TW201223577A - Neuromodulation cryotherapeutic devices and associated systems and methods - Google Patents

Abstract

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

Description

201223577 VI. INSTRUCTIONS: [CROSS REFERENCE TO RELATED APPLICATIONS] This application claims the benefit of the following application: (a) US Provisional Application No. 61/406,968, October 26, 2010; (b) U.S. Provisional Application No. 61/528,091, August 26, 2011; (c) US Provisional Application No. 61/528,684, August 29, 2011; (d) US Provisional Application No. 61/546 , 5, 10, application on October 12, 2011; (e) US application No. 13/279,330, October 23, 2011 application; (f) US application No. 13/279,328, October 23, 2011曰Application; (g) US Application No. 13/279,327, October 23, 2011; (h) US Application No. 13/279,326, October 23, 2011; (i) US Application Application No. 13/279,325, October 23, 2011, (j) US Application No. 13/279, 3 12, October 23, 2011; (k) US Application No. 13/279, 3 16 , October 23, 2011, 201223577 ^ Application; (l) US application No. 13/279,321, application for October 23, 2002; and (m) US application No. 13/279,324, 2 11 years said application; (n) US201 international application No. PCT / 1/057490, Application October 24, 2011. All of the above applications are incorporated herein by reference in their entirety. In addition, the components and features of the specific examples disclosed in the application incorporated by reference can be combined with the various components and features disclosed and claimed in the present application. Applicant's US Provisional Application No. 61(10), No., August 5, 2011, US Patent Application No. (10), 20H, August 5, please, < pcT International Towel Case No. 171; 8201 1/46845 and August 5, 2010, the date of the application of the United States, May 6th, the US Temporary Shenjing Case No. 6W37U0 is related to the case, and the above-mentioned request is the full text The manner of reference is incorporated herein. Accordingly, the components of the specific examples disclosed in the claims and the combinations of the various components and features disclosed and claimed herein. TECHNICAL FIELD OF THE INVENTION The technology of the present invention generally relates to the treatment of low temperature pain. In particular, very specific examples are directed to intravascular nerves. The low temperature treatment of Meng Panyu related systems and methods. ',,, and 201223577 [Prior Art] The sympathetic nervous system (SNS) is the primary non-autonomous body control system typically associated with compression responses. The SNS fiber innervates almost all tissues in the human body system and can affect its properties, such as pupil diameter intestinal activity: and urinary discharge*. This regulation has an adaptive utility in maintaining homeostasis or allowing the body to respond quickly to % of the factors, simple, slow, and activated as a common unsuitable response that can drive the progression of many disease conditions. In particular, experiments in humans have identified that excessive activation of renal SNS may contribute to the complex pathophysiology of hypertension, volume overload conditions (such as heart failure), and progressive kidney disease. For example, radioactive tracer diluents have an increased rate of renal norepinephrine (ne) spillover in patients with a high initial pressure. Cardiac-renal sympathetic over-excitation may be evident in patients with heart failure. In these patients, it is often found from the heart and kidneys: the flow rate to the blood system increases. Increased _ activation usually characterizes chronic and 2 kidney diseases. In patients with end stage renal disease, high bloodletter levels indicate a cardiovascular disease and several causes of death. This conclusion is “the main contributor to the sensation of the sensation derived from the diseased kidney. It is the main contributor to its persistence. The stomach swells and the renal sympathetic nerves terminate in the duct, the proximal glomerular structure and the renal tubule Stimulation can lead to increased renin release, reduction of Naga and renal blood flow. In the disease, the disease is significantly stimulated in the special condition and the disease is significantly stimulated. Lunar month b neuromodulation component, and these components can contribute to the increase of blood pressure in hypertensive patients with 201223577. The decrease of renal blood flow and glomerular filtration rate caused by renal sympathetic nerve stimulation may be the heart The basis of renal function loss in renal syndrome (ie, renal dysfunction as a progressive complication of chronic heart failure). Pharmacological strategies that hinder renal sympathetic stimulation include central sympathetic block drugs, P Blockers (intended to reduce renin release), angiotensin-converting enzyme inhibitors and receptor blockers (intended to block the action of angiotensin u and aldosterone activation due to renin release) and diuretics (intended to fight Renal sympathetically mediated sodium and water retention. However, these pharmacological strategies have significant limitations, including limited efficacy, compliance issues, side effects, etc. Therefore, public health strongly requires alternative treatment strategies. Disclosed herein are neuromodulation cryotherapy devices and related systems and methods. A cryotherapy device configured in accordance with a particular embodiment of the present technology can include an elongated shaft having a distal portion and a supply along at least a portion of the shaft The lumen can be configured to position the distal portion within the blood vessel adjacent to the treatment site of the renal artery or renal ostium. The supply lumen can be configured to receive a liquid cryogen. A cooling assembly can be further included at the distal end portion of the shaft. The cooling assembly can include a fluid communication with the supply lumen and configured to approach the target site when the cooling assembly is deployed The nerve delivers the application number of the cryotherapy cooling. [Embodiment] Many aspects of the present invention can be more fully understood with reference to the following drawings. The components are not necessarily to scale. Instead, emphasis is placed on clearly illustrating the principles of the present invention 201223577. In addition, components may be shown as transparent in some views (for clarity only, and not to indicate that the components illustrated are necessarily transparent Specific details of several specific examples of the present technology are described below with reference to Figures 1 through 5B. Although a number of specific examples of devices, systems, and methods for renal neurovascular endovascular regulation using cryotherapy are described below, Other applications and other specific examples other than those described herein are also within the scope of the present technology. In addition, several other specific examples of the technology may have different configurations, components, or procedures than those described herein. The skilled artisan will appreciate from this that the present technology may have other specific examples with additional elements, or that the present technology may have other specific examples that do not have several of the features shown and described below with reference to Figures j through 59b.

Renal neuropathy

Hours, days or weeks). Or short-term (eg, for several minutes, several expected renal neuromodulation can effectively treat several clinical conditions characterized by an increase in overall sympathetic activity in 201223577, and in particular, conditions associated with central sympathetic over-stimulation, such as hyper-blood, = failure, acute myocardial infarction, metabolic syndrome, insulin resistance, diabetic left ventricular hypertrophy, chronic and terminal renal disease, inappropriate fluid retention during heart failure, heart and kidney syndrome, and sudden death. Attenuated nerve signaling contributes to sympathetic tone / impulsive systemic reduction, and renal neuromodulation is expected to be useful in the treatment of several conditions associated with systemic sympathetic overactivation or hyperexcitability', renal neuromodulation potentially potentially benefiting multiple organs and body structures governed by sympathetic nerves For example, a reduction in sympathetic impulses in the sputum can reduce insulin resistance in patients with metabolic syndrome and type 2 diabetes. In addition, osteoporosis can be activated by sympathetic nerves and may benefit from concomitant renal neuromodulation sympathetic impulse downregulation. Provide relevant patient anatomy and physiology A more detailed description. Various techniques can be used to partially or completely disable the neural pathway, such as innervating the neural pathway of the kidney. For example, hypothermia involves cooling the tissue at the target site in a manner that modulates nerve function. The mechanism of cryotherapy for tissue damage includes For example, direct cell damage (eg, necrosis), vascular damage (eg, lack of nutrients in the cells by injury to the blood vessels), and sublethal hypothermia and subsequent apoptosis. Exposure to cryotherapy cooling can lead to acute cell death (eg, Immediately after exposure and/or delayed cell death (eg, during tissue unwinding and subsequent over-perfusion). Several specific examples of the present technology include cooling the structure at or near the inner surface of the renal artery wall to enable proximity (eg, Adjacent) the tissue is effectively cooled to the depth where the sympathetic renal nerves are located. For example, the cooling structure is cooled to cause a therapeutically effective hypothermia renal tone 201223577, which is expected to be sufficiently cold. The lunar nerve can slow down or can block the long-term decrease of nerve signaling. ^ 乂The long-term or permanent hypothermia of arsenic-induced arsenic is ok. Afc sister has a sexually controlled renal nerve. For example, with an analgesic effect in sputum, w, the pain of hypothermia Less. Compared with the order, cryotherapy can require η and thermal resection process L * to be more analgesic to maintain the patient in the procedure 曰 In addition, reduce pain can reduce the number of children #λ bm 风's move And thus increase the operator's success rate and reduce the ph ph ph. Cryogenic therapy typically does not result in a tight collagen, ',' and thus low & therapy is typically independent of vascular stenosis. The therapy is generally operated at a degree to which the cryotherapy applicator adheres to the moist tissue. This may be beneficial as it helps for a steady, consistent and continuous contact during treatment. Typical treatment conditions can make this a suction:. The feature of stress is because, for example, the patient may move during treatment, the catheter connected to the medication may move, and/or the breath may cause the kidney to move the renal artery. In addition, the blood flow is pulsating and causes the renal artery to pulsate. Adhesion associated with cryotherapy cooling may also be advantageous when treatment may be more difficult to achieve a short renal artery that stabilizes intravascular positioning.

Specific Sinus Cases by Siigijg. System Figure 1 illustrates a cryotherapy system configured in accordance with several specific examples of the present technology. The cryotherapy system 1 can include a console 1〇2 and a cryo/alpha therapy 120. In the specific example shown in FIG. 1, the console 丨〇 2 includes a refrigerant 1 〇 6 in which the supply container 104 ′ is in the supply container 1 〇 4, and a supply control unit connected to the 201223 577 ^ container 1043 ⁄4 body. 8. The supply of the stomach i() 4 may be a single-purpose cartridge or a larger container having a refrigerant i 〇 6 in an amount sufficient for a plurality of procedures. For example, the larger supply container can be a refillable cylinder. The supply container 104 is configured to maintain the refrigerant 106 at a desired pressure. For example, in a particular embodiment, the supply vessel 104 contains a liquid N2 crucible at a pressure of 75 psi or greater than 75 psi so that it is at least substantially liquid at ambient temperature. In other embodiments, the refrigerant 1〇6 may include carbon dioxide, hydrofluorocarbon (“HFC”; eg, Freon®, R_41〇A, etc.) and/or may be sufficient to maintain the refrigerant 106 at ambient temperature. Other suitable compressed or condensed refrigerants that remain in the supply vessel 1〇4 at substantially high liquid pressure (e.g., about 210 psi for R-410A). The supply control valve 108 is coupled to a supply line 1 that is configured to deliver refrigerant 丨〇6 to the low m treatment device 120. The supply control valve J 〇8 can be operated manually or automatically. The console 102 may optionally include a pump (such as a vacuum pump or a DC electric pump) and/or a back pressure control valve 113 coupled to the discharge line 115. The discharge line 115 is configured to receive the discharge from the cryotherapy device 12 Refrigerant 11 7 . The pump 111 reduces the back pressure of the evaporated refrigerant and synergizes with the supply flow rate to increase the freezing force. In other embodiments, the expanded refrigerant 117 can be discharged to ambient pressure. The console 102 can further include an optional controller 118 that operates the supply control valve 108 and the back pressure control valve 丨丨3. The controller i 8 may be, for example, a processor or a dedicated circuit that implements a computerized algorithm to automatically execute a program. The console 102 can also include an optional user interface for receiving user input and/or providing information to the user and/or circuitry for monitoring an optional sensor (eg, pressure or temperature) 11 201223577 (if at hypothermia) Device 丨2 〇 exists). In one embodiment, the controller 118 operates the back pressure control valve 113 to control the amount of vacuum applied to the discharged refrigerant crucible 7 returned from the cryotherapy device 120. This adjusts the back pressure of the evaporated refrigerant to control the temperature in the cryotherapy device 12. In another embodiment, the supply control valve i 〇 8 and/or the back pressure control valve i 丨 3 can be used to increase the back pressure of the discharged refrigerant 11 7 . Increasing the back pressure of the discharged refrigerant 丨丨7 increases the boiling point of the refrigerant. For example, in the case of ruthenium, a slight increase in back pressure from i atm to about 2 atm will result in a boiling point of about _88. The enthalpy is raised to about -75 C; increasing the back pressure to 3 atm will raise the boiling point to about _65 cc. In some embodiments, the cryotherapy system can also pre-cool the refrigerant 106 to provide greater refrigeration in the refrigerant ι 6 as the refrigerant 106 reaches the cooling system. For example, system 1 may include a pre-cooler 119 (shown in phantom) in console 1〇2. In other embodiments, the system _ can include a pre-cooler along the supply, line 110, at the handle of the system, at the handle of the proximal region of the system 100, or elsewhere with the cryotherapy device 120. The cryotherapy device 120 includes a shaft 122 having a proximal portion 124, a hand #125 in the line end region of the proximal end 124, and a distal portion 12 distally extending relative to the proximal portion 124. The cooling assembly 130 can be included at the distal end portion 126 of the shaft 122. The shaft 122 is configured to position the distal portion > 126 at a treatment site adjacent to the renal artery or renal orifice (e.g., in or near) the vasospasm, and the cooling assembly 130 is sorrowed to provide a therapeutically effective hypothermia Renal neuromodulation. 2A is a cross-sectional view showing a distal end portion 126 of the shaft 122 and a specific example of a cooling total & 13 呈 in a delivery state (eg, a low profile or a contracted configuration), and FIG. 2B is in a deployed state. An enlarged cross-sectional view of the cold-but assembly 130 (eg, an expansion configuration). In the particular example illustrated in Figure 2A, the distal end portion 126 of the shaft 122 can include a first region 12 and a second region 12 that is recessed inwardly relative to the first region 127a (separated by dashed lines). The first region 127a and the second region 127b may be distinguished by a step 128 such as a slot (e.g., an annular or other circumferential groove configured to fit another component). Accordingly, the first region 127a can have a first outer dimension or a first cross-sectional dimension (e.g., area or diameter), and the second region 127b can have a second cross-sectional dimension that is less than the first dimension. Shaft 122 • can be sized to fit within 8Fr or less than 8Fr sheath 15Q (e.g., a guide sheath) to accommodate small renal arteries. The cryotherapy device 120 can also include a supply tube or supply lumen 132 and a discharge tube or discharge lumen 134 along at least a portion of the shaft 122. The supply lumen 132 can be a small tube configured to hold the refrigerant in a liquid state under high pressure. The inner diameter of the supply (four) 132 is selected such that at least a portion of the refrigerant reaching the cooling assembly m is in a liquid state at the distal end 135 of the supply lumen m. The lining lumen 134 can be an outer tube ' and the supply lumen 13 4 a extends within the venting lumen 134 at least along the axis 126. As described in more detail below, several specific examples of the cryotherapy device 12 can be accessed by the lead 139 to the controller m (or U- or multiple sensors 138, such as a sever sensor or Pressure sensor. In several specific examples, the cryotherapy system 100 can be configured to verify proper calibration of the sensor 138 prior to cryotherapy treatment. For example, in a cryotherapy system (10) 'System (10) can automatically compare the measured temperature from the temperature sensor with 13 201223577 room temperature to check the temperature sensor for proper operation. The specific example of the cooling assembly 13〇 shown in Figures 2A and 2B can have a lamb The device 140, which may include a balloon i42 or other type of expandable member that may define an inflation lumen configured to completely occlude the renal artery or the renal orifice. The balloon 142 may be relatively short (eg, 10 1 mm or less) to accommodate the renal artery. Length and 4 turns (eg 4 to 6 cm), and in the expanded configuration may have a diameter sufficient to contact a significant portion of the inner circumference of the renal artery (eg, 3 mm to 10 mm in diameter). Other specific examples described below Balloon It is configured to only partially occlude the renal artery or renal stenosis. Balloon 142A comprises a compliant material, a non-compliant material, and/or a group of compliant materials and non-compliant materials. In various embodiments, for example, balloon 142 Made of polyurethane urethane and/or other compliant or semi-compliant materials, the material can expand and conform to the vessel wall to completely occlude vessels of different sizes (eg, an inner diameter of about 3 to about 10 mm or in In a particular application, about 4 to about 8 vascular.) In other embodiments, the balloon 142 can be composed of resistant and/or other non-compliant materials and sized to accommodate blood vessels within a certain size range. The non-compliant balloon can be sized to accommodate an inner diameter of between about 3 mm and 6 mm, and the larger non-compliant nylon balloon can be sized to accommodate an inner diameter of about 7 mm and 丨〇mm Between the blood vessels. In the specific example illustrated in Figures 2A and 2B, the distal end of the balloon 142 is not attached to the support member (e.g., the inner lumen 132 and/or other support), and thus can be impregnated Molded and/or otherwise formed to have The distal portion is continued. The continuous distal portion of the balloon 142 provides a gentle surface to contact the vessel wall to avoid tearing, puncturing, and/or otherwise damaging the vessel 201223577. The outer balloon is shown in Figure 2B. The cooling assembly ° 〃 has a better _ total length 'this can help locate the cooling assembly 130 ° cold assembly in a relatively short blood vessel (for example, a renal artery of 6 cm or less in length) 130 may include an orifice 144 that is in fluid communication with the expansion chamber. In one embodiment, the orifice 144 may be inserted into the return end 135 of the supply lumen 132. 土,, 田 146 Remote definition. Alternatively, the opening of the supply chamber and the opening at 135 define an orifice. The capillary 146 and/or the aperture may have a diameter smaller than the diameter of the supply lumen i 3 2 to impede the flow of the refrigerant adjacent to the expansion chamber to increase the amount of refrigerant 106 entering the expansion chamber and to concentrate the cold assembly. The freezing force at i 3 〇. In other embodiments, the supply lumen 132 can have a substantially constant inner diameter (eg, 0._吋^ 〇3), 〇.009 吋 (0.023 mm), 0.010 吋 ( 254.254 mm) etc.) such that the aperture 144 has a diameter at least equal to the supply lumen i32. Low ~ The treatment device 12〇 can then be placed on the handle 125 (Figure ,, or console 1〇: (广1) Further including other hardware (such as valves, flow meters, pressure gauges, etc.) and/or software to control the refrigerant 丄〇6 via the supply lumen m and directing the refrigeration force to the distal end of the vehicle 122> Concentration. * The aperture 144 may be sized relative to the area and/or length of the lm within the distal portion 126 of the (four) 122 to provide sufficient flow of refrigerant, '仗 to create a sufficient pressure drop in the expansion chamber, and The discharged refrigerant ι 7 is allowed to be sufficiently discharged through the discharge lumen 134. In a specific example, the orifice: 44 There is a diameter of about 吋.003吋 (0.076 mm) or more than 0.003吋, such as about 〇.〇〇4 mouth ten (〇.101 _) to about 0.009 mouth f (0.229 mm). 15 201223577 In various embodiments, The inner diameter and/or cross-sectional area of the discharge lumen 132 and the diameter and/or cross-sectional area of the orifice 144 may have a ratio of between about ιιι. For example, the discharge lumen 132 may have a diameter of about 〇3〇.吋 "Μ mm) and an inner diameter of between about 0.050 吋 (1.27 mm), and the orifice 144 may have about 0.003 吋 (〇.〇762 mm) to about 0·0〇8吋 (〇2〇3 claws) Claw; for example, 0.004 inch (0-101 mm)). In other embodiments, 'discharge lumen 134 and orifice 144 may have other suitable dimensions, and in other embodiments, shaft 122 may include other lumens extending therethrough. Or a device (eg, a pressure sensing lumen, other fluid passages, etc.), and the ratio of the cross-sectional dimension of the exhaust lumen 132 to the 2 cross-sectional dimensions occupied by the supply lumen and/or other components within the shaft 122 may be about 4:1 can also be manipulated by changing the length of the supply lumen 132 and the capillary 146 relative to each other The flow rate of ot; 06. For example, in some embodiments, the capillary 146 can be at most the length of the supply lumen 132. In various embodiments, the capillary 146 can have a length between 〇 (j8em) and (76.2 cm). And the supply lumen 132 can be sized accordingly. In other embodiments, the capillary f 146 can be shorter or longer relative to the supply inner moon 132 and/or the capillary 14 can be omitted. The cooling assembly 13〇 is delivered to the target site in the vessel v in the blood vessel while the cooling assembly 13 is in the delivery configuration shown in Figure 2A. Reference Figure = 'The cooling total < 130 and the outer 15 接着 are then moved relative to each other to cause the cooling assembly 130 to extend distally beyond the outer sheath 丨 5 。. For example, the outer sheath 150 can be pulled proximally and/or the cooling assembly 13 can be pushed distally (in operation, the refrigerant 106 passes through the supply lumen 132, through the orifice 144, and enters the gas 16 201223577 'In the expansion chamber defined by the ball M2. When the refrigerant 106 passes through the orifice 144, 'expands into the gas phase, thereby inflating the balloon and causing significant temperature drop in the expansion chamber. Contacting the tissue at the target T Portions of the medicinal device 140 may be a heat transfer region 149 or a heat transfer region that produces therapeutically effective hypothermia renal neuromodulation with the cryogen 1G6 in the dilatation-cavity. The circulated cryogen 117 is worn in the proximal direction. The inner lumen 134 is vented. In various embodiments, the length of the shaft 122 can be minimized to reduce the loss of refrigerant (e.g., frictional losses) flowing through the supply lumen 132 and the exhaust lumen to enhance the cooling assembly 130. The freezing potential and efficiency. For example, the additional friction loss caused by the longer discharge lumen can suppress the discharge of the discharged refrigerant 117, and thereby increase the force and temperature in the balloon 142. State to have less than 90 cm (eg 80 cm to rm, 7 The total length of λ ^ n to 85 Cm 70 coffee to 8 〇 cm, etc. ::, he's the 'shaft 122 may be longer and' or include other features to enhance the freezing force at the cooling assembly 130. And the cooling assembly 13 illustrated in Figure 23 produces a full circumference treatment at a position = two with respect to the target 7 (i.e., the longitudinal direction of the blood g ¥ is perpendicular or otherwise cut in the plane) Completely around the blood area). + person _ π P continuous extension of the circumferential cold)) π king occlusion blood vessels ¥ limit ash flow heating heat transfer area (4), = cooling force can be more effectively applied to the target τ. Although occlusion may result in renal ischemia during the eye, it has been found that the controller 118 (figure) can be programmed to be used or mechanically in a period sufficient to fully close the cryotherapy (eg, 2 to 5 minutes). The timer controls the interval to limit the duration of the refrigerant flow (Example 17 201223577 eg 2 to 5 minutes). Alternatively, the timer can be incorporated into the handle i25 (Fig. or other parts of the cryotherapy device 120. Presence sensor At 138, sensor m can provide feedback to control $118 to adjust or control system 1. In some embodiments, the control algorithm may be fully automated, but in other embodiments, the delivered therapy may be utilized. User input. In other embodiments, the duration of the refrigerant flow may be limited by the refrigerant in the supply vessel 1〇4; S: as described in more detail below, in other embodiments, the cooling assembly 130 may The blood flow is configured to partially occlude. In various embodiments, the sensor 138 can be a thermocouple located on an outer surface of the balloon 142 and can be configured to provide an immediate temperature reading of the external temperature of the balloon 142. Thus, the cryotherapy system 1 can be adjusted via control U 8 (eg, using a software control loop) such that it is based on the instantaneous external balloon temperature and the predetermined treatment temperature (eg, _4 〇 〇, _6 〇 〇 〇, etc. Increasing or decreasing the cooling force output. For example, the valve can be adjusted by opening and closing valves (eg, supply control valve 108 and/or back pressure control valve 113) in response to the measured temperature at different stages of cryogenic therapy. Cooling force output. In other embodiments, proportional control may be used to adjust the cooling force output, wherein the delivery pressure of the refrigerant 106 and/or the flow rate of the vacuum pump ui may vary in response to the measured external balloon temperature. The external thermocouple allows the cryotherapy system 100 to compensate for variables that affect cooling at the target site T, such as changes in the arterial diameter 'flow through the arteries and/or through other blood vessels near the renal artery. Figure 2C to Figure 2E To illustrate an enlarged cross-section 18 of the distal portion 12 6 of the cryotherapy device 丨 2 组态 configured in accordance with other embodiments of the present technology. 2C 'The distal end portion 152 of the balloon 142 can be coupled to the distal connector 162 via a thermal bond, an adhesive, and/or other suitable attachment mechanism. The distal connector 162 can have a curved bullet as shown in Figure 2C. The tip, or - may be otherwise configured to provide a non-traumatic tip for passage through the vascular structure. The cryotherapy device 120 further includes a guidewire lumen 133a that can receive the guidewire 133b to guide the distal portion 126 of the shaft 122 through the vessel In the specific example illustrated in Figure 2C, the guidewire lumen 133& is fully extended through the shaft 122 in an over-the-wire (OTW) configuration, from the adapter 201 (eg, Figure 1 The proximal opening of the shaft 122 at the illustrated handle 125) extends beyond the distal opening of the shaft 122, while the lumen 133a is only in the quick exchange (Κχ) set in Figure 2E although the guidewire lumen is shown in Figure 2E. In the specific example, the guide wire lumen 126 extends through the side wall of the shaft 122, but the car is folded from the 122 to the ground and the day a > "any between the proximal and distal ends

The state extends through a portion of the shaft 122. The proximal end of the 133a is distal to the distal portion 126. In other embodiments, the guidewire lumen 133a can be accessed at the axis. 201223577 Figure 3A illustrates the use of a system 100 to hypothermia the renal nerve. The hypothermia treatment device 120 provides access to the renal nerve plexus via an intravascular road scale P leading to the respective renal artery RA. As illustrated, a section of the proximal portion 124 of the axis i 22 is exposed outside the patient. By manipulating the proximal portion 124 of the shaft 122 from the intravascular path p, the caregiver can advance the shaft 122 by bending the intravascular path P (e.g., via the femoral or radial artery) and maneuvering the distal portion 126 distally (e.g. Use the actuator in handle 125). For example, the shaft 122 can further include one or more pull wires or other guides to guide the distal portion 126 through the vascular structure. Image guidance (e.g., ct, radiography, US OCT) or another suitable medical device or combination thereof may be used to assist the instructor in maneuvering. After the cooling applicator 140 is properly located in the renal artery RA or at the renal ostium, the console 102 can be used (Fig. n, and/or another member to expand or otherwise deploy until the applicator 140 Contacting the inner wall of the renal artery RA. The targeted application of the cooling force of the applicator 14 向 to the tissue is then applied to induce one or more desired neuromodulatory effects on the local area of the renal artery and adjacent areas of the renal plexus, which are located in the kidney The adventitia, adjacent to the adventitia of the renal artery, or adjacent to the adventitia of the renal artery. The purposeful application of the neuromodulatory effect may be neuromodulation along all or part of the renal plexus. The neuronal delta-segment effect is generally at least partially associated with the applicator i The temperature of the crucible, the contact of the applicator 140 with the blood wall, the residence time of the applicator 14 冷却 during cooling, and the number of cooling cycles (eg, one or more cooling cycles i separated by the warming period and blood passing through the blood vessel) The flow effect varies. The cooling effect may include a cold applicator such that the target nerve fiber temperature is below the desired threshold to reach 20 201223577 = low: change or cut. For example ' In the drug device 14, the cold portion of the refrigerant gas to about, to about: the gas in the drug device 140 is 7 mesh, and the body can have about _8 (TC to The temperature of about _4〇〇c. In the specific example of J =, the neuromodulation effect can be applied within 10 seconds of the application of the cold applicator 14Q (for example, 90 seconds, ^ A month small mouth) - In a specific example,: 1 second, 30 seconds, etc. occurs. In the cooling cycle, two = can include two separated by a warming period... In the case of a his body, the method can have multiple rises The above cooling cycle. The cooling helium ring may have the same continuous field or different performance time, such as about 1 sec to about % sec each. 升: hold: the continuation time may be sufficient to partially or completely thaw the cooling interface In some specific examples, the duration of the heating period may be about 5 seconds ^ about 9 seconds. The individual heating period between cooling cycles may last for the same amount of time: the same time. The cooling cycle can be predetermined and the temperature is raised. The duration of the loop is = in the algorithm, or the system can include use based on the balloon and / or gas: appearance Automatic control calculation of the feedback loop of pressure and/or temperature on the top ^ For example, the '(4) algorithm can be used to terminate the heating cycle and initiate cooling by based on the Lili and/or temperature measurements: when the cold material has been fully resolved Depending on the number and length of the cooling cycles, the self-deployment of the cooling assembly Η, for example, as shown in Figure 2Β) to the total assembly time of the cooling assembly to the delivery state (eg, as shown in Figure 2Α) Can be less than $ minutes (eg, less: 3 minutes). When treating two renal artery R Α, deploying a total of < 13 冷却 in the first renal artery ra to reposition in the second renal artery ra, The total program time for deploying and shrinking the cooling assembly 130 can be less than 2012 minutes 21 201223577 (eg 10 knives, 4 liters, 6 minutes, etc.). In some embodiments, the procedure can be reduced by positioning the applicator 140 around the full circumference of the renal artery RA (eg, along the same plane or laterally spaced parallel planes) and performing neuromodulation in a single application. time. In other embodiments, the applicator 14 can be applied to less than the renal artery RA < full circumference and/or in more than one application. Figure 3B is a block diagram illustrating a method 300 for cryomodulating renal nerves using another system described above with reference to Figures i through 3A or another suitable system in accordance with one embodiment of the present technology. Referring collectively to FIG. 3B, method 300 can include positioning a cooling assembly 130 in a delivery state (eg, as shown in FIG. 2A) in a renal artery or renal ostium within a blood vessel (block 305). The cryotherapy device 12A and/or portions thereof (e.g., cooling assembly 130) can be inserted into a guiding catheter (e.g., sheath 150 as shown in Figures 2A-2C) to facilitate intravascular delivery of the cooling assembly 130. In certain embodiments, for example, the cryotherapy device 120 can be configured to fit within an 8 Fr guiding catheter or smaller (e.g., 7 Fr, 6 Fr, etc.) guiding catheter to access a small peripheral blood vessel. As noted above, the OTW or RX guide wire can also be used to manipulate the shaft 122 and the cooling assembly 13 〇 and enhance control of the shaft 122 and the cooling assembly 丨3 。. The method 300 can further include connecting the cryotherapy device 12A to the console 102 (block 310), and partially or fully inflating the inflatable component (eg, balloon 142) of the cooling assembly 130 to determine if the cooling assembly 130 is at the target site. The correct position (blocks 3 1 5 and 320). The expandable member can be inflated via a supply lumen 132 from a second fluid supply reservoir (e.g., air) in fluid communication with the expandable member from 22201223577 from the supply container 4 at the console 102. If the cooling is not always at the desired location, at least some of the swellable members 325 can be released. In some embodiments, for example, cryotherapy device 12 can be disconnected. And using the syringe via (4) 2: The swellable component is completely deflated for manual deflation of the expandable component. In a specific example, the cryotherapy device can remain attached to the console and a syringe (eg, a cock syringe) can be attached along the length of the shaft 122 to deflate the expandable component. In other embodiments, the controller 102 can include a different method for partially or completely deflated the expandable member. In other embodiments, a radiopaque marker and/or a radiopaque marker can be used to position the cooling assembly 130 at the target site. The cooling assembly I30 is suitably positioned within the first renal artery or its small opening _ steerable console 102 to initiate cooling of the renal system at the cooling assembly 130 to cause partial or complete denervation of the kidney ( Block 3 3 . One or more cycles of cryogenic cooling (eg, second increment, palpitations, 90 seconds increment) may be applied in one or more locations along the circumference and/or length of the first renal artery or first renal orifice. A quantity, etc.) In one particular embodiment, for example, two 9G second cycles can be used. In various embodiments, the expandable component can remain fully or partially inflated between cooling cycles to maintain the cooling assembly 130 Position at the target site. After renal neuromodulation at the first renal artery, method 300 can further include deflation of the expandable member and contraction of the cooling assembly 13 (block 335). The cryotherapy device 12〇 is separated from the console 1〇2 23 201223577 and the syringe or other suitable evacuation device is attached to the proximal end of the shaft i22 to manually deflate the expandable member. In other embodiments, the length of the shaft (2) can be connected. syringe The cryotherapy device i2 is not separated from the console or the expandable member can be automatically deflated (eg, via the controller 11 8). In a second embodiment, the cooling assembly can be retracted after the expandable member is deflated In the catheter. Optionally, the cooling assembly 130 can be removed from the guiding catheter during the repositioning and temporarily stored in a sterile position (eg, in a saline solution). The cooling assembly 13 can then be positioned in the second renal artery or The second renal orifice (block 340), and the expandable member can be inflated to confirm the position of the cooling assembly 130 (block 345) (> In selected embodiments, the contrast material can be delivered distally beyond the cooling assembly 130 The second renal artery can be located using fluoroscopy and/or other suitable imaging techniques. If necessary, the used supply container 1〇4 in the console 102 can be refilled or removed and replaced with a new one. A container (eg, a disposable cryogen cartridge) is provided to provide sufficient cryogen for renal neuromodulation at the second renal artery or the second renal ostium. The console 1〇2 is placed during repositioning of the cooling assembly 130. low In a specific example of separation of the treatment device 120, the console 1〇2 can be reconnected to the cryotherapy device 120 such that the renal nerves are circumscribing at the second renal artery or the first renal orifice by applying cryogenic cooling (squares) 3 5 0 ) to continue the method 3 〇〇. In other embodiments, the various steps in the method 3 can be modified, omitted, and/or other steps can be added. For example, outside the sterile field for cryotherapy Open the console 1 〇 2 and load the supply container 丨〇 4 and position it in a sterile pouch or sterile housing so that it can be brought into the sterile area. 24 201223577 If the supply volume must be reloaded or refilled during cryotherapy No. (10)' can remove the console 1〇2 from the sterile area, reload, and return to the sterile area ten (eg, in a sterile pouch or sterile housing). In other embodiments, the empty supply container 1〇4 can be removed from the console 1〇2 and stored in a sterile pouch or sterile enclosure surrounding the control bowl 102 and can be refilled in a sterile pouch or sterile housing. The supply container is coupled to the console 1〇2 such that the console 102 does not leave the sterile field during treatment. In other embodiments, the console 102 can remain outside of the sterile field and operate remotely. 4A is an enlarged cross-sectional view of the distal end portion 426 of the cryotherapy device 420 configured in accordance with another embodiment of the present technology. The m treatment device 420 includes cryotherapy substantially as described above with reference to FIGS. Features of device 120 that are similar in features. For example, cryotherapy devices include elongated shafts! 22. A supply lumen 132 and a discharge lumen 134 extending along at least a portion of the shaft 122, and a cooling assembly 130 at a distal end portion of the shaft 1〇2. The cooling assembly 〇 〇 includes an expandable member, such as a balloon or other suitable expandable member that defines at least a portion of the expansion chamber and receives at least substantially vapor phase refrigerant 1 〇 6 via orifice 144. In the illustrated embodiment, the distal end of the supply lumen 132 is coupled to the distal end portion 452 of the balloon 142 to provide additional support and/or control for the cooling assembly 13A, and the orifice port 44 is along the supply lumen 132. The length of the opening (e.g., rather than at the distal end 135 of the supply lumen 132 or the end of the capillary) is positioned. The distal portion 452 of the supply lumen 132 and balloon 142 can be joined together using an adhesive (e.g., thermal adhesive), fasteners, and/or other suitable attachment mechanisms known in the art. In other embodiments, the supply 25 201223577 lumen 132 can terminate at or terminate in the inflation lumen, and/or the cryotherapy device 420 can further include support extending from the axis m to at least the distal portion 452 of the balloon ι 42 Parts (not shown). As shown in FIG. 4A, the cryotherapy device 42A can further include a connector 454 at a proximal end portion of the ball 142 that can be coupled over the distal portion 426 of the shaft 122 and thereby light the balloon 142 Connected to the shaft 122. The connector 454 can be defined by a proximal portion of the balloon integral with the expandable portion (e.g., the neck of the balloon 142), as shown in Figure 4A, or the connector 454 can be a separate and distinct component relative to the balloon 142. Such as a collar or other suitable holder. Use a thermal adhesive 'adhesive, interlocking surfaces (eg threads), friction fit, snap fit, suction and/or other suitable. The attachment mechanism connects the connector 454 to the distal end portion of the shaft 122 or the connector 454 can be formed integrally with the distal end portion. In the illustrated embodiment, the connector 454 is located adjacent the step 128 above the second region 12 of the shaft 122. The first region 12~ of the end portion 426 may have a first outer cross-section and = inch or diameter 0D1, and the second region away from the step 128 may have a diameter: two: outer cross-sectional dimension 0 The second outer cross-sectional dimension or the reduced outer dimension of the outer dimension of the 2-way end portion 426 at the step 128 is "placement connection = the step of the step file. In some embodiments, the dimensions are sized such that the first area is flush with the outer surface 457 of the connector 454. Accordingly, the outer diameter OR of the second 26 201223577 region 127b can be equal to twice the outer diameter OR of the first region 127a minus the thickness of the connection benefit 454. In other embodiments, the outer diameter ODi of the second region 127b can be greater or less than twice the thickness of the connector 454. In selected embodiments, when the cooling assembly 13〇 is moved to a deployed state (eg, as shown in FIG. 4A), the connector 454 is not expandable such that it remains within the recessed area and/or substantially The area 12 to the outer surface is flush. In other embodiments, the connector 454 can expand and increase the cross-sectional area as the cooling assembly 13〇 moves to the deployed state. In the specific real economy shown in FIG. 4A, the cross-sectional area of the discharge lumen (as defined, for example, by the inner surface of the shaft 122) is also reduced at the transition between the first region 127 & and the second region 127b to cause the shaft The distal portion of 122 has a first inner cross-sectional dimension or diameter ι at the first region 127a and a smaller second inner cross-sectional dimension or diameter 1 〇 2 at the second region 127b. In order to avoid pressure buildup in the expansion chamber that may be caused by the discharge of the necking (10) 134, the second region mb may be located only at the most distal end of the shaft 122 adjacent to the expansion chamber, wherein the discharged refrigerant 117 The highest density. For example, the second region 127b can have a length of less than 4 cm (eg, 2 cm, 1 cm, etc.). The discharged refrigerant m is also sufficiently discharged via the smaller inner diameter of the second region 127b without undue limitation because the length of the second region 127b along the longitudinal axis of the shaft 122 may be relatively short. For example, the length of the second region 127b can be minimized to adequately accommodate the connector 454. According to this, the smaller discharge inner chamber 134 at the second region mb can mainly transport the high-density discharge refrigerant m' and can be discharged at the first region U7a when the density of the discharged refrigerant U7 is lowered. The refrigerant ιΐ7 27 201223577 is discharged into the larger discharge inner chamber 134 to facilitate proper discharge through the smaller second inner diameter of the second region i27b. In operation, the second region 12 recessed inwardly reduces the profile of the distal portion 426 of the shaft 122 and/or provides a substantially smooth transition from the shaft 122 to the connector 454 without jeopardizing the discharge of the discharge lumen 134. characteristic. The low profile distal end portion 426 of the shaft 122 can also contribute to the delivery of the proximal portion 124 (Fig.) from the shaft 122 to the distal portion 4% between the shaft 122 and the outer sheath 5 The fluid contrast material surrounding the cooling assembly, as shown in FIG. 2A, is delivered to image and position (eg, using a fluoroscopy) a target in the vascular structure. As shown in FIG. 4A, for example, the recessed second region 127b provides one or more passages or channels C around the distal portion of the shaft 122 that are large enough to deliver contrast material to the distal end. The assembly 130 is cooled without being blocked by the protruding connectors or balloons. In some specific examples, when the difference between the first outer diameter OD of the corresponding first region 127a and the second region 127b and the second outer diameter 0〇2 is less than 〇〇1吋 (〇254, sufficient poetry can be formed The channel c of the material. In other specific examples, the difference between the outer dimensions OR of the first region l27a and the second region n7b may be larger or smaller. When used during renal neuromodulation, The first renal artery is positioned by delivering a contrast material over the channel C to the distal end of the delivery device. The renal artery is adjusted at the first renal artery, and the cooling assembly is retracted to the self-deployed state. a delivery state in which additional contrast material can be delivered distally via channel c over the cooling assembly 13A to locate the second renal artery. In other embodiments, the distal portion of the vehicle 122 is not included (4) 28 201223577 4 A Rather than gradually reducing the discharge lumen 134, it may have a substantially uniform k-sectional dimension. The discharge lumen may be relatively easily adapted to the guidewire lumen (eg, as shown in Figures 2C-2E) a guide wire extending through the guide wire lumen The cooling assembly 13G ^ is located at the target site τ in the blood vessel V. In this specific example, after the guide wire has contracted, it can be delivered distally via the guide wire lumen for the target site (eg, two renal arteries) An imaged contrast material. Figure 4B is an enlarged cross-sectional view of a distal portion 456 of a cryotherapy device 460 configured in accordance with another embodiment of the present technology. The cryotherapy device 460 includes substantially as described above with reference to Figure 4a. Features of the cryotherapy device 420 are similar. For example, the distal portion A% of the axis I] has a step 128 that distinguishes the first region 127a from the smaller second region i27b. However, as shown in Figure 4B In a specific example, the second region 127b is defined by a separate tube 459 that protrudes from the shaft 122. Similar to the inwardly stepped portion of the shaft 122 shown in Figure 4A, the tube 459 reduces the discharge at 12% of the second region. The cross-sectional area of the cavity 134. As shown in Figure 4B, the cryotherapy device 46 can further include a proximal connector 458 that connects the balloon 142 to the distal end portion 456 of the shaft 122. Concave area The connector 456 of Figure 4B differs in that the proximal connector 458 shown in Figure 4B extends over the second region 127b to the outer surface 455 of the first region 127a. By making the proximal connector 456 Extending over a region 12, a larger surface area is available for attaching the balloon 142 to the distal portion 456 of the shaft 122. Accordingly, the length of the second region 127b can be reduced to facilitate drainage through the neck. Cavity I"

29 201223577 (for example, as shown in FIGS. 4A and 4B) the refrigerant ι 7 is appropriately discharged. In some specific implementations, the proximal connector 458 is non-expandable such that it maintains a substantially lower profile in both the deployed and delivery states against the outer surface 455 of the region 127a. This can reduce or prevent the proximal connector 458 from pulling on the proximal connection (1) when the deployment configuration is contracted to the delivery configuration; In other embodiments, the proximal connector 458 is at least partially swellable, but is configured to maintain a low profile of the distal portion 456 in a cooling total & Accordingly, a cryotherapy device 46 having an extended proximal end connection '458 can provide a substantially lower profile for delivery of the cooling assembly within s! 3 at a target site within a small peripheral blood vessel (eg, a renal artery), and/or may provide - or multiple channels C through which fluid imaging material may be delivered to a far greater % than the cooling assembly 13 〇 ^ 2 As further shown in FIG. 4B, the cryotherapy device 46A also includes a distal connector 462 that retains the distal portion 452 of the balloon 142 and a support P 433 that extends through the balloon 142 to support the balloon 142 in both the delivery state and the deployed state. . The distal connector 462 can also be coupled to or integrally formed with the non-invasive tip 464 extending distally therefrom (e.g., by thermal bonding). Non-traumatic tip—extends from the distal connector by approximately 〇·5 c: to 5 Cm (eg, approximately 1 cm to 2 cm) and has approximately 0.010 吋 (0.254 _) to “spoon 0.050 吋 (1 27 ) The outer diameter. In one embodiment, for example, the non-traumatic tip 464 can have a length of about 2 and an outer diameter of at least 〇〇35 leaves (〇.889 mm; for example, 0.03 8 忖 (0_965 mm)). In a particular example, the non-invasive tip 464 can have other suitable lengths and/or outer diameters. The non-traumatic tip 464 can act as a fixed guide to facilitate passage 30 201223577 'transvascular structure. In several specific examples, The angle and/or rotational orientation of the non-traumatic tip 464 is adjusted by a control line 467 (e.g., a pull wire) extending through the sleeve i22 ' = to / portion. The user can manipulate the control line to • twist or otherwise move the non-invasive The distal tip 464, thereby guiding the distal portion 456 of the ankle 22 to the target site τ. In other embodiments, the non-traumatic tip 464 can be guided through the #122 and beyond the distal connector to guide, line (eg, Figure 2C shows the distal end of the guide, line mb) • The non-traumatic tip 464 can be made of a material and structure that is substantially smooth and flexible so that it can be gently contacted and deflected away from the vessel wall as it passes through the vascular structure, and thus avoids The tube through which it passes causes perforations and/or other trauma. For example, the non-traumatic tip (10) can be made of a flexible coil (eg, a starting coil) on a core or wire (eg, without a wire). In the example, the line can be configured to be self-invasive

The proximal tip of the traumatic tip 464 is gamma gamma gamma - and the distal end of the knife 469a to the non-traumatic tip 464 is gradually plum-shaped. With the point 丨丄, 牛 而 吕 吕 楔 ' wedge line at the proximal portion 469a can generally have about 0 paste (〇 127 mm) and Q 〇 15 when ... mm; for example, please 9_ (G.229 mm)) Between the outer diameter of the circle, and can be flattened to the distal part of the machine to about 〇〇. 〇〇 寸 (〇〇 25 _) and about 忖 5 忖 (〇. 127 匪; for example 0.003 忖 (〇〇 76rnm )) The thickness between. In selected embodiments, the line is substantially flat within about /3 i /2 of the non-traumatic tip (10) from the proximal end. In other specific embodiments, the non-invasive pocket end 464 can have a generally circular cross-section that is wedge-shaped or non-wedge. In several embodiments, at least a portion of the non-traumatic tip 4M (eg, package 31 201223577 around a line around the line) may "and/or may assist in passing the cryotherapy device (10) when using (4) technology + 6 (four) imaging techniques Other radiopaque materials of the vascular structure (eg, platinum/rhodium alloy) are made. In certain aspects of the present technology, balloon 142 may also include radiopaque markers and/or no at its proximal and distal portions. Transmission line markings (e.g., made with radiopaque ink) facilitate the passage and deployment. In other embodiments, the non-invasive tip 464 can be made of other deflectable and lightweight materials and structures, such as polymeric materials ( For example, Pebax® polymer, nylon, etc.), polymeric materials on metal wires (such as stainless steel wires), and/or other suitable materials. In the specific example illustrated in Figure 4B, non-invasive tips_lean forming And 7 or otherwise formed as a curved or slanted portion. When the non-invasive. damaging tip 464 is made of a moldable material (e.g., stainless steel, platinum, etc.), the non-invasive tip 464 can be formed and / or reformed to the desired curvature. In other embodiments, the non-invasive tip 464 can be pre-formed from a non-formable material such that it has an unadjustable set curve. The curve in the non-invasive tip 464 can be further assisted By passing through the vascular structure. For example, the curve can help maintain the cooling assembly 130 within the desired blood vessel (eg, within the renal artery and avoiding its side branches. Pressure monitoring in cryotherapy rates 图 Figure 5A is in accordance with the teachings of the present invention A partial schematic view of another specific treatment system 5 (10), and Figure 5B is an enlarged cross-sectional view of the distal portion of the system of Figure 5 A. The cryotherapeutic system 5 can include substantially as described above with reference to Figures i through 3B. Features similar to those of the cryotherapy system. Referring to Figure 5A', for example, the cryotherapy system 5 〇 " 32 201223577 includes a cryotherapy device 52G and a console 5G2. The console may include facets to be configured to cry to low temperatures. The treatment packs £52G of circulating refrigerant throughout the supply line with 510% refrigerant supply capacity of $5〇4 and supply control. The console 5〇2 can also be lightly connected to configured to receive From the pump 511 and/or the back pressure control (four) 513 of the discharge line 515 of the cryogenic treatment device 520 that has evaporated the refrigerant 517. The control n 518 is operable to the supply control and/or the back pressure control valve 513 to regulate the passage. The cryogen treatment device 52G refrigerant flow. In the illustrated embodiment, the cryotherapy device 52() includes a handle having a shaft 522 at a proximal end region of the proximal portion 524 of the shaft 522, and having a distal end at the shaft 522 The distal end portion 526 of the cooling assembly 530 at the distal end of the end > 526. As further shown in Figure 5A, the console 5〇2 can also include a pressure transducer or sense coupled to the pressure line 571. A detector 570 (e.g., a PX209-100G5V pressure transducer manufactured by 〇 mega Engineering 〇f Stamf〇rd, CT) monitors the pressure within one portion of the cooling assembly 53 (e.g., the expansion chamber) during cryotherapy. In various embodiments, the pressure sensor 57A can be coupled to the controller 51 to act as a feedback mechanism that controls the supply control valve 5〇8 and/or the back pressure control valve 513, and thus in response to the cooling assembly 53 The pressure sensed by the crucible is used to regulate the flow of refrigerant to the cooling assembly 53 〇 and/or from the cooling assembly 53 。. For example, pressure sensor 57A can be configured to indicate a pressure between predetermined thresholds (e.g., within the burst pressure range of the expansion chamber). In response thereto, the controller 518 can reduce or terminate the flow of refrigerant by at least partially closing the supply control valve 5〇8 and/or by reducing the back pressure in the discharge line 515 (eg, using a vacuum pump 5丨丨). From the cooling assembly 53 〇 refrigerant 33 201223577 flow. In other embodiments, the pressure sensor 570 can be directly coupled to the supply control valve 508 and/or the back pressure control 513 to automatically adjust the valves 508 and 513 to open and/or close in response to the sensed pressure. In several specific examples, cryogenic therapy system 500 can be configured to verify that pressure sensor 570 is properly calibrated prior to cryotherapy. For example, system 500 can automatically check the functionality of pressure sensor 570 by comparing the pressure readings of pressure sensor 57 with ambient pressure when system 5 is turned on. Referring now to Figure 5B, the distal end region of the cryotherapy device 520 can include features substantially similar to those of the cryotherapy device 12A described above with reference to Figures 2A-2E. For example, cryotherapy device 52A includes a supply lumen 132 coupled to supply line 510 (FIG. 5A), an ejection lumen 134 coupled to discharge line 515 (FIG. 5A), and a balloon 142 or defined expansion lumen. The applicator 1 400 of other types of expandable components. As shown in Figure 5B, the cryotherapy device 52A can further include a pressure-seeing lumen 572 coupled to the pressure sensor 57A (Figure 5A) via a pressure line 571 (Figure 5A). Pressure monitoring lumen 572 can extend through shaft 522 and have. The swell L (eg, by the balloon 142 $) is fluidly connected to the distal end 74 [force i depending on the size of the lumen 572 (eg, cross-sectional area, inner diameter: or outer diameter) may be large enough to provide substantial accuracy The pressure readings in the expansion chamber are measured, but small enough to reduce or prevent interference with the refrigerant via the discharge, and the supply lumen 132 and the pressure monitoring lumen 572 can have a first cross-sectional dimension (eg, First-cross-sectional area), and row 'inner month: 1 34 may have a second cross-sectional dimension (eg, second cross-sectional area) 'The ratio of the first cross-sectional dimension to the first cross-sectional dimension is 4: Between 34 201223577 10.1. In some embodiments, the pressure monitoring lumen 572 can have an inner diameter of no more than 0.03 leaves (〇.762 _; such as 〇.〇15 leaves (〇381匪), 〇〇1〇吋 (0_762 mm), etc.) And not exceeding the outer diameter of 〇〇6〇吋 (i 52 mm; for example, 0.02 吋 (0.508 mm), 0·015 吋 (〇381 赖), etc.), and the discharge lumen 134 can be sized accordingly. In the particular example illustrated in Figure 5B, the pressure monitoring lumen 572 terminates in the shaft 522 before the outer diameter is necked at the second region 127b of the distal portion 52A. This configuration can be used in a specific example of the inner diameter necking of the shaft 522 (e.g., as shown in Figures 4A and 4B) to avoid limiting the discharge of the expanded refrigerant at the smaller second region 127b. In other embodiments, the opening 574 of the pressure monitoring lumen 572 can be at or in the balloon 542. The pressure monitoring lumen 572 can also have a length sufficient to position the opening 574 and the cooling assembly 530 within the vessel at the target site τ (e.g., via the femoral artery or radial artery at the renal artery or renal orifice). For example, the pressure monitoring lumen 572 can have a length equal to the full length of the shaft 522 (e.g., at least 48 彳 (122 cm)). In other embodiments, the pressure monitoring lumen 572 can have other different suitable lengths and/or sizes. For example, the pressure monitoring lumen 572 can have a first length and the pressure line 571 connected thereto can have a second length (eg, 48 吋 (122 cm), 3 〇吋 (% cm), 12 吋 (30 cm) Etc.) to extend the pressure monitoring lumen 572 to the pressure sensor 570' to allow the console 5〇2 to be in a desired position (eg, on a table) during the cryotherapy treatment. During the cryotherapy treatment, pressure monitoring lumen 572 and pressure sensor 570 (Fig. 5A) can be configured to provide pressure changes indicative of expansion within the chamber

35 201223577 Signal. For example, the 'pressure sensor 57' is configured to indicate that the threshold pressure is below the burst pressure of the balloon 142 to reduce the likelihood of the balloon 142 breaking during cryotherapy. The gas $ 142 may have a burst pressure that depends at least in part on the material of manufacture of the balloon 142. For example, a compliant material (eg, a polyurethane) typically has a lower burst pressure (eg, 80) than a non-compliant material (eg, nylon) that can have a burst pressure of 3 Torr or higher. Psi, 1 〇〇 psl, 200 psi, etc.). The pressure sensor can be configured to monitor the threshold pressure, which can be equal to a pressure value below the burst pressure that provides an appropriate reaction time to react to pressure changes before the balloon M2 ruptures. In his specific example, the pressure sensor 57A can be configured to indicate when the balloon 42 is operating outside of its desired operating pressure range (e.g., 20 to 6 psi). The time delay between the pressure at the opening 574 of the pressure monitoring lumen 572 at the inflation chamber and the pressure reading at the pressure sensor 570 may depend on the volume of the pressure monitoring lumen 572. Thus, the pressure monitoring lumen 572 can have a volume having a reaction time sufficient to properly respond to pressure changes in the expansion chamber (e.g., prior to balloon 142 rupture). In some embodiments, for example, pressure sensor 570 has a reaction time of less than 1 > 5 seconds, such as a reaction time of less than 1 second, 0.2 seconds, 0.1 seconds, or 15 milliseconds. To enhance the accuracy of the pressure readings and reduce the reaction time of the pressure sensor 57, the retractable pressure monitors the length of the lumen 572 and can reduce the significant volume increase of the pressure monitoring lumen 572 prior to connection to the pressure sensor 570. . For example, the pressure monitoring lumen 572 can be coupled to the pressure line 571 at the proximal portion 524 (FIG. 5A) of the shaft 522 (eg, at the handle 525), and the pressure line 571 can have 36 201223577 'with pressure monitoring Cavity 572 has a similar cross-sectional area. In other specific examples, the 'pressure monitoring lumen 572 can be coupled to the pressure sensor 570 at the handle 525 (eg, omitting the pressure line 57A) to shorten the total length of the pressure tube to the pressure sensor 57. The wires can be coupled to pressure sensor 570 to carry signals to console 502. Referring to Figures 5A and 5B together, in some embodiments, the pressure line 517 and/or the pressure monitoring lumen 572 can be joined using a joint or adapter 576 (e.g., a quick connect adapter). To the pressure sensor 57〇. In the specific example illustrated in Figure 5A, the 'example' adapter 576 includes a fluid connection pressure line 571 and an internal reservoir or channel 578 of the pressure sensor 570. Channel 578 can have a substantially smaller volume to avoid breaking the pressure differential between pressure line 571 and pressure sensor 507 and enhance pressure measurement accuracy. For example, in one embodiment, channel 578 has a volume of no more than 立方1 cubic centimeter. In other embodiments, channel 578 can have a larger internal volume. In other embodiments, the adapter 576 can couple the pressure monitoring lumen 572 with the pressure line 571 at the handle 525 or other location adjacent the proximal portion 524 of the shaft 522. Thus, the adapter 576 allows the pressure monitoring lumen 572 and/or the pressure line 571 to separate from the pressure transducer 57 after the cryotherapy treatment so that the pressure monitoring lumen 572 can be discarded and the pressure transducer 5 70 can be stored. (eg, with handle 525 and/or console 502) for subsequent cryotherapy treatment without damaging the pressure reading accuracy at pressure sensor 57. Referring again to FIG. 5B, in various other embodiments, the cryotherapy device 520 can further include other gas supply lumens 579 coupled to the supply container 5〇4 (FIG. 5A) or other gas supply reservoirs for delivery to the inflation lumen. The other 37 201223577 gas and thus the temperature of the applicator 140. For example, the gas supply lumen 579 can deliver a refrigerant 5〇6 (eg, nitrous oxide) and/or other additions to the balloon 142 prior to delivery of the refrigerant 5〇6 via the orifice 144. Pressurize or not pressurize the gas (such as air) to increase the pressure inside the balloon M2 (for example, from about 5 psi to about 60 ό Π. ϊ+- ! «β , ρ 1玍n 5UPS1). Other gases in the ball 142 reduce the pressure drop of the refrigerant 5G6 in the expansion chamber and thereby increase the temperature within the balloon 142. Thus, the gas supply lumen 579 can be used to initiate, restrict, and/or suspend other gases from flowing into the expansion chamber (eg, using a valve) and adjust the temperature of the balloon without the need for complex components in the console 502 (eg, pressure regulators, sub- Cooler, etc.) to change the pressure drop within the gas $142. Moreover, when the gas supply lumen 579 is consuming to a separate gas reservoir (e.g., an air supply), the gas supply lumen 579 can be used to deliver gas to the gas (10) prior to delivery of the refrigerant 506 to the gas cartridge 142. To monitor the position of the application @14〇 at the target site T. In other embodiments, a pressure regulator (not shown; such as a pressure relief valve) may be added to the discharge lumen 134 to capture the vaporized refrigerant 517 so that it does not exit the gas and/or capture it. The pressure in the lumen 13" is exhausted until the balloon 142 is at a predetermined value (e.g., as sensed using the pressure monitoring lumen 572). In other embodiments, the cryotherapy device 52 is configured to evacuate the lumen 134 and the gas supply lumen. Each of the 579 can include a pressure regulator such that the pressure within the balloon 142 can be adjusted during the hypothermia treatment process. j艮 The temperature in the warm pedestal is reduced in the cryo-renal neuromodulation to limit the volume of refrigerant available for cooling. Accordingly, it can be used to increase the cooling capacity of the refrigerant. Pre-cooling the refrigerant before the refrigerant expands in the cooling system at 38 201223577 is an example of a method of increasing the cooling month & force of the refrigerant. Even when cooling mainly via phase change, 'cooling the refrigerant before the phase change can increase the cooling amount. In addition, if the supply pipe is in thermal communication with the discharge pipe, the temperature of the refrigerant in the supply pipe can be lowered to cool. The refrigerant discharged from the discharge pipe' can thereby reduce the back pressure in the associated cooling assembly and thereby further increase the cooling at the associated cooling assembly. Pre-cooling can reduce the volume of refrigerant required for low-temperature renal neuromodulation This allows for the use of smaller and more flexible shafts within the a-tube structure. Pre-cooling also mitigates other components of the cryotherapy system, such as insulating components in the applicator and releasing heat during operation. In-line s〇lenoid valve) associated cooling capacity reduction β is typically supplied from outside the vascular structure at room temperature (eg, from a room temperature vacuum bottle). Coolant. When pressurized refrigerant moves along the supply tube within the vascular structure, its temperature can be increased by heat transfer to warm blood and tissue. For example, when supplied at room temperature (eg, about 23 C) When the pressurized refrigerant passes through the vascular structure under body temperature (for example, about 37 〇), the temperature of the pressurized refrigerant can be increased by about 25 C to 37 C before reaching the cooling assembly. According to the present technology Several specific example configurations The low fox treatment device can include a pre-cooling assembly configured to cool the pressurized refrigerant prior to expansion of the pressurized refrigerant in the associated cooling assembly. For example, the pressurized refrigerant can be cooled to The associated cooling assembly has a temperature below body temperature prior to expansion (eg, less than about 2 〇〇c or less than about 1 〇. 〇 The pre-cooling assemblies can be configured to be outside the vascular structure and/or utilized The refrigerant supply is the same as the associated cooling assembly. In the specific example of 39 201223577 configured in accordance with the teachings of the present invention, 'pre-cooling can be used to maintain the refrigerant in liquid form until it reaches a cooling assembly that requires cryogenic cooling. For example, evaporation associated with temperature rise as the cryogen passes through portions of the cryotherapy device adjacent the cooling assembly can be reduced. In this section, the terms "proximal" and "distal" refer to the position relative to the source of pressurized refrigerant. For example, the proximal end may refer to a location closer to the source of the refrigerant and the distal end may refer to a location further away from the source of pressurized refrigerant. Figures 6A-6B illustrate a portion of a cryotherapy device 6 that includes a pre-cooling assembly 602, an elongated shaft 6〇4 defining a discharge passage, and a hub 606 between the pre-cooling assembly and the shaft. The pre-cooling assembly 602 includes a flexible tubular member 6〇8 extending between the hub 606 and an adapter 610 configured to connect to a source of pressurized refrigerant (not shown). The hub 6 6 may include a primary connector 612 coupled to the shaft 604, a discharge port 614 for venting to the atmosphere, a first branch 616 coupled to the squaring member 608, and a second branch 618 coupled to the control conduit 62A. In several embodiments, the hub 6〇6 can include one or more additional branches, such as including a proximal syringe adapter (eg, including a proximal syringe configured to pierce the septum with a needle of a syringe) Device

A filler material is introduced into the filling cavity. The filling material is discussed in more detail below with respect to the cooling assembly within the vascular structure. Referring to Figures 6A-6B, two control lines 621 (Figure 6b) can be self-controlled to guide the conduit 620. 'Bridge& 606 can be defined as a main discharge flow path from the shaft 6〇4 via discharge. . The tubular member 608 606 extends into the shaft 604. The general exit 614 to ambient 608 includes a tubular proximal portion 622 at the adapter 610 40 201223577 and a tubular distal portion 624 at the first branch 616. As best shown in FIG. 6B, the tubular proximal portion 622 can include a first plug 626 and a second plug 628, and the adapter 610 can include an opening 630 adjacent the second plug 628. Adapter 610 can include a variety of structures suitable for connection to a source of pressurized refrigerant, such as a threaded joint, a compression joint, or a barbed joint. In the particular example shown in Figure 6B, the main supply tube 632 is supplied to the inner chamber, and the pre-cooling assembly 602 includes a pre-cooling supply tube 634 defining a pre-cooling supply chamber. The primary supply tube 632 and the pre-cooling supply tube 634 can include a primary supply proximal opening 636 and a pre-cooling supply proximal opening 638 at the second plug 628, respectively. The primary supply proximal opening 630 and the pre-cooling supply proximal opening 638 fluidly connect the primary supply tube 632 and the pre-cooling supply tube 634 to the passage defined by the opening 630, respectively. Main supply tube 632 and pre-cooling supply tube 634 extend from second plug 628 through tubular proximal portion 622 and first plug 626. The tubular distal portion 624 defines a pre-cooling expansion chamber that extends from the first plug 626 to the primary exhaust flow path. The pre-cooling supply tube 634 extends a pre-cooling distal opening n 64Q that extends slightly beyond the first plug 626 and terminates in the inflation chamber. The pre-cooling expansion chamber is thereby fluidly coupled to the refrigerant stream via pre-cooling supply @634 such that the pre-cooling discharge flow path extends from the pre-cooling distal opening 64〇 to the primary exhaust flow path. The main supply tube 632 extends through the pre-cooling expansion chamber, through the hub 606 and extends into the shaft 〇4 from the glaze 604. The σ of the main supply pipe 632 extending from the main supply proximal opening 636 to the shaft is divided into the first portion of the main supply pipe 632. The main supply pipe 632 flute ·~Αιτ, the first part (not shown) adjacent to the group

41 201223577 Cooling assembly (not shown) in the vascular structure. The pressurized refrigerant is expanded from the pre-cooling supply pipe 634 to the pre-cooling expansion chamber to cool the pre-cooling expansion chamber and thereby cool the main supply pipe 632 and the liquid refrigerant in the main supply pipe. If pre-cooling is performed away from the entry point of the vascular structure (eg, if the pressurized refrigerant is cooled in the console prior to delivery to the entry point of the vascular structure), the heat from the atmosphere may cause pre-cooling to pressurize The refrigerant heats up undesirably. Positioning the pre-cooling expansion chamber adjacent to the hub reduces this undesirable temperature rise. The pre-cooling assembly configured in accordance with some embodiments of the present technology may have a pressurized refrigerant sufficient to allow pre-cooling of the expanding refrigerant in the expansion chamber and the main supply tube in the pre-cooling expansion chamber. The length of heat transfer between them. By way of example, a pre-cooling chamber configured in accordance with several embodiments of the present technology may have a length greater than, a force l〇cm such as greater than about 15 crn or greater than about 25 cm. The pre-cooling chamber configured in accordance with several embodiments of the present technology has a length of from about 20 cm to about 30 cm. After the cold main supply pipe 632, the refrigerant from the pre-cooling expansion chamber s sinks the refrigerant flow from the discharge passage and discharges the discharge port 6 14 into the atmosphere. 6B shows the first arrow 642 indicating the flow direction of the refrigerant through the discharge port 614 and the first front head 640 indicating the flow direction of the refrigerant through the pre-cooling expansion chamber, and the flow direction of the refrigerant through the discharge port 614 is substantially discharged. Channel alignment. In contrast, the direction of flow of the refrigerant through the pre-cooling expansion chamber is not aligned with the flow direction of the discharge passage or refrigerant through the discharge π 614. A similar embodiment of the cryotherapy device 700 201223577 • A portion of the cryotherapy device 700 differs in that the device 700 has a pre-cooling expansion chamber that is fluidly separated from the discharge channel. For example, the cryotherapy device 700 includes a pre-cooling assembly 7〇2' that includes a valve 7〇4 and a fluid that separates the pre-cooling expansion chamber from the inner portion of the shaft 604 and the hinge 606. Two plugs 706. Main supply tube 632 extends through third plug 706 and into shaft 604. Arrow 708 indicates the direction of flow of refrigerant through the pre-cooling expansion chamber when valve 704 is open. When the valve 7〇4 is closed, the pressure in the pre-cooling expansion chamber can be increased until it is balanced with the pre-cooling supply pipe 634, thereby stopping the flow through the pre-cooling supply pipe. In this way, opening and closing the valve 7〇4 can turn the pre-cooling on or off. Partial opening of valve 7〇4 adjusts the pressure within the pre-cooling expansion chamber and thereby regulates the flow of refrigerant through pre-cooling supply line 634 and associated pre-cooling temperatures. For example, actuator 710 can be operatively coupled to valve 〇4 and configured to receive signals from processor 712. The processor 712 can be configured to receive a "and/or sensor number from the user interface to the actuator 7 1 〇 to fully or incrementally open or close the valve. In the second sense, sense 1 716 It can be a temperature sensor for the associated cooling assembly. In one specific example, the 'temperature sensor can send a signal to the processor 712 to _cool the assembly or the tissue detected adjacent to the cooling assembly is high: : value 'to open the object and increase pre-cooling; or (1) if cooling total: the detected temperature of the tissue adjacent to the cold section assembly is lower than the desired value of the closed valve 704 and reduce the pre-cooling. Figure 8B illustrates the technique according to the present invention A further embodiment of a cryotherapy device having a pre-cooler 802. The final portion of the tubular member 608 is connected to form a first plug 626 of the pre-cooling assembly 6〇2 (Fig. 6A to Figure 6B) can be challenging. The pre-cooler 8〇2 can include a shunt connected to the main supply pipe instead of the first plug 626 and the pre-cooling supply pipe 634 (figure (5)). For example, the pre-cooler 8 〇2 may include a shunt 8〇4 connected to the main supply pipe 806 and has a capacity The proximal portion 810 and the container distal end portion 812 are containers 8A. In this particular embodiment, the flow divider 804 divides the container 8〇2 into a container proximal portion 81〇 and a container distal portion 812. The container proximal portion 81 defines A proximal lumen or combination supply lumen between the opening 63〇 and the splitter 8〇4, and a container distal portion 812 defines a pre-cooling expansion chamber. As best shown in Figure 8B, the splitter 8〇4 defines the fluid Main passage 814 connected to main supply pipe 806 and pre-cooling passage 816 along the periphery of splitter 8〇4. Still referring to Figure 8B, pre-cooling passage 8 16 is sized to generate sufficient expansion for the refrigerant and pre-cooling expansion The pressure drop of the chamber cooling. The flow divider 8〇4 includes a tubular section 818 and a shunt plug 820. The shunt plug 820 is located between the outer surface of the main supply tube 806 and the inner surface of the container 808. The outer cross-sectional dimension can be selected ( For example, the diameter) is slightly smaller than the tubular section 8 1 8 of the cross-sectional dimension (e.g., diameter) within the container 808. The shunt plug 820 can include, for example, a set to be bonded to the outer surface of the main supply tube 806 and the inner surface of the container 808. Adhesive material. In a specific example, the shunt 804 floats in the vessel 808 (i.e., it is not fixed within the vessel 808) such that the pre-cooling passage 816 is an annular space between the splitter 804 and the inner surface of the vessel 808. In other specific examples The 'diverter' can have a different configuration. For example, the shunt can be fixed to the 44 201223577 container and the pre-cooling channel can extend around only the part of the shunt (such as the kidney flexure) & through the shunt. In a specific example, the diverter can be coupled to the vessel about a circumference of the entire container, and the diverter can include an opening that is spaced inwardly around the periphery of the fish diverter. For example, the flow splitter can include a configuration to expand the refrigerant into the pre-cooled expansion chamber (4) port. Figures 9A through 9B illustrate portions of a low temperature therapeutic device i 9G0 similar to the cryotherapy device 8 of Figure 8A, except that it has a different shunt and a primary configuration. The cryotherapy pack 9 (10) includes a main supply tube 902 and a pre-cooler 904 including a splitter 9〇6 connected to the main supply tube 9〇2. Pre-cooling g 904 may also include a container 9〇8 having a container proximal end > 91G and a container distal end portion 912 on the opposite side of the split $鸠. In this particular shot, the splitter 9() 6 includes a tubular segment and can be constructed, for example, from a block of cylindrical material having a hole (for example rubber, polymer, metal or another material), the main supply tube 9〇2 being wearable. The holes are screwed or otherwise connected. As shown most clearly in Figure 9B, the splitter 9〇6 can define a pre-cooling passage 914 along the periphery of the splitter 906. The main supply tube 9〇2 can extend through the flow divider 906 and can be coupled to the inner surface of the proximal end portion 910 of the container adjacent the opening 63〇. When the proximal chamber is under high pressure, the accessible portion of the main supply tube 906 that is coupled to the proximal portion 91 of the container can be used to prevent undesirable longitudinal movement of the splitter 906 and the main supply tube 902. The pre-cooling assembly configured in accordance with several embodiments of the present technology can be configured for close configuration. For example, at least a portion of the pre-cooling assembly can be within the handle of the cryotherapy device. Figure 1A illustrates a portion of a cryotherapy device including a pre-cooling assembly 1 〇〇 2 and a hub 10 〇 4 in the handle 1 〇〇 6 2012 20125577. The pre-cooling assembly 1002 includes an extension from the hub 1 〇〇 4, through the bottom portion 1手柄1 of the handle 1〇〇8, and extending to a mating configured to connect to a pressurized refrigerant source (not shown) The flexible tubular member 1〇〇8 of the device 1012. The hub 1004 can include an elongated discharge port 1014 extending through the bottom portion ι〇1, and the control conduit 1016 can extend from the hub 1004 through the bottom portion 1010. In one embodiment, the tubular member 1008 is wrapped around the discharge port 1014. The handle 1006 can also be insulated to prevent heat loss into the atmosphere and improve pre-cooling efficiency. The figure illustrates a portion of the cryotherapy device 11 00 having an alternate configuration within the handle and around the handle. The cryotherapy device i i includes a pre-cooling assembly 11 〇 2 and a hub 11 〇 4 in the handle II 0 6 . The pre-cooling assembly 11 〇 2 includes a flexible tubular member 11〇8 extending from the pivot 11 04 and passing through the bottom portion u丨〇 of the handle 丨丨〇6. The hub 11〇4 may include an elongated discharge port extending through the bottom portion III 0! ! 12' and the control line conduit i i 14 can extend from the hub i丨 through the bottom portion 111〇. In one embodiment, the tubular member 8 includes a helical portion 间隔 16 spaced from the discharge port 1112. The handle 丨丨〇 6 can also be insulated to prevent heat loss into the atmosphere and improve pre-cooling efficiency. Device Set # Considering the above discussion of a cryotherapy device configured in accordance with several embodiments of the present technology, various different cooling assemblies, occluding components, and other cryotherapy device components are described below with reference to Figures 12-55. It will be appreciated that the specific features of the cryotherapy device assembly described below and/or the cryotherapy device components described below can be used in the cryotherapy system 1 shown in Figure 1, for stand-alone or self-contained handheld devices. Medium, or for another suitable system. 46 201223577 To: more, the same reference numerals are used in the present invention to identify similar or like elements or features, but the use of the same reference numerals does not imply that the parts should be the same. In fact, in many of the examples described herein, the same compilation is different in structure and/or function. Several specific examples of cryotherapy device components described below can be characterized to contribute to - or multiple therapeutic goals associated with hypotensive renal neuromodulation. (1) Several specific examples of administration n described below are configured to apply cryogenic cooling in a desired localized or overall treatment format. The desired localized treatment pattern can include, for example, partial circumferential cooling at one or more longitudinal segments of the iliac artery or renal stenosis. H The overall treatment pattern can include a localized/alpha treatment at the treatment site. combination. For example, the overall treatment pattern may be a partial or complete circumference in a plane perpendicular to the renal artery or renal ostium. Treatment 3L # In order to facilitate the desired localization or overall treatment pattern, an applicator configured in accordance with several embodiments of the present technology may have a heat transfer portion, such as a primary heat transfer portion and a secondary heat transfer. section. When the field comprising the applicator cooling assembly is operated in a deployed state, the main heat transfer portion of the applicator may have a heat transfer rate sufficient to produce a therapeutically effective low temperature renal nerve regulation. The secondary heat transfer portion of the applicator may have a lower heat transfer rate during operation such as a heat transfer rate that is insufficient to produce a therapeutically effective low temperature renal neuromodulation. The positioning of the primary heat transfer portion and the secondary heat transfer portion may correspond to the desired localized or overall treatment pattern. Several specific examples of applicators described below include features that are configured to affect the positioning of the primary heat transfer portion and the secondary heat transfer portion. Such criteria may include, for example, features associated with: (a) differences within the applicator 47 201223577 convective heat transfer; fk~ or (C) application number f sitting differentially by the applicator Heat transfer, · and / contact or septum ;;; the difference between the renal artery or the renal stenosis, such as: New Zealand configuration to selectively guide: include (for example, the refrigerant supply tube and the hole... !"The difference between the different parts of the transfer transfer characteristics ^The difference between the conduction type hot air balloon and the gas ball with a low cooling level (for example, non-cooling rate and high thermal conductivity material), the second plant, composition (such as low The heat-transfer drug device is connected to the red and slender heat-insulating member of the rolling ball. The characteristics of the contact or spacing associated with the application of the renal artery or the renal orifice may include, for example, the characteristics of other balloons and complex balloons, such as shapes. Spiral, curved, longitudinal asymmetry and radial asymmetry), surface differences (eg pits, grooves, protrusions and protrusions) and differential expansion (eg partially restricted expansion) 〇 - application as described below Several specific examples of the device are also configured Helps sized, such as reduced (e.g., low profile) to deliver the cross-sectional size and suitable to have different sizes of the renal artery and / or renal provided with the opening cross-sectional dimension of a therapeutically effective treatment deployment. For example, several specific embodiments of the applicator described below include a balloon that at least partially contracts when the associated cooling assembly is in a delivery state and at least partially expands when the associated cooling assembly is in a deployed state. Features associated with a given size may include, for example, balloon composition (e.g., compliant and non-compliant materials), other balloons, and characteristics of complex balloons, such as shapes (e.g., compliant and non-compliant shapes). Non-compliant materials (e.g., polyethylene terephthalate) can have, for example, from about 〇% to about 30%, of the 2012 201227577 compliance (e.g., elasticity). A compliant material (e.g., a thermoplastic elastomer thereof) may be present (the oxime ester and its b) have, for example, from about 3% to about 5% by weight of the oxime. Non-compliant materials are typically compared to compliant materials. There are more (e.g., higher pressure levels). Several specific examples of the applicator described below can be configured to facilitate the desired degree of closure of the renal artery and/or the renal orifice. Several specific examples of applicators described below are configured. The knife is occluded and a therapeutically effective cooling for renal neuromodulation is applied to the treatment site without blocking blood flow through the treatment site. Features associated with 邛 occlusion include, for example, the characteristics of complex balloons such as shapes (e.g., helical, curved, longitudinally asymmetric, and radial asymmetry) and poor (four) garments (e.g., partially restricted expansion). With regard to certain treatments, it may be desirable to have an occlusion of the king, such as completely or almost completely blocking blood flow through the renal artery or the renal orifice. Features associated with complete occlusion may include, for example, squatting: any suitable feature associated with it. As described below, a cryotherapy device configured in accordance with a right-hand specific embodiment of the present technology can include an occluding component, such as an expandable component of a cooling assembly (eg, a balloon defining an inflation lumen) or a separate occluding component (eg, adjacent cooling) Assembly). The occlusive component can be combined with any suitable applicator described herein to provide occlusion in conjunction with the characteristics of the applicator. . . A cooling assembly configured in accordance with the teachings of the present invention can include a structure that utilizes freezing and/or liquid blood adjacent to the application of a drug to promote one or more therapeutic targets associated with hypothermic renal neuromodulation. Freezing and/or liquid blood adjacent to the applicator can affect factors such as heat transfer, sizing, and occlusion. For example, several specific examples can be configured to freeze blood around the applicator to produce a full 49 201223577 or partial occlusion. In some cases, there may be less than about η » field frozen blood layer (for example, with a thickness of = 7_ or a thickness of cold blood (four) Main: two cooling, the balloon can be configured so that the king of the balloon wants The heat transfer portion forms a cold with the renal motion ^ , Λ ^ . , which can be used to contribute to the thickness of the cold portion of the effect; the east blood. For example, the layer is such that r is: size or desired In addition, the balloon can be configured. The formation between the knife and the kidney or the small mouth of the kidney has a double (the thickness of the ankle (for example, greater than about 0.8 =, 1_4 i.2_). The thickness of the cold blood. These balloons can be recessed. P and non-concave parts and other suitable structures as described in more detail below. 滴滴热传图12 to Figure 16 Β illustrates the use of differential convection Several specific examples of heat transfer to affect the therapeutic cryotherapy device. Features associated with convective heat transfer within the applicator may contribute to hypothermic renal neuromodulation - or multiple therapeutic targets - such as desired localization or overall Treatment pattern. These features may include (for example) Configuring to selectively introduce a refrigerant supply tube and orifice that causes the refrigerant to expand to different portions of the applicator. Figure 12 illustrates the inclusion of a cooling assembly at a distal portion 1204 of the elongated shaft 12〇6 defining the discharge passage. One portion of the cryotherapy device 12 of 1202. As described above, the distal portion 1204 can have a step 1208, and the cooling assembly 1202 can include a drug having a plurality of heat transfer portions (defined individually as 1211a through 1211d) The applicator 121 can also have a balloon 1212 having a distal neck 1214, and the balloon 1212 can define a configured 50 201223577 to create and deliver a cryogenically cooled inflation lumen. The device 12 can further include ' 'Tianchang guiding member 12 1 6a, a first supply pipe defining a first supply inner cavity 〖2 i 8 and a second supply pipe 122 疋 of a second supply inner cavity. The guiding part i2i6a can be 、, ,, i The guidewire lumen is shaped to receive the guidewires 丨2丨6b, as described in more detail above. The guide components described with respect to other cryotherapy device components described herein can be similarly configured, but for clarity of illustration, typically not illustrated Show The guide wire is closed. In the illustrated embodiment, the guide member i 2 & has a straight end and extends to the distal neck portion 1214. Alternatively, the guide member ΐ2ΐ6& can include a rounded end and/or extend beyond the distal neck Similarly, in other cryotherapy device assemblies described herein, the illustrated ends of the guiding members and/or supply tubes exiting the withdrawal portion of the balloon can have a variety of suitable shapes (eg, non-invasive shapes). And may extend different distances relative to the distal neck of the balloon. The first supply tube 1218 can include a first angled distal end portion 1222, and the cooling assembly 1202 can include a first end at the end of the first angled distal portion 1222 Aperture 1224. Similarly, the second supply tube 122A can include a second angled distal end portion 1226, and the cooling assembly can include a second aperture 1228 at the end of the second angled distal end portion. The illustrated first-tilt distal end portion 1222 and second oblique distal end portion 1226 are longitudinally spaced apart along the length of the cooling assembly η and radially spaced about the length of the cooling assembly 12〇2. In other specific embodiments, the first angled distal end portion 1222 and the first: angled distal portion 1226 have the same longitudinal and/or radial position or another configuration. When the cooling assembly 1202 is in a deployed state, the refrigerant may flow through the first supply pipe 1218 and the second supply pipe 122G, respectively, through the first-tilt distal end portion, the i22S2 201223577 and the second inclined distal end portion 1226'. The first orifice i224 and the 1228° first-tilt distal portion 1222 and the second oblique distal portion 1226, respectively, can respectively transfer the portion 1 to the UUa and the mid-guided expanded refrigerant. Therefore, the heat transfer portions 12 11a and 121 ld may have a higher overall heat transfer rate relative to the other heat transfer portions of the application 121 when the refrigerant flows out of the first port 1224 and the second port 1228, especially Convection heat transfer material. This change in heat transfer rate may correspond to the desired cooling pattern, a partial circumferential cooling pattern at some or all of the longitudinal segments of the applicator 1210. The difference in heat transfer rate may vary depending on the distance from the heat transfer portions 1211 & and i2ud. A functionally significant difference in heat transfer rate distinguishes the heat transfer portion 1211a from the heat transfer portion 12Uc, which is generally circumferentially opposed to the heat transfer portion 121la. Similarly, a functionally significant difference in heat transfer rate distinguishes between heat transfer portion 12 Ud and heat transfer portion 1211b, which is generally circumferentially opposed to heat transfer portion i2ud. In several embodiments, the heat transfer portions 12Ua and 12Ud have a heat transfer rate sufficient to produce a therapeutically effective renal neuromodulation, while the heat transfer portions 1211b and 1211c have a heat transfer rate insufficient to produce a therapeutically effective renal neuromodulation. The first supply tube 1 2 1 8 and the second supply tube 1220 can be configured to, for example, cause the refrigerant to expand at an angle that is about 45 degrees from the length of the applicator 1210 or the length of the cooling assembly 1202. In several other specific examples, one or more of the supply tubes are configured to be about 15 in length relative to the applicator or cooling assembly. To about 90. The angle (such as from about 30 to about 45., or from about 30 to about 40.) leads to a cold agent. Furthermore, the first supply tube 1 2 1 8 can be at different angles than the second supply tube 1 220 201223577. The longitudinal distance between the first aperture 1224 and the second aperture 090 0 of the cooling assembly configured according to the present invention may be, for example, about 1 mm to about 2 〇 mm, The language is about 2 mm to about 15 mm, or about 3 mm to about 1 mm. A cooling assembly configured in accordance with several embodiments of the present technology may alternatively include a supply tube or supply lumen having a curved and/or helical portion. Figure 13 illustrates a portion of the distal end portion 1304 of the elongated shaft 1306 defining the discharge passage opening at the distal end portion 13〇4 including a portion of the cooling assembly 13〇2^low (10) treatment device 13〇〇. The distal end portion 13A can have a delta step 1307, and the cooling assembly 1302 can include an applicator 13() 8 having a first heat transfer portion ^3〇09 and a second heat transfer portion 131G. The first heat transfer portion "09 and the second heat transfer portion 131" are elongated and radially spaced around the length of the cooling assembly = 〇2. The applicator 13 8 can also have a balloon 1311 that can be defined to produce and deliver a cryogenically cooled expansion chamber. The apparatus U (10) can further include an elongated guide member 1312 and a supply tube 1313 extending along the length of the shaft 13〇6. Within the balloon 1311, the supply tube 1313 can include a helical blade 1314 that exits the distal portion U04 and wraps around the distal portion (10) (e.g., distal (4) (10) to the central axis of the helical portion 1314). The cooling assembly 1302 can include a plurality of apertures spaced apart along the birch portion of the helical portion 1314 (identically identified as (4) a to 1316 small in a specific example of a month, if the helical portion [m becomes straight, the hole The ports 131 and 1316e will be generally radially aligned. In this particular example, the shape of the helical portion nu is such that the apertures 1316^i3i6e point in different radial directions. In other embodiments, the helical portions 1314 can have different numbers. 53 201223577 Mesh and/or oriented orifices l316a to l316e. The helical portion 1314 positions the orifices 1 3 1 6a to 1 3 1 6e closer to the balloon i3 than in the case where the supply tube 1312 is straight. This allows the refrigerant exiting the orifice 1316ai 131 to contact the balloon 1 311 at a higher velocity and increase the amount of convective cooling at the corresponding heat transfer portion of the balloon 13n. This also provides initial contact with the refrigerant. The size and spacing of the balloon 1311 are more controlled. (4) The cooling assembly configured by the material example of the present invention may include a distance of more than about (four) mm from the central longitudinal axis of the cooling assembly when the cooling assembly is deployed. For example big An aperture of about G" 匪, greater than about 0.5 or greater than about _). For example, t, the apertures in several embodiments may be about 0_01 mm from the central longitudinal axis of the cooling assembly when the cooling assembly is deployed. Between about 4 _ or about 〇丨 and about 2 mm. Similarly, a cooling assembly configured in accordance with several embodiments of the present technology may include less than about the balloon when the cooling assembly is deployed 4 _ (for example, less than about 2 _, less than about i _ or less than about 〇 5 mm). For example, f, in some specific examples, the hole 可 can be about a distance from the balloon when the cooling assembly is deployed. Between mm and about 4 mm or between about 5 mm and about 2 mm. Further, a cooling assembly configured in accordance with several embodiments of the present technology may include an aperture that is positioned such that the aperture is in the aperture The distance between the central longitudinal axis of the cooling assembly and the aperture of the swell is not less than about 20% of the distance from the central longitudinal axis to the inner surface of the balloon in the plane perpendicular to the longitudinal axis of the core (for example, not less than about 25%, 4〇% or 6〇%). In the specific example illustrated, the orifice i 3 j 6a, i 3 i 6c, i 3 i 6e generally point to the upper half of the balloon 1311, while the apertures m6b, m6d generally 54 on the 201223577 point to the lower half of the balloon 1 3 11. When the cooling assembly 1 3 〇 2 is deployed The flow of refrigerant through the orifices 1316a, 1316c, 13 16e produces a first heat transfer portion 1309, while the flow of refrigerant through the orifices U16b' 1316d produces a second heat transfer portion 1310. The first heat transfer portion 13〇 The 9 and second heat transfer portions 13 10 may have a higher overall heat transfer rate, particularly a convective heat transfer rate, relative to other heat transfer portions of the applicator i 3 〇 8 due to the flow of refrigerant. This change in heat transfer rate may correspond to the desired cooling pattern, such as a partial circumferential cooling pattern at some or all of the longitudinal segments of applicator 1308. In several embodiments, the first heat transfer portion 13〇9 and the second heat transfer portion 1310 have a heat transfer rate sufficient to produce a therapeutically effective renal neuromodulation, while in the first heat transfer portion 13〇9 and The portion of applicator 1308 between the two heat transfer portions 13 10 has a rate of heat transfer that is insufficient to produce a therapeutically effective renal neuromodulation. Figure 14 illustrates a portion of the cryotherapy device 1400 that differs from the device 1300 of the figure primarily in terms of ejection configuration. The device 14A includes a cooling assembly 1402 at a distal end portion 1404 of the elongated shaft 1406 defining a discharge passage. The distal portion 1404 can have a step 1407, a plurality of discharge openings 1408, and a rounded end 1409. The cooling assembly 14〇2 can include an applicator 1410 having a balloon 1411 having a distal neck 1412, and the balloon 1411 can define an expansion lumen configured to generate and deliver cryogenic cooling. Apparatus 1400 can further include a supply tube 1413 extending along the length of shaft 1406 and extending into balloon 1411. Within the balloon 1411, the supply tube 14丨3 can include a screw 55 that exits the distal portion 1404 and wraps around the distal portion 14〇4 (eg, the distal portion 1404 can define a central axis of the helical portion 1414) 201223577 The shape is 丨4丨4. The helical coil of the helical portion 1414 can be positioned between the discharge openings 1408. The cooling assembly 14〇2 may include a plurality of apertures (respectively identified as 141 to i4i6d) that are laterally spaced along the helical portion. In the illustrated embodiment, the distal portion 14〇4 is sufficiently narrow such that the helical portion 1414 wraps around the distal portion without substantially extending beyond the diameter of the axis 1406 adjacent the distal portion 14〇4. 4〇4 around. Accordingly, the cold section assembly 1402 can be configured to fit within the delivery sheath of a size sized according to the axis 〇6 in the delivery state. The plurality of discharge openings 14A8 can aid in the flow of the effluent and alleviate any flow restriction associated with the size of the distal portion 14A4. Thus, as discussed above, the relatively high density of the venting channel is expanded. The refrigerant can reduce the back-end portion 1 4 4 4 in the case where the back pressure is not necessarily caused to increase unduely. Similar to the apertures 1316a through 1316e of the device 13 of Figure 13, the apertures 1416a through 1416d of the illustrated embodiment are laterally spaced apart along the helical portion 1414. However, unlike the orifices 1316a through 13 16d of the apparatus 1300 of Figure 13, the orifices 1416a through 14i6d in the illustrated embodiment are configured to be oriented in different radial directions around the length of the cooling assembly 14〇2. Coolant flow. Specifically, the orifices 141 6a through 14 16d are configured to induce a flow of refrigerant in a direction that is radially spaced by an increment of about 90°. The orifices 14 1 6a through 14 1 6d are sized such that the respective heat transfer portions have greater than about 90. The arc. Thus, the projected circumference of the heat transfer portion corresponding to the apertures 14 1 6a through 14 1 6d is substantially completely circumferential and partially circumferential in a particular longitudinal segment of the cooling assembly 1402. Positioning the primary refrigerant expansion zone as discussed above with reference to Figure 133 56 201223577

Converging to the balloon can contribute to convective heat transfer. Figures 15A-15B illustrate portions of a cryotherapy device 1500 that can also be configured to position a primary cryogen expansion region closer to the balloon. The device 15A includes a cooling assembly 1502 at a distal end portion 15〇4 of the elongated shaft 15〇6 defining the discharge passage. The distal portion 1504 can have a step 15〇7, and the cooling assembly 15〇2 can include an applicator 1508 having an outer balloon 1510 that can be defined, configured to create and deliver a cryogenically cooled inflation lumen. The device 15A can further include a supply tube 1512 and an internal balloon 1514. Supply tube 1512 has a rounded end 1516 and is extendable along the length of shaft 1506 and through the outer balloon (10)

End part. The inner balloon 1514 extends around a portion of the supply tube MU within the outer balloon 151''. In several other specific embodiments configured in accordance with the teachings of the present invention, the supply tube 1512 terminates within an internal distributor (such as the internal balloon i5i4), and/or the device can include an extension that can be extended through the internal balloon and through the outer balloon 1510 The guiding part of the end part. Referring again to the specific example of apparatus 15a shown in Figures i5A through 15B, the portion of supply tube ι 512 within inner balloon i5i4 can include supply tube aperture 1518. The cooling assembly (10) may include internal balloon apertures π 152 分布 arranged in a spiral arrangement or other suitable arrangement on the inner balloon b i 4 . The inner balloon aperture σ 152 〇 can be, for example, a laser cut-out in the inner balloon 15U. When the cooling assembly 15〇2 is in a delivery state, the outer balloon 1 5 1〇 and the inner balloon 1 5 14 can be delivered into the outer sheath at least eight inches. VIII contraction to assemble when the cooling assembly 1 502 is deployed, the double agent can flow from the supply camp hole 1518 through the supply tube aperture 1518 and into the inner balloon ΐ 5 ΐ 4 'tube aperture 1518 can be large enough Allow the refrigerant to enter. Supply door #Pin ball 1514 and 57 201223577 Do not make a significant part of the liquid to inquire about the "liquid phase - a gas phase change" (for example, most liquid refrigerants). |also made ^ m ° in the state of the government, the internal balloon outside the supply tube 1512 1 5 1 4 internal; 丨 丨 ϊ ★ ★ 广 ★ ★ ★ ★ ★ ★ ★ ★ ★ ★ 绝对 绝对 绝对 绝对 绝对 绝对 绝对 绝对 绝对 绝对 绝对 绝对 绝对 绝对 绝对 绝对The absolute vapor pressure of the refrigerant in the supply tube portion is from about 100% to about 100% 'such as from about 20% to about 嶋 or about 33% to about 嶋. The first free passage area (equal to the inner balloon aperture σ 152〇) The total free passage area) may be smaller than the second free passage area (equal to the total free passage area of the supply tube orifice 1518). The size of the inner balloon aperture σ(10) may be selected and the number of the first free passage area may be controlled by the number. Similarly The first free passage area is controlled by a large j and/or number of supply tube orifices ΐ5ΐ8. The refrigerant may expand from the inner balloon 1514 through the inner balloon aperture 152 to cool one or more corresponding heats of the applicator 1508. Passing part. In detail, the inner balloon aperture 1520 can be configured to cool the generally helical heat transfer portion. Figures 16A-16B illustrate a cryotherapy device 16A that differs from the cooling assembly 1500 of Figure 15A in terms of external balloon shape. Device 16A includes cooling total In 1602, the cooling assembly 1602 includes an applicator 1604 having an outer balloon 16〇6 having raised spiral portions 16〇8 and recessed portions 1610. Raising the inner surface of the helical portion 16〇8 The expanded refrigerant can be configured to receive the inner balloon orifice 1 520, and raising the inner surface shape of the helical portion 1608 can help localize the increased convective cooling at the raised helical portion 1608. The recessed portion 16 10 is generally configured to not contact the renal artery or renal ostium. Localizing the increased convective cooling to raise the helical portion 16 6 can contribute to cooling efficiency and cooling position selectivity. The portion 1 608 may correspond to a heat transfer portion having a higher heat transfer rate than the other heat transfer 58 201223577 of the applicator 1604, such as a heat transfer portion corresponding to the concave portion 161G. For example, During operation, the raised helical portion 16G8 may correspond to a heat transfer portion having a heat transfer rate that produces a therapeutically effective renal neuromodulation, and another heat transfer portion of the applicator (eg, corresponding to The heat transfer portion of the recessed portion 161 / has a heat transfer rate that is less than X to produce a therapeutically effective renal neuromodulation. The guided type of transfer 17 Α to 22 Β illustrates that differential conduction heat transfer can be used to influence the treatment. Several specific examples of low/dish/alpha therapy devices. Features associated with conductive heat transfer via an applicator may contribute to one or more therapeutic goals of hypothermic renal neuromodulation such as desired localization or overall treatment Model. In a number of specific examples, such devices use a thermally insulating component to control conduction. Features associated with differential conduction heat transfer via an applicator may include, for example, other balloons (eg, non-cooling balloons and balloons with low cooling levels), differential compositions (eg, 'low thermal conductivity and high thermal conductivity materials ), differential thickness ' ('for example 'balloon wall thickness) and insulation structure (mn, inside the balloon or attached to the balloon wall of the elongated insulation). Figure 17B illustrates a portion of the cryotherapy device including the cooling assembly 17G2 at the distal end portion 1704 defining the elongate shaft 17〇6 of the venting channel. The distal portion 1704 can have a step 17〇7, and the total cooling force 17〇2 can include a balloon pi^ applicator configured to contact the renal artery or the renal orifice. The applicator i can further include a plurality of elongate members, the length of the elongate insulating members being substantially parallel to the length of the cooling year 1702 and radially spaced about the circumference of the cooling assembly 17G2. 59

fw-A 201223577 Balloon 1710 may define an expansion chamber configured to generate and deliver cryogenically cooled. The device 1700 can further include a supply tube i 7丨2 extending along the length of the shaft 17〇6 and extending into the balloon 171, and the cooling assembly i 7〇2 can include an aperture 1714 at the end of the supply tube 1712 . The heat insulating member 1711 can reduce conduction cooling through the adjacent portion of the balloon 171 while the cooling assembly 17 is in the deployed state. For example, the portion of the balloon mo between the insulating members 丨7丨1 may have a heat transfer rate sufficient to produce a therapeutically effective renal neuromodulation, while the balloon portion at the insulating member ηι丨 may have a lower heat transfer The rate, such as a rate of heat transfer that is insufficient to produce a therapeutically effective renal neuromodulation. The insulating component 1711 can be elongated and generally continuous along the length of a portion of the applicator 1708. Accordingly, the heat transfer portion corresponding to the portion of the balloon 1710 between the heat insulating members 丨7 11 may be substantially non-circular at the longitudinal section of the cooling assembly 17〇2. The heat insulating member 1711 may include a raw material having a thermal conductivity lower than or equal to the thermal conductivity of the raw material of the balloon 171A. In several embodiments, the insulating member 1711 has a different composition than the balloon 171 and is attached to the inner surface of the balloon. Several other specific examples may include a heat insulating member 1711 that is similar (e.g., identical) or different in composition to the balloon ΐ7ι. Raw materials suitable for the heat insulating member configured in accordance with several specific examples of the present technology include adiabatic polymeric foams (e.g., polyamine phthalate foams). In several embodiments, the insulating component 1711 can be integrally formed with or coupled to the balloon 1710. Fig. 18A to Fig. 8B illustrate a portion of the cryotherapy device 18A similar to the device 17A of Figs. 17-8 to 17B except for the configuration of the heat insulating member. 201223577 - Insulation components configured in accordance with several embodiments of the present technology may have different insulating properties than the deployed state in the delivery state. For example, in the » deployment state, the insulation component can be configured to be filled with a filler material. Apparatus ' 1 800 includes a cooling assembly 1 8〇2 having an applicator 1 8〇4 having a balloon 1806 that defines an expansion chamber configured to produce and deliver cryogenically cooled. The applicator 1 804 also includes a plurality of insulating members 1808. The device 180A may further include a fill tube 18 丨〇, and the insulating member 18 8 may be configured to be filled via the fill tube 1 8 1 在 in the deployed state. In the particular embodiment illustrated, the fill tube 1810 includes a main portion 1812 and four branches 1814, wherein the branch fluids connect the main portion to one of the insulating members 18 8 . The insulating member 108 08 and the filling tube 1 8 1 流体 are fluidly separated from the expansion chamber in the balloon 806. The fill tube 1 8 1 0 has a proximal portion (not shown) configured to receive a fill material from a source of filler material (not shown) outside of the vascular structure. The fill tube 1 810 and the insulating member 1 〇 8 can be configured to fully, largely or partially contract in the delivery state. This configuration can be used to allow the introduction of fluid fill material in the delivery state without the need to vent a replaced gas. Several other specific examples can include a substantially non-shrinkable fill tube and a thermally insulating member configured to receive a replacement gas or liquid from the fill tube. The proximal portion of the fill tube configured in accordance with several embodiments of the present technology can be fluidly coupled to a fill port such as a fill port including a syringe adapter, such as including a needle configured to be pierced with a syringe containing a filler material. Syringe adapter for the diaphragm. The fill port can be configured to reduce (eg, prevent) air passage, for example, before, during, and/or after the fill material passes. However, in the dry example of 61 201223577, air may be suitable for the filling material. Other components of the cryotherapy device including the fill tube configured in accordance with several embodiments of the present technology, including the specific examples described herein, may be grouped in a similar manner. Filling materials suitable for use in cryotherapy devices configured in accordance with several embodiments of the present technology include liquids (e.g., saline), gases (e.g., air), biologically inert materials, and radiopaque materials (e.g., contrast agents). Although four insulating members are shown in Figures (10), a cooling assembly configured in accordance with several embodiments of the present technology can include any suitable number of insulating members such as at least one or more insulating members. Moreover, the thermally insulating component configured in accordance with several embodiments of the present technology may generally be a separate component or a single component, and may have a variety of suitable shapes. 19A to 19C illustrate a portion of the cryotherapy device 19. Referring to Figure 19A, device 1900 can include a cooling assembly 19〇2 at a distal end portion 19〇4 of an elongated shaft 1906 defining a discharge passage. The distal portion dm can have a step 1907, and the cooling assembly 19〇 can include an applicator 1908 having a balloon 191 that can define an expansion lumen configured to generate and deliver cryogenic cooling. The device 19 can further include Extending along the length of the shaft 19〇6 and extending into the supply tube 1912 in the balloon i91〇, the cooling assembly 19〇2 may include an aperture 19丨4 at the end of the supply tube 1912. The device 19 can be advanced to include a helical insulating member 1916 which can be, for example, a thicker portion of the balloon 191 having an additional thickness at the inner surface of the balloon 1910 (i.e., the outer surface of the balloon 1910 is substantially It is smooth, or otherwise flat around the spiral heat insulating member 1 916 and around the spiral heat insulating member 19^6. The spiral heat insulating member 1916 may correspond to the applicator 19〇8 having a lower heat transfer rate than the other portions of the applicator 19〇8 during the operation period 201223577 when the cooling assembly 19〇2 is in the deployed state. The heat transfer part. For example, the rate of heat transfer away from the portion of the applicator of the helical insulating member 1916 may be sufficient to produce a therapeutically effective renal neuromodulation during operation, while the portion of the applicator 1908 at the helical insulating member 916 is The rate of heat transfer may not be sufficient to produce a therapeutically effective kidney god: regulation. 19B and 19C are cross-sectional views at different longitudinal positions of the applicator 19〇8. As shown in Fig. 19B and Fig. 19C, the circumferential position of the spiral heat insulating member (4) is varied along the length of the cooling assembly 19 () 2 so that the portion of the balloon measured away from the spiral heat insulating member 1916 is along the cooling assembly 19 〇. The longitudinal segments of length 2 are generally non-circular. 20A to 20C illustrate a portion of the cryotherapy device 2 similar to the device 1900 of Figs. 19 to 19C except for the shape of the heat insulating member. Referring to Figure 20A, device 2000 includes a cooling assembly 2002' having an applicator"2'. The applicator has a balloon 2_ that can define an expansion chamber configured to produce and deliver cryogenically cooled. The applicator 4 also includes a thermal insulation component 2008 that is substantially similar to an interlaced double helix (e.g., an entangled right handed helix and a left handed helix). The heat transfer portion of the applicator 2〇〇4 in the heat insulating portion 2 substantially separates the heat transfer portion of the applicator 2GG4 from the heat insulating member 2. The heat insulating member 2 0 0 8 can be smashed and can be moved between the delivery state and the deployed state by the suffix, the person aa J left, and the sorrow® cold assembly 2002.砵2000 starts to shrink and/or expand. For example, if the balloon 2006 is generally rabbit, it can be a baby. u ^ If the forging is flexible and non-compliant, then the insulating member 2000 can be substantially wall-walled or lls--supplied and compliant or non-compliant. If the balloon 2006 is generally compliant, only the 丨 则 则 则 则 则 则 则 则 2008 2008 2008 2012 2012 2012 2012 2012 2012 2012 2012 2012 2012 2012 2012 2012 2012 2012 2012 2012 2012 2012 2012 2012 2012 2012 2012 2012 2012 2012 2012 2012 2012 2012 2012 2012 Figure! The heat insulating member i7i6, the brain shown in Figs. 7A to 18B, and the spiral heat insulating member 916 shown in Figs. 19A to 19B are configured with respect to the respective balloons (four), positions, and chests. In some embodiments of the present invention, the thermal modulus of the insulating member is between about 5 G% and about 15 G% of the elastic modulus of the respective balloon, such as between about 〇 and about 14% or about 33%. About 130%. The insulating member configured in accordance with other embodiments of the present technology may be fully or partially coupled to the respective balloon, or in other embodiments, the insulating member may not be attached to the balloon. When the insulating member is only partially connected or not connected to the corresponding balloon, the expansion and/or contraction of the corresponding balloon may be relatively independent of the insulating member. 21A-21C illustrate a portion of a cryotherapeutic device 2100 that includes a cooling assembly 2丨〇2 at a distal end portion 2丨〇4 of an elongated shaft 21 〇6 defining a discharge passage. The distal portion 2104 can have a step 2107 and a rounded lip 2108. The cooling assembly 2102 can include an applicator 2109 having a balloon 2110. The balloon 2110 has a distal neck 2111, and the balloon 2110 can define an expansion lumen configured to generate and deliver cryogenic cooling. The device 2 can further include an elongated guide member 2112 and a supply tube 2114 extending along the length of the shaft 2106 and extending into the balloon 2110. Cooling assembly 2102 can include an orifice 2116 at the end of the supply tube. In the illustrated embodiment, the guiding member 2112 extends to the distal neck 2111. The applicator 2109 further includes a first elongated thermal insulation member 2 11 8 and a second elongated thermal insulation member 2 120. Instead of the balloon 2110°, the first elongated thermal insulation component 2118 and the second elongated thermal insulation component 2120 are instead attached, and the first elongated thermal insulation component 2118 and the second elongated thermal insulation δ 64 201223577 邛 2120 are attached to the inner surface of the distal end portion 2104. When the cooling assembly 2102 is in the deployed state, the first heat insulating member 2 ι 8 and the second heat insulating member 212 are movable relative to the balloon 2 (10) in response to gravity. The first heat insulating member 2118 and the second heat insulating member 2m are movable over the circular lip 2 (10) as they settle in the balloon. As shown in Fig. 2ia, the first heat insulating member 2118 and the second heat insulating member 2120 can be settled along the P 邛 under the balloon 211〇. As shown in Fig. 2 i B, the first heat insulating member 2 11 8 and the second heat insulating member 212 () have a cross-sectional area similar to a rounded triangle. In other specific examples, similar insulating members may have different cross-sectional areas. The circular triangular cross-sectional area may be particularly useful for increasing the contact area of the sides of the substantially unconnected insulating member with the inner surface of the balloon while preventing overlapping of a plurality of substantially unconnected insulating members. Referring to Figure 21C, the device 21A in the delivery sheath 2122 is shown in a delivery state. As shown in Fig. 21C, in the delivery state, the first heat insulating member 2118 and the second heat insulating member 212 are contracted together with the balloon 2 11 . 22A through 22B illustrate a portion of the cryotherapy device 2200 similar to the device 2100 of Figs. 2a through 21C, except for the configuration of the insulating member. Apparatus 2200 includes a cooling assembly 22A having an applicator 2204 having a balloon 2206 that defines an expansion chamber configured to produce and deliver cryogenically cooled. The applicator 2204 also includes a first elongated thermal insulation component 2208 and a first thermal insulation component 2210®. The device 2200 can further include a fill tube 2212, and the first thermal insulation component 2208 and the second thermal insulation component 2210 can be configured to be deployed in a deployed state. The fill tube 2212 is filled. The fill tube 22 12 can include a hub 2214 that branches at the hub 2214 into a first insulation 65 201223577 component 2208 and a second insulation component 2210. The first insulating member 2208 and the second insulating member 2210 and the filling tube 2212 can be fluidly separated from the balloon 2206 as discussed above with reference to the insulating member 1 8 〇 8 of the device 1 800 of FIG. 18A to FIG. . The fill tube 22 12 can have a proximal portion (not shown) configured to receive a fill material from outside the tubular structure. The fill tube 2 2 1 2 and the first insulating member 2208 and the second insulating member 2210 can be configured to fully, largely or partially contract when the cold heading assembly 2202 is in a delivery state. A cooling assembly configured in accordance with several embodiments of the present technology may include one or more insulating members having various suitable shapes to create different types of heat transfer portions around the applicator. For example, the pattern can be selected such that the substantially uninterrupted heat transfer portion at the insulating member can be large enough to adequately localize therapeutically effective cooling for renal neuromodulation (eg, 2 for kidney, _ section) In other words, therapeutically effective cooling does not generally cross the heat transfer portion at the extrudate). Additionally or alternatively, the heat transfer portion spaced apart by the pattern of insulating members may be selected to be large enough to allow for proportionality, such that if the cooling heat transfer is too small as the heat transfer portion of the area that is separated by the heat transfer portion, the nerve is passed through The adjusted total heat transfer may not be sufficient to produce a therapeutically effective cooling for kidney D. FIG. 23A to FIG. 3 are specific examples of the hypothermia treatment device including a complex balloon, or more: the therapeutic doped balloon can contribute to the same size and size as the hypothermic renal nerve regulation. The target, such as the desired localization or overall treatment type Q, is occlusion. Complex balloons can have a variety of suitable properties, 66 201223577 • Such as shapes (eg spiral, curved, longitudinal asymmetry and radial asymmetry), 'surface differences (eg recesses, grooves, protrusions and protrusions) and differential expansion* (eg partially restricted expansion). Figures 23A-23B illustrate a portion of a cryotherapy device 23 00 that includes a cooling assembly 2302 at a distal end portion 23〇4 of an elongated shaft 23 00 defining a discharge passage. The distal end portion 23A can have a step 2307, a first discharge port 23 08, a second discharge port 23〇9, and a rounded end 231〇. The cooling assembly 2302 can include an applicator 2311 having a first balloon 2312 defining a first inflation lumen and a second balloon 2313 defining a second inflation lumen. The first balloon 2312 and the second balloon 2313 are fluidly connected to the discharge passage via the first discharge port 2308 and the second discharge port 2 3 0 9 , respectively. The device 2300 can further include a supply tube 2314 extending along the length of the vehicle 2306, and the cooling assembly 2302 can further include a first aperture 2316 and a second aperture 2318. The first orifice 2316 is aligned with the first discharge port 2308 such that the refrigerant expands through the first discharge port 23 08 and into the first balloon 2312, and the second orifice 2318 is aligned with the second discharge port 2309 to cause The refrigerant expands through the second discharge port 23〇9 and enters the second balloon 23 13 . The first balloon 23 12 and the first balloon 23 13 are spaced apart along the length of the cooling assembly 230.2 and are configured to expand laterally across different portions of the arc along the length of the cooling assembly 2302. When the cooling assembly 2302 is in a deployed state, the first balloon 2312 can be configured to contact a first portion of the circumferential portion of the renal artery or the small lumen inner surface, and the second balloon 23 13 can be configured to contact the renal artery or The second partial circumferential portion of the inner surface of the renal orifice. The first partial circumferential portion and the second partial circumferential portion may have a combined projection of the phoenix circumference in a plane perpendicular to the length of the renal artery or the small renal opening. Accordingly, when treatment requires partial circumferential cooling and a full circumferential overall cooling pattern at the longitudinal segments, the cooling assembly 2302 can be configured to facilitate the treatment without repositioning the cooling assembly during treatment 23 02 . While both the first balloon 23 12 and the second balloon 23 丨 3 are deployed, they can push each other toward the generally opposite side of the renal artery or the inner surface of the renal orifice. For example, 5, the distal portion 23〇4 can transmit a force between the first balloon 23 12 and the second balloon 2313, while the portion adjacent the distal portion of the shaft 23〇6 maintains the distal end. The file is substantially parallel to the kidney. The length of the arteries or kidneys. During this and other operations, the cooling assembly 23〇2 can be configured to be non-occlusive (i.e., not completely occluding the renal artery or renal ostia). For example, the cooling assembly 23〇2 can be configured to allow a percentage of normal blood flow (eg, at least about 1%, at least about 10%, or at least about 25% of normal ash flow) through the renal artery or small kidney D FIGS. 24A to 24B illustrate a portion of the cryotherapy device 24 that is different from the device 2300 of FIGS. 23A to 23B mainly in terms of discharge configuration. Apparatus 2400 & includes a cooling assembly 24〇2 at the distal end portion 2404 of the elongated vehicle defining the discharge passage. The distal end portion 24A can have a step 2407, a first discharge port 24〇8, a second discharge port 24〇9, and a round end = 2410. The cooling assembly 24〇2 can include an applicator 2411 having a first balloon 24丨2 defining a first inflation lumen and a second balloon 2413 defining a second inflation lumen. The first balloon 2412 and the second balloon 2413 are fluidly connected to the discharge passage via the first discharge port 2408 and the second discharge port 2409, respectively. The device 24A can further include a length extending along the length of the shaft 2406 and having a first lateral branch

68 201223577 • 2416 and supply tube 2414 of the second lateral branch 2418. The cooling assembly "Μ" may further include an opening to the first balloon 2412 at the end of the first lateral branch 2416 - the opening 242 () and the second balloon 2413 at the end of the second lateral branch mu Second aperture 2422. Unlike device 23A, which is not shown in Figures 23A-23B, device 24A includes a circumferentially opposite side of distal portion 2404 and for first balloon 2412 and second balloon "n" Refrigerant supply and refrigerant discharge device. The first balloon 2412 and the second balloon 2413 extend around a fully circumferential longitudinal segment of the distal portion 24〇4, but are coupled to the distal portion 2404 and shaped to expand asymmetrically about the distal portion 24〇4. The cooling assembly configured in accordance with several embodiments of the present technology may include a number of partial circumferential balloons different from the cooling assemblies 23〇2, 24〇2 shown in Figures 23A-24B. For example, in a number of specific In an example, the cooling assembly 2302 can include the first balloon 2312 or the second balloon 2313 instead of including both. Similarly, the cooling assembly 24〇2 may include the first balloon 2412 or the second balloon 2413 instead of including both. The cooling assemblies 2302, 2402 shown in Figures 23A-24B may also include a greater number of balloons, such as 3 or 4 balloons spaced longitudinally and radially apart. In addition, the size of the balloon can vary. For example, in several specific examples, the first balloon 2312 and the second balloon 2313 of the cooling assembly 23〇2 or the first balloon 2412 and the second balloon 2413 of the cooling assembly 24〇2 are configured to provide a partial circumference. Overall cooling pattern. Cooling assemblies configured in accordance with several embodiments of the present technology may include applicators having balloons that have various suitable surface characteristics, such as being configured to facilitate separate or combined with a fully circumferential overall cooling pattern. Ο J! 69 201223577 The surface characteristics of the partial circumferential cooling at the longitudinal section. Figure 25 illustrates a portion of a cryotherapy device 25 that includes a cooling assembly 2502 at a distal end portion 2504 defining an elongated shaft 2506 of the venting channel. The distal portion has σ.Ρό 2507' and the cooling assembly 2502 can include a balloon having a defined expansion lumen and having a distal neck 2 5 11 , a helical recess 2 5丨2, and a non-recessed portion 2 5丄3 2510 applicator 2508. The device 2500 can further include an elongated guide member 2514' extending through the distal neck portion 2511 and a supply tube 25A6 extending along the length of the shaft 25〇6 and extending into the balloon 25. The cooling assembly 2502 can further include an aperture 2518 at the distal end of the supply tube 2516. When the cooling assembly 2502 is in a delivery state, the helical recess 2512 can correspond to a heat transfer portion of the applicator 2508 having a lower heat transfer rate than a portion of the applicator 2508 spaced apart from the helical recess 2512. . The space between the helical recessed region 2512 and the inner surface of the renal artery or renal small opening at the treatment site allows the portion of the renal artery or renal orifice closest to the helical recessed region 25丨2 to be at a low temperature in the balloon 251 Insulation. For example, frozen or liquid blood within this space can provide thermal insulation. The depth of the helical recessed region 2512 relative to the non-recessed portion 2513 can be, for example, corresponding to a thickness of a material (eg, liquid or frozen blood) sufficient to insulate the renal artery or renal orifice from the cryo-cooling within the balloon 251G. depth. For example, the depth can be between about 0.2 mm and about 2 mm, such as between about 3 mm and about mm. In several other specific embodiments of the cryotherapy device assembly described herein, the concave portion of the balloon can have a similar depth relative to the non-recessed portion of the balloon. Figure 26 illustrates a portion of another embodiment of a cryotherapy device 26 that includes a cooling assembly 26602 at the end portion 2604 at a distance 70 23 6 defining the venting passage. The distal portion 2604 can have a step 26〇7, and the cooling assembly 2602 can include an applicator having a balloon 2610 defining an inflation lumen and having a distal neck portion 2611, a plurality of concave regions 2612, and a non-recessed portion 2613 2608. The recess 2612 can be configured to surround the circumference of the balloon 2610 in a helical pattern. The cooling assembly 2602 can further include an elongated guide member 2614 that extends through the distal neck portion 2611. Device 2600 can also include a supply tube 26 16 that extends along the length of shaft 26〇6 and that extends into balloon 2610. Cooling assembly 2602 can further include an aperture 2618 at the distal end of supply tube 2616. When the cooling assembly 2602 is deployed, the function of the recessed portion 2612 and the non-recessed portion 2613 can be similar to the helical recessed portion 2512 and the non-recessed portion 2513 of the device 2500 shown in FIG. Figures 27A-27C illustrate a cryotherapy device 2700 <- portion similar to device 2600 of Figure 26, but device 2700 is configured to have a smaller occlusion in the renal artery or renal ostium compared to device 2600 of Figure 26 Sex. Apparatus 2700 includes a cooling assembly 2702 at a distal end portion 2704 of an elongated shaft 2706 defining a discharge passage. The distal portion 2704 can have a step 2707, and the cooling assembly 2702 can include a defined expansion lumen and having a proximal branch 271, a tubular main portion 2712, a distal branch 2713, a plurality of recesses 2714, and a non-recessed portion 2716. The applicator 2708 of the balloon 2710. A plurality of recesses 27 14 can be configured to surround the circumference of the balloon 27 1 in a spiral pattern. When the cooling assembly 2702 is in a deployed state, the function of the recessed portion 2714 and the non-recessed portion 2716 can be similar to the recessed portion 2612 and the non-recessed portion 2613 of the device 2600 shown in Figure 26t. The proximal branch 2711 can be configured to fluidly connect the tubular primary 71 201223577 portion 2712 to the exhaust passage. The device 2700 can further include an elongated guide member 2718 that can extend along the length of the shaft 2706 and that is coupled to the distal branch 2713, and extends along the length of the shaft 2706, through one of the proximal branches 2711, and extends to the tubular main portion 2712 Supply tube 2 720. The proximal branch 2711 and the distal branch 2713 can be configured to space the tubular major portion 2712 from the guiding member 2718. The cooling assembly 2702 can further include an aperture 2722 at the distal end of the supply tube 2720. When the cooling assembly 2702 is in a deployed state, the cooling assembly 2702 can define a flow path (e.g., a blood flow path) between the outer surface of the guiding member 27 1 8 and the balloon 27 1 0. For example, the flow path can extend around the proximal branch 2711, through the tubular main portion 2712 (e.g., between the guide member 2718 and the inner surface of the tubular main portion 2712) and around the distal branch 271 3 . As shown in Figure 27B, the tubular main portion 2712 can include an insulated inner portion 2724 that surrounds the flow path. The adiabatic inner portion 2724 can be configured to at least partially insulate the fluid in the flow path from the cryogenic cooling within the tubular main portion 丄2. In the illustrated embodiment, the insulated inner portion 2724 can be part of the balloon 2710 having a greater thickness than the other portions of the balloon 271. In several other embodiments, the adiabatic inner portion 2724 has a different composition than the other portions of the balloon 271 and/or includes one or more separate insulating structures. Alternatively, the balloon 271A can include a tubular main portion 2712 having an inner portion that is not more thermally insulated than other portions of the balloon 2731. Figure 28 illustrates a portion of a cryotherapy device 2800 similar to device 2600 of Figure 26 except for the configuration of the recessed and non-recessed portions. Apparatus 28〇〇 72 201223577 includes 2 a cooling assembly 28〇2 having an applicator 2804 having a balloon 28〇6 with a detonable expansion chamber. The balloon 28〇6 includes a plurality of protrusions 2808 and a non-dog-up portion 281〇. The projections 28〇8 can be configured to surround the circumference of the balloon 28〇6 in a helical pattern or other suitable pattern. When the cooling assembly 2802 is in the delivery state, the non-protruding portion 281A can correspond to the heat transfer portion of the applicator 2804 having a lower heat transfer rate than the applicator portion at the protrusion 2808. The space between the non-protrusion portion 2810 and the inner surface of the renal artery or renal ostium at the treatment site may insulate the portion of the renal artery or kidney π that is closest to the non-protrusion portion from the cryogenic temperature within the balloon 28 () 6. For example, the frozen or liquid jk liquid in this chamber can provide thermal insulation. Eight balloons of different shapes can contribute to certain treatment tickets associated with hypothermic renal neuromodulation. For example, the helical shape can contribute to the desired localization or overall treatment profile. Figure 29 illustrates the portion of the cryotherapy 4 set 00 comprising the cooling assembly 29〇2 at the distal end portion 29〇4 of the elongated shaft 29〇6 of the venting channel. The distal portion 2904 can have a step 2907, an exit aperture 2908, and a discharge port 29〇9. The cooling assembly 29〇2 can include an applicator 2910 having a helical balloon 2911 defining a balloon lumen and having a balloon proximal portion 29 12 and a balloon distal portion 29 14 . The balloon proximal portion 2912 has a weak "body connection" to the exit channel via the exit aperture 2908. The balloon distal end portion 2914 is coupled to the outer surface of the distal end portion 2904 around the discharge opening 2909 to fluidly connect the helical balloon 2911 to the discharge passage. The helical globule 2911 is wrapped around the distal end portion 29〇4 (e.g., the distal portion μ(10) defines a central axis of the helical balloon 291丨. The device 29〇〇 can further include a sinusoidal supply lumen and has an axis along the axis 29〇 The main portion of the length extension of 6 is 201223577 291 8 and the supply tube 2916 of the inclined distal end portion 2920 of the shaft 2906 is retracted through the exit hole 2908. Cooling her into 2Qno + _ Ω Ρ 成 ~ 2902 may also include tilting The distal end of the distal portion is 2922. The supply tube 2 s 2916 and the aperture 2922 can be grouped - the refrigerant in the longitudinal direction substantially corresponding to the proximal portion 29 of the balloon: toward: inwardly expanding to the balloon In the end portion 2912, when cooling the state of the assembly, the refrigerant may flow from the balloon proximal portion 2912 to the balloon: the P blade 2914 flows 'and then flows proximally along the discharge channel. Upon reaching the balloon distal portion 2914 Thereafter, the refrigerant may have consumed some, most, or all of the low temperature cooling capacity. Figure 30 illustrates a portion of the cryotherapy device that is different from the figure in the direction of flow of the refrigerant: Device 3_included in definition The cold portion assembly 3002 of the distal portion of the elongated shaft of the passageway. The distal portion 3〇〇4 may have a stepped 靡 and the cooling initiation may include a defined expansion chamber and a balloon proximal portion And the applicator of the helical balloon 3〇14 of the distal portion 3018 of the ball. The proximal portion of the balloon can be attached to the outer surface of the distal portion 3_ adjacent to the distal end of the distal portion 3_, thereby The balloon is fluidly connected to the discharge passage. The device side may further include a supply tube 3019 having a curved distal end portion 3〇2〇. The spiral balloon 3〇14 may be wrapped around the supply tube 3(4) (for example, the supply tube 3〇) 19 can define a spiral balloon "in the middle, the axis". The supply tube 3〇19 can extend along the length of the shaft 3_, and extend the heart to extend the outer part of the balloon, along the spiral balloon 3〇14 The heart axis extends and extends into the distal portion of the balloon. The balloon distal portion 3〇16 can be sealed around the supply tube side and at least partially connected to the distal end portion of the f-curve

S 74 201223577 3020. The cooling assembly 3002 can further include fluidly connecting the supply tube 3〇i9 to the aperture 3021 of the balloon distal end portion 3018. The supply tube 3〇19 and the orifice 3〇2i can be configured to cause the coolant to expand into the distal portion of the balloon in a direction generally corresponding to the longitudinal orientation of the balloon distal portion 3018. When the cooling assembly 3002 is deployed, the refrigerant can flow from the balloon distal portion 3018 to the balloon proximal portion 3016 and then flow proximally along the discharge channel. Figure 3 illustrates a portion of the cryotherapy device 3 00 that is similar to the device of Figure 3 except for the shape of the helical balloon. The device 3丨〇〇 includes a cooling assembly 3102 at the distal end portion 3 1 04 of the elongated shaft 3 1 06 defining the discharge passage. The distal end portion 3104 can have a step 3108, and the cooling assembly 31〇2 can include definitions The applicator 311A of the spiral balloon 3112 that expands the lumen and has a balloon proximal portion 3丨M and a balloon distal portion 3116. The balloon proximal portion 3114 can be coupled to the outer surface of the distal portion 3104 adjacent the distal end of the distal portion 31〇4 to fluidly connect the helical balloon 3112 to the discharge channel. The device 3100 can further include a supply tube 3 11 7 having a distal end portion 3丨丨8. The spiral balloon 3 112 can be wrapped around the supply tube 3 11 7 but can also be radially spaced from the supply officer 3117. The supply tube 3117 can extend along the length of the shaft 3106, extend out of the shaft 3 106, extend out of the balloon proximal portion 3丨14, extend along the central axis of the helical balloon 3 112 and extend into the balloon distal portion 3116. The balloon distal portion 3U6 can be sealed around the supply tube 3117. The cooling assembly can further include fluidly connecting the supply tube 3丨17 to the orifice 3 119 of the balloon distal portion 3 116. When the cooling assembly 3 102 is in the state of being deployed, the refrigerant may flow from the balloon distal portion 3 116 to the balloon proximal portion 3丨14, Ο 75 201223577 and then along the discharge channel to a proximal diameter may help The eight-hearted I-shaped balloon 3U2 wide spiral, knife and soil. For example, when the cooling 铯3 3 02 is deployed, cooling her #^田7 Ρ~3102 Ρ Ρ 3102 can be defined outside the supply pipe 3117 and the spiral balloon 311 chuan 7 The flow path between the appearances (for example, the blood flow path). Fig. 32A to Fig. 32R%, 6 may have one of the low temperature treatment devices 3200 corresponding to the complicated shape of the molded part (such as the shape of the cuckoo). As discussed above, in a plurality of and configured hypothermia devices according to the present teachings, the centered milk ball can be at least partially retracted from when the corresponding cooling assembly is in a delivery state to the cooling assembly. When deployed, the 刀 4 knife expands. When inflated in the deployed state, the complex balloon can have a predefined shape (e.g., molded or otherwise incorporated into the overall shape of the balloon) or corresponding to the shape of the separately formed structure. The cryotherapy device 3200 shown in Figures 32a-MB includes a cooling assembly 32〇2 at a distal end portion 32〇4 of the elongated shaft 3206 defining the discharge passage. The distal portion 32〇4 can have a step 3207, and the cooling assembly 32〇2 can include an applicator 32〇8. The device 3200 can further include an elongated profiled member 321 and a supply tube 3212 having a sloped distal end portion 3214. The applicator 3208 can include a balloon 3216 having a distal seal 3217. Balloon 3216 can extend around elongated shaped member 3210 and can define an expansion lumen. The distal seal 3217 can be the flattened portion of the balloon 32 16 . The walls of the balloon 32 16 are sealed together here (e.g., with heat and/or with an adhesive). A balloon configured in accordance with several other embodiments of the present technology can have another type of closed distal end. As discussed above, the balloon can be closed around a structure such as a guide member and/or supply tube. The balloon can also be closed around the plug. Additionally, the balloon can have an integral closed distal end. 76 201223577. By way of example, t, the balloon can be molded over the mold (e.g., dipped) with an integral closed distal end. • The crucible forming component 3210 can be configured to have a generally linear configuration when the cooling assembly 3202 is in a delivery center and has a curvilinear configuration when the cooling assembly 3202 is in a deployed state. The cooling assembly 32〇2 can also include an aperture 3218 at the distal end of the angled distal end portion 3214. The supply tube 3212 and the orifice w18 can be configured to cause the coolant to expand into the balloon 3216 in a direction generally corresponding to the longitudinal orientation of the balloon KM adjacent the orifice 3218. The balloon 3216 has a shape that at least partially corresponds to the curved configuration of the molded part 3210 in the deployed state. The illustrated configuration of the curve is generally a spiraled kernel or may be another shape, such as a serpentine shape. The molded part 3 21 may have shape memory (e.g., one-way shape memory or two-way shape memory), and may include a shape memory material such as a nickel-titanium alloy (e.g., nitinium). The shape memory may allow the molded part 321 and the balloon 3216 to move to a pre-selected configuration (e.g., curved, curved, spiral or serpentine configuration) in the deployed state. For example, the configuration can be selected to allow the applicator 32〇8 to apply the desired localized or overall treatment pattern. Similarly, the helical shape and other shapes shown in Figure 32A can be selected to provide a degree of occlusion at the treatment site, such as partial occlusion rather than complete occlusion. When exposed to cryogenic temperatures, the shape delta recall material may lose some or all of the molding properties. Configurations according to several embodiments of the present technology <cooling assembly 32〇2 may include moving to a balloon 3216 in a pre-selected configuration corresponding to the shape of the molded component 32丨〇 prior to or during preliminary cryogenic cooling. . When cryogenic cooling causes the molded part 3210 to lose some or all of the molding properties, the low temperature adhesion between the balloon 3216 and the outer material 77 201223577 (eg, blood and/or tissue) allows the balloon to maintain its pre-selected configuration at least until low temperature The adhesion ends. In the particular example illustrated in Figures 32A-32B, the molded component 3210 is generally shown in the center of the balloon, i.e., the balloon 3216 is substantially uniformly expanded around the 尧-shaped member 32 1 Q. Alternatively, the molded part 321G may have a different position within the balloon 3216 when the cooling assembly is in a deployed state. For example, the molded part 321() can be near the inner surface of the balloon 3216. When the molded member 321 is spaced apart from the wall of the balloon 3216, the balloon Kb can cause pressure and dissipate acting on the renal artery or the renal orifice. As shown in Figure 32A, the molded component 3210 can extend through the distal seal 3217. Alternatively, the molded component 321" is not attached to the balloon 3216 and/or terminates at a portion of the apertured ball 3216 adjacent the distal seal a. Further, the distal end of the molded component 3210 can be configured to be spaced apart from the renal artery or orifice when the cooling assembly 3202 is deployed. In some embodiments, the balloon 3216 is configured to generally surround the molded component 3210 without any internal support structure: uniform expansion. Alternatively, the balloon 3216 can include an internal structure (eg, a mesh) extending across the interior of the balloon 3216, and the molded component 3210 can be coupled to the interior at a location spaced from the inner surface of the balloon 3216. structure. The internal structure of the two 1 may be a partition between separate balloons (example > as illustrated in Figure 45A to Figure). In some specific examples, it is extended along the central axis of the balloon 3216 in the deployed state. Structure. For example, in the deployed state, the distal portion 3 can extend along the central axis, and the balloon 3216 and the molded member 3210 can be laterally open at the distal portion 3204. As another example, the far end

The S 78 201223577 portion 3204 can include a reduced diameter extension extending along a central axis of the balloon 32A6 and a further opening that fluidly connects the balloon 3216 to the discharge passage independently of the reduced diameter extension. The structure extending along the central axis of the balloon 32丨6 can include an internal cavity (e.g., configured to receive a lumen of a guide or control line) >>> device (e.g., filter) and/or monitoring device (e.g., Thermocouple or pressure transducer). Device 3200 can be modified for non-hyperthermia therapeutic applications. By way of example, the supply tube 32丨2 can be removed and the device 3200 can be used to benefit from other applications at the treatment site that are not fully occluded. In renal neuromodulation applications and other applications, the balloon 3216 can be non-occlusive in the deployed state, e.g., can form a blood flow path along the central axis of the balloon 3216. In some non-cryogenic treatment applications, the distal portion 3204 can support a configuration configured for vascularization (e.g., a resection), while the balloon 3216 tints the device 3200 to the vessel wall. In these and other embodiments, the balloon 3216 advantageously maintains the distal portion 3204 in a central position within the blood vessel. • A to Figure 33D can have a predefined bend = cryotherapy device 330 in the deployed configuration. Part of it. The device 33A includes a total cooling = 2 at the distal end portion 3304 of the elongated shaft 3306 at the I 3302 exit ramp. The distal portion 3304 can have a step 33〇7, and the cooling assembly 33〇2 can define an applicator 3308 of the balloon 331° of the inflation lumen. The balloon has a balloon proximal portion 3312 and a balloon distal portion 3316. The device 33 is slid into and out of the 311 « 冷却 including the cooling assembly 33G2 extending along the shaft 3306 and may have an aperture in the proximal portion 3312 of the balloon. Cooling assembly

79 201223577 3302 is in a deployed state, the balloon 33 1〇 is curved along its length and has a generally concave first-wall cut-out shown as a lower portion of the balloon in M 33A) and a substantially non-recessed (eg, convex) second wall 3324 (Shown as the upper part of the balloon in the picture). The balloon proximal portion 3132, the balloon intermediate portion 3314, and the balloon distal portion can be configured to partially contact the circumferential portion of the renal artery or renal ostium. For example, when the cooling assembly 33〇2 is deployed, the balloon intermediate portion can be configured to generally follow the second wall 3324 and generally not along the first wall = contact the renal artery or the renal small D. For example, when the cooling assembly 3302 is in the = state, the balloon proximal portion 3312 and the distal portion of the balloon are along the first 3322 and generally do not contact the renal artery or renal orifice along the second wall (10). The curved shape of the ball can have a uniform contact pattern so that the gas θ contributes to the desired localization or overall treatment pattern. As shown in Fig. 33A to Fig. 33c + 0 Η balloon intermediate portion 3314 #ball 3310 may be included at 3326. In the illustrated second - Μ 3322, the elastic portion of the ball 3310 is thicker: In the example, when the reduced elastic portion 3326 can be in a gas delivery state, the gas is as shown in Figure 33D, within the cooling assembly 3302 3328. ... 31G can be partially shrunk so that the assembly can be kept outside the delivery 3326 can maintain V::: 33. 2 in the delivery state, the elastic reduction portion is flat 1 cold:: = = 'elastic reduction portion can be roughly divided into 3326 In contrast, when ^ u 2 is in the deployed state, the portion with the elastic reduction portion, especially the portion 3326, is at the portion of the second portion 3324 along the second wall 3324 of the portion of the ball 3310 of the squash ball. Expansion (eg, compliance expansion) to a greater 80 201223577 =. In the material embodiment, the reduced elastic portion (10) is substantially non-tetra' and substantially compliant at the portion of the balloon intermediate portion 3314 along the second wall of the apertured ball 3310. When the cooling assembly 3 is deployed, the limitations associated with the reduced portion I knife can contribute to the side of the ball. The reduced elasticity portion 3326 can be configured to be recessed relative to the renal artery or renal orifice when the cooling assembly 3302/deployed state, and accordingly does not encompass heat having a heat transfer rate sufficient to produce a therapeutically effective renal neuromodulation Pass the part. In addition to reducing the elasticity, the thickness of the reduced elastic portion 3326 can reduce its thermal conductivity' to help improve cooling efficiency and/or further contribute to the desired localized or overall therapeutic profile. Figure 34. A portion of the cryotherapy device 3400 that is similar to the device 3300 of Figures 51 to 33D except for having different support configurations. The device 3400 includes a cooling assembly 34〇2 having an applicator 34〇4, and the applicator (10) eight has a balloon 34〇6 defining an inflation lumen. The cooling assembly 34〇2 also includes an elongated support member 34〇8 having a curved distal end 3410. The elongate support member 3 and its ankle support member as described herein can move with the respective cooling assembly as the cooling assembly is delivered between the force delivery state and the deployed = state. For example. The elongated support member 3408 can help prevent the balloon 34〇6 from sticking or twisting during treatment. The elongate support member can optionally be attached to the distal end of the respective balloon by four points. This can be used, for example, to maintain the balloon in a slender configuration. Figures 35A through 35A illustrate a portion of the cryotherapy device 35, the interaction of which with the guide member at least partially results in a complex balloon shape. In other specific examples of the right stem, the at least one & balloon is shaped by interaction with another cryotherapy rupture component (e.g., a shaft or supply tube). Figure 3 > 81 201223577 ^ The apparatus 3 shown in Fig. 35B includes a cooling assembly 35 which is located at the distal end portion of the longitudinal axis 3506 defining the discharge passage. The device can include an elongated guide member 3508 and a supply tube 3512, and the cooling assembly 35: includes a bore π 3514 at the distal end of the supply tube 3512. The cooling assembly can be stepped into a distal end-body neck with a definable inflation lumen and having a proximal portion 3 of the balloon, a proximal integral neck 352g coupled to the distal portion 3504, and a guide member 3508. The balloon 3516 is squeaked. The balloon 3516 can also have a restricted longitudinal portion 3524 (Fig. 3 and the expandable longitudinal portion 3526 (Fig.). The restricted longitudinal portion can be at least partially coupled to the guiding member 35G8. For example From the distal neck 3522 to the balloon proximal end portion 3518, the balloon "the inner surface of the cymbal can be connected to the guide. The p piece 35 〇 8. When the cooling assembly 35 () 2 is deployed, the (four) longitudinal portion 3526 Can be spaced apart from the side of the guide member. The partially constrained shape of the balloon 3516 can be used to promote the desired localized or overall treatment pattern. Further, the 'restricted longitudinal portion 3524 can define at least a portion of the longitudinal flow path around the balloon 3516 (eg, blood flow) Path.) This can be used, for example, to promote occlusion at the treatment site, such as partial occlusion and occlusion. Figure 36 illustrates a different connection pattern between the balloon and the guide member and Figure 35A. The cryotherapy device similar to the cryotherapy device of Fig. 35B. 36 can be considered as an alternative to Fig. 35B to illustrate all of the components of the cryotherapy device shown in the following specific figures 5A to 35B except for Fig. 36. The display is similar to that of Figure 35. The cryotherapy device 3600 includes an elongated guide member 鸠2 and has a radially spaced apart 82 201223577 restricted longitudinal portion 3 $ μ β , balloon 3604. Although Ditu.36 exhibit = separate Opening the longitudinal portion of the longitudinal portion 3; expanding the longitudinal portion; 3 two-year-old 曰 + / - hunting by, for example, the guide member 3602 does not =: rr connects the balloon _ to the guiding member 3608. In addition, the longitudinal portion is restricted 3606 and / or the distribution of the longitudinal part of the expansion; 1 the longitudinal part of the restricted longitudinal part and the longitudinal part of the expansion: ::: r or asymmetry (for example, 3 700 parallel to the guide part hall - the month includes the % The cryotherapy device of the shaped balloon is employed. The third phase of the device includes an elongated shaft measurement at a defined discharge passage. The cooling assembly 37G2 at the portion 3704, and the supply tube and the 37G2 are included in the supply tube 3. ·The opening of the distal end 371〇3714 applicator 3712, balloon 3714 has a first balloon first: and a second balloon segment 3718. The first balloon slice has a balloon far (four) Γ phase portion 3724 and a: distal portion 3726. The first assembly 37 〇 The knife 3722 is fluidly coupled to the second distal portion 3726. When cooled to the first deployed state, the refrigerant may move from the first-near end portion 3720.: Γ: 3722 flow, then flow to the second distal portion = After the two distal parts, the refrigerant may have consumed some of the main cooling capacity. Accordingly, the second balloon segment can discharge the refrigerant from the first distal end portion 3722 and has a heat transfer rate ..., a transfer portion of the heat transfer portion of the 'th balloon segment 3716. In several alternative embodiments, the 'balloon segment 83 201223577 3716 and the second balloon segment 3718 are separate balloons that are fluidly coupled at their distal ends. In another implementation, the first balloon segment and the second balloon segment may be a single stack of the fingertips + *rr \ f , , _ too. Score. The first balloon segment 3718, similar to the non-cooling balloon described below, allows the renal artery or kidney to be at the treatment site. The P-knife is insulated from the low temperature in the first balloon segment 3716. This can be used, for example, to promote the desired localization or overall treatment profile. A plurality of sputums* Figures 38 to 51 illustrate cryotherapy devices including a plurality of balloons, such as right-handed specific examples, which may contribute to hypothermic renal neuromodulation or multiple therapeutic goals, such as desired localities Or general treatment type, big J and Van Wang occlusion. In a plurality of embodiments of the cryotherapy device according to the present invention, _P(10) persons, ', and f can be used in combination with a primary balloon configured to generate a therapeutically effective cooling for renal neuromodulation ( =: Main heat transfer part) IM h % . Knife J /, a secondary balloon configured to prevent or suppress the effective cooling temperature of the therapist at the selected location. In several embodiments, the secondary milk ball includes a secondary heat transfer portion. For example, the secondary balloon can be warmed up, hot: cooled or has a low degree of cooling. Or, a number of specific facts: a balloon such as a qi qi and a β-element include a main heat transfer portion and a secondary ball or no secondary balloon. ' Fig. 3 8 至 to Fig. 3 8 R bb θ + β / mouth This description can have multiple low temperature treatments of the main balloon. One of the 3800s of the Dunhuang 3800, the P knife. Apparatus 3 800 includes a cooling assembly 3802 at a defined discharge passage, "Tianchang Axis 3800. The far minute 3804 may have an n ratio qcn<>7. D, 3807, and the device 3800 can include an elongated guide 3808 and a supply Λ 81 81 . The cooling assembly 38〇2 may include the length of the orifice at the end of the supply tube 84 201223577 3810, which is substantially parallel to the cooling assembly, having a common folding balloon 3414. The balloon 3814 cloth, the ankle portion 3816, or circumferentially sub-hills around the guiding member 3808, the common proximal portion 3816, and the balloon 3814 can be deployed: the portion 3816 can define an inflation lumen. When the cooling assembly is 38° 2 at 287 = Γ, the refrigerant expanded from the supply f 3810 can enter the common proximal end: the knives 6 and circulate within the balloon 38U to expand and cool. Refrigeration = '(4) The shared proximal portion 3816 exits the balloon view and flows along the discharge channel. The acupoints are only 1 d, and the globules 3814 can be configured to contact the septum between the renal veins or the renal orifice at the treatment site (e.g., spaced apart longitudinal portions). This can be used to promote the desired localization or overall treatment profile. In addition, the space between the balloons 3814 = may define at least a portion of the longitudinal flow path (e.g., blood path) around the balloon 3814. This can be used, for example, to promote a degree of occlusion at the treatment site, such as partial occlusion rather than complete occlusion. Strictly illustrated in Figures 39A-39C, a portion of a cryotherapy device 3900 that can have a plurality of balloons having different degrees of cooling is illustrated. The device 39A includes a cooling assembly at the distal end portion 39〇4 of the elongated shaft 3906, an elongated guide member 3907, and a plurality of supply tubes (identified individually as 39〇8a to 39〇8d). The cooling assembly 3902 can include a plurality of apertures (identically identified as 391 (^ to 391 〇d) at the distal ends of the supply tubes 39〇8a to 39〇8d, and the applicator 3912 includes a plurality of elongated balloons (at 39A and 39c are individually identified as 3914a through 3914d). Balloons 3914a through 3914d are circumferentially distributed about guide members 39A, and individually include a proximal neck 3916 that can fluidly connect balloons 3914a through 3914d to the discharge passage ( Figure 39A). The orifices 39l, 3910d 85 201223577 orifices 3910b, 3910c have a larger free passage area. Similarly, the supply tubes 3908a, 3908d have a smaller free passage area than the supply tubes 3908b, 3908d. The balloons 3914a to 3914d are substantially equal in size and have substantially equal internal surface area and external surface area. The ratio of the free channel area to the inner surface area of the orifices and/or supply tubes of the balloons 3914a, 3914d compared to the balloons 39i4b, 3914c may This can result in balloon 391 consumption, cooling within 39.14d relative to the balloon, and 3i 4c. For example, balloons 3914a, 3914d can be configured to serve with balloon 391 391讦 compared The gaseous refrigerant is circulated at a low temperature. Additionally or alternatively, when the cooling assembly 3902 is deployed, the balloons 3914a, 3914d can be configured for substantially surface area limited cooling, while the cooling assembly 39〇2 In the deployed state, balloons 3914b, 3914c are configured for substantially cryogen limited cooling. A certain degree of cooling is provided to tissue near the target area of therapeutically effective renal neuromodulation (eg, a lower degree of cooling, such as Insufficient for cooling of hypothermic renal neuromodulation.) For example, to reduce the increase in heat around the tissue at the target area of therapeutically effective renal neuromodulation. The use of multiple balloons may also contribute to the desired localization or overall size. The degree of occlusion of the sample and/or treatment site, such as partial occlusion rather than complete occlusion. Figure 40 illustrates a cryotherapy device side similar to the cryotherapy device of Figures 39C, except for having different differential cooling mechanisms. The following independent specific examples are described instead of FIG. 39B: FIG. 39 to the cryotherapy device 39 shown in FIG. 39C, except for all the components except FIG. 0 The midamble is not similar to the other than the _39B. The cryotherapy device side includes a shaft 4002 having an inner wall δ 86 201223577 4004 that divides the shaft side into a fluid separation discharge passage, and a supply tube 4006 individually located in the discharge passages. The supply tube 4006 has substantially equal dimensions and may have apertures (not shown) of substantially equal size. The cryotherapy device 4000 also includes a plurality of pressure regulators (individually identified as 4008a to) in fluid communication with the discharge passages. 4008d). Pressure regulators 4008a through 4008d can be configured to be located outside of the blood structure. Adjusting the back pressure in the discharge passage can cause a temperature change in the corresponding balloon (not shown). For example, the pressure regulators 4〇〇8a, 4〇〇8d can maintain the first discharge pressure in the corresponding discharge passage and the balloon, and the pressure regulators 4〇〇8b, 4008c can maintain the corresponding discharge passages and the first of the balloons. Two (different) monthly pressure. In this way, differential cooling similar to the differential cooling described above with respect to apparatus 3900 shown in Figures 39A-39C can be achieved. Figure 4 1 shows a portion of a cryotherapy device 41 (10) having a plurality of helical balloons. The device 4100 includes a cooling assembly 4101, a supply tube 4104, and a filler 4105 at a distal portion 4102 defining an elongated shaft 41〇3 of the discharge passage. The cooling assembly 4101 may include a first supply aperture 41〇6, a second supply aperture 4107, and a filling aperture at the distal end of the filling tube 4105. The cold portion assembly 4 1 0 1 also includes a plurality of Application of a spiral balloon Γ 09 In one embodiment, the applicator 4109 includes a first helical balloon 4110 having a first distal end portion 4112 and a first proximal portion 4114, having a second distal portion 4118 and The second proximal portion 412 has a second "shaped balloon 4116 (shown in dots for clarity of illustration), and a third helical balloon 4122 having a third file 4124 and a third proximal portion 4126. The first supply aperture 41〇6 and the second supply port 41〇 can be fluidly connected to the first distal end portion 4112 and the third distal end portion 4124, respectively, and the first 87 201223577 spiral balloon 4110 and the third spiral balloon 4122 can define expansion. The second balloon proximal portion 4120 can be sealed around the fill tube 4107 and fluidly coupled to the fill aperture 4108' and the second spiral balloon 4116 can define a fill cavity. When the cooling assembly 4101 is deployed, the second spiral Balloon 4116 can be configured to fill The filling tube 4105 is filled. The refrigerant can be expanded into the first distal end portion 4112 and the third distal end portion 4124, and the first spiral balloon 4 ιι and the third spiral balloon 4122 can be independently convoluted or combined. The helical pattern provides primary cooling. The second helical balloon 4 11 6 can insulate the portion of the renal artery or renal orifice from the cryogenic cooling within the first helical balloon 4丨丨0 and the third helical balloon 4丨22. This can be used, for example, to promote the desired localized or nanobody treatment pattern. Further, the interior between the supply tube 40〇4 and the first spiral balloon 411〇, the second spiral balloon 4116, and the third spiral balloon 4122 The space may define at least a portion of the longitudinal flow path (e.g., blood flow path). This may be used, for example, to promote occlusion at the treatment site, such as partial occlusion rather than complete occlusion. Figure 42 illustrates similar to device 4100 shown in Figure 41 but A portion of the cryotherapy device 4200 having an improved supply configuration and drainage configuration in a spiral balloon. The device 4200 includes a cold portion at a distal portion 4203 of the elongated shaft 4204 defining the discharge channel. The assembly 4202, the elongated 5 turns guide 4205 and the supply tube 4206. The cooling assembly 4202 can include a supply aperture 4207 at the distal end of the supply tube 42〇6 and an applicator 4208 having a plurality of helical balloons. In a specific example, the applicator 4208 includes a first helical balloon 421A having a first distal portion 4212 and a first proximal portion 4214, a second distal portion 4218, and a second proximal portion 422〇 The spiral 88 201223577 shaped balloon 42i6 (shown in a dotted view for clarity) and a third helical balloon 4222 having a third distal end portion 4224 and a third proximal end portion 4226. The first distal portion 4212 and the third distal portion are fluidly coupled to one another and fluidly coupled to the second distal portion 4218. The first proximal portion and the third proximal portion 4226 are fluidly coupled to the exhaust passage. The refrigerant expands to the second proximal end portion 422() when the cooling assembly is torn into the deployed state, and the second helical balloon 4216 can provide primary cooling in a helical pattern. The first spiral balloon 4210 and the second spiral balloon 4222 can receive the refrigerant discharged from the second distal portion 4218, and can cool the renal artery or the renal small portion and the first, spiral balloon 4216. Insulation. With respect to the cryotherapy device 4200 not shown in Fig. 41, the device side is applicable when less cooling is required and/or the interval between major cooling areas is required to be larger. In a number of specifics (four), the same number of spiral balloons (the balloons are warmed up, insulated, not cooled, or have a lower degree of cooling) are intertwined in various arrangements (where the spiral balloon is configured to provide primary cooling) 'To facilitate the desired localization or overall treatment profile. Figures 43A through 43C illustrate a portion of a cryotherapy device 43 that can include a movable balloon relative to other portions of the cooling assembly. The apparatus C (10) includes a cold head assembly 430 at the distal end portion of the elongated shaft 43〇3 defining the discharge passage, and an elongated molding member 43〇4, a first supply tube 及, and a second supply tube 4306. The distal portion 4302 can have a step 4307, and the cooling assembly 4301 can include a first aperture 4308 at a distal end of the first supply tube 4305 and a second aperture side at a distal end of the second supply tube 43〇6. The cooling assembly 4301 further includes an applicator 43U having a first elongated balloon 14U defining a first expansion chamber and a second elongated balloon 43i2 defining a second inflation chamber. The first balloon 43u has a first proximal portion 43i4, a first intermediate portion 4S15, and a first distal portion 4316. The second balloon 4312 has a second proximal portion 4318, a second intermediate portion 4319, and a second distal portion 4320. The first balloon 4311A has a second balloon that has an inner side 4322 closest to the molded member 43〇4 and an outer side 4324 opposite the inner portion 4322. The first distal end portion 4316 and the second distal end portion 432 are coupled to the molded member 43A. In a number of specific examples, the molded part 43. 4 also defines a guide lumen through which the guide wire can pass. As shown in Fig. 43C, when the cooling assembly 43() 1 is in the deployed state, the molded member 4304 is contracted relative to the shaft 43 03 to move the first intermediate portion 43 and the second intermediate portion 4319 away from the molded member 43 (). 4 lateral movement. The portion of the first-middle portion 4315 and/or the second intermediate portion 4319 may be weakened (eg, creased, heat treated to cause weakening, and/or thinned) or otherwise configured to define priority Kidney curvature position. As shown in the figure, after the molded part 4304 is contracted, the inner side portion 4315 and the inner side 4322 of the second middle/knife 43 19 are generally recessed along the length thereof, while the first middle 1 P knife 43 15 and the second middle portion are simultaneously recessed. The outer side 4324 of the portion 4319 is generally convex along its length. The controlled deflection of the balloon may be particularly useful, for example, to facilitate a small risk of a low risk of applying excessive inflation pressure to the kidney or vein or the small renal orifice. Controlled deflection can be used when the applicator's - or multiple balloons are substantially non-compliant and/or the size of the expander is not realistic. Figures 44A-44C illustrate portions of the cryotherapy device 4400 similar to the low temperature 90 201223577 • treatment device 4300 shown in Figures 43A-43, but having a greater number of elongated balloons and including secondary balloons. The device 4400 includes a distal end portion of the elongated shaft 4404 having a *step 4405 and defining a discharge passage. 4402, a cooling assembly 4406 at the distal end portion 4402, and an elongated profiled member 4408. The molded component 4304 can be solid or can define a lumen, such as a guidewire through which the guide lumen can pass. The device side further includes a first supply 4410, a second supply tube 4414, a third supply tube (not shown), and a fill tube 4416. The cooling assembly 4406 can include a first supply aperture 4418 at a distal end of the first supply tube 441A, a first supply aperture 4420 at a distal end of the second supply tube 4414, and a distal end of the third supply tube A three-port (not shown) and a fill port 4422 at the distal end of the fill tube 44丨6. Cooling assembly 06 also includes an elongated first balloon 4426 defining a first expansion lumen, an elongated second balloon 4428 defining a second inflation lumen, an elongated third balloon 4430 defining a third inflation lumen (Fig. 44B), and defining a fill The applicator 4424 of the elongated fourth balloon 4432 of the cavity. The first balloon 4426, the second balloon 々々Μ, and the third balloon 4430 are fluidly coupled to the first supply aperture 4418, the second supply aperture 4420, and the second supply aperture. The fourth balloon is fluidly coupled to the fill orifice 4422 and is sealed around the fill tube 4416. The first balloon 4426, the second balloon 4428, the second balloon 443〇, and the fourth balloon 4432 are coupled to the molded component 4408 such that when the cooling assembly 44〇6 is deployed, the molded component 4408 is opposite, as shown in FIG. 44c. Contraction of the shaft 4404 causes the applicator 4424 to expand laterally. The first balloon material 26, the second balloon 4428, and the third balloon 4430 can have a heat transfer portion having a heat transfer rate sufficient to produce a therapeutically effective stimulator. The first balloon 4426, the second balloon 4428, and the third balloon 4430 91 201223577 can be configured to provide primary cooling. The fourth balloon 4432 can be a secondary balloon. In several other specific examples, configurations similar to those of the cryotherapy device 4300 shown in FIGS. 43A-43B and the cryotherapy device 4400 shown in FIGS. 44A-44C include a different number of primary balloons ( There are secondary balloons or no secondary balloons). In addition to size, such configurations may contribute to other therapeutic goals, such as the desired localization or overall treatment profile. 45A-45B illustrate a portion of a cryotherapy device 4500 that includes a primary balloon and a secondary balloon that can have different compositions. The device 4500 includes a cooling assembly 4502 at a distal portion 4504 of an elongated shaft 4506 defining a discharge channel. Tube 4508 and fill tube 4509. Cooling assembly 4502 includes a supply orifice 4510 at the distal end of supply tube 4508 and a fill orifice 4514 at the distal end of filler 4509. Cooling assembly 4502 also includes an applicator 4516 having a first balloon 4518 defining an inflation lumen and a second balloon 4520 defining a filling lumen. The first balloon 4518 has a proximal neck 4522 that is within the distal portion 45〇4 and fluidly connects the first balloon 4518 to the venting channel. The second balloon is sealed around the fill tube 45A and fluidly coupled to the fill port 4514. When the cooling assembly 45〇2 is deployed, the first balloon 4518 can be configured to deliver primary cooling and the second balloon 452〇 can be a secondary balloon. In several embodiments, the first balloon 4518 has a lower degree of compliance and/or flexibility than the second balloon 452A. For example, the first balloon 45 18 can be substantially non-compliant, while the second balloon can be substantially conformable. Further, the 'first balloon' 4518 can be substantially non-compliant, and the second balloon can be compliant on the A body. Non-compliant materials typically have higher strength than compliant materials (eg, higher pressure ratings for this and / 92 201223577 • or for other reasons, generally compliant materials are well suited for configuration • to receive Expanded cryogen directly from the orifice and/or balloon that is therapeutically effective to cool the kidney for neuromodulation. The compliant material is generally suitable for expansion to different sizes to accommodate different cross-sectional dimensions Renal artery and renal orifice. The device 45〇〇 shown in Figures 45A-45B and several other cryotherapy device components described herein can be configured to take advantage of the different properties of non-compliant materials and compliant materials. 45B and 45C are transverse cross-sectional views of a device 45 〇 0 sized to fit within a renal artery or renal orifice having different cross-sectional dimensions. The first balloon 4518 in Figures 45B and 45C has substantially the same Dimensions. However, the second balloon 452A in Fig. 45C compliantly expands to a greater extent than in Fig. 45B. Even if the first balloon 4518 expands substantially non-compliant, the second balloon 452 The compliant expansion can also move the first balloon into contact with the inner surface of the renal artery or the renal orifice. The compliance expansion of the second balloon 452 can be carefully controlled via the filling tube 4509 to prevent excessive expansion of the renal artery or renal orifice. The enlarged view of FIG. 45B-1 includes a non-compliant material layer 4526 and a segment 4524 of a compliant material layer 4528. The non-compliant material layer 4526 can be a portion of the first balloon 4518, and the compliant material layer 4528 can be A portion of the second balloon 4520. In one specific example, the first balloon 4518 and the second balloon 4520 can be joined together at the segment 4524, but in other "body instances" the first balloon 45 (8 and the second balloon) Figure 24 illustrates a cryotherapy device 46 that is similar to the cryotherapy device 4500 of Figures 45a, except for having different partitions. Figure 46 can be viewed as 93 201223577 instead of Figure 45B to illustrate the following independent examples. All of the elements of the cryotherapy device 4500 shown in Figure VIII are similar except that shown in Figure 46 with respect to Figure 45. The cryotherapy device 4_ includes the first balloon 46. 02, the second balloon measures and the partition 46 〇 6 between the first balloon view and the second balloon 4604. As shown in the enlargement in FIG. 461, the partition 4606 includes a single layer, which may be the first layer a non-compliant layer of the balloon. In another embodiment, the partition 6 may comprise a single layer, the early layer being a compliant layer of the second balloon 4604. The constructing device 46〇〇, a substantially compliant balloon A portion, such as an incomplete balloon, can be coupled to a substantially non-(four) balloon, (iv) a substantially compliant balloon having a chamber defined at least in part by a portion of the substantially non-compliant balloon. In cross-section, as shown in Figure 46, the first balloon 46〇2 can be a generally D-shaped balloon, and the second balloon 4604 can be a generally ^-shaped balloon attached to a generally D-shaped balloon. The cryotherapy device configured in accordance with several embodiments of the present technology can include a helical primary balloon and a non-helical secondary balloon. 47 illustrates a portion of a cryotherapy device 4700 that includes a fly, 'heart 4702' at the distal end portion of the elongated shaft 47〇6 defining the discharge passage. Device 47 〇〇 = includes supply tube 4707. Cooling assembly 4702 includes an applicator 4708 having a helical first balloon dichotomy, the balloon having a first proximal portion 叼 and a first end portion 4714 and defining an inflation lumen. Supply tube 47A can extend into: proximal portion 4712, and cooling assembly 4702 can have an orifice 4718 at the distal end of supply tube 4707 within first proximal portion 4712. The first proximal portion 4712 is sealed around the supply tube 4707. The cooling assembly 47〇2 can be 201223577. The step includes a second balloon 472G having a second proximal end & 4722 and a second distal end portion 4724 exiting the cavity. The second distal end portion 4724 can be fluidly coupled to the first distal end portion 4714 and the first balloon can be wrapped around the second air balloon 4720. The second proximal portion 4722 can be fluidly coupled to the exhaust passage. When the cooling assembly 47G2 is deployed, the refrigerant can flow from the first proximal portion 4712 to the first distal portion 4714 and then to the proximal end through the second balloon 4720. The back pressure from the refrigerant can cause the balloon to expand (e.g., compliant expansion), thereby increasing the diameter of the spiral of the first gas. This can be used, for example, to facilitate sizing. In addition, the helical shape of the balloon side can be used, for example, to promote the desired localization or overall treatment profile. Figures 48A through 48B illustrate a portion of a cryotherapy device 48 having helically shaped primary and non-helical secondary balloons in different configurations. Apparatus 4800 includes a cooling assembly 4802 at a portion of the elongated shaft 48〇6 defining the discharge passage: portion 4804. The distal portion 48〇4 can have a step 48〇/, and the cooling assembly 4802 can include an applicator 4808 having a helical first balloon defining an inflation lumen and having a first proximal portion 4812 and a first distal portion 4814 . The device 4800 can also include a supply tube 4816 that extends into the first proximal portion "n" and the cooling assembly 4802 can have an aperture 4818 at the distal end of the supply tube 4816 within the first proximal portion 4812. A proximal portion 4812 is sealed around the supply tube 4816. The cooling assembly 48〇2 can further include a second balloon 4820 having a body proximal neck 4822 coupled to the distal portion 4804. The second balloon 4820 can be defined as a group The state is in a discharge chamber that expands (e.g., compliance 95 201223577) in response to back pressure from the refrigerant discharged from the first balloon 4810. The first balloon 4810 can be coupled to the second balloon 4820, a balloon The expansion of 4820 (for example, compliant expansion) can increase the diameter of the spiral of the wind 4810 to move the curved portion of the first balloon a 1 更 closer to the kidney movement. The inner surface of the small vein of the kidney is the first balloon.

The 481 〇 is placed in the second balloon 4820 for 彳¢, and 14 A Μ j is used, for example, to provide redundant cryogen loading within the vascular structure. Figure 49 illustrates a portion of the cryotherapy device side having a spiral configuration of a primary balloon and a non-helical secondary balloon. The device 49 includes a cooling assembly side at a distal end portion of the elongated shaft defining the discharge passage. The distal portion 49() 4 can have a step 4_ and a plurality of

The opening 4907 is discharged. Cooling her out jQno - γα» L P~ into 4902 may include applicator 49〇8 having a helical first balloon (9) 定义 defining an inflation lumen and having a first proximal portion 4912 and a distal-end portion 4914. The device 49A can also include a supply tube 4916 that extends into the first proximal P-knife 4912, and the cooling assembly can have an orifice 4918 at the distal end of the supply tube 4916. The first proximal portion 4912 can be sealed around the supply tube 4916. The cooling assembly 49〇2 can further include a second balloon located around the distal end portion 49G4 and having a proximal proximal neck portion 4922 attached to the distal portion side. The first balloon _ can be wrapped around the first balloon 4920, and the first distal portion 4914 can be fluidly coupled to the distal portion 49〇4 of the distal end of the second balloon 4920. The second balloon 492A can be configured to passively receive refrigerant from the discharge passage through the discharge opening 4907 when the cooling assembly 49〇2 is deployed, and can be configured to respond to the first balloon 4910 The discharged refrigerant is expanded by the back pressure (for example, compliantly expanded). Expansion of the second balloon 492 (eg, compliance expansion)

S 96 201223577 can increase the diameter of the spiral on the first balloon side by the part of 4910 (for example, the inner surface of the ball of the ball of the 纟考曲弟. The movement of the curve is closer to the renal artery or the small figure 50 shows that there is another configuration The spiral main balloon and the non-helical secondary balloon are at the side of the cryotherapy device. The device employs a cooling fin 5002 at the distal end portion of the elongated shaft of the venting channel, and the filling tube 5_ is filled. a filling opening 5005 at the distal end of the pipe and a supply pipe 5〇〇 6. The cooling assembly 5〇〇2 includes a supply opening _7 at the distal end of the supply pipe. The supply pipe 5_ may include a return hole The corner of the mouth near the lake 7 is 5嶋' such as an elbow. The cooling assembly bay further includes a spiral-shaped balloon having a defined expansion cavity and having a first proximal portion 5〇1 and a first distal portion 5G12. The medicinal device 5009. The cooling assembly 5002 can also include a second balloon 5〇14 having a second proximal portion 5〇16 and a second distal portion 5(4). The second proximal portion 5〇16 can be fluidly coupled to the filling aperture 5005 and sealed around the filling tube 5〇〇4. The second distal end The minute 5018 can be sealed around the supply f 5 (10) 6 'but fluidly separated from the supply tube view and the first balloon 5010. The first balloon 5 〇 1 〇 can be wrapped around the second balloon 5 〇 14 and configured to receive from the supply f 5(4) and discharging the refrigerant into the discharge passage via the first proximal portion 5011. The second balloon 5014 can be configured to receive expansion of the filler material 2 from the fill tube 5〇〇4 (eg, compliantly Swelling, thereby increasing the diameter of the first balloon 5〇'1〇, thereby causing the first balloon 5〇1() to be moved (for example, the bending portion = moving closer to the inner surface of the renal artery or the renal orifice) Figure 51 illustrates a portion of a cryotherapy device 5 having a spiral configuration of a main balloon and a non-helical 97 201223577 secondary balloon. The device 5 1 includes an elongated shaft 51 〇 3 in a defined discharge channel. The cooling assembly 510 at the distal end portion 51〇2, the supply tube 51〇6, and the filling tube 51〇8<> the distal end portion 51〇2 may have a step 5104 and an outlet hole 5105. The cooling assembly 51〇1 may Included in the supply port 51〇7 at the distal end of the supply tube 5106 and at the far end of the fill tube The filling orifice 5109. The cooling assembly 5101 can further include an applicator 5110 having a helical first balloon 5111 having a first proximal portion 5112 and a first distal portion 5Η defining an inflation lumen. The supply tube 51〇 6 may extend from the exit aperture 5105 and extend into the first proximal end portion 5112 and the first proximal end portion 5112 may be sealed around the supply tube 51A. The cooling assembly 5ι may further include a portion located around the distal portion 5102 and There is a second balloon 5U6 coupled to a body proximal neck 5118 of the distal portion 5102. The second balloon 5U6 can be configured to receive the filling material from the filling tube 51〇8 and expand (e.g., compliantly expand), thereby increasing the helical diameter of the first balloon 5111, thereby causing the first balloon 5 to A portion (eg, a curved portion) moves closer to the inner surface of the renal artery or renal ostium. The proximal secondary balloon and the secondary balloon may be longitudinally spaced apart along the length of a portion of the cryotherapy device configured in accordance with several specific embodiments of the present technology. For example, the secondary balloon can be part of an occlusion component configured to completely or partially occlude the renal artery and/or the renal orifice. Figures 52A through 53 illustrate several specific examples of cryotherapy devices including proximal secondary balloons. Figure 52A to Figure 52B illustrate a portion of the cryogenic δ 98 201223577 treatment device 5200 including the cooling assembly 52〇2 and the occluding member 52〇4 that are longitudinally spaced apart along the elongated shaft 5206 defining the discharge passage. The shaft 52〇6 may have a first step-down portion 52 08, a cooling assembly discharge port 5209 at the first step-down portion 52〇8, a second step-down portion 52丨〇, and a second step-down. The occlusion member discharge port 52丨i at the portion 52 1 0. The cooling assembly 52〇2 and the occluding member 52〇4 may be located at the first step-down portion 52〇8 and the second step-down portion 5210, respectively. Device 5200 can include a supply tube 5212, and cooling assembly 52〇2 can have an aperture 5213 at the distal end of supply tube 5212. The cooling assembly 52〇2 can also include an applicator 5214 having a first balloon 5215 defining an inflation lumen. The supply tube 5212 can extend from the shaft 5206 at an angle and into the first balloon 5215. The occluding member 52〇4 can include a second balloon 52 16 that defines an occlusion cavity. The second balloon 52 16 can be configured to passively receive refrigerant from the discharge passage through the occlusion member discharge port 5 2 11 and can be configured to respond to the back of the refrigerant discharged from the cooling assembly 5202 Compressed and expanded (eg, compliantly expanded). Cooling assembly 5202 and occluding member 5204 can be at least partially collapsed in the delivery state, and are shown in Figures 52-52B, respectively, in an expanded state and a deployed state. In the expanded state, the occluding member 52A can have a cross-sectional dimension configured to completely occlude the renal artery and/or the small renal orifice. As shown in Figure 52B, device 5200 can further include a first elongate control member 5218, a second elongate control member 5220, and a control tube 5222 having a first distal branch 5224 and a second distal branch 52%. The shaft 52〇6 can further include a first distal attachment point 5228, a second distal attachment point 523〇, and a flex portion 5232 between the first step-down portion 5208 and the second step-down portion 521〇. The first elongate control member 5218 can extend along the control tube 5222, extend along the first distal branch 5224, and is coupled to the first distal connection point 99 201223577 5228. The second elongated control member 522 can extend along the control tube 5222, extend along the second distal branch 5226, and be coupled to the second distal attachment point 523A. The device 5200 can be configured to increase or decrease the deflection of the first control member 5218 and/or the second control member 5220 to control the deflection of the shaft 52〇6. The axis π% is flexible at the flex portion 5232 to position the first balloon against the vessel wall or port. In addition to fully occluding a blood vessel or a small orifice or as an alternative occlusion component 5204 can be configured in an expanded state within the renal artery or renal ostium. Supporting the shaft 5206' to controllably reposition the cooling assembly within the renal artery or renal orifice 5202. For example, the cooling assembly 52〇2 can be repositioned to produce a therapeutically effective low temperature renal neuromodulation in different portions of the renal artery or renal ostium. Figure 53 illustrates a portion of the cryotherapy device 53 similar to the cryotherapy device 5200 shown in Figure 53A, but with device μ (eight) and other remote cooling configurations and different supply and control configurations. The apparatus includes a cooling assembly = and an occluding member 53 〇 4 that are longitudinally spaced apart along an elongated shaft 53Q6 defining a discharge passage. The shaft _ can have a distal attachment point plus a distal tip portion 5308 defining a distal inflation lumen. The cooling assembly 53〇2 includes an applicator WO member side having a first balloon 5312 defining an inflation lumen including a definition separate from the discharge passage (4) = ball 5314. The first milk filling tube of the device_further_.53i6 and the filling of the first "the balloon" 5314, the filling of the eight's 1st, the first brother, the first balloon, the balloon, the balloon, and the distal end portion 53G, the knife 5320 The supply step of 5322 includes a fill aperture 5324 that can supply a fill material to the second balloon 5314. ', 7郃~ into 5302 further includes a configuration via δ 100 201223577 to cause the refrigerant to expand into the first balloon 53 12 The first supply aperture 53 26 and the second supply aperture 5 3 2 8 configured to cause the coolant to expand to the distal tip portion 5308 — the device 5300 further includes an elongated control member 5330 and a control tube 5 3 3 2. The control unit 5 3 3 0 can extend along the control officer 5 3 3 2 and connect to the remote connection point 5307. The device 5300 can be configured to increase or decrease the tension of the control member 5330 to control the deflection of the shaft 5306. An occlusion vessel or a small orifice or as an alternative to the 'occlusion component 5 3 0 4 can be configured in an expanded state to support the shaft 5306 within the renal artery or renal small alpha, thereby controlled repositioning cooling within the renal artery or renal orifice Assembly 5302. For example The cooling assembly 53 02 can be repositioned to produce therapeutically effective hypothermia renal neuromodulation in different portions of the renal artery or renal ostium. Alternatively, the cooling assembly configured in accordance with several embodiments of the present technology is deployed There is a cooling mechanism under malaria that does not involve evaporation of the refrigerant. For example, such specific examples may include configuring to circulate a liquid cryogen or supercritical refrigerant at a cryogenic temperature to cause passage through the applicator The primary heat transfer portion performs a convection-type and conduction-type cooling cooling assembly. In these applicators, the flow resistance of the supply can be substantially equal to the flow resistance of the discharge device. For example, the cross-sectional area of the supply lumen Can be substantially equal to the cross-sectional area of the discharge passage. In some embodiments, a cryotherapy device having a cooling assembly configured to circulate a refrigerant without phase change can have a cooling aid The assembly supplies the refrigerant and/or the characteristics of the refrigerant discharged from the cooling assembly. For example, the first pump may be included to increase the flow to the total cooling 101 201223577 The pressure of the refrigerant, and/or may include a vacuum source (eg, a second pump) to reduce the pressure of the refrigerant flowing out of the cold section assembly. In addition to or in addition to the first pump, the refrigerant may be supplied from a pressurized source. Based on operational considerations, such as the refrigerant viscosity and flow resistance of the supply, the discharge device, and the heat transfer portion of the cryotherapy device, the supply pressure and the discharge pressure may be selected to produce different refrigerant flow rates. For example, The flow rate is selected at a rate sufficient to produce a therapeutically effective low temperature renal neuromodulation. Figure 54 illustrates a cryotherapy device 54 that can be configured to perform convective heat transfer without a refrigerant phase change. Part of it. The device 54A includes a cooling assembly 5402 at a distal end portion 54A4 of the elongated shaft 54A6 defining the discharge passage. The cooling assembly 54A includes an applicator 5408 having a balloon 5410 defining a circulation chamber. The device 5400 also includes a supply tube 5412 extending along the length of the shaft 5406 and extending into the balloon 5410, and the cooling assembly 54〇2 includes an aperture 541 at the distal end of the supply tube 5412. In several embodiments, the supply tube 5412 It is relatively large and configured to deliver liquid refrigerant, and the orifices 54 14 are unconfigured to produce a pressure drop sufficient to vaporize the refrigerant. When the cooling assembly 5402 is deployed, the balloon 541 can be configured to fill a refrigerant that is at least substantially liquid phase. The refrigerant can be circulated from the supply pipe 5412 to the discharge passage. Figure 54 includes an arrow 5416 indicating the direction in which the refrigerant flows through the balloon 541. The refrigerant may be a liquid having a lower freezing point (e.g., ethanol)' and may be delivered via the supply pipe 54丨2 at a low temperature. Convective heat transfer between the cryogen and the chaotic ball 5410 cools the renal artery or renal orifice to produce a therapeutically effective renal neuromodulation. Figure 55 illustrates that it can be configured to enter without a refrigerant phase change.

S 102 201223577 The convection-type heat transfer of the cryotherapy device 5500 part. The device 55A includes a total cooling of 5 5 0 2 at the untwisted portion 5504 of the elongated shaft 550, and the elongated shaft 5 5 〇6 includes a squint ±, including dividing the shaft into a defining supply cavity The vertical portion 5 5 10 and the axis division area 5 5 0 8 defining the second longitudinal portion 55 I2 of the exit channel. The cooling is reduced to $ ς m ^ including the application of the balloon 5516 ^4, and the balloon 5516 includes the gas material # 5518 defining the U-shaped cavity in the balloon. The balloon 5516 can be circulated such that the liquid refrigerant circulates from the first longitudinal portion 5 5 1 0, and the barrel (4) Τ τ is passed through the dome-shaped chamber and into the second longitudinal portion 5512. Figure 55 includes the indicating refrigerant Arrow 5520 through balloon 5516. Ν In several embodiments, the cooling assembly is configured to circulate a supercritical fluid (eg, supercritical nitrogen or water) "supercritical fluid can provide significant without agitation Cooling 'but typically must be maintained at a relatively high pressure. The cooling assembly configured to circulate the supercritical fluid may include a supply structure having a pressure rating, a heat transfer structure, and a discharge structure. The cooling assemblies can include non-expandable applicators (e.g., metal walls) that can be moved during treatment to contact different portions of the renal artery or renal orifice. θ Even other specific pastes can improve the above The low temperature wire set (4) (4) sign (4) into (4) (4) other specific examples of the technical state of electricity described in the above Figures i to Fig. 5 and Fig. 12 to Fig.. For example, the low temperature treatment device of the item 17Α to Fig. 7Β Noo and other cryotherapy devices without the guiding members described above and illustrated in Figures i to 5 and Figures 1-5 may be included in the vicinity of the distal portion of the balloon or extend through the balloon. Guide member of the end portion. The cryotherapy device similarly described above and illustrated in Figures 1 to 5B and Figures 12 to 5 may comprise controls configured to receive control lines (e.g., pull wires) Components. For example, a control wire can be used to control (eg, deflect, tilt, position, or guide) another cryotherapy device assembly outside of the cooling assembly, applicator, or vascular structure. The cryotherapy device assembly illustrated in Figures 12 to 55 includes balloons having various features (e.g., shape and composition). In some cases, 'manufacturing considerations and other factors may make certain features desirable to some extent. For example, certain materials may be more compatible with the extrusion process than the molding process, or vice versa. Similarly, using certain manufacturing processes may be more likely than using other manufacturing processes. In forming some balloon shapes i, for example, in some cases it may be difficult to form a balloon with an integral closed distal end using extrusion. The above may be modified or interchanged according to such factors and Figures i to 5B and 12 to balloon and balloon features in the cryotherapy device assembly of Figure W. For example, in the balloons described above and illustrated in Figures i to 5B and Figures 12 to 55, the distal neck ( For example, sealing the distal neck can be replaced by an integral closed distal end. This can be used, for example, to make balloons that are more compatible with the extrusion manufacturing process. The cryotherapy devices described above can also be interchanged. Other specific examples.

,〗to. The inner balloon 15M of the cooling assembly 1502 illustrated in Fig. 15A is opened into the cold (four) + 19 〇 2 t + a of the + in Fig. 19A to J9C. ^ ^ ^ as another embodiment, Fig. 12 The first 201223577 supply tube 1218 of the low/dish/ourgency device 120 illustrated and illustrated in FIG. 17A to FIG. 17B can be incorporated into the cooling assembly 1702 illustrated in FIGS. 17A-17B. Wherein the first angled distal end portion 1222 is configured to cause the coolant to expand between the insulating members 177. The related sympathy is the branch of the autonomic nervous system. The sympathetic nervous system (SNS) is a branch of the autonomic nervous system together with the enteric nervous system and the parasympathetic nervous system. Its initiative is always at a basic level (called sympathetic tone) and becomes more active during the stress period. As with other parts of the nervous system, the sympathetic nervous system operates through a series of interconnected gods. Although many paternal neurons are located within the central nervous system (Cns), they are often considered part of the peripheral nervous system (PNS). Sympathetic neurons of the spinal cord, which is part of the CNS, are associated with peripheral sympathetic neurons via a series of sympathetic ganglia. Within the ganglion, spinal sympathetic neurons are connected to surrounding sympathetic neurons via synapses. Therefore, spinal sympathetic neurons are called presynaptic (or preganglionic) neurons, while peripheral sympathetic neurons are called postsynaptic (or postganglionic) neurons. At the synapse in the sympathetic ganglia, preganglionic sympathetic neurons release acetylcholine, a chemical messenger that binds to and activates the nicotine acetylcholine at the postganglionic neurons. As a response to this stimulus, post-ganglionic neurons release nor adrenal ine/norep inephrine. Prolonged activation induces the release of adrenaline from the adrenal medulla. After the release of norepinephrine and adrenaline, it binds to the adrenergic receptor on the surrounding tissue. Binding to adrenergic receptors causes a god, a dollar and a hormone response. Physiological manifestations include dilated pupils, increased heart rate, sporadic '• regional vomiting, and increased blood pressure. Since the choline-activated receptor binds to the sweat gland, 105 201223577 therefore also showed an increase in sweating. The sympathetic nervous system is responsible for up-regulating and down-regulating multiple constant mechanisms in living organisms. The fibrous nerves of SNS innervate tissue in almost all organ systems, providing at least some regulatory functions for a variety of physiological characteristics such as pupil diameter, intestinal peristalsis, and urinary output. This reaction is also known as the sympathetic adrenal response of the body' because it ends in Adrenal medulla's preganglionic sympathetic nerve fibers (and all other sympathetic nerve fibers) secrete acetylcholine, activate adrenaline (adrenaline/epinephrine) secretion and norepinephrine (n〇radrenaline/norepinephrine) to a lesser extent secretion. Therefore, this response, which acts primarily on the cardiovascular system, is mediated directly by the pulse transmitted by the sympathetic nervous system and indirectly via the adrenal medulla. Scientifically, the SNS is generally regarded as an automatic adjustment system, that is, a system in which the syllabary sounds interfere with the mind. - Some improved theorists suggest that ^ = system works in early organisms to maintain survival, because the delivery of the nervous system is more expensive for physical activity. One of the preparations for this: In order to wake up, the sympathetic outreach is ready. θ finds that it is alive. 1. Sympathetic god. Silk as shown in Figure 56. SNS provides ajh.. in the fine body of the body through the Lu's gods. The paternal nerve originates from the inside of the spine. H week is considered to extend to the middle of the second or third lumbar region. Because the sympathetic nerves are 4 angstroms) _ 0 This begins in the thoracic region of the spinal cord and the legs ^ So the SNS has a thoracolumbar outcome, and the axons of the specific nerve leave the anterior root 106 201223577 spinal cord. It passes near the ridge (sensory) ganglion and enters the branch before the spinal nerve. However, unlike the distribution of somatic nerves, the axons of these nerves are rapidly separated by a white-branched junction that extends alongside the spinal cord, and the white-branched connection system is connected to the vertebra (near the spine) or to the front of the vertebra (at the aortic bifurcation point). Nearby) ganglion. In order to reach the target organ and gland, the axons should travel long distances in the body, and for this purpose, multiple axons communicate their messages to the second cell via synaptic transmission. The end of the axon is connected across the synaptic cleft to the dendrites of the second cell. The neurotransmitter presented by the first cell (presynaptic cell) spans the synaptic cleft and activates the second cell (post-synaptic cell). The message is then sent to the final destination. In the SNS and other components of the peripheral nervous system, these synapses are formed at locations referred to above as ganglia. The cells that are out of the fiber are called preganglionic cells, and the cells that leave the ganglion are called post-ganglionic cells. As mentioned earlier, the pre-segment cells of the SNS are located in the first thoracic (τι) and third lumbar (L" of the spinal cord. The post-ganglionic cells have their cell bodies in the ganglion and emit their axons to the target. Organs or glands. The ganglion not only includes the sympathetic trunk, but also the cervical ganglia (neck, neck, and neck) that emit sympathetic nerve fibers to the head and thoracic organs, as well as the celiac ganglia and mesenteric ganglia. Sympathetic nerve fibers to the intestines. 2. Renal nerve distribution As shown in Figure 57, the renal plexus is tightly bound to the renal artery. The renal plexus RP is an autonomic nerve that surrounds the renal artery and is buried in the renal artery. The renal nerve plexus extends along the renal artery until it reaches 107 201223577 kidney entity. The fibers that contribute to the renal plexus RP are derived from the celiac ganglia, superior mesenteric ganglia, aortic renal ganglia, and aortic plexus. The plexus plexus RP, also known as the renal nerve, mainly contains sympathetic components. There is no (or at least very few) parasympathetic distribution in the kidney. The preganglionic neuronal cell body is located in the middle of the spinal cord. Cell column. The preganglionic axon becomes a small splanchnic nerve (the smallest splanchnic nerve), the first lumbar splanchnic nerve, the second lumbar splanchnic nerve, and migrates to the abdominal cavity through the paraspinal ganglia (which does not form a synapse). Ganglia, superior mesenteric ganglia and aortic renal ganglia. Post-ganglionic neuronal cell bodies leave the celiac ganglia, superior mesenteric ganglia and aortic renal ganglia to the renal plexus RP and innervate the renal vascular structure. The sympathetic activity is transmitted through the SNS in a bidirectional flow. The outgoing message can cause different parts of the body to change at the same time. For example, the sympathetic nervous system can speed up the heart rate; widen the bronchial passage; reduce the peristalsis (motion) of the large intestine; Enhances esophageal peristalsis; causes dilated pupils, piloerection (goose bumps) and sweating (sweating); and elevated blood pressure. The incoming message transmits signals from various organs and sensory receptors in the body to other organs, especially the brain. Blood pressure, heart failure, and chronic kidney disease are several of various disease states caused by long-term activity of SNS (especially the renal sympathetic nervous system). The long-term activity of SNS is a response that is unfavorable for adaptation that drives the progression of these diseases. The renin-angiotensin-aldosterone medical management system (RAAS) is a long-standing but less effective method of reducing SNS overactivity. As described, the renal sympathetic nervous system has been identified in both experiments and humans to cause hypertension, volume overload conditions (such as heart failure) and

S 108 201223577 • The main factors of the complex pathophysiology of nephropathy. The radioactive sputum dilution method was used to measure the sputum adrenaline overflow from the mH overflow into the plasma. The study showed that H f adrenaline in patients with essential hypertension. E) The rate of overflow is more than the same as in the case of high blood in childhood, especially with the higher rate of NE overflow rate, which is consistent with the blood dynamics commonly seen in early facial blood pressure, and It is characterized by an increase in heart rate, an increase in cardiac output, and an increase in renal blood s & sensitization. It is known that the primary primary blood pressure is generally neurogenic, and the sling is accompanied by significant sympathetic nervous system overactivity. Inflammation, the activity of heart and kidney sympathetic nerve activity is more obvious, as evidenced by the overflow of NE from the heart and kidneys in this group of patients, which is evidenced by the increase in amplitude. Recently, all kidneys involving etiological death and congestive heart transplantation are involved. Strong negative predictive value of sympathetic activity: pay. The money point, the predicted value is independent of the overall sympathetic activity, kidney, sputum filtration rate and left ventricular ejection fraction. This reduction 瞥丄Θ U, the temple is also known Designed to be y The survival rate of the treatment plan for renal sensation of nerve sensation. Lai has ^ "heart failure

Both chronic kidney disease and terminal sinus are characterized by sympathetic nerve activity and reluctance. It has been shown that patients with end stage renal disease have a blood stasis ^ Φ ^ ^ τ cloud adrenaline content for all causes of death and death due to heart disease, and predictive. This finding is also true for patients with diabetic nephropathy and those who suffer from kidney disease caused by sputum sputum. There is a main cause of the sensory afferent signal that is active in the diseased kidney, and the central sympathetic nerve is elevated. The adverse effects of long-term paternal nerve hyperactivity in this group of patients, the blood pressure of the . Left ventricular hypertrophy 109 201223577 Large, ~ ventricular arrhythmia, sudden cardiac death, insulin resistance, diabetes and metabolic syndrome. (1) 1·^·^Nerve transmission method The sympathetic nerve to the kidney terminates in the blood vessel, the juxtaglomerular apparatus and the renal tubule. Stimulation of the renal sympathetic nerve can cause increased renin release, increased sodium (Na+) reabsorption, and reduced renal blood flow. These components of the neuromodulated renal function are highly irritating in disease-like cancer characterized by increased sympathetic tone and clearly cause an increase in blood pressure in hypertensive patients. Renal blood flow and renal spheroid filtration rate caused by renal sympathetic efferent stimulation may be the basic cause of renal function decline in heart and kidney syndrome. As a progressive complication of chronic heart failure, cardio-resin syndrome is renal dysfunction. The clinical course is usually volatility in the clinical pathology and treatment of patients. Pharmacological strategies to counteract renal sympathetic stimulation include centrally acting sympatholytic blocker P (to reduce renin release), angiotensin-converting enzyme inhibitors and receptor blockers ( It is designed to block the activity of angiotensin II and aldosterone activation after renin release) and diuretics (to counteract renal sympathetically mediated sodium and water retention). However, current pharmacological strategies have significant limitations, including limited efficacy, compliance issues, side effects, and other problems. (ii) Renal sensory afferent nerves The kidneys are linked to the overall structure of the medial sacral nervous system via the renal sensory afferent nerve. Various forms of "kidney damage" can induce sensory afferent signals to be active. For example, a decrease in stroke volume or renal patency, or adenosine enrichment, can cause afferent neural connections to be active. As shown in Figures 58A and 58B, this afferent link δ 110 201223577 may be from the kidney to the brain, or may be from one kidney to another (via the medial sacral nervous system). These incoming signals are centrally integrated and can cause increased sympathetic outflow. This sympathetic pressure is directed to the kidney, thereby activating raas and inducing enhanced renin secretion, nanoretention, volume retention, and vasoconstriction. Central sympathetic overactivity also affects other organs and body structures that distribute sympathetic nerves, such as the heart and peripheral vascular structures, causing the sympathetic activity to cause the aforementioned adverse effects, many of which also lead to an increase in blood pressure. Therefore, physiology suggests that (i) regulating tissue with efferent sympathetic nerves can reduce inappropriate renin release, salt retention, and reduce renal blood flow, and (η) modulate tissue with afferent sensory nerves via which the hypothalamus can be The direct action of the lower part and the contralateral kidney reduces systemic factors that cause hypertension and other diseases associated with increased central sympathetic tone. & Removal of Afferent Kidneys f has a central low-pressure effect, and it is also expected that the central transects that are transmitted to other organs that have paternal nerves, such as the heart and vascular structures, exhibit the desired reduction. Other linings in arsenic B. As provided above, 'removing the renal nerves may be beneficial for the treatment of a variety of clinical conditions characterized by increased sympathetic sacral motility (especially enhanced renal sympathetic activity), such as hypertension, Metabolic syndrome, insulin resistance, diuretic left heart to hypertrophy, chronic end stage renal disease, heart failure, sputum stagnation, ~ renal syndrome and sudden death. Because of the reduction of systemic sympathetic tone/stress, the removal of renal nerves is also associated with other conditions associated with systemic sympathetic overactivity. Removal of renal nerves may also benefit other organs with sympathetic distribution. Body 111 201223577 Structure 'includes the organs and body structures identified in Figure 56. For example, as discussed previously, reducing central sympathetic stress can reduce insulin resistance in patients with metabolic syndrome and type 2 diabetes. In addition, the sympathetic nerves of patients with osteoporosis are also active and can also benefit from the down-regulation of sympathetic nerves caused by the removal of renal nerves. C. Intravascular Access to the Renal Artery According to the present technique, neuromodulation can be achieved by the intravascular access to the left and/or right renal plexus RP that is tightly bound to the left and/or right renal artery. As shown in Figure 59a, the blood from the heart is pumped from the left ventricle of the heart and through the aorta. The aorta descends through the chest and branches into the left and right renal arteries. Below the renal artery, the aorta is divided into two branches, the left and right iliac arteries. The left and right radial arteries descend through the left and right legs and connect the left and right femoral arteries. As shown in Fig. 59B, the fluid also enters the iliac vein through the femoral vein and enters the inferior vena cava to collect in the vein and return to the heart. The inferior vena cava branches into left and right renal veins. Above the renal vein, the inferior vena cava transmits blood up to the right of the heart~ room. Blood is drawn from the right atrium, enters the lungs through the right ventricle, and is oxidized in the lungs. The blood combined with oxygen is input into the left atrium from the lungs. Oxidized blood from the left to the chamber is returned to the aorta through the left ventricle. As will be described in more detail below, the femoral artery can be accessed at the base of the femoral triangle (just below the midpoint of the inguinal ligament) and the catheter can be inserted. The catheter can be accessed by 'S. The ankle is inserted subcutaneously into the femoral artery, and the cane artery and the active vein are inserted into the left renal artery or the right renal artery. This includes intravascular pathways that lead to the respective renal arteries and/or other renal blood vessels with minimal invasiveness. The wrist, upper arm, and shoulder regions provide additional locations for introducing catheters into the arterial system 112 201223577 . Finally, a仏丨 r ^ ^ . Lu, in the selective case can use the radial artery, • surgery, can be used to enter the zygomatic arch. Using standard angiography techniques (or via the right side of the syndrome, the lower iliac artery and the brachiocephalic artery), through the aortic arch, the aorta and the renal artery. The '°' and/or the right renal plexus RP (4) Ml ^ blood official access is achieved, so the nature of the kidney (four) structure f and characteristics can be achieved by the juice device, system and method of renal nerve regulation: "匕The nature and characteristics may vary from patient to patient and/or may vary from one specific to the other, and may vary with the disease state (such as hypertension, vocal: sputum, plant disease, end stage renal disease, insulin resistance, diabetes, metabolism). Such properties and characteristics, as described herein, may be £ <efficacy and specific design of equipment within the blood. Relevant properties may include, for example, material/mechanical, spatial, and hydrodynamic mechanical properties. As mentioned earlier, the catheter can be placed in the inferior iliac artery through the minimally invasive endovascular approach. However, it is determined that the minimally invasive renal arterial material can be ambiguous because, for example, the catheter is routinely inserted into the artery. Compared with the 'f arteries, which are usually extremely distorted, the diameter is relatively smaller or the length is relatively shorter. In addition, renal artery atherosclerosis is common in Xu. Among the patients with cardiovascular disease. Renal artery: = significantly different To make the determination of the minimum invasive pathway more:: Inter-patient dissimilarity of μ can be seen, for example, relative torsion, diameter, length 113 201223577 degrees and / or atherosclerotic plaque load' and the deviation angle of the renal artery autonomous artery branching branch Devices, systems, and methods for achieving renal neuromodulation via an intravascular pathway should address these and other aspects of renal artery anatomy and their heterogeneity among patient populations when entering the renal artery with minimal invasiveness. In addition to the complexity of the renal artery pathway, the specificity of the kidney anatomy also complicates the establishment of stable contact between the neuromodulation device and the lumen surface or wall of the renal artery. When the neuromodulation device includes a cryotherapy device, the plant is uniformly positioned. The application of appropriate contact forces to the vessel wall by the cryotherapy device and adhesion between the cryoapplicator and the vessel wall is very important for predictability. However, the compact space within the renal artery and arterial distortion are impeding access. In addition, establishing consistent contact is complicated by patient movement, respiration, and/or cardiac cycle' because these factors can cause kidney movement Significant movement relative to the aorta' and the cardiac cycle can cause the renal artery to dilate briefly (ie, cause pulsation h even after entering the renal artery and promoting stable contact between the neuromodulation device and the surface of the arterial lumen, and within the adventitia of the artery The surrounding of the adventitia of the artery should be safely regulated by the neuromodulation device. It is not easy to effectively apply thermal therapy from the renal artery in the clinical complications associated with the therapy. For example, the endometrium of the renal artery Ten membranes are highly susceptible to thermal damage. As discussed in more detail below, the intima-media thickness separating the lumen of the riser and its outer membrane means that the distance between the target renal nerve and the surface of the arterial lumen can be several millimeters. The nerve delivers or removes sufficient energy from the target renal nerve to modulate the target kidney, without overcooling or heating the vessel wall to the extent that the vessel wall is frozen, shrunk, or may affect it. Related to excessive heat of mouth: late 114 201223577 The clinical complications are blood clotting caused by blood clotting through the arteries. The thrombus can cause a renal infarction, which can cause irreversible damage to the kidney. Therefore, care should be taken from the renal arterial heat treatment. The complex humoral and thermodynamic conditions present in the renal arteries during this treatment, especially those that may affect the heat transfer kinetics at the treatment site, add energy to the pulse (eg, heat of heating) and/or Tissue removal of heat (such as cooling heat conditions) can be very important. 7 The neuromodulation device should also be configured to allow for the positioning and repositioning of the adjustable energy delivery element within the renal artery, as the treatment location can also affect clinical efficacy. For example, # renal nerves may be circumferentially spaced around the renal artery, so applying full circumferential treatment from within the renal artery may be attractive. In some cases, a full-circle damage that may be caused by continuous circumferential treatment may be associated with a narrow renal artery. Thus, it may be desirable to form more complex lesions along the longitudinal dimension of the renal artery via the cryotherapy device and/or to reposition the neuromodulation device at the treatment site. However, it should be noted that the benefits of performing circumferential resection may be more important than the possibility of renal artery stenosis, or may be mitigated by some specific examples or in some patients, and that circumferential resection may be an objective and may be altered The positioning and repositioning of the neuromodulation device has been shown to be applicable to the particularly distorted opening of the renal artery < $ branch vessel, resulting in the operation of the device in the presence of the proximal artery of the === arterial main vessel should also be: a war situation. The movement of the mechanical device applied to the carotid artery in the renal device can be used to dissect, perforate, strip the inner membrane or destroy the inner elastic membrane by, for example, inserting, manipulating, or overcoming the test. Temporarily occluded through the kidney with minimal or no complications

115 201223577 = The blood flow is short. "The occlusion should be avoided for a large amount of time because the kidneys cause (d), such as ischemia. It is beneficial to avoid occlusion completely or to limit the duration of occlusion (eg 2 to 5 minutes) when the body is beneficial. According to the above challenges: (1) renal artery intervention; (1) against the vessel wall: sin and stable placement of the treatment element; (7) effective treatment across the vessel wall ', · '4) allowing treatment device positioning and repositioning at multiple treatment locations ' and (5) Avoid blood flow occlusion or limit the duration of ash occlusion, possibly: various irrelevant and related properties of the renal vascular structure including, for example: (1) blood, blood & length, intima-membrane thickness, friction coefficient and torsion; b) dilatation, hardness and elastic modulus of the vessel wall; (c) systolic phase, peak blood flow velocity at the end of diastolic period, and mean systolic peak diastolic blood flow velocity and mean/maximum volume blood flow velocity (4) specific heat capacity of blood and/or blood vessel wall, blood and/or blood vessel wall < thermal conductivity, and/or thermal convection and/or radiant heat transfer of blood flowing through the treatment wall of the vessel wall; (e) breathing, patient movement / or movement of the renal artery induced by blood flow pulsation relative to the aorta; and (f) and the deviation angle of the renal artery from the aorta. These properties will be discussed in more detail for the renal artery. Depending on the system and method of renal neuromodulation, these properties of the renal artery may also determine and/or constrain design features. As noted above, the device positioned within the renal artery should conform to the geometry of the artery. Renal artery diameter Dra Typically in the range of about 2 mm to 1 mm, most patients have a Dra of about 4 mm to about 8 mm and an average of about 6 mm. Renal artery length Lra (between it in the aorta/renal artery) The small mouth of the joint and its end branch are generally in the range of about 5 to 116 201223577 70 mm, and most of the patient's body is within the range of about 20 mm to 50 mm. Because the target kidney is thin and thin flag ^ ^ ^ The plexus is occluded in the adventitia of the renal artery, so the intima-media thickness ΜΤ is re-introduced (ie, the membranous surface of the ventricle & the luminal surface of the artery to the outer membrane containing the target nerve structure) Outward ^) is also significant and generally About 0.5 π to .5 with the dry circumference, the average is about 15 brewing. Although a certain treatment ice is in the ', deep, (for example, from the inner wall of the renal artery, the treatment should not exceed mm) __Target tissue and anatomical structure 'plugs such as the renal vein. Another characteristic feature of the renal artery is the degree of movement of the kidney phase material induced by breathing and / or blood flow pulsation. The kidney located in the (four) pulse phase can breathe Move to 头 4" under the action of sexual shift. This significantly shifts the renal arteries connecting the aorta to the kidneys, requiring an excellent balance of stiffness and flexibility of the neuromodulation device to maintain a low temperature applicator or other heat treatment element in contact with the vessel wall during the breathing cycle. . Further, the angle of deviation of the renal artery from the aorta may vary significantly from patient to patient and may also vary significantly in the patient due to, for example, kidney movement. The off angle is about 30. Up to 135 miles. The above specific examples of the/low ambulatory device are configured to be positioned in and/or near the renal artery and/or renal stenosis via the femoral artery only the radial artery or another suitable for the golden tube approach. In any of the above specific examples described above with reference to Figures J-55, a single balloon can be configured to inflate to a direct control of from about 3 mm to about 8 mm, and the plurality of balloons can all be configured to inflate to The diameter is from about 3 mm to about 8 mm, and in some specific examples from 4 mm to 8 mm. In addition, the above-mentioned reference to Figures i to 55 and the description of 117 201223577 = What specific real money 'balloons can be individually and / or all have about 8 _ to;, Figure 1: :: degrees ' and on the right specific examples In the middle is 10 _. For example, 〇 至 置 置 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 经 经 经 经 经 经The shaft of the device described in any of the specific examples shown in Figures 1 through 55 can be sized to fit within, such as the 4Fr axis size. Shaft embodiment 1 - A cryotherapy device comprising: an intraductal: an elongated shaft of a distal portion, wherein the shaft is configured to position the distal portion in the blood adjacent to the renal artery or renal ostium a portion; a towel or otherwise separated from::: at least a portion of the supply of the shaft, the supply chamber is also configured to receive liquid refrigerant; and there is a total cooling at the distal portion Into, the cooling assembly::. a state and a deployment state, the cooling assembly includes - the application of the benefit has at least one with the supply of the inner cavity fluid - the transfer portion and a second heat transfer portion of the heat transfer, . J - ^ A first heat transfer portion Configuring to receive a refrigerant having a first-receiving rate in the deployed state and the second heat-transfer portion is configured to have - less than the first in the cooling assembly deployment state The heat transfer rate, the transfer rate 'i, wherein the first heat transfer portion is non-circular at a longitudinal segment along the length of the cold p~. The cryotherapy device of embodiment 1, wherein the cooling assembly has a central longitudinal axis and includes an orifice through which a refrigerant can flow, the 201223577 applicator comprising - having an inner surface And in the plane at the orifice and perpendicular to the axis, the center longitudinal direction in the deployed state

The distance from the line to the 5 hole opening τ I is not less than about 2 〇〇 / 0 of the distance from the central longitudinal axis to the inner surface in the deployed state. =3. The cryotherapy device of embodiment 1, further comprising - along. The discharge passage of the shaft to the ν portion is such that the cooling assembly includes a hole σ through which the refrigerant can flow, the supply chamber having a substantially helical portion including the orifice 'the spiral portion Winding around the discharge passage, and the orifice is configured to direct from the supply lumen to the first heat transfer portion to cause expansion of the refrigerant. 4' The cryotherapy device of embodiment 3, wherein the cooling assembly has a central longitudinal axis, a line, and in the deployed state the aperture is spaced from the central longitudinal axis by more than about 0.1 nun. 5. The cryotherapy device of embodiment 3, wherein the applicator comprises a balloon having an inner surface, and wherein the aperture is less than about 1 mm from the inner surface in the deployed state. Wherein the cooling assembly is packaged and the orifices are disposed in the apparatus. The cryotherapy device of Embodiment 3 includes a plurality of orifices through which the refrigerant can flow, at different circumferential locations around the helical portion. 7. The cryotherapy device of embodiment 1, further comprising a heat insulating member adjacent to the second heat transfer portion. 8. The cryotherapy device of embodiment 7, wherein the applicator comprises a balloon having an inner surface, the second heat transfer portion being a portion of the balloon, and the insulating member adjacent the inner surface. * 119 201223577 9. The cryotherapy device of embodiment 8, wherein the first heat transfer portion and the second heat transfer portion are substantially helical. The cryotherapy device of embodiment 7, wherein the applicator comprises a balloon, the first heat transfer portion is a first portion of the first average thickness of the balloon, and the second heat transfer portion is the The balloon has a second portion having a second average thickness and the first average thickness is less than the first average thickness. The low temperature treatment device of embodiment 1, further comprising a first elongated heat insulating member and a second elongated heat insulating member, wherein: the applicator has a third heat transfer portion 'the third heat transfer portion Receiving, in the deployed state, the refrigerant assembly receives a refrigerant having a third heat transfer rate greater than the second heat transfer rate; ^ the applicator has a fourth heat transfer portion, the fourth heat transfer portion being In the deployed state, when the cooling assembly receives the refrigerant, having a first heat transfer rate adjacent to the second heat transfer rate adjacent to the first heat transfer rate and the third heat transfer rate; The second insulating member is adjacent to the fourth heat transfer portion; and the third heat transfer portion VIII, alone or in combination with the first heat transfer portion, is non-circular at a longitudinal segment along the length of the cooling assembly. 12. The cryotherapy device of embodiment U, wherein the first thermal insulation component and the second thermal insulation component are configured to receive a filling cavity of the filling material, and the filling lumens have a contracted configuration and an expansion group state. 13. The cryotherapy device of embodiment U, wherein the first and second primary thermal insulation members are substantially parallel to the long night of the cooling assembly in the deployed state 120 201223577. 14. j, d ^ 埶a The cryotherapy device of embodiment 1, further comprising an elongated, '',,," member, wherein the applicator includes a balloon, and at least one of the insulating members is occluded Connected to the balloon and movable within the balloon in the deployed state. 15. The cryotherapy device of embodiment 14 wherein the insulating member has a substantially triangular cross-sectional area. 2. The cryotherapy device of embodiment 14 wherein the portion of the insulating member is in a cylinder state to move in response to gravity in the deployed state. The cryotherapy device of embodiment 14 wherein the insulating member is in a red state to receive a filled lumen of the filling material, and the filling lumen has a collapsed configuration and an expanded configuration. ―, 18· Implementing your " hypothermia treatment device further comprising - an inner balloon of the inner balloon cavity in fluid communication with the supply lumen, wherein the applicator comprises an externally broken, alpha + alpha ^ Ν The ball, 4 internal balloon is in the outer part, the inner balloon includes an orifice that can be steamed, g, m wide and 7 (1) J is moved through, and the balloon has a contracted configuration and an expanded configuration. The cryotherapy device of embodiment 18, wherein the supply portion extends through the inner balloon. (20. The cryotherapy apparatus according to embodiment 18, wherein the interior is surrounded by a plurality of circumferences disposed at different circumferential positions of the inner balloon, 21. The cryotherapy device of the embodiment 20 is a spiral. Shaped configuration. 201223577 22. The hypothermia treatment of the embodiment 18 has a concave portion and a non-recessed portion non-recessed portion, and the second heat transfer portion transmitting portion includes the knife including the concave portion 3. The cryotherapy device of embodiment 22, and the knife 0 is substantially helical. Eight non-recessed portions 4. The cryotherapy device of Example 丨8, 苴--outer balloon cavity, shaw interior balloon and /邛The ball rolling body connection has a first free passage area: -= between the total flow: the 'total fluid connection between the chambers has a second free passage, the passage area being smaller than the second free passage area. A cryotherapy device comprising: an intraductal: an elongated shaft of a distal portion, wherein the shaft is configured to be positioned in the renal artery or renal ostium in the blood m portion or otherwise treated in the renal artery or renal ostium And; in the axis a cooling assembly at the distal end portion, the cooling being in a delivery-to-delivery state and a deployed state, and the 'cooling assembly' includes a plurality of orifices through which a drug agent and a refrigerant can flow, the holes A discrete area of the mouthpiece that provides a non-circular total cryogenic cooling pattern for directing the flow of refrigerant into the applicator. 26. The cryotherapy device of embodiment 25, wherein the step comprises The cooling assembly delivers a refrigerant supply lumen, wherein the 5 Xuan supply lumen extends at least partially within the applicator, and the orifices are along the 5 Hai applicator The apertured portion of one of the inner chambers is spaced apart from each other. 27. The cryotherapy device of embodiment 20, wherein the portion of the supply lumen is 122 201223577, the portion of the supply lumen is a linear I, and the holes The cryotherapy device of Embodiment 26, wherein the portion of the applicator is a spiral tube, and the holes are along the hole The outer portion of the spiral tube is disposed. 29 as in embodiment 26 a cryotherapy device further comprising a tilted first supply branch and a tilted second supply branch, one of the apertures being distal to one of the first supply branches, and the other of the apertures being The first supply branch and the first supply branch are longitudinally spaced along the length of the cooling assembly. 30. The cryotherapy device of embodiment 29, further comprising a first inner supply chamber and a second supply inner chamber, wherein the first supply inner chamber and the second inner chamber are configured to transport the refrigerant along the axial direction of the cooling assembly, The branch defines a distal end portion of the first supply lumen and the first supply defines a distal portion of the second supply lumen. 31. A cryotherapy device comprising: an elongated shaft having a distal portion, wherein the shaft is configured to position the distal portion within a renal artery or renal ostium within a blood vessel or otherwise 4 proximal to the kidney At a treatment site of the arterial or renal ostium; a supply lumen along at least a portion of the shaft, the supply lumen having a first flow impedance and configured to deliver a liquid and/or supercritical refrigerant; At least a portion of the exhaust passage having a second flow impedance configured to deliver liquid and/or supercritical refrigerant; and 123 201223577 a cooling assembly at the distal end of the shaft, The cooling assembly has a delivery state and a deployed state, the cooling assembly including an applicator having a balloon in fluid communication with the supply lumen and the discharge passage, and wherein the first flow impedance is substantially Equal to the second flow impedance. 32_ A method for treating a patient, the method comprising: placing one of the cryotherapy devices, one of the cryotherapy devices, in the blood vessel, the applicator, the renal artery or the renal artery, or otherwise adjacent to the renal artery or At a treatment site of a small renal artery, wherein the applicator is at a distal end portion of an elongated shaft; and wherein the liquid refrigerant is converted into a gaseous refrigerant in the cooling assembly via the applicator A heat transfer portion cools a portion of the treatment site at a rate of heat transfer sufficient to produce a therapeutically effective hypotensive renal neuromodulation, wherein the heat transfer portion is substantially planar in substantially any plane perpendicular to the length of the renal artery The method of embodiment 32, wherein: the portion of the treatment site is the treatment site - the first portion - the heat transfer portion is a first heat transfer portion; the second heat transfer portion is a heat Transfer rate - the orifice to the second port to the second 埶 1 *, \ the method further comprises, via one of the applicators, sufficient to produce a therapeutically effective hypotensive renal neuromodulation Cooling down a second portion of the treatment site; converting the liquid refrigerant includes expanding the refrigerant through a first heat transfer portion and expanding the refrigerant through a second hole transfer portion; the first orifice and the The second orifice is spaced longitudinally and radially along the length of the cooling assembly at 124 201223577. and • the second heat transfer portion combined with the first heat transfer portion is perpendicular to the renal artery The length of the length is substantially non-circular in substantially any plane. 34. The method of embodiment 32, the method further comprising delivering the liquid cryogen through a substantially helical portion of a supply lumen prior to converting the liquid, 々%丨 to the gaseous refrigerant. 35. The method of embodiment 34, the method further comprising discharging the gaseous refrigerant via a discharge passage extending along a central axis of the distal helical portion. 3. The method of embodiment 3-4, wherein: the portion of the treatment site is a first portion of the treatment site; the heat transfer portion is a first heat transfer portion; the method further comprising passing the applicator A second heat transfer portion cools a second portion of the treatment site at a rate of heat transfer sufficient to produce a therapeutically effective low temperature renal neuromodulation; converting the liquid cryogen comprises passing the refrigerant through a first orifice The first heat transfer portion expands and expands the refrigerant to the second heat transfer portion via a second orifice; the first orifice and the second orifice are on the spiral portion, and the cooling is along the cooling The length of the assembly is spaced longitudinally and radially apart; and the second heat transfer portion alone or in combination with the first heat transfer portion is substantially non-perpendicular in substantially any plane perpendicular to the length of the renal artery Circumferential. 125 201223577 37. The method of embodiment 32, wherein: the portion of the treatment site is the first portion of the treatment site. The heat transfer portion is a first heat transfer portion; the method further comprises: treating the treatment The second portion of the portion is insulated from the second heat transfer portion of the applicator; and the application device includes a heat insulating member adjacent the second heat transfer portion. 38. The method of embodiment 37, wherein the crucible-heat transfer portion and the second heat transfer portion are substantially helical. 3. The method of embodiment 3, wherein: the portion of the treatment site is the first portion of the treatment site; the heat transfer portion is a first heat transfer portion; the method further comprising passing the applicator a second heat transfer portion cooling a second portion of the treatment site at a rate of heat transfer sufficient to produce a therapeutically effective low temperature renal neuromodulation; the method further comprising administering a third portion of the treatment site to the administration One of the third heat transfer portions is insulated; the third heat transfer portion is located substantially between the first heat transfer portion and the second heat transfer portion; and the third applicator includes adjacent to the third heat transfer portion The elongated heat insulating member; and the second heat transfer portion alone or in combination with the first heat transfer portion is substantially non-circular in substantially any plane perpendicular to a length of one of the renal arteries. 40. The method of embodiment 39, the method further comprising introducing into the alpha tube from the insulating tube 126 201223577 a component from the 41. and introducing the filling lumen into the filling chamber 10 to introduce a filling material, the shrinking configuration expanding to - expanding Configuring a cryotherapy device comprising: the shaft configured to be positioned within the intravascular orifice or otherwise adjacent to an elongated shaft having a distal portion that is positioned in the renal artery or renal small renal artery or kidney At the treatment site of the small mouth; at least one of the eight along the axis +

At the supply of the inner cavity, the supply inner cavity is configured to receive the liquid refrigerant; and a cooling total & at the remote end, the cooling assembly has a delivery state and a deployment state, The cooling assembly includes an orifice and an applicator including a first balloon and a second balloon, the orifice being in communication with the supply lumen μ. The first balloon has a heat transfer in fluid communication with the orifice a knife wherein the second balloon at least partially contracts in the delivery state, wherein the distal heat transfer portion has a heat sufficient to produce a therapeutically effective hypotensive renal neuromodulation when the cooling assembly receives the refrigerant in the deployed state The transfer rate 'and wherein the heat transfer portion is non-circular at a longitudinal segment along the length of the cooling assembly. A cryotherapy device comprising: an elongated shaft having a distal portion configured to position the distal portion within a renal artery or renal ostium within a blood vessel or otherwise adjacent to a renal artery or a treatment site at the renal mouth; - a supply lumen along at least a portion of the shaft, the supply lumen configured to receive a liquid cryogen; and a cooling assembly at the distal portion, the cooling assembly Having a • * 127 201223577 delivery status and deployment state, the cooling assembly includes an orifice and an applicator including a - balloon and a second balloon, the orifice being in fluid communication with the supply lumen ' 5 The first balloon has a first heat in fluid communication with the orifice: the first balloon has a second heat transfer portion, and the second balloon is at least partially contracted in the delivery state, The first heat transfer portion:: the compliance is substantially smaller than the second heat transfer portion, wherein the first heat transfer portion has in the deployed state when the cooling assembly receives the refrigerant; the bean/alpha therapy The first effective low temperature renal nerve regulation Transfer speed: 'where the second heat transfer portion has a second heat transfer less than the first heat transfer rate in the cooling state in the deployed state, and wherein the first heat transfer portion The non-circumferential portion of the length along the length of the cooling assembly is as follows. The cryotherapy device according to Example 42 is less compliant than the second balloon. 4: % The cryotherapy device of Example 42 wherein the A balloon is substantially non-compliant and the second balloon is substantially compliant. : 5: The cryotherapy device of embodiment 42, wherein: the 31st ball has a - substantially D-shaped cross section The first heat transfer portion is substantially non-compliant; the I ball has a C-shaped cross-sectional area of a cross-sectional area of the 气球-shaped body attached to the first balloon; And: the second heat transfer portion is substantially compliant. The cryotherapy device of embodiment 42 wherein the applicator is expandable and configured to completely occlude the renal artery having different cross-sectional dimensions

S 128 201223577 Small mouth. 47. The cryotherapy device of embodiment 42, wherein the second balloon is configured in the deployed state to insulate one of the treatment sites from the 5 ball. & 48. The cryotherapy device of embodiment 42, wherein the applicator includes a segment between the first balloon and the second balloon, the segment being substantially non-compliant. 49. The cryotherapy device of embodiment 42, wherein the first balloon defines a first chamber, the second balloon defines a second chamber, the first chamber is fluidly separated from the second chamber, the device Further included is a fill lumen along at least a portion of the shaft 2, and the fill lumen is configured to supply a fill material to the second chamber. 5. The cryotherapy device of embodiment 42, wherein: the cooling assembly has a first length; a length, three lengths; and two lengths in the deployed state, the first balloon is elongated and has a sixth The first balloon is elongate and has a first length, a second length, and the second substantially parallel. 5 1. A cryotherapy device comprising: - an elongated shaft having a distal portion of a length configured to position the distal portion within a renal artery or renal ostium within a blood vessel or other Means adjacent to the treatment site of the renal artery or the renal ostium; a supply lumen provided for at least a portion of the extraction, the supply lumen configured to receive a liquid cryogen; and 129 201223577 - at the axis An applicator at the distal end portion, the applicator having a delivery state and a deployed state and including a first chamber and a second chamber having a fluid with the supply lumen Connecting the first heat transfer portion, and the second chamber star has a 篦__ having a first heat transfer portion, wherein the first heat transfer portion is substantially compliant with the second heat transfer Part, wherein the first heat transfer portion of the crucible has a sufficient amount to produce a "lowering renal neuromodulation effective at the cooling assembly" when the cooling assembly receives the refrigerant under the deployment L, wherein the The second track, the state eight -, ",, 1 search °卩 In this deployment state, when the S Xuan cooling assembly receives the refrigerant, it has the first heat transfer rate of the first heat transfer rate of 6 hai, and the flute in the pot ^ ^ /, τ ° The first heat transfer portion extends less than the full circumference of the applicator in t straight to the length of the face. 52. A cryotherapy device comprising: an: an elongated shaft having a distal portion, the shaft being configured to position the terminal portion in the renal artery or the renal sinus or (in the renal sinus) Other means adjacent to the treatment site of the renal artery or renal stenosis; other means adjacent to the supply::: at least a portion of the supply lumen, the supply lumen configured to receive liquid cryogen; The cooling assembly at the distal end portion, the cooling assembly includes an orifice and a first ball applicator, the orifice is in fluid communication with the supply lumen, and the flute-&gt i 仏 仏 仏 ball defines a first chamber and has a first port in which the orifice is in fluid communication with a "two chamber and a right ... hand portion, the second balloon defines - at least partially contracted The first balloon is in the delivery so that the first heat transfer portion has a first amount sufficient to produce therapeutically effective hypotensive renal neuromodulation when the cooling assembly receives the refrigerant in the deployment state 130 201223577 Heat transfer rate, wherein the second heat transfer portion is a second heat transfer rate of the first heat transfer rate when the cooling assembly receives the refrigerant in the deployed state, and wherein the first heat transfer; + ', the knife is along the length of the cooling assembly The longitudinal segment is non-circular

And sorrowfully conveying the refrigerant from the first chamber; and at least a portion of the __ channel along the shaft passes through the first discharge passage of the phase boring tool, the second discharge, ～, to convey from the first The two chambers are separated from the channel fluid. And the violation of the first row of 5:32. The cryotherapy device of the example 52, the further step comprising: - the second - discharge channel fluid connection of the first - pressure regulator; and d: r out channel fluid connection Second pressure regulator. The cryotherapy device of the column 52, wherein: the first balloon has a -first internal surface area, the milk ball has a second internal surface area, the pupil opening is - θ, the first chamber is second, and the second is the channel area - An orifice, the first cooling assembly inlet: two fluid communication, the orifice, the chamber having the second free passage area is in fluid communication with the second orifice, and the ratio of the surface area of the free passage ^^*^ Greater than a ratio of the area to the second surface area. 131 201223577 5 5 . If she is 7 , the cryotherapy device of the case 52 , wherein: the orifice is 1_ orifice, shai first amine gold _. in fluid communication with the first orifice, shai cooling total The battle further includes a second aperture, the second cavity @δH is in fluid communication with the second aperture, 5Hi-孑1* mouth; ^2 and the first chamber is configured to be in the deployed state The lower surface area limits the cooling; and the second orifice a is produced - and the second chamber is configured to enter the above-described refrigerant limited cooling in the deployed state. The cryotherapy device of embodiment 52, wherein the cooling assembly is configured to have a refrigerant in the first chamber at a first average 'degree of ## ring 'Let the refrigerant in the second chamber at - the second average fox degree is followed by '% - the average temperature is lower than the second average temperature. The cryotherapy device of embodiment 52, wherein the applicator comprises a second balloon, the first balloon and the second balloon being within the third balloon. 58. The cryotherapy device of embodiment 52, wherein: the cooling assembly has a first length, the first balloon is elongated and has a second length, the second balloon is elongated and has a third length And the first length, the second length, and the third length are substantially parallel in the deployed state. A 59. A cryotherapy device comprising: an elongated shaft having a distal portion of a length configured to position the distal portion within the renal artery or renal ostium within the blood vessel or otherwise

S 132 201223577 is located adjacent to the treatment site of the renal artery or renal ostium; a $+ along the axis is connected to the supply... The supply lumen is configured to receive liquid cryogen; at the distal end of the axis In some places, the delivery state of the applicator and a disposition can also plagiarize and have at least one first-chamber and -th-chamber, the first cavity officer and the ancient _ Leyi The worker-to-there is a sputum transfer unit in fluid communication with the supply lumen, and wherein the 埶 遽 寻 is found. The knives extend around a full circumference of the applicator in a plane perpendicular to the length; the first-discharge assembly is configured to deliver the first chamber from the second chamber In the deployed state, the cooling assembly has a heat transfer rate sufficient to produce a therapeutically effective low temperature renal neuromodulation; and a first-discharge assembly configured to deliver from the second lumen The refrigerant of the chamber is such that when the cooling chamber receives the refrigerant in the deployed state, the second heat transfer kite, the second heat transfer kite, and the first discharge assembly are smaller than the first heat transfer rate. Separating from the first discharge assembly fluid. 60. A cryotherapy device comprising: "eight-ported end. The elongated shaft of the iliac crest, the shaft configured to be positioned within the renal artery or renal ostium in the blood vessel, or otherwise Adjacent to the treatment site of the renal artery or renal ostium; α / α at least a portion of the supply lumen, the supply lumen configured to receive liquid cryogen; and - the delivery state of the shaft And a cooling assembly at the distal end portion, the cooling assembly is deployed, the cooling assembly includes an aperture and 3 133 201223577 an applicator including a first balloon and a second balloon, the orifice The supply lumen fluid communication Hei-balloon has a helical heat transfer portion bent about the second balloon and in fluid communication with the orifice, and the second balloon is at least partially constricted in the delivery state, wherein the heat transfer In the deployed state, the cooling assembly has a heat transfer rate sufficient to produce a therapeutically effective low temperature renal neuromodulation when the cooling assembly receives the refrigerant. 61. The cryotherapy device of embodiment 60, wherein the first balloon is substantially The second balloon is substantially compliant, and the second balloon is substantially compliant. The cryotherapy device of embodiment 60, wherein the first balloon is substantially compliant, and the second balloon is substantially The non-compliant device of claim 60, wherein the first balloon and the second balloon are substantially compliant. 64. The cryotherapy device of embodiment 60, wherein the first balloon and The second balloon is substantially non-compliant. The cryotherapy device of embodiment 60, wherein the heat transfer portion is a first heat transfer portion, the heat transfer rate being a first heat transfer rate, the first The second balloon has a second heat transfer portion having a second heat transfer rate less than the first heat transfer rate when the cooling assembly receives the refrigerant in the deployed state. 66. The cryotherapy as in Example 60 a device, wherein the applicator is expandable and configurable to completely occlude a renal artery or a renal orifice having a different cross-sectional dimension. 67. The cryotherapy device of embodiment 60, wherein the heat transfer portion has a helix straight The second balloon is generally compliant and is

S 134 201223577 The second balloon is swollen in the deployed state to increase the diameter of the spiral. 6. The cryotherapy device of embodiment 60, wherein the first gas chamber defines a first chamber, the second balloon defines a second chamber, the first chamber is fluidly separated from the second chamber The device further includes a fill lumen along at least a portion of the wheel, and the fill lumen is configured to supply a fill material to the second chamber. "" 69. The cryotherapy device of embodiment 60, wherein the first balloon package = a helical portion, the second balloon having a second pass = sorrow in the deployed state to occlude the renal artery or the renal mouth A substantially circular cross-sectional dimension, and the helical portion is wrapped around the second balloon. The cryotherapy device of embodiment 60, wherein the second balloon has an outer wall surface and the first balloon is at least partially inserted into the outer wall surface. The balloon device is 71. The cryotherapy device of embodiment 60, wherein The second has an inner wall surface and the first balloon is at the inner wall surface. The balloon sets a chamber to receive the cryotherapy device of the embodiment 60, wherein the first - the first chamber, the flute a flows, the first ball, the second chamber, the first fluid is connected to the The second chamber flutes to and the first chamber of 6 hai is configured to receive the refrigerant of the first chamber of 3 hai. 73--a cryotherapy device comprising: an intravascular proximal cavity group having a distal portion for positioning the distal portion (four) axis 'the vehicle is configured to be located in the renal artery or renal sinus Beans in the ancient kidney arteries or small renal mouth, "Θ or other treatment sites; 5 袖 sleeve to small 乂 - 4 points supply lumen, the supply 135 201223577 state to receive liquid refrigerant; And an applicator at the distal end portion, the applicator having a first chamber and a second chamber in fluid communication with the supply lumen, the first chamber having a supply and a supply (4) a heat transfer portion that is in communication with the body, and the first = chamber includes a helical portion that is curved around the second chamber, and wherein the helical portion has a state in the deployed state when the cooling assembly receives the refrigerant: A heat transfer rate sufficient to produce a therapeutically effective hypothermia renal neuromodulation, 74. A cryotherapy device comprising: #- an elongated shaft having a distal portion of a length that is configured to be placed within a blood vessel The distal portion is positioned within the renal artery or renal ostium or Other means adjacent to the treatment site of the renal artery or renal ostium; - a supply lumen along at least a portion of the shaft, the supply lumen configured to receive liquid cryogen; and a total cooling at the distal portion The cooling assembly has a delivery state and a deployed state, the cooling assembly including an orifice and an applicator including a -th-spiral balloon and a second spiral balloon, the two and the supply The cavity and the first spiral balloon are in fluid communication, and the first spiral balloon and the second spiral balloon are wound around one of the shafts== at least part of the parent, wherein the first spiral balloon is a first heat transfer rate sufficient to produce a therapeutically effective hypotensive renal neuromodulation in the deployed state when the cooling assembly receives the cryogen, and wherein the second helical balloon is in the cooling assembly in the deployed state Receiving a refrigerant having a second heat transfer rate less than the first heat transfer rate. 75. The cryotherapy device of embodiment 74, wherein the device is further 136 201223577. at least one of the package 3 / σ 3 a discharge channel, and wherein the first spiral balloon and the second spiral balloon are wrapped around the discharge channel. 76. The cryotherapy device of embodiment 74, wherein the first spiral balloon defines a first a chamber, the second spiral balloon defining a second chamber, the first chamber being fluidly separated from the second chamber, the device further comprising at least a portion of the filling chamber of the vehicle The filling lumen is configured to supply a filling material to the second chamber. 77. The cryotherapy device of embodiment 74, wherein the first spiral balloon defines a first chamber, the second spiral balloon defining a a second chamber fluidly coupled to the second chamber, the second chamber configured to receive cryogen from the first chamber. 78. cryotherapy as in Example 74 The device, wherein the applicator includes a second spiral balloon having a third heat transfer less than the first heat transfer rate when the cooling assembly receives the refrigerant in the deployed state Rate, and wherein the third spiral balloon A small portion of the first spiral helical balloon and the second balloon s Hai interlacing. 79. The cryotherapy device of embodiment 78, wherein: the cooling assembly has a length, the first spiral balloon has a first curved portion, and the second spiral balloon has a second curved portion, the third The spiral balloon has a third curved portion, and the second curved portion and the third curved portion are on the opposite side of the first curved portion along the length. 80_ The cryotherapy device of embodiment 78, wherein the first spiral

137 201223577 Balloon definition - a first chamber, the second spiral balloon defines a second chamber, the third spiral balloon defines a third chamber, the first chamber and the second chamber and the first The three chamber fluid is separated, the apparatus further includes a fill lumen along at least a portion of the shaft, and the fill lumen is configured to supply a fill material to the second chamber, the third chamber, or both. 8. The cryotherapy device of embodiment 78, wherein the first helical balloon defines a first chamber, the second helical balloon defining a second lumen to. The first spiral balloon defines a third chamber, the first chamber is fluidly connected to the second chamber and the third chamber, and the second chamber and the third chamber are configured A refrigerant from the first chamber is received. 82. The cryotherapy device of embodiment 74, wherein the applicator comprises a third helical balloon having a sufficient amount of treatment in the deployed state when the cooling assembly receives the cryogen The third heat transfer rate of the effective hypothermia renal neuromodulation, and wherein the third spiral balloon is to ^'. The split is interlaced with the first spiral balloon and the second spiral balloon. 83. The cryotherapy device of embodiment 8 wherein: the cooling assembly has a length, the first spiral balloon has a first curved portion, and the second helical balloon has a second curved portion, the first The triple spiral balloon has a third curved portion, and the first curved portion and the third curved portion are on the opposite side of the second curved portion along the length. 84_ The cryotherapy device of embodiment 82, wherein the first spiral-shaped 138 201223577 balloon defines a first chamber, the second spiral balloon defines a second chamber, the = three spiral balloon definition - the first a three chamber, the second chamber is fluidly separated from the first chamber to the third chamber, the device further comprising a filling cavity along the "Xuan axis to the V portion", and the filling cavity is configured The cryotherapy device of embodiment 82, wherein the first spiral balloon defines a first chamber, and the second spiral balloon defines a second chamber, the first The triple spiral balloon defines a third chamber, and the first chamber and the third chamber are fluidly connected to the first chamber of the crucible, and the second chamber is Configuring to receive refrigerant from the first chamber. 86. A cryotherapy device comprising: an elongated shaft having a distal portion having a length configured to position the distal portion within a blood vessel At the treatment site of the renal artery or renal stenosis or otherwise adjacent to the renal artery or renal orifice / / 4 at least a portion of the supply lumen, the supply lumen configured to receive a liquid cryogen; and an applicator at the distal portion, the applicator having a delivery state deployment state And including a first chamber having a first heat transfer portion in fluid communication with the supply lumen, and a first chamber including - a substantially helical shape a portion of the second cavity to include a second substantially helical portion, and the first substantially helical portion and the second large portion are at least partially intertwined The delivery portion is in the deployed state when the cooling assembly receives the sputum and sputum to produce therapeutically effective hypotensive renal neuromodulation

139 201223577 The heat transfer rate, and wherein the transfer portion extends around a full circumference of the applicator in a plane perpendicular to the length. 87. A cryotherapy device comprising: a % having a terminal portion, ', a long shaft' of the field, the shaft being configured to position the distal portion within the renal artery or the renal ostium within the blood vessel or Otherly adjacent to the treatment site of the renal artery or renal ostium; a supply lumen along at least a portion of the shaft, the supply lumen configured to receive liquid cryogen; & ν &#令Ρ〜成, the cooling assembly has a delivery state and a deployment, &, person, ^ to 7 assemblies including an orifice and an applicator, the instrument includes a first balloon defining a first chamber and a second balloon defining a second chamber, the ^^.s ^ orifice being in fluid communication with the supply lumen, the first ball having a The orifice fluid is connected to the flute flute-name β 目士16, Zhao Yuntong's brother, a heat transfer part, and the shape of the second balloon is at least m. The splitting contraction, the second force to the Xing Zihai first cavity palace total public departure, wherein the first pass transmits Qiu Ba. Plus w to the body knife "P P in the deployment state in the cooling into the reception In the case of a refrigerant, there is a first heat transfer rate which is effective for the oral therapy, wherein the second U is under the enthalpy when the cooling assembly receives the refrigerant. Have, pass, and two deployment status

Rate of the second heat transfer rate, and ...: a:: (4) - heat transfer rate, the first heat transfer portion of the gossip is the non-circular longitudinal segment of the length of the 'V«兮A assembly; A '° °" ... at least a portion of the D-axis is filled, and the chamber is filled with a chamber-to-paste to supply a filling material to the first chamber of the crucible. 如. Low temperature 縻, where the first balloon does not

S 140 201223577 can be contracted such that it has a fixed volume. 89. The cryotherapy device of embodiment 87, wherein the first heat transfer portion comprises a metal heat transfer member. 90. The cryotherapy device of embodiment 87, wherein the second balloon is within the first balloon. 91. The cryotherapy device of embodiment 87, wherein: the distal portion has a length, and the second balloon is configured to preferentially expand substantially in a first direction relative to the length; the orifice Configuring to cause the refrigerant to expand from the supply lumen to the first heat transfer portion substantially in a second direction relative to the length; and an angle between the first direction and the second direction is About 15. To about 180 baht. 92. The cryotherapy device of embodiment 87, wherein the second balloon has an inner surface and the filling lumen is substantially non-retractable and attached to the inner surface. 93. The cryotherapy device of embodiment 87, wherein the applicator is expandable and configured to completely occlude a renal artery or a small orifice having a different cross-sectional dimension. 94. The cryotherapy device of embodiment 87, wherein the second balloon is configured in a deployed state to insulate a portion of the fish from the treatment site. ...Hai-Balloon 9 5. A cryotherapy device comprising: an elongated shaft having a distal portion of a length configured to position the distal portion in the renal artery within 3 141 201223577 blood vessels Or at a treatment site adjacent to the renal artery or renal ostium in the renal orifice or otherwise; a supply lumen along at least a portion of the shaft, the supply lumen configured to receive a liquid cryogen; a portion of the applicator having a delivery state and a deployed state and including a first chamber and a second chamber, the first chamber having a first heat in fluid communication with the supply lumen a transfer portion, the second chamber has a second heat transfer portion, and the second chamber is in fluid separation from the first chamber, and the first heat transfer portion receives refrigeration in the cooling assembly in the deployed state The agent has a first heat transfer rate sufficient to produce a therapeutically effective low temperature renal neuromodulation, " the second rail transfer portion has a less than the first in the deployed state when the cooling assembly receives the cryogen Second heat transfer rate Passing M ball. Xuan, ^ ^ ... 1 seek rate, and wherein the first heat transfer portion extends around a full circumference of the applicator in a flat ten plane perpendicular to the length; and a along the axis At least a portion of the cavity is filled with a cavity that is filled to supply the filling material to the second chamber. 96. A hypothermia treatment device comprising: a slender thin portion having a terminal portion, the 兮±^ axis 8 hp configured to position the proximal portion of the blood vessel in the renal artery or kidney ^ . . Other than the treatment site of the adjacent renal artery or renal ostium; a seat along at least a portion of the shaft A. ', the inner lumen, the supply lumen; state to receive liquid cryogen; a cold heading assembly at the distal end portion of the shaft, the cooling total)

S 142 201223577 -· has a delivery state and a deployment state, the cooling oil 1~ includes an aperture and an instrument, the applicator includes - defining a 笸. 矣咕疋 矣咕疋 弟 - the first chamber a balloon and a second balloon of the second chamber, the orifice is supplied with a fluid of the inner cavity. The first balloon has a first heat transfer portion in fluid communication with the orifice, the first balloon Having a second heat transfer portion that at least partially contracts in an edge-delivered state, the second chamber being fluidly coupled to the first-to-t, t-second chamber configured to receive from a refrigerant of the first chamber, wherein the first heat transfer portion has a sufficient amount of low temperature renal neuromodulation effective in the treatment of the cooling assembly when the cooling assembly receives the refrigerant in the deployed state a heat transfer rate, the first heat transfer portion of the center, the first heat transfer portion having a second heat transfer rate less than the first heat transfer rate when the cooling assembly receives the refrigerant in the deployed state Rate, and 1 ^, medium. The first heat transfer portion of the hai is non-circular at the longitudinal segment of the length of the icy cooling. 97_ The cryotherapy as in Example 96 _ ^ d I, wherein the first chamber has a first refrigerant _ A edge time in the deployment state, the second chamber is in the deployed state There is a second refrigerant sheet J ~ retention time, and the residence time of the helium-consistency agent is less than the residence time of the second refrigerant. </ RTI> 98. The hypothermia treatment perforating device of embodiment 96, wherein the device further comprises 3 - along the at least a portion of the axis - café - + channel, and the first chamber and first The face to fluid is connected to the discharge passage. &quot;· The apparatus of claim 96, wherein the apparatus further comprises a row along a row of at least a portion of the shaft *.a, the bitter soil outlet channel The m-terminal portion of the channel, and the first - ^ , χ ^ ^, the cavity is fluidly connected to the second chamber via the distal end of the discharge channel. 143 201223577 ▲ 1. The cryotherapy device of embodiment 96, wherein the second balloon is configured to passively fill the refrigerant from the first balloon. The cryotherapy device of embodiment 96, wherein the applicator is swellable and configured to completely occlude a renal artery having a different cross-sectional dimension or 102. The cryotherapy device of embodiment 96 wherein the The two balloons are configured in the deployed state to insulate the first ball of the treatment site. A cryotherapy device according to the embodiment of the invention, wherein the cooling assembly has a first length, two lengths, three lengths, and three lengths in the deployed state, the first balloon is elongated and has - the second balloon is elongate and has - the first length, the second length and the second substantially parallel. The shaft is configured to supply a lumen set within σ or in other directions. The cryotherapy device comprises: an elongated shaft having a distal portion of a length, the distal portion of the vessel being intravascularly Positioned at the treatment site of the renal artery or renal proximal renal artery or renal ostium. A supply of internal cavity state along at least a portion of the shaft to receive liquid cryogen; and a drug application at the distal portion Or the instrument has a delivery state and a deployed state and includes - a first, a second to the second chamber, the first chamber has a fluid connection with the supply lumen - the second chamber has a second Heat transfer portion = heat transfer portion, I ° second chamber fluid connection 201223577 is connected to the first chamber, wherein the second chamber is configured to receive refrigerant from the first chamber, wherein The first heat transfer portion has a first heat transfer rate sufficient to produce a therapeutically effective low temperature renal nerve regulation under the deployment bear when the cooling assembly receives the refrigerant, wherein the second heat transfer portion is In the deployment state, the cooling assembly is received The refrigerant has a second heat transfer rate at the first heat transfer rate, and wherein the first heat transfer portion extends around a full circumference of the applicator 2 in a plane perpendicular to the length. 70 105. The cryotherapy device of embodiment 1 to 4, wherein the lower portion contains a portion of the discharge channel, and the discharge channel is configured to deliver the refrigerant of the two chambers. The second chamber is configured to deliver refrigerant from the first chamber to the outlet passage. 106. The cryotherapy device of embodiment 105, wherein: the end 4: a first chamber distal end; - the first chamber near the distal portion of the rotational cooling #丨向向-室室六亥第二The chamber has a second chamber distal portion and is configured to transfer refrigerant from the second chamber to the second chamber near the proximal portion, the core portion to the second chamber = The discharge passage has a distal end portion of the discharge passage, and the proximal portion of the second lower chamber is adjacent to the distal end portion of the row 107 passage.低温The low temperature treatment of the embodiment 105 is from the flute, the 罝 'the 荦 荦 荦 ° 亥 亥 亥 腔 腔 腔 腔 腔 腔 腔 腔 腔 腔 腔 至 至 至 亥 亥 亥 亥 亥 亥 亥 亥 亥 亥 亥 亥 亥 亥 亥 亥 亥 亥 亥The flow path of the agent passes through the second chamber, 145 3 the shaft is configured to supply the lumen in the mouth or otherwise. 201223577 108. A cryotherapy device comprising - having - length An elongated shaft of the distal portion, the endoscopic portion of the distal end portion located at a treatment site of the renal artery or renal proximal renal artery or renal ostium; - a supply of the lumen along at least a portion of the shaft to receive liquid a refrigerant; a Xerox at the distal end portion of the shaft that breaks through the knives, and the application is in a delivery state of '4 and a deployed state and includes a first chamber and a chamber having a fluid communication with the supply lumen: wherein the heat transfer portion has a temperature sufficient to produce a therapeutically effective low temperature renal delivery rate in the deployed state, and wherein the heat transfer portion is in-vertical Surrounding less than the applicator in the thousand faces a circumferential extension; and - a discharge passage along at least a portion of the shaft, the discharge passage W conveying refrigerant from the (four)-chamber, wherein the second chamber state is to deliver refrigeration from the chamber to the discharge passage Agent. 1 09. A method for treating a patient, the method comprising the second cavity heat transfer assembly receiving the adjusted length, the group chamber, the group cooling unit, and a cooling device of the cryotherapy device An applicator is located in the small portion of the renal artery or renal artery or otherwise adjacent to the treatment site of the renal artery or the small opening of the renal artery, wherein the applicator is at the distal end portion of an elongated shaft; a delivery state deployed to a deployed state, the second balloon comprising a first balloon and a second balloon, the second balloon being at least partially contracted in the delivery state; and 201223577 by using a liquid cryogen in the cooling assembly Converting the gaseous refrigerant to a portion of the treatment site via a heat transfer portion of the first balloon that is sufficient to produce a therapeutically effective low phoenix neuromodulation heat transfer rate, the &apos; This portion is substantially non-circular in substantially any plane perpendicular to the length of one of the renal arteries. 11 〇 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — At a treatment site of an arterial or lunar artery orifice, wherein the applicator is at a distal end portion of an elongated shaft; deploying the cooling assembly from a delivery state to a deployed state, the application benefit comprising a first balloon And a second balloon that at least partially contracts in the delivery state, wherein deploying the cooling assembly includes expanding the first balloon substantially non-compliantly and substantially conforming the second balloon Expanding by converting the liquid cryogen into a gaseous refrigerant within the cooling assembly via a heat transfer portion of the first balloon to cool the heat transfer rate sufficient to produce a therapeutically effective low temperature renal neuromodulation a first portion of the treatment site, the first portion of the treatment site being substantially non-circular in substantially any plane perpendicular to a length of one of the renal arteries; and in the deployed state The second portion of one of the treatment sites is insulated from the second balloon. 111. The method of embodiment 110, wherein deploying the cooling assembly comprises expanding the applicator to span the renal artery or the small opening of the renal artery -

147 201223577 Cross-sectional dimensions. The method of embodiment 110, wherein the first balloon defines a first chamber, the second balloon defines a second chamber, and the method further comprises passing at least a portion along the axis A fill lumen introduces a fill material into the second chamber, wherein the first chamber is fluidly separated from the second chamber. 113. The method of embodiment 112, wherein the filler material is biologically inert. 114. A method for treating a patient, the method comprising: positioning an applicator of a cryotherapy device, a cooling assembly, within a small lumen of a renal artery or renal artery or otherwise adjacent to a renal artery Or at the treatment site of the small renal artery, the applicator is at a distal end portion of one of the elongated shafts; "to deploy the cooling assembly from a delivery state to a deployed state, the medication includes a definition a first balloon of a first chamber and a second balloon defining a second force chamber. The second balloon is at least partially contracted at a first pressure in the delivery state to allow gaseous refrigerant to pass through the first chamber Circulating; circulating a gaseous refrigerant at a pressure different from the first pressure - by the second chamber; by using a liquid filament-shaped refrigerant in the cooling assembly Turning into a gas-cooling, this is the first 埶 诚 ... 得 经由 得 得 得 得 得 得 得 得 得 得 得 得 得 得 得 得 得 该 该 该 该 该 该 该 该 该 该 该 该 该 该 该 该 该Treatment of one of the 4 brothers, the treatment department The third portion is substantially non-circular in any substantially perpendicular to the length of one of the f arteries; the stone passes through one of the first balloons of the Shai second 埶..., the delivery portion is less than First ^

S 148 201223577 Transfer rate - part. Cooling the treatment site at a heat transfer rate

11 5. As an example, the body is limited by surface area. The method of 4 wherein the first heat transfer rate is &apos; and the second heat transfer rate is substantially a refrigerant, such as the method of embodiment 114, the method further comprising adjusting the first pressure and the second force. 11 7 - A method for treating a patient, the method comprising: in the blood department, one of the cooling devices of the cryotherapy device is located in the small artery of the lunar artery or the renal artery or otherwise adjacent At the treatment site of the renal artery or the lunar artery small π, the applicator is at a distal end portion of the elongated shaft; the helium cooling assembly is deployed from a delivery state to a deployed state, the applicator comprising a first balloon and a second balloon, the first balloon comprising a spiral portion &amp; at least partially surrounding the second balloon, and the second balloon at least partially contracting in the delivery state; By cooling the liquid refrigerant into a gaseous refrigerant in the cooling assembly, cooling at a heat transfer rate sufficient to produce a therapeutically effective low/plate renal neuromodulation at the heat transfer portion of the first balloon One portion of the treatment site 'this portion of the treatment site is substantially non-circular in substantially any plane perpendicular to the length of the renal artery. 118. The method of embodiment 117, wherein deploying the cooling assembly comprises expanding an instrument to span the small cross-sectional dimension of the renal artery or the renal artery. 119. The method of embodiment 117, wherein the deploying the cooling assembly comprises expanding the first balloon substantially conformally to increase a helical diameter of the helical portion. 120. The method of embodiment π, the method further comprising: discharging a gaseous refrigerant from the first balloon; and supplying the second balloon with a gaseous refrigerant from the first balloon. 1 2 1. A method for treating a patient, the method comprising: positioning an applicator of a cooling assembly of a cryotherapy device within a blood vessel or otherwise adjacent to a renal artery or a renal artery Where the renal artery or renal artery is at a treatment site where the applicator is at a distal end portion of an elongated auxiliary; the cooling assembly is deployed from a delivery state to a deployed state, the applicator including a first a balloon and a second balloon, the first balloon including a first spiral portion, the second balloon including a second spiral portion, and the first spiral portion and the second spiral portion are at least partially intertwined; Converting the liquid cryogen into a gaseous refrigerant within the cooling assembly, cooling the treatment via a heat transfer portion of the first balloon at a rate of heat transfer sufficient to produce a therapeutically effective cryo-renal neuromodulator a first portion of the portion, the first portion of the treatment site being substantially non-circular in substantially any plane perpendicular to a length of one of the renal arteries; and the treatment site being deployed in the deployed state One of the second portions is insulated from the second balloon. 12 2 · The method of Embodiment 12 1 The method further comprising: discharging a gaseous refrigerant from the first balloon;

S 150 201223577 勹 卓 卓 二 Balloon supply from 1. 气 The first balloon of gaseous refrigerant. As in Example 121, the application of the cooling assembly including the vein or the small port of the renal artery is expanded to cross the renal cross-sectional dimension. The method wherein the first balloon defines a first chamber, and the method further fills a portion of the filling chamber to the first chamber and the second chamber 124. As in the chamber of the embodiment U1, the first The two balloons define a second chamber for one person, and the method further includes introducing a filling material into the blood donor through at least two chambers along the axis, wherein the body is separated. 12 5 as in Example 12 4 &lt;# ' wherein the filler material is biologically inert. 126. A method for use in a therapy-patient, the method comprising: cooling an applicator of a cryotherapy device in a blood vessel: located in a small opening of a renal artery or renal artery or otherwise Adjacent to the treatment site of the renal artery or the small orifice of the lunate artery, the applicator is at a distal end portion of the elongated shaft; the cooling assembly is deployed from a delivery state to a deployed state, the applicator comprising a Defining a first balloon of a first chamber and a second balloon defining a second cavity, the second chamber being at least partially contracted in the delivery state; by means of a liquid refrigerant in the cooling assembly Converting the gaseous refrigerant to a first portion of the treatment site via a heat transfer portion of the first balloon at a rate of heat transfer sufficient to produce a therapeutically effective hypothermia renal neuromodulation, the first portion of the treatment site being In substantially any plane perpendicular to the length of one of the renal arteries, substantially non-circular;

151 201223577 part of the filling lumen to the chamber and the second chamber first portion and the first vessel are introduced into the filling material via a second chamber along the shaft, wherein the first fluid is separated; The balloon at the treatment site is insulated in the S Hai deployment state. 1 2 7. The method of Example 1 2 6 and the intermediate /mu/, δ 亥海 filling material is biologically inert. 128. The method of embodiment 126, wherein cooling the first portion of the treatment site comprises cooling the first portion of the treatment site via the metal heat transfer component of the heat transfer portion. 129. The method of embodiment 126, wherein the second balloon introduces a filler material into the second chamber within the first balloon to increase an amount of space occupied by the second balloon within the first balloon. . 13. The method of embodiment 120, wherein deploying the cooling assembly comprises expanding the applicator to span a cross-sectional dimension of the renal artery or the small opening of the renal artery. 131. The method of embodiment 126, the method further comprising preferentially expanding the second balloon in a first direction relative to one of the lengths of the cooling assembly, wherein converting the liquid refrigerant to a gaseous refrigerant comprises Generally in the inch. The length of the sinus-in the second direction causes the coolant to expand toward the heat transfer portion, and an angle between the first direction and the second direction is about 15. To about 180. 〇13厶 A method for treating a patient, the method comprising: positioning one of the cryotherapy devices in a blood vessel, the applicator 152 201223577 - positioning in the small artery of the renal artery or renal artery or other Means adjacent to the treatment site of the renal artery or the small portion of the renal artery, wherein the applicator is at the distal end of an elongated shaft; the deployment of the cooling assembly from a delivery state to a deployed state, the administration The first balloon of the first chamber and the second balloon to the first balloon are at least partially contracted in the delivery state; the liquid is cooled in the cooling assembly The agent is converted into a gaseous refrigerant, and the heat transfer portion of the first balloon of the first sea is cooled in a first portion of the treatment site at a heat transfer rate sufficient to produce a therapeutically effective low-shirt renal neuromodulation, the treatment The first portion of the portion is substantially non-circular in substantially any plane perpendicular to a length of one of the renal arteries; the second portion of the treatment site is seconded to the second gas Thermal insulation; discharged from the first chamber of the gaseous refrigerant; and a second chamber to supply the gaseous refrigerant from the first chamber. 1 3 3. The method of embodiment 132, wherein deploying the cooling assembly comprises expanding the applicator to span a cross-sectional dimension of the renal artery or the small opening of the renal artery. 134. The method of embodiment 132, wherein supplying the second chamber with gaseous refrigerant from the first chamber comprises passively filling the second balloon with a gaseous refrigerant. 135. The method of embodiment 132, wherein supplying the second chamber with gaseous refrigerant from the first chamber comprises supplying a gaseous state via a distal portion of the exhaust passage along at least a portion of the shaft The refrigerant, the discharge passage 153 201223577 is configured to rotate the gaseous refrigerant from the first chamber. 1 3 6 _ The method of Embodiment 1 3 2, the method further comprising: at a first refrigeration The residence time of the agent causes the gaseous refrigerant to circulate in the first chamber; and the circulation of the gaseous refrigerant in the second chamber during a second refrigerant residence time wherein the first refrigerant residence time is less than the The second refrigerant retention time. The method of embodiment 132, wherein supplying the second chamber with gaseous refrigerant from the first chamber comprises delivering the first chamber to a discharge passage a gaseous refrigerant, the discharge passage being along at least a portion of the shaft 138. The method of embodiment 137, the method further comprising: from a proximal portion of the first chamber to a distal portion of the first chamber Delivering a gaseous refrigerant; from the first chamber The distal portion delivers a gaseous refrigerant to a distal portion of the second chamber; and delivers a gaseous refrigerant from the distal portion of the second chamber to a proximal portion of the second chamber 9. The method of embodiment 137, wherein discharging the fluorine-containing refrigerant from the first chamber comprises discharging a gaseous refrigerant along the flow path of a main gaseous refrigerant to the chamber, and The primary gaseous refrigerant flow path vocalizes through the second chamber. II. A cryotherapy device comprising: an elongated shaft having a distal portion configured to be distally within the blood vessel The end portion is located in the renal artery or renal small mouth or otherwise adjacent

154 S 201223577 at the treatment site of the renal artery or renal stenosis; a supply lumen along at least a portion of the shaft, the supply lumen configured to receive a liquid cryogen; and a cooling assembly at the distal portion The cooling assembly has a delivery state and a deployed state, the cooling assembly including an orifice and an applicator including a dispensing balloon defining a dispensing chamber, the orifice being in fluid communication with the supply lumen The application balloon has a heat transfer portion in fluid communication with the orifice, wherein the applicator is configured to produce a therapeutically effective hypotensive renal nerve in the deployed state when the cooling assembly receives the cryogen Adjusting; and an occluding member spaced apart from the applicator, the occlusive component having a collapsed state and an expanded state, wherein the occluding member has a set edge to completely occlude the vicinity of the treatment site in the expanded state A cross-sectional dimension of the renal artery and/or spleen. The cryotherapy device of embodiment 140, wherein the occluding member comprises an occlusion balloon, the occlusion balloon defining a fluid connection to the occlusion chamber of the application chamber. 142. The embodiment, ... a bad sputum, further comprising a discharge raft along at least a portion of the shaft; a gamma + u 1 spelling channel wherein the occlusion chamber is fluidly coupled to the discharge passage. 'Original setting' wherein the application chamber has a first refrigerant damper W burial time in the deployed state of the low temperature treatment of Example 141, wherein the occlusion chamber has a deflation state in the expanded state a second refrigerant residence time, and wherein the first refrigerant residence time is less than the second refrigerant residence time. 144. The cryotherapy device of embodiment 141, further comprising - 155 201223577 filling a lumen along at least a portion of the shaft, wherein the filling lumen is fluidly coupled to the occlusion chamber, and wherein the occluding chamber is coupled to the supply The lumen fluid is separated. 145. The cryotherapy device of embodiment 140, wherein the occluding component is expandable and configured to completely occlude a renal artery or renal orifice having a different diameter in the expanded state. 146. The cryotherapy device of embodiment 140, wherein the occluding component comprises an occlusion balloon and the occlusion balloon is substantially compliant. 147. The cryotherapy device of embodiment 140, further comprising a handle having a proximal portion at the handle, wherein the shaft includes a control lumen and an elongated control member within the control lumen And wherein the control member is operatively coupled to the distal portion and the handle such that increasing or decreasing the tension of the control member can control deflection of at least one section of the distal portion away from the occluding member. 148. The cryotherapy device of embodiment 140, wherein the applicator has an applicator cross-sectional dimension in the deployed state that is less than the cross-sectional dimension of the occluding member in the expanded state such that the applicator The renal artery and/or renal orifice at the treatment site is not completely occluded in this deployed state. The cryotherapy device of embodiment 1 40, wherein the cooling assembly comprises an elongate support member, and wherein the applicator chamber includes a helical balloon wrapped around at least a portion of the support member. The cryotherapy device of embodiment 140, wherein: the cooling assembly has a length, the application balloon having a plurality of concave portions and a plurality of concave portions surrounding the plurality of concave portions in the deployed state The shape of the recessed region, 156 201223577 The non-recessed region at least partially defines the heat transfer portion, and the heat transfer portion is non-circular at a longitudinal segment along the length. 151. The cryotherapy device of embodiment 150, wherein the application balloon is substantially cylindrical in shape in the deployed state. 1 52. The cryotherapy treatment of embodiment 140, wherein: the cooling assembly has a length, the application balloon having a plurality of protrusions and a non-protruding region surrounding the plurality of protrusions in the deployed state a shape, the plurality of protrusions at least partially defining the heat transfer portion; and the heat transfer portion is non-circular at a longitudinal segment along the length. 153. The cryotherapy device of embodiment 140, wherein: the cooling assembly has a length and an elongated support member along at least a portion of the length, wherein the application balloon comprises a non-circular connection portion The non-circular portion of the support member is spaced apart from the support member in the deployed state, the non-circular portion at least partially defining the heat transfer portion, and the heat transfer portion of the sweat is non-circular at the longitudinal section of the length along the length . 1 54. The cryotherapy device of embodiment 1, wherein: the connecting portion is a first connecting portion, the non-circular portion is a first non-circular portion, and the applying balloon comprises a connecting to the supporting portion 1 1 thousand The second connecting portion of the dispensing balloon includes a second non-circular portion spaced apart from the supporting member by the 157 201223577 in the deployed state, and the first non-circumferential portion of the ΔH is between the first connecting portion, The second non-circular portion of the second β-hai is between the first connecting portion, and the knives and the second and the second non-opening and the circumferential portion of the F are cold-finished The circumferential portion and the second non-circumferential portion define the heat transfer portion. At least 15: 5. The cryotherapy device of embodiment I53, wherein the &quot;Hai application balloon is a first application. The balloon, the δ metajunction is a first connecting portion, and the non-circular portion is a first The non-circumferential portion, the applicator includes a second applicator balloon along the length of the spot, the first application balloon portion of the second applicator balloon includes a second non-circumferential portion and - the: the second The connecting portion is coupled to the support member, and the second non-circular portion is longitudinally spaced apart in the deployed state, and further, the first non-circumferential portion and the second non-circular heat transfer portion. π t4夂156. The cryotherapy device of embodiment 14 (), wherein: the cooling assembly has a length, the application balloon has a spiral concave portion and a spiral connection connection interval spacing connection Supportingly recesses 158 201223577 portion, the helical non-recessed portion at least partially defines the heat transfer portion and the heat transfer portion is non-circular at longitudinal segments along the length. 157. The cryotherapy device of embodiment 14 wherein: the application balloon is elongate and has a length, a proximal portion of the application balloon along one of the lengths, a middle portion of the application balloon, and a dispensing balloon. An end portion, and the applicator balloon is curved along the length such that the applicator balloon has a first wall portion having a generally concave curvature along the length and a substantially along the length in the deployed state a second wall portion having a non-concave curvature, the knife intermediate portion of the application balloon being configured to contact the renal artery substantially along the second wall portion and substantially not along the first wall portion in the deployed state and/or The renal orifice, the wall portion defining the heat transfer portion at least partially at the intermediate portion of the application balloon; and the heat transfer portion is non-circular in the longitudinal segment along the length. 158. The cryotherapy device of embodiment 157, wherein the first wall segment has a -th thickness - and wherein the second wall portion has a second thickness that is less than the first thickness. 159. The cryotherapy device of embodiment 14 wherein: the application balloon is elongate and has a length, and a portion of the elongated shaped cooling assembly includes at least a component along the length, 201223577 the molded component is in the delivery The state has a substantially linear configuration and has a curved configuration in the deployed state, and the dispensing balloon has a shape at least partially corresponding to the curved configuration in the deployed state. 160. The cryotherapy device of embodiment 159, wherein the application balloon is substantially helical in shape in the deployed state. 161. The cryotherapy device of embodiment 159, wherein the application balloon is substantially serpentine in shape in the deployed state. The cryotherapy device of embodiment 1 40, wherein: the cooling assembly has a length, the device includes an elongated molded member longitudinally movable relative to the shaft, the application balloon having a first length along the length a proximal portion of the balloon, a first portion of the first balloon, and a distal portion of the first balloon, the applicator including a second balloon proximal portion, a second balloon intermediate portion, and a second balloon distally along the length a second elongated balloon of the end portion, *&gt; a distal end portion of the first balloon and a distal portion of the second balloon are coupled to the molded part to allow the first balloon to be retracted relative to the axis The two balloons are bent along the length, and the intermediate portion of the first balloon and the intermediate portion of the first balloon are laterally moved away from the molding member, and the first balloon intermediate portion has a first outer side, and the first outer side is in the deployed state. The lower portion has a substantially non-concave curvature along the length, the second balloon intermediate portion has a second outer side, and the second outer side is

S 160 201223577 has a substantially non-concave curvature along the length in the deployed state, the first outer side and the second outer side at least partially singulating the heat transfer portion, and the heat transfer portion is in a longitudinal direction along the length The film is a non-circular. 263. A method for treating a patient, the method comprising: positioning a treatment number of a cooling assembly of a cryotherapy device in a blood vessel at a treatment site adjacent to a renal artery or a renal orifice, wherein the application The drug holder is at a distal end portion of an elongated shaft; the longitudinal portion of the treatment site is cooled via a heat transfer portion of the applicator by converting the liquid refrigerant into a gaseous refrigerant in the cooling system At least one non-circumferential portion, and thereby producing a therapeutically effective low temperature renal neuromodulation; and expanding an occlusive component at one of the renal artery and/or the renal ostia to reduce blood flow through the treatment site, Wherein the treatment site is remote from the occlusion site. 164. The method of embodiment 163, wherein expanding the occluding member comprises occluding one of the occluding members with a balloon filled with a gaseous refrigerant. 165. The method of embodiment 163, wherein expanding the occluding component comprises passively filling one of the occluding members with a balloon to passively fill the gaseous refrigerant. The method of embodiment 63, wherein expanding the occluding member comprises introducing a filling material into an occluding cavity of the occluding member via filling the lumen along one of at least a portion of the shaft. 167. The method of embodiment 163, wherein expanding the occluding member comprises expanding the occluding member from a contracted state to an expanded state, the occlusion having a condition of about 4 and about 1 in a swelled state. A diameter between the claws. The method of embodiment 163, wherein the occluding component comprises a compliant balloon and expanding the occluding component comprises expanding the compliant balloon to substantially conform to an inner wall of the renal artery or renal ostium. 169. The method of embodiment 163, wherein the non-circular portion is a non-circumferential enthalpy and the step further comprises repositioning the heat transfer portion to cool the treatment site - one of the longitudinal segments and the second non-circumferential In part, and thereby producing a therapeutically effective hypotensive renal neuromodulation. The method of embodiment 163, wherein the applicator has a delivery condition, a deployed condition, and a cross-sectional dimension configured to not completely occlude the renal artery and/or renal ostium in the deployed state. The method of embodiment 163, wherein the occluding the occluding component is performed prior to cooling the at least one non-circular portion. 1 72. A cryotherapy device comprising: an elongated shaft that is separated from an IS distal end portion and a proximal end portion, the shaft group "positioning the distal portion within the winning tube adjacent to the renal artery or the renal sac... Treatment. The proximal portion of the '2 position is configured to be outside the vascular structure; a cryogenic cooling assembly at the distal end portion of the shaft; a first portion along the at least a portion of the shaft The second is mainly supplied to the inner cavity, wherein the primary supply of the inner cavity is close to the cryogenic cooling assembly; and the pre-cooling assembly of the knife once configured to be outside the gray pipe structure comprises a pre-cooling supply a chamber and a pre-cooling expansion chamber 162 201223577 The expansion chamber is in fluid communication with the pre-cooling supply chamber such that liquid refrigerant from the pre-cooling portion supply chamber expands in the pre-cooling expansion chamber, and the main supply The first portion of the lumen extends through the pre-cooling expansion chamber. P3 - a hypothermia treatment device comprising: an elongated shaft having a distal portion and a proximal portion, the shaft being configured to be within the blood The distal part is positioned a treatment site adjacent to the spleen artery or the renal ostium; a cooling assembly at the distal portion; a main supply lumen along at least a portion of the shaft, the main supply lumen being sorrowful to receive liquid cryogen And a pre-cooling cartridge assembly surrounding the main supply chamber and outside the vascular structure, the pre-cooling assembly including a pre-cooling supply lumen, configured to receive the pre-cooling supply lumen An elongated pre-cooling month of the refrigerant and a discharge port having a length greater than about 1 〇cm, wherein a proximal end portion of the 供应 main supply lumen extends through the pre-cooling chamber. 1 74. As an example The cryotherapy device of 丨73, further comprising a discharge passage along at least a portion of the 3D axis, wherein the discharge port is fluidly connected to the discharge passage. 175. The cryotherapy device of Embodiment 174, wherein the step further comprises a a hub that is located at the intersection between the pre-cooling assembly and the shaft, the discharge passage having a substantially straight discharge flow path through the hub, wherein the length is not associated with the discharge flow Path alignment. 1 76. The cryotherapy device of embodiment 1 73, wherein the step further comprises configuring the main supply lumen and the pre-cooling supply lumen to be connected to a 163 201223577 liquid cryogen source 77. The cryotherapy device of embodiment 1 76, further comprising a tubular member having a tubular proximal portion and a tubular distal portion, the tubular proximal portion including the pre-cooling Supplying a lumen, and the tubular distal portion includes the pre-cooling chamber, wherein: the adapter includes a plug in the tubular member between the tubular proximal portion and the tubular distal portion a plug, the primary supply lumen and the pre-cooling supply lumen extending through the plug, the primary supply lumen having an opening D in the tubular proximal portion, the pre-cooling supply lumen having a tube in the tube An opening in the proximal portion is shaped and the tubular proximal portion is configured to be coupled to the source of liquid cryogen. 1 78. The cryotherapy device of embodiment 1, wherein the length is from about 2 〇 cm to about 3 〇 cm. 179. The cryotherapy device of embodiment 173, wherein at least one section of the portion of the pre-cooling chamber that is primarily supplied to the lumen is at least partially serpentine. 180. The cryotherapy device of embodiment 173, further comprising a handle at the proximal portion, wherein at least a portion of the pre-cooling assembly is within the handle. 181. The cryotherapy device of embodiment 173, wherein the discharge port comprises a valve.

182. The cryotherapy device of embodiment 181, wherein the pre-cooling chamber is substantially fluidly separated from the venting channel. 1 83. A cryotherapy device comprising: an esculent end having a distal end portion and a proximal end portion, the shaft configured to position the distal end portion adjacent to the renal artery or the renal ostium in the blood vessel At the treatment site and positioning the proximal portion outside of the vascular structure; a cooling assembly at the distal portion; a primary supply lumen along at least a portion of the shaft, the primary supply lumen configured to receive a liquid refrigerant; a discharge passage along at least a portion of the shaft, the discharge passage configured to deliver a gaseous refrigerant from the cooling assembly; and - at a proximal portion of the main supply chamber and a pre-cooling assembly outside the vascular structure, the pre-cooling assembly including a pre-cooling chamber, a manifold in a proximal portion of the pre-cooling chamber, and a pre-cooling drain away from the manifold The manifold has a main passage coupled to the main supply chamber and a peripheral passage radially outward from the main passage, and wherein the pre-cooling assembly is configured to be from the pre-cooling supply Liquid in cavity The refrigerant expands to cool the pre-cooling chamber. 184. A cryotherapy device comprising: an elongated shaft having a distal portion and a proximal portion, the shaft configured to position the distal portion adjacent to a renal artery or a small renal orifice within a blood vessel a portion, the proximal portion configured to be outside the vascular structure; - a cryogenic cooling assembly at the distal portion of the shaft; - having a / first portion and a second portion 165 along at least a portion of the shaft 201223577 is mainly supplied to the inner cavity, wherein the second portion of the main supply inner cavity is adjacent to the cryogenic cooling assembly; and a pre-cooler having a container configured to receive a liquid refrigerant flow, a diverter in the container, a pre-cooling passage along a periphery of one of the diverters, and a pre-cooling expansion chamber in the container having a proximal portion defined by the diverter, wherein the shunt device a main passage connected to the first portion of the main supply chamber to allow a portion of the liquid refrigerant to flow through the main passage to the main supply chamber and another portion of the liquid refrigerant to pass therethrough Pre-cooling the cooling channels flows into the expansion chamber. 185. The inner chamber includes 186. an inner surface 187. defines the main body to have a definition 188. The main body is defined to have a surface that is part of the main pre-cooling chamber. An opening in the pre-cooling supply lumen. The cryotherapy device of embodiment 1, wherein the container has and the primary supply lumen is not fixed to the inner surface. The cryotherapy device of embodiment 184, further comprising a primary supply conduit to supply the lumen, the primary supply conduit having an outer surface of at least a portion of the peripheral passage. The cryotherapy device of embodiment 1 84, further comprising a supply of a lumen to the main supply conduit and wherein the chamber has an inner surface and the shunt secures the outer portion of the supply conduit The surface is interposed between the pre-cooling supply lumen and wherein the shunt defines at least the primary supply 189' of the pre-cooling passage, such as the cryotherapy device 166 201223577 of the embodiment 184. The conduit has a pre-cooling An average outer diameter within the cavity, and wherein the flow divider has an outer diameter of the primary supply conduit that is greater than a portion of the average outer diameter. 190. The cryotherapy device of embodiment 184 wherein the container has an inner surface and the pre-cooling channel comprises - a curved gap between the shunt and the inner surface. 191. The cryotherapy device of embodiment 184, wherein the container has an inner surface and the pre-cooling passage includes an annular gap between the flow divider and the inner surface. 192. A method for treating a patient, the method comprising: positioning an applicator of a cooling assembly of a cryotherapy device in a blood vessel at a treatment site adjacent to a renal artery or a renal orifice, wherein the application The drug holder is at a distal end portion of an elongated shaft including a proximal portion at an outer portion of the vascular structure; the liquid cryogen is passed through a primary supply lumen along at least a portion of the shaft; Providing a pre-cooling liquid refrigerant in a pre-cooling portion of the inner chamber, the pre-cooling portion being in a pre-cooling chamber of one of the pre-cooling assemblies outside the vascular structure, wherein the pre-cooling portion pre-cools the liquid to be cooled The agent includes expanding a liquid refrigerant from an orifice into the pre-cooling chamber, the orifice receiving a liquid refrigerant from a pre-cooling supply chamber of the pre-cooling assembly; and causing the liquid refrigerant to be The cooling assembly expands into a gaseous refrigerant. 1 9 3 · A method for treating a patient, the method comprising: positioning an applicator 167 201223577 of a cooling device of a cryotherapy device in a gold tube at a treatment site adjacent to the renal artery or the renal orifice Wherein the applicator is at a distal end portion of an elongate shaft, the elongate shaft comprising a proximal portion at an outer portion of the vascular structure; passing a liquid cryogen through a primary supply lumen along at least a portion of the shaft; Pre-cooling the liquid refrigerant in a pre-cooling portion of the main supply chamber of the 6th sea, wherein the pre-cooling portion is in an elongated pre-cooling chamber of one of the pre-cooling assemblies outside the dome structure, wherein the pre-cooling The partially pre-cooled liquid refrigerant includes expanding the liquid refrigerant into the pre-cooling chamber from an orifice configured to receive the liquid refrigerant from the pre-cooling supply inner chamber of the pre-cooling assembly and The gaseous refrigerant is delivered along a length of the pre-cooling chamber of greater than about 10 cm; and the liquid refrigerant is expanded into a gaseous refrigerant within the cooling assembly. The method of embodiment 93, wherein the cooling assembly comprises a row of outlets, and conveying the rolled refrigerant comprises delivering a gaseous refrigerant from the orifice to the discharge port. 195. The method of embodiment 193, the method further comprising discharging gaseous refrigerant from the cooling assembly through a discharge passage along at least a portion of the shaft, wherein the discharge outlet is fluidly coupled to the discharge passage. 196. The method of embodiment 193, wherein the discharge port comprises a valve, and the method further comprises closing or opening the valve to control a pressure of one of the gaseous refrigerants in the pre-cooling chamber. 197. A method for treating a patient, the method comprising: applying a cryotherapy device to one of the cooling assemblies in the blood vessel

S 168 201223577 is located adjacent to the renal artery or at a proximal portion of one of the elongated shafts; at the treatment site of the renal orifice, wherein the applicator end portion includes the vascular junction causing liquid cooling The pre-cooling liquid refrigerant is pre-cooled in a pre-cooling portion of the primary supply chamber, the at least one of the at least one portion of the inner chamber; the pre-cooling portion is outside the vascular structure - pre-cooling assembly - pre-cooling the liquid refrigerant in the pre-cooling portion in the elongate pre-cooling chamber - including limiting the liquid refrigerant from the -combination supply chamber through at least a portion of the defined remote combination supply chamber One of the openings defined by the inner surface of one of the combined supply conduits flows into the pre-cooling chamber; the liquid refrigerant is supplied to the orifice and the main supply chamber through the combined supply chamber; and the liquid refrigerant is The cooling assembly expands into a gaseous refrigerant. 198. The method of embodiment 97, wherein the primary supply lumen is in a primary supply conduit having an outer surface, and wherein liquid refrigerant from the set of supply lumens is restricted from flowing into the preform through the orifice The cooling chamber includes a restriction between the outer surface and the inner surface. 199. The method of embodiment 197, wherein the primary supply lumen is in a primary supply conduit having an outer surface, wherein the pre-cooling assembly comprises an internal supply lumen between the outer surface and the outer surface Pre-cooling the flow restricting member between the chambers, and wherein restricting the flow of liquid refrigerant from the combined supply chamber into the pre-cooling chamber through the orifice includes restricting flow between the flow P-clamping member and the inner surface . 169 201223577 It contains:

State to receive a liquid refrigerant; and 200. a cryotherapy device from an elongated vehicle having a distal portion,

a heat transfer portion in fluid communication with the orifice, having a circumferentially non-uniform body communication under the application, the balloon having a heat transfer portion in the deployed state being received at the cooling assembly The cryogen has a rate of heat transfer sufficient to produce a therapeutically effective low temperature renal neuromodulation. 2. A cryotherapy device comprising: an elongated shaft having a distal portion configured to position the distal portion within a vessel adjacent to a treatment site adjacent to a renal artery or a renal orifice. a supply chamber along at least a portion of the shaft, the supply chamber configured to receive a liquid cryogen; and a cooling assembly at the distal portion, the cooling assembly having a delivery state and a deployment In the state, the cooling assembly includes an orifice and an applicator, the applicator including a balloon having a plurality of concave portions and/or surrounding the plurality of concave portions in the deployed state. The heart is recessed into the shape of a region, the orifice being in fluid communication with the supply lumen, the balloon having a heat transfer portion in fluid communication with the orifice, the non-recessed region at least partially defining the heat transfer portion 'where the heat The delivery portion has a heat transfer rate sufficient to produce a therapeutically effective hypothermia renal neuromodulation when the assembly receives the cryogen at the deployment bear 170 201223577 y. 202. The cryotherapy device of embodiment 2, wherein the plurality of concave portions have a circumferentially uneven distribution on the applicator. 203. The cryotherapy device of embodiment 201, wherein the shape of the balloon is substantially cylindrical. 2. The cryotherapy device of embodiment 201, wherein the shape of the balloon is a tubular shape having a longitudinal axis, and wherein the shape of the balloon defines a blood flow path along the longitudinal axis At least part. The cryotherapy device of embodiment 201, wherein the cooling assembly has a length, and wherein the heat transfer portion is non-circular at a longitudinal segment along the length of the cooling assembly. 2 6. A cryotherapy device comprising: an elongated shaft having a distal portion, the shaft configured to position the end portion in a blood vessel adjacent to a treatment site adjacent to the renal artery or the renal orifice; At least a portion of the shaft is supplied to the inner chamber, the supply chamber is configured to receive a liquid refrigerant; and a cooling assembly at the distal end portion, the cooling assembly having a transfer ·, . In the state of the deployment, the cooling assembly includes an orifice and an applicator comprising a balloon, the balloon having a shape having a plurality of protrusions and a non-protruding region surrounding the plurality of protrusions in the deployed state "The orifice is in fluid communication with the supply lumen" the balloon has - and the heat transfer portion of the aperture, the plurality of protrusions at least partially defining the name heat transfer. p minutes 'where the heat transfer portion is in the deployed state The cold 171 201223577 is sufficient to produce a therapeutically effective low temperature kidney but the assembly has a neuromodulation heat transfer rate when receiving the refrigerant. /JUU. / 〇 装置 device, wherein the applicator has a circumference Evenly distributed 2 8) The low, 戸, and 由 由 m m m m m m 如 如 如 m m m m m m m m m m m m m m m m m m m m m m m 低温 低温 低温 低温 低温 低温 低温 低温 低温 低温The shape is generally tubular in shape having a longitudinal axis, and wherein the shape of the balloon defines at least a portion of the blood flow path along the longitudinal axis. 210. The cryotherapy treatment of embodiment 206, wherein the cooling The assembly has a length, and wherein the heat transfer portion is non-circular at a longitudinal segment along the length of the cooling assembly. 2 1 1 - a cryotherapy device comprising: an elongated portion having a distal end portion An axis configured to position the end portion in a blood vessel adjacent to a treatment site adjacent to the renal artery or the renal orifice; ^ at least a portion of the supply lumen of the ~5-axis axis, the supply lumen configured Receiving a liquid refrigerant; and a cooling assembly at the distal end portion, the cooling assembly having a delivery state and a deployed state, the cooling assembly including an orifice and an applicator tapping device having a spiral Balloon, the aperture and the Supplying a lumen fluid communication 忒 helical balloon having a heat transfer knife in fluid communication with the orifice, wherein the heat transfer portion has a therapeutically effective low temperature in the deployed state when the cooling assembly receives the refrigerant The rate of heat transfer in renal neuromodulation.

S 172 201223577 212. As in embodiment 211 the ball has a helix axis and is partially reduced. The cryotherapy device, Yiyi along the spiral axis, wherein the blood flow path of the spiral gas is 2 1 3 as in the low temperature treatment device of the embodiment 2 11 "where the cooling tender has a length, and wherein the heat transfer 214. The cryotherapy device of embodiment 211, further comprising a discharge channel along at least a portion of the axis, wherein: 乂I 3 The discharge passage is configured to deliver a gaseous refrigerant Π; the spiral balloon has a proximal opening and a distal end opening the helical balloon fluidly connecting the cavity at the distal opening; and the spiral is a balloon is fluidly coupled to the venting opening 215 at the proximal opening. The cryogenic treatment component of the embodiment 211, wherein the cooling assembly comprises an elongate branch member, and wherein the helical balloon is wrapped around the branch member 216. The cryotherapy device of embodiment 215 wherein the support member comprises a portion of the supply lumen. 217. The cryotherapy device of embodiment 211, wherein a cooling assembly having a length, wherein the s-helical balloon comprises a first helical coil and a second helical coil, and wherein the first helical coil and the second helical coil are spaced apart along the length. - A cryotherapy device comprising: 173 201223577 - an elongated shaft having a distal portion configured to position the retracted portion within a blood vessel adjacent to a treatment site of a renal artery or a renal orifice;至少. at least a portion of the inner axis of the supply axis, the supply state to receive the liquid refrigerant; and /, ', 豇! a cooling assembly at the distal end portion, delivery state and - deployment state, The cooling assembly includes two §: = a balloon having a helical concave knife and a helical non-recessed portion in the deployed state, the orifice body communicating 'the balloon having a lumen flow with the U The heat transfer portion of the L/gut body is connected, the spiral non-recessed portion at least partially dissipates the heat transfer portion, and the heat transfer portion has a sufficient amount in the deployment state Produce a treatment The rate at which the cryogen is received. The heat transfer rate of the therapeutically effective hypothermia renal neuromodulation 219. The low temperature as in Example 218 and having a η ^ 褒 where the cooling assembly: has a twist 'and where the heat transfer The portion is non-circular at a longitudinal segment along the length of the cooling assembly. 22. A cryotherapy device comprising: - an elongated shaft having a distal portion that is configured to The end portion is positioned adjacent to the kidney s ... at a treatment site adjacent to the renal artery or the renal ostium; a supply lumen is provided along at least a portion of the side axis, the supply lumen, through the group L to receive the liquid cryogen; a cooling assembly at the distal end portion, the cooling assembly having a delivery state and a deployed state, the cold DO assembly comprising an orifice and a drug benefit, the applicator comprising a Has a length along the length - the proximal end of the balloon

S 174 201223577 4 is an elongated balloon of a balloon intermediate portion and a balloon distal portion, the chaotic ball being curved along the length such that the balloon has a first, substantially concave curvature along the length in the deployed state a wall portion and a second wall portion having a substantially non-concave curvature along the length, wherein the balloon intermediate portion is configured to generally follow the second wall portion and substantially not along the first portion in the deployed state The wall portion contacts the renal artery and/or the renal orifice, the balloon having a heat transfer portion in fluid communication with the orifice, wherein the second wall portion at the intermediate portion of the balloon at least partially defines the heat transfer portion, and wherein The heat transfer portion has a heat transfer rate in the deployed state that is sufficient to produce a therapeutically effective hypothermia renal neuromodulation when the cooling assembly receives the cryogen. 2 2 1 'A cryotherapy device according to the embodiment 2, wherein the cooling assembly has a length, and wherein the heat transfer portion is non-circular at a longitudinal segment along the length of the cooling assembly. 222. The cryotherapy device of embodiment 220, wherein the balloon is in the middle

Positioned, wherein the distal end of the balloon is along the first wall portion and is configured to substantially non-contact the renal artery and/or renal orifice 224 along the second wall portion in the deployed state. As an embodiment 223 cryotherapy device, wherein the balloon is distal

The 175 201223577 portion is configured to contact the renal artery and/or the renal orifice substantially along the first wall portion and generally not along the second wall portion in the deployed state. 226. The cryotherapy device of embodiment 225, wherein the first wall portion at the proximal portion of the balloon at least partially defines the heat transfer portion. .. 2 2 7. A cryotherapy device comprising: an elongated shaft having a distal portion configured to position the distal portion within a vessel adjacent to a renal artery or a small renal orifice a supply chamber along at least a portion of the shaft, the supply chamber being leveled to receive liquid refrigerant; and a cooling assembly at the distal portion, the cooling assembly having/delivering state and In a deployed state, the cooling assembly includes an elongated support member aperture and an applicator in fluid communication with the supply lumen, the applicator having a balloon having a swellable longitudinal portion and a sputum a constrained longitudinal portion coupled to the branch member, the expandable longitudinal portion being spaced apart from the branch member in the deployed state, the balloon having a heat transfer portion in fluid communication with the aperture Wherein the expansion longitudinal portion of the town at least partially defines the heat transfer portion &amp; and wherein the thermal transfer portion is sufficient to produce therapeutically effective when the cooling assembly receives the refrigerant in the deployed state The rate of heat transfer in hypothermic renal neuromodulation. 228. The cryotherapy device of embodiment 227, wherein the cooling assembly" has a length, and wherein the heat transfer portion is non-circular at a longitudinal segment along the length of the cooling assembly. and as in Example 227 a cryotherapy device in which the cooling assembly is *degree' and wherein 6

176 S 201223577 is at least a portion of the blood flow path of the length. The cryotherapy device of embodiment 227 includes a portion of the supply lumen. Wherein the support member 23. The cryotherapy device of Embodiment 227, the cooling assembly has a length, ^. The restricted longitudinal portion is - the first restricted, the expandable longitudinal portion is a first expandable longitudinal :, the balloon includes - a second restricted longitudinal portion connected to the support portion, the balloon includes - in the deployed state, the first portion of the expandable longitudinal portion The expanded longitudinal portion is between the second, second constrained longitudinal portion, the constraining longitudinal portion and the first expandable longitudinal portion being between the = two restricted longitudinal portions, and being radially spaced about the split longitudinal portion The heat transfer portion is defined by a first-expandable longitudinal (four) minute and the second expandable portion. The trowel is at least 232. The cryotherapy device of embodiment 231, wherein the longitudinally extending/deflecting knife and the second restricted longitudinal portion are elongated along the length. 23 3 · A cryotherapy device comprising: &quot; ^3 ||, an elongated shaft having a distal end portion, the shaft being configured to be in the distal end but within the interior of the wind. The iliac crest is located adjacent to the treatment site of the renal artery or the renal ostium. - at least a portion of the distal axis of the supply lumen, the supply of the lumen material, Ί 177 201223577 state to receive the liquid cryogen; and one at the distal end a portion of the cooling assembly, the cooling assembly having a length, a delivery state, and a deployed state, the cooling assembly including an orifice and - application n 'the applicator includes one of the intervals along the length a balloon and a second balloon, the orifice being in fluid communication with the supply lumen, the first balloon having a first non-circular portion spaced from the support member in the deployed state, the second balloon having an a second non-circular portion spaced apart from the support member in the deployed state, wherein the applicator has a heat transfer portion knife, and the heat transfer transfer portion has a state in the deployment state when the cooling assembly receives the refrigerant - A heat transfer rate sufficient to produce a therapeutically effective low temperature renal neuromodulation wherein the first non-circular portion and the second non-circumferential portion at least partially define the heat transfer portion. The cryotherapy device of embodiment 233, wherein the first non-circumferential portion defines a -first longitudinal section of the heat transfer portion, and wherein the second non-circumferential portion defines one of the heat transfer portions and a second longitudinal region & And wherein the first longitudinal section and the first-sharp-longitudinal section are spaced apart along the length and are right-handed in a plane perpendicular to the s-sinus length"--a substantially complete circumference The cryotherapy device of Embodiment 233, wherein the orifice is a first orifice and is in fluid communication with the first non-circular raft, and wherein the cooling assembly comprises a second and a second a second orifice in fluid communication with the circumferential file. A cryotherapy device comprising: a thin #心^^ 灸 moxibustion shaft having a distal portion configured to be placed within a blood vessel. Located at the treatment site adjacent to the renal artery&gt; arterial or renal ostium; &amp; at least a portion of the iliac shaft is supplied to the lumen&apos;

S 178 201223577 complaining of receiving liquid refrigerant; and a cooling assembly at the distal end portion, the cooling assembly having a delivery state and a deployed state 'the cooling assembly comprising an elongated plastic part, a hole a mouthpiece and an applicator, the applicator comprising a balloon having a shape memory, a first configuration in the delivery state, and a second configuration in the deployed state, the balloon In the deployed state, having a shape at least partially corresponding to the second configuration, the orifice being in fluid communication with the supply lumen, the balloon having a heat transfer portion in fluid communication with the orifice, wherein the heat transfer portion In the deployed state, the cooling assembly has a heat transfer rate sufficient to produce a therapeutically effective low temperature renal neuromodulation when the cryogen is received. 237. The cryotherapy device of embodiment 236, wherein the first configuration is more elongated than the second configuration. 238. The cryotherapy device of claim 36, wherein the cooling assembly has a length, and wherein the heat transfer portion is non-circular at a longitudinal segment along the length of the cooling assembly. 2 3 9. If the embodiment 2 3 6 is low, the sputum is also strong/therapeutic device, wherein the molded part comprises a titanium alloy. The configuration is substantially a screw device in the low temperature treatment state of embodiment 236, wherein the balloon is in the shape of a spiral. 241. A therapeutic device comprising: the shaft configured to position the distal portion at a treatment site at a distal end portion of the distal end portion of the treatment assembly at the distal end portion The treatment assembly has a

179 201223577 The delivery state and a deployed state, the treatment assembly comprising an elongated molded part and a balloon, the molded part having a shape memory, a first configuration in the delivery state, and a second in the deployed state Configuration, where the balloon is in "Hai. In the state of the deployment, there is a shape at least partially corresponding to the second configuration. 242. A cryotherapy device comprising: a thin, long axis having a distal portion configured to position a distal portion of the vessel in a blood vessel adjacent a treatment site adjacent the renal artery or renal orifice; At least a portion of the supply of the inner cavity, the supply lumen being configured to receive a liquid cryogen; at least a portion of the inner cavity of the shaped component; at least a portion of the interior of the molded component a portion of the elongate shaped member is longitudinally movable relative to the shaft; and a cooling assembly at the distal portion, the cooling assembly having a one-degree "sending state" and a deployed state, the cooling assembly including An orifice and a dispensing device, the applicator comprising a first elongated balloon and a second elongated balloon, the first balloon having a first balloon front portion, a first balloon intermediate portion and - along the length a first balloon-shaped distal portion, the second elongated gas: "the length of the sea has a second balloon proximal portion, a second balloon intermediate portion and a second balloon distal portion, (4) - the balloon distal portion and the first Two ^ ball end part connection The molded component is such that pulling the two components relative to the shaft causes the first balloon intermediate portion and the second air material portion to move away from the first balloon intermediate portion of the molded component 1 to have a state in the deployed state The length has a first outer diameter that is substantially non-concave

S 180 201223577: The side, the second balloon intermediate portion has a second outer side having a substantially non-concave curvature along the length in the deployed state, wherein the applicator has a heat transfer portion, the heat transfer portion In the deployed state, the cooling assembly receives a refrigerant having a heat transfer rate sufficient to produce a therapeutically effective low temperature renal neuromodulation, and wherein the first outer side at least partially defines the heat transfer portion. 243. The cryotherapy device of embodiment 242, wherein the heat transfer portion is non-circular at a longitudinal segment along the length of the cooling assembly. 244. The cryotherapy device of embodiment 242, wherein the first balloon has a preferentially curved position along the length, and wherein pulling the molded component relative to the axis causes the first balloon to follow the length at the preferentially curved position Bending 0 2 4 5 · The cryotherapy device of Example 4 4 4 wherein the preferential bending position comprises a crease. 246. The cryotherapy device of embodiment 242, wherein the first balloon proximal portion and the second balloon proximal portion are coupled to the shaft. 247. The cryotherapy device of embodiment 242, wherein the step further comprises a discharge passage along at least a portion of the shaft, wherein the &quot;&quot; Xuan discharge passage is configured to deliver a gaseous refrigerant, the first balloon Having a first distal opening and a first proximal opening, the balloon has a second distal opening and a second proximal opening, and the balloon is fluidly connected at the first distal opening In the supply chamber, the second balloon is fluidly connected to the supply port 181 201223577 cavity at the second distal opening, and the fluid is connected to the first balloon at the first distal opening channel. The second balloon is fluidly coupled to the discharge port at the second distal opening a. The cryotherapy device of embodiment 242 further comprising a filled lumen along at least a portion of the shaft, wherein the filling The cavity is configured to supply a fill material to the second balloon, wherein the first balloon is fluidly coupled to the ritual lumen and wherein the first balloon is fluidly separated from the second balloon. 249·: A method for treating a patient, the method comprising: positioning a drug applicator of a cooling assembly of a cryotherapy device in a blood vessel at a drug applicator adjacent to a renal artery or a small renal artery a distal end portion of one of the elongated shafts; 丄&quot; a deployment of the cooling assembly from a delivery state to a deployed state, the instrument comprising a balloon having a circumferentially uneven shape in the deployed state At least partially contracting in the delivery state; and - cooling a portion of the treatment site via a heat transfer portion of the balloon by the cold (four) to (four) (four) refrigeration-money-state refrigerant and thereby producing a therapeutically effective low temperature Renal neuromodulation, the portion of the treatment site being substantially non-circular in substantially any plane perpendicular to the length of one of the renal arteries. 205. A method for treating a patient, the method comprising: placing an applicator in a cooling assembly of a cryotherapy device in the blood; positioning the treatment site adjacent to the renal artery or the small opening of the renal artery, Wherein the 182 201223577 musical instrument is at a distal end portion of an elongated shaft; the cooling assembly is deployed from a delivery state to a deployed state, the applicator includes a balloon having a plurality of balloons in the deployed state a recessed portion and a shape surrounding the non-recessed region of the plurality of recessed portions' the balloon at least partially shrinks in the delivery state; and by converting the liquid refrigerant into a gaseous state within the cooling assembly Cooling agent cools a portion of the treatment site via the non-recessed region and thereby produces a therapeutically effective hypothermia renal neuromodulation, the portion of the treatment site being generally planar in substantially any plane perpendicular to one of the lengths of the renal artery The upper is non-circular. The method of embodiment 2, wherein the shape is substantially a tubular shape having a longitudinal axis 'where the shape defines at least a portion of a blood flow path along the longitudinal axis' and wherein the method further comprises Blood is directed through the blood flow path when the applicator is in the deployed state. 2 5 2. A method for treating a patient, the method comprising: positioning an applicator of a cooling assembly of a cryotherapy device in a blood vessel at a treatment site adjacent to a renal artery or a small orifice of a renal artery, Wherein the applicator is at a distal end portion of an elongated shaft; the cooling assembly is deployed from a delivery state to a deployed state, the instrument comprising a ball ' δ 玄 balloon having a state in the deployed state a shape having a plurality of protrusions and a non-protrusion region surrounding the plurality of protrusions, the balloon at least partially contracting in the delivery state; and converting the liquid refrigerant into a gaseous refrigerant by the cooling assembly And cooling the part of the treatment site through the plurality of large ones, and thereby producing the therapeutically effective low-temperature renal nerve _ 201223577 _ ^ This part of the treatment site of the lang xiaoxuan is perpendicular to the 廑 of one of the renal artery Negative is generally substantially non-circular in any plane. 253. The method of embodiment 252, wherein the shape of the balloon is substantially tubular in shape having a longitudinal axis, and wherein the shape of the balloon defines a blood flow path along the longitudinal axis, a portion 'and wherein the method further comprises directing blood through the blood flow path while the cooling assembly is in the state of the portion. 254. A method for treating a patient, the method comprising: positioning a hypothermia treatment-cooling assembly-application number in a tube adjacent to a renal artery or a renal artery small port # &lt;燎4 position Wherein the instrument is located at a distal end portion of the shaft; the cooling assembly is deployed from a delivery skin to a deployed state, the instrument comprising a spiral balloon, the screw*, ^, foot The balloon at least partially contracts in the delivery state; and &amp; cooling one of the treatment sites via one of the heat transfer portions of the helical balloon by converting the liquid cryogen into a gaseous refrigerant within the cooling assembly. The knife and thus the therapeutically effective hypothermia renal neuromodulation, the portion of the treatment site being substantially non-circular in substantially any plane perpendicular to the length of the renal artery. 255. The method of embodiment 254, wherein the helical balloon has a central axis and defines at least a portion of the blood flow path along the central axis and wherein the method is further included in the cooling total less than the deployment In the state, blood is guided through the blood flow path. The method of embodiment 254, wherein cooling one of the treatment sites comprises flowing a gaseous refrigerant from a distal end portion of the helical balloon to a proximal portion of the helical balloon. 2 57. A method for treating a patient, the method comprising: positioning an applicator of a cooling assembly of a cryotherapy device in a blood vessel at a treatment site adjacent to a renal artery or a small orifice of a renal artery, wherein The applicator is at a distal end portion of an elongated shaft; the cooling assembly is deployed from a delivery state to a deployed state, the applicator including a balloon having a helical recess in the deployed state And a helical non-recessed portion that at least partially contracts in the delivery state; and through the helical non-recessed by converting the liquid cryogen into a gaseous refrigerant within the cooling assembly Partially cooling a portion of the treatment site and thereby producing a therapeutically effective hypothermia renal neuromodulation, the tendon of the treatment site being substantially non-circular in substantially any plane perpendicular to one of the lengths of the renal artery . 258. A method for treating a patient, the method comprising: positioning an applicator of a cooling assembly of a cryotherapy device in a place of treatment at a treatment site adjacent to a renal artery or a small orifice of a renal artery, wherein The applicator is at a distal end portion of an elongated vehicle; the cooling assembly is deployed from a delivery state to a deployed state, the application benefit comprising - an elongated balloon having a length, along the length - a balloon a proximal end, a middle portion of the balloon, and a distal portion of the balloon, the balloon being curved along the length such that the balloon, in the deployed state, has a first wall portion having a generally concave curvature along the length of the 185 201223577 and a second wall portion having a substantially non-concave curvature along the length, the balloon intermediate portion being configured to contact the renal artery substantially along the second wall portion and substantially not along the first wall portion in the deployed state And/or a small renal mouth, the balloon at least partially contracting in the delivery state; and passing the middle portion of the balloon by converting the liquid refrigerant into a gaseous refrigerant in the S-cooling assembly The portion of the second wall portion of the cooling of the treatment site, and the low temperature resulting in an effective treatment for renal neuromodulation, the /. The portion of the treatment site is substantially non-circular in substantially any plane perpendicular to the length of one of the renal arteries. 259. The method of embodiment 258, wherein the portion of the treatment site is the first portion of the treatment site, and the method further comprises via the gas. The first wall portion of the scorpion portion cools a second portion of the treatment site to produce a therapeutically effective hypothermia renal neuromodulation, wherein the second portion of the treatment site is perpendicular to the length of the renal artery Generally substantially non-circular in any plane. 260. The method of embodiment 259, the method further comprising cooling a third portion of the treatment site via the first wall portion at the proximal portion of the balloon to produce a therapeutically effective hypotensive renal neuromodulation, wherein the treatment The third portion of the portion is substantially non-circular in substantially any plane perpendicular to the length of the renal artery. 26 1. A method for treating a patient, the method comprising: positioning an applicator of a cooling assembly of a cryotherapy device in a blood S at a treatment site adjacent to a renal artery or a small orifice of a renal artery, wherein The application

S 186 201223577 The drug dispenser is at a distal end portion of an elongated shaft; deploying the cooling assembly from a delivery state to a deployed state includes preferentially expanding the balloon-expandable longitudinal portion of the applicator The restricted longitudinal portion of the balloon does not substantially expand, the balloon is at least partially constricted in the delivery state; and the swellable is achieved by converting the liquid cryogen into a gaseous refrigerant within the cooling assembly The longitudinal portion cools a portion of the treatment site and thereby produces a therapeutically effective hypothermia renal neuromodulation, the portion of the treatment site being substantially non-circular in substantially any plane perpendicular to one of the lengths of the renal artery. 262. The method of embodiment 261, wherein the restricted longitudinal portion defines at least a portion of a blood flow path along a longitudinal axis of the applicator, and wherein the method further comprises the cooling assembly being in the deployed state When the liquid is guided through the blood flow path. 263. A method for treating a patient, the method comprising: positioning an applicator of a cooling assembly of a cryotherapy device within a blood vessel at a treatment site adjacent to a renal artery or a small orifice of a renal artery, wherein The applicator is at a distal end portion of an elongated shaft; deploying the delta cooling assembly from a delivery state to a deployed state, including longitudinal movement - an elongated molded component, - limiting externality to enable the component From a first configuration to a second configuration, the second configuration corresponds to one of the shaped parts of the shape memory, wherein the applicator comprises a balloon, the ball having at least partially corresponding in the deployed state In the shape of the second configuration 'the balloon at least partially contracts in the delivery state; and 187 201223577 via the balloon-heat transfer by converting the liquid refrigerant into a gaseous refrigerant within the cooling assembly Partially cooling the portion of the treatment site and thereby producing a therapeutically effective hypotensive renal nerve. The bamboo stalk, the soil circumference, and the portion of the s treatment site are substantially perpendicular to the length of the renal artery. Plane generally on a non-circumferential. 264. The method of embodiment 263, wherein the first configuration of the Bajia 5 Hai is slimmer than the second configuration. 265. A method for treating a patient, the method comprising: positioning a treatment assembly in a tube at a treatment site, wherein the treatment assembly is at a distal portion of an elongated shaft; Deploying from a delivery state to a deployed state includes a longitudinal movement - an elongated molded part, a restricted outer part or both to change the shaped part from a first configuration to a first one, and 嘘, s The second configuration corresponds to a shape memory of the molded part, wherein the applicator includes a balloon having, in the deployed state, a substantially helical shape at least partially corresponding to the second configuration The balloon is at least partially constricted in the delivery state; and a portion of the treatment site is treated with a treatment component that extends in the deployed state along a central axis of the generally helical shape of the balloon . 2. The method of embodiment 265, wherein the blood flow through the treatment site is not completely occluded when the treatment assembly is in the deployed state. 267. A method for treating a patient, the method comprising : one of the cryotherapy device cooling device applicators 188 201223577 is positioned in the blood vessel at a treatment site adjacent to the renal artery or the small opening of the renal artery, wherein the applicator is at a distal end portion of one of the elongated shafts Deploying the cooling assembly from a delivery state to a deployed state, comprising longitudinally moving a molded component relative to the shaft such that the first-elongated balloon-first intermediate portion of the applicator and the applicator A second intermediate portion of one of the second elongated balloons moves laterally away from the molded component, the first intermediate portion of the balloon having a first-outer (four) balloon having a substantially non-concave curvature along the length in the deployed state The intermediate portion has a second outer side having a substantially non-concave curvature along the length in the deployed state, the balloon being at least partially constricted in the delivery state, the first portion of the first balloon Between a first balloon proximal end portion and a first balloon distal end portion, the second balloon intermediate #分处" a second balloon proximal end split between the second balloon distal end portion The balloon and the second balloon at least partially contract in the delivery state; and cooling a portion of the treatment site via the first outer side by converting the liquid cryogen into a gaseous refrigerant within the cooling assembly, and thereby Producing a therapeutically effective hypothermia renal neuromodulation, the portion of the treatment site being substantially non-circular in substantially any + face perpendicular to the length of one of the renal arteries. 268. The method of embodiment 267, wherein The portion of the treatment site is a first portion of the treatment site, and the method further comprises cooling the second portion of the treatment site via the second lateral portion to produce a treatment: effective hypothermia renal neuromodulation, wherein the treatment site The second portion is substantially non-perpendicular in substantially any plane perpendicular to the length of the renal artery

189 201223577 The circumference of the . 269. The method of embodiment 267, the method further comprising supplying a filling material to the second balloon via filling the lumen along one of at least a portion of the shaft, wherein cooling the portion of the treatment site comprises passing a gaseous refrigerant through the The first balloon flows. 207. A cryotherapy device comprising: a shaft having a distal portion, wherein the shaft is configured to position the distal portion within the vessel at a treatment site adjacent at least adjacent to the renal artery or renal orifice a cooling assembly at the distal end portion of the shaft, the cooling assembly including an expansion chamber having a burst pressure and a threshold pressure below the burst pressure; at least a portion along the shaft The pressure monitoring lumen, the pressure monitoring lumen having a first opening at the distal end portion of the shaft and a second opening at a proximal end portion of the shaft, wherein the first opening is An inflation chamber is in fluid communication; and a pressure sensor configured to be external to the patient and operatively coupled to the pressure monitoring lumen, wherein the pressure monitoring lumen and the pressure sensor are configured to provide an indication A signal of a change in pressure within the expansion chamber. 27. The cryotherapy device of embodiment 270, wherein: the pressure monitoring lumen has a length at least equal to one of the lengths of the shaft; and the pressure monitoring lumen is configured to provide from the inflation lumen to the pressure sense One to more 0.5 second reaction time of the detector.

S 190 201223577 2 7 2 The cryotherapy device of Embodiment 2 70, further comprising: a supply lumen along at least a portion of the shaft, the supply lumen being in fluid communication with the inflation lumen; a portion of the discharge chamber is in fluid communication with the expansion chamber; a valve coupled to the supply chamber and the waste force sensor; and wherein: the expansion chamber includes a balloon, the valve group And at least partially reducing a flow of refrigerant through the supply chamber when the pressure sensor measures that one of the pressures in the expandable member is higher than the threshold pressure, the pressure monitoring chamber having a configuration An inner diameter for accurately determining the pressure within the expandable component and configured to flow an outer diameter of the refrigerant through the discharge lumen having a negligible effect; and the pressure monitoring lumen is configured to provide A reaction time from the expansion chamber to the pressure detector of less than one second. 273. The cryotherapy device of embodiment 270, further comprising: a supply lumen along at least a portion of the shaft, the supply lumen configured to receive at least one substantially liquid cryogen; Discharge the inner cavity along at least a portion of the shaft, the discharge lumen being in fluid communication with the expansion chamber; and wherein: the inner discharge lumen has an internal cross-sectional dimension, the supply lumen and the pressure monitoring lumen are together The distal end portion 191 201223577 of the enamel enamel has an outer cross-sectional dimension, and the ratio of the inner cross-sectional dimension to the outer cross-sectional dimension is between 4:1 and 1 0:1. 274. The cryotherapy device of embodiment 270, wherein: the shaft has a first length; and the pressure monitoring lumen has an inner diameter of about o. olo, - about 15 吋 (0.381 mm) And a second length that is at least equal to the first length of the shaft. 275. The cryotherapy device of embodiment 274, wherein the shaft is configured to fit within a 6 Fr guiding sheath, the first length of the shaft being at least 12 〇cm ° 2 7 6 • as in Example 2 7 The cryotherapy device of claim 0 further comprising a controller coupled to the shaft and the pressure sensor, wherein the controller is configured to measure the threshold pressure or higher pressure at the pressure sensor At least the flow of refrigerant to the expansion chamber is reduced. 2 7 7. The cryotherapy device of embodiment 207, further comprising an adapter having a channel between the pressure sensor and the pressure monitoring lumen, wherein the channel has One does not exceed the volume of cc. 278. The cryotherapy device of embodiment 270, wherein the expansion chamber comprises a compliant material having a burst pressure of at least 300 psi. 2 7 9 The cryotherapy device of embodiment 2, wherein the expansion chamber comprises a compliant material having a burst pressure of at most 200 psi. 2 0 0. The cryotherapy device of embodiment 2, wherein: the shaft is configured to fit within a 6 Fr guide; and

S 192 201223577 The cooling assembly includes at least one of the expandable Qiu Du* & 夕 部分-part definition having a voucher 2 u, an A-expansion member, a β, a delivery state, and an expansive state The expansion chamber has its outer diameter in the expanded state. In addition, 'spoon 3 mm to about 1 低温 low temperature treatment device, comprising: a shaft having a proximal end portion and a distal end portion; and a distal portion of the shaft at the distal end portion An assembly, wherein sth cools one-/, an expansion chamber in which the distal end portion of the shaft is in fluid communication; and a pressure sensor at the proximal end portion of the shaft and in fluid communication with the expansion chamber such that A time delay between the pressure change in the expansion (four) and the pressure sensing benefit - the measurement pressure is within a reaction time to prevent the expansion chamber from rupturing. 282. The cryotherapy device of embodiment 281, wherein the reaction time is less than 0.01 seconds. 283. The cryotherapy device of embodiment 281, further comprising a pressure monitoring lumen having a proximal portion coupled to the pressure sensor and a distal portion in fluid communication with the inflation chamber . 284. The cryotherapy device of embodiment 283, wherein the pressure monitoring lumen has an inner diameter of no more than 0.030 吋 (0.762 mm) and an outer diameter of no more than 0.060 吋 (1.52 mm). 2 8 5. The cryotherapy treatment of Example 2 8 3, wherein the pressure monitoring lumen has a length of at least 48 吋 (122 cm). 286. The cryotherapy device of embodiment 283, further comprising an adapter coupled between the hen pressure sensor and the pressure monitoring lumen 193 201223577 'where the adapter has a less than 0 . The internal volume of 丨cc. 287. The cryotherapy device of embodiment 281, wherein: the reaction time is less than 〇·1 second; and the cryotherapy device further comprises a pressure monitoring lumen having a coupling to the pressure sensor The proximal portion and a distal portion in fluid communication with the inflation lumen, the pressure monitoring lumen having a length of at least 120 cm. 288. The cryotherapy device of embodiment 28, wherein: the shaft is configured to fit within a 6 Fr guide; and the beta cooling assembly includes an expandable member having a delivery state and an expanded state, At least a portion of the expandable member defines the expansion chamber, wherein the edge expandable member has a maximum outer diameter of 1 mm and a length of one to ten mm in the expanded state. 2 8 9. A method for treating a patient, the method comprising: positioning a cooling assembly at a predetermined location at least adjacent to an axis of the peripheral blood tube. Wherein the cooling assembly includes an expansion chamber having a threshold pressure; causing the co-coolant to expand in the expansion chamber; applying a therapeutic cooling to the nerve adjacent to the peripheral blood vessel using the s cooling assembly; An external pressure sensor measures a pressure in the expansion chamber, wherein the 玄 external pressure sensor is coupled to a pressure monitoring lumen in fluid communication with the expansion chamber; and when the pressure is measured in the expansion chamber When the gas is less than the threshold pressure, provide

S 194 201223577 Instructions. 290. The method of embodiment 289, wherein measuring the pressure in the expansion chamber with an external pressure sensor comprises measuring a pressure in the expansion chamber such that a pressure change in the expansion chamber is associated with the external pressure A time delay between the measured pressures at the sensor is less than 1 second. The method of embodiment 289, wherein providing an indication when the measured pressure in the expansion chamber is at least the threshold pressure comprises providing an indication when the measured pressure approaches a burst pressure of the expansion chamber. 292. The method of embodiment 289, the method further comprising coupling the external pressure sensor to the pressure monitoring lumen with an adapter having an internal volume of no more than 0.1 cc. 293. The method of embodiment 289, wherein: positioning the cooling assembly at the distal portion of the shaft at least adjacent the peripheral blood vessel comprises positioning the cooling assembly at least about the axis of the adjacent renal artery Measuring the pressure in the expansion chamber by the external pressure sensor comprises measuring a pressure in the expansion chamber via a pressure monitoring lumen having a length of at least 120 cm; and when the expansion chamber The indication that the measured pressure is at least the threshold pressure includes indicating the measured pressure within a reaction time to prevent the expansion chamber from rupturing. 294. A method for treating a patient, the method comprising: positioning an inflation lumen within a blood vessel adjacent a posterior nerve fiber that innervates the kidney of the patient;

195 201223577 low temperature adjusting at least a portion of the nerve fibers adjacent the expansion chamber; and measuring a pressure in the expansion chamber with an external pressure sensor, wherein the external pressure sensor is in fluid communication with the expansion chamber. 295. The method of embodiment 294, wherein measuring the pressure in the expansion chamber with an external pressure sensor comprises coupling the external pressure sensor to one of the distal ends of the shaft to one of the shafts One of the proximal portions is pressure monitoring the lumen, the expansion chamber being at the distal end portion of the shaft. 296. The method of embodiment 295, wherein measuring a pressure comprises measuring a pressure with the external pressure sensor via the pressure monitoring lumen within 0.1 second of a change in pressure at the expansion chamber. The method of embodiment 296, wherein measuring the pressure comprises monitoring the lumen using a pressure of eight to 乂 1 mm and an inner diameter of no more than 0.7 62 mm. A cryotherapy device comprising: a shaft comprising a proximal portion and a distal portion, wherein the distal portion includes a concave region inwardly relative to the proximal portion; At least a portion of the discharge lumen; a supply lumen along at least a portion of the shaft; and an expandable member at the region and a fluid connection with the supply lumen and the discharge lumen

a cold section assembly including a recess connected to the distal end portion

S 196 201223577 is divided into the recessed area. 299. The cryotherapy device of embodiment 298, further comprising a connector configured to connect the expandable portion adjacent the recess. ° ° °Hulable member 300. The cryotherapy device of embodiment 299, the member of which is - balloon 'and its t connector is one of the balloons: 4 the proximal portion of the inflatable portion is fixed # 3 (H. The cryotherapy device of Embodiment 299, wherein: the distal end portion of the shaft comprises a first region, a flute of the -^ domain - a tomb # 艰 steps away from the second region of the first region And the connector is at least partially above the step and the first region, the ferrule, in the deployed state, having an outer diameter in the delivery state: I bought a similar 3 02. as in embodiment 299 The cryotherapy device, wherein: the distal end portion of the shaft includes a first region, a second region remote from the first region, and a defined inward concave region and distinguishing the first region from the second region a step; and at least a portion of the connector is in the recess adjacent the step. 303. The cryotherapy device of embodiment 298, wherein: the expandable member comprises a distal portion; and the cryotherapy device is stepped Including extending from the distal end portion of the expandable member Non-invasive tip. 304• A cryotherapy device comprising: a shaft comprising a distal portion configured to be located in a renal blood vessel, 197 201223577. The extended portion of the shaft includes a pair of p丄^ a first region of the first outer dimension and a second region having a first outer dimension smaller than the first outer dimension, /, wherein the second region is away from the first region. - discharging at least a portion of the axis An inner cavity; and a cooling assembly at the distal end portion of the shaft, wherein the cooling total includes - an expandable portion above the second region of the distal portion

And the expandable member has an expansion chamber that receives expansion refrigerant and is in fluid communication with the discharge lumen. 3. The cryotherapy device of embodiment 3-4, wherein: the distal portion of the shaft includes a step that distinguishes the first region from the second region; and the expandable member includes a phase opposite the step Adjacent to the connector above the second region, the expandable member extends distally from the connector. 3. The cryotherapy device of Embodiment 3, wherein the distal portion of the shaft includes a step that distinguishes the first region from the second region; and the expandable member includes a a connector over at least a portion of the region, the expandable member extending distally from the connector. 307. The cryotherapy device of embodiment 3-4, wherein: the first region of the distal portion has a first outer surface. The distal portion further includes a step that distinguishes the first region from the second region The expandable member includes a connector over the second region of the distal portion;

S 198 201223577 The expansion chamber has a delivery state having a first volume and a deployed state having a second volume greater than the first volume; and the connector of the expandable member is at least adjacent to the step and in the expansion The cavity is substantially flush with the first outer surface of the first region in the delivery state. The cryotherapy device of embodiment 304, wherein: the distal portion of the shaft further comprises a difference to the first a step of the region and the second region; the expansion chamber having a delivery state having a first volume and a deployment state having a second volume greater than the first volume; and the expandable member includes a deployment state And a connector having a substantially constant outer diameter in the delivery state. 309. The cryotherapy device of embodiment 308, wherein the connector is above the step. 3. The cryotherapy device of embodiment 304, wherein: the discharge lumen at the first region has a first inner diameter; and the discharge lumen at the second region has a smaller than the first Straight seed _ the second inner diameter. The cryotherapy device of embodiment 304, wherein: at least a portion of the inflation lumen has a treatment temperature; and the drainage lumen at the second region of the distal portion is configured to The volume of the therapeutic temperature of the sensation chamber is 312. The cryotherapy device of the embodiment 311, the hair shaft and the iliac shaft, are substantially reduced by the ventricle at the second region. The second region of the end portion of the 199 201223577 has a length of about 4 cm. J丄·ί. As in the third embodiment, the 么4 and the 古古古/αtherapy exhibition, wherein the expansion cavity package 3 - has a balloon of the connector, and the Qiu Xi'an, the connection connection Above the second region of the distal end. 314. The cryotherapy device of embodiment 304, wherein: the expandable member comprises a connector over the first field, the connection 1 § having a thickness; the first portion of the distal portion - The region has a first outer diameter; and the second region of the distal portion of the shaft has a second outer diameter equal to/not exceeding the first diameter minus twice the thickness of the connecting portion. 315. The cryotherapy device of embodiment 304, wherein the axis is further away. The split includes a difference between the first region of the first region and the recessed region of the second region. 316. A method of treating a patient, the method comprising: positioning a cooling assembly within the blood vessel at least adjacent the peripheral blood vessel, wherein the cooling assembly includes an expandable member having an axis a connector above the distal end portion and an expansion lumen defined by at least a portion of the expandable member, wherein the distal end portion of the shaft has a first cross-sectional outer dimension at a first region and a second cross-sectional outer dimension at the second region that is less than the first cross-sectional dimension, and wherein the connector of the expandable member is adjacent the first region and the second region of the distal portion a boundary; expanding the uniform refrigerant in the expansion chamber; and lowering the at least a portion of the nerve fibers adjacent to the peripheral blood vessel of the cooling assembly. ‘

The method of embodiment 3, wherein the peripheral blood vessel is a first peripheral blood vessel 'where the inflation chamber has a delivery state and a deployed state, and wherein the method further comprises: terminating the first The low temperature regulation of the nerve fibers in the peripheral blood vessels and the contraction of the expansion chamber to the delivery state, the expandable member having a connector over the second region, wherein the connector is in the delivery chamber for the delivery a state substantially flush with the outer dimension of the first cross-section of the first region; removing the cooling assembly from the first peripheral blood vessel; delivering a contrast material from the proximal portion of the shaft to the shaft The distal portion and the expandable member are surrounded; the camping light positions the second peripheral blood vessel; the cooling assembly is positioned within the blood vessel at least adjacent to the second peripheral blood vessel; causing the refrigerant to expand in the expansion chamber; And low temperature adjusting at least a portion of the nerve fibers of the second peripheral blood vessel adjacent to the cooling assembly. 3 1 8 - A method of treating a patient, the method comprising: positioning a cooling assembly at least adjacent to a renal artery or a renal orifice, wherein the cooling assembly comprises an expandable member having a adjacent axis a connector of an inward step at a distal end portion, wherein the distal end portion has a first region adjacent the inward step and a second region remote from the inward step; causing a uniform refrigerant in the expandable member Expanding in at least a portion; 201 201223577 passing the refrigerant through the distal end of the second portion of the second region at the second region; and using the cooling assembly to the nerve #耐跃尬, + ^ Fork with "dirty kidney nerves applied therapeutic cooling. Wherein the positioning of the cooling assembly comprises 319 in which therapeutic cooling is applied. The method of embodiment 318 deploys the expandable member from an outer sheath. 320. After the method of embodiment 3 19, the method further comprising: shrinking the cooling assembly into the outer member; relocating the cooling assembly at least adjacent to the other kidney At the same time, a contrast agent flows along the axis; and the expansion, passage and application procedures are repeated. A cryotherapy device comprising: a shaft comprising a distal portion, the shaft being configured to fit within a 6 Fr guiding sheath; and a distal portion of the shaft being virtual With ancient times. The cold assembly, the cooling assembly, having between 8 cm and about 15 cm, the county A-^mu, the length and the expandable member having a delivery state, the j: + shape The energy-r, the A 3 swellable component has about 3 mm and about under the expansion core! 〇mm door nun (inter- OD. = Example 321 of the low temperature treatment device, 钿. 卩 includes - has a first - outer first only 夂 first region and one has a smaller than 乂 从The second region of the second outer diameter is deflated as the cryotherapy device of the 322, which enters the step of the region and the second region.

S 202 201223577 32=The low temperature treatment (IV) of embodiment 323, wherein the expandable pulse member comprises a velocity 325 adjacent to the step between the first region and the second region connector. The cryotherapy as in Example 321 The device, wherein: - wherein: at least a portion of the expandable member is - the treatment temperature; the cryotherapy device further comprises: - at least - a portion of the shaft of the discharge lumen, the discharge lumen having a a third inner diameter at a region of the π-passenger and a second inner diameter at the second region less than the first inner diameter, wherein the discharge lumen is configured to pass the uniform refrigerant Second: the field: the venting lumen is at least substantially maintained at the therapeutic temperature of the expandable member. 326. The cryotherapy device of embodiment 321 wherein the shaft has a 4 Fr axis size. The cryotherapy device of Example 321 wherein the expandable member comprises at least one balloon, and wherein the balloon has a length of one to 10 cm and an outer diameter of one to eight mm in an expanded state. 328. Using a cryogenic device square The method includes: deploying a cooling assembly from a 6 Fr outer sheath, wherein the cooling assembly includes an expandable member having an inward step at a distal end portion of one of the adjacent shafts a connector, wherein the distal portion has a first region adjacent to the inward step and a second region remote from the inward step; expanding a co-coolant in at least a portion of the expandable member; and causing The refrigerant passes through the second region of the distal portion - the outlet. 203 201223577, the method further comprises expanding in the expansion member; Fr in the outer sheath; 329. the method of embodiment 328 terminates the refrigerant at The expandable causes the cooling assembly to contract to the 6 to cause a contrast material to flow along the outer sheath; and repeats the deployment, expansion, and passage procedures. 330. A cryotherapy device comprising: the tube has a distal end a portion of the elongated shaft, wherein the inner end portion is positioned at the treatment site; the shaft is configured to supply a lumen to at least a portion of the blood stasis shaft, the supply lumen configured to receive at least one substantially liquid a refrigerant; a discharge lumen along at least a portion of the shaft, the discharge lumen having a first diameter and open to deliver the refrigerant proximally after expansion; and a distal portion of the shaft a cooling assembly having an orifice having a second diameter and in fluid communication with the supply lumen and an expansion chamber in fluid communication with the S-port, the first diameter and the second diameter A ratio between 4:1 and 1 〇:1, wherein the orifice is configured to deliver the substantially gaseous refrigerant to the inflation chamber. 33. The cryotherapy device of embodiment 330, wherein The discharge lumen has an inner diameter between about 0.030 吋 (0-762 mm) and about 0.05 吋 (1.27 mm); and the cooling assembly further includes a flow restricting lumen in the supply lumen. Restricting the lumen having a distal portion in the inflation lumen, wherein the orifice is adjacent the distal portion of the flow restricting lumen, the orifice and the flow restricting lumen having about 0.0030 吋 (0.076 mm) and about

S 204 201223577 . An inner diameter between 0.0080 (0.2.03 mm). 332. The cryotherapy device of embodiment 330, Α push-stop ♦, and the rigorous step comprises: a flow restricting lumen in the supply lumen and open to the inflation lumen, wherein the flow restriction lumen has about 2 A length between 吋 (5.1 cm) and approximately 3〇咕', ' ', '6.2 cm). 3 3 3. The cryotherapy device of embodiment 3, wherein: the treatment site is at least one of a renal artery and a renal ostium. § Hai supply lumen has a first inner diameter and a first length; The cooling assembly further includes a capillary tube in the supply lumen and open to the expansion chamber, the capillary having a second outer portion that is smaller than the first inner diameter and a second length smaller than the first length, wherein The hair: the tube includes a distal portion of the orifice and wherein the refrigerant flows into the capillary from the supply lumen in at least one substantially liquid state and exits the orifice in at least one substantially gaseous state; The inflation lumen contains an applicator configured to produce a therapeutically effective low temperature renal neuromodulation. 334. The cryotherapy device of embodiment 330, wherein a distal end portion of the supply lumen defines the orifice, and wherein an inner diameter of the supply lumen is a scoop of 0.0040 吋 (〇1〇2 mm) and about 〇 〇1〇吋 (〇254 mm ). 335. The cryotherapy device of embodiment 330, further comprising: a flow restricting lumen in the swell of the swell, wherein the flow limit. The lumen comprises - defining the distal end of the orifice a portion, and wherein the supply lumen has a first length and the flow restriction lumen has a second length of at most V3 of the first length. 205 201223577 3 3 6. The cryotherapy device of Example 3 3 0, wherein the shaft is configured

338. One of the regions of Example 330 has a ratio of 4: 丨 to less than 丨〇_1. The cryotherapy device further includes a guidewire lumen extending through at least a portion of the shaft. 3 3 9. The cryotherapy device of Embodiment 3 3, wherein: a distal opening of the shaft has a proximal end having a proximal opening and a distal end having a mouth; and the lumen of the 3 Guidewire is at least The proximal opening extends between the distal opening. 340. The cryotherapy device of embodiment 338, wherein: the δ mysterious axis has a length between a proximal end and a forced end; and the guidewire lumen has a between the proximal end of the shaft and the distal end Proximal opening. 34 1 - A cryotherapy device comprising: an elongated shaft having a distal portion, wherein the shaft is configured to position the distal portion within the vessel at least adjacent to at least one of a renal artery and a renal orifice At a treatment site; a supply lumen along at least a portion of the shaft 'the supply lumen configured to receive a liquid cryogen; a discharge passage along at least a portion of the shaft, the discharge passage having a set State to convey a cross-sectional opening of an expanded refrigerant; and

S 206 201223577 : a cooling assembly at the distal end portion of the shaft, the cooling assembly having a sputum station. ^, · heart to receive the substantially gaseous refrigerant from the supply lumen The ratio of the cross-sectional opening of the discharge passage at the cooling assembly and the cross-sectional dimension of the supply chamber at the cooling assembly is between 4:1 and 1〇:1 . 342. The cryotherapy device of embodiment 341, further comprising a capillary in the supply lumen and open to the expansion lumen, wherein the capillary has an opening having a diameter of at least 〇 (3) 4 吋 (0.102 mm). 343. The cryotherapy treatment of embodiment 342, wherein the supply lumen has a first length and the capillary has a second length that is at most % of the first length. 344. The cryotherapy device of embodiment 341, further comprising - configured to deliver the guidewire lumen of the cooling assembly via a wire. 345. The cryotherapy device of embodiment 341, further comprising a rapid exchange archwire lumen. 346. The cryotherapy device of embodiment 341, wherein the discharge channel has a first zone and the supply lumen occupies a second zone of the discharge channel, and wherein the first zone and the second zone A ratio of heart 1 is less than 10:1. '一...A α· positioning an applicator of an elongated shaft in the blood vessel at a treatment site at least adjacent to the renal artery or the renal orifice, wherein the applicator is at: the end portion; 31 And the distal portion of the shaft is supplied with a flow of the lumen flow 13 207 201223577, wherein the supply lumen extends along at least a portion of the shaft; the refrigerant from the applicator Passing through a discharge lumen extending along at least a portion of the shaft, wherein the discharge lumen has a first internal cross-sectional area, the aperture having a second internal cross-sectional area 'and the first interior a ratio of one of the cross-sectional area to the second internal cross-sectional area is between 4:1 and 1 〇:1; and cooling a portion of the treatment site via one of the applicators to cool and effect therapeutically effective Low temperature renal neuromodulation. 348. The method of embodiment 347, wherein expanding the co-coolant from one of the fluid ports in fluid communication with the one of the distal end portions of the shaft comprises causing the refrigerant to have a diameter of about 0.003. 〇.〇76mm) and an orifice expansion between about 〇_〇〇8 inches (0.203 mm). 349. The method of embodiment 348, wherein expanding the co-coolant from one of the fluid ports in fluid communication with the one of the distal end portions of the shaft comprises expanding the cryogen from a flow restricting lumen An orifice expansion at the distal end portion '3H supply lumen has a first length'. The flow restriction lumen has a second length of at most V3 of the first length. The method of embodiment 347, wherein the positioning of the applicator of the elongated shaft within the blood vessel at the treatment site comprises extending at least a portion of the shaft via a guide line, wherein the δ guide line extends through The pumping - guiding the inner lumen of the line. The method of embodiment 3, wherein the extending of at least a portion of the shaft through the guide line comprises passing a guide wire completely through a length of the shaft

208 201223577 'Extension' wherein the length of the shaft is from a distal end to a proximal end. The method of embodiment 35, wherein at least the portion of the shaft is extended via the guidewire comprising delivering the medicament to the treatment site using a rapid exchange guidewire configuration. 3 5 3 - A method for treating a patient, the method comprising: positioning a cryotherapy device in a blood vessel at a target site in a renal artery or a renal stenosis of the patient; - making the cryotherapy device at least adjacent Dislocating the target site from a delivery state to a deployed state; removing heat from tissue at the target site and thereby producing a therapeutically effective renal neuromodulation; and contracting the cryotherapy device from the deployed state to the A delivery state wherein the cryotherapy device has a programmed period of less than 5 minutes from deployment to contraction. The method of embodiment 353, wherein the target site is a first target site in the first renal artery or the first renal ostium, and wherein the method further comprises: the cryotherapy to be in the delivery state within the blood vessel The device is positioned at least adjacent to the second target site of the second renal artery or the second renal orifice of the patient; deploying the cryotherapy device from the delivery state to the deployed state at least adjacent to the second target site; removing Heat from the tissue at the second target site, and thereby producing a therapeutically effective renal neuromodulation; and

209 201223577 contracting the cryotherapy device from the deployed state to the delivery state, wherein the m brewing/sigma therapy device is deployed at the first target site until the cryotherapy device contracts at the second target for a program period less than 12 minutes. 355. The method of embodiment 3S3, wherein: positioning the cryotherapy device within the blood f at least adjacent the target site comprises positioning the cryotherapy device at least adjacent to the renal artery of the patient And removing heat from the tissue at the target site comprises cooling at least a portion of the renal artery via the applicator at a rate of heat transfer sufficient to produce therapeutically effective hypotensive renal neuromodulation, the cooling having At least one cooling cycle of up to 1000 seconds. 356. The method of embodiment 353, wherein removing heat from the tissue at the target site comprises modulating the renal nerves in a single application cryocooling during the program cycle. The method of embodiment 3, wherein the removal of heat from the tissue at the target site comprises removing from the amount sufficient to produce a therapeutically effective renal neuromodulation around the full circumference of the renal artery. The heat of the tissue at the target site. The method of claim 3, wherein the removal of heat from the tissue at the target site is removed in an amount sufficient to produce a therapeutically effective renal neuromodulation around the renal artery. The heat from the tissue at the target site. 359. The method of embodiment 353, wherein removing heat from the tissue at the target site comprises at least two cooling cycles separated by a warming cycle

S 210 201223577 The renal nerves are cooled by cryogenic cooling. The method of embodiment 359, wherein the renal nerves are cryogenically cooled in at least two cooling cycles each having a duration of less than 6 sec. 36. A method for treating a patient, the method comprising: positioning an energy delivery device at at least adjacent nerve fibers that innervate the kidney of the patient; delivering the energy delivery device from within the blood vessel The state is deployed to a deployed state; and an energy field sufficient to modulate the neural function of the post-ganglionic nerve fibers is delivered via the energy delivery device, wherein deploying the energy delivery and delivering the energy field has a program time of less than 5 minutes. 2. The method of embodiment 3, wherein: locating the energy delivery device at least adjacent to the post-ganglionic nerve fibers comprises positioning an applicator of a cryotherapy device at least adjacent to the blood vessel Post-ganglionic nerve fibers; and delivering the energy field comprises: expanding a co-coolant in at least a portion of the applicator, and subcooling and adjusting the post-ganglionic nerve fibers of the innervating kidney via the applicator to cause The therapeutically effective cryogenic cooling comprises at least one cooling cycle of less than 100 seconds. 363. The method of embodiment 362, wherein the delivering an energy field sufficient to modulate nerve function of the post-ganglionic nerve fibers via the energy delivery device comprises cryogenically cooling using at least two cooling cycles separated by a warming cycle

C 211 201223577 The nerves innervate the nerve fibers of the kidney. 3 64. A cryotherapy device comprising: an elongated shaft having an 8-terminal portion, wherein the shaft is configured to position the distal portion at a treatment site within blood g; a distal end of the shaft a portion of the cold section assembly, the cooling assembly having a -delivered state, a deployed state and an expansion chamber, wherein the refrigerant expands in the expansion chamber, and which causes the cryogenic device to be configured to be less than 5 Automatically terminating a program cycle within minutes and wherein the program cycle begins when the cooling assembly moves from the delivery state to the deployed state at the treatment site, and the program cycle terminates delivery to the inflation lumen at the cooling assembly The refrigerant ends. 3. The cryotherapy device of embodiment 364, wherein: the treatment site is adjacent to at least one of a renal artery and a renal ostium; the cooling assembly further comprising a configuration configured to have a foot in the deployed state An applicator that produces a therapeutically effective rate of heat transfer of hypothermic renal neuromodulation; and the cryotherapy device further comprises: a supply lumen along at least a portion of the shaft, the supply lumen being received by the group I To - substantially liquid refrigerant ' and the supply lumen is in fluid communication with the expansion chamber, and a discharge lumen along at least a portion of the shaft, the discharge lumen being in fluid communication with the expansion chamber. 366. The cryotherapy device of embodiment 364, wherein the programmed period is less than two minutes.

S 212 201223577 3 6 7 · The cryotherapy device of Embodiment 3 64, wherein the cooling assembly is provided with an applicator having a heat extending around a circumference of the applicator that is not completely circumferential A delivery portion, and wherein the heat transfer portion is configured to deliver a therapeutically effective hypothermia neuromodulation at the treatment site when the cooling assembly is in the deployed state. 8' The cryotherapy device of embodiment 3, wherein the cooling assembly v^&quot; includes an applicator having a heat transfer portion extending around a full circumference of the applicator, and wherein The heat transfer portion is configured via configuration 2 to deliver therapeutically effective hypothermia neuromodulation at the treatment site while the cooling assembly is in the deployed state. 369. The cryotherapy device of embodiment 364, wherein the cooling assembly further comprises a configuration configured to imaginatively pass through the μ in the single application during the program cycle. Put, ea _

The cryotherapy device of embodiment 364, wherein the cryogenic device is wherein the cooling system I cycle ends. 213 201223577 is configured to automatically terminate the program cycle when a preset amount of the refrigerant is used. 3 7 4 The cryotherapy device of Embodiment 3 6 4 further comprising a controller&apos; the controller includes instructions for causing the controller to automatically terminate the program cycle at a preset time interval. The above detailed description of the specific examples of the present invention is not intended to be exhaustive or to limit the invention to the precise forms disclosed. While the specific embodiments and examples of the present technology have been described above for illustrative purposes, various equivalent modifications can be made within the scope of the present technology, as will be appreciated by those skilled in the art. For example, although steps are provided in a specified order, alternative specific embodiments may be performed in a different order. The various specific examples described herein can also be combined to provide other specific examples. The above description of the specific embodiments of the present invention is not to be construed as a If the context permits 5 noon, the singular or plural terms may also include plural or singular terms, respectively. In addition, with regard to a list with two or more items, unless the word "or" is expressly restricted to only a single item that excludes other items, the use or "in the list shall be construed as including (a) in the list. Any single item, (匕) all items in the list, or (c) any combination of items in the list. In addition, the term "comprising" is used throughout to mean to include at least the features, and does not exclude any greater number of the same features and/or other types.

S 214 201223577 Features. It is also to be understood that the specific embodiments have been described herein for the purposes of illustration In addition, although advantages associated with certain specific examples of the present technology have been described in the context of these specific examples, other specific examples may exhibit such advantages, and not all specific examples necessarily require that such advantages be presented Within the scope of this technology. Accordingly, the present invention and related art may cover other specific examples not explicitly shown or described herein. BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 illustrates a cryotherapy system 0 in accordance with an embodiment of the present technology. FIG. 2A is a diagram illustrating a distal end portion of a shaft and a delivery state (eg, a low profile or a contraction button) in accordance with an embodiment of the present technology. An enlarged cross-sectional view of a specific example of the cooling assembly of the state. Figure 2B is an enlarged cross-sectional view of the cooling assembly of Figure 2A in a deployed state (e.g., an expanded configuration). 2C and 2D are enlarged cross-sectional side and end views of a cooling assembly configured in accordance with another embodiment of the present technology. Figure 2E is an enlarged cross-sectional view of the proximal and distal portions of a cryotherapy device configured in accordance with another embodiment of the present technology. Figure 3A illustrates hypothermic regulation of renal nerves using a cryotherapy system in accordance with one embodiment of the present technology. FIG. 3B is a block diagram of a method for low temperature regulation of the lunar nerve according to any specific example of the present technology. FIG. 4A and FIG. 4B are diagrams of a specific example according to the present invention. 215 201223577 Stepped distal portion An enlarged cross-sectional view of the cryotherapy device. Figure 5A is a partial schematic illustration of a cryotherapy system configured in accordance with another embodiment of the present technology. Figure 5B is an enlarged cross-sectional view of the distal end portion of the shaft and the cooling assembly in a deployed state in accordance with the teachings of the present invention. Figure 6A is a plan view showing a pre-cooling assembly configured in accordance with one embodiment of the present technology. Figure 6B is a cross-sectional view illustrating the pre-cooling assembly of Figure 6A. Figure 7 is a cross-sectional view showing a pre-cooling assembly configured with a valve in accordance with an embodiment of the present technology. 7A is a cross-sectional view of a pre-cooling assembly configured to be configured according to one embodiment of the present technology. The pre-cooling assembly has a shunt. Figure 8B is a cross-sectional view illustrating the pre-cooling assembly of Figure 8A. To illustrate a pre-cooled to 'cross-sectional view of a configuration according to another embodiment of the present technology, the pre-cooling assembly has a shunt. Figure 9B is a cross-sectional view illustrating the pre-cooling assembly of Figure 9A. Fig. 10 is a view showing the tubular shape Λβ # μ of the assembly according to an embodiment of the present technology. A partial view of the piece around the discharge opening in the handle. μ 1 A partial dry view of a pre-formed component that is configured to be wrapped around a discharge opening in the handle in accordance with the teachings of the present invention. I. Fig. 12 is a cross-sectional view illustrating the assembly. According to one embodiment of the present technology, the cooling is configured, and the cooling assembly has supply pipes, and the supply pipes are provided.

S 216 201223577 has a slanted distal part. Figure 13 is a cross-sectional view illustrating a cooling assembly configured in accordance with one embodiment of the present technology, the cooling assembly having a supply tube having a helical portion wrapped around the discharge passage. Figure 14 is a cross-sectional view illustrating a cooling assembly configured in accordance with another embodiment of the present technology. The cooling assembly has a supply tube having a helical portion wrapped around the discharge passage. Figure 15A is a cross-sectional view showing a cooling assembly configured in accordance with one embodiment of the present technology, the cooling assembly having an inner balloon having an internal balloon aperture. Figure 15B is a cross-sectional view illustrating the cooling assembly of Figure 15A. Figure 16 is a cross-sectional view of a cooling assembly configured in accordance with one embodiment of the present technology, the cooling assembly having an inner a ball and an outer balloon, the inner balloon having an inner balloon aperture having an inner balloon aperture Raise the convoluted portion. Figure 1 6B is a cross-sectional view illustrating the cooling assembly of Figure 6A. Figure 17A is a cross-sectional view showing a cooling assembly configured in accordance with one embodiment of the present technology, the cooling assembly having elongated heat insulating members. Figure 178 is a cross-sectional view illustrating the cooling assembly of Figure 17A. Figure 18A is a cross-sectional view showing a cooling assembly configured in accordance with another embodiment of the present technology, the cooling assembly having elongated thermal insulation components. Figure 18B is a cross-sectional view illustrating the cooling assembly of Figure 18A. Figure 19A is a cross-sectional view showing a cooling assembly configured in accordance with one embodiment of the present technology, the cooling assembly having a spiral insulating member. 217 3 201223577 FIGS. 19B and 19C are cross-sectional views illustrating the cooling assembly of FIG. 19A. Fig. 20A is a plan view showing the cooling L of a configuration according to an embodiment of the present invention, the cooling assembly having a heat insulating member similar to an interlaced double helix. 20' and FIG. 2〇c are cross-sectional views illustrating the cooling assembly of FIG. Figure 21 is a cross-sectional view showing a cooling assembly configured in accordance with another embodiment of the present technology, the cooling assembly having elongated thermal insulation members movable within the balloon. Figure 2B is a cross-sectional view illustrating the cooling assembly of Figure 21A. Figure 2ic is a cross-sectional view showing the cooling assembly of Figure Ua in a delivery sheath in a delivery state. Figure 22A is a cross-sectional view showing a cooling assembly configured in accordance with one embodiment of the present technology, the cooling assembly having two long thermal insulation members movable within the balloon. 22B is a cross-sectional view illustrating the cooling assembly of FIG. 22A. Figure 23 is a plan view showing a cold I7 configuration according to an embodiment of the present technology. The cooling assembly has a plurality of partial circumferential balloons. Figure 23B is an isometric view illustrating the cooling assembly of Figure 23A. Figure 24A is a diagram illustrating another embodiment of the techniques in accordance with the present invention. 'j-face' The cooling assembly has a plurality of partial circumferential balloons. Figure 24B is an isometric view illustrating the cooling assembly of Figure 24A. Figure 25 is a cross-sectional view showing the configuration of the embodiment of the present invention. The cooling assembly has a spiral recess. Figure % is a cross-sectional view showing a cooling 218 201223577 assembly configured in accordance with one embodiment of the present technology, the cooling assembly having spaced apart recesses. Figure 27A is a cross-sectional view showing a cooling assembly of another embodiment of the present invention having spaced apart recesses in accordance with the teachings of the present invention. Figure 27B is a cross-sectional view illustrating the cooling assembly of Figure 27A. Figure 27C is an isometric view illustrating the cooling assembly of Figure 27A. Figure 28 is a cross-sectional view showing a cold heading assembly configured in accordance with an embodiment of the present technology, the cooling assembly having spaced apart protrusions. 17 Teeth Figure 29 is a cross-sectional view showing the cold discharge of a configuration according to one embodiment of the present technology. The cooling assembly has a spiral balloon wrapped around the discharge passage. The bubble diagram 30 is a cross-sectional view illustrating a cold configuration according to one embodiment of the present technology. The cooling assembly has a convoluted balloon wrapped around the supply lumen. Figure 31 is a cross-sectional view of a configuration of another embodiment of the present invention having a helical balloon surrounded by a supply lumen. Figure 32A is a cross section showing one of the techniques of the present invention having a molded part having a shape memory. Figure 32B is a cross-sectional view illustrating the cooling assembly of Figure 32A. However, H A is a cold cross-sectional view illustrating a configuration according to the embodiment of the present invention, the cooling assembly having a balloon curved along its length. Figure is a cross-sectional view illustrating the cooling assembly of Figure 33A. ‘,’, ° 。 。 。 。 。 。 。 。 。 。 。 。 。 。 。 。 。 。 。 。 。 。 。 。 。 。 。 。 。 。 。 。 。 。 Figure 34 is a cross-sectional view showing a cooling assembly configured in accordance with another embodiment of the present technology, the cooling assembly having a balloon curved along its length. Figure 3 5A is a cross-sectional view showing a cooling assembly configured in accordance with one embodiment of the present technology, the cooling assembly having a balloon having a restricted longitudinal portion. Figure 35B is a cross-sectional view illustrating the cooling assembly of Figure 35A. Figure 36 is a cross-sectional view showing a cooling assembly configured in accordance with another embodiment of the present technology, the cooling assembly having a balloon having a restricted longitudinal portion. Figure 37 is a cross-sectional view showing a cooling assembly configured in accordance with one embodiment of the present technology, the cooling assembly having an annular balloon. Figure 38A is a cross-sectional view showing a cooling assembly configured in accordance with one embodiment of the present technology, the cooling assembly having a plurality of elongated balloons. Figure 38B is a cross-sectional view illustrating the cooling assembly of Figure 38A. Figure 39A is a cross-sectional view showing a cooling assembly configured in accordance with another embodiment of the present technology. The cooling assembly has a plurality of elongated balloons. 39B and FIG. 3C are cross-sectional views illustrating the cooling assembly of FIG. 39A. Figure 40 is a diagram showing the configuration of a cold &quot;P(10) according to another embodiment of the present technology; the cooling assembly has a plurality of elongated balloons. Figure 4 is a cross-sectional view showing a cooling assembly configured in accordance with one embodiment of the present technology. The cooling assembly has a plurality of spiral balloons. 2 is a clarification of the appearance of another concrete assembly according to the technology of the present invention, and the sorrow of the sorrow. j. The cooling assembly has a plurality of spiral balloons. 220 201223577 FIG. 43A is a cross-sectional view showing a cooling assembly according to one of the techniques of the present invention, which is configured with a plurality of connections, and the cooling assembly has a plurality of connections to the s, 〜W &gt; A slender balloon of combat components. Figure 43B is a cross-sectional view illustrating the cooling assembly of Figure 43A. Figure 43C is a cross-sectional view illustrating the cooling assembly of Figure 43A with the forming member contracted. Figure 44A is a cross-sectional view showing a further embodiment of a cooling assembly having a plurality of elongated balloons attached to a molded component in accordance with another embodiment of the present technology. Figure 44B is a cross-sectional view illustrating the cooling assembly of Figure 44A. Figure 44C is a cross-sectional view illustrating the cooling assembly of Figure 44A with the shaped member contracted. Figure 4 5A is a cross-sectional view showing a cooling assembly configured in accordance with one embodiment of the present technology, the cooling assembly having a plurality of elongated balloons having different compositions. Figure 45B is a cross-sectional view illustrating the expansion of the cooling assembly of Figure 45A to a first cross-sectional dimension. Fig. 4 5B-1 is an enlarged cross-sectional view illustrating the divided area shown in Fig. 45B. Figure 45C is a cross-sectional view illustrating the expansion of the cooling assembly of Figure 45A to a second cross-sectional dimension that is greater than the first cross-sectional dimension. Figure 46 is a cross-sectional view showing a cooling assembly configured in accordance with another embodiment of the present technology, the cooling assembly having a plurality of elongated balloons having different compositions. 221 201223577 Figure 46_1 is an enlarged cross-sectional view illustrating the divided area shown in Figure 46. Figure 47 is a cross-sectional view showing a cooling assembly configured in accordance with an embodiment of the present technology, having a spiral-shaped primary balloon wrapped around a secondary balloon. Figure 48A is a cross-sectional view showing a cooling assembly configured in accordance with one embodiment of the present technology having a spiral main balloon in a secondary balloon. Figure 48B is a cross-sectional view illustrating the cooling assembly of Figure 48A. Figure 49 is a cross-sectional view showing a cold section assembly configured in accordance with another embodiment of the present technology, having a spiral primary balloon wrapped around a secondary balloon. Figure 50 is a cross-sectional view showing a cold section assembly configured in accordance with another embodiment of the present technology having a convoluted primary balloon wrapped around a secondary balloon. Fig. 51 is a view showing a cold-formed configuration of a cold-shaped main balloon surrounded by a secondary balloon in accordance with another embodiment of the present technology. ^ A is a low- and occlusive component configured to be configured in accordance with one embodiment of the present technology. -’. A cross-sectional view of the distal portion of the treatment device, the distal portion including cooling total Figure 52B for illustrating the distal end portion of Figure 52A

Assembly and occlusion components. A cross-sectional view of the distal portion of the 52A. The low configuration of a specific example includes the cooling

S 222 201223577 Figure 54 is a cross-sectional view illustrating a cooling assembly configured in accordance with one embodiment of the present technology, which may be well suited for circulating a refrigerant without phase change. Figure 55 is a cross-sectional view showing a cooling assembly configured in accordance with another embodiment of the present technology, which is well suited for circulating a refrigerant without phase change. Figure 56 is a conceptual illustration of how the sympathetic nervous system (SNS) and brain communicate via _ body. /, Figure 57 is an enlarged anatomical view of the nerve that innervates the left kidney to form a nerve surrounding the left renal artery. &amp; Clusters Figure 58A and Figure 58B are human anatomy diagrams and conceptual diagrams depicting the incoming communication of neurotransmissions between brains and months. Fig. 59Α and Fig. 59Β are the solutions of human arterial and venous vascular structures respectively [Main component symbol description] 223

Claims (1)

201223577 VII. Patent application scope: 1. A cryotherapy device comprising: an elongated shaft having the 1^°卩, which is configured to be a sacral end in a blood vessel. P bifurcation is located in the renal artery or renal stenosis or otherwise adjacent to the treatment site of the renal artery or renal ostium; a supply lumen to the φ _ \ / ~ 4 points along the axis, the supply lumen. a state to receive a liquid refrigerant; a cooling assembly at the distal end portion, the cooling assembly having a delivery state and a deployment state, the t-cooling assembly includes an orifice and a formulation including a definition An applicator for the application balloon of the chamber, the orifice being in communication with the supply lumen/M body, the application balloon having a heat transfer portion in fluid communication with the orifice, wherein the applicator is configured to In the deployed state, the cooling assembly receives therapeutically effective low temperature renal nerve regulation; and an occlusive component spaced apart from the vicinity of the application n, the occlusive component having a contracted state and an expanded state, The occlusion member has a cross-sectional dimension configured to completely occlude the renal artery and/or renal orifice adjacent the treatment site in the expanded state. 2. The cryotherapy device of claim 3, wherein the occluding component comprises a occlusion balloon, and the occlusion balloon is fluidly coupled to the occlusion cavity of the application chamber. 3. The cryotherapy device of claim 2, further comprising - a discharge passage along at least a portion of the shaft, wherein the occlusion chamber is fluidly coupled to the discharge passage. 4. The cryotherapy device of claim 2, wherein the application 224 201223577 ^ cavity has a first refrigerant residence time in the deployed state, wherein the closed base cavity has a first state in the expanded state The second refrigerant residence time, and wherein - the first refrigerant retention time is less than the second refrigerant retention time. 5. The cryotherapy device of claim 2, further comprising a filling lumen along at least a portion of the shaft, wherein the filling lumen is fluidly coupled to the occlusion cavity, and wherein the occluding cavity and the supply The lumen fluid is separated. 6. The cryotherapy device of claim 1, wherein the occlusion is operative and configured to completely occlude a renal artery or a renal orifice having a different diameter in the expanded state. 7. The cryotherapy device of claim 3, wherein the occlusion element comprises an occlusion balloon and the occlusion balloon is substantially compliant. 8. The cryotherapy device of claim 2, further comprising a handle having a proximal portion at the handle, wherein the shaft includes a control lumen and a lumen within the control lumen An elongated control member, and wherein the control member is operatively coupled to the distal portion and the handle such that increasing or decreasing tension of the control member controls deflection of at least one section of the distal portion away from the occluding member . 9. The cryotherapy device of claim 2, wherein the applicator has a cross-sectional dimension of the applicator that is smaller than a cross-sectional dimension of the occluding member in the expanded state in the deployed state such that The applicator does not completely occlude the renal artery and/or glomerular σ 该 at the treatment site in the sputum deployment state. 10. The cryotherapy device of claim 1 wherein the sputum 225 201223577 assembly includes a An elongated support member 'and wherein the applicator chamber includes a spiral balloon wrapped around at least a portion of the branch member. 11. The cryotherapy device of claim 1, wherein: the cooling assembly has a length, the application balloon having a plurality of concave portions and a surrounding concave portion in the deployed state The shape of the non-recessed region, the non-recessed region at least partially defining the heat transfer portion, and the heat transfer portion being non-circular at a longitudinal segment along the length. 12. The cryotherapy device of claim 5, wherein the application balloon is substantially cylindrical in shape in the deployed state. 13. The cryotherapy device of claim 2, wherein: the cooling assembly has a length, the dispensing balloon has, in the deployed state, a plurality of protrusions and a plurality of protrusions surrounding the plurality of protrusions The shape of the raised region, the plurality of protrusions at least partially defining the heat transfer portion; and the heat transfer portion being non-circular at a longitudinal segment along the length. 14. The cryotherapy device of claim 1 of the patent scope, wherein: The dispensing balloon includes a non-circular portion and a connecting portion, the connecting portion being coupled to the support member, The non-circular portion is in the deployed state, the non-circular portion at least partially defining the heat transfer portion along the length 226 201223577 分范第一第一_, wherein: a first connection portion, the non-circumferential portion is - the application balloon includes a first non-circumferential portion, an estimated second connection portion connected to the support member, the application balloon includes a a second non-circumferential portion, between the beta deployment 8 and the support member p, the first non-circumferential portion, the file is at the first connection portion and the second connection portion 4 the second non-circumferential portion Between the parts, and about the 迕 迕 忒 忒 忒 忒 忒 忒 ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; The circumferential portion is to the heat transfer portion. 16. If the cryotherapy device of claim 14 is applied to the patent, the Xerox oxygen ball is a “first” application balloon, the connecting portion is a first connecting portion, and the non-circular portion of the The knife is a first non-circumferential portion, and the applicator is white-opened by the first-to-shoulder along the length and the longitudinal direction of the first application balloon-- Xerox balloon, the second application balloon part, the abdomen a first circumferential portion and a second first connecting portion are connected to the supporting member, and the second non-circular portion of the second portion is longitudinally spaced apart from the supporting portion 227 201223577 in the deployed state, and the first non-circumferential The portion and the second non-circular portion define, at least in part, the heat transfer portion. The invention relates to a cryotherapy device according to the scope of the patent application, wherein: the cooling assembly has a length, the Xuan application balloon has a spiral concave portion and a spiral non-recessed portion, the spiral non-recessed portion The portion of the heat transfer portion is at least partially defined, and the heat transfer portion is non-circular at a longitudinal segment along the length. 18. The cryotherapy device of claim 1, wherein: the application balloon is elongated and has a length, a proximal portion of the application balloon along one of the lengths, a beginning device + a middle portion of the Xerox ball And a distal portion of the application balloon, the application balloon being curved along the length such that the application balloon has, in the deployed state, a first wall portion having a substantially concave curvature along the length and having: a second wall portion of the length that is substantially non-concavely curved, the middle portion of the "Xuan application pill ball is configured to contact the kidney substantially along the mth portion and substantially not along the first wall portion in the deployed state An arterial and/or renal orifice, the second wall portion at the intermediate portion of the application balloon at least partially defines the heat transfer portion; and the heat transfer portion is non-circular at a longitudinal segment along the length. 19. The cryotherapy device of claim 18, wherein the S 228 201223577 - the wall portion has a first thickness, and wherein the second wall portion has a second thickness that is less than the first thickness. 2. The cryotherapy device of claim 2, wherein: the sputum application balloon is elongated and has a length, and the cooling assembly comprises at least a portion of the length of the _ ώ: 1 ^ /α s hai a molded part having a substantially linear configuration in the delivery state and having a curve configuration in the deployed state, and/the application balloon having an at least partially corresponding portion of the curve set in the deployed state The shape of the state. # 21. The cryotherapy device of claim 2, wherein the shape of the Schole balloon in the deployed state is substantially helical. The cryotherapy device of claim 20, wherein the application balloon has a substantially serpentine shape in the deployed state. 23. The cryotherapy device of claim 1, wherein: the cooling assembly has a length, the device includes an elongated shaped portion ball longitudinally movable relative to the axis, the application balloon having oxygen along the length The proximal portion of the ball, the intermediate portion of the balloon, and the distal portion of the first balloon - the applicator includes - a second balloon proximal portion, a second balloon intermediate portion, and a second balloon distal portion along the length a distal portion of the elongated balloon and a portion of the first end of the balloon 229 201223577 == such that the first milk ball is bent along the length f and the intermediate portion of the second balloon and the second balloon are laterally moved away from the molded part by shrinking the molded part relative to the axis, 3° knife a balloon intermediate portion having a first outer side, the first deployed state having a substantially non-concave curvature along the length, the second balloon intermediate portion having a second outer side, the second outer side being disposed in the deployed state The length has a substantially non-concave curvature, the edge-outer side and the second outside portion at least partially defining the heat transfer, and the heat transfer portion is non-circular at a longitudinal segment along the length. 24. A method for treating a patient, the method comprising: positioning an applicator of a cooling assembly of a cryotherapy device in a blood s at a treatment site adjacent to a renal artery or a renal orifice, wherein the administering The device is at a distal end portion of an elongated shaft; the longitudinal portion of the treatment site is cooled by a heat transfer portion of the applicator by converting the liquid refrigerant into a gaseous refrigerant in the cooling system At least one non-circumferential portion, and thereby producing a therapeutically effective low temperature renal neuromodulation; and expanding an occlusive component at one of the renal artery and/or the renal ostia to reduce blood flow through the treatment site, wherein The treatment site is remote from the occlusion site. 25. The method of claim 24, wherein expanding the occluding member comprises occluding one of the occluding members with a balloon filled with a gaseous refrigerant. The method of claim 24, wherein expanding the occluding member 201223577 comprises passively filling one of the occluding members with a balloon to passively fill the gaseous refrigerant. 27. The method of claim 24, wherein expanding the occluding member comprises introducing a filling material into the occluding cavity of one of the occluding members via filling the lumen along one of the at least one portion of the shaft. 28. The method of claim 24, wherein the occluding the occluding member comprises expanding the occluding member from a contracted state to an expanded state, the occluding member having about 4 mm and about 1 in the expanded state. A diameter between 〇mm. 2. The method of claim 24, wherein the occluding component comprises a compliant balloon and expanding the occluding component comprises expanding the compliant balloon to an inner wall substantially conforming to the renal artery or renal ostium. The method of claim 24, wherein the non-circumferential portion is a -th-non-circumferential portion and the method further comprises repositioning the heat transfer portion to cool the longitudinal portion of the treatment site - the second non- The circumferential portion, and thus the therapeutically effective low temperature renal neuromodulation. 31. The method of claim 24, wherein the applicator has a delivery state and a deployed state and is configured to not completely occlude the renal artery and/or the renal orifice in the deployed state. Section size. 32. The method of claim 24, wherein the occluding member (4) is attached prior to the at least one non-circular portion. Eight, schema: (such as the next page) 231