises the second aperture with second clear passage area,

Fluid connection between described the second Room and described the second aperture, and

Ratio between ratio between described the first clear passage area and described first surface are long-pending amasss greater than described the second clear passage area and described second surface.

46. the cold therapy equipment in the example 43, wherein---

Described aperture is the first aperture,

Fluid connection between described the first Room and described the first aperture,

Described cooling package further comprises the second aperture,

Fluid connection between described the second Room and described the second aperture,

For the limited cooling of substantially surface area under deployed condition configures described the first aperture and described the first Room, and

For the limited cooling of substantially cold-producing medium under deployed condition configures described the second aperture and described the second Room.

47. the cold therapy equipment in the example 43, wherein be configured under the first mean temperature at described the first indoor circulation cold-producing medium at the described cooling package under the described deployed condition, and under the second mean temperature at described the second indoor circulation cold-producing medium, described the first mean temperature is lower than described the second mean temperature.

48. the cold therapy equipment in the example 43, wherein said applicator comprises the 3rd balloon, and described the first and second balloons are arranged in described the 3rd balloon.

49. the cold therapy equipment in the example 43, wherein---

Described cooling package has the first length,

Described the first balloon be elongation and have the second length,

Described the second balloon be elongation and have the 3rd length, and

Described first, second, and third length is parallel under described middle deployed condition substantially.

50. a cold therapy equipment comprises:

The bar that comprises the elongation of the distal portions with length, described bar be configured to described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant;

Be positioned at the applicator of the described distal portions of described bar, described applicator has sending state and deployed condition and comprises at least the first chamber and the second Room, described the first Room have and described supply chamber between the hot transmitting portions of fluid connection, and wherein said hot transmitting portions is extended in the plane perpendicular to described length around described complete side face around not enough described applicator;

First discharges assembly, is configured to transport cold-producing medium from described the first Room, so that described the first Room has the first heat transfer rate that is enough to cause medicable freezing kidney neuroregulation when described cooling package receives cold-producing medium under the described deployed condition; And

Second discharges assembly, be configured to transport cold-producing medium from described the second Room, so that described the second Room has second heat transfer rate lower than described the first heat transfer rate when described cooling package receives cold-producing medium under the described deployed condition, wherein said second discharges assembly not and described first discharges fluid connection between the assembly.

51. a cold therapy equipment comprises:

Bar with elongation of distal portions, described bar be configured to described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant; And

Be positioned at the cooling package of the described distal portions of described bar, described cooling package has sending state and deployed condition, described cooling package comprises aperture and applicator, described applicator comprises the first balloon and the second balloon, fluid connection between described aperture and the described supply chamber, described the first balloon has the hot transmitting portions of helical form, the hot transmitting portions of described helical form crooked near described the second balloon and and described aperture between fluid connection, and described the second balloon subsides under described sending state at least in part, and wherein said hot transmitting portions has the heat transfer rate that is enough to cause medicable freezing kidney neuroregulation when described cooling package receives cold-producing medium under the described deployed condition.

Be roughly flexible 52. the cold therapy equipment in the example 51, wherein said the first balloon are substantially the second balloon inflexibility and described.

53. the cold therapy equipment in the example 51, wherein said the first balloon are substantially flexible and described the second balloon and are roughly inflexibility.

54. the cold therapy equipment in the example 51, wherein said the first balloon and the second balloon are substantially flexible.

55. the cold therapy equipment in the example 51, wherein said the first and second balloons are substantially inflexibility.

56. the cold therapy equipment in the example 51, wherein said hot transmitting portions is the first hot transmitting portions, described heat transfer rate is the first heat transfer rate, described the second balloon has the second hot transmitting portions, and the described second hot transmitting portions has second heat transfer rate lower than described the first heat transfer rate when described cooling package receives cold-producing medium under the described deployed condition.

57. the cold therapy equipment in the example 51, wherein said applicator are distensible and the renal artery or the nephrostome that are configured to entirely shut and have the different cross section size.

58. the cold therapy equipment in the example 51, wherein said hot transmitting portions has screw diameter, and described the second balloon is roughly flexible, expands described the second balloon and increase described screw diameter under described deployed condition.

59. the cold therapy equipment in the example 51, wherein said the first balloon has been determined the first Room, described the second balloon has been determined the second Room, that liquid separates between described the first Room and described the second Room, described equipment further comprises the filling chamber along at least a portion of described bar, and described filling chamber is configured to provide packing material to described the second Room.

60. the cold therapy equipment in the example 51, wherein said the first balloon comprises the helical form part, described the second balloon has the sectional dimension of the circle of being roughly under described deployed condition, be configured to inaccessible described renal artery or nephrostome, and described spiral part twines described the second balloon.

61. the cold therapy equipment in the example 51, wherein said the second balloon have outer wall surface and described the first balloon embeds described outer wall surface at least in part.

62. the cold therapy equipment in the example 51, wherein said the second balloon have inner wall surface and described the first balloon is in described inner wall surface.

63. the cold therapy equipment in the example 51, wherein said the first balloon has been determined the first Room, described the second balloon is determined the second Room, and described the first Room is connected to described the second Room in the fluid connection mode, and described the second Room is configured to receive cold-producing medium from described the first Room.

64. a cold therapy equipment comprises:

Bar with elongation of distal portions, described bar be configured to described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant; And

Be positioned at the applicator of described distal portions, described applicator has the first Room and the second Room, fluid connection between wherein said the first Room and the described supply chamber, described the first Room have and described supply chamber between the hot transmitting portions of fluid connection, and described the first Room is included near crooked spiral part described the second Room, and wherein said spiral part has the heat transfer rate that is enough to cause medicable freezing kidney neuroregulation when described cooling package receives cold-producing medium under the described deployed condition.

65. a cold therapy equipment comprises:

The bar that comprises the elongation of the distal portions with length, described bar be configured to described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant;

Be positioned at the cooling package of described distal portions, described cooling package has sending state and deployed condition, described cooling package comprises aperture and applicator, described applicator comprises the first spiral balloon and the second spiral balloon, described aperture and described supply chamber and described the first balloon fluid connection, and described the first and second spiral balloons twine the part of described bar and interweave at least in part, wherein said the first spiral balloon has the first heat transfer rate that is enough to cause medicable freezing kidney neuroregulation under the described deployed condition when described cooling package receives cold-producing medium, and wherein said the second spiral balloon has second heat transfer rate lower than described the first heat transfer rate when described cooling package receives cold-producing medium under the described deployed condition.

66. the cold therapy equipment in the example 65, wherein said equipment further comprise along the passing away of at least part of described bar, and wherein said the first and second spiral balloons twine described passing away.

67. the cold therapy equipment in the example 65, wherein said the first spiral balloon has been determined the first Room, described the second spiral balloon has been determined the second Room, that liquid separates between described the first Room and described the second Room, described equipment further comprises the filling chamber along at least a portion of described bar, and described filling chamber is configured to provide packing material to described the second Room.

68. the cold therapy equipment in the example 65, wherein said the first spiral balloon has been determined the first Room, described the second spiral balloon has been determined the second Room, fluid connection between described the first Room and described the second Room, and described the second Room is configured to receive cold-producing medium from described the first Room.

69. the cold therapy equipment in the example 65, wherein said applicator comprises the triple helical balloon, described triple helical balloon has three heat transfer rate lower than described the first heat transfer rate under the described deployed condition when described cooling package receives cold-producing medium, and wherein said triple helical balloon interweaves with described the first and second spiral balloons at least in part.

70. the cold therapy equipment in the example 69, wherein---

Described cooling package has length,

Described the first spiral balloon has the first sweep,

Described the second spiral balloon has the second sweep,

Described triple helical balloon has the 3rd sweep, and

The described second and the 3rd sweep is in the opposite side along described length of described the first sweep.

71. the cold therapy equipment in the example 69, wherein said the first spiral balloon has been determined the first Room, described the second spiral balloon has been determined the second Room, described triple helical balloon has been determined the 3rd Room, described the first Room is that liquid separates with the described second and the 3rd Room, described equipment further comprises the filling chamber along at least a portion of described bar, and described filling chamber is configured to described the second Room, the 3rd Room or the two supply packing material.

72. the cold therapy equipment in the example 69, wherein said the first spiral balloon has been determined the first Room, described the second spiral balloon has been determined the second Room, described triple helical balloon has been determined the 3rd Room, described the first Room and the described second and the 3rd Room fluid connection, described second, third chamber are configured to receive cold-producing medium from described the first Room.

73. the cold therapy equipment in the example 65, wherein said applicator comprises the triple helical balloon, described triple helical balloon has the 3rd heat transfer rate that is enough to cause medicable freezing kidney neuroregulation under the described deployed condition when described cooling package receives cold-producing medium, and wherein said triple helical balloon interweaves with described the first and second spiral balloons at least in part.

74. the cold therapy equipment in the example 73, wherein---

Described cooling package has length,

Described the first spiral balloon has the first sweep,

Described the second spiral balloon has the second sweep,

Described triple helical balloon has the 3rd sweep, and

The described first and the 3rd sweep is in the opposite side along described length of described the second sweep.

75. the cold therapy equipment in the example 73, wherein said the first spiral balloon has been determined the first Room, described the second spiral balloon has been determined the second Room, described triple helical balloon has been determined the 3rd Room, described the second Room not with the described first and the 3rd Room fluid connection, described equipment further comprises the filling chamber along the described bar of at least a portion, and described filling chamber is configured to described the second Room supply packing material.

76. the cold therapy equipment in the example 73, wherein said the first spiral balloon has been determined the first Room, described the second spiral balloon has been determined the second Room, described triple helical balloon has been determined the 3rd Room, the described first and the 3rd Room is connected to described the second Room in the mode of fluid connection, and described the second Room is configured to receive cold-producing medium from described the first Room.

77. a cold therapy equipment comprises:

The bar that comprises the elongation of the distal portions with length, described bar be configured to described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant;

Be positioned at the applicator of described distal portions, described applicator has sending state and deployed condition and comprises the first Room and the second Room, described the first Room has the hot transmitting portions with described supply chamber fluid connection, described the first Room comprises the first cardinal principle helical form part, described the second Room comprises the second cardinal principle helical form part, and described the first and second cardinal principle spiral parts interweave at least in part, wherein said hot transmitting portions has the heat transfer rate that is enough to cause medicable freezing kidney neuroregulation under the described deployed condition when described cooling package receives cold-producing medium, and wherein said hot transmitting portions is extended in the plane perpendicular to described length around the complete side face of not enough described applicator.

78. a cold therapy equipment comprises:

Bar with elongation of distal portions, wherein said bar be configured to described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant;

Be positioned at the cooling package of described distal portions, described cooling package has sending state and deployed condition, described cooling package comprises aperture and applicator, described applicator comprises the first balloon of having determined the first Room and has determined the second balloon of the second Room, fluid connection between described aperture and the described supply chamber, described the first balloon have and described aperture between the first hot transmitting portions of fluid connection, described the second balloon has the second hot transmitting portions, described the second balloon subsides under described sending state at least in part, described the second Room described the first Room fluid connection of getting along well, the wherein said first hot transmitting portions has the first heat transfer rate that is enough to cause medicable freezing kidney neuroregulation when described cooling package receives cold-producing medium under the described deployed condition, the wherein said second hot transmitting portions has second heat transfer rate lower than described the first heat transfer rate under the described deployed condition when described cooling package receives cold-producing medium, and the wherein said first hot transmitting portions along vertical section of the length of described cooling package is being non-side face;

Along the filling chamber of at least a portion of described bar, described filling chamber is configured to described the second Room supply packing material.

79. it is that it has fixing volume that the cold therapy equipment in the example 78, wherein said the first balloon can not collapse over.

80. the cold therapy equipment in the example 78, the wherein said first hot transmitting portions comprises the metal fever transmission member.

81. the cold therapy equipment in the example 78, wherein said the second balloon is in described the first balloon.

82. the cold therapy equipment in the example 78, wherein---

Described distal portions has length,

Described the second balloon is configured to preferentially substantially expand at the first direction with respect to described length,

Described aperture be configured to from the expansion of the cold-producing medium in described supply chamber with respect to the second direction guiding of described length to the described first hot transmitting portions, and

Angle between described first direction and the described second direction is that approximately 15 degree arrive approximately 180 degree.

83. the cold therapy equipment in the example 78, wherein said the second balloon have that inner surface and described filling chamber are substantially inflexibility and are connected to described inner surface.

84. the cold therapy equipment in the example 78, wherein said applicator are distensible and the renal artery or the nephrostome that are configured to entirely shut and have the different cross section size.

85. the cold therapy equipment in the example 78, wherein described the second balloon under described deployed condition is configured to a part and the isolation of described the first balloon heat with described therapentic part.

86. a cold therapy equipment comprises:

The bar that comprises the elongation of the distal portions with length, described bar be configured to described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant;

Be positioned at the applicator of described distal portions, described applicator has sending state and deployed condition and comprises the first Room and the second Room, described the first Room have and described supply chamber between the first hot transmitting portions of fluid connection, described the second Room has the second hot transmitting portions, and described the second Room and described the first Room are that liquid separates

The wherein said first hot transmitting portions has the first heat transfer rate that is enough to cause medicable freezing kidney neuroregulation when described cooling package receives cold-producing medium under the described deployed condition, the wherein said second hot transmitting portions has second heat transfer rate lower than described the first heat transfer rate under the described deployed condition when described cooling package receives cold-producing medium, and the wherein said first hot transmitting portions is extended in the plane perpendicular to described length around the complete side face of not enough described applicator; And

Along the filling chamber of the described bar of at least a portion, described filling chamber is configured to described the second Room supply packing material.

87. a cold therapy equipment comprises:

Bar with elongation of distal portions, wherein said bar be configured to described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant; With

Be positioned at the cooling package of the described distal portions of described bar, described cooling package has sending state and deployed condition, described cooling package comprises aperture and applicator, described applicator comprises the first balloon of having determined the first Room and the second balloon of having determined the second Room, fluid connection between described aperture and the described supply chamber, described the first balloon have and described supply chamber between the hot transmitting portions of fluid connection, described the second balloon has the second hot transmitting portions, described the second balloon subsides under described sending state at least in part, described the second Room and described the first Room fluid connection, wherein said the second Room is configured to receive cold-producing medium from described the first Room, the wherein said first hot transmitting portions has the first heat transfer rate that is enough to cause medicable freezing kidney neuroregulation when described cooling package receives cold-producing medium under the described deployed condition, the wherein said second hot transmitting portions has second heat transfer rate lower than described the first heat transfer rate under the described deployed condition when described cooling package receives cold-producing medium, and the wherein said first hot transmitting portions along vertical section of the length of described cooling package is being non-side face.

88. the cold therapy equipment in the example 87, wherein said the first Room has the first cold-producing medium retention time in described deployed condition, described the second Room has the second refrigerant retention time in described deployed condition, wherein said the first cold-producing medium retention time is shorter than described second refrigerant retention time.

89. the cold therapy equipment in the example 87, wherein said equipment further comprises along the passing away of the described bar of at least a portion, and described the first and second Room are connected to described passing away in the mode of fluid connection.

90. the cold therapy equipment in the example 87, wherein said equipment further comprises along the passing away of the described bar of at least a portion, described passing away has the passing away distal portions, and described the first Room is connected to described the second Room in the fluid connection mode by described passing away distal portions.

91. the cold therapy equipment in the example 87, wherein said the second balloon are configured to passively by the cold-producing medium expansion from described the first balloon.

92. the cold therapy equipment in the example 87, wherein said applicator are distensible and the renal artery or the nephrostome that are configured to entirely shut and have the different cross section size.

93. the cold therapy equipment in the example 87, wherein described the second balloon in described deployed condition is configured to heat isolation between the part of described therapentic part and described the first balloon.

94. the cold therapy equipment in the example 87, wherein---

Described cooling package has the first length,

Described the first balloon be elongation and have the second length,

Described the second balloon be elongation and have the 3rd length, and

Described first, second, and third length is parallel under described middle deployed condition substantially.

95. a cold therapy equipment comprises:

The bar that comprises the elongation of the distal portions with length, described bar be configured to described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant; With

Be positioned at the applicator of described distal portions, described applicator has sending state and deployed condition and comprises the first Room and the second Room, described the first Room has the first hot transmitting portions with described supply chamber fluid connection, described the second Room has the second hot transmitting portions, and described the second Room and described the first Room fluid connection, wherein said the second Room is configured to receive cold-producing medium from described the first Room, the wherein said first hot transmitting portions has the first heat transfer rate that is enough to cause medicable freezing kidney neuroregulation when described cooling package receives cold-producing medium under the described deployed condition, the wherein said second hot transmitting portions has second heat transfer rate lower than described the first heat transfer rate under the described deployed condition when described cooling package receives cold-producing medium, and the wherein said first hot transmitting portions is extended in the plane perpendicular to described length around the complete side face of not enough described applicator.

96. the cold therapy equipment in the example 95, further comprise along the passing away of the described bar of at least a portion, and described passing away is configured to transport cold-producing medium from described the first Room, and wherein said the second Room is configured to cold-producing medium is transported to described passing away from described the first Room.

97. the cold therapy equipment in the example 96, wherein---

Described the first Room has the first Room distal portions and the first Room proximal part, and is configured to cold-producing medium is transported to described the first Room distal portions from described the first Room proximal part,

Described the second Room has the second Room distal portions and the second Room proximal part,, and be configured to cold-producing medium is transported to described the second Room proximal part from described the second Room distal portions.

98. the cold therapy equipment in the example 96, wherein said applicator have the mobile path of main refrigerant, from described the first Room to described passing away, and described main refrigerant flows the path by described the second Room.

99. a cold therapy equipment comprises:

The bar that comprises the elongation of the distal portions with length, described bar be configured to described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant;

Be positioned at the applicator of the described distal portions of described bar, described applicator has sending state and deployed condition and comprises the first Room and the second Room, described the first Room have and described supply chamber between the hot transmitting portions of fluid connection, the wherein said first hot transmitting portions has the heat transfer rate that is enough to cause medicable freezing kidney neuroregulation under the described deployed condition when described cooling package receives cold-producing medium, and wherein said hot transmitting portions is extended in the plane perpendicular to described length around the complete side face of not enough described applicator; And

Along the passing away of the described bar of at least a portion, described passing away is configured to transport cold-producing medium from described the first Room, and wherein said the second Room is configured to transport cold-producing medium from described the first Room to described passing away.

100. a cold therapy equipment comprises:

Bar with elongation of distal portions, wherein said bar be configured to described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant;

Be positioned at the cooling package of described distal portions, described cooling package has sending state and deployed condition, described cooling package comprises aperture and applicator, described applicator comprises the applicator balloon of having determined the applicator chamber, fluid connection between described aperture and the described supply chamber, described applicator balloon have and described aperture between the hot transmitting portions of fluid connection, wherein said applicator is configured to causing medicable freezing kidney neuroregulation under the described deployed condition when described cooling package receives cold-producing medium; And

To the obstruction component of near-end away from described applicator, described obstruction component has collapsed mode and expansion state, and the sectional dimension that wherein said obstruction component has is configured to entirely shut under described expansion state near renal artery and/or the nephrostome of described therapentic part.

101. the cold therapy equipment in the example 100, wherein said inaccessible assembly comprises the inaccessible balloon of having determined inaccessible chamber, and described inaccessible chamber is connected to described applicator chamber in the mode of fluid connection.

102. the cold therapy equipment in the example 101 comprises further that along the passing away of the described bar of at least a portion wherein said inaccessible chamber is connected to described passing away in the mode of fluid connection.

103. the cold therapy equipment in the example 101, wherein said applicator chamber had for the first cold-producing medium holding time under described deployed condition, wherein said inaccessible chamber has the second refrigerant holding time under described expansion state, and wherein said the first cold-producing medium holding time is shorter than the described second refrigerant holding time.

104. the cold therapy equipment in the example 101 comprises further that along the filling chamber of the described bar of at least a portion wherein said filling chamber is connected to described inaccessible chamber in the mode of fluid connection, and wherein said inaccessible chamber is that liquid separates with described supply chamber.

105. the cold therapy equipment in the example 100, wherein said obstruction component are distensible and are configured to the renal artery or the nephrostome that entirely shut and have different-diameter under described expansion states.

106. the cold therapy equipment in the example 100, wherein said obstruction component comprises inaccessible balloon, and described inaccessible balloon is flexible substantially.

107. the cold therapy equipment in the example 100, further comprise handle, described bar has the proximal part that is positioned at described handle, wherein said bar comprises the control member of the elongation in control chamber and the described control chamber, and wherein said control member operationally is coupled to described distal portions and described handle, thereby increases or the tension force that reduces described control member is controlled at least one section deflection of the distal portions of described obstruction component.

108. the cold therapy equipment in the example 100, wherein said applicator has the applicator sectional dimension under described deployed condition, it is less than the sectional dimension of described obstruction component under described expansion state, so renal artery and/or the nephrostome of described applicator incomplete inaccessible described therapentic part under described deployed condition.

109. the cold therapy equipment in the example 100, wherein said cooling package comprises the support member of elongation, and wherein said applicator chamber comprises the helical form balloon, and described balloon twines at least a portion of described support member.

110. the cold therapy equipment in the example 100, wherein---

Described cooling package has length,

The shape of described applicator balloon under described deployed condition comprises a plurality of females and around the non-sunk area of described a plurality of females,

Described non-sunk area is determined described hot transmitting portions at least in part, and

Described hot transmitting portions along vertical section of described length is being non-side face.

111. the cold therapy equipment in the example 110, the shape of wherein said applicator balloon under described deployed condition is roughly cylindrical.

112. the cold therapy equipment in the example 100, wherein---

Described cooling package has length,

The shape of described applicator balloon under described deployed condition comprises a plurality of outstanding and around described a plurality of outstanding non-outburst areas,

Described a plurality of outstanding described hot transmitting portions of determining at least in part, and

Described hot transmitting portions along vertical section of described length is being non-side face.

113. the cold therapy equipment in the example 100, wherein---

Described cooling package has length and along the support member of the elongation of the described length of at least a portion,

Described applicator balloon comprises non-circumferential surface sections and coupling part,

Described coupling part is connected to described support member,

Described non-circumferential surface sections is separated with described support member under described deployed condition,

Described non-circumferential surface sections is determined described hot transmitting portions at least in part, and

Described hot transmitting portions along vertical section of described length is being non-side face.

114. the cold therapy equipment in the example 113, wherein---

Described coupling part is the first pontes,

Described non-circumferential surface sections is the first non-circumferential surface sections,

Described applicator balloon comprises the second coupling part that is installed to described support member,

Described applicator balloon comprises the second non-circumferential surface sections, and it is separated with described support member under described deployed condition,

The described first non-circumferential surface sections is between described the first and second coupling parts,

The described second non-circumferential surface sections is between described the first and second coupling parts and separates around described length with described first non-all faces diametrically, and

The described first and second non-circumferential surface sections are determined described hot transmitting portions at least in part.

115. the cold therapy equipment in the example 113, wherein---

Described applicator balloon is the first applicator balloon,

Described coupling part is the first pontes,

Described non-circumferential surface sections is the first non-circumferential surface sections,

Described applicator comprises the second applicator balloon, and it is opened along described length and described the first applicator balloon longitudinal subdivision,

Described the second applicator balloon comprises the second non-circumferential surface sections and the second coupling part,

Described the second coupling part is connected to described support member,

The described second non-circumferential surface sections is opened along described length and described support member longitudinal subdivision under described deployed condition, and

The described first and second non-circumferential surface sections are determined described hot transmitting portions at least in part.

116. the cold therapy equipment in the example 100, wherein---

Described cooling package has length,

Described applicator balloon has spiral female and spiral lands,

Described spiral lands is determined described hot transmitting portions at least in part, and

Described hot transmitting portions is non-side face along described length in vertical section.

117. the cold therapy equipment in the example 100, wherein---

Described applicator balloon for elongation and have length, the applicator balloon proximal part along described length, applicator balloon mid portion and an applicator balloon distal portions,

So described applicator balloon has the first wall part and the second wall part along the described applicator balloon of described curved in length, under described deployed condition, described the first wall part has the curve that is roughly spill along described length, described the second wall part has along the cardinal principle of described length and is not the curve of spill

Described applicator balloon mid portion is configured to and does not contact along the described second renal artery and/or nephrostome than part with cardinal principle generally along described the second wall part under described deployed condition,

Described the second wall part at described applicator balloon mid portion is determined described hot transmitting portions at least in part, and,

Described hot transmitting portions along vertical section of described length is being non-side face.

118. the cold therapy equipment in the example 117, wherein said the first wall part has the first thickness, and wherein said the second wall part has the second thickness than described the first thin thickness.

119. the cold therapy equipment in the example 100, wherein---

Described applicator balloon for elongation and have length,

Described cooling package comprises along the standard element of the elongation of the described length of at least a portion,

Described standard element has linear configurations substantially under described sending state, and has curved configuration under described deployed condition, and

Described applicator balloon has at least in part the shape corresponding to described curved configuration under described expansion shape body.

120. the cold therapy equipment in the example 119, the shape of wherein said applicator balloon under described deployed condition is roughly helical form.

121. the cold therapy equipment in the example 119, the shape of wherein said applicator balloon under described deployed condition be roughly wriggle circuitous.

122. the cold therapy equipment in the example 100, wherein---

Described cooling package has length,

Described equipment comprises the standard element of elongation, can vertically move with respect to described bar,

Described applicator balloon has the first balloon proximal part along described length, the first balloon mid portion and the first balloon distal portions,

Described applicator comprises the balloon of the second elongation, and it has the second balloon proximal part, the second balloon mid portion and the second balloon distal portions along described length,

Described the first balloon distal portions and the second balloon distal portions are connected to described standard element, so that with respect to described bar retract described standard element so that described the first and second balloons along described curved in length, and so that described the first balloon mid portion and described the second balloon mid portion shifted laterally away from described standard element

Described the first balloon mid portion has first outside, and described first outside has under described deployed condition along the non-concave curve of the cardinal principle of described length,

Described the second balloon mid portion has second outside, and described second outside has under described deployed condition along the non-concave curve of the cardinal principle of described length,

Described hot transmitting portions is determined in described first and second outsides at least in part, and

Described hot transmitting portions along vertical section of described length is being non-side face.

123. a cold therapy equipment comprises:

Bar with elongation of distal portions and proximal part, described bar be configured to described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part, described proximal part is configured to outside described vascular system;

Be positioned at the sub-cooled assembly of the described distal portions of described bar;

Main supply along the described bar of at least a portion is answered the chamber, and it has first and second portion, and wherein said main supply answers the described second portion in chamber near described sub-cooled assembly; And

The pre-cooling assembly, it is configured in outside the described vascular system, described pre-cooling assembly comprise pre-cooling support the chamber and and described pre-cooling support the pre-cooling expansion chambers of fluid connection between the chamber, so that support the liquid refrigerant in chamber to expand in described pre-cooling expansion chambers from described pre-cooling, and described main supply answers the described first in chamber to extend through described pre-cooling expansion chambers.

124. a cold therapy equipment comprises:

Bar with elongation of distal portions and proximal part, described bar be configured to described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Be in the cooling package of described distal portions;

Main supply along the described bar of at least a portion is answered the chamber, and it is configured to receive liquid refrigerant; With

Outside described vascular system, answer the pre-cooling assembly of the part in chamber around described main supply, described pre-cooling assembly comprises pre-cooling support chamber, is configured to support the chamber to receive the fore-cooling room of the elongation of cold-producing medium from described pre-cooling, and outlet, described fore-cooling room has greater than the about length of 10cm, and wherein said main supply answers the proximal part in chamber to extend through described fore-cooling room.

125. the cold therapy equipment in the example 124 further comprises the edge along the passing away of the described bar of at least a portion, wherein said outlet is connected to described passing away in the fluid connection mode.

126. the cold therapy equipment in the example 125, the concentrated section that further comprises the intersection between described pre-cooling assembly and described bar, described passing away has substantially straight discharge flow path by described concentrated section, the described discharge flow path alignment of getting along well of wherein said length.

127. the cold therapy equipment in the example 124 further comprises adapter, it is configured to answer chamber and described pre-cold supply chamber to be connected to the liquid refrigerant source described main supply.

128. the cold therapy equipment in the example 127 further comprises tubular element, it has tubulose proximal part and tubular distal, and described tubulose proximal part comprises that pre-cooling supports the chamber, and described tubular distal comprises the fore-cooling room, wherein---

Described adapter comprises the described tubulose proximal part that is in described tubular element and the plug between the described tubular distal,

Described main supply answers chamber and described pre-cold supply chamber to extend through described plug,

Described main supply answers the chamber to have opening in described tubulose proximal part,

Described pre-cold supply chamber has the opening that is arranged in described tubulose proximal part, and

Described tubulose proximal part is configured to be connected to described liquid refrigerant source.

129. the cold therapy equipment in the example 124, wherein said length is from about 20cm to about 30cm.

130. it is to wriggle to make a circulation that the cold therapy equipment in the example 124, wherein said main supply answer at least one section of the part of chamber in described fore-cooling room at least part of.

131. the cold therapy equipment in the example 124 further comprises the handle that is positioned at described proximal part, at least a portion of wherein said pre-cooling assembly is in described handle.

132. the cold therapy equipment in the example 124, wherein said outlet comprises valve.

133. the cold therapy equipment in the example 132, wherein said fore-cooling room substantially be that liquid separates between the described passing away.

134. a cold therapy equipment comprises:

Bar with elongation of distal portions and proximal part, described bar be configured to described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part, and described proximal part placed outside the described vascular system;

Be positioned at the cooling package of described distal portions;

The main supply that is configured to receive liquid refrigerant along the described bar of at least a portion is answered the chamber;

Along the passing away of the described bar of at least a portion, described passing away is configured to gaseous refrigerant is transported from described cooling package; And

Be positioned at described main supply and answer the proximal part in chamber and the pre-cooling assembly outside described vascular system, described pre-cooling assembly comprises the fore-cooling room, be arranged in the manifold of proximal part of described fore-cooling room and the pre-cooling discharger that leaves described manifold to far-end, wherein said manifold has and is coupled to that described main supply is answered the main channel in chamber and from the radially outer peripheral channel in described main channel, and wherein said pre-cooling arrangement of components is cooled off described fore-cooling room for making described liquid refrigerant expand from described pre-cold supply chamber.

135. a cold therapy equipment comprises:

Bar with elongation of distal portions and proximal part, described bar be configured to described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part, described proximal part is configured to be in outside the described vascular system;

Be positioned at the sub-cooled assembly of the described distal portions of described bar;

Main supply along the described bar of at least a portion is answered the chamber, and it has first and second portion, and wherein said main supply answers the described second portion in chamber near described sub-cooled assembly; And

Precooler, it has the container that is configured to receive liquid refrigerant stream, the diverter in the described container, along pre-cooled dose of passage and the pre-cooling expansion chambers in described container of the periphery of described diverter, described pre-cooling expansion chambers has the proximal part of being determined by described diverter, wherein said diverter has and is connected to the main channel that described main supply is answered the described first in chamber, arrive described main supply and answer the chamber so that the part of liquid refrigerant flows through described main channel, and another part of liquid refrigerant flows through described precooling agent passage and enters described pre-cooling expansion chambers.

136. the cold therapy equipment in the example 135, wherein said main supply answer the chamber to be included in opening in the described pre-cold supply chamber.

137. the cold therapy equipment in the example 135, wherein said container have inner surface and described main supply answers the chamber not to be fixed to described inner surface.

138. the cold therapy equipment in the example 135 comprises further and determines that described main supply answers the main supply in chamber to answer conduit that described main supply answers conduit to have the outer surface of at least a portion of determining described peripheral channel.

139. the cold therapy equipment in the example 135, further comprise and determine that described main supply answers the main supply in chamber to answer conduit, described main supply answers conduit to have outer surface, wherein said chamber has inner surface, and described diverter is fixed to described main supply and answers conduit on the outer surface between described pre-cold supply chamber and the described fore-cooling room, and wherein said diverter has been determined at least a portion of described precooling agent passage.

140. the cold therapy equipment in the example 135, wherein said main supply answer conduit to have mean outside diameter in described fore-cooling room, and wherein said diverter is the part that described main supply is answered conduit, and have the external diameter larger than described mean outside diameter.

141. the cold therapy equipment in the example 135, wherein said container has inner surface, and described pre-cooling passage is included in the gap of the bending between described diverter and the described inner surface.

142. the cold therapy equipment in the example 135, wherein said container has inner surface, and described precooling agent passage is included in the annular gap between described diverter and the described inner surface.

143. a cold therapy equipment comprises:

Bar with elongation of distal portions, described bar be configured to described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant;

Be positioned at the cooling package of described distal portions, described cooling package has sending state and deployed condition, described cooling package comprises aperture and applicator, described applicator has balloon, described balloon has circumferential skimble-scamble shape under described deployed condition, fluid connection between the supply chamber is told by described aperture and institute, described balloon have and described aperture between the hot transmitting portions of fluid connection, wherein said hot transmitting portions has the heat transfer rate that is enough to cause medicable freezing kidney neuroregulation when described cooling package receives cold-producing medium under the described deployed condition.

144. a cold therapy equipment comprises:

Bar with elongation of distal portions, described bar be configured to described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant;

Be positioned at the cooling package of described distal portions, described cooling package has sending state and deployed condition, described cooling package comprises aperture and applicator, described applicator comprises balloon, the shape of described balloon under described deployed condition has a plurality of females and centers on the non-sunk area of described a plurality of females, fluid connection between described aperture and the described supply chamber, described balloon have and described aperture between the hot transmitting portions of fluid connection, described non-sunk area has been determined described hot transmitting portions at least in part, and wherein said hot transmitting portions has the heat transfer rate that is enough to cause medicable freezing kidney neuroregulation when described cooling package receives cold-producing medium under the described deployed condition.

145. the cold therapy equipment in the example 144, wherein said a plurality of females have the even distribution of circumferential asymmetry on described applicator.

146. the cold therapy equipment in the example 144, the shape of wherein said balloon is roughly cylindrical.

147. the cold therapy equipment in the example 144, the shape of wherein said balloon are roughly tubulose and have longitudinal axis, and the shape of wherein said balloon has been determined along at least a portion of the blood flow paths of described longitudinal axis.

148. the cold therapy equipment in the example 144, wherein said cooling package has length, and wherein said hot transmitting portions along vertical section of the described length of described cooling package is being non-side face.

149. a cold therapy equipment comprises:

Bar with elongation of distal portions, described bar be configured to described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive described liquid refrigerant; And

Be positioned at the cooling package of described distal portions, described cooling package has sending state and deployed condition, described cooling package comprises aperture and applicator, described applicator comprises balloon, the shape of described balloon in described deployed condition has a plurality of outstanding and around described a plurality of outstanding non-outburst areas, fluid connection between described aperture and the described supply chamber, described balloon have and described aperture between the hot transmitting portions of fluid connection, described a plurality of outstanding described hot transmitting portions of having determined at least in part, wherein said hot transmitting portions has the heat transfer rate that is enough to cause medicable freezing kidney neuroregulation when described cooling package receives cold-producing medium under the described deployed condition.

150. the cold therapy equipment in the example 149, wherein said a plurality of outstanding inhomogeneous distributions on side face that have on described applicator.

151. the cold therapy equipment in the example 149, the shape of wherein said balloon is roughly cylindrical.

152. the cold therapy equipment in the example 149, the shape of wherein said balloon are roughly tubulose and have longitudinal axis, and the shape of wherein said balloon has been determined along at least a portion of the blood flow paths of described longitudinal axis.

153. the cold therapy equipment in the example 149, wherein said cooling package has length, and wherein said hot transmitting portions along vertical section of the length of described cooling package is being non-side face.

154. a cold therapy equipment comprises:

Bar with elongation of distal portions, described bar be configured to described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant; With

Be positioned at the cooling package of described distal portions, described cooling package has sending state and deployed condition, described cooling package comprises aperture and applicator, described applicator has the spiral balloon, fluid connection between described aperture and the described supply chamber, suffered spiral balloon have and described aperture between the hot transmitting portions of fluid connection, wherein said hot transmitting portions has the heat transfer rate that is enough to cause medicable freezing kidney neuroregulation when described cooling package receives cold-producing medium under the described deployed condition.

155. the cold therapy equipment in the example 154, wherein said spiral balloon has the helical form axis and has determined along at least a portion of the blood flow paths of described helical form axis.

156. the cold therapy equipment in the example 154, wherein said cooling package has length, and wherein said hot transmitting portions along vertical section of the length of described cooling package is being non-side face.

157. the cold therapy equipment in the example 154 further comprises along the passing away of the described bar of at least a portion, wherein---

Described passing away is configured to transport the cold-producing medium of gaseous state,

Described spiral balloon has proximal openings and distal openings,

Described spiral balloon is connected to described supply chamber in the fluid connection mode in described distal openings, and

Described spiral balloon is connected to described passing away in the fluid connection mode in described proximal openings.

158. the cold therapy equipment in the example 154, wherein said cooling package comprises the support member of elongation, and the wherein said spiral balloon at least a portion of twining described supporting member.

159. the cold therapy equipment in the example 158, wherein said support member comprises the part in described supply chamber.

160. the cold therapy equipment in the example 154, wherein said cooling package has length, and wherein said spiral balloon comprises the first spiral winding and the second spiral winding, and wherein said the first and second spiral windings are separated along described length.

161. a cold therapy equipment comprises:

Bar with elongation of distal portions, described bar be configured to described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant; With

Be positioned at the cooling package of described distal portions, described cooling package has sending state and deployed condition, described cooling package has aperture and applicator, described applicator comprises balloon, described balloon has spiral female and spiral lands under described deployed condition, fluid connection between described aperture and the described supply chamber, described balloon have and described aperture between the hot transmitting portions of fluid connection, described spiral lands has been determined described hot transmitting portions at least in part, and wherein said hot transmitting portions has the heat transfer rate that is enough to cause medicable freezing kidney neuroregulation when described cooling package receives cold-producing medium under the described deployed condition.

162. the cold therapy equipment in the example 161, wherein said cooling package has length, and wherein said hot transmitting portions along vertical section of the length of described cooling package is being non-side face.

163. a cold therapy equipment comprises:

Bar with elongation of distal portions, described bar be configured to described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant; With

Be positioned at the cooling package of described distal portions, described cooling package has sending state and deployed condition, described cooling package comprises aperture and applicator, described applicator comprises the balloon of elongation, described balloon has length, balloon proximal part along described length, balloon mid portion and balloon distal portions, so the described balloon of executing has the first wall part and the second wall part along the described applicator balloon of described curved in length, under described deployed condition, described the first wall part has the curve that is roughly spill along described length, described the second wall part has along the cardinal principle of described length and is not the curve of spill, wherein said balloon mid portion is configured to not contact with described renal artery and/or nephrostome along described the first wall part generally along described the second wall part and cardinal principle under described deployed condition, described balloon has the hot transmitting portions with described aperture fluid connection, wherein determined at least in part described hot transmitting portions at described second wall part of described balloon mid portion, and wherein said hot transmitting portions when receiving cold-producing medium, described cooling package has the heat transfer rate that is enough to cause medicable freezing kidney neuroregulation under the described deployed condition.

164. the cold therapy equipment in the example 163, wherein said freezing assembly has length, and wherein said hot transmitting portions along vertical section of the length of described cooling package is being non-side face.

165. the cold therapy equipment in the example 163, wherein described the first wall part at described balloon mid portion has the first thickness, and wherein has the second thickness than described the first thin thickness at described second wall part of described balloon mid portion.

166. the cold therapy equipment in the example 163, wherein said balloon distal portions are configured to not contact with described renal artery and/or nephrostome along described the second wall part generally along described the first wall part and cardinal principle under described deployed condition.

167. the cold therapy equipment in the example 166 has wherein been determined described hot transmitting portions at least in part at described first wall part of described balloon distal portions.

168. the cold therapy equipment in the example 167, the nearly section of wherein said balloon partial configuration is not contact with described renal artery and/or nephrostome along described the second wall part generally along described the first wall part and cardinal principle under described deployed condition.

169. the cold therapy equipment in the example 168 has wherein been determined described hot transmitting portions at least in part at described first wall part of the nearly section part of described balloon.

170. a cold therapy equipment comprises:

Bar with elongation of distal portions, described bar be configured to described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant; With

Be positioned at the cooling package of described distal portions, described cooling package has sending state and deployed condition, described cooling package comprises the support member of elongation, the aperture, and applicator, fluid connection between described aperture and the described supply chamber, described applicator has balloon, described balloon has distensible longitudinal component and restricted longitudinal component, described restricted longitudinal component is connected to described support member, described distensible longitudinal component is separated mutually with described support member under described deployed condition, described balloon have and described aperture between the hot transmitting portions of fluid connection, wherein said distensible longitudinal component has been determined described transmitting portions at least in part, and wherein said hot transmitting portions has the heat transfer rate that is enough to cause medicable freezing kidney neuroregulation when described cooling package receives cold-producing medium under the described deployed condition.

171. the cold therapy equipment in the example 170, wherein said cooling package has length, and wherein said hot transmitting portions along vertical section of the length of described cooling package is being non-side face.

172. the cold therapy equipment in the example 170, wherein said cooling package has length, and wherein said restricted longitudinal component has been determined along at least a portion of the blood flow paths of the length of described cooling package.

173. the cold therapy equipment in the example 170, wherein said support member comprises at least a portion in described supply chamber.

174. the cold therapy equipment in the example 170, wherein---

Described cooling package has length,

Described restricted longitudinal component is the first restricted longitudinal component,

Described distensible longitudinal component is the first expansible longitudinal component,

Described balloon comprises the second restricted longitudinal component, and it is connected to described support member,

Described balloon comprises the second expansible longitudinal component, and it is separated mutually with described support member under described deployed condition,

The described first expansible longitudinal component between the described first and second restricted longitudinal components,

The described second expansible longitudinal component and is separated around described length with the described first expansible longitudinal component between the described first and second restricted longitudinal components diametrically, and

The described first and second expansible longitudinal components are determined described hot transmitting portions at least in part.

175. the cold therapy equipment in the example 174, the wherein said first and second restricted longitudinal components extend along described length.

176. a cold therapy equipment comprises:

Bar with elongation of distal portions, described bar be configured to described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant; With

Be positioned at the cooling package of described distal portions, described cooling package has length, sending state and deployed condition, described cooling package comprises aperture and applicator, described applicator comprises along separated the first balloon of described length and the second balloon, fluid connection between described aperture and the described supply chamber, described the first balloon has under described deployed condition and described support member the separated first non-circumferential surface sections, described the second balloon has under described deployed condition and described support member the separated second non-circumferential surface sections, wherein said applicator has hot transmitting portions, described hot transmitting portions has the heat transfer rate that is enough to cause medicable freezing kidney neuroregulation under the described deployed condition when described cooling package receives cold-producing medium, and the wherein said first and second non-circumferential surface sections are determined described hot transmitting portions at least in part.

177. the cold therapy equipment in the example 176, the wherein said first non-circumferential surface sections has been determined first vertical section of described hot transmitting portions, the wherein said second non-circumferential surface sections has been determined the second vertical section of described hot transmitting portions, cut wherein said first and second vertically section separate and have in the complete side face projection perpendicular to the cardinal principle in the plane of described length along described length.

178. the cold therapy equipment in the example 176, wherein said aperture are the first aperture cut and the described first non-circumferential surface sections between fluid connection, and wherein said cooling package comprises and the described second non-circumferential surface sections between the second aperture of fluid connection.

179. a cold therapy equipment comprises:

Bar with elongation of distal portions, described bar be configured to described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant; With

Be positioned at the cooling package of described distal portions, described cooling package has sending state and deployed condition, described cooling package comprises the standard element of elongation, the aperture, and applicator, described applicator comprises balloon, described standard element comprises shape memory, the second configuration under under the described sending state first configuration and the described deployed condition, the shape of described balloon under described deployed condition is at least in part to being used for described the second configuration, fluid connection between described aperture and the described supply chamber, described balloon have and described aperture between the hot transmitting portions of fluid connection, wherein said hot transmitting portions has the heat transfer rate that is enough to cause medicable freezing kidney neuroregulation when described cooling package receives cold-producing medium under the described deployed condition.

180. the cold therapy equipment in the example 179, wherein said the first configuration is stretched longlyer than described the second configuration.

181. the cold therapy equipment in the example 179, wherein said cooling package has length, and wherein said hot transmitting portions along vertical section of the length of described cooling package is being non-side face.

182. the cold therapy equipment in the example 179, wherein said standard element comprises Nitinol.

183. the cold therapy equipment in the example 179, the shape of wherein said balloon under described deployed condition is roughly helical form.

184. a therapeutic equipment comprises:

Bar with elongation of distal portions, described bar are configured in blood vessel described distal portions be placed therapentic part; And

Be positioned at the curative component of described distal portions, described curative component has sending state and deployed condition, described curative component comprises qualitative member and the balloon of elongation, described typing makes up the second configuration that has under the configuration of first under shape memory, the described sending state and the described deployed condition, and the shape of wherein said balloon under described deployed condition is at least in part corresponding to described the second configuration.

185. a cold therapy equipment comprises:

The doing of elongation with distal portions, described bar be configured to described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant; With

At least standard element chamber of part along described bar;

The standard element of the elongation at least a portion in described standard element chamber, described standard element can move with respect to described bar in the vertical; And

Be positioned at the cooling package of described distal portions, described cooling package has length, sending state, and deployed condition, described cooling package comprises aperture and applicator, described applicator comprises the first balloon of elongation and the second balloon of elongation, described the first balloon has the first balloon proximal part along described length, the first balloon mid portion, and the first balloon distal portions, the second balloon of described elongation has the second balloon proximal part along described length, the second balloon mid portion and the second balloon distal portions, described the first balloon distal portions and described the second balloon distal portions are connected to described standard element, cause described the first balloon mid portion and described the second balloon mid portion shifted laterally away from described standard element so that spur described standard element with respect to described bar, described the first balloon mid portion has first outside, described first outside has under described deployed condition along the non-concave curve of the cardinal principle of described length, described the second balloon mid portion has second outside, described second outside has under described deployed condition along the non-concave curve of the cardinal principle of described length, wherein said applicator has hot transmitting portions, described hot transmitting portions has the heat transfer rate that is enough to cause medicable freezing kidney neuroregulation under the described deployed condition when described cooling package receives cold-producing medium, and described hot transmitting portions is determined in wherein said first outside at least in part.

186. the cold therapy equipment in the example 185, wherein said hot transmitting portions along vertical section of the length of described cooling package is being non-side face.

187. the cold therapy equipment in the example 185, wherein said the first balloon has the priority bending position along described length, and wherein spurs described standard element with respect to described bar and can cause described the first balloon crooked on described preferential position along described length.

188. the cold therapy equipment in the example 185, wherein said priority bending position comprises fold.

189. the cold therapy equipment in the example 185, wherein said the first balloon proximal part and described the second balloon proximal part are connected to described bar.

190. the cold therapy equipment in the example 185 further comprises along the passing away of at least a portion of described bar, wherein---

Described passing away is configured to transport the cold-producing medium of gaseous state,

Described the first balloon has the first distal openings and the first proximal openings,

Described the second balloon has the second distal openings and the second proximal openings,

Described the first balloon is connected to described supply chamber in the fluid connection mode in described the first distal openings,

Described the second balloon is connected to described supply chamber in the fluid connection mode in described the second distal openings,

Described the first balloon is linked to described passing away in the fluid connection mode in described the first distal openings, and

Described the second balloon is linked to described passing away in the fluid connection mode in described the second distal openings.

191. the cold therapy equipment in the example 185, further comprise along the filling chamber of at least a portion of described bar, wherein said filling chamber is configured to described the second balloon supply packing material, wherein said the first balloon is connected to described supply chamber in the fluid connection mode, and wherein said the first balloon and described the second balloon are that liquid separates.

192. a cold therapy equipment comprises:

Bar with distal portions, wherein said bar are configured in blood vessel described distal portions be placed at least near renal artery or nephrostome;

Be positioned at the cooling package of the distal portions of described bar, described cooling package comprises expansion chambers, and described expansion chambers has burst pressure and is lower than the threshold value pressure of described burst pressure;

Pressure along the described bar of at least a portion monitors the chamber, and described pressure monitors that the chamber has the first opening of the distal portions that is positioned at described bar and is positioned at the second opening of the proximal part of described bar, fluid connection between wherein said the first opening and the described expansion chambers; And

Be configured to place the pressure transducer outside the patient body, it operationally is coupled to described pressure and monitors the chamber, and wherein said pressure monitors that chamber and described pressure transducer are configured to provide signal, the pressure change in the described expansion chambers of described signal designation.

193. the cold therapy equipment in the example 192, wherein:

Described pressure monitors that the length in chamber equals the length of described bar at least; And

Described pressure monitors that the chamber is configured at the most 0.5 second the response time from described expansion chambers to described pressure transducer.

194. the cold therapy equipment in the example 192 further comprises:

Along the supply chamber of the described bar of at least a portion, fluid connection between described supply chamber and the described expansion chambers;

Along the discharge side of the described bar of at least a portion, fluid connection between described discharge side and the described expansion chambers;

Valve, it is coupled to described supply chamber and described pressure transducer, and

Wherein---

Described expansion chambers comprises balloon,

Described valve is configured to record pressure in the described expansion chambers on described threshold value pressure the time when sensor, reduces at least in part the refrigerant flow by described supply chamber,

Described pressure monitors that the chamber has internal diameter and external diameter, and described internal diameter is configured to measure exactly the pressure in the described expansion chambers, and described outer diameter configuration is for ignoring on the impact of the cold-producing medium discharge by described discharge side, and

Described pressure monitor the chamber be configured to provide from described expansion chambers to described pressure transducer less than 1 second response time.

195. the cold therapy equipment in the example 192 further comprises:

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive the basic at least liquid cold-producing medium that is;

Along the discharge side of the described bar of at least a portion, fluid connection between described discharge side and the described expansion chambers, and

Wherein---

Described discharge side has interior sectional dimension,

Described supply chamber and described pressure monitor that the chamber has the outer cross section size of the described distal portions that is positioned at described bar jointly, and

The ratio of described interior sectional dimension and outer sectional dimension is between 4: 1 and 10: 1.

196. the cold therapy equipment in the example 192, wherein:

Described bar has the first length; And

Described pressure monitors that the chamber has and is approximately 0.010 internal diameter, the external diameter of about 0.015 inch (0.381mm), and the second length that equals at least described first length of described bar.

197. the cold therapy equipment in the example 196, wherein said bar are configured to be suitable for being in the guide sheath of 6Fr, the first length of described bar is 120cm at least.

198. the cold therapy equipment in the example 192, further comprise the controller that is coupled to described bar and described pressure transducer, wherein said controller is configured to measure described threshold value pressure or more during High Voltage, be reduced at least in part the refrigerant flow of described expansion chambers when described pressure transducer.

199. the cold therapy equipment in the example 192 further comprises adapter, it has the passage between described sensor and described pressure supervision chamber, and wherein said passage has the volume that is not more than 0.1cc.

200. comprising, the cold therapy equipment in the example 192, wherein said expansion chambers has at least flexible material of the burst pressure of 300psi.

201. comprising, the cold therapy equipment in the example 192, wherein said expansion chambers has the at the most flexible material of the burst pressure of 200psi.

202. the cold therapy equipment in the example 192, wherein:

Described bar is configured to be suitable for being in the 6Fr guide sheath; And

Described cooling package comprises expandable members, and it has sending state and expansion state, and at least a portion of described expandable members is determined described expansion chambers, and wherein said expandable members has under described expansion state from about 3mm to the about external diameter of 10mm.

203. a cold therapy equipment comprises:

Bar with proximal part and distal portions;

Be positioned at the cooling component of the described distal portions of described bar, wherein said cooling package comprise and the described distal portions of described bar between the expansion chambers of fluid connection; And

The described proximal part of described bar and and described expansion chambers between the pressure transducer of fluid connection so that the pressure change in the described expansion chambers and described pressure transducer place record time delay between the pressure within the response time of avoiding expansion chambers to break.

204. the cold therapy equipment in the example 203, wherein said response time was less than 0.01 second.

205. the cold therapy equipment in the example 203 comprises that further pressure monitors the chamber, its have the proximal part that is coupled to described pressure transducer and and described expansion chambers between the distal portions of fluid connection.

206. the cold therapy equipment in the example 205, wherein said pressure monitor that the chamber has the internal diameter that is not more than 0.030 inch (0.762mm) and the external diameter that is not more than 0.060 inch (1.52mm).

207. the cold therapy equipment in the example 205, wherein said pressure monitor that the chamber has the length of at least 48 inches (122cm).

208. the cold therapy equipment in the example 205 further comprises adapter, it is coupling in described pressure transducer and described pressure monitors that wherein said adapter has the internal capacity less than 0.1cc between the chamber.

209. the cold therapy equipment in the example 203, wherein:

Described response time was less than 0.1 second; And

Described cold therapy equipment comprises that further pressure monitors the chamber, its have the proximal part that is coupled to described pressure transducer and and described expansion chambers between the distal portions of fluid connection, described pressure monitors that the chamber has at least length of 120cm.

210. the cold therapy equipment in the example 203, wherein:

Described bar is configured to be suitable for being in the guide sheath of 6Fr; And

Described cooling package comprises expandable members, this expandable members has sending state and expansion state, at least a portion of described expandable members is determined described expansion chambers, and wherein said expandable members has the maximum outside diameter of 10mm and has the at the most length of 10mm under described expansion state.

211. a cold therapy equipment comprises:

The bar that comprises proximal part and distal portions, wherein said distal portions comprise the depression inside with respect to described proximal part;

Discharge side along the described bar of at least a portion;

Supply chamber along the described bar of at least a portion; And

Cooling package, it comprise be connected near the expandable members of the depression of described distal portions and and described supply chamber and discharge side between the expansion chambers of fluid connection, described expansion chambers is determined by at least a portion of described expandable members and is had sending state and a deployed condition, wherein when described expansion chambers is in described sending state, at least a portion of described expandable members is in the described depression of described distal portions of described bar.

212. the cold therapy equipment in the example 211, wherein said expandable members further comprises adapter, and described adapter is connected to described expandable members near described depression.

213. the cold therapy equipment in the example 212, wherein said expandable members are balloon, and wherein said adapter is determined by the proximal part of described balloon.

214. the cold therapy equipment in the example 212, wherein:

The described distal portions of described bar comprises the first area, away from the second area of described first area and the ladder determining described inside depression and described first area and described second area are demarcated; With

Described adapter is at least partially in described ladder and top, described first area, and the external diameter of described adapter under described deployed condition is similar to described sending state substantially.

215. the cold therapy equipment in the example 212, wherein:

The described distal portions of described bar comprises the first area, away from the second area of described first area and the ladder determining described inside depression and described first area and described second area are demarcated; With

At least a portion of described adapter is arranged in the described depression near described ladder.

216. the cold therapy equipment in the example 214, wherein:

Described expandable members comprises distal portions; And

Described cold therapy equipment further comprises atraumatic tip, and its distal portions from described expandable members extends.

217. a cold therapy equipment comprises:

Bar, it has the distal portions that is configured to be arranged in the kidney blood vessel, the described distal portions of described bar comprises the first area with first external dimensions and the second area that has less than the second external dimensions of described the first external dimensions, and wherein said second area is away from described first area;

Discharge side along the described bar of at least a portion; And

Be positioned at the cooling package of the described distal portions of described bar, wherein said cooling package is included in the expandable members of the described second area top of described distal portions, described expandable members has expansion chambers, described expansion chambers be configured to receive expansion cold-producing medium and and described discharge side between fluid connection.

218. the cold therapy equipment in the example 217, wherein:

The described distal portions of described bar comprises the ladder that described first area and described second area are demarcated; And

Described expandable members comprises the adapter that is positioned near the described second area top of described ladder, and described expandable members is from described adapter to remote extension.

219. the cold therapy equipment in the example 217, wherein:

The described distal portions of described bar comprises the ladder that described first area and described second area are demarcated; And

Described expandable members is included in the adapter of top of the described first area of at least a portion, and described expandable members is from described adapter to remote extension.

220. the cold therapy equipment in the example 217, wherein:

The first area with first outer surface of described distal portions;

Described distal portions further comprises the ladder that described first area and described second area are demarcated;

Described expandable members is included in the adapter of the described second area top of described distal portions;

The described adapter of described expandable members is at least near described ladder and substantially flushing with described the first outer surface when described expansion chambers is in described sending state.

221. the cold therapy equipment in the example 217, wherein:

The described distal portions of described bar further comprises the ladder that described first area and described second area are demarcated;

Described expansion chambers has the sending state that has the first volume and has deployed condition greater than the second volume of described the first volume; And

Described expandable members comprises adapter, and described adapter has substantially invariable external diameter in described deployed condition and described sending state.

222. the cold therapy equipment in the example 221, wherein said adapter is above described ladder.

223. the cold therapy equipment in the example 217, wherein:

Described discharge side has the first internal diameter in described first area; And

Described discharge side has the second internal diameter less than described the first internal diameter at described second area.

224. the cold therapy equipment in the example 217, wherein:

At least a portion of described expansion chambers has the treatment temperature; And

Described discharge side the described second area of described distal portions have be configured to when described cold-producing medium by described discharge side when described second area is discharged, the basic at least volume that keeps described treatment temperature.

225. having, the cold therapy equipment in the example 224, the described second area of the described distal portions of wherein said bar is not more than the approximately length of 4cm.

226. the cold therapy equipment in the example 217, wherein said expansion chambers comprise a balloon, described balloon has an adapter, and wherein said adapter is connected to the top of the described second area of described distal portions.

227. the cold therapy equipment in the example 217, wherein:

Described expandable members is included in the adapter of described second area top, and described adapter has thickness;

The described first area of described distal portions has the first external diameter; And

The second external diameter that the described second area of the described distal portions of described bar has equals to be not more than twice poor that described the first diameter deducts the thickness of described coupling part.

228. the cold therapy equipment in the example 217, the described distal portions of wherein said bar comprise the notch that described first area and described second area are demarcated.

229. a cold therapy equipment comprises:

The bar that comprises distal portions, wherein said bar are configured to be suitable in the guide sheath of 6Fr; And

Be positioned at the cooling package of the described distal portions of described bar, described cooling package has in about 8cm and the about length between the 15cm and have the expandable members of sending state and expansion state, and wherein said expandable members has under described expansion state at approximately 3mm and the approximately external diameter between the 10mm.

230. the cold therapy equipment in the example 229, the described distal portions of wherein said bar comprise the first area with first external diameter and the second area that has less than the second external diameter of described the first external diameter.

231. the cold therapy equipment in the example 230 further comprises the ladder of dividing described first area and described second area.

232. the cold therapy equipment in the example 231, wherein said expandable members comprise the adapter near the ladder between described the first and second zones.

233. the cold therapy equipment in the example 229, wherein:

At least a portion of described expandable members has the treatment temperature; And

Described cold therapy equipment further comprises along the discharge side of at least a portion of described bar, described discharge side has the first internal diameter and has the second internal diameter less than described the first internal diameter at described second area in described first area, wherein said discharge side is configured to pass through described discharge side when described second area is discharged when cold-producing medium, the described treatment temperature of basic at least maintenance.

234. the cold therapy equipment in the example 229, wherein said bar have 4Fr bar size.

235. the cold therapy equipment in the example 229, wherein expandable members comprises at least one balloon, and wherein said balloon has the length of 10cm at the most and the external diameter of 8mm at the most under expansion state.

236. a cold therapy equipment comprises:

Bar with elongation of distal portions, wherein said bar are configured in blood vessel described distal portions be placed therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive the basic at least liquid cold-producing medium that is;

Along the discharge side of the described bar of at least a portion, described discharge side has the first diameter of being convenient to transport described cold-producing medium after expansion; And

Be positioned at the cooling package of the described distal portions of described bar, described cooling package has aperture and expansion chambers, described aperture have Second bobbin diameter and and described supply chamber between fluid connection, fluid connection between described expansion chambers and the described aperture, the ratio of described the first and second diameters is between 4: 1 and 10: 1, and wherein said aperture is configured to transport the basic cold-producing medium of gaseous state that is to described expansion chambers.

237. the cold therapy equipment in the example 236, wherein:

Described discharge side has at approximately 0.030 inch (0.762mm) and the approximately internal diameter between 0.05 inch (1.27mm); And

Described cooling package further comprises the flow restriction chamber of described supply intracavity, described flow restriction chamber has the distal portions in described expansion chambers, wherein said aperture is near the described distal portions in described flow restriction chamber, and described aperture and described flow-control chamber have at approximately 0.0030 inch (0.076mm) and the approximately internal diameter between 0.0080 (0.203mm).

238. the cold therapy equipment in the example 236 further is included in the described supply chamber and to the flow restriction chamber that described expansion chambers is opened, the length in wherein said flow restriction chamber is at approximately 2 inches (5.1cm) and approximately between 30 inches (76.2cm).

239. the cold therapy equipment in the example 236, wherein:

Described therapentic part is at least one in renal artery and the nephrostome;

Described supply chamber has the first internal diameter and the first length; And

Described cooling package further comprises capillary tube in the described supply chamber and open to described expansion chambers, described capillary tube has less than the second external diameter of described the first internal diameter with less than the second length of described the first length, wherein said capillary tube comprises the distal portions of determining described aperture, and wherein said cold-producing medium flows to described capillary tube and leaves described aperture with at least part of gaseous state under for liquid state basic at least from described supply chamber; And

Described expansion chambers comprises applicator, and it is configured to produce medicable low the kidney warming neuroregulation.

240. the cold therapy equipment in the example 236, the distal portions in wherein said supply chamber has been determined described aperture, and wherein said supply chamber has at approximately 0.0040 inch (0.102mm) and the approximately internal diameter between 0.010 inch (0.254mm).

241. the cold therapy equipment in the example 236, further comprise the flow restriction chamber, it is in the described expansion chambers at least in part, wherein said flow restriction chamber comprises the distal portions of determining described aperture, and wherein said supply chamber has the first length and described flow restriction chamber has 1/3 the second length that is at most described the first length.

242. the cold therapy equipment in the example 236, wherein said bar are configured in blood vessel just described distal portions and insert renal artery or arteriorenal mouthful.

243. the cold therapy equipment in the example 236, wherein said bar have the first area and described supply chamber has occupied second area in described bar, the ratio of described the first area and described second area be 4: 1 to less than 10: 1.

244. the cold therapy equipment in the example 236 further comprises the wire of the described bar that extends through at least a portion.

245. the cold therapy equipment in the example 244, wherein:

Described bar has the near-end that comprises proximal openings and the far-end that comprises distal openings; And

Described guidewire lumen is extended between described at least near-end and distal openings.

246. the cold therapy equipment in the example 244, wherein:

Described bar has the length between near-end and far-end; And

Described guidewire lumen has in the described near-end of described bar and the proximal openings between the described far-end.

247. a cold therapy equipment comprises:

Bar with elongation of distal portions, wherein said bar are configured to described distal portions at least one therapentic part in blood vessel is built at least near renal artery and nephrostome;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid cold-producing medium;

Along the passing away of the described bar of at least a portion, described passing away has the cross section opening of the cold-producing medium that is configured to transport expansion; And

Be positioned at the cooling package of the described distal portions of described bar, described cooling package has the expansion chambers that is configured to receive from that chamber of described supply basic cold-producing medium for gaseous state, wherein said passing away in the cross section of described cooling package opening and described supply chamber at the ratio of the sectional dimension at described cooling package place between 4: 1 and 10: 1.

248. the cold therapy equipment in the example 247, the capillary tube that further is included in described supply intracavity and opens to described expansion chambers, wherein said capillary tube has opening, and the diameter of described opening is at least 0.004 inch (0.102mm).

249. the cold therapy equipment in the example 248, wherein said supply chamber have the first length and described capillary tube and have 1/3 the second length that is at most described the first length.

250. the cold therapy equipment in the example 247 further is included as on the line of described cooling package and sends the guidewire lumen that configures.

251. the cold therapy equipment in the example 247 further comprises quick exchange guidewire lumen.

252. the cold therapy equipment in the example 247, wherein said passing away has the first area, and that chamber of described supply occupied the second area in the described passing away, and the ratio of wherein said the first area and described second area is 4.1 to less than 10: 1.

253. a cold therapy equipment comprises:

Bar with elongation of distal portions, wherein said bar are configured to described distal portions is built in therapentic part at blood vessel;

Be in the cooling package of the described distal portions of described bar, described cooling package has the expansion chambers that sending state, deployed condition and cold-producing medium are expanded therein; And

Wherein said cold therapy equipment is configured to be less than automatic stop intra-operative in 5 minutes, and when described sending state moved to described deployed condition, and described intra-operative stopped to stop when described expansion chambers is sent cold-producing medium at described cooling package wherein said intra-operative at described cooling package.

254. the cold therapy equipment in the example 253, wherein:

In the close renal artery of described therapentic part or the nephrostome at least one;

Described cooling package further comprises applicator, and it is configured to have the heat transfer rate that is enough to cause medicable kidney neuroregulation in 100 seconds under the described deployed condition; And

Described cold therapy equipment further comprises---

Along the supply chamber of at least a portion of described bar, described supply chamber is configured to receive and substantially at least is liquid cold-producing medium, and fluid connection between described supply chamber and the described expansion chambers; And

Along the discharge side of at least a portion of described bar, fluid connection between described discharge side and the described expansion chambers.

255. the cold therapy equipment in the example 253, wherein said intra-operative is shorter than 2 minutes.

256. the cold therapy equipment in the example 253, wherein said cooling package further comprises applicator, described applicator has hot transmitting portions, this hot transmitting portions is extended around the whole side face of the described applicator of deficiency, and wherein said hot transmitting portions is configured to when described cooling package is in described deployed condition, sends medicable low temperature neuroregulation at described therapentic part.

257. the cold therapy equipment in the example 253, wherein said cooling package further comprises applicator, it has the hot transmitting portions of extending around the whole side face of described applicator, and wherein said heat transmitting portions is configured to when described cooling package is in described deployed condition, sends medicable low temperature neuroregulation at described therapentic part.

258. the cold therapy equipment in the example 253, wherein said cooling package further comprises applicator, and it is configured to send medicable low temperature neuroregulation at described therapentic part in described perioperative single application.

259. the cold therapy equipment in the example 258, wherein said therapentic part are external perihaemal canal, and wherein said applicator is configured in single application to send medicable low temperature neuroregulation around the whole environment of described external perihaemal canal.

260. the cold therapy equipment in the example 258, wherein said therapentic part is external perihaemal canal, and wherein said applicator is configured in the described single application as two separate part circumferential surface sections around described external perihaemal canal sends medicable low temperature neuroregulation at least.

261. the cold therapy equipment in the example 253, wherein said intra-operative stop when described deployed condition moves to described sending state when described cooling system.

262. the cold therapy equipment in the example 253, wherein said cold therapy equipment are configured to come the described intra-operative of automatic stop based on the cold-producing medium with the reservation capacity.

263. the cold therapy equipment in the example 253 further comprises controller, it comprise so that described controller in the described perioperative instruction of ticket reserving time interval automatic stop.

Sum up

The above detailed description of the embodiment of present technique be not intended be exclusiveness or make present technique be confined to above disclosed precise forms.Although described for illustration purposes in this article specific embodiment and the example of present technique, as those skilled in the relevant art will recognize, in the scope of present technique, can realize equivalent modifications.For example, although according to proposed each step to definite sequence, alternative embodiment can be according to different order execution in step.Can also make up to provide other embodiment with various embodiment as herein described.

According to aforementioned content, will be appreciated that the characteristic embodiment that has described in this article present technique for illustrational purpose, but not shown or to describe well-known 26S Proteasome Structure and Function in detail confused with the explanation of the embodiment that avoids unnecessarily making present technique.In the situation that context allows, odd number or plural number can also comprise respectively plural number or singular references.

In addition, unless the word "or" is confined to only mean the single project relevant with two or more projects of string clearly, do not comprise other project, any single project in then should being interpreted as comprising the use of "or" in this type of tabulation in (a) tabulation, (b) all items in the tabulation or (c) any combination of the project in the tabulation.In addition, term " comprises " and is used for from start to finish meaning to comprise described at least feature, so that do not get rid of the same characteristic features of any more big figure and/or the further feature of addition type.Will be appreciated that also this paper has been in illustrational purpose and has described specific embodiment, but in the situation that can carry out various modifications without prejudice to present technique.In addition, although in the context of those embodiment, described the advantage that is associated with some embodiment of present technique, but other embodiment also can demonstrate this type of advantage, and not all embodiment must demonstrate this type of advantage with in the scope that drops on present technique.Therefore, the disclosure and corresponding technology can be contained other embodiment that this paper does not illustrate clearly or describes.

The cross reference of association request

The application requires the priority of following pending application:

(a) application number of submitting on October 26th, 2010 is 61/406,968 U.S. Provisional Application;

(b) application number of submitting on August 26th, 2011 is 61/528,091 U.S. Provisional Application;

(c) application number of submitting on August 29th, 2011 is 61/528,684 U.S. Provisional Application;

(d) application number of submitting on October 12nd, 2011 is 61/546,510 U.S. Provisional Application;

(e) application number of submitting on October 23rd, 2011 is 13/279,330 U. S. application;

(f) application number of submitting on October 23rd, 2011 is 13/279,328 U. S. application;

(g) application number of submitting on October 23rd, 2011 is 13/279,327 U. S. application;

(h) application number of submitting on October 23rd, 2011 is 13/279,326 U. S. application;

(i) application number of submitting on October 23rd, 2011 is 13/279,325 U. S. application;

(j) application number of submitting on October 23rd, 2011 is 13/279,312 U. S. application;

(k) application number of submitting on October 23rd, 2011 is 13/279,316 U. S. application;

(l) application number of submitting on October 23rd, 2011 is 13/279,321 U. S. application;

(m) application number of submitting on October 23rd, 2011 is 13/279,324 U. S. application;

The integral body of all above-mentioned applications is incorporated the application by reference into.Further, in the application of incorporating into by reference the component of disclosed embodiment and feature can with the application in disclose with each component of advocating right and feature merging.

The association request of incorporating into by reference

The application number that on October 7th, 2011 submitted to is 61/545,052 U.S. Provisional Application, the application number that on August 5th, 2011 submitted to is 13/204,504 U.S. Patent application, the application number that on August 5th, 2011 submitted to is the PCT international application of PCT/US2011/46845, and the application number of submitting on August 5th, 2010 is 61/371,110 U.S. Provisional Patent Application, relevant with the application, the integral body of above-mentioned application is incorporated the application by reference into.Similarly, in the application of incorporating into by reference the component of disclosed embodiment and feature can with the application in disclose with each component of advocating right and feature merging.

Claims (10)

1. a cold therapy equipment is characterized in that, comprising:

Bar with elongation of distal part and distal part, described bar are configured to place among renal artery or the nephrostome described distal part or near therapentic part, and described portions of proximal is configured to outside vascular system;

Be positioned at the sub-cooled assembly of the described distal part of described bar;

Main supply along at least a portion of described bar is answered the chamber, and it has first and second portion, and wherein said main supply answers the described second portion in chamber near described sub-cooled assembly; And

Precooler, it has the container that is configured to receive liquid refrigerant stream, the diverter in the described container, along pre-cooled dose of passage and the pre-cooling expansion chambers in described container of the periphery of described diverter, described pre-cooling expansion chambers has the proximal part of being determined by described diverter, wherein said diverter has and is connected to the main channel that described main supply is answered the described first in chamber, arrive described main supply and answer the chamber so that the part of liquid refrigerant flows through described main channel, and another part of liquid refrigerant flows through described precooling agent passage and enters described pre-cooling expansion chambers.

2. cold therapy equipment as claimed in claim 1 is characterized in that, wherein said container has inner surface and described diverter is not fixed to described inner surface.

3. cold therapy equipment as claimed in claim 1 is characterized in that, wherein said container has inner surface and described supply chamber is not fixed to described inner surface.

4. cold therapy equipment as claimed in claim 1 is characterized in that, further comprises determining that described main supply answers the main supply in chamber to answer conduit, and described main supply answers conduit to have the outer surface of at least a portion of determining described peripheral channel.

5. cold therapy equipment as claimed in claim 1, it is characterized in that, further comprise and determine that described main supply answers the main supply in chamber to answer conduit, described main supply answers conduit to have outer surface, wherein said chamber has inner surface, and described diverter is fixed to described main supply and answers conduit on the outer surface between described pre-cold supply chamber and the described fore-cooling room, and wherein said diverter has been determined at least a portion of described precooling agent passage.

6. cold therapy equipment as claimed in claim 1, it is characterized in that, wherein said main supply answers conduit to have mean outside diameter in described fore-cooling room, and wherein said diverter is the part that described main supply is answered conduit, and has the external diameter larger than described mean outside diameter.

7. cold therapy equipment as claimed in claim 1 is characterized in that, wherein said container has inner surface, and described pre-cooling passage is included in the gap of the bending between described diverter and the described inner surface.

8. cold therapy equipment as claimed in claim 1 is characterized in that, wherein said container has inner surface, and described precooling agent passage is included in the annular gap between described diverter and the described inner surface.

9. cold therapy equipment as claimed in claim 1 is characterized in that, wherein said pre-cooling expansion chambers has greater than about 10 centimetres length.

10. cold therapy equipment as claimed in claim 1 is characterized in that, further comprise along the passing away of at least a portion of described bar, wherein said precooler comprise and described passing away between the outlet of fluid connection.

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