TWI513451B - 用於神經調節治療之估算及反饋的裝置、系統及方法 - Google Patents

用於神經調節治療之估算及反饋的裝置、系統及方法 Download PDF

Info

Publication number
TWI513451B
TWI513451B TW100138604A TW100138604A TWI513451B TW I513451 B TWI513451 B TW I513451B TW 100138604 A TW100138604 A TW 100138604A TW 100138604 A TW100138604 A TW 100138604A TW I513451 B TWI513451 B TW I513451B
Authority
TW
Taiwan
Prior art keywords
treatment
impedance
temperature
renal
predetermined
Prior art date
Application number
TW100138604A
Other languages
English (en)
Other versions
TW201221114A (en
Inventor
Sowmya Ballakur
Robert J Beetel
Paul Friedrichs
David Herzfeld
Andrew Wu
Denise Zarins
Mark Leung
Original Assignee
Medtronic Ardian Luxembourg
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Medtronic Ardian Luxembourg filed Critical Medtronic Ardian Luxembourg
Publication of TW201221114A publication Critical patent/TW201221114A/zh
Application granted granted Critical
Publication of TWI513451B publication Critical patent/TWI513451B/zh

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/08—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by means of electrically-heated probes
    • A61B18/10—Power sources therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/1206—Generators therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1492—Probes or electrodes therefor having a flexible, catheter-like structure, e.g. for heart ablation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F7/00—Heating or cooling appliances for medical or therapeutic treatment of the human body
    • A61F7/12—Devices for heating or cooling internal body cavities
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00017—Electrical control of surgical instruments
    • A61B2017/00022—Sensing or detecting at the treatment site
    • A61B2017/00075—Motion
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00345—Vascular system
    • A61B2018/00404—Blood vessels other than those in or around the heart
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00434—Neural system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00505—Urinary tract
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00505—Urinary tract
    • A61B2018/00511—Kidney
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00577—Ablation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00642—Sensing and controlling the application of energy with feedback, i.e. closed loop control
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00642—Sensing and controlling the application of energy with feedback, i.e. closed loop control
    • A61B2018/00648—Sensing and controlling the application of energy with feedback, i.e. closed loop control using more than one sensed parameter
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00666—Sensing and controlling the application of energy using a threshold value
    • A61B2018/00672—Sensing and controlling the application of energy using a threshold value lower
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00666—Sensing and controlling the application of energy using a threshold value
    • A61B2018/00678—Sensing and controlling the application of energy using a threshold value upper
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00696—Controlled or regulated parameters
    • A61B2018/00702—Power or energy
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00696—Controlled or regulated parameters
    • A61B2018/00761—Duration
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00773—Sensed parameters
    • A61B2018/00791—Temperature
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00773—Sensed parameters
    • A61B2018/00791—Temperature
    • A61B2018/00797—Temperature measured by multiple temperature sensors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00773—Sensed parameters
    • A61B2018/00791—Temperature
    • A61B2018/00815—Temperature measured by a thermistor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00773—Sensed parameters
    • A61B2018/00791—Temperature
    • A61B2018/00821—Temperature measured by a thermocouple
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00773—Sensed parameters
    • A61B2018/00863—Fluid flow
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00773—Sensed parameters
    • A61B2018/00875—Resistance or impedance
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F7/00—Heating or cooling appliances for medical or therapeutic treatment of the human body
    • A61F2007/0093—Heating or cooling appliances for medical or therapeutic treatment of the human body programmed
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F7/00—Heating or cooling appliances for medical or therapeutic treatment of the human body
    • A61F7/12—Devices for heating or cooling internal body cavities
    • A61F2007/126—Devices for heating or cooling internal body cavities for invasive application, e.g. for introducing into blood vessels

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Surgery (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Biomedical Technology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Physics & Mathematics (AREA)
  • Plasma & Fusion (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Otolaryngology (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Cardiology (AREA)
  • Vascular Medicine (AREA)
  • Thermal Sciences (AREA)
  • Surgical Instruments (AREA)

Description

用於神經調節治療之估算及反饋的裝置、系統及方法 【相關申請案之交叉引用】
本申請案主張以下申請中之申請案的權益：(a)美國臨時申請案第61/406,531號，申請於2010年10月25日；(b)美國臨時申請案第61/528,108號，申請於2011年8月26日；(c)美國臨時申請案第61/528,091號，申請於2011年8月26日；及(d)美國臨時申請案第61/528,684號，申請於2011年8月29日。
所有以上申請案均以全文引用的方式併入本文中。另外，以引用的方式併入本文中之申請案中所揭示之實施例的組分及特徵可與本申請案中揭示及主張之各種組分及特徵組合。
本發明係關於神經調節治療，且更特定言之係關於用於向提供神經調節治療之裝置的操作者提供估算及反饋的裝置、系統及方法。
交感神經系統(SNS)為通常與壓迫反應相關之主要非自主身體控制系統。SNS之纖維神經支配人類身體幾乎每一器官系統中之組織且可影響諸如瞳孔直徑、腸動力及尿排出量之特徵。該調節作用可適用於維持動態平衡或為身體對環境因素作出快速反應做好準備。然而，SNS之慢性活化為一種常見的不適反應，其可驅使許多疾病病況發展。尤其已在實驗上且在人類中確定腎SNS過度活化可能導致高血壓、容量負荷過重狀態(諸如心臟衰竭)及進行性腎病之複雜病理生理學。舉例而言，放射性示蹤劑稀釋已表明原發性高血壓患者體內腎臟去甲腎上腺素(NE)溢出率增加。
心-腎交感神經亢進在心臟衰竭患者體內尤為顯著。舉例而言，在該等患者體內常可見自心臟及腎臟至血漿之NE溢出加重。增強之SNS活化通常為慢性及晚期腎病之特徵。在晚期腎病患者中，已表明高於中值之NE血漿含量預示心血管疾病且為死亡之若干原因。對於糖尿病或造影劑腎病變患者而言亦為如此。有證據表明，源自病變腎臟之感覺傳入信號為引發及維持高中樞交感神經流出的主要因素。
神經支配腎臟之交感神經終止於血管、近腎小球器及腎小管中。刺激腎交感神經可導致腎素釋放增加、鈉(Na+ )再吸收增加及腎血流量減少。腎功能之該等神經調節組分在特徵為交感神經張力升高之疾病病況中大大受刺激，且可能導致高血壓患者之血壓增加。腎血流量及腎小球濾過率由於腎交感神經傳出刺激而減少可能成為心-腎症候群中腎功能喪失(亦即作為慢性心臟衰竭之進行性併發症的腎功能障礙)之基礎。阻止腎傳出交感神經刺激後果之藥理學策略包括作用於中樞神經之抑交感神經作用藥物、β阻斷劑(欲減少腎素釋放)、血管收縮素轉化酶抑制劑及受體阻斷劑(欲阻斷由腎素釋放所引起之血管收縮素II作用及醛固酮活化)以及利尿劑(欲對抗腎交感神經介導之鈉及水滯留)。然而，該等藥理學策略具有顯著侷限性，包括功效有限、適應性問題、副作用及其他限制。因此，公共衛生強烈需要替代性治療策略。
本發明之技術一般關於用於為執行程序(諸如電及/或熱誘導之腎神經調節(亦即致使神經支配腎臟之神經纖維為惰性或失活或以其他方式使其功能完全或部分減少))之臨床醫師或其他從業者提供適用估算及反饋的裝置、系統及方法。舉例而言，在一實施例中，反饋涉及完全治療，且尤其涉及對治療在技術上成功之可能性的評估。在某些實施例中，可基於定義之標準來分析在治療過程期間監測之一或多個參數(諸如與溫度、阻抗、血管收縮、心跳速率、血流量及/或患者運動相關之參數)。基於該分析，可為操作者指示基於治療技術成功可能性之治療可接受性或缺乏可接受性。
在其他實施例中，可為操作者提供關於無法完成之治療(諸如由於與超過預定及/或計算臨限值之溫度或阻抗相關之監測值或經測定超出預定及/或計算範圍之值而中斷之程序)的反饋及/或指令。在該等實施例中，可基於定義之標準來分析在不完全治療過程期間監測之一或多個參數(諸如與溫度、阻抗及/或患者運動相關之參數)。基於該分析，可為操作者提供其他指令或反饋，諸如是否應對治療部位成像以評估治療裝置是否無意中移動，或是否可進行其他治療嘗試等。
下文參考圖1至14B描述本技術若干實施例之具體細節。儘管下文描述關於用以估算神經調節治療之裝置、系統及方法的諸多實施例，但除本文所述以外之其他應用及其他實施例亦在本技術之範疇內。另外，本技術之若干其他實施例可具有與本文所述不同之組態、組分或程序。因此，一般技術者將相應瞭解本技術可具有含其他要素之其他實施例，或本技術可具有無下文參考圖1至14B所示及所述之若干特徵的其他實施例。
術語「遠端」及「近端」在下文描述中係關於相對於治療臨床醫師之位置或方向使用。「遠端」為遠離臨床醫師或在遠離臨床醫師方向上之位置。「近端」為靠近臨床醫師或在朝向臨床醫師方向上之位置。
I.腎神經調節
腎神經調節使神經支配腎臟之神經部分或完全喪失能力或以其他方式進行有效破壞。特定而言，腎神經調節包含抑制、減少及/或阻斷沿神經支配腎臟之神經纖維(亦即傳出及/或傳入神經纖維)的神經通信。喪失能力可為長期(例如永久性或歷時數月、數年或數十年之時間)或短期的(例如歷時數分鐘、數小時、數天或數週之時間)。預期腎神經調節可有效治療特徵為總體交感神經活性增加之若干臨床病狀，且尤其為與經刺激之中樞交感神經相關聯之病狀，諸如高血壓、心臟衰竭、急性心肌梗塞、代謝症候群、胰島素抗性、糖尿病、左心室肥大、慢性及晚期腎病、心臟衰竭中之不當體液滯留、心-腎症候群及猝死。傳入神經信號減少會導致交感神經張力/傳動全身性減少，且預期腎神經調節適用於治療與全身性交感神過度活性或亢進相關聯之若干病狀。腎神經調節可潛在地有益於受交感神經神經支配之各種器官及身體結構。舉例而言，中樞交感神經傳動減少可降低折磨代謝症候群及II型糖尿病患者之胰島素抗性。另外，骨質疏鬆症可由交感神經活化且可得益於伴隨腎神經調節之交感神經傳動下調。下文第IV部分中提供相關患者解剖學及生理學之更詳細描述。
可使用各種技術使神經路徑(諸如神經支配腎臟之神經路徑)部分或完全喪失能力。能量(例如電能、熱能)藉由能量傳遞元件有目的地應用於組織可誘發腎動脈局部區域及腎叢RP相鄰區域(緊密地位於腎動脈外膜內或與其相鄰)上的一或多種所要熱加熱效應。有目的地應用熱加熱效應可沿整個腎叢RP或其一部分達成神經調節作用。
熱加熱效應可包括熱消融與非消融熱改變或損壞兩者(例如經由持續加熱及/或電阻加熱)。所要熱加熱效應可包括將目標神經纖維之溫度升高至所要臨限值以上以達成非消融熱改變，或升高至更高溫度以上以達成消融熱改變。舉例而言，對於非消融熱改變而言目標溫度可高於體溫(例如約37℃)但小於約45℃，或對於消融熱改變而言目標溫度可為約45℃或更高。
更特定而言，暴露於超過約37℃體溫但低於約45℃溫度之熱能(熱)可經由適度加熱目標神經纖維或灌注目標纖維之血管結構而誘發熱改變。在血管結構受影響之情況下，目標神經纖維拒絕灌注，導致神經組織壞死。舉例而言，此可誘發纖維或結構之非消融熱改變。暴露於高於約45℃溫度或高於約60℃之熱可經由實質上加熱纖維或結構而誘發熱改變。舉例而言，該等較高溫度可熱消融目標神經纖維或血管結構。在某些患者中，可能需要達到使目標神經纖維或血管結構熱消融、但小於約90℃或小於約85℃或小於約80℃及/或小於約75℃之溫度。無論用以誘發熱神經調節之熱暴露類型如何，均希望腎交感神經活性(「RSNA」)減小。下文第IV部分中提供相關患者解剖學及生理學之更詳細描述。
II.腎神經調節之系統及方法
圖1說明根據本發明技術之一實施例組態之腎神經調節系統10(「系統10」)。系統10包括可操作地耦接至能源或能量產生器26之血管內治療裝置12。在圖1所示之實施例中，治療裝置12(例如導管)包括一細長軸16，該細長軸16具有一近端部分18、一位於近端部分18之近端區域的手柄總成34及一相對於近端部分18向遠端延伸之遠端部分20。治療裝置12進一步包括一治療總成或治療區22，其包括一位於軸16之遠端部分20處或靠近其之能量傳遞元件24(例如電極)。在所說明之實施例中，第二能量傳遞元件24以虛線說明以表明本文所揭示之系統及方法可與具有一或多個能量傳遞元件24之治療裝置一起使用。另外，將瞭解儘管僅展示兩個能量傳遞元件24，但治療裝置12可包括其他能量傳遞元件24。
能量產生器26(例如RF能量產生器)經組態以產生所選形式及量值之能量，經由能量傳遞元件24傳遞至目標治療部位。能量產生器26可經由電纜28電耦接至治療裝置12。至少一根電源線(未展示)沿細長軸16或通過細長軸16中之內腔至能量傳遞元件24且輸送治療能量至能量傳遞元件24。控制機構(諸如腳踏板32)可連接(氣動連接或電連接)至能量產生器26以使得操作者可起始、終止及視情況調整能量產生器之各種操作特徵，包括(但不限於)功率傳遞。能量產生器26可經組態以經由自動控制演算法30及/或在臨床醫師控制下傳遞治療能量。另外，可對系統10之處理器執行一或多種估算/反饋演算法31。該等估算/反饋演算法31在結合治療操作執行時可諸如經由與系統10相關聯之顯示器33為系統10之使用者提供反饋。反饋或估算可使系統10之操作者能確定給定治療之成功性及/或估算可能失敗條件。因此，該反饋可用於幫助操作者學習在進行治療時如何增加成功可能性。下文參考圖3至10B描述關於適合控制演算法30及估算/反饋演算法31的其他詳情。
在某些實施例中，系統10可經組態以經由能量傳遞元件24提供單極電場傳遞。在該等實施例中，中性或分散電極38可電連接至能量產生器26且附接至患者外部(如圖2中所示)。另外，一或多個感應器(未展示)，諸如一或多個溫度(例如熱電偶、熱敏電阻等)、阻抗、壓力、光學、流量、化學或其他感應器，可位於接近能量傳遞元件24處或其內部且連接至一或多根電源線(未展示)。舉例而言，總計可包括兩根電源線，其中兩根線均可自感應器輸送信號，且一根線可用於達成雙重目的且亦可將能量傳送至能量傳遞元件24。或者，兩根線均可將能量輸送至能量傳遞元件24。
在包括多個能量傳遞元件24之實施例中，能量傳遞元件24可獨立地同時、選擇性或相繼傳遞功率(亦即可以單極方式使用)，及/或可在任何所要元件組合之間傳遞功率(亦即可以雙極方式使用)。此外，必要時，視情況可允許臨床醫師選擇使用何種能量傳遞元件24進行功率傳遞以在腎動脈內形成高度定製之損害。
在上面實施系統10之計算裝置可包括中央處理器、記憶體、輸入裝置(例如鍵盤及指向裝置)、輸出裝置(例如顯示裝置)及儲存裝置(例如磁碟機)。輸出裝置可經組態以與治療裝置12通信(例如經由電纜28)，從而控制到達能量傳遞元件24之功率及/或自能量傳遞元件24或任何相關聯之感應器獲得信號。顯示裝置可經組態以提供關於功率位準或感應器資料之指示(諸如音訊、視覺或其他指示)，或可經組態以將資訊傳達至另一裝置。
記憶體及儲存裝置為可由實施目標權限實施系統之電腦可執行指令編碼之電腦可讀媒體，其意謂含有該等指令之電腦可讀媒體。另外，指令、資料結構及訊息結構可經儲存或經由資料輸送媒體(諸如通信鏈路上之信號)輸送且可經加密。可使用各種通信鏈路，諸如網際網路、局域網路、廣域網路、點對點撥號連接、行動電話網路等等。
系統10之實施例可在各種操作環境中實施及使用，包括個人電腦、伺服電腦、手持型或膝上型裝置、多處理器系統、基於微處理器之系統、可程式化消費型電子產品、數位攝影機、網路PC、小型電腦、大型電腦、包括任何以上系統或裝置之計算環境等。
系統10可描述於由一或多個電腦或其他裝置執行之電腦可執行指令(諸如程式模組)的一般背景下。程式模組一般包括執行特定任務或實施特定抽象資料類型之常式、程式、對象、組件、資料結構等。程式模組之功能在各種實施例中視需要通常可組合或分配。
圖2(且參考圖12)說明用系統10之一實施例調節腎神經。治療裝置12經由血管內路徑進入腎叢RP，諸如自股(如說明)、臂、橈或腋動脈中之經皮進入部位至各自腎動脈RA內之目標治療部位。如所說明，軸16之近端部分18之一部分暴露於患者外部。藉由自血管內路徑外部操縱軸16之近端部分18(例如經由手柄總成34)，臨床醫師可使軸16經由有時彎曲之血管內路徑前進且遠端操縱或致動軸遠端部分20。影像引導，例如電腦斷層攝影(CT)、螢光透視、血管內超音波(IVUS)、光學相干斷層攝影(OCT)或另一適合引導模態或其組合可用以幫助臨床醫師進行操縱。另外，在某些實施例中，影像引導組件(例如IVUS、OCT)可併入治療裝置12本身中。一旦在各自腎動脈內，能量傳遞元件24與組織之間接近、對準及接觸，則藉由能量傳遞元件24將來自能量產生器26之能量有目的地應用於組織將在腎動脈之局部區域及腎叢RP之相鄰區域(緊密地位於腎動脈外膜內、與其相鄰或緊密接近)上誘發一或多種所要神經調節效應。有目的地應用能量可沿整個腎叢RP或其一部分達成神經調節作用。
神經調節效應一般至少部分地隨功率、時間、能量傳遞元件24與血管壁之間的接觸及流經血管之血流量而變化。神經調節效應可包括去神經支配、熱消融及非消融熱改變或損壞(例如經由持續加熱及/或電阻加熱)。所要熱加熱效應可包括將目標神經纖維之溫度升高至所要臨限值以上以達成非消融熱改變，或升高至更高溫度以上以達成消融熱改變。舉例而言，對於非消融熱改變而言目標溫度可高於體溫(例如約37℃)但小於約45℃，或對於消融熱改變而言目標溫度可為約45℃或更高。所要非熱神經調節效應可包括改變神經中輸送之電信號。
III.估算治療及反饋
A.綜述
在一實施例中，使用系統10投與之治療包括經由一或多個能量傳遞元件(例如電極)向腎動脈內壁傳遞能量，歷時預定時間量(例如120秒)。可對左及右腎動脈投與多次治療(例如4至6次)以達成所要覆蓋範圍。舉例而言，治療之技術目標可為將至少約3 mm深度之組織加熱至將損害神經之溫度(例如約65℃)。該程序之臨床目標為神經調節(例如損害)足夠數量之腎神經(交感神經腎叢之傳出或傳入神經)以使交感神經張力減少。若達成治療之技術目標(例如將約3 mm深度之組織加熱至約65℃)，則形成腎神經組織損害之機率高。技術上成功治療之次數愈多，調節足夠比例腎神經之機率愈大，因此臨床成功之機率愈大。
在整個治療期間，可存在多種狀態指示治療不成功之可能性。在某些實施例中，基於該等狀態之指示，可停止或修改系統10之操作。舉例而言，某些指示可導致能量傳遞中斷且諸如在顯示器33上可顯示適當訊息。可產生顯示訊息及/或導致治療方案中斷或修改的因素包括(但不限於)指示超出可接受或預期臨限值及/或可預定或計算之範圍的阻抗、血流量及/或溫度量測值或變化。訊息可指示諸如患者病狀類型(例如異常患者病狀)、超出可接受或預期臨限值之參數類型及/或值、對臨床醫師之建議動作的指示或能量傳遞已停止之指示的資訊。然而，若未觀察到非預期或異常量測值，可繼續根據程式化概況在目標部位處傳遞能量歷時指定持續時間，達成完全治療。在完全治療之後，停止能量傳遞且可顯示指示治療完成之訊息。
然而，可在不起始指示異常患者病狀之情況下完成治療，然而，可能發生改變(例如降低)技術上成功治療之機率的事件或事件組合。舉例而言，傳遞能量之電極可能移動或無意中置放在電極與腎動脈壁之間的不充分接觸處，藉此導致損害深度或溫度不足。因此，即使在未指示異常患者病狀之情形下完成治療，仍可能難以估算治療之技術成功性。同樣，在異常患者病狀之指示可由系統10報導的程度上，可能難以瞭解異常患者病狀之原因(諸如在預期範圍以外之溫度及/或阻抗值)。
如上文所述，可提供在系統10之基於處理器之組件(諸如與產生器26一起提供之一或多個組件)上執行的一或多種估算/反饋演算法31。在該等實施例中，該一或多種估算/反饋演算法31能夠為使用者提供有意義之反饋，此反饋可用於估算給定治療及/或可用於瞭解某些類型異常患者病狀之意義及如何減少該等病狀發生率。舉例而言，若特定參數(例如阻抗或溫度值)引起或指示治療未如預期進行且(在某些情況下)可導致技術上不成功之治療，則系統10可提供反饋(例如經由顯示器33)以警示臨床醫師。對臨床醫師之警示範圍可為對不成功治療之簡單通知至在後續治療中修改特定治療參數(例如治療期間之阻抗值、能量傳遞元件24在患者體內之置放等)的建議。系統10可因此自完全治療循環獲得知識且基於該知識修改後續治療參數以改良功效。該一或多種估算/反饋演算法31可考慮之量測值的非詳盡實例包括關於以下之量測值：指定時間內之溫度變化、最大溫度、最大平均溫度、最小溫度、在預定或計算時間相對於預定或計算溫度之溫度、指定時間內之平均溫度、最大血流量、最小血流量、在預定或計算時間相對於預定或計算血流量之血流量、隨時間之平均血流量、最大阻抗、最小阻抗、在預定或計算時間相對於預定或計算阻抗之阻抗、指定時間內之阻抗變化或指定時間內相對於溫度變化之阻抗變化。可在一或多個預定時間、時間範圍、計算時間及/或量測事件發生時或相對於其發生時之時間進行量測。將瞭解，以上清單僅提供大量不同量測值之實例，且可使用其他適合量測值。
B.控制所應用之能量
使用本文揭示之治療向目標組織傳遞療法，可有益於能量以控制方式傳遞至目標神經結構。控制之能量傳遞將使熱治療區能夠延伸至腎筋膜內，同時減少對血管壁之不利能量傳遞或熱效應。控制之能量傳遞亦可達成更一致、可預測且有效之總體治療。因此，產生器26理想地包括處理器，該處理器包括具有用於執行演算法30(參見圖1)之指令的記憶體組件以控制功率及能量傳遞至能量傳遞裝置。演算法30(其代表性實施例描繪於圖3中)可作為由耦接至產生器26之處理器執行之習知電腦程式來實施。使用逐步指令之臨床醫師亦可手動實施演算法30。
根據演算法監測之操作參數可包括例如溫度、時間、阻抗、功率、血流量、流動速度、體積流動速率、血壓、心跳速率等。溫度之離散值可用於觸發功率或能量傳遞之變化。舉例而言，高溫度值(例如85℃)可指示組織脫水，在此情形下演算法可減少或停止功率及能量傳遞以防止對目標或非目標組織之不良熱效應。或者或另外，可使用時間來防止對非目標組織之不良熱改變。對於每一治療而言，檢查設定時間(例如2分鐘)以防止不定之功率傳遞。
可使用阻抗來量測組織變化。阻抗指示治療部位之電特性。在熱誘發實施例中，當對治療部位施加電場時，隨著組織細胞對電流之電阻變小，阻抗將減小。若施加過多能量，則電極附近可能發生組織脫水或凝固，隨著細胞損失保水性及/或電極表面積減少(例如經由凝固物積聚)，將增加阻抗。因此，組織阻抗增加可指示或預示對目標或非目標組織之不良熱改變。在其他實施例中，可使用阻抗值來評估能量傳遞元件24與組織之接觸。對於多電極組態(例如當能量傳遞元件24包括兩個或兩個以上電極時)而言，個別電極阻抗值之間的相對小差異可指示與組織之接觸良好。對於單電極組態而言，穩定值可指示接觸良好。因此，來自該一或多個電極之阻抗資訊可提供給下游監測者，繼而可為臨床醫師提供關於與組織接觸之能量傳遞元件24之品質的指示。
或者或另外，功率為控制療法傳遞中之有效監測參數。功率為電壓與電流之函數。演算法30可修改電壓及/或電流以達成所要功率。
亦可使用前述參數之導數(例如變化速率)來觸發功率或能量傳遞之變化。舉例而言，可監測溫度之變化速率以使得在偵測到溫度突然升高之情況下減少功率輸出。同樣，可監測阻抗之變化速率以使得在偵測到阻抗突然升高之情況下減少功率輸出。
如圖3中可見，當臨床醫師起始治療(例如經由圖1中說明之腳踏板32)時，控制演算法30包括對產生器26之指令以在第一時間段t1 (例如15秒)內將其功率輸出逐漸調整至第一功率位準P1 (例如5瓦特(watt))。第一時間段期間之功率增加通常為線性的。因此，產生器26以P1 /t1 之一般恆定速率增加其功率輸出。或者，功率增加可為非線性的(例如呈指數或呈抛物線)，具有可變增加速率。一旦達到P1 及t1 ，則演算法可保持在P1 ，直至新時間t2 ，歷時預定時間段t2 -t1 (例如3秒)。在t2 ，功率在預定時間段t3 -t2 (例如1秒)內以預定增量(例如1瓦特)增加至P2 。預定時間段內約1瓦特之預定增量的此功率上升可持續，直至達到最大功率PMAX 或滿足某些其他條件。在一實施例中，PMAX 為8瓦特。在另一實施例中，PMAX 為10瓦特。視情況功率可維持在最大功率PMAX ，歷時所要時間段或長達所要總治療時間(例如長達約120秒)。
在圖3中，演算法30例示性地包括功率控制演算法。然而，應瞭解演算法30或者可包括溫度控制演算法。舉例而言，功率可逐漸增加，直至獲得所要溫度達所要持續時間。在另一實施例中，可提供功率控制與溫度控制演算法之組合。
如所論述，演算法30包括監測某些操作參數(例如溫度、時間、阻抗、功率、流動速度、體積流動速率、血壓、心跳速率等)。該等操作參數可連續或週期性地監測。演算法30針對預定參數概況檢查所監測參數以確定該等參數個別或組合是否在預定參數概況所設定之範圍內。若所監測參數在預定參數概況所設定之範圍內，則可以命令之功率輸出繼續治療。若所監測參數不在預定參數概況所設定之範圍內，則演算法30相應調整命令之功率輸出。舉例而言，若達到目標溫度(例如65℃)，則功率傳遞保持恆定，直至總治療時間(例如120秒)期滿。若達到或超過第一溫度臨限值(例如70℃)，則以預定增量(例如0.5瓦特、1.0瓦特等)減少功率，直至達到目標溫度。若達到或超過第二功率臨限值(例如85℃)，藉此指示不良病狀，則可終止功率傳遞。系統可裝配各種可聽及可視警報以警示某些病狀之操作者。
以下為演算法30可調整及/或終止/中斷命令之功率輸出之情況的非詳盡清單：
(1)所量測溫度超過最大溫度臨限值(例如約70℃至約85℃)。
(2)源自所量測溫度之平均溫度超過平均溫度臨限值(例如約65℃)。
(3)所量測溫度之變化速率超過變化速率臨限值。
(4)當產生器26具有非零輸出時，一定時間段內之溫度升高低於最小溫度變化臨限值。能量傳遞元件24與動脈壁之間之不良接觸可導致此類狀況。
(5)所量測阻抗超過或超出阻抗臨限值(例如<20歐姆(Ohm)或>500歐姆)。
(6)所量測阻抗超過相對臨限值(例如阻抗自起始或基線值減小，隨後升高至該基線值以上)。
(7)所量測功率超過功率臨限值(例如>8瓦特或>10瓦特)。
(8)所量測功率傳遞持續時間超過時間臨限值(例如>120秒)。
例如與電生理學治療中用以達成心臟組織消融之功率位準(例如大於約15瓦特、大於約30瓦特等之功率位準)相比，在根據本發明技術之腎神經調節治療期間傳遞之最大功率量值宜相對較低(例如小於約15瓦特、小於約10瓦特、小於約8瓦特等)。由於可使用相對低之功率位準來達成該腎神經調節作用，因此在功率傳遞期間將能量傳遞元件及/或非目標組織維持在所要溫度或所要溫度以下(例如在約50℃或50℃以下，例如或在約45℃或45℃以下)所需之血管內注射液的流動速率及/或總體積亦可相對低於例如在電生理學治療中使用之較高功率位準(例如高於約15瓦特之功率位準)下所要求之值。在使用主動冷卻之實施例中，血管內輸注液之流動速率及/或總體積之相對減少有利地促使在禁忌使用較高功率位準，因此相應較高輸液速率/體積之較高風險患者群組(例如患有心臟病、心臟衰竭、腎功能不全及/或糖尿病之患者)中使用血管內輸液。
C.治療之技術估算
圖4為根據本發明技術之一實施例組態之治療演算法80的方塊圖。演算法80經組態以估算治療中之事件、確定治療技術成功之機率及顯示訊息，由此為系統10(或另一適合治療系統)之操作者提供反饋。若確定治療具有次最佳技術成功之預定機率，則可顯示指示治療未如預期進行之訊息。替代實施例可將治療分類為若干範圍之成功機率，諸如1至5級之成功機率。類似地，在某些實施例中，演算法80可估算治療是否屬於高成功機率類、極低成功機率類或介於其間之某一類。
作為治療特徵且可由演算法80用於估算治療之變數包括(但不限於)：時間(亦即治療持續時間)、功率、溫度變化、最大溫度、平均溫度、血流量、溫度或阻抗之標準偏差、阻抗變化或該等或其他變數之組合。舉例而言，某些或所有該等變數可提供給演算法80作為治療資料82。在演算法80之該概括性描述中，治療資料80可基於標準84之不同分類或程度的級別或級數來評估。根據標準84之一對治療資料82進行有利評估可導致顯示(區塊86)指示治療可接受或成功之訊息。根據標準84發現治療資料82不可接受可導致治療資料進入下一估算標準84。
在所述實施例中，根據所有標準84發現治療資料均不可接受可導致執行其他估算，諸如所述之分析及計分步驟88。可估算分析及計分步驟之輸出(例如分值90)(區塊92)。基於該估算92，治療可認為可接受，且顯示相應螢幕(區塊86)；或不可接受，且顯示指示治療未如預期進行之螢幕94。在其他實施例中，演算法80可包括對治療未如預期進行之指示做出反應之自動行為(例如供應給能源之功率位準自動減少)。
圖4描繪治療估算演算法之概括性及簡單實施例，而圖5描繪治療估算演算法100之一實施例的更詳細實例。治療估算演算法100可在可耗時120秒(如所描繪)或某個其他適合之持續時間的完全治療(區塊102)之後且使用在治療過程期間產生之資料及/或量測值進行計算。
在所述實施例中，可能認為當電極與血管壁未緊密接觸時，出現小於理想治療之機率最大。因此，流程圖中之決策區塊104、106、108及110與不同標準相關，且基於在完全治療過程中觀測或量測之資料102，篩檢出似乎具有一或多個在預定範圍以外之標準(亦即不具有高成功機率)的彼等治療。在所述實施例中，在決策區塊104、106、108及110處未篩檢出之彼等治療進入線性判別分析(LDA)112以進一步估算治療。在其他實施例中，可進行其他適合之分析來替代所述LDA。分配給每一步驟之值(亦即由各自標準估算)及LDA中所用之係數114可由自若干治療收集之資料及/或自動物研究獲取之經驗得出。
在所述實施例中，第一決策區塊104藉由檢查在第一個15秒內之平均溫度變化是否大於14℃來估算對能量傳遞之初始溫度反應。在一實施例中，平均溫度係指在短時間量(例如3秒)內之平均值，其基本上濾除由脈動血流引起之高頻率大波動。如所瞭解，治療電極之溫度升高為自組織至電極之傳熱結果。若電極與血管壁未充分接觸，則能量傳遞至在其周圍流動之血液且電極溫度不會增加如此多。謹記此點，若第一個15秒內之平均溫度變化大於例如14℃，則該初始溫度反應可指示充分電極接觸、接觸力及/或血流速率(至少在治療開始時)，且若在剩餘治療中未遇到治療未如預期進行之指示，則不存在治療次最佳或技術上不成功之高機率。因此，決策區塊104處之肯定回答導致顯示「治療完成」訊息120。然而，若第一個15秒內之平均溫度變化小於或等於例如14℃，則該初始溫度反應可指示電極與血管壁未充分接觸。因此，決策區塊104處之否定回答導致進入標準106以進一步估算。
在決策區塊106處，藉由檢查最大平均溫度是否大於例如56℃來估算最熱溫度。無論持續時間如何，溫度升高至臨限值位準(例如56℃)以上均足以允許技術成功。因此，高於臨限值之溫度可足以指示成功損害形成，而不管決策區塊104處之初始溫度升高未指示充分接觸。舉例而言，電極初始時可未充分接觸，但隨後可至少接觸足以使血管壁發熱，使得電極內之溫度感應器讀數高於56℃的時間。決策區塊106處之肯定結果導致顯示「治療完成」訊息120。然而，決策區塊106處之否定結果指示最大平均溫度未充分升高。因此，演算法100進入決策區塊108以進一步估算。
在決策區塊108處，估算功率維持其最大量之時間段內的平均溫度(亦即自平均計算值減去上升期)。在一實施例中，該估算由確定45秒至120秒之時間段內，平均即時溫度是否大於53℃組成。以此方式，該標準進行檢查以確定溫度是否在某持續時間內高於臨限值。若決策區塊108作出肯定判別，則不管初始溫度反應及最大平均溫度不足以指示技術成功性(亦即決策區塊104及106失敗)，最後75秒內之平均溫度均指示充分接觸足夠時間。舉例而言，可能產生足夠損害，但由於血流自電極吸取高熱量，因此在電極中量測之最大平均溫度不大於56℃。因此，決策區塊108處之肯定結果導致顯示「治療完成」訊息120。然而，決策區塊108處之否定結果指示持續功率階段之平均即時溫度不足且演算法100進入決策區塊110以進一步估算治療。
在決策區塊110處，藉由檢查預定時間段(例如45秒至114秒)內之阻抗變化百分比是否大於初始阻抗之預定值(例如14%)來估算阻抗變化。初始阻抗測定為在治療開始後不久(例如6秒時)之阻抗以消除在此時間段之前阻抗量測值之可能錯讀(例如由於造影劑注射)。如所瞭解，組織對射頻(RF)電流之阻抗隨組織溫度增加而減小，直至組織充分加熱至導致其脫水，此時其阻抗開始上升。因此，組織阻抗減小可指示組織溫度上升。持續功率階段期間之即時阻抗變化百分比可如下計算：
若決策區塊110產生肯定判別，則不管先前三個決策區塊未展示溫度充分上升(亦即決策區塊104、106及108失敗)，阻抗變化均可指示組織經充分加熱，但電極中之溫度感應器未充分上升。舉例而言，即使組織經加熱，但極高血流量仍可導致電極溫度維持相對較低。因此，決策區塊110處之肯定結果導致顯示「治療完成」訊息120。然而，決策區塊110處之否定結果導致演算法100進入執行LDA 112。
在LDA 112處，連同每一事件之重要性等級估算事件組合。舉例而言，在所述實施例中，在決策區塊104、106、108、110處估算之標準均包括於LDA 112中。另外，在該實施例中，可包括三個其他標準：(1)平均溫度之標準偏差(其可提供關於由呼吸引起之滑動程度的指示)；(2)即時溫度之標準偏差(其可提供關於可變血流量及/或接觸力及/或間斷性接觸之指示)；及(3)治療結束時調整之平均阻抗變化(其可進一步表徵阻抗變化且提供關於組織溫度變化之指示)。若該分析確定變數之組合對減少技術成功性具有顯著影響(例如在決策區塊122處LDA分值<0)，則顯示「非預期治療」訊息124。否則，顯示「治療完成」訊息120。
應瞭解，上述各種參數僅為與演算法100之一實施例相關之代表性實例，且一或多個該等參數在其他實施例中可變化。此外，上文關於特定治療部分所述之特定值在其他實施例中可基於例如不同裝置組態、電極組態、治療方案等而修改/變化。
如上所述，演算法100經組態以估算治療且顯示指示治療完成或者治療未如預期進行之訊息。基於描述治療估算之訊息，臨床醫師(或使用自動化技術之系統)隨後可決定是否需要進一步治療及/或一或多個參數在後續治療中是否應修改。舉例而言，在上述實例中，演算法100可估算大量一般與電極與血管壁之間的不良接觸有關之情形以有助於確定治療是否次最佳。舉例而言，當電極隨患者呼吸及動脈移動而前後滑動時，當電極在患者移動時移位時，當無意中移動導管時，當導管未偏斜至使電極與血管壁之間充分接觸或有充足接觸力所需之程度時，及/或當電極置放於不穩定位置時，可發生不良接觸。此外，如上文所述，若特定參數或參數組可引起或導致次最佳治療時，系統10(圖1)可提供反饋以警示臨床醫師在後續治療期間修改一或多個治療參數。預期治療之該估算及反饋有助於臨床醫師學習改良其置放技術以獲得更佳接觸且降低技術上不成功治療之頻率。
D.與高溫條件相關之反饋
儘管前文描述治療技術成功性之概括性估算，但可用於系統10(圖1)操作者之另一種反饋形式為與患者或治療病狀之特定類型相關之反饋。舉例而言，系統10可產生與高溫條件相關之訊息。特定而言，在傳遞能量之治療期間，組織溫度可增加至特定位準以上。安置於電極中或其附近之溫度感應器(例如熱電偶、熱敏電阻等)提供關於電極中溫度之指示，且某種程度上提供關於組織溫度之指示。在能量傳遞至組織時電極不直接加熱。實際上，組織經加熱且熱量傳導至電極及電極中之溫度感應器。在一實施例中，若即時溫度上升至預定最大溫度(例如85℃)以上，則系統10可中斷能量傳遞。在此情形下，系統可產生指示高溫條件之訊息。然而，視情況而定，臨床醫師之不同動作可為適當的。
若組織過熱，則可超過建立之溫度臨限值。高組織溫度暗示可能動脈急劇收縮或動脈壁突起。此可在注意到出現高溫且產生訊息後即刻或短時間內(例如約50秒至約100秒)發生。在該情形下，可指令臨床醫師對治療部位成像以在起始另一治療之前注意收縮或突起。
圖6例如為說明根據本發明技術之一實施例用於在偵測到高溫條件時為操作者提供反饋之演算法150的方塊圖。在一實施例中，演算法150係回應於高溫條件(區塊152)而執行且估算(決策區塊154)來自治療之資料以確定該高溫條件涉及包括突發不穩定性之情形還是不涉及此情形。突發不穩定性可例如由患者或導管之突然移動引起，由此引起電極更猛烈地推至(亦即接觸力增加)血管壁中，亦可伴隨有移動至另一位置。在決策區塊154處未偵測到突發不穩定性之情形下，可顯示第一訊息(區塊156)，諸如偵測到高溫之指示及對治療部位成像以確定該部位是否受損之指令。在決策區塊154處偵測到突發不穩定性之情形下，可顯示另一訊息(區塊158)，除指示出現高溫及指令臨床醫師對治療部位成像以外，亦可指示電極可能自其原始部位移動。該反饋可提示臨床醫師比較先前影像且避免在原始部位或電極移至之部位再次治療。
E.與高阻抗相關之反饋
如同高溫一樣，在某些情況下系統10(圖1)可產生與出現高阻抗有關之訊息。如所瞭解，對自治療電極穿過身體至分散返回電極之RF電流的阻抗可提供關於與治療電極接觸之組織特徵的指示。舉例而言，安置於腎動脈血流中之電極可量測與接觸血管壁之電極相比較低之阻抗。此外，當組織溫度升高時，其阻抗減小。然而，若組織過熱，則其可脫水且其阻抗可增加。在逐漸加熱組織之治療期間，預期阻抗將減小。阻抗顯著升高可為諸如組織脫水或電極移動之不利情形的結果。在某些實施例中，若即時阻抗升高高於自起始阻抗之預定最大阻抗變化，則系統10可經組態以中斷能量傳遞。
圖7例如為說明根據本發明技術之一實施例用於在出現高阻抗條件時為操作者提供反饋之演算法170的方塊圖。在所述實施例中，演算法170估算來自治療之資料且確定偵測高阻抗事件(區塊172)是否可能涉及以下情形：(a)組織溫度高且可能脫水；(b)電極移動；或(c)電極與血管壁接觸不良或未接觸。演算法170估算資料以確定出現該三種情形中之哪一者(若出現)且相應顯示三種訊息174、176或178之一。
根據演算法170之一實施例，在偵測高阻抗(區塊172)時，估算治療期間之最大平均溫度(決策區塊180)。若該溫度在某臨限值以上(例如在60℃或60℃以上)，則高阻抗可歸因於導致脫水之高組織溫度。在此情形下，可顯示訊息174，指令臨床醫師檢查收縮或突起(亦即對治療部位成像)且避免在同一位置再次治療。相反，若溫度低於臨限值(例如低於60℃)，則演算法170進入決策區塊182。
在所述實施例中，在決策區塊182處，演算法170估算當功率相對較低時，在治療早期(例如在能量傳遞之最初20秒內)是否發生高阻抗事件。若是，則組織溫度不可能高，且更可能為電極初始時接觸不良或無接觸且隨後建立更佳接觸，導致阻抗跳變。在此情形下，可顯示訊息176，指令臨床醫師嘗試建立更佳接觸且在同一部位重複治療。然而，若該事件在治療稍後期(例如過去20秒以上)發生，則演算法170進入決策區塊184。
在決策區塊184處，演算法170估算在治療期間何時發生高阻抗事件。舉例而言，若該事件在預定時間段(例如45秒)之後發生，則當功率達到高位準時，演算法進入決策區塊186。然而，若該事件在功率上升且未處於其最高值時(在20秒與45秒之間)發生，則演算法進入決策區塊188。
在決策區塊186處，演算法170計算在高阻抗事件時與特定時間(例如45秒)之阻抗相比阻抗變化百分比(%ΔZ)。此為功率維持於高位準下之時間段。在一實施例中，阻抗變化百分比如下計算：
若ΔZ%大於或等於預定量(例如7%)，則組織可能由於高溫開始脫水。在此情形下，可顯示訊息174，指令臨床醫師檢查收縮或突起(亦即對治療部位成像)且避免在同一位置再次治療。否則，組織脫水不太可能且更可能為電極移動導致高阻抗事件。在此情形下，可顯示訊息178，告知臨床醫師電極可能已移動。在電極已移動或可能已移動之情形下，組織溫度不可能達到高位準。因此，預期若無其他位置或僅有限之其他位置進行另一治療，則可在同一位置進行治療。
在決策區塊188處，演算法170可確定是否出現突發不穩定性。若存在該不穩定性，則電極可能移動。在此情形下，可顯示訊息178，提示臨床醫師電極可能已移動。如上文論述，臨床醫師可小心謹慎且避免原始位置或電極移至之位置，或若無其他部位或僅有限數目之部位可用於進一步治療，則臨床醫師可選擇治療同一位置。否則，若未出現突發不穩定性，則更可能為電極接觸不良。在此情形下，可顯示訊息176，指令臨床醫師嘗試建立更佳接觸且治療同一部位係安全的。
使用替代量測值及計算，可達成偵測高阻抗條件之相同目標。舉例而言，在演算法170之另一實施例中，獲取樣品時間間隔(例如20秒)之溫度及阻抗資料。在較短時間間隔(例如每1.5秒)下，計算阻抗及溫度資料之標準偏差。某一間隔之第一標準溫度計算為溫度之標準偏差除以初始時間間隔下之溫度標準偏差。若阻抗量測值之標準偏差大於或等於預定值(例如10歐姆)且第一標準溫度大於預定臨限值(例如3)，則演算法170可顯示訊息176，指示電極接觸不良。然而，若阻抗量測值之標準偏差在可接受範圍以外，但第一標準溫度在可接受範圍以內，則將顯示訊息178以警示臨床醫師存在電極不穩定性。
根據演算法170之另一實施例，兩個或兩個以上電極24(例如安置於圖1之導管12之治療區22上)之阻抗各自可提供獨立之阻抗讀數。在將治療總成22傳遞至治療部位(例如腎動脈內)期間，電極24之阻抗讀數通常由於血管結構解剖學而不同，此係因為導管12將遵照最小電阻之路徑，常在血管結構彎曲處彎曲以僅接觸腎動脈之一個壁。
在某些實施例中，治療總成22一經定位用於治療，治療總成22即可向周圍擴張以接觸腎動脈壁區段之整個周圍表面。此擴張可使多個電極24與腎動脈壁接觸。隨著治療總成22擴張成治療組態且電極24與腎動脈壁之接觸增加，個別電極24之阻抗值可增加及/或接近同一值。在良好穩定接觸下，阻抗值之波動亦如上所述減小。能量產生器26可不斷或連續地監測個別阻抗值。隨後可比較該等值以確定何時建立有效接觸，作為成功治療之指示。在其他實施例中，可將阻抗之變動平均值與阻抗值之預定變化範圍相比較，設定有界限以引導穩定性量測。
F.與血管收縮相關之反饋
在其他實施例中，系統10可產生與發生血管收縮相關之訊息。特定而言，當傳遞治療時，血管可收縮至次最佳直徑。收縮之血管可導致血流量減少、治療部位溫度增加及血壓增加。可藉由對即時溫度資料之幅度(「包絡線」)取樣來量測血管收縮。可將現有包絡線與先前獲取之包絡線樣品(例如200 ms之前)相比較。若現有包絡線與先前時間點包絡線之差值小於預定值(例如小於-0.5℃，或換言之，目前包絡線值與先前時間點之包絡線值相比減小不足0.5度)，則在未來時間點獲取量測值(例如在5秒內)。若未來時間點與現有時間點之平均溫度差值大於給定溫度臨限值(例如大於1℃)，則演算法800可確定存在不利之高程度收縮，且可中斷/改變能量傳遞。在該情形下，系統10可產生指示高收縮條件之訊息。然而，視情況而定，臨床醫師之不同動作可為適當的。
圖8例如為說明根據本發明技術之一實施例用於在偵測到高度血管收縮時為操作者提供反饋之演算法800的方塊圖。在一實施例中，演算法800係回應於高收縮程度(例如血管收縮在某一直徑或某一直徑以下)(區塊802)而執行且估算(決策區塊804)來自治療之資料以確定高收縮程度涉及包括突發不穩定性之情形還是不涉及此情形。突發不穩定性之指示可指示電極24移動。
在決策區塊804處未偵測到突發不穩定性之情形下，可顯示第一訊息(區塊806)，諸如已偵測到高收縮程度之指示及讓臨床醫師減小治療功率之指令。在其他實施例中，能量位準可回應於所偵測之收縮程度自動改變。在決策區塊804處偵測到突發不穩定性之情形下，可顯示另一訊息(區塊808)，除指示出現高收縮程度及對臨床醫師之指令以外，亦可指示電極24可能自其原始部位移動。該反饋可提示臨床醫師改變或中斷治療。
G.與心臟因素相關之反饋
1.與異常心跳速率相關之反饋
如同上文提及之其他生理學條件，在某些情形下，系統10可產生與出現異常心跳速率相關之訊息。特定而言，當傳遞治療時，心跳速率可超出或低於有利條件(例如暫時程序性或慢性心動徐緩)。可藉由量測即時溫度及阻抗來確定瞬時心跳速率。更特定而言，可使用第二階Butterworth濾波器濾除例如0.5 Hz與2.5 Hz之間的即時溫度讀數。確定濾除信號之局部最大值。局部最大值為所偵測之即時溫度信號峰值。當信號峰值對應於心臟循環中之週期變化時，瞬時心率為峰值間之間隔。
在一實施例中，若心跳速率在所需範圍以外，則系統10可中斷/改變能量傳遞。在該情形下，系統可產生指示不利心跳速率條件之訊息。然而，視情況而定，臨床醫師之不同動作可為適當的。
圖9例如為說明根據本發明技術之一實施例用於在偵測到異常心跳速率條件時為操作者提供反饋/指令之演算法900的方塊圖。舉例而言，在一實施例中，演算法900可回應於異常心跳速率條件(例如高於或低於預定臨限值)而執行(區塊902)。在決策區塊904處，演算法900估算來自治療之資料以確定所偵測之異常心跳速率條件是否涉及包括突發不穩定性之情形。突發不穩定性之指示可指示電極移動。
在決策區塊904處未偵測到突發不穩定性之情形下，可對臨床醫師顯示第一訊息(區塊906)，諸如已偵測到異常心跳速率之指示及讓臨床醫師減小治療功率之指令。在其他實施例中，能量位準可回應於所偵測之不利心跳速率而自動改變。在決策區塊904處偵測到突發不穩定性之情形下，可顯示另一訊息(區塊908)，除指示發生異常心跳速率及對臨床醫師之指令以外，亦可指示電極可能自其原始部位移動。該反饋可提示臨床醫師改變或中斷治療。
2.與低血流量相關之反饋
系統10亦可經組態以產生與低血流量條件相關之訊息。舉例而言，若治療期間血流量降至某一位準以下(或若血管不利地狹窄)，則對流熱自電極24移除且組織表面減小。過高組織溫度可導致上述消極後果，諸如血栓形成、炭化、不可靠之損害尺寸等。自產生器26減少功率以防止組織達到不可接受之溫度可導致損害深度不足，且神經可能未加熱至足夠之消融溫度。可使用演算法來量測血流量或血流之熱損失。在一實施例中，可用置放於腎動脈中另一導管上或治療導管12上之流量計或都卜勒感應器(Doppler sensor)來量測血流量。在另一實施例中，可藉由傳遞能量(例如RF能量)使血液、組織或基質溫度上升來量測熱損失或熱衰減。能量可切斷且演算法可包括監測作為熱衰減之量度的溫度。快速熱衰減可表示血流量充足，而逐漸熱衰減可表示低血流量。舉例而言，在一實施例中，若即時溫度量測值相對於起始溫度之斜率超過預設臨限值(例如2.75)且平均溫度大於預設溫度(例如65℃)，則演算法910可指示低血流量。在其他實施例中，可藉由量測傳遞RF或電阻熱之電極的溫度振盪來表徵熱衰減及/或血流量。在給定溫度或功率傳遞幅度/量值下，狹窄之振盪範圍可指示相對低之熱衰減/血流量。
圖9B例如為說明根據本發明技術之一實施例在出現低血流量條件時為操作者提供反饋/指令之演算法910的方塊圖。在一實施例中，演算法910回應於所偵測之低血流量條件(例如流量低於預定臨限值)而執行(區塊912)。在區塊914處，演算法910估算來自治療之資料以確定低血流量條件是否涉及包括突發不穩定性之情形。在決策區塊914處未偵測到突發不穩定性之情形下，可顯示第一訊息(區塊916)，諸如已偵測到低血流量之指示及讓臨床醫師減小治療功率之指令。在偵測到突發不穩定性之情形下，可顯示另一訊息(區塊918)，除指示發生低血流量及對臨床醫師之指令以外，亦可指示電極可能自其原始部位移動。如上所述，該反饋可促使臨床醫師改變或中斷治療。
在其他實施例中，若血流量或熱衰減值低於典型或預定臨限值，則能量傳遞演算法910可包括自動改變治療或導管之一或多個條件或特徵以改良血流量。舉例而言，在一實施例中，演算法910可藉由提供至能量傳遞元件24之能量呈脈衝形式提供而非提供連續能量來回應於低血流量。此可使得較低血流量可更充足地自組織表面移除熱量，同時仍產生足夠深之損害以消融神經。
在另一實施例中，演算法910可包括藉由冷卻電極來回應於低血流量，如2011年4月26日申請之國際專利申請案第PCT/US2011/033491號及2010年8月30日申請之美國專利申請案第12/874,457號中進一步詳述。以上申請案以全文引用的方式併入本文中。
在另一實施例中，演算法910可藉由需要向該區域手動增加血流量來回應於低血流量。舉例而言，非阻塞性氣球可在腹主動脈中膨脹，藉此增加腎動脈中之壓力及流量。該氣球可併入治療導管或另一導管上。
H.反饋顯示
圖10A及10B為說明根據本發明技術之態樣組態之代表性產生器顯示螢幕的螢幕擷取畫面。圖10A例如為治療期間追蹤增強阻抗之顯示螢幕1100。顯示器1100包括在選定時間段(例如100秒)內即時追蹤阻抗量測值之圖形顯示1110。該圖形顯示1110例如可為以週期性間隔更新之動態、滾動顯示，為操作者提供阻抗量測值之瞬時及歷史追蹤。顯示1110亦可包括具有目前阻抗之阻抗顯示1120以及關於阻抗之標準偏差指示1122。在一實施例中，標準偏差指示1122經組態為當該值大於10時閃爍。此類指示可警示造影劑注射之操作者造影劑注射影響量測或電極可能不穩定。下文描述關於造影劑注射指示之其他資訊。
圖10B例如為具有用於操作者之額外資訊的另一代表性顯示螢幕1130。在該實例中，顯示螢幕1130經組態以警示造影劑注射之操作者且系統在開始之前正等待造影至清晰(例如停用RF約1至2秒，直至造影清晰)。在另一實施例中，顯示螢幕1130可經組態以提供其他警示訊息(例如「可能不穩定電極」等)。預期上述顯示螢幕1110及1130中提供之額外資訊可在RF開啟之前改良接觸評估，且改良治療效率及功效。
上文參考圖10A及10B描述之額外資訊可基於本文所述之演算法或其他適合演算法產生。舉例而言，在一實施例中，演算法可不斷檢查RF開啟之前時期的造影劑注射/穩定性。若電極穩定且歷時1秒無造影，則將基線阻抗Z設定為等於1秒內之平均阻抗Z。在一特定實例中，將即時阻抗與一秒窗口內之平均阻抗值的兩個標準偏差相比較。在另一特定實例中，可將即時阻抗與固定值相比較(例如確定標準偏差是否大於10)。在其他實例中，可使用其他配置。
若即時阻抗量測值在此範圍內，則不顯示訊息。然而，若即時阻抗不在平均值之兩個標準偏差內，則電極可能為不穩定的(亦即漂移、移動等)且可對使用者顯示上文參考圖10A及10B描述之一或兩種訊息(例如「等待造影至清晰」、「可能不穩定電極」)。舉例而言，對於造影劑注射偵測而言，除阻抗之標準偏差以外，演算法可經組態為將即時溫度量測值之標準偏差化為因子以尋求即時溫度偏移至起始體溫以下。溫度偏移截止點之精確值可變化。在一特定實例中，系統可經組態以使得若伴隨即時溫度下降，阻抗增加(例如標準偏差>10)，則系統將標示造影偵測事件，導致對操作者顯示「等待造影至清晰」訊息。然而在其他實例中，可使用其他演算法及/或範圍來確定造影劑注射事件及/或電極之穩定性。另外，在其他實施例中，系統可基於所偵測之條件修改/調整各種治療參數，而不對臨床醫師顯示該等訊息。
IV.相關解剖學及生理學
以下論述提供關於相關患者解剖學及生理學之其他詳情。此部分欲補充及擴展先前關於相關解剖學及生理學之論述，且提供關於與腎去神經支配相關之揭示技術及治療益處的額外內容。舉例而言，如前文所提及，腎血管結構之若干特性可告知用於經由血管內通道達成腎神經調節之治療裝置及相關方法的設計，且對該等裝置強加特定設計要求。特定設計要求可包括評估腎動脈、促使該等裝置之能量傳遞元件與腎動脈之管腔表面或壁之間穩定接觸及/或用神經調節裝置有效調節腎神經。
A.交感神經系統
交感神經系統(SNS)為除腸神經系統及副交感神經系統以外自主神經系統之分支。其在基礎水準下始終具有活性(稱作交感神經張力)，且在壓力時間期間更具活性。如同神經系統之其他部分，交感神經系統經由一系列相互連接之神經元運作。交感神經元常被認為係周邊神經系統(PNS)之一部分，儘管有許多在中樞神經系統(CNS)內。脊髓(其為CNS之一部分)之交感神經元經由一系列交感神經節與周邊交感神經元通信。在神經節內，脊髓交感神經元經由突觸接合周邊交感神經元。因此，脊髓交感神經元稱作突觸前(或節前)神經元，而周邊交感神經元稱作突觸後(或節後)神經元。
在交感神經節內之突觸處，節前交感神經元釋放乙醯膽鹼，其為一種結合且活化節後神經元上之菸鹼型乙醯膽鹼受體的化學信使。回應於此刺激，節後神經元主要釋放去甲腎上腺素(正腎上腺素)。長時期活化可引發自腎上腺髓質釋放腎上腺素。
一經釋放，去甲腎上腺素及腎上腺素即結合周邊組織上之腎上腺素激導性受體。結合於腎上腺素激導性受體會引起神經元及激素反應。生理學表現包括瞳孔放大、心跳速率增加、偶發性嘔吐及血壓增加。由於結合汗腺之膽鹼激導性受體，故亦可見發汗增加。
交感神經系統負責上調及下調活生物體內之多種自動調節機制。來自SNS之纖維神經支配幾乎每一器官系統中之組織，對諸如瞳孔直徑、腸動力及尿排出量之多種事物提供至少一些調節功能。此反應亦稱作身體之交感-腎上腺反應，因為在腎上腺髓質中終止之節前交感神經纖維(以及所有其他交感神經纖維)均分泌乙醯膽鹼，其活化腎上腺素之分泌，且在較小程度上活化去甲腎上腺素(正腎上腺素)之分泌。因此，主要作用於心血管系統之此反應經由經交感神經系統傳輸之脈衝直接介導，且經由自腎上腺髓質分泌之兒茶酚胺間接介導。
科學一般將SNS看作自主調節系統，亦即不受意識思維干預而運作之系統。一些進化理論家提出，交感神經系統在早期生物體中為維持存活而運作，因為交感神經系統負責激活身體行動。此激活作用之一實例為睡醒前之時刻，此時交感神經流出物自發增加以準備行動。
1.交感神經鏈
如圖11中所示，SNS提供可使大腦與身體通信之神經網路。交感神經源自脊柱內，朝向中間外側細胞柱(或側角)中脊髓中部，起始於脊髓之第一胸段且認為其延伸至第二或第三腰段。由於其細胞起始於脊髓之胸區及腰區，因此稱SNS具有胸腰部流出物。該等神經之軸突經由前部支根/根離開脊髓。其穿過脊柱(感應)神經節附近，由此處進入脊柱神經之前支。然而，與軀體神經支配不同，其經由連接至沿脊柱延伸之椎骨旁(其位於脊柱附近)或椎骨前(其位於主動脈分叉附近)神經節之白色分支連接體快速分出。
為到達目標器官及腺體，軸突將在體內穿行較長距離，且為達成此目的，許多軸突經由突觸傳輸將其訊息轉至第二細胞。軸突末端穿過一定空間將突觸連接至第二細胞之樹突。第一細胞(突觸前細胞)穿過突觸間隙傳送神經傳遞質，神經傳遞質在此處活化第二細胞(突觸後細胞)。隨後將訊息載運至最終目的地。
在周邊神經系統之SNS及其他組分中，在稱作神經節之位點處產生該等突觸。傳送其纖維之細胞稱作節前細胞，而纖維離開神經節之細胞稱作節後細胞。如前文所提及，SNS之節前細胞位於脊髓之第一胸(T1)段與第三腰(L3)段之間。節後細胞在神經節中具有其細胞體且將其軸突傳送至目標器官或腺體。
神經節不僅包括交感神經幹，而且亦包括頸部神經節(上部、中部及下部)(其將交感神經纖維傳送至頭部及胸部器官)及腹腔與腸系膜神經節(其將交感神經纖維傳送至腸)。
2.腎臟之神經支配
如圖12所示，腎臟由與腎動脈密切相關之腎叢RP神經支配。腎叢RP為包圍腎動脈且嵌埋於腎動脈外膜內之自主神經叢。腎叢RP沿腎動脈延伸，直至其到達腎臟本體。促成腎叢RP之纖維起於腹腔神經節、腸系膜上神經節、主動脈腎神經節及主動脈叢。腎叢RP(亦稱作腎神經)主要包含交感神經組分。不存在(或至少極小)腎臟之副交感神經神經支配作用。
節前神經元細胞體位於脊髓之中間外側細胞柱中。節前軸突穿過椎骨旁神經節(其不形成突觸)以成為較小內臟神經、最小內臟神經、第一腰部內臟神經、第二腰部內臟神經且行進至腹腔神經節、腸系膜上神經節及主動脈腎神經節。節後神經元細胞體離開腹腔神經節、上部腸系膜神經節及主動脈腎神經節至腎叢RP且分佈至腎血管結構。
3.腎交感神經神經活性
訊息以雙向流之形式穿過SNS。傳出訊息可同時觸發身體不同部分之變化。舉例而言，交感神經系統可加速心跳速率；加寬支氣管通道；減少大腸動力(運動)；收縮血管；增加食道蠕動；導致瞳孔放大、豎毛(雞皮疙瘩)及出汗(發汗)；及升高血壓。傳入訊息將來自體內各種器官及感覺受體之信號載運至其他器官，且尤其載運至大腦。
高血壓、心臟衰竭及慢性腎臟疾病為由SNS(尤其為腎交感神經系統)之慢性活化引起之多種疾病病況中的一些。SNS之慢性活化為驅使該等疾病病況發展的不適反應。腎素-血管收縮素-醛固酮系統(RAAS)之醫藥管理已長期存在，但某種程度上為降低SNS過度活性無效之方法。
如上文所提及，已在實驗上與人類中確認腎交感神經系統為高血壓、容量負荷過重狀態(諸如心臟衰竭)及進行性腎病之複雜病理生理學的主要原因。採用放射性示蹤劑稀釋方法以量測自腎臟至血漿之去甲腎上腺素溢出的研究表明原發性高血壓患者體內腎去甲腎上腺素(NE)溢出率增加，在年輕高血壓個體中尤為如此，與自心臟之NE溢出率增加相呼應，其與通常在早期高血壓中所見之血液動力學概況相一致且其特徵在於心跳速率、心臟輸出及腎血管抗性增加。現已知，原發性高血壓通常為神經性的，常伴有顯著之交感神經系統過度活性。
如由該患者群中自心臟及腎臟至血漿之NE溢出的過度增加所表明，心腎交感神經活性之活化在心臟衰竭中甚至更為顯著。與此觀點一致的是，近期在充血性心臟衰竭患者中證明腎交感神經活化對所有成因死亡及心臟移植之強負性預測值，其與總體交感神經活性、腎小球濾過率及左心室射血分數無關。該等發現支持以下觀點，即經設計用以減少腎交感神經刺激之治療方案具有提高心臟衰竭患者存活率之潛能。
慢性與晚期腎病之特徵在於交感神經活化增強。在晚期腎病患者中，已證明高於中值之去甲腎上腺素血漿含量預測所有成因之死亡及由心血管疾病引起之死亡。對於患有糖尿病或造影劑腎病變之患者而言亦為如此。有令人信服之證據表明，源自患病腎臟之感覺傳入信號為在該患者群中起始及維持高中樞交感神經流出量之主要因素；此促使慢性交感神經過度活性之熟知不利後果發生，諸如高血壓、左心室肥大、心室調律不整、心源性猝死、胰島素抗性、糖尿病及代謝症候群。
(i)腎交感神經傳出活性
腎臟之交感神經終止於血管、近腎小球器及腎小管中。刺激腎交感神經可導致腎素釋放增加、鈉(Na+ )再吸收增加及腎血流量減少。腎功能之該等神經調節組分在特徵為交感神經張力升高之疾病病況中大大受刺激，且可能導致高血壓患者之血壓增加。腎血流量及腎小球濾過率由於腎交感神經傳出刺激而減少可能成為心-腎症候群中腎功能喪失(亦即作為慢性心臟衰竭之進行性併發症的腎功能障礙，伴有通常隨患者臨床狀態及治療而波動之臨床過程)之基礎。阻止腎傳出交感神經刺激後果之藥理學策略包括作用於中樞神經之抑交感神經作用藥物、β阻斷劑(欲減少腎素釋放)、血管收縮素轉化酶抑制劑及受體阻斷劑(欲阻斷由腎素釋放所引起之血管收縮素II作用及醛固酮活化)以及利尿劑(欲對抗腎交感神經介導之鈉及水滯留)。然而，該等藥理學策略具有顯著侷限性，包括功效有限、適應性問題、副作用及其他限制。
(ii)腎感覺傳入神經活性
腎臟經由腎感覺傳入神經與中樞神經系統中之完整結構通信。若干形式之「腎損傷」可誘發感覺傳入信號之活化。舉例而言，腎缺血、心搏出量或腎血流量減少或腺苷酶充裕可觸發傳入神經通信之活化。如圖13A及13B中所示，該傳入通信可自腎臟至大腦或可自一個腎臟至另一腎臟(經由中樞神經系統)。該等傳入信號經中樞神經整合且可導致交感神經流出量增加。該交感神經傳動指向腎臟，藉此活化RAAS且誘發腎素分泌、鈉滯留、體積滯留及血管收縮增加。中樞交感神經過度活性亦影響由交感神經神經支配之其他器官及身體結構，諸如心臟及周邊血管結構，導致所述對交感神經活化之不利作用，其若干態樣亦歸因於血壓升高。
因此，生理學表明：(i)以傳出交感神經調節組織將減少不當之腎素釋放、鹽滯留且減少腎血流量；及(ii)以傳入感覺神經調節組織將經由其對後部下丘腦以及對側腎臟之直接作用而減少對高血壓及其他與中樞交感神經張力增加相關聯之疾病病況的全身性貢獻。除傳入腎去神經支配之中樞血壓過低作用以外，預期將有利減少各種其他交感神經神經支配器官(諸如心臟及血管結構)的中樞交感神經流出量。
B.腎去神經支配之其他臨床益處
如上文所提供，腎去神經支配可用於治療特徵為總體且尤其腎交感神經活性增加之若干臨床病狀，該等病狀諸如高血壓、代謝症候群、胰島素抗性、糖尿病、左心室肥大、慢性晚期腎病、心臟衰竭中之不當體液滯留、心-腎症候群及猝死。由於傳入神經信號之減少會導致交感神經張力/傳動全身性減少，因此，腎去神經支配亦可用於治療其他與全身性交感神經亢進相關聯之病狀。因此，腎去神經支配亦可有益於交感神經神經支配之其他器官及身體結構，包括圖11中鑑別者。舉例而言，如前文所論述，中樞交感神經傳動減少可降低折磨罹患代謝症候群及II型糖尿病之人的胰島素抗性。因此，骨質疏鬆症患者亦經由交感神經活化且亦可受益於伴隨腎去神經支配之交感神經傳動下調。
C.達成通向腎動脈之血管內通道
根據本發明之技術，與左及/或右腎動脈密切相關之左及/或右腎叢RP的神經調節可經由血管內通道達成。如圖14A所示，藉由心臟收縮而移動之血液由主動脈自心臟之左心室輸送。主動脈穿過胸腔及分支向下延伸至左及右腎動脈中。在腎動脈以下，主動脈在左及右髂骨動脈處分叉。左及右髂骨動脈分別向下延伸穿過左及右腿且接合左及右股動脈。
如圖14B所示，血液彙集於靜脈中且返回心臟，經由股靜脈返回髂骨靜脈及下腔靜脈中。下腔靜脈分叉成左及右腎靜脈。在腎靜脈上方，下腔靜脈向上延伸以將血液輸送至心臟之右心房中。自右心房，血液經由右心室泵至肺中，在肺中氧化。自肺，經氧化之血液輸送至左心房中。自左心房，經氧化之血液藉由左心室輸送回主動脈。
如下文將更詳細描述，可在剛好位於腹股溝韌帶中點下部之股三角區基點進入股動脈且插入導管。可經由該進入部位將導管經皮插入股動脈、穿過髂骨動脈及主動脈且置放於左或右腎動脈中。此包含為各別腎動脈及/或其他腎血管提供最小侵襲性通道之血管內路徑。
手腕、上臂及肩部區域提供其他用於向動脈系統中引入導管之位置。舉例而言，在選擇情形下可使用橈動脈、肱動脈或腋動脈之導管插入。使用標準血管造影技術使經由該等進入點引入之導管可穿過位於左側之鎖骨下動脈(或經由位於右側之鎖骨下動脈及頭臂動脈)、穿過主動脈弧、向下穿過降主動脈且進入腎動脈。
D.腎血管結構之特性及特徵
由於左及/或右腎叢RP之神經調節可根據本發明之技術經由血管內通道來達成，因此腎血管結構之特性及特徵可對達成該腎神經調節之設備、系統及方法的設計施加限制及/或予以告知。某些該等特性及特徵可在患者群體之間變化及/或在特定患者中隨時間而變化，以及回應於諸如以下之疾病病況而變化：高血壓、慢性腎臟疾病、血管疾病、晚期腎病、胰島素抗性、糖尿病、代謝症候群等。如本文解釋之該等特性及特徵對程序功效及血管內裝置之特定設計有影響。舉例而言，相關特性可包括材料/機械、空間、流體動力學/血液動力學及/或熱動力學特性。
如前文所論述，導管可經由最小侵襲性血管內路徑經皮行進至左或右腎動脈中。然而，最小侵襲性腎動脈通道可具挑戰性，例如因為與常規使用導管進入之某些其他動脈相比，腎動脈常極其扭曲、可具有相對小之直徑及/或可具有相對短之長度。此外，腎動脈粥樣硬化在許多患者中為常見的，尤其為患有心血管疾病之患者。腎動脈解剖學亦可在患者之間顯著變化，此進一步使得最小侵襲性通道變得複雜。舉例而言，在相對扭曲度、直徑、長度及/或動脈粥樣硬化斑負荷以及腎動脈自主動脈分叉之分開角方面可見顯著的患者間變化。用於經由血管內通道達成腎神經調節之設備、系統及方法應說明腎動脈解剖學及其在最小侵襲性進入腎動脈時患者群體之間的變化之該等及其他態樣。
除使得腎動脈通道變得複雜以外，腎解剖學之細節亦使得在神經調節設備與腎動脈之管腔表面或壁之間建立穩定接觸變得複雜。當神經調節設備包括能量傳遞元件(諸如電極)時，一致定位及由能量傳遞元件施加至血管壁之適當接觸力對於可預測性而言係重要的。然而，腎動脈內之緊密空間以及動脈之扭曲會使導航受阻。此外，建立一致接觸因患者移動、呼吸及/或心臟循環而變得複雜，此係因為該等因素可引起腎動脈相對於主動脈顯著移動，且心臟循環可瞬時擴張腎動脈(亦即引起動脈壁脈動)。
即使在進入腎動脈且促成神經調節設備與動脈管腔表面之間的穩定接觸之後，動脈外膜中及其周圍之神經仍應經由神經調節設備安全地調節。考慮到潛在之臨床併發症與腎動脈內熱治療相關聯，所以有效施用該治療並非微不足道。舉例而言，腎動脈之內膜及中膜極易被熱損傷損壞。如下文更詳細論述，將血管內腔與其外膜分隔之內膜-中膜厚度意謂目標腎神經可距動脈管腔表面數毫米遠。足夠能量應傳遞至目標腎神經或自其移除足夠熱量來調節目標腎神經，而不將血管壁過度冷卻或加熱至壁冷凍、脫水或潛在不利地影響之程度。與過度加熱相關聯之潛在臨床併發症為自流經動脈之血液凝聚而形成之血栓。假定該血栓可導致腎臟梗塞，藉此對腎臟造成不可逆轉之損害，則應小心施加腎動脈內之熱治療。因此，治療期間在腎動脈中存在之複雜流體機械學及熱力學條件，尤其在治療部位可影響熱傳遞動力學之彼等條件，對於對腎動脈中之組織施加能量(例如加熱熱能)及/或自其移除熱量(例如冷卻熱條件)而言可為重要的。
神經調節設備亦應經組態以使得能量傳遞元件可在腎動脈內可調節地定位及再定位，因為治療位置亦可影響臨床功效。舉例而言，考慮到腎神經可在腎動脈周圍沿圓周間隔，在腎動脈內施加完整圓周治療可具吸引力。在某些情形下，可能由連續圓周治療引起之全圓損害可能與腎動脈狹窄相關。因此，宜經由本文所述之篩網結構沿腎動脈之縱向方向形成更複雜之損害及/或將神經調節設備再定位至多個治療位置。然而應注意，產生圓周消融之益處可超出腎動脈狹窄之可能性，或在某些實施例中或在某些患者中該風險可減小，且產生圓周消融可為目標。另外，可證明神經調節設備之可變定位及再定位適用於腎動脈尤其扭曲或鄰近分支血遠離腎動脈主血管，使得在某些位置之治療具有挑戰性的情形。在腎動脈中操縱裝置亦應考慮裝置對腎動脈造成之機械損傷。例如藉由插入、操縱、轉向彎曲等裝置在動脈中之活動可導致剖開、穿孔、內膜裸露或使內彈性層破裂。
流經腎動脈之血流可短時間暫時閉塞，具有極小或無併發症。然而，應避免顯著時間量閉塞，因為需預防對腎臟之損傷(諸如缺血)。宜完全避免閉塞，或若閉塞有益於該實施例，則宜將閉塞之持續時間限制為例如2至5分鐘。
基於(1)腎動脈介入術、(2)相對於血管壁一致且穩定置放治療元件、(3)沿血管壁有效施加治療、(4)定位及可能再定位治療設備以慮及多個治療位置及(5)避免血流閉塞或限制其持續時間之上述挑戰，可關注之腎血管結構的獨立及相關特性包括例如(a)血管直徑、血管長度、內膜-中膜厚度、摩擦係數及扭曲度；(b)血管壁之膨脹性、硬度及彈性模數；(c)峰值收縮、舒張末期血流速度以及平均收縮-舒張峰值血流速度及平均/最大體積血流速率；(d)血液及/或血管壁之比熱容量、血液及/或血管壁之熱導率、及/或穿過血管壁治療部位之血流熱對流及/或輻射熱傳遞；(e)由呼吸、患者移動及/或血流脈動誘發之腎動脈相對於主動脈之運動；及(f)以及腎動脈相對於主動脈之分開角。將更詳細論述腎動脈之該等特性。然而，視用於達成腎神經調節之設備、系統及方法而定，腎動脈之該等特性亦可引導及/或限制設計特徵。
如上文所示，定位於腎動脈內之裝置應符合動脈之幾何結構。腎動脈血管直徑DRA 通常在約2至10 mm之範圍內，大部分患者群體具有約4 mm至約8 mm且平均約6 mm之DRA 。主動脈/腎動脈接合點處之腎動脈小孔與其遠端分支之間的腎動脈血管長度LRA 一般在約5至70 mm之範圍內，且顯著部分之患者群體在約20至50 mm之範圍內。由於目標腎叢嵌埋於腎動脈之外膜內，因此複合內膜-中膜厚度IMT(亦即自動脈管腔表面至含有目標神經結構之外膜的徑向朝外距離)亦值得注意且一般在約0.5至2.5 mm之範圍內，其平均值約為1.5 mm。儘管一定治療深度對於到達目標神經纖維係重要的，但治療不應過深(例如自腎動脈內壁>5 mm)以避免非目標組織及解剖結構(諸如腎靜脈)。
可關注之腎動脈的另一特性為由呼吸及/或血流脈動誘發之腎相對於主動脈之運動度數。位於腎動脈遠端之患者腎臟在呼吸移動下可向顱側移動多達4"。此可使連接主動脈與腎臟之腎動脈顯著運動，藉此要求神經調節設備達成硬度與可撓性之間的獨特平衡以在呼吸循環期間維持熱治療元件與血管壁之間的接觸。此外，腎動脈與主動脈之間的分開角可在患者之間顯著變化，且亦可在同一患者中例如由於腎臟運動而動態變化。分開角通常可在約30°至135°之範圍內。
V.結論
本技術實施例之以上詳細描述不欲為詳盡的，或不欲將本技術限於上文揭示之確切形式。儘管上文為達成說明目的而描述本技術之特定實施例及實例，但如熟習相關技術者所瞭解，各種相等修改在本技術範疇內為可能的。舉例而言，儘管步驟以給定次序呈現，但替代實施例可以不同次序執行各步驟。本文所述之各種實施例亦可組合以提供其他實施例。
由上文將瞭解，本文為達成說明目的而描述本技術之特定實施例，但熟知結構及功能尚未詳細顯示或描述以避免不必要地模糊本技術實施例之描述。若上下文允許，則單數或複數術語亦可各別包括複數或單數術語。舉例而言，如前文所示，儘管本文之諸多揭示內容以單數形式描述能量傳遞元件24(例如電極)，但應瞭解，本發明不排除兩個或兩個以上能量傳遞元件或電極。
此外，在提及兩個或兩個以上項目之清單時，除非明 確限制詞彙「或」僅意謂排除其他項目之單一項目，否則在該清單中使用「或」應解釋為包括(a)該清單中之任何單一項目、(b)該清單中之所有項目或(c)該清單中項目之任意組合。另外，全文使用之術語「包含」意謂至少包括所述特徵，以使得不排除任何更多數目之相同特徵及/或其他類型之其他特徵。亦應瞭解，本文為達成說明目的而描述特定實施例，但在不偏離本技術之情況下可進行各種修改。此外，儘管與本技術某些實施例相關之優勢已在彼等實施例之內容中加以描述，但其他實施例亦可展示該等優勢，且並非所有實施例均需要一定展示該等優勢以在本技術之範疇內。因此，本發明及相關技術可包含本文中未明確顯示或描述之其他實施例。
本發明可由一或多個以下條款來定義：1.一種用於腎神經調節之系統，該系統包含：一導管，其包含一具有一近端部分及一遠端部分之細長軸，其中該遠端部分包含一經組態以置放於腎血管中之能量傳遞元件；一能源，其耦接至該能量傳遞元件且經組態以經由該能量傳遞元件將能量傳遞至接近該腎血管之壁之目標神經纖維，其中該能源包含一組件，其經組態以(a)在第一時間段內使能量傳遞增加至預定第一功率位準；(b)將能量傳遞維持在該第一功率位準歷時第二時間 段；及(c)若在該第二時間段之後溫度值小於預設臨限值溫度，則將能量傳遞增加至第二預定功率位準；且其中該能源進一步包含一組件，其經組態以(d)獲得一組對應於使用該導管、該能源及該能量傳遞元件進行之完全治療的治療資料；(e)根據一或多個標準估算該組治療資料以確定該完全治療之估值是否可能在預定範圍內；及(f)提供關於該完全治療之該估值是否可能在該預定範圍內之指示。
2.如條款1之系統，其中該組治療資料為對應於第一完全治療之第一組治療資料，且其中該系統經進一步組態以(a)至少部分地基於對該第一治療資料之該估算及關於該第一完全治療之該估值是否在該預定範圍內之該指示修改該第一預定功率位準、該第一時間段、該第二時間段及/或該第二預定功率位準；(b)使用該經修改之第一預定功率位準、經修改之第一時間段、經修改之第二時間段及/或經修改之第二預定功率位準進行第二治療；及(c)獲得對應於第二完全治療之第二組治療資料。
3.如條款1之系統，其中該組治療資料包含關於基於溫度之量測值、基於阻抗之量測值、基於血流量之量測值或基於移動之測定值中之一或多者的資料。
4.如條款1之系統，其中該組治療資料包含一或多個關 於以下之量測值：指定時間內之溫度變化、最大溫度、最大平均溫度、最小溫度、在預定或計算時間相對於預定或計算溫度之溫度、指定時間內之平均溫度、最大血流量、最小血流量、在預定或計算時間相對於預定或計算血流量之血流量、隨時間變化之平均血流量、最大阻抗、最小阻抗、在預定或計算時間相對於預定或計算阻抗之阻抗、指定時間內之阻抗變化或指定時間內相對於溫度變化之阻抗變化。
5.如條款1之系統，其中：該能量傳遞元件包含一第一能量傳遞元件，且其中該導管進一步包含一耦接至該能源且經組態以將能量傳遞至該目標神經纖維的第二能量傳遞；且該組治療資料包含關於該第一能量傳遞元件之基於阻抗之量測值的第一組資料及關於該第二能量傳遞元件之基於阻抗之量測值的第二組資料。
6.如條款5之系統，其中根據一或多個標準估算該組治療資料包含將該第一組資料與該第二組資料相比較。
7.如條款1之系統，其中估算該組治療資料包含產生一用以確定該完全治療是否成功之分值。
8.如條款1之系統，其中估算該組治療資料包含執行線性判別分析。
9.如條款8之系統，其中該線性判別分析產生一用以確定該完全治療是否成功之分值。
10.如條款1之系統，其進一步包含一顯示螢幕，且其 中該提供之指示包含在該顯示螢幕上顯示之訊息。
11.如條款10之系統，其進一步包含一用於量測治療部位或電極之阻抗的阻抗感應器，且其中該能源經進一步組態以在選定時間段內追蹤即時阻抗量測值且在該顯示螢幕上顯示該即時阻抗量測值。
12.一種電腦可讀儲存媒體，其含有在由一電腦執行時執行包含以下之操作的指令：增加由一導管載運之一能量傳遞元件的能量傳遞，其中在第一時間段內使能量傳遞增加至預定第一功率位準，且其中該能量傳遞元件經定位以將能量傳遞至接近人類患者之腎血管之壁的目標神經纖維；將能量傳遞維持在該第一功率位準歷時第二時間段；若在該第二時間段之後溫度值小於預設臨限值溫度，則將能量傳遞增加至第二預定功率位準；獲得一組對應於使用該能量傳遞元件進行之完全治療的治療資料；根據一或多個標準估算該組治療資料以確定該完全治療之估值是否可能在預定範圍內；及提供關於該完全治療之該估值是否在該預定範圍內之指示。
13.如條款12之電腦可讀儲存媒體，其中該組治療資料包含關於基於溫度之量測值、基於阻抗之量測值、基於血流量之量測值或基於移動之測定值中之一或多者的資料。
14.如條款12之電腦可讀儲存媒體，其中操作參數包含 溫度、時間、阻抗、功率、血流量、流動速度、體積流動速率、血壓或心跳速率中之一或多者。
15.如條款12之電腦可讀儲存媒體，其中該組治療資料包含一或多個關於以下之量測值：指定時間內之溫度變化、最大溫度、最大平均溫度、最小溫度、在預定或計算時間相對於預定或計算溫度之溫度、指定時間內之平均溫度、最大血流量、最小血流量、在預定或計算時間相對於預定或計算血流量之血流量、隨時間變化之平均血流量、最大阻抗、最小阻抗、在預定或計算時間相對於預定或計算阻抗之阻抗、指定時間內之阻抗變化或指定時間內相對於溫度變化之阻抗變化。
16.如條款12之電腦可讀儲存媒體，其中該組治療資料包含對應於第一完全治療之第一組治療資料，且其中該等操作進一步包含：至少部分地基於對該第一治療資料之估算及關於該第一完全治療之該估值是否在該預定範圍內之該指示修改該第一預定功率位準、該第一時間段、該第二時間段及/或該第二預定功率位準；使用該經修改之第一預定功率位準、經修改之第一時間段、經修改之第二時間段及/或經修改之第二預定功率位準進行第二治療；及獲得對應於第二完全治療之第二組治療資料。
17.如條款12之電腦可讀儲存媒體，其中估算該組治療資料包含產生一用以確定該完全治療是否在該預定範圍內 或該完全治療是否未如預期進行之分值。
18.如條款12之電腦可讀儲存媒體，其中估算該組治療資料包含執行線性判別分析。
19.如條款17之電腦可讀儲存媒體，其中該線性判別分析產生一用以確定該完全治療是否在該預定範圍內之分值。
20.如條款12之電腦可讀儲存媒體，其中該提供之指示包含顯示在用於投與該完全治療之一系統之一顯示螢幕上的訊息。
21.如條款20之電腦可讀儲存媒體，其中提供關於該完全治療是否在該預定範圍內之指示包含：若該治療之該估值在該預定範圍內，則在該顯示螢幕上顯示第一訊息；及若該治療之該估值指示治療未如預期進行，則在該顯示螢幕上顯示第二不同訊息。
22.如條款12之電腦可讀儲存媒體，其中若操作參數超出預定範圍，則將能量傳遞增加至預定第二功率位準包含若第一能量傳遞元件與第二能量傳遞元件之阻抗值差異超出預定範圍，則將能量傳遞增加至預定第二功率位準。
10‧‧‧腎神經調節系統
12‧‧‧治療裝置
16‧‧‧細長軸
18‧‧‧近端部分
20‧‧‧遠端部分
22‧‧‧治療總成/治療區
24‧‧‧能量傳遞元件
26‧‧‧能量產生器
28‧‧‧電纜
30‧‧‧自動控制演算法
31‧‧‧估算/反饋演算法
32‧‧‧腳踏板
33‧‧‧顯示器
34‧‧‧手柄總成
38‧‧‧中性或分散電極
80‧‧‧治療演算法
100‧‧‧治療估算演算法
112‧‧‧線性判別分析(LDA)
114‧‧‧係數
150‧‧‧演算法
170‧‧‧演算法
800‧‧‧演算法
900‧‧‧演算法
910‧‧‧演算法
1100‧‧‧顯示器
1110‧‧‧圖形顯示
1120‧‧‧阻抗顯示
1122‧‧‧標準偏差指示
1130‧‧‧顯示螢幕
參考以下圖式可更佳地理解本發明之諸多態樣。圖式中之組分不必按比例。實際上，重在明確說明本發明之原則。
圖1說明根據本發明技術之一實施例組態之腎神經調 節系統。
圖2說明用根據本技術之一實施例之導管設備調節腎神經。
圖3為描繪根據本技術之一實施例可結合圖1系統使用之能量傳遞演算法的圖。
圖4及5為說明根據本發明技術之實施例用於估算治療之演算法的方塊圖。
圖6為說明根據本發明技術之一實施例用於在出現高溫條件時為操作者提供反饋之演算法的方塊圖。
圖7為說明根據本發明技術之一實施例用於在出現高阻抗條件時為操作者提供反饋之演算法的方塊圖。
圖8為說明根據本發明技術之一實施例用於在出現高度血管收縮時為操作者提供反饋之演算法的方塊圖。
圖9A為說明根據本發明技術之一實施例用於在出現異常心跳速率條件時為操作者提供反饋之演算法的方塊圖。
圖9B為說明根據本發明技術之一實施例用於在出現低血流量條件時為操作者提供反饋之演算法的方塊圖。
圖10A及10B為說明根據本發明技術之態樣組態之代表性產生器顯示螢幕的螢幕擷取畫面。
圖11為對交感神經系統(SNS)以及大腦如何經由SNS與身體通信之概念性說明。
圖12為神經支配左腎以在左腎動脈周圍形成腎叢之神經的放大解剖圖。
圖13A及13B提供分別描繪大腦與腎臟之間的神經傳 出與傳入通信的人體解剖圖及概念圖。
圖14A及14B分別為人類動脈及靜脈血管結構之解剖圖。
10‧‧‧腎神經調節系統
12‧‧‧治療裝置
16‧‧‧細長軸
18‧‧‧近端部分
20‧‧‧遠端部分
22‧‧‧治療總成/治療區
24‧‧‧能量傳遞元件
26‧‧‧能量產生器
28‧‧‧電纜
30‧‧‧自動控制演算法
31‧‧‧估算/反饋演算法
32‧‧‧腳踏板
33‧‧‧顯示器
34‧‧‧手柄總成
38‧‧‧中性或分散電極

Claims (11)

  1. 一種用於腎神經調節之系統，該系統包含：一導管，其包含一具有一近端部分及一遠端部分之細長軸，其中該遠端部分包含一經組態以置放於腎血管中之能量傳遞元件；一能源，其耦接至該能量傳遞元件且經組態以經由該能量傳遞元件將能量傳遞至接近該腎血管之壁之目標神經纖維，其中該能源包含一組件，其經組態以(a)在第一時間段內使能量傳遞增加至預定第一功率位準；(b)將能量傳遞維持在該第一功率位準歷時第二時間段；及(c)若在該第二時間段之後溫度值小於預設臨限值溫度，則將能量傳遞增加至第二預定功率位準；且其中該能源進一步包含一組件，其經組態以(d)獲得一組對應於使用該導管、該能源及該能量傳遞元件進行之完全治療的治療資料；(e)根據一或多個標準估算該組治療資料以確定該完全治療之估值是否可能在預定範圍內；及(f)提供關於該完全治療之估值是否可能在該預定範圍內之指示。
  2. 如申請專利範圍第1項之系統，其中該組治療資料為對應於第一完全治療之第一組治療資料，且其中該系統經 進一步組態以(a)至少部分地基於對該第一治療資料之估算及關於該第一完全治療之該估值是否在該預定範圍內之該指示修改該第一預定功率位準、該第一時間段、該第二時間段及/或該第二預定功率位準；(b)使用經修改之第一預定功率位準、經修改之第一時間段、經修改之第二時間段及/或經修改之第二預定功率位準進行第二治療；及(c)獲得對應於第二完全治療之第二組治療資料。
  3. 如申請專利範圍第1項之系統，其中該組治療資料包含關於基於溫度之量測值、基於阻抗之量測值、基於血流量之量測值或基於移動之測定值中之一或多者的資料。
  4. 如申請專利範圍第1項之系統，其中該組治療資料包含一或多個關於以下之量測值：指定時間內之溫度變化、最大溫度、最大平均溫度、最小溫度、在預定或計算時間相對於預定或計算溫度之溫度、指定時間內之平均溫度、最大血流量、最小血流量、在預定或計算時間相對於預定或計算血流量之血流量、隨時間變化之平均血流量、最大阻抗、最小阻抗、在預定或計算時間相對於預定或計算阻抗之阻抗、指定時間內之阻抗變化或指定時間內相對於溫度變化之阻抗變化。
  5. 如申請專利範圍第1項之系統，其中：該能量傳遞元件包含一第一能量傳遞元件，且其中該導管進一步包含一耦接至該能源且經組態以將能量傳 遞至所述目標神經纖維的第二能量傳遞；且該組治療資料包含關於該第一能量傳遞元件之基於阻抗之量測值的第一組資料及關於該第二能量傳遞元件之基於阻抗之量測值的第二組資料。
  6. 如申請專利範圍第5項之系統，其中根據一或多個標準估算該組治療資料包含將該第一組資料與該第二組資料相比較。
  7. 如申請專利範圍第1項之系統，其中估算該組治療資料包含產生一用以確定該完全治療是否成功之分值。
  8. 如申請專利範圍第1項之系統，其中估算該組治療資料包含執行線性判別分析。
  9. 如申請專利範圍第8項之系統，其中該線性判別分析產生一用以確定該完全治療是否成功之分值。
  10. 如申請專利範圍第1項之系統，其進一步包含一顯示螢幕，且其中所提供之指示包含在該顯示螢幕上顯示之訊息。
  11. 如申請專利範圍第10項之系統，其進一步包含一用於量測治療部位或電極之阻抗的阻抗感應器，且其中該能源經進一步組態以在選定時間段內追蹤即時阻抗量測值且在該顯示螢幕上顯示該即時阻抗量測值。
TW100138604A 2010-10-25 2011-10-25 用於神經調節治療之估算及反饋的裝置、系統及方法 TWI513451B (zh)

Applications Claiming Priority (4)

Application Number Priority Date Filing Date Title
US40653110P 2010-10-25 2010-10-25
US201161528108P 2011-08-26 2011-08-26
US201161528091P 2011-08-26 2011-08-26
US201161528684P 2011-08-29 2011-08-29

Publications (2)

Publication Number Publication Date
TW201221114A TW201221114A (en) 2012-06-01
TWI513451B true TWI513451B (zh) 2015-12-21

Family

ID=45973616

Family Applications (1)

Application Number Title Priority Date Filing Date
TW100138604A TWI513451B (zh) 2010-10-25 2011-10-25 用於神經調節治療之估算及反饋的裝置、系統及方法

Country Status (6)

Country Link
US (5) US9066720B2 (zh)
EP (2) EP2632373B1 (zh)
JP (3) JP6046041B2 (zh)
CN (2) CN103313671B (zh)
TW (1) TWI513451B (zh)
WO (1) WO2012061153A1 (zh)

Families Citing this family (318)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8016823B2 (en) 2003-01-18 2011-09-13 Tsunami Medtech, Llc Medical instrument and method of use
US9433457B2 (en) 2000-12-09 2016-09-06 Tsunami Medtech, Llc Medical instruments and techniques for thermally-mediated therapies
US10835307B2 (en) 2001-06-12 2020-11-17 Ethicon Llc Modular battery powered handheld surgical instrument containing elongated multi-layered shaft
US8444636B2 (en) 2001-12-07 2013-05-21 Tsunami Medtech, Llc Medical instrument and method of use
US20040082859A1 (en) 2002-07-01 2004-04-29 Alan Schaer Method and apparatus employing ultrasound energy to treat body sphincters
US7258690B2 (en) 2003-03-28 2007-08-21 Relievant Medsystems, Inc. Windowed thermal ablation probe
US6907884B2 (en) 2002-09-30 2005-06-21 Depay Acromed, Inc. Method of straddling an intraosseous nerve
US8361067B2 (en) 2002-09-30 2013-01-29 Relievant Medsystems, Inc. Methods of therapeutically heating a vertebral body to treat back pain
DE202004021951U1 (de) 2003-09-12 2013-06-19 Vessix Vascular, Inc. Auswählbare exzentrische Remodellierung und/oder Ablation von atherosklerotischem Material
US8396548B2 (en) 2008-11-14 2013-03-12 Vessix Vascular, Inc. Selective drug delivery in a lumen
US9713730B2 (en) 2004-09-10 2017-07-25 Boston Scientific Scimed, Inc. Apparatus and method for treatment of in-stent restenosis
US8019435B2 (en) 2006-05-02 2011-09-13 Boston Scientific Scimed, Inc. Control of arterial smooth muscle tone
EP2021846B1 (en) 2006-05-19 2017-05-03 Koninklijke Philips N.V. Ablation device with optimized input power profile
ATE536147T1 (de) * 2006-06-28 2011-12-15 Ardian Inc Systeme für wärmeinduzierte renale neuromodulation
WO2008049082A2 (en) 2006-10-18 2008-04-24 Minnow Medical, Inc. Inducing desirable temperature effects on body tissue
EP3257462B1 (en) 2006-10-18 2022-12-21 Vessix Vascular, Inc. System for inducing desirable temperature effects on body tissue
EP2455036B1 (en) 2006-10-18 2015-07-15 Vessix Vascular, Inc. Tuned RF energy and electrical tissue characterization for selective treatment of target tissues
EP2170198B1 (en) 2007-07-06 2015-04-15 Tsunami Medtech, LLC Medical system
US9924992B2 (en) 2008-02-20 2018-03-27 Tsunami Medtech, Llc Medical system and method of use
US8721632B2 (en) 2008-09-09 2014-05-13 Tsunami Medtech, Llc Methods for delivering energy into a target tissue of a body
US9089360B2 (en) 2008-08-06 2015-07-28 Ethicon Endo-Surgery, Inc. Devices and techniques for cutting and coagulating tissue
US8768469B2 (en) 2008-08-08 2014-07-01 Enteromedics Inc. Systems for regulation of blood pressure and heart rate
CA2957010C (en) 2008-09-26 2017-07-04 Relievant Medsystems, Inc. Systems and methods for navigating an instrument through bone
US10028753B2 (en) 2008-09-26 2018-07-24 Relievant Medsystems, Inc. Spine treatment kits
US8097926B2 (en) 2008-10-07 2012-01-17 Mc10, Inc. Systems, methods, and devices having stretchable integrated circuitry for sensing and delivering therapy
US8389862B2 (en) 2008-10-07 2013-03-05 Mc10, Inc. Extremely stretchable electronics
JP5646492B2 (ja) 2008-10-07 2014-12-24 エムシー１０ インコーポレイテッドＭｃ１０，Ｉｎｃ． 伸縮可能な集積回路およびセンサアレイを有する装置
US9123614B2 (en) 2008-10-07 2015-09-01 Mc10, Inc. Methods and applications of non-planar imaging arrays
KR20110104504A (ko) 2008-11-17 2011-09-22 미노우 메디컬, 인코포레이티드 조직 토폴로지의 지식 여하에 따른 에너지의 선택적 축적
US11284931B2 (en) 2009-02-03 2022-03-29 Tsunami Medtech, Llc Medical systems and methods for ablating and absorbing tissue
WO2010138919A2 (en) 2009-05-28 2010-12-02 Angiodynamics, Inc. System and method for synchronizing energy delivery to the cardiac rhythm
US9895189B2 (en) 2009-06-19 2018-02-20 Angiodynamics, Inc. Methods of sterilization and treating infection using irreversible electroporation
US8663220B2 (en) 2009-07-15 2014-03-04 Ethicon Endo-Surgery, Inc. Ultrasonic surgical instruments
WO2011041727A1 (en) 2009-10-01 2011-04-07 Mc10, Inc. Protective cases with integrated electronics
US10441345B2 (en) 2009-10-09 2019-10-15 Ethicon Llc Surgical generator for ultrasonic and electrosurgical devices
US11090104B2 (en) 2009-10-09 2021-08-17 Cilag Gmbh International Surgical generator for ultrasonic and electrosurgical devices
US11998266B2 (en) 2009-10-12 2024-06-04 Otsuka Medical Devices Co., Ltd Intravascular energy delivery
WO2011053757A1 (en) 2009-10-30 2011-05-05 Sound Interventions, Inc. Method and apparatus for treatment of hypertension through percutaneous ultrasound renal denervation
US9161801B2 (en) 2009-12-30 2015-10-20 Tsunami Medtech, Llc Medical system and method of use
US8469981B2 (en) 2010-02-11 2013-06-25 Ethicon Endo-Surgery, Inc. Rotatable cutting implement arrangements for ultrasonic surgical instruments
CA2795229A1 (en) 2010-04-09 2011-10-13 Vessix Vascular, Inc. Power generating and control apparatus for the treatment of tissue
US9192790B2 (en) 2010-04-14 2015-11-24 Boston Scientific Scimed, Inc. Focused ultrasonic renal denervation
US8473067B2 (en) 2010-06-11 2013-06-25 Boston Scientific Scimed, Inc. Renal denervation and stimulation employing wireless vascular energy transfer arrangement
US9358365B2 (en) 2010-07-30 2016-06-07 Boston Scientific Scimed, Inc. Precision electrode movement control for renal nerve ablation
US9155589B2 (en) 2010-07-30 2015-10-13 Boston Scientific Scimed, Inc. Sequential activation RF electrode set for renal nerve ablation
US9463062B2 (en) 2010-07-30 2016-10-11 Boston Scientific Scimed, Inc. Cooled conductive balloon RF catheter for renal nerve ablation
US9084609B2 (en) 2010-07-30 2015-07-21 Boston Scientific Scime, Inc. Spiral balloon catheter for renal nerve ablation
US9408661B2 (en) 2010-07-30 2016-08-09 Patrick A. Haverkost RF electrodes on multiple flexible wires for renal nerve ablation
US9943353B2 (en) 2013-03-15 2018-04-17 Tsunami Medtech, Llc Medical system and method of use
EP2627274B1 (en) 2010-10-13 2022-12-14 AngioDynamics, Inc. System for electrically ablating tissue of a patient
US8974451B2 (en) 2010-10-25 2015-03-10 Boston Scientific Scimed, Inc. Renal nerve ablation using conductive fluid jet and RF energy
US9066720B2 (en) 2010-10-25 2015-06-30 Medtronic Ardian Luxembourg S.A.R.L. Devices, systems and methods for evaluation and feedback of neuromodulation treatment
US9220558B2 (en) 2010-10-27 2015-12-29 Boston Scientific Scimed, Inc. RF renal denervation catheter with multiple independent electrodes
ES2912362T3 (es) 2010-11-09 2022-05-25 Aegea Medical Inc Método de colocación y aparato para suministrar vapor al útero
US9028485B2 (en) 2010-11-15 2015-05-12 Boston Scientific Scimed, Inc. Self-expanding cooling electrode for renal nerve ablation
US9668811B2 (en) 2010-11-16 2017-06-06 Boston Scientific Scimed, Inc. Minimally invasive access for renal nerve ablation
US9089350B2 (en) 2010-11-16 2015-07-28 Boston Scientific Scimed, Inc. Renal denervation catheter with RF electrode and integral contrast dye injection arrangement
US9326751B2 (en) 2010-11-17 2016-05-03 Boston Scientific Scimed, Inc. Catheter guidance of external energy for renal denervation
US9060761B2 (en) 2010-11-18 2015-06-23 Boston Scientific Scime, Inc. Catheter-focused magnetic field induced renal nerve ablation
US9023034B2 (en) 2010-11-22 2015-05-05 Boston Scientific Scimed, Inc. Renal ablation electrode with force-activatable conduction apparatus
US9192435B2 (en) 2010-11-22 2015-11-24 Boston Scientific Scimed, Inc. Renal denervation catheter with cooled RF electrode
US20120157993A1 (en) 2010-12-15 2012-06-21 Jenson Mark L Bipolar Off-Wall Electrode Device for Renal Nerve Ablation
WO2012100095A1 (en) 2011-01-19 2012-07-26 Boston Scientific Scimed, Inc. Guide-compatible large-electrode catheter for renal nerve ablation with reduced arterial injury
US9159635B2 (en) 2011-05-27 2015-10-13 Mc10, Inc. Flexible electronic structure
EP2734259B1 (en) 2011-07-20 2016-11-23 Boston Scientific Scimed, Inc. Percutaneous device to visualize, target and ablate nerves
JP6106669B2 (ja) 2011-07-22 2017-04-05 ボストン サイエンティフィック サイムド，インコーポレイテッドＢｏｓｔｏｎ Ｓｃｉｅｎｔｉｆｉｃ Ｓｃｉｍｅｄ，Ｉｎｃ． ヘリカル・ガイド内に配置可能な神経調節要素を有する神経調節システム
JP6320920B2 (ja) 2011-08-05 2018-05-09 エムシーテン、インコーポレイテッド センシング素子を利用したバルーン・カテーテルの装置及び製造方法
US9078665B2 (en) 2011-09-28 2015-07-14 Angiodynamics, Inc. Multiple treatment zone ablation probe
US9662060B2 (en) 2011-10-07 2017-05-30 Aegea Medical Inc. Integrity testing method and apparatus for delivering vapor to the uterus
WO2013055826A1 (en) 2011-10-10 2013-04-18 Boston Scientific Scimed, Inc. Medical devices including ablation electrodes
US9420955B2 (en) 2011-10-11 2016-08-23 Boston Scientific Scimed, Inc. Intravascular temperature monitoring system and method
WO2013055815A1 (en) 2011-10-11 2013-04-18 Boston Scientific Scimed, Inc. Off -wall electrode device for nerve modulation
US9364284B2 (en) 2011-10-12 2016-06-14 Boston Scientific Scimed, Inc. Method of making an off-wall spacer cage
WO2013058962A1 (en) 2011-10-18 2013-04-25 Boston Scientific Scimed, Inc. Deflectable medical devices
EP2768568B1 (en) 2011-10-18 2020-05-06 Boston Scientific Scimed, Inc. Integrated crossing balloon catheter
EP3366250A1 (en) 2011-11-08 2018-08-29 Boston Scientific Scimed, Inc. Ostial renal nerve ablation
US9119600B2 (en) 2011-11-15 2015-09-01 Boston Scientific Scimed, Inc. Device and methods for renal nerve modulation monitoring
US9119632B2 (en) 2011-11-21 2015-09-01 Boston Scientific Scimed, Inc. Deflectable renal nerve ablation catheter
JP6441679B2 (ja) 2011-12-09 2018-12-19 メタベンション インコーポレイテッド 肝臓系の治療的な神経調節
EP2769694B1 (en) * 2011-12-12 2016-09-14 Olympus Corporation Treatment system
US9265969B2 (en) 2011-12-21 2016-02-23 Cardiac Pacemakers, Inc. Methods for modulating cell function
CN104244856B (zh) 2011-12-23 2017-03-29 维西克斯血管公司 重建身体通道的组织或身体通路附近的组织的方法及设备
EP2797534A1 (en) 2011-12-28 2014-11-05 Boston Scientific Scimed, Inc. Device and methods for nerve modulation using a novel ablation catheter with polymeric ablative elements
US9050106B2 (en) 2011-12-29 2015-06-09 Boston Scientific Scimed, Inc. Off-wall electrode device and methods for nerve modulation
US10390877B2 (en) 2011-12-30 2019-08-27 Relievant Medsystems, Inc. Systems and methods for treating back pain
WO2013119545A1 (en) 2012-02-10 2013-08-15 Ethicon-Endo Surgery, Inc. Robotically controlled surgical instrument
US9439668B2 (en) 2012-04-09 2016-09-13 Ethicon Endo-Surgery, Llc Switch arrangements for ultrasonic surgical instruments
US20130296840A1 (en) * 2012-05-01 2013-11-07 Medtronic Ablation Frontiers Llc Systems and methods for detecting tissue contact during ablation
US10660703B2 (en) 2012-05-08 2020-05-26 Boston Scientific Scimed, Inc. Renal nerve modulation devices
US11871901B2 (en) 2012-05-20 2024-01-16 Cilag Gmbh International Method for situational awareness for surgical network or surgical network connected device capable of adjusting function based on a sensed situation or usage
US9226402B2 (en) 2012-06-11 2015-12-29 Mc10, Inc. Strain isolation structures for stretchable electronics
US20140005705A1 (en) 2012-06-29 2014-01-02 Ethicon Endo-Surgery, Inc. Surgical instruments with articulating shafts
US9226767B2 (en) 2012-06-29 2016-01-05 Ethicon Endo-Surgery, Inc. Closed feedback control for electrosurgical device
US9326788B2 (en) 2012-06-29 2016-05-03 Ethicon Endo-Surgery, Llc Lockout mechanism for use with robotic electrosurgical device
US9393037B2 (en) 2012-06-29 2016-07-19 Ethicon Endo-Surgery, Llc Surgical instruments with articulating shafts
US9351754B2 (en) 2012-06-29 2016-05-31 Ethicon Endo-Surgery, Llc Ultrasonic surgical instruments with distally positioned jaw assemblies
US9408622B2 (en) 2012-06-29 2016-08-09 Ethicon Endo-Surgery, Llc Surgical instruments with articulating shafts
US20140005702A1 (en) 2012-06-29 2014-01-02 Ethicon Endo-Surgery, Inc. Ultrasonic surgical instruments with distally positioned transducers
US9198714B2 (en) 2012-06-29 2015-12-01 Ethicon Endo-Surgery, Inc. Haptic feedback devices for surgical robot
EP2866645A4 (en) 2012-07-05 2016-03-30 Mc10 Inc CATHETER DEVICE WITH FLOW MEASUREMENT
US9295842B2 (en) 2012-07-05 2016-03-29 Mc10, Inc. Catheter or guidewire device including flow sensing and use thereof
WO2014032016A1 (en) 2012-08-24 2014-02-27 Boston Scientific Scimed, Inc. Intravascular catheter with a balloon comprising separate microporous regions
US10588691B2 (en) 2012-09-12 2020-03-17 Relievant Medsystems, Inc. Radiofrequency ablation of tissue within a vertebral body
EP2895095A2 (en) 2012-09-17 2015-07-22 Boston Scientific Scimed, Inc. Self-positioning electrode system and method for renal nerve modulation
US10398464B2 (en) 2012-09-21 2019-09-03 Boston Scientific Scimed, Inc. System for nerve modulation and innocuous thermal gradient nerve block
US10549127B2 (en) 2012-09-21 2020-02-04 Boston Scientific Scimed, Inc. Self-cooling ultrasound ablation catheter
US9171794B2 (en) 2012-10-09 2015-10-27 Mc10, Inc. Embedding thin chips in polymer
US9082025B2 (en) 2012-10-09 2015-07-14 Mc10, Inc. Conformal electronics integrated with apparel
EP2906135A2 (en) * 2012-10-10 2015-08-19 Boston Scientific Scimed, Inc. Renal nerve modulation devices and methods
US9095367B2 (en) 2012-10-22 2015-08-04 Ethicon Endo-Surgery, Inc. Flexible harmonic waveguides/blades for surgical instruments
IL238516B (en) 2012-11-05 2022-08-01 Relievant Medsystems Inc System and methods for creating curved pathways through bone and regulating the nerves within the bone
US20140135804A1 (en) 2012-11-15 2014-05-15 Ethicon Endo-Surgery, Inc. Ultrasonic and electrosurgical devices
JP6389193B2 (ja) * 2013-01-24 2018-09-12 タイラートン インターナショナル ホールディングス インコーポレイテッドＴｙｌｅｒｔｏｎ Ｉｎｔｅｒｎａｔｉｏｎａｌ Ｈｏｌｄｉｎｇｓ Ｉｎｃ． 身体構造イメージング
US9956033B2 (en) 2013-03-11 2018-05-01 Boston Scientific Scimed, Inc. Medical devices for modulating nerves
WO2014143571A1 (en) 2013-03-11 2014-09-18 Boston Scientific Scimed, Inc. Medical devices for modulating nerves
US9808311B2 (en) 2013-03-13 2017-11-07 Boston Scientific Scimed, Inc. Deflectable medical devices
EP2971232A1 (en) 2013-03-14 2016-01-20 ReCor Medical, Inc. Methods of plating or coating ultrasound transducers
EP2968984B1 (en) 2013-03-14 2016-08-17 ReCor Medical, Inc. Ultrasound-based neuromodulation system
US20140275993A1 (en) * 2013-03-15 2014-09-18 Medtronic Ardian Luxembourg S.a.r.I. Devices, Systems, and Methods for Specialization of Neuromodulation Treatment
EP2967725B1 (en) 2013-03-15 2019-12-11 Boston Scientific Scimed, Inc. Control unit for detecting electrical leakage between electrode pads and system comprising such a control unit
US9987070B2 (en) * 2013-03-15 2018-06-05 St. Jude Medical, Cardiology Division, Inc. Ablation system, methods, and controllers
WO2014150553A1 (en) 2013-03-15 2014-09-25 Boston Scientific Scimed, Inc. Methods and apparatuses for remodeling tissue of or adjacent to a body passage
US10265122B2 (en) 2013-03-15 2019-04-23 Boston Scientific Scimed, Inc. Nerve ablation devices and related methods of use
US9706647B2 (en) 2013-05-14 2017-07-11 Mc10, Inc. Conformal electronics including nested serpentine interconnects
WO2014197625A1 (en) 2013-06-05 2014-12-11 Metavention, Inc. Modulation of targeted nerve fibers
CN105473092B (zh) 2013-06-21 2019-05-17 波士顿科学国际有限公司 具有可旋转轴的用于肾神经消融的医疗器械
JP2016523147A (ja) 2013-06-21 2016-08-08 ボストン サイエンティフィック サイムド，インコーポレイテッドＢｏｓｔｏｎ Ｓｃｉｅｎｔｉｆｉｃ Ｓｃｉｍｅｄ，Ｉｎｃ． 同乗型電極支持体を備えた腎除神経バルーンカテーテル
US9707036B2 (en) 2013-06-25 2017-07-18 Boston Scientific Scimed, Inc. Devices and methods for nerve modulation using localized indifferent electrodes
AU2014284558B2 (en) 2013-07-01 2017-08-17 Boston Scientific Scimed, Inc. Medical devices for renal nerve ablation
EP3019105B1 (en) 2013-07-11 2017-09-13 Boston Scientific Scimed, Inc. Devices for nerve modulation
CN105377170A (zh) 2013-07-11 2016-03-02 波士顿科学国际有限公司 具有可伸展电极组件的医疗装置
US9925001B2 (en) 2013-07-19 2018-03-27 Boston Scientific Scimed, Inc. Spiral bipolar electrode renal denervation balloon
EP3024405A1 (en) 2013-07-22 2016-06-01 Boston Scientific Scimed, Inc. Renal nerve ablation catheter having twist balloon
CN105555220B (zh) 2013-07-22 2019-05-17 波士顿科学国际有限公司 用于肾神经消融的医疗器械
JP2016527649A (ja) 2013-08-05 2016-09-08 エムシー１０ インコーポレイテッドＭｃ１０，Ｉｎｃ． 適合する電子機器を含む可撓性温度センサ
US9724151B2 (en) 2013-08-08 2017-08-08 Relievant Medsystems, Inc. Modulating nerves within bone using bone fasteners
CN105473093B (zh) 2013-08-22 2019-02-05 波士顿科学国际有限公司 具有至肾神经调制球囊的改善的粘附力的柔性电路
WO2015035047A1 (en) 2013-09-04 2015-03-12 Boston Scientific Scimed, Inc. Radio frequency (rf) balloon catheter having flushing and cooling capability
US10052495B2 (en) 2013-09-08 2018-08-21 Tylerton International Inc. Detection of reduced-control cardiac zones
US10952790B2 (en) 2013-09-13 2021-03-23 Boston Scientific Scimed, Inc. Ablation balloon with vapor deposited cover layer
US9814514B2 (en) 2013-09-13 2017-11-14 Ethicon Llc Electrosurgical (RF) medical instruments for cutting and coagulating tissue
CN105705093A (zh) 2013-10-07 2016-06-22 Mc10股份有限公司 用于感测和分析的适形传感器系统
EP3057488B1 (en) 2013-10-14 2018-05-16 Boston Scientific Scimed, Inc. High resolution cardiac mapping electrode array catheter
US11246654B2 (en) 2013-10-14 2022-02-15 Boston Scientific Scimed, Inc. Flexible renal nerve ablation devices and related methods of use and manufacture
US9770606B2 (en) 2013-10-15 2017-09-26 Boston Scientific Scimed, Inc. Ultrasound ablation catheter with cooling infusion and centering basket
JP6259098B2 (ja) 2013-10-15 2018-01-10 ボストン サイエンティフィック サイムド，インコーポレイテッドＢｏｓｔｏｎ Ｓｃｉｅｎｔｉｆｉｃ Ｓｃｉｍｅｄ，Ｉｎｃ． 医療デバイスおよび同医療デバイスを製造する方法
CN105636538B (zh) 2013-10-18 2019-01-15 波士顿科学国际有限公司 具有柔性导线的球囊导管及其使用和制造的相关方法
US10433902B2 (en) 2013-10-23 2019-10-08 Medtronic Ardian Luxembourg S.A.R.L. Current control methods and systems
JP2016534842A (ja) 2013-10-25 2016-11-10 ボストン サイエンティフィック サイムド，インコーポレイテッドＢｏｓｔｏｎ Ｓｃｉｅｎｔｉｆｉｃ Ｓｃｉｍｅｄ，Ｉｎｃ． 除神経フレックス回路における埋め込み熱電対
US10098685B2 (en) 2013-10-30 2018-10-16 Medtronic Cryocath Lp Feedback system for cryoablation of cardiac tissue
US9265926B2 (en) 2013-11-08 2016-02-23 Ethicon Endo-Surgery, Llc Electrosurgical devices
CN105813545A (zh) 2013-11-22 2016-07-27 Mc10股份有限公司 用于感测和分析心搏的适形传感器系统
GB2521228A (en) 2013-12-16 2015-06-17 Ethicon Endo Surgery Inc Medical device
CN105828709A (zh) * 2014-01-03 2016-08-03 Mc10股份有限公司 包括流量感测的导管或导丝装置及其使用
CN105874606B (zh) 2014-01-06 2021-01-12 Mc10股份有限公司 包封适形电子系统和器件及其制作和使用方法
CN105899157B (zh) 2014-01-06 2019-08-09 波士顿科学国际有限公司 抗撕裂柔性电路组件
US9795436B2 (en) 2014-01-07 2017-10-24 Ethicon Llc Harvesting energy from a surgical generator
WO2015104672A2 (en) 2014-01-10 2015-07-16 Tylerton International Holdings Inc. Detection of scar and fibrous cardiac zones
EP3424453A1 (en) 2014-02-04 2019-01-09 Boston Scientific Scimed, Inc. Alternative placement of thermal sensors on bipolar electrode
US11000679B2 (en) 2014-02-04 2021-05-11 Boston Scientific Scimed, Inc. Balloon protection and rewrapping devices and related methods of use
JP2017505215A (ja) * 2014-02-07 2017-02-16 ベルブ メディカル， インコーポレイテッド 腎盂の切除のための方法およびシステム
KR20160129007A (ko) 2014-03-04 2016-11-08 엠씨10, 인크 전자 디바이스를 위한 다부분 유연성 봉지 하우징
US9554854B2 (en) 2014-03-18 2017-01-31 Ethicon Endo-Surgery, Llc Detecting short circuits in electrosurgical medical devices
US10092310B2 (en) 2014-03-27 2018-10-09 Ethicon Llc Electrosurgical devices
US9737355B2 (en) 2014-03-31 2017-08-22 Ethicon Llc Controlling impedance rise in electrosurgical medical devices
US9999463B2 (en) 2014-04-14 2018-06-19 NeuroMedic, Inc. Monitoring nerve activity
US9913680B2 (en) 2014-04-15 2018-03-13 Ethicon Llc Software algorithms for electrosurgical instruments
US10610292B2 (en) 2014-04-25 2020-04-07 Medtronic Ardian Luxembourg S.A.R.L. Devices, systems, and methods for monitoring and/or controlling deployment of a neuromodulation element within a body lumen and related technology
CN106659531A (zh) 2014-05-07 2017-05-10 毕达哥拉斯医疗有限公司 受控组织消融技术
WO2015179662A1 (en) 2014-05-22 2015-11-26 Aegea Medical Inc. Integrity testing method and apparatus for delivering vapor to the uterus
CN106794030B (zh) 2014-05-22 2019-09-03 埃杰亚医疗公司 用于执行子宫内膜消融术的系统和方法
US10285724B2 (en) 2014-07-31 2019-05-14 Ethicon Llc Actuation mechanisms and load adjustment assemblies for surgical instruments
EP3200712B1 (en) 2014-10-01 2020-11-25 Medtronic Ardian Luxembourg S.à.r.l. Systems for evaluating neuromodulation therapy via hemodynamic responses
US9899330B2 (en) 2014-10-03 2018-02-20 Mc10, Inc. Flexible electronic circuits with embedded integrated circuit die
US10297572B2 (en) 2014-10-06 2019-05-21 Mc10, Inc. Discrete flexible interconnects for modules of integrated circuits
USD781270S1 (en) 2014-10-15 2017-03-14 Mc10, Inc. Electronic device having antenna
EP3220844B1 (en) 2014-11-19 2020-11-11 EPiX Therapeutics, Inc. Systems for high-resolution mapping of tissue
WO2016081611A1 (en) 2014-11-19 2016-05-26 Advanced Cardiac Therapeutics, Inc. High-resolution mapping of tissue with pacing
SG11201703943VA (en) 2014-11-19 2017-06-29 Advanced Cardiac Therapeutics Inc Ablation devices, systems and methods of using a high-resolution electrode assembly
US10639092B2 (en) 2014-12-08 2020-05-05 Ethicon Llc Electrode configurations for surgical instruments
WO2016100720A1 (en) * 2014-12-17 2016-06-23 Medtronic Ardian Luxembourg S.A.R.L. Systems and methods for assessing sympathetic nervous system tone for renal neuromodulation therapy
US11534239B2 (en) 2014-12-22 2022-12-27 Biosense Webster (Israel) Ltd. Systems and method or uses of ablating cardiac tissue
US10376308B2 (en) 2015-02-05 2019-08-13 Axon Therapies, Inc. Devices and methods for treatment of heart failure by splanchnic nerve ablation
US10245095B2 (en) 2015-02-06 2019-04-02 Ethicon Llc Electrosurgical instrument with rotation and articulation mechanisms
CN107530004A (zh) 2015-02-20 2018-01-02 Mc10股份有限公司 基于贴身状况、位置和/或取向的可穿戴式设备的自动检测和构造
US10398343B2 (en) 2015-03-02 2019-09-03 Mc10, Inc. Perspiration sensor
US10595929B2 (en) 2015-03-24 2020-03-24 Ethicon Llc Surgical instruments with firing system overload protection mechanisms
US9636164B2 (en) 2015-03-25 2017-05-02 Advanced Cardiac Therapeutics, Inc. Contact sensing systems and methods
US10383685B2 (en) 2015-05-07 2019-08-20 Pythagoras Medical Ltd. Techniques for use with nerve tissue
US10765470B2 (en) 2015-06-30 2020-09-08 Ethicon Llc Surgical system with user adaptable techniques employing simultaneous energy modalities based on tissue parameters
US11051873B2 (en) 2015-06-30 2021-07-06 Cilag Gmbh International Surgical system with user adaptable techniques employing multiple energy modalities based on tissue parameters
US10898256B2 (en) 2015-06-30 2021-01-26 Ethicon Llc Surgical system with user adaptable techniques based on tissue impedance
US11129669B2 (en) 2015-06-30 2021-09-28 Cilag Gmbh International Surgical system with user adaptable techniques based on tissue type
US10034704B2 (en) 2015-06-30 2018-07-31 Ethicon Llc Surgical instrument with user adaptable algorithms
US20170007157A1 (en) * 2015-07-08 2017-01-12 Rainbow Medical Ltd. Electrical-signal-based electrode-tissue contact detection
WO2017015000A1 (en) 2015-07-17 2017-01-26 Mc10, Inc. Conductive stiffener, method of making a conductive stiffener, and conductive adhesive and encapsulation layers
WO2017031129A1 (en) 2015-08-19 2017-02-23 Mc10, Inc. Wearable heat flux devices and methods of use
US11058475B2 (en) 2015-09-30 2021-07-13 Cilag Gmbh International Method and apparatus for selecting operations of a surgical instrument based on user intention
CN108290070A (zh) 2015-10-01 2018-07-17 Mc10股份有限公司 用于与虚拟环境相互作用的方法和系统
CN108289630A (zh) 2015-10-05 2018-07-17 Mc10股份有限公司 用于神经调节和刺激的方法和系统
US10207110B1 (en) 2015-10-13 2019-02-19 Axon Therapies, Inc. Devices and methods for treatment of heart failure via electrical modulation of a splanchnic nerve
US10595930B2 (en) 2015-10-16 2020-03-24 Ethicon Llc Electrode wiping surgical device
US10285751B2 (en) * 2015-10-16 2019-05-14 Biosense Webster (Israel) Ltd. System and method for controlling catheter power based on renal ablation response
DE102015226846A1 (de) * 2015-12-30 2017-07-06 Olympus Winter & Ibe Gmbh Elektrochirurgiesystem zum Generieren von hochfrequentem Wechselstrom
US10575892B2 (en) 2015-12-31 2020-03-03 Ethicon Llc Adapter for electrical surgical instruments
US10828058B2 (en) 2016-01-15 2020-11-10 Ethicon Llc Modular battery powered handheld surgical instrument with motor control limits based on tissue characterization
US11129670B2 (en) 2016-01-15 2021-09-28 Cilag Gmbh International Modular battery powered handheld surgical instrument with selective application of energy based on button displacement, intensity, or local tissue characterization
US11229471B2 (en) 2016-01-15 2022-01-25 Cilag Gmbh International Modular battery powered handheld surgical instrument with selective application of energy based on tissue characterization
US10716615B2 (en) 2016-01-15 2020-07-21 Ethicon Llc Modular battery powered handheld surgical instrument with curved end effectors having asymmetric engagement between jaw and blade
US11331037B2 (en) 2016-02-19 2022-05-17 Aegea Medical Inc. Methods and apparatus for determining the integrity of a bodily cavity
US10555769B2 (en) 2016-02-22 2020-02-11 Ethicon Llc Flexible circuits for electrosurgical instrument
US10277386B2 (en) 2016-02-22 2019-04-30 Mc10, Inc. System, devices, and method for on-body data and power transmission
WO2017147053A1 (en) 2016-02-22 2017-08-31 Mc10, Inc. System, device, and method for coupled hub and sensor node on-body acquisition of sensor information
SG11201807618QA (en) 2016-03-15 2018-10-30 Epix Therapeutics Inc Improved devices, systems and methods for irrigated ablation
WO2017165684A1 (en) * 2016-03-24 2017-09-28 Boston Scientific Scimed Inc. Regional flow sensor on cardiac catheter
CN109310340A (zh) 2016-04-19 2019-02-05 Mc10股份有限公司 用于测量汗液的方法和系统
US10485607B2 (en) 2016-04-29 2019-11-26 Ethicon Llc Jaw structure with distal closure for electrosurgical instruments
US10702329B2 (en) 2016-04-29 2020-07-07 Ethicon Llc Jaw structure with distal post for electrosurgical instruments
US10646269B2 (en) 2016-04-29 2020-05-12 Ethicon Llc Non-linear jaw gap for electrosurgical instruments
US10456193B2 (en) 2016-05-03 2019-10-29 Ethicon Llc Medical device with a bilateral jaw configuration for nerve stimulation
JP2019523108A (ja) * 2016-05-05 2019-08-22 ベストブレイン リミテッド ニューロフィードバックシステムおよび方法
EP3457975A2 (en) 2016-05-18 2019-03-27 Pythagoras Medical Ltd. Helical catheter
US10524859B2 (en) 2016-06-07 2020-01-07 Metavention, Inc. Therapeutic tissue modulation devices and methods
DK3474760T3 (da) * 2016-06-27 2023-03-20 Galvanize Therapeutics Inc Generator og et kateter med en elektrode til at behandle en lungepassage
JP7217230B2 (ja) 2016-07-29 2023-02-02 アクソン セラピーズ，インク． 内臓神経アブレーションによる心不全の治療の為のデバイス、システム及び方法
US10376305B2 (en) 2016-08-05 2019-08-13 Ethicon Llc Methods and systems for advanced harmonic energy
US10447347B2 (en) 2016-08-12 2019-10-15 Mc10, Inc. Wireless charger and high speed data off-loader
EP3496642B1 (en) * 2016-10-04 2021-11-17 St. Jude Medical, Cardiology Division, Inc. Devices for estimating tip-tissue coupling of an ablation catheter tip
US10905492B2 (en) 2016-11-17 2021-02-02 Angiodynamics, Inc. Techniques for irreversible electroporation using a single-pole tine-style internal device communicating with an external surface electrode
US11400205B2 (en) 2016-11-23 2022-08-02 Biosense Webster (Israel) Ltd. Balloon-in-balloon irrigation balloon catheter
US11266430B2 (en) 2016-11-29 2022-03-08 Cilag Gmbh International End effector control and calibration
CN110809448B (zh) 2017-04-27 2022-11-25 Epix疗法公司 确定导管尖端与组织之间接触的性质
US11911045B2 (en) 2017-10-30 2024-02-27 Cllag GmbH International Method for operating a powered articulating multi-clip applier
US11801098B2 (en) 2017-10-30 2023-10-31 Cilag Gmbh International Method of hub communication with surgical instrument systems
US11759224B2 (en) 2017-10-30 2023-09-19 Cilag Gmbh International Surgical instrument systems comprising handle arrangements
US11304749B2 (en) 2017-11-17 2022-04-19 Medtronic Ardian Luxembourg S.A.R.L. Systems, devices, and associated methods for neuromodulation with enhanced nerve targeting
WO2019118976A1 (en) 2017-12-17 2019-06-20 Axon Therapies, Inc. Methods and devices for endovascular ablation of a splanchnic nerve
US11659023B2 (en) 2017-12-28 2023-05-23 Cilag Gmbh International Method of hub communication
US11857152B2 (en) 2017-12-28 2024-01-02 Cilag Gmbh International Surgical hub spatial awareness to determine devices in operating theater
US11389164B2 (en) 2017-12-28 2022-07-19 Cilag Gmbh International Method of using reinforced flexible circuits with multiple sensors to optimize performance of radio frequency devices
US11969216B2 (en) 2017-12-28 2024-04-30 Cilag Gmbh International Surgical network recommendations from real time analysis of procedure variables against a baseline highlighting differences from the optimal solution
US10758310B2 (en) 2017-12-28 2020-09-01 Ethicon Llc Wireless pairing of a surgical device with another device within a sterile surgical field based on the usage and situational awareness of devices
US11937769B2 (en) 2017-12-28 2024-03-26 Cilag Gmbh International Method of hub communication, processing, storage and display
US11633237B2 (en) 2017-12-28 2023-04-25 Cilag Gmbh International Usage and technique analysis of surgeon / staff performance against a baseline to optimize device utilization and performance for both current and future procedures
US11896443B2 (en) 2017-12-28 2024-02-13 Cilag Gmbh International Control of a surgical system through a surgical barrier
US11744604B2 (en) 2017-12-28 2023-09-05 Cilag Gmbh International Surgical instrument with a hardware-only control circuit
US11832899B2 (en) 2017-12-28 2023-12-05 Cilag Gmbh International Surgical systems with autonomously adjustable control programs
US11844579B2 (en) 2017-12-28 2023-12-19 Cilag Gmbh International Adjustments based on airborne particle properties
US11013563B2 (en) 2017-12-28 2021-05-25 Ethicon Llc Drive arrangements for robot-assisted surgical platforms
US11998193B2 (en) 2017-12-28 2024-06-04 Cilag Gmbh International Method for usage of the shroud as an aspect of sensing or controlling a powered surgical device, and a control algorithm to adjust its default operation
US11166772B2 (en) 2017-12-28 2021-11-09 Cilag Gmbh International Surgical hub coordination of control and communication of operating room devices
US11969142B2 (en) 2017-12-28 2024-04-30 Cilag Gmbh International Method of compressing tissue within a stapling device and simultaneously displaying the location of the tissue within the jaws
US11818052B2 (en) 2017-12-28 2023-11-14 Cilag Gmbh International Surgical network determination of prioritization of communication, interaction, or processing based on system or device needs
US20190201146A1 (en) 2017-12-28 2019-07-04 Ethicon Llc Safety systems for smart powered surgical stapling
US11257589B2 (en) 2017-12-28 2022-02-22 Cilag Gmbh International Real-time analysis of comprehensive cost of all instrumentation used in surgery utilizing data fluidity to track instruments through stocking and in-house processes
US11666331B2 (en) 2017-12-28 2023-06-06 Cilag Gmbh International Systems for detecting proximity of surgical end effector to cancerous tissue
US11202570B2 (en) 2017-12-28 2021-12-21 Cilag Gmbh International Communication hub and storage device for storing parameters and status of a surgical device to be shared with cloud based analytics systems
US11132462B2 (en) 2017-12-28 2021-09-28 Cilag Gmbh International Data stripping method to interrogate patient records and create anonymized record
US11109866B2 (en) 2017-12-28 2021-09-07 Cilag Gmbh International Method for circular stapler control algorithm adjustment based on situational awareness
US11896322B2 (en) 2017-12-28 2024-02-13 Cilag Gmbh International Sensing the patient position and contact utilizing the mono-polar return pad electrode to provide situational awareness to the hub
US11786251B2 (en) 2017-12-28 2023-10-17 Cilag Gmbh International Method for adaptive control schemes for surgical network control and interaction
US11786245B2 (en) 2017-12-28 2023-10-17 Cilag Gmbh International Surgical systems with prioritized data transmission capabilities
US11771487B2 (en) 2017-12-28 2023-10-03 Cilag Gmbh International Mechanisms for controlling different electromechanical systems of an electrosurgical instrument
US11903601B2 (en) 2017-12-28 2024-02-20 Cilag Gmbh International Surgical instrument comprising a plurality of drive systems
US11864728B2 (en) 2017-12-28 2024-01-09 Cilag Gmbh International Characterization of tissue irregularities through the use of mono-chromatic light refractivity
US11026751B2 (en) 2017-12-28 2021-06-08 Cilag Gmbh International Display of alignment of staple cartridge to prior linear staple line
US10892995B2 (en) 2017-12-28 2021-01-12 Ethicon Llc Surgical network determination of prioritization of communication, interaction, or processing based on system or device needs
US11678881B2 (en) 2017-12-28 2023-06-20 Cilag Gmbh International Spatial awareness of surgical hubs in operating rooms
US11154352B2 (en) * 2018-01-23 2021-10-26 Biosense Webster (Israel) Ltd. Power controlled short duration ablation with varying temperature limits
US10786306B2 (en) 2018-01-24 2020-09-29 Medtronic Ardian Luxembourg S.A.R.L. Denervation therapy
US10959669B2 (en) 2018-01-24 2021-03-30 Medtronic Ardian Luxembourg S.A.R.L. Systems and methods for assessing the efficacy of neuromodulation therapy
US20190223754A1 (en) * 2018-01-24 2019-07-25 Medtronic Ardian Luxembourg S.A.R.L. Systems, devices, and methods for assessing efficacy of renal neuromodulation therapy
US11253189B2 (en) 2018-01-24 2022-02-22 Medtronic Ardian Luxembourg S.A.R.L. Systems, devices, and methods for evaluating neuromodulation therapy via detection of magnetic fields
US11717343B2 (en) 2018-01-24 2023-08-08 Medtronic Ireland Manufacturing Unlimited Company Systems, devices, and associated methods for neuromodulation in heterogeneous tissue environments
JP7334167B2 (ja) 2018-01-26 2023-08-28 アクソン セラピーズ，インク． 内臓神経の血管内アブレーションの為の方法及びデバイス
US11259830B2 (en) 2018-03-08 2022-03-01 Cilag Gmbh International Methods for controlling temperature in ultrasonic device
US11701162B2 (en) 2018-03-08 2023-07-18 Cilag Gmbh International Smart blade application for reusable and disposable devices
US11707293B2 (en) 2018-03-08 2023-07-25 Cilag Gmbh International Ultrasonic sealing algorithm with temperature control
US11090047B2 (en) 2018-03-28 2021-08-17 Cilag Gmbh International Surgical instrument comprising an adaptive control system
US11259806B2 (en) 2018-03-28 2022-03-01 Cilag Gmbh International Surgical stapling devices with features for blocking advancement of a camming assembly of an incompatible cartridge installed therein
US11633120B2 (en) 2018-09-04 2023-04-25 Medtronic Ardian Luxembourg S.A.R.L. Systems and methods for assessing efficacy of renal neuromodulation therapy
CN113038895A (zh) * 2018-09-14 2021-06-25 伯恩森斯韦伯斯特(以色列)有限责任公司 用于消融心脏组织的系统
WO2020053831A1 (en) * 2018-09-14 2020-03-19 Biosense Webster (Israel) Ltd. Systems for ablating cardiac tissue
US11071585B2 (en) 2018-09-14 2021-07-27 Biosense Webster (Israel) Ltd. Systems and methods of ablating cardiac tissue
CN109793568B (zh) * 2019-01-30 2020-12-01 苏州信迈医疗器械有限公司 一种多极消融装置
US11751872B2 (en) 2019-02-19 2023-09-12 Cilag Gmbh International Insertable deactivator element for surgical stapler lockouts
US11298129B2 (en) 2019-02-19 2022-04-12 Cilag Gmbh International Method for providing an authentication lockout in a surgical stapler with a replaceable cartridge
US11779391B2 (en) * 2019-02-28 2023-10-10 Biosense Webster (Israel) Ltd. Forming a lesion based on pre-determined amount of abaltive energy vs lesion size curve
JP2020146208A (ja) * 2019-03-13 2020-09-17 オムロンヘルスケア株式会社 治療機器、治療システム、治療機器の制御方法、及び治療機器の制御方法プログラム
WO2020257763A1 (en) 2019-06-20 2020-12-24 Axon Therapies, Inc. Methods and devices for endovascular ablation of a splanchnic nerve
DE102019121375A1 (de) * 2019-08-07 2021-02-25 Aesculap Ag Vorrichtung und Verfahren zur Bestimmung eines Abschaltzeitpunktes eines medizinischen Instruments
WO2021050767A1 (en) 2019-09-12 2021-03-18 Relievant Medsystems, Inc. Systems and methods for tissue modulation
WO2021086987A1 (en) * 2019-10-31 2021-05-06 Medtronic Ardian Luxembourg S.A.R.L. Adjustment of renal denervation energy delivery
US11744636B2 (en) 2019-12-30 2023-09-05 Cilag Gmbh International Electrosurgical systems with integrated and external power sources
US11944366B2 (en) 2019-12-30 2024-04-02 Cilag Gmbh International Asymmetric segmented ultrasonic support pad for cooperative engagement with a movable RF electrode
US11696776B2 (en) 2019-12-30 2023-07-11 Cilag Gmbh International Articulatable surgical instrument
US11684412B2 (en) 2019-12-30 2023-06-27 Cilag Gmbh International Surgical instrument with rotatable and articulatable surgical end effector
US11779329B2 (en) 2019-12-30 2023-10-10 Cilag Gmbh International Surgical instrument comprising a flex circuit including a sensor system
US11937863B2 (en) 2019-12-30 2024-03-26 Cilag Gmbh International Deflectable electrode with variable compression bias along the length of the deflectable electrode
US11452525B2 (en) 2019-12-30 2022-09-27 Cilag Gmbh International Surgical instrument comprising an adjustment system
US11986201B2 (en) 2019-12-30 2024-05-21 Cilag Gmbh International Method for operating a surgical instrument
US20210196363A1 (en) 2019-12-30 2021-07-01 Ethicon Llc Electrosurgical instrument with electrodes operable in bipolar and monopolar modes
US11911063B2 (en) 2019-12-30 2024-02-27 Cilag Gmbh International Techniques for detecting ultrasonic blade to electrode contact and reducing power to ultrasonic blade
US11786294B2 (en) 2019-12-30 2023-10-17 Cilag Gmbh International Control program for modular combination energy device
US11660089B2 (en) 2019-12-30 2023-05-30 Cilag Gmbh International Surgical instrument comprising a sensing system
US11589916B2 (en) 2019-12-30 2023-02-28 Cilag Gmbh International Electrosurgical instruments with electrodes having variable energy densities
US11779387B2 (en) 2019-12-30 2023-10-10 Cilag Gmbh International Clamp arm jaw to minimize tissue sticking and improve tissue control
US11786291B2 (en) 2019-12-30 2023-10-17 Cilag Gmbh International Deflectable support of RF energy electrode with respect to opposing ultrasonic blade
US11812957B2 (en) 2019-12-30 2023-11-14 Cilag Gmbh International Surgical instrument comprising a signal interference resolution system
US11950797B2 (en) 2019-12-30 2024-04-09 Cilag Gmbh International Deflectable electrode with higher distal bias relative to proximal bias
US12023086B2 (en) 2019-12-30 2024-07-02 Cilag Gmbh International Electrosurgical instrument for delivering blended energy modalities to tissue
AU2021208701A1 (en) 2020-01-17 2022-07-07 Axon Therapies, Inc. Methods and devices for endovascular ablation of a splanchnic nerve
CN113941088A (zh) * 2020-07-17 2022-01-18 纽罗西格玛公司 用于三叉神经刺激的脉冲发生器
US11974803B2 (en) 2020-10-12 2024-05-07 Biosense Webster (Israel) Ltd. Basket catheter with balloon
CN112791262B (zh) * 2020-12-31 2023-02-03 杭州堃博生物科技有限公司 射频操作数据调控方法、装置及注射泵
US11957852B2 (en) 2021-01-14 2024-04-16 Biosense Webster (Israel) Ltd. Intravascular balloon with slidable central irrigation tube
CN114191707B (zh) * 2021-12-15 2022-12-23 广东花至美容科技有限公司 基于皮肤阻抗的美容仪射频功率控制方法及设备
CN114052896A (zh) * 2021-12-17 2022-02-18 苏州润迈德医疗科技有限公司 一种消融导管效果参数测评方法和测评装置

Citations (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP1169976A1 (en) * 2000-07-07 2002-01-09 Biosense, Inc. Multi-electrode catheter, system and method
US20020123738A1 (en) * 1998-06-11 2002-09-05 Target Therapeutics, Inc. Catheter with composite stiffener
WO2006041881A2 (en) * 2004-10-05 2006-04-20 Ardian, Inc. Methods and apparatus for renal neuromodulation
US20060247618A1 (en) * 2004-11-05 2006-11-02 Asthmatx, Inc. Medical device with procedure improvement features
US20070208336A1 (en) * 2006-01-27 2007-09-06 David Kim Ablation device and system for guiding ablation device into body
US20080051704A1 (en) * 2006-08-28 2008-02-28 Patel Rajnikant V Catheter and system for using same
US20100168739A1 (en) * 2008-12-31 2010-07-01 Ardian, Inc. Apparatus, systems, and methods for achieving intravascular, thermally-induced renal neuromodulation

Family Cites Families (781)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US2130758A (en) 1935-06-01 1938-09-20 E J Rose Mfg Company Of Califo Electrode for diathermy treatment and the like
US2276995A (en) 1938-01-22 1942-03-17 A J Ginsberg Electrotherapy
US2276996A (en) 1940-11-30 1942-03-17 A J Ginsberg Non-radio-interfering therapeutic apparatus
US3181535A (en) 1957-10-04 1965-05-04 Diapulse Mfg Corp Of America Athermapeutic apparatus
US3043310A (en) 1959-04-24 1962-07-10 Diapulse Mfg Corp Of America Treatment head for athermapeutic apparatus
US3127895A (en) 1962-07-02 1964-04-07 Dynapower System Corp Therapeutic pulse generation and control circuit
US3270746A (en) 1963-08-26 1966-09-06 Dynapower Systems Corp High-performance electrotherapeutic treatment head
US3329149A (en) 1964-10-28 1967-07-04 Dynapower Systems Corp Of Cali Supporting arm for electrotherapeutic treatment head
US3563246A (en) 1967-04-24 1971-02-16 Intelectron Corp Method and apparatus for improving neural performance in human subjects by electrotherapy
US3522811A (en) 1969-02-13 1970-08-04 Medtronic Inc Implantable nerve stimulator and method of use
SE346468B (zh) 1969-02-24 1972-07-10 Lkb Medical Ab
US3670737A (en) 1970-07-02 1972-06-20 Diapulse Corp Of America Ultra-short wave athermapeutic apparatus
US3760812A (en) 1971-03-19 1973-09-25 Univ Minnesota Implantable spiral wound stimulation electrodes
US3774620A (en) 1971-06-14 1973-11-27 Nemectron Gmbh Electromedicinal apparatus for interference current therapy
US3895639A (en) 1971-09-07 1975-07-22 Rodler Ing Hans Apparatus for producing an interference signal at a selected location
US3800802A (en) 1972-01-07 1974-04-02 Int Medical Electronics Ltd Short-wave therapy apparatus
US3794022A (en) 1972-06-30 1974-02-26 E Nawracaj Dual oscillator, variable pulse duration electrotherapeutic device
US3803463A (en) 1972-07-10 1974-04-09 J Cover Weapon for immobilization and capture
US3897789A (en) 1973-09-13 1975-08-05 Stanley J Blanchard Acupuncture apparatus
US3894532A (en) 1974-01-17 1975-07-15 Acupulse Inc Instruments for transcutaneous and subcutaneous investigation and treatment
US3911930A (en) 1974-03-01 1975-10-14 Stimulation Tech Method and structure of preventing and treating ileus, and reducing acute pain by electrical pulse stimulation
US4011861A (en) 1974-04-03 1977-03-15 Case Western Reserve University Implantable electric terminal for organic tissue
US4055190A (en) 1974-12-19 1977-10-25 Michio Tany Electrical therapeutic apparatus
US3952751A (en) 1975-01-08 1976-04-27 W. Denis Kendall High-performance electrotherapeutic apparatus
US4026300A (en) 1975-03-14 1977-05-31 Liberty Mutual Method and apparatus for interfacing to nerves
US3987790A (en) 1975-10-01 1976-10-26 Alza Corporation Osmotically driven fluid dispenser
US4315503A (en) 1976-11-17 1982-02-16 Electro-Biology, Inc. Modification of the growth, repair and maintenance behavior of living tissues and cells by a specific and selective change in electrical environment
US4105017A (en) 1976-11-17 1978-08-08 Electro-Biology, Inc. Modification of the growth repair and maintenance behavior of living tissue and cells by a specific and selective change in electrical environment
US4266532A (en) 1976-11-17 1981-05-12 Electro-Biology, Inc. Modification of the growth, repair and maintenance behavior of living tissues and cells by a specific and selective change in electrical environment
US4071033A (en) 1976-12-20 1978-01-31 Nawracaj Edward P Electrotherapeutic device with modulated dual signals
US4141365A (en) 1977-02-24 1979-02-27 The Johns Hopkins University Epidural lead electrode and insertion needle
US4360019A (en) 1979-02-28 1982-11-23 Andros Incorporated Implantable infusion device
US4305115A (en) 1979-03-14 1981-12-08 Harry H. Leveen Electrostatic shield
US4692147A (en) 1980-04-02 1987-09-08 Medtronic, Inc. Drug administration device
US4405305A (en) 1980-10-27 1983-09-20 University Of Utah Research Foundation Subcutaneous peritoneal injection catheter
US4379462A (en) 1980-10-29 1983-04-12 Neuromed, Inc. Multi-electrode catheter assembly for spinal cord stimulation
CS226514B1 (en) 1981-01-28 1984-04-16 Petr Ing Csc Slovak Apparatus for stimulating live tissues
US4454883A (en) 1982-02-16 1984-06-19 Therafield Holdings Limited Electrotherapeutic apparatus
US4530840A (en) 1982-07-29 1985-07-23 The Stolle Research And Development Corporation Injectable, long-acting microparticle formulation for the delivery of anti-inflammatory agents
US4467808A (en) 1982-09-17 1984-08-28 Biolectron, Inc. Method for preventing and treating osteoporosis in a living body by using electrical stimulation non-invasively
US4487603A (en) 1982-11-26 1984-12-11 Cordis Corporation Implantable microinfusion pump system
FR2541902B1 (fr) 1983-03-04 1986-02-07 Cofrem International Sa Appareil therapeutique athermique
AU577549B2 (en) 1983-09-14 1988-09-29 Jacob Zabara Neurocybernetic prothesis
JPS60100516A (ja) 1983-11-04 1985-06-04 Takeda Chem Ind Ltd 徐放型マイクロカプセルの製造法
US4816016A (en) 1984-03-16 1989-03-28 Pudenz-Schulte Medical Research Corp. Subcutaneous infusion reservoir and pump system
US4618600A (en) 1984-04-19 1986-10-21 Biotechnology Research Associates, J.V. Novel polypeptide diuretic/vasodilators
JPS6023729A (ja) 1984-05-31 1985-02-06 Matsushita Electric Ind Co Ltd 給湯器
US4587975A (en) 1984-07-02 1986-05-13 Cardiac Pacemakers, Inc. Dimension sensitive angioplasty catheter
US4674482A (en) 1984-09-12 1987-06-23 Irt, Inc. Pulse electro-magnetic field therapy device with auto bias circuit
US4602624A (en) 1984-10-11 1986-07-29 Case Western Reserve University Implantable cuff, method of manufacture, and method of installation
US4608985A (en) 1984-10-11 1986-09-02 Case Western Reserve University Antidromic pulse generating wave form for collision blocking
US4649936A (en) 1984-10-11 1987-03-17 Case Western Reserve University Asymmetric single electrode cuff for generation of unidirectionally propagating action potentials for collision blocking
US4865845A (en) 1986-03-21 1989-09-12 Alza Corporation Release rate adjustment of osmotic or diffusional delivery devices
US4709698A (en) 1986-05-14 1987-12-01 Thomas J. Fogarty Heatable dilation catheter
US5014699A (en) 1986-05-23 1991-05-14 Trustees Of The University Of Pennsylvania Electromagnetic method and apparatus for healing living tissue
US4998532A (en) 1986-05-23 1991-03-12 Lti Biomedical, Inc. Portable electro-therapy system
US4715852A (en) 1986-07-21 1987-12-29 Eaton Corporation Implanted medication infusion device
US4774967A (en) 1986-09-09 1988-10-04 American Biointerface Corporation Method and apparatus for mammalian nerve regeneration
US4791931A (en) 1987-08-13 1988-12-20 Pacesetter Infusion, Ltd. Demand pacemaker using an artificial baroreceptor reflex
US4852573A (en) 1987-12-04 1989-08-01 Kennedy Philip R Implantable neural electrode
DE68925030T2 (de) 1988-01-21 1996-07-25 Massachusetts Inst Technology Molekültransport durch gewebe mit der verwendung von elektroporation.
US5389069A (en) 1988-01-21 1995-02-14 Massachusetts Institute Of Technology Method and apparatus for in vivo electroporation of remote cells and tissue
US4890623A (en) 1988-03-14 1990-01-02 C. R. Bard, Inc. Biopotential sensing device and method for making
CA1319174C (en) 1988-04-21 1993-06-15 Lawrence E. Bertolucci Electrical nerve stimulation device for nausea control
US4955377A (en) 1988-10-28 1990-09-11 Lennox Charles D Device and method for heating tissue in a patient's body
US5094242A (en) 1988-11-07 1992-03-10 Regents Of The University Of California Implantable nerve stimulation device
US5059423A (en) 1988-12-13 1991-10-22 Alza Corporation Delivery system comprising biocompatible beneficial agent formulation
US5057318A (en) 1988-12-13 1991-10-15 Alza Corporation Delivery system for beneficial agent over a broad range of rates
US5458631A (en) 1989-01-06 1995-10-17 Xavier; Ravi Implantable catheter with electrical pulse nerve stimulators and drug delivery system
WO1990007303A1 (en) 1989-01-06 1990-07-12 Angioplasty Systems, Inc. Electrosurgical catheter for resolving atherosclerotic plaque
US5779698A (en) 1989-01-18 1998-07-14 Applied Medical Resources Corporation Angioplasty catheter system and method for making same
US5125928A (en) 1989-04-13 1992-06-30 Everest Medical Corporation Ablation catheter with selectively deployable electrodes
US4976711A (en) 1989-04-13 1990-12-11 Everest Medical Corporation Ablation catheter with selectively deployable electrodes
US5006119A (en) 1989-05-25 1991-04-09 Engineering & Research Associates, Inc. Hollow core coaxial catheter
US20030220521A1 (en) 1989-07-27 2003-11-27 G.D. Searle & Co. Renal-selective prodrugs for control of renal sympathetic nerve activity in the treatment of hypertension
US5112614A (en) 1989-09-14 1992-05-12 Alza Corporation Implantable delivery dispenser
RU1785710C (en) 1989-10-06 1993-01-07 Vremennyj Nauchnyj Kollektiv O Microwave resonant therapeutic device
US4979511A (en) 1989-11-03 1990-12-25 Cyberonics, Inc. Strain relief tether for implantable electrode
US5188837A (en) 1989-11-13 1993-02-23 Nova Pharmaceutical Corporation Lipsopheres for controlled delivery of substances
US5851206A (en) 1990-03-13 1998-12-22 The Regents Of The University Of California Method and apparatus for endovascular thermal thrombosis and thermal cancer treatment
US5193048A (en) 1990-04-27 1993-03-09 Kaufman Dennis R Stun gun with low battery indicator and shutoff timer
US5184617A (en) 1990-06-05 1993-02-09 Staodyn, Inc. Output pulse compensation for therapeutic-type electronic devices
US5095905A (en) 1990-06-07 1992-03-17 Medtronic, Inc. Implantable neural electrode
ATE123658T1 (de) 1990-06-15 1995-06-15 Cortrak Medical Inc Vorrichtung zur abgabe von medikamenten.
US5498238A (en) 1990-06-15 1996-03-12 Cortrak Medical, Inc. Simultaneous angioplasty and phoretic drug delivery
US5499971A (en) 1990-06-15 1996-03-19 Cortrak Medical, Inc. Method for iontophoretically delivering drug adjacent to a heart
US5234693A (en) 1990-07-11 1993-08-10 Alza Corporation Delivery device with a protective sleeve
US5234692A (en) 1990-07-11 1993-08-10 Alza Corporation Delivery device with a protective sleeve
US5058584A (en) 1990-08-30 1991-10-22 Medtronic, Inc. Method and apparatus for epidural burst stimulation for angina pectoris
US5111815A (en) 1990-10-15 1992-05-12 Cardiac Pacemakers, Inc. Method and apparatus for cardioverter/pacer utilizing neurosensing
EP0491979A1 (de) 1990-12-22 1992-07-01 Peter Dr. Ing. Osypka Herzschrittmacher-Katheter mit zwei Polen
US5324255A (en) 1991-01-11 1994-06-28 Baxter International Inc. Angioplasty and ablative devices having onboard ultrasound components and devices and methods for utilizing ultrasound to treat or prevent vasopasm
US5263480A (en) 1991-02-01 1993-11-23 Cyberonics, Inc. Treatment of eating disorders by nerve stimulation
US5425364A (en) 1991-02-15 1995-06-20 Cardiac Pathways Corporation Flexible strip assembly without feedthrough holes and device utilizing the same
US5269303A (en) 1991-02-22 1993-12-14 Cyberonics, Inc. Treatment of dementia by nerve stimulation
US5199428A (en) 1991-03-22 1993-04-06 Medtronic, Inc. Implantable electrical nerve stimulator/pacemaker with ischemia for decreasing cardiac workload
US5215086A (en) 1991-05-03 1993-06-01 Cyberonics, Inc. Therapeutic treatment of migraine symptoms by stimulation
US5335657A (en) 1991-05-03 1994-08-09 Cyberonics, Inc. Therapeutic treatment of sleep disorder by nerve stimulation
US5299569A (en) 1991-05-03 1994-04-05 Cyberonics, Inc. Treatment of neuropsychiatric disorders by nerve stimulation
US5251634A (en) 1991-05-03 1993-10-12 Cyberonics, Inc. Helical nerve electrode
US5458568A (en) 1991-05-24 1995-10-17 Cortrak Medical, Inc. Porous balloon for selective dilatation and drug delivery
WO1992020291A1 (en) 1991-05-24 1992-11-26 Applied Medical Resources, Inc. Articulating tissue cutter assembly
US5472443A (en) 1991-06-07 1995-12-05 Hemostatic Surgery Corporation Electrosurgical apparatus employing constant voltage and methods of use
US5137727A (en) 1991-06-12 1992-08-11 Alza Corporation Delivery device providing beneficial agent stability
US5766151A (en) 1991-07-16 1998-06-16 Heartport, Inc. Endovascular system for arresting the heart
US5213098A (en) 1991-07-26 1993-05-25 Medtronic, Inc. Post-extrasystolic potentiation stimulation with physiologic sensor feedback
US5222494A (en) 1991-07-31 1993-06-29 Cyberonics, Inc. Implantable tissue stimulator output stabilization system
US5231988A (en) 1991-08-09 1993-08-03 Cyberonics, Inc. Treatment of endocrine disorders by nerve stimulation
JPH07502423A (ja) 1991-10-03 1995-03-16 ザ　ゼネラル　ホスピタル　コーポレーション 血管拡張のための装置および方法
US5215089A (en) 1991-10-21 1993-06-01 Cyberonics, Inc. Electrode assembly for nerve stimulation
CA2106408A1 (en) 1991-11-08 1993-05-09 Stuart D. Edwards Systems and methods for ablating tissue while monitoring tissue impedance
DE69233091T2 (de) 1991-11-08 2004-05-06 Boston Scientific Ltd., St. Michael Ablationselektrode mit isoliertem temperaturmesselement
US5906614A (en) 1991-11-08 1999-05-25 Ep Technologies, Inc. Tissue heating and ablation systems and methods using predicted temperature for monitoring and control
CA2106409A1 (en) 1991-11-08 1993-05-09 Stuart D. Edwards Radiofrequency ablation with phase sensitive power detection
US5304206A (en) 1991-11-18 1994-04-19 Cyberonics, Inc. Activation techniques for implantable medical device
US5358514A (en) 1991-12-18 1994-10-25 Alfred E. Mann Foundation For Scientific Research Implantable microdevice with self-attaching electrodes
US5193540A (en) 1991-12-18 1993-03-16 Alfred E. Mann Foundation For Scientific Research Structure and method of manufacture of an implantable microstimulator
US5193539A (en) 1991-12-18 1993-03-16 Alfred E. Mann Foundation For Scientific Research Implantable microstimulator
US5203326A (en) 1991-12-18 1993-04-20 Telectronics Pacing Systems, Inc. Antiarrhythmia pacer using antiarrhythmia pacing and autonomic nerve stimulation therapy
US5301683A (en) 1991-12-23 1994-04-12 Durkan John A Diagnosing carpal tunnel syndrome
US5697882A (en) 1992-01-07 1997-12-16 Arthrocare Corporation System and method for electrosurgical cutting and ablation
GB9204217D0 (en) 1992-02-27 1992-04-08 Goble Nigel M Cauterising apparatus
AU682146B2 (en) 1992-03-09 1997-09-25 St. George's Hospital Medical School Image neurography and diffusion anisotropy imaging
US5540681A (en) 1992-04-10 1996-07-30 Medtronic Cardiorhythm Method and system for radiofrequency ablation of tissue
US5573533A (en) 1992-04-10 1996-11-12 Medtronic Cardiorhythm Method and system for radiofrequency ablation of cardiac tissue
US5300068A (en) 1992-04-21 1994-04-05 St. Jude Medical, Inc. Electrosurgical apparatus
US5370680A (en) 1992-05-27 1994-12-06 Magnetic Resonance Therapeutics, Inc. Athermapeutic apparatus employing electro-magnetic fields
JP3493196B2 (ja) 1992-06-24 2004-02-03 サイベロニクス，インク． 神経刺激による神経精神障害の治療
US5772590A (en) 1992-06-30 1998-06-30 Cordis Webster, Inc. Cardiovascular catheter with laterally stable basket-shaped electrode array with puller wire
US5304120A (en) 1992-07-01 1994-04-19 Btx Inc. Electroporation method and apparatus for insertion of drugs and genes into endothelial cells
US5507724A (en) 1992-07-01 1996-04-16 Genetronics, Inc. Electroporation and iontophoresis apparatus and method for insertion of drugs and genes into cells
US5542916A (en) 1992-08-12 1996-08-06 Vidamed, Inc. Dual-channel RF power delivery system
US5484400A (en) 1992-08-12 1996-01-16 Vidamed, Inc. Dual channel RF delivery system
DE4229693A1 (de) 1992-09-05 1994-03-10 Achim Dr Hansjuergens Elektrotherapeutisches Gerät
CA2144407C (en) 1992-09-10 2000-05-30 Charles B. Berde Biodegradable polymer matrices for sustained delivery of local anesthetic agents
US5922340A (en) 1992-09-10 1999-07-13 Children's Medical Center Corporation High load formulations and methods for providing prolonged local anesthesia
US5700485A (en) 1992-09-10 1997-12-23 Children's Medical Center Corporation Prolonged nerve blockade by the combination of local anesthetic and glucocorticoid
US5478303A (en) 1992-09-18 1995-12-26 Foley-Nolan; Darragh Electromagnetic apparatus for use in therapy
US5338662A (en) 1992-09-21 1994-08-16 Bio-Preserve Medical Corporation Organ perfusion device
US5553611A (en) 1994-01-06 1996-09-10 Endocardial Solutions, Inc. Endocardial measurement method
WO1994007446A1 (en) 1992-10-05 1994-04-14 Boston Scientific Corporation Device and method for heating tissue
US5634899A (en) 1993-08-20 1997-06-03 Cortrak Medical, Inc. Simultaneous cardiac pacing and local drug delivery method
US5807306A (en) 1992-11-09 1998-09-15 Cortrak Medical, Inc. Polymer matrix drug delivery apparatus
US5342357A (en) 1992-11-13 1994-08-30 American Cardiac Ablation Co., Inc. Fluid cooled electrosurgical cauterization system
WO1994010922A1 (en) 1992-11-13 1994-05-26 Ep Technologies, Inc. Cardial ablation systems using temperature monitoring
US5334193A (en) 1992-11-13 1994-08-02 American Cardiac Ablation Co., Inc. Fluid cooled ablation catheter
US5441483A (en) 1992-11-16 1995-08-15 Avitall; Boaz Catheter deflection control
CA2109980A1 (en) 1992-12-01 1994-06-02 Mir A. Imran Steerable catheter with adjustable bend location and/or radius and method
DK0673530T3 (da) 1992-12-11 1999-03-22 Siemens Medical Systems Inc Parkeringsenhed til et patientovervågningssystem
US5256141A (en) 1992-12-22 1993-10-26 Nelson Gencheff Biological material deployment method and apparatus
US5317155A (en) 1992-12-29 1994-05-31 The Electrogesic Corporation Corona discharge apparatus
US5429634A (en) 1993-09-09 1995-07-04 Pdt Systems Biogenic implant for drug delivery and method
US5792187A (en) 1993-02-22 1998-08-11 Angeion Corporation Neuro-stimulation to control pain during cardioversion defibrillation
US5397338A (en) 1993-03-29 1995-03-14 Maven Labs, Inc. Electrotherapy device
US5439440A (en) 1993-04-01 1995-08-08 Genetronics, Inc. Electroporation system with voltage control feedback for clinical applications
FR2704151B1 (fr) 1993-04-21 1995-07-13 Klotz Antoine Olivier Dispositif électronique destiné à la stimulation adrénergique du système sympathique relatif à la média veineuse.
DK0702723T3 (da) 1993-04-21 2003-01-13 Pasteur Institut Biokompatibelt implantat til ekspression og udskillelse af terapeutisk forbindelse in vivo
US6517811B2 (en) 1993-05-06 2003-02-11 Research Corporation Technologies, Inc. Compounds for cancer imaging and therapy
US5584863A (en) 1993-06-24 1996-12-17 Electropharmacology, Inc. Pulsed radio frequency electrotherapeutic system
US5860974A (en) 1993-07-01 1999-01-19 Boston Scientific Corporation Heart ablation catheter with expandable electrode and method of coupling energy to an electrode on a catheter shaft
EP0706345B1 (en) 1993-07-01 2003-02-19 Boston Scientific Limited Imaging, electrical potential sensing, and ablation catheters
US5817093A (en) 1993-07-22 1998-10-06 Ethicon Endo-Surgery, Inc. Impedance feedback monitor with query electrode for electrosurgical instrument
US5507791A (en) 1993-08-31 1996-04-16 Sit'ko; Sergei P. Microwave resonance therapy
US6210403B1 (en) 1993-10-07 2001-04-03 Sherwood Services Ag Automatic control for energy from an electrosurgical generator
US5496312A (en) 1993-10-07 1996-03-05 Valleylab Inc. Impedance and temperature generator control
US5582609A (en) 1993-10-14 1996-12-10 Ep Technologies, Inc. Systems and methods for forming large lesions in body tissue using curvilinear electrode elements
US5400784A (en) 1993-10-15 1995-03-28 Case Western Reserve University Slowly penetrating inter-fascicular nerve cuff electrode and method of using
US5397308A (en) 1993-10-22 1995-03-14 Scimed Life Systems, Inc. Balloon inflation measurement apparatus
US5470352A (en) 1993-10-29 1995-11-28 Northeastern University Balloon angioplasty device
US5571147A (en) 1993-11-02 1996-11-05 Sluijter; Menno E. Thermal denervation of an intervertebral disc for relief of back pain
US5433739A (en) 1993-11-02 1995-07-18 Sluijter; Menno E. Method and apparatus for heating an intervertebral disc for relief of back pain
US5599345A (en) 1993-11-08 1997-02-04 Zomed International, Inc. RF treatment apparatus
US5730127A (en) 1993-12-03 1998-03-24 Avitall; Boaz Mapping and ablation catheter system
JPH07157424A (ja) 1993-12-03 1995-06-20 Lintec Corp 局所麻酔用ゲル製剤
US5458626A (en) 1993-12-27 1995-10-17 Krause; Horst E. Method of electrical nerve stimulation for acceleration of tissue healing
US5437664A (en) 1994-01-18 1995-08-01 Endovascular, Inc. Apparatus and method for venous ligation
US6099524A (en) 1994-01-28 2000-08-08 Cardiac Pacemakers, Inc. Electrophysiological mapping and ablation catheter and method
US5447529A (en) 1994-01-28 1995-09-05 Philadelphia Heart Institute Method of using endocardial impedance for determining electrode-tissue contact, appropriate sites for arrhythmia ablation and tissue heating during ablation
US5697975A (en) 1994-02-09 1997-12-16 The University Of Iowa Research Foundation Human cerebral cortex neural prosthetic for tinnitus
US6858024B1 (en) 1994-02-14 2005-02-22 Scimed Life Systems, Inc. Guide catheter having selected flexural modulus segments
US5584830A (en) 1994-03-30 1996-12-17 Medtronic Cardiorhythm Method and system for radiofrequency ablation of cardiac tissue
GB9407135D0 (en) 1994-04-11 1994-06-01 Aberdeen University And Plasma Treatment of osteoporosis
US5505201A (en) 1994-04-20 1996-04-09 Case Western Reserve University Implantable helical spiral cuff electrode
WO1995033514A1 (en) 1994-06-09 1995-12-14 Magnetic Resonance Therapeutics, Inc. Electro-therapeutic method
US5505700A (en) 1994-06-14 1996-04-09 Cordis Corporation Electro-osmotic infusion catheter
US6009877A (en) 1994-06-24 2000-01-04 Edwards; Stuart D. Method for treating a sphincter
US5800429A (en) 1994-06-24 1998-09-01 Somnus Medical Technologies, Inc. Noninvasive apparatus for ablating turbinates
US6405732B1 (en) 1994-06-24 2002-06-18 Curon Medical, Inc. Method to treat gastric reflux via the detection and ablation of gastro-esophageal nerves and receptors
US6056744A (en) 1994-06-24 2000-05-02 Conway Stuart Medical, Inc. Sphincter treatment apparatus
US5735846A (en) 1994-06-27 1998-04-07 Ep Technologies, Inc. Systems and methods for ablating body tissue using predicted maximum tissue temperature
EP0767628B1 (en) 1994-06-27 2004-01-14 Boston Scientific Limited Non-linear control systems for heating and ablating body tissue
JP3578460B2 (ja) 1994-06-27 2004-10-20 ボストン サイエンティフィック リミテッド 体内の温度を感知するためのシステム及び方法
CA2194062C (en) 1994-06-27 2005-06-28 Dorin Panescu System for controlling tissue ablation using temperature sensors
US5540684A (en) 1994-07-28 1996-07-30 Hassler, Jr.; William L. Method and apparatus for electrosurgically treating tissue
US5626862A (en) 1994-08-02 1997-05-06 Massachusetts Institute Of Technology Controlled local delivery of chemotherapeutic agents for treating solid tumors
US5810802A (en) 1994-08-08 1998-09-22 E.P. Technologies, Inc. Systems and methods for controlling tissue ablation using multiple temperature sensing elements
US5454782A (en) 1994-08-11 1995-10-03 Perkins; Rodney C. Translumenal circumferential energy delivery device
EP0776235A4 (en) 1994-08-17 1999-08-25 Magnetic Resonance Therapeutic ELECTROTHERAPEUTIC SYSTEM
US5531778A (en) 1994-09-20 1996-07-02 Cyberonics, Inc. Circumneural electrode assembly
US5540734A (en) 1994-09-28 1996-07-30 Zabara; Jacob Cranial nerve stimulation treatments using neurocybernetic prosthesis
WO1996011723A1 (en) 1994-10-17 1996-04-25 Australasian Medical Technology Limited Devices and methods for implementation of pulsed electromagnetic field therapy
US5722401A (en) 1994-10-19 1998-03-03 Cardiac Pathways Corporation Endocardial mapping and/or ablation catheter probe
US5660848A (en) 1994-11-02 1997-08-26 The Population Council, Center For Biomedical Research Subdermally implantable device
ES2191719T3 (es) 1994-11-10 2003-09-16 Univ Kentucky Res Found Dispositivo implantable y recargable de descarga controlada para suministrar farmacos directamente a una parte interna del cuerpo.
US5571150A (en) 1994-12-19 1996-11-05 Cyberonics, Inc. Treatment of patients in coma by nerve stimulation
US5569198A (en) 1995-01-23 1996-10-29 Cortrak Medical Inc. Microporous catheter
US6409722B1 (en) 1998-07-07 2002-06-25 Medtronic, Inc. Apparatus and method for creating, maintaining, and controlling a virtual electrode used for the ablation of tissue
WO1996034571A1 (en) 1995-05-04 1996-11-07 Cosman Eric R Cool-tip electrode thermosurgery system
WO1996039086A1 (en) 1995-06-06 1996-12-12 Valleylab Inc. Power control for an electrosurgical generator
US5540730A (en) 1995-06-06 1996-07-30 Cyberonics, Inc. Treatment of motility disorders by nerve stimulation
EP0773753B1 (en) 1995-06-07 2003-10-08 Gore Hybrid Technologies, Inc. An implantable containment apparatus for a therapeutical device
US6149620A (en) 1995-11-22 2000-11-21 Arthrocare Corporation System and methods for electrosurgical tissue treatment in the presence of electrically conductive fluid
US6041252A (en) 1995-06-07 2000-03-21 Ichor Medical Systems Inc. Drug delivery system and method
US6113592A (en) 1995-06-09 2000-09-05 Engineering & Research Associates, Inc. Apparatus and method for controlling ablation depth
US6322558B1 (en) 1995-06-09 2001-11-27 Engineering & Research Associates, Inc. Apparatus and method for predicting ablation depth
AU706541B2 (en) 1995-06-09 1999-06-17 Euro-Celtique S.A. Formulations and methods for providing prolonged local anesthesia
US5697925A (en) 1995-06-09 1997-12-16 Engineering & Research Associates, Inc. Apparatus and method for thermal ablation
US5868737A (en) 1995-06-09 1999-02-09 Engineering Research & Associates, Inc. Apparatus and method for determining ablation
WO1997004702A1 (en) 1995-07-28 1997-02-13 Ep Technologies, Inc. Systems and methods for conducting electrophysiological testing using high-voltage energy pulses to stun heart tissue
US6023638A (en) 1995-07-28 2000-02-08 Scimed Life Systems, Inc. System and method for conducting electrophysiological testing using high-voltage energy pulses to stun tissue
US5983131A (en) 1995-08-11 1999-11-09 Massachusetts Institute Of Technology Apparatus and method for electroporation of tissue
US5672174A (en) 1995-08-15 1997-09-30 Rita Medical Systems, Inc. Multiple antenna ablation apparatus and method
US5711326A (en) 1995-08-25 1998-01-27 Whirlpool Corporation Dishwasher accumulator soil removal grating for a filter system
US5707400A (en) 1995-09-19 1998-01-13 Cyberonics, Inc. Treating refractory hypertension by nerve stimulation
US6615071B1 (en) 1995-09-20 2003-09-02 Board Of Regents, The University Of Texas System Method and apparatus for detecting vulnerable atherosclerotic plaque
AU709432B2 (en) 1995-09-20 1999-08-26 California Institute Of Technology Detecting thermal discrepancies in vessel walls
US5700282A (en) 1995-10-13 1997-12-23 Zabara; Jacob Heart rhythm stabilization using a neurocybernetic prosthesis
US6283951B1 (en) 1996-10-11 2001-09-04 Transvascular, Inc. Systems and methods for delivering drugs to selected locations within the body
IL151563A0 (en) 1995-10-13 2003-04-10 Transvascular Inc A longitudinal compression apparatus for compressing tissue
US5817092A (en) 1995-11-09 1998-10-06 Radio Therapeutics Corporation Apparatus, system and method for delivering radio frequency energy to a treatment site
US5755750A (en) 1995-11-13 1998-05-26 University Of Florida Method and apparatus for selectively inhibiting activity in nerve fibers
US6073048A (en) 1995-11-17 2000-06-06 Medtronic, Inc. Baroreflex modulation with carotid sinus nerve stimulation for the treatment of heart failure
US5837001A (en) 1995-12-08 1998-11-17 C. R. Bard Radio frequency energy delivery system for multipolar electrode catheters
US6010613A (en) 1995-12-08 2000-01-04 Cyto Pulse Sciences, Inc. Method of treating materials with pulsed electrical fields
CN2291164Y (zh) 1996-12-23 1998-09-16 祝强 降压仪
US5658619A (en) 1996-01-16 1997-08-19 The Coca-Cola Company Method for adhering resin to bottles
ATE247429T1 (de) 1996-02-02 2003-09-15 Transvascular Inc System für interstitielle transvaskuläre chirurgische eingriffe
CZ300994B6 (cs) 1996-02-02 2009-10-07 Alza Corporation Implantabilní zarízení pro dodávání aktivního cinidla
US5913876A (en) 1996-02-20 1999-06-22 Cardiothoracic Systems, Inc. Method and apparatus for using vagus nerve stimulation in surgery
WO1997029802A2 (en) 1996-02-20 1997-08-21 Advanced Bionics Corporation Improved implantable microstimulator and systems employing the same
US6036687A (en) 1996-03-05 2000-03-14 Vnus Medical Technologies, Inc. Method and apparatus for treating venous insufficiency
US5747060A (en) 1996-03-26 1998-05-05 Euro-Celtique, S.A. Prolonged local anesthesia with colchicine
US5690681A (en) 1996-03-29 1997-11-25 Purdue Research Foundation Method and apparatus using vagal stimulation for control of ventricular rate during atrial fibrillation
US6735471B2 (en) 1996-04-30 2004-05-11 Medtronic, Inc. Method and system for endotracheal/esophageal stimulation prior to and during a medical procedure
US6006134A (en) 1998-04-30 1999-12-21 Medtronic, Inc. Method and device for electronically controlling the beating of a heart using venous electrical stimulation of nerve fibers
US6449507B1 (en) 1996-04-30 2002-09-10 Medtronic, Inc. Method and system for nerve stimulation prior to and during a medical procedure
AU3116897A (en) 1996-05-01 1997-11-19 Vidamed, Inc. Systems and methods for optimizing the delivery of radio frequency energy for lesion formation within human tissue
US5690691A (en) 1996-05-08 1997-11-25 The Center For Innovative Technology Gastro-intestinal pacemaker having phased multi-point stimulation
US5859762A (en) 1996-05-13 1999-01-12 International Business Machines Corporation Docking station for portable computers
US5938690A (en) 1996-06-07 1999-08-17 Advanced Neuromodulation Systems, Inc. Pain management system and method
DE19623840A1 (de) 1996-06-14 1997-12-18 Berchtold Gmbh & Co Geb Elektrochirurgischer Hochfrequenz-Generator
US5861021A (en) 1996-06-17 1999-01-19 Urologix Inc Microwave thermal therapy of cardiac tissue
US20020040204A1 (en) 1996-06-24 2002-04-04 Dev Nagendu B. Electroporation-enhanced inhibition of vascular neointimal hyperplasia
US5944710A (en) 1996-06-24 1999-08-31 Genetronics, Inc. Electroporation-mediated intravascular delivery
US5983141A (en) 1996-06-27 1999-11-09 Radionics, Inc. Method and apparatus for altering neural tissue function
US6246912B1 (en) 1996-06-27 2001-06-12 Sherwood Services Ag Modulated high frequency tissue modification
US6245026B1 (en) 1996-07-29 2001-06-12 Farallon Medsystems, Inc. Thermography catheter
US5924997A (en) 1996-07-29 1999-07-20 Campbell; Thomas Henderson Catheter and method for the thermal mapping of hot spots in vascular lesions of the human body
US6058328A (en) 1996-08-06 2000-05-02 Pacesetter, Inc. Implantable stimulation device having means for operating in a preemptive pacing mode to prevent tachyarrhythmias and method thereof
US5836943A (en) 1996-08-23 1998-11-17 Team Medical, L.L.C. Electrosurgical generator
US5906636A (en) 1996-09-20 1999-05-25 Texas Heart Institute Heat treatment of inflamed tissue
US5800464A (en) 1996-10-03 1998-09-01 Medtronic, Inc. System for providing hyperpolarization of cardiac to enhance cardiac function
US5814079A (en) 1996-10-04 1998-09-29 Medtronic, Inc. Cardiac arrhythmia management by application of adnodal stimulation for hyperpolarization of myocardial cells
US5704908A (en) 1996-10-10 1998-01-06 Genetronics, Inc. Electroporation and iontophoresis catheter with porous balloon
US5893885A (en) 1996-11-01 1999-04-13 Cordis Webster, Inc. Multi-electrode ablation catheter
US6091995A (en) 1996-11-08 2000-07-18 Surx, Inc. Devices, methods, and systems for shrinking tissues
US5954719A (en) 1996-12-11 1999-09-21 Irvine Biomedical, Inc. System for operating a RF ablation generator
US5871449A (en) 1996-12-27 1999-02-16 Brown; David Lloyd Device and method for locating inflamed plaque in an artery
US6026326A (en) 1997-01-13 2000-02-15 Medtronic, Inc. Apparatus and method for treating chronic constipation
WO1998030279A1 (en) 1997-01-13 1998-07-16 Neurodan A/S An implantable nerve stimulator electrode
AU6156198A (en) 1997-02-12 1998-08-26 Oratec Interventions, Inc. Concave probe for arthroscopic surgery
US6208894B1 (en) 1997-02-26 2001-03-27 Alfred E. Mann Foundation For Scientific Research And Advanced Bionics System of implantable devices for monitoring and/or affecting body parameters
JP2001513679A (ja) 1997-02-26 2001-09-04 アルフレッド イー マン ファウンデーション フォア サイエンティフィック リサーチ バッテリ給電式の患者の皮下挿入器具
US5954761A (en) 1997-03-25 1999-09-21 Intermedics Inc. Implantable endocardial lead assembly having a stent
EP1011804B1 (en) 1997-03-27 2009-08-19 Alfred E. Mann Foundation System of implantable devices for monitoring and/or affecting body parameters
US6261281B1 (en) 1997-04-03 2001-07-17 Electrofect As Method for genetic immunization and introduction of molecules into skeletal muscle and immune cells
US7027869B2 (en) 1998-01-07 2006-04-11 Asthmatx, Inc. Method for treating an asthma attack
US5907589A (en) 1997-04-10 1999-05-25 Motorola, Inc. GHZ range frequency divider in CMOS
US5871481A (en) 1997-04-11 1999-02-16 Vidamed, Inc. Tissue ablation apparatus and method
US5948007A (en) 1997-04-30 1999-09-07 Medtronic, Inc. Dual channel implantation neurostimulation techniques
US6024740A (en) 1997-07-08 2000-02-15 The Regents Of The University Of California Circumferential ablation device assembly
WO1998051290A2 (en) 1997-05-16 1998-11-19 Children's Medical Center Corporation Local anesthetic formulations comprising a site 1 sodium channel blocker combined with a second active agent
EP0998217B1 (en) 1997-05-23 2009-01-07 ProRhythm, Inc. Disposable high intensity focused ultrasound applicator
WO1999000060A1 (en) 1997-06-26 1999-01-07 Advanced Coronary Intervention Electrosurgical catheter for resolving obstructions by radio frequency ablation
USRE40279E1 (en) 1997-06-26 2008-04-29 Sherwood Services Ag Method and system for neural tissue modification
US6248345B1 (en) 1997-07-02 2001-06-19 Euro-Celtique, S.A. Prolonged anesthesia in joints and body spaces
US6869431B2 (en) 1997-07-08 2005-03-22 Atrionix, Inc. Medical device with sensor cooperating with expandable member
US6117101A (en) 1997-07-08 2000-09-12 The Regents Of The University Of California Circumferential ablation device assembly
EP0996482B1 (en) 1997-07-16 2007-02-14 Metacure NV Smooth muscle controller
US6258084B1 (en) 1997-09-11 2001-07-10 Vnus Medical Technologies, Inc. Method for applying energy to biological tissue including the use of tumescent tissue compression
US6358246B1 (en) 1999-06-25 2002-03-19 Radiotherapeutics Corporation Method and system for heating solid tissue
US6139546A (en) 1997-10-06 2000-10-31 Somnus Medical Technologies, Inc. Linear power control with digital phase lock
US6917834B2 (en) 1997-12-03 2005-07-12 Boston Scientific Scimed, Inc. Devices and methods for creating lesions in endocardial and surrounding tissue to isolate focal arrhythmia substrates
AU2022999A (en) 1997-12-31 1999-07-19 Heartport, Inc. Methods and apparatus for perfusion of isolated tissue structure
US6146380A (en) 1998-01-09 2000-11-14 Radionics, Inc. Bent tip electrical surgical probe
US6080149A (en) 1998-01-09 2000-06-27 Radiotherapeutics, Corporation Method and apparatus for monitoring solid tissue heating
CA2295134A1 (en) 1998-01-15 1999-07-22 Amethyst Technologies, Inc. Improved pulsed electromagnetic energy treatment apparatus and method
US6251130B1 (en) 1998-03-24 2001-06-26 Innercool Therapies, Inc. Device for applications of selective organ cooling
US6415187B1 (en) 1998-02-10 2002-07-02 Advanced Bionics Corporation Implantable, expandable, multicontact electrodes and insertion needle for use therewith
US6522932B1 (en) 1998-02-10 2003-02-18 Advanced Bionics Corporation Implantable, expandable, multicontact electrodes and tools for use therewith
US6205361B1 (en) 1998-02-10 2001-03-20 Advanced Bionics Corporation Implantable expandable multicontact electrodes
US6562037B2 (en) 1998-02-12 2003-05-13 Boris E. Paton Bonding of soft biological tissues by passing high frequency electric current therethrough
US6273886B1 (en) 1998-02-19 2001-08-14 Curon Medical, Inc. Integrated tissue heating and cooling apparatus
US6258087B1 (en) 1998-02-19 2001-07-10 Curon Medical, Inc. Expandable electrode assemblies for forming lesions to treat dysfunction in sphincters and adjoining tissue regions
US6142993A (en) 1998-02-27 2000-11-07 Ep Technologies, Inc. Collapsible spline structure using a balloon as an expanding actuator
US6086527A (en) 1998-04-02 2000-07-11 Scimed Life Systems, Inc. System for treating congestive heart failure
US6314325B1 (en) 1998-04-07 2001-11-06 William R. Fitz Nerve hyperpolarization method and apparatus for pain relief
CA2326786A1 (en) 1998-04-14 1999-10-21 Charles L. Brown, Iii Iontophoresis, electroporation and combination catheters for local drug delivery to arteries and other body tissues
US6219577B1 (en) 1998-04-14 2001-04-17 Global Vascular Concepts, Inc. Iontophoresis, electroporation and combination catheters for local drug delivery to arteries and other body tissues
US5916154A (en) 1998-04-22 1999-06-29 Nellcor Puritan Bennett Method of enhancing performance in pulse oximetry via electrical stimulation
US6269269B1 (en) 1998-04-23 2001-07-31 Medtronic Inc. Method and apparatus for synchronized treatment of obstructive sleep apnea
US6058331A (en) 1998-04-27 2000-05-02 Medtronic, Inc. Apparatus and method for treating peripheral vascular disease and organ ischemia by electrical stimulation with closed loop feedback control
US5928272A (en) 1998-05-02 1999-07-27 Cyberonics, Inc. Automatic activation of a neurostimulator device using a detection algorithm based on cardiac activity
US6192889B1 (en) 1998-05-05 2001-02-27 Woodside Biomedical, Inc. Method of suppression and prevention of the gag reflex
US6558378B2 (en) 1998-05-05 2003-05-06 Cardiac Pacemakers, Inc. RF ablation system and method having automatic temperature control
US6059778A (en) 1998-05-05 2000-05-09 Cardiac Pacemakers, Inc. RF ablation apparatus and method using unipolar and bipolar techniques
CA2331532A1 (en) 1998-05-08 1999-11-18 Genetronics, Inc. Electrically induced vessel vasodilation
US6508815B1 (en) 1998-05-08 2003-01-21 Novacept Radio-frequency generator for powering an ablation device
US6428537B1 (en) 1998-05-22 2002-08-06 Scimed Life Systems, Inc. Electrophysiological treatment methods and apparatus employing high voltage pulse to render tissue temporarily unresponsive
US7198635B2 (en) 2000-10-17 2007-04-03 Asthmatx, Inc. Modification of airways by application of energy
WO1999065561A1 (en) 1998-06-19 1999-12-23 Cordis Webster, Inc. Method and apparatus for transvascular treatment of tachycardia and fibrillation
US6322559B1 (en) 1998-07-06 2001-11-27 Vnus Medical Technologies, Inc. Electrode catheter having coil structure
JP2003505114A (ja) 1998-07-13 2003-02-12 ジェネトロニクス、インコーポレーテッド パルス電場による皮膚および筋肉を標的とした遺伝子治療
US6972013B1 (en) 1998-07-13 2005-12-06 Genetronics, Inc. Enhanced delivery of naked DNA to skin by non-invasive in vivo electroporation
US7599736B2 (en) 2001-07-23 2009-10-06 Dilorenzo Biomedical, Llc Method and apparatus for neuromodulation and physiologic modulation for the treatment of metabolic and neuropsychiatric disease
US6304787B1 (en) 1998-08-26 2001-10-16 Advanced Bionics Corporation Cochlear electrode array having current-focusing and tissue-treating features
US6245065B1 (en) 1998-09-10 2001-06-12 Scimed Life Systems, Inc. Systems and methods for controlling power in an electrosurgical probe
US6183468B1 (en) 1998-09-10 2001-02-06 Scimed Life Systems, Inc. Systems and methods for controlling power in an electrosurgical probe
WO2000015130A2 (en) 1998-09-10 2000-03-23 Scimed Life Systems, Inc. Systems for controlling an ablation process performed with a heart electrocatheter
US6123702A (en) 1998-09-10 2000-09-26 Scimed Life Systems, Inc. Systems and methods for controlling power in an electrosurgical probe
US7901400B2 (en) 1998-10-23 2011-03-08 Covidien Ag Method and system for controlling output of RF medical generator
US6796981B2 (en) 1999-09-30 2004-09-28 Sherwood Services Ag Vessel sealing system
US7137980B2 (en) 1998-10-23 2006-11-21 Sherwood Services Ag Method and system for controlling output of RF medical generator
US6123718A (en) 1998-11-02 2000-09-26 Polymerex Medical Corp. Balloon catheter
US10967045B2 (en) 1998-11-02 2021-04-06 Secretary of State for Health and Social Care Multicomponent meningococcal vaccine
US6451015B1 (en) 1998-11-18 2002-09-17 Sherwood Services Ag Method and system for menu-driven two-dimensional display lesion generator
US7313444B2 (en) 1998-11-20 2007-12-25 Pacesetter, Inc. Self-anchoring coronary sinus lead
US6436096B1 (en) 1998-11-27 2002-08-20 Olympus Optical Co., Ltd. Electrosurgical apparatus with stable coagulation
US6210406B1 (en) 1998-12-03 2001-04-03 Cordis Webster, Inc. Split tip electrode catheter and signal processing RF ablation system
US20070066972A1 (en) 2001-11-29 2007-03-22 Medwaves, Inc. Ablation catheter apparatus with one or more electrodes
US6077227A (en) 1998-12-28 2000-06-20 Medtronic, Inc. Method for manufacture and implant of an implantable blood vessel cuff
US7122019B1 (en) 2000-11-28 2006-10-17 Flowmedica Inc. Intra-aortic renal drug delivery catheter
US7780628B1 (en) 1999-01-11 2010-08-24 Angiodynamics, Inc. Apparatus and methods for treating congestive heart disease
US7329236B2 (en) 1999-01-11 2008-02-12 Flowmedica, Inc. Intra-aortic renal drug delivery catheter
US7481803B2 (en) 2000-11-28 2009-01-27 Flowmedica, Inc. Intra-aortic renal drug delivery catheter
US6749598B1 (en) 1999-01-11 2004-06-15 Flowmedica, Inc. Apparatus and methods for treating congestive heart disease
US6451011B2 (en) 1999-01-19 2002-09-17 Hosheng Tu Medical device having temperature sensing and ablation capabilities
US6423057B1 (en) 1999-01-25 2002-07-23 The Arizona Board Of Regents On Behalf Of The University Of Arizona Method and apparatus for monitoring and controlling tissue temperature and lesion formation in radio-frequency ablation procedures
US6461314B1 (en) 1999-02-02 2002-10-08 Transurgical, Inc. Intrabody hifu applicator
US6464696B1 (en) 1999-02-26 2002-10-15 Olympus Optical Co., Ltd. Electrical surgical operating apparatus
US6464687B1 (en) 1999-03-09 2002-10-15 Ball Semiconductor, Inc. Implantable drug delivery system
US6508774B1 (en) 1999-03-09 2003-01-21 Transurgical, Inc. Hifu applications with feedback control
JP4102031B2 (ja) 1999-03-09 2008-06-18 サーメイジ インコーポレイテッド 組織を治療するのための装置および方法
US6678558B1 (en) 1999-03-25 2004-01-13 Genetronics, Inc. Method and apparatus for reducing electroporation-mediated muscle reaction and pain response
US6692738B2 (en) 2000-01-27 2004-02-17 The General Hospital Corporation Delivery of therapeutic biologicals from implantable tissue matrices
US6325797B1 (en) 1999-04-05 2001-12-04 Medtronic, Inc. Ablation catheter and method for isolating a pulmonary vein
US6366808B1 (en) 2000-03-13 2002-04-02 Edward A. Schroeppel Implantable device and method for the electrical treatment of cancer
US6738663B2 (en) 1999-04-09 2004-05-18 Oncostim, A Minnesota Corporation Implantable device and method for the electrical treatment of cancer
US6178349B1 (en) 1999-04-15 2001-01-23 Medtronic, Inc. Drug delivery neural stimulation device for treatment of cardiovascular disorders
US6317615B1 (en) 1999-04-19 2001-11-13 Cardiac Pacemakers, Inc. Method and system for reducing arterial restenosis in the presence of an intravascular stent
US6939346B2 (en) 1999-04-21 2005-09-06 Oratec Interventions, Inc. Method and apparatus for controlling a temperature-controlled probe
US6341236B1 (en) 1999-04-30 2002-01-22 Ivan Osorio Vagal nerve stimulation techniques for treatment of epileptic seizures
US6923784B2 (en) 1999-04-30 2005-08-02 Medtronic, Inc. Therapeutic treatment of disorders based on timing information
WO2000066017A1 (en) 1999-05-04 2000-11-09 Curon Medical, Inc. Electrodes for creating lesions in tissue regions at or near a sphincter
US6178352B1 (en) 1999-05-07 2001-01-23 Woodside Biomedical, Inc. Method of blood pressure moderation
US6304777B1 (en) 1999-05-26 2001-10-16 Impulse Dynamics N.V. Induction of cardioplegia applied electrical signals
US6442424B1 (en) 1999-05-26 2002-08-27 Impulse Dynamics N.V. Local cardiac motion control using applied electrical signals
US7171263B2 (en) 1999-06-04 2007-01-30 Impulse Dynamics Nv Drug delivery device
EP1198271A4 (en) 1999-06-25 2009-01-21 Univ Emory DEVICES AND METHODS FOR STIMULATING THE VAGUSNERVS
US6272383B1 (en) 1999-06-28 2001-08-07 Woodside Biomedical, Inc. Electro-acupuncture method using an electrical stimulator
US7053063B2 (en) 1999-07-21 2006-05-30 The Regents Of The University Of California Controlled electroporation and mass transfer across cell membranes in tissue
US6300108B1 (en) 1999-07-21 2001-10-09 The Regents Of The University Of California Controlled electroporation and mass transfer across cell membranes
US6927049B2 (en) 1999-07-21 2005-08-09 The Regents Of The University Of California Cell viability detection using electrical measurements
US6326177B1 (en) 1999-08-04 2001-12-04 Eastern Virginia Medical School Of The Medical College Of Hampton Roads Method and apparatus for intracellular electro-manipulation
US6450942B1 (en) 1999-08-20 2002-09-17 Cardiorest International Ltd. Method for reducing heart loads in mammals
AU7362400A (en) 1999-09-10 2001-04-10 Transurgical, Inc. Occlusion of tubular anatomical structures by energy application
US7510536B2 (en) 1999-09-17 2009-03-31 University Of Washington Ultrasound guided high intensity focused ultrasound treatment of nerves
CA2384866C (en) 1999-09-28 2012-07-10 Stuart D. Edwards Treatment of tissue by application of energy and drugs
US6272377B1 (en) 1999-10-01 2001-08-07 Cardiac Pacemakers, Inc. Cardiac rhythm management system with arrhythmia prediction and prevention
US6473644B1 (en) 1999-10-13 2002-10-29 Cyberonics, Inc. Method to enhance cardiac capillary growth in heart failure patients
US6514248B1 (en) 1999-10-15 2003-02-04 Neothermia Corporation Accurate cutting about and into tissue volumes with electrosurgically deployed electrodes
US6287304B1 (en) 1999-10-15 2001-09-11 Neothermia Corporation Interstitial cauterization of tissue volumes with electrosurgically deployed electrodes
US6669655B1 (en) 1999-10-20 2003-12-30 Transurgical, Inc. Sonic element and catheter incorporating same
EP1224436A1 (en) 1999-10-29 2002-07-24 Universität Zürich Method of volumetric blood flow measurement
US6436091B1 (en) 1999-11-16 2002-08-20 Microsolutions, Inc. Methods and implantable devices and systems for long term delivery of a pharmaceutical agent
US6542781B1 (en) 1999-11-22 2003-04-01 Scimed Life Systems, Inc. Loop structures for supporting diagnostic and therapeutic elements in contact with body tissue
US6711444B2 (en) 1999-11-22 2004-03-23 Scimed Life Systems, Inc. Methods of deploying helical diagnostic and therapeutic element supporting structures within the body
DE50014442D1 (de) 1999-11-30 2007-08-09 Biotronik Gmbh & Co Kg Gerät zur Regelung der Herzfrequenz und der Herzpumpkraft
EP1106202A3 (de) 1999-11-30 2004-03-31 BIOTRONIK Mess- und Therapiegeräte GmbH & Co Ingenieurbüro Berlin Elektrode zu intravaskuläran Stimulation, Kardioversion und/oder Defibrillation
US6635057B2 (en) 1999-12-02 2003-10-21 Olympus Optical Co. Ltd. Electric operation apparatus
US6592567B1 (en) 1999-12-07 2003-07-15 Chf Solutions, Inc. Kidney perfusion catheter
US6415183B1 (en) 1999-12-09 2002-07-02 Cardiac Pacemakers, Inc. Method and apparatus for diaphragmatic pacing
US20030150464A1 (en) 1999-12-17 2003-08-14 Casscells S. Ward Inducing apoptosis of atrial myocytes to treat atrial fibrillation
US6328699B1 (en) 2000-01-11 2001-12-11 Cedars-Sinai Medical Center Permanently implantable system and method for detecting, diagnosing and treating congestive heart failure
US20060085046A1 (en) 2000-01-20 2006-04-20 Ali Rezai Methods of treating medical conditions by transvascular neuromodulation of the autonomic nervous system
US6885888B2 (en) 2000-01-20 2005-04-26 The Cleveland Clinic Foundation Electrical stimulation of the sympathetic nerve chain
US6356786B1 (en) 2000-01-20 2002-03-12 Electrocore Techniques, Llc Method of treating palmar hyperhydrosis by electrical stimulation of the sympathetic nervous chain
US6356787B1 (en) 2000-02-24 2002-03-12 Electro Core Techniques, Llc Method of treating facial blushing by electrical stimulation of the sympathetic nerve chain
US6438423B1 (en) 2000-01-20 2002-08-20 Electrocore Technique, Llc Method of treating complex regional pain syndromes by electrical stimulation of the sympathetic nerve chain
US6514226B1 (en) 2000-02-10 2003-02-04 Chf Solutions, Inc. Method and apparatus for treatment of congestive heart failure by improving perfusion of the kidney
US6868289B2 (en) 2002-10-02 2005-03-15 Standen Ltd. Apparatus for treating a tumor or the like and articles incorporating the apparatus for treatment of the tumor
US7565206B2 (en) 2000-02-17 2009-07-21 Standen Ltd. Treating a tumor or the like with electric fields at different orientations
AU2001239987A1 (en) 2000-03-06 2001-09-17 Tissuelink Medical, Inc. Fluid delivery system and controller for electrosurgical devices
US8048070B2 (en) 2000-03-06 2011-11-01 Salient Surgical Technologies, Inc. Fluid-assisted medical devices, systems and methods
US6536949B1 (en) 2000-03-07 2003-03-25 Richard R. Heuser Catheter for thermal evaluation of arteriosclerotic plaque
US6770070B1 (en) 2000-03-17 2004-08-03 Rita Medical Systems, Inc. Lung treatment apparatus and method
US6605084B2 (en) 2000-03-24 2003-08-12 Transurgical, Inc. Apparatus and methods for intrabody thermal treatment
US6287608B1 (en) 2000-04-11 2001-09-11 Intellicardia, Inc. Method and apparatus for treatment of congestive heart failure by improving perfusion of the kidney by infusion of a vasodilator
US6558382B2 (en) 2000-04-27 2003-05-06 Medtronic, Inc. Suction stabilized epicardial ablation devices
US20010044596A1 (en) 2000-05-10 2001-11-22 Ali Jaafar Apparatus and method for treatment of vascular restenosis by electroporation
AU2001261486A1 (en) 2000-05-12 2001-11-26 Cardima, Inc. Multi-channel rf energy delivery with coagulum reduction
US6306423B1 (en) 2000-06-02 2001-10-23 Allergan Sales, Inc. Neurotoxin implant
AU6682401A (en) 2000-06-13 2001-12-24 Atrionix Inc Surgical ablation probe for forming a circumferential lesion
CA2415134C (en) 2000-07-13 2015-09-22 Transurgical, Inc. Thermal treatment methods and apparatus with focused energy application
US6962587B2 (en) 2000-07-25 2005-11-08 Rita Medical Systems, Inc. Method for detecting and treating tumors using localized impedance measurement
DE04078528T1 (de) 2000-07-26 2005-09-01 Advanced Bionics Corp., Sylmar Wiederaufladbares Stimulationssystem
WO2002011634A1 (de) 2000-08-08 2002-02-14 Erbe Elektromedizin Gmbh Hochfrequenzgenerator für die hochfrequenzchirurgie mit einstellbarer leistungsbegrenzung und verfahren zur steuerung der leistungsbegrenzung
US6697670B2 (en) 2001-08-17 2004-02-24 Minnesota Medical Physics, Llc Apparatus and method for reducing subcutaneous fat deposits by electroporation with improved comfort of patients
US6795728B2 (en) 2001-08-17 2004-09-21 Minnesota Medical Physics, Llc Apparatus and method for reducing subcutaneous fat deposits by electroporation
US6892099B2 (en) 2001-02-08 2005-05-10 Minnesota Medical Physics, Llc Apparatus and method for reducing subcutaneous fat deposits, virtual face lift and body sculpturing by electroporation
US6862479B1 (en) 2000-08-30 2005-03-01 Advanced Bionics Corporation Spinal cord stimulation as a therapy for sexual dysfunction
JP4219679B2 (ja) 2000-09-07 2009-02-04 コビディエン アクチェンゲゼルシャフト 椎間板の処置のための装置
US6405079B1 (en) 2000-09-22 2002-06-11 Mehdi M. Ansarinia Stimulation method for the dural venous sinuses and adjacent dura for treatment of medical conditions
US6850801B2 (en) 2001-09-26 2005-02-01 Cvrx, Inc. Mapping methods for cardiovascular reflex control devices
US7499742B2 (en) 2001-09-26 2009-03-03 Cvrx, Inc. Electrode structures and methods for their use in cardiovascular reflex control
US7616997B2 (en) 2000-09-27 2009-11-10 Kieval Robert S Devices and methods for cardiovascular reflex control via coupled electrodes
US6522926B1 (en) 2000-09-27 2003-02-18 Cvrx, Inc. Devices and methods for cardiovascular reflex control
US7840271B2 (en) 2000-09-27 2010-11-23 Cvrx, Inc. Stimulus regimens for cardiovascular reflex control
US6985774B2 (en) 2000-09-27 2006-01-10 Cvrx, Inc. Stimulus regimens for cardiovascular reflex control
US7158832B2 (en) 2000-09-27 2007-01-02 Cvrx, Inc. Electrode designs and methods of use for cardiovascular reflex control devices
US7623926B2 (en) 2000-09-27 2009-11-24 Cvrx, Inc. Stimulus regimens for cardiovascular reflex control
US6845267B2 (en) 2000-09-28 2005-01-18 Advanced Bionics Corporation Systems and methods for modulation of circulatory perfusion by electrical and/or drug stimulation
US7306591B2 (en) 2000-10-02 2007-12-11 Novasys Medical, Inc. Apparatus and methods for treating female urinary incontinence
US6640120B1 (en) 2000-10-05 2003-10-28 Scimed Life Systems, Inc. Probe assembly for mapping and ablating pulmonary vein tissue and method of using same
US7104987B2 (en) 2000-10-17 2006-09-12 Asthmatx, Inc. Control system and process for application of energy to airway walls and other mediums
WO2002034330A2 (en) 2000-10-26 2002-05-02 Medtronic, Inc. Method and apparatus to minimize the effects of a cardiac insult
EP1331965B1 (en) 2000-10-26 2008-07-16 Medtronic, Inc. Apparatus for electrically stimulating the nervous system to improve ventricular dysfunction, heart failure, and other cardiac conditions
US6616624B1 (en) 2000-10-30 2003-09-09 Cvrx, Inc. Systems and method for controlling renovascular perfusion
US7081114B2 (en) 2000-11-29 2006-07-25 St. Jude Medical, Atrial Fibrillation Division, Inc. Electrophysiology/ablation catheter having lariat configuration of variable radius
US6681136B2 (en) 2000-12-04 2004-01-20 Science Medicus, Inc. Device and method to modulate blood pressure by electrical waveforms
US6676657B2 (en) 2000-12-07 2004-01-13 The United States Of America As Represented By The Department Of Health And Human Services Endoluminal radiofrequency cauterization system
US6752804B2 (en) 2000-12-28 2004-06-22 Cardiac Pacemakers, Inc. Ablation system and method having multiple-sensor electrodes to assist in assessment of electrode and sensor position and adjustment of energy levels
US8133218B2 (en) 2000-12-28 2012-03-13 Senorx, Inc. Electrosurgical medical system and method
US6666845B2 (en) 2001-01-04 2003-12-23 Advanced Neuromodulation Systems, Inc. Implantable infusion pump
WO2002053207A2 (en) 2001-01-04 2002-07-11 Advanced Neuromodulation Systems, Inc. Implantable infusion pump
WO2002054941A2 (en) 2001-01-11 2002-07-18 Rita Medical Systems Inc Bone-treatment instrument and method
US6600954B2 (en) 2001-01-25 2003-07-29 Biocontrol Medical Bcm Ltd. Method and apparatus for selective control of nerve fibers
US6672312B2 (en) 2001-01-31 2004-01-06 Transurgical, Inc. Pulmonary vein ablation with myocardial tissue locating
US6564096B2 (en) 2001-02-28 2003-05-13 Robert A. Mest Method and system for treatment of tachycardia and fibrillation
US6620151B2 (en) 2001-03-01 2003-09-16 Advanced Neuromodulation Systems, Inc. Non-constant pressure infusion pump
US6666862B2 (en) 2001-03-01 2003-12-23 Cardiac Pacemakers, Inc. Radio frequency ablation system and method linking energy delivery with fluid flow
AU2002250250A1 (en) 2001-03-01 2002-09-19 Three Arch Partners Intravascular device for treatment of hypertension
WO2002069821A1 (en) 2001-03-06 2002-09-12 Thermemed Corp. Vaporous delivery of thermal energy to tissue sites
US6786904B2 (en) 2002-01-10 2004-09-07 Triton Biosystems, Inc. Method and device to treat vulnerable plaque
US6682527B2 (en) 2001-03-13 2004-01-27 Perfect Surgical Techniques, Inc. Method and system for heating tissue with a bipolar instrument
EP1379197A4 (en) 2001-03-23 2009-06-03 Durect Corp DISPOSAL OF MEDICINAL PRODUCTS OF DELAYED RELEASE DEVICES IMPLANTED IN MYOKARD TISSUE OR PER ICARDROOM
WO2002085448A2 (en) 2001-04-20 2002-10-31 The Board Of Regents Of The University Of Oklahoma Cardiac neuromodulation and methods of using same
US20030120270A1 (en) 2001-04-23 2003-06-26 Transurgical, Inc. Ablation therapy
US7250048B2 (en) 2001-04-26 2007-07-31 Medtronic, Inc. Ablation system and method of use
US7959626B2 (en) 2001-04-26 2011-06-14 Medtronic, Inc. Transmural ablation systems and methods
US6663627B2 (en) 2001-04-26 2003-12-16 Medtronic, Inc. Ablation system and method of use
US6989010B2 (en) 2001-04-26 2006-01-24 Medtronic, Inc. Ablation system and method of use
US6684105B2 (en) 2001-08-31 2004-01-27 Biocontrol Medical, Ltd. Treatment of disorders by unidirectional nerve stimulation
US6648883B2 (en) 2001-04-26 2003-11-18 Medtronic, Inc. Ablation system and method of use
US6972016B2 (en) 2001-05-01 2005-12-06 Cardima, Inc. Helically shaped electrophysiology catheter
JP4656755B2 (ja) 2001-05-07 2011-03-23 オリンパス株式会社 電気手術装置
CN100518685C (zh) 2001-05-10 2009-07-29 脉管动力股份有限公司 组织消融设备
JP2004533297A (ja) 2001-05-29 2004-11-04 メドトロニック・インコーポレーテッド 心臓病の予防及び処置のための閉ループ神経調節システム
US7127284B2 (en) 2001-06-11 2006-10-24 Mercator Medsystems, Inc. Electroporation microneedle and methods for its use
US20060167498A1 (en) 2001-07-23 2006-07-27 Dilorenzo Daniel J Method, apparatus, and surgical technique for autonomic neuromodulation for the treatment of disease
ATE292992T1 (de) 2001-07-27 2005-04-15 Impella Cardiotech Ag Neurostimulationseinheit zur immobilisation des herzens während kardiochirurgischer operationen
US6994706B2 (en) 2001-08-13 2006-02-07 Minnesota Medical Physics, Llc Apparatus and method for treatment of benign prostatic hyperplasia
US6622041B2 (en) 2001-08-21 2003-09-16 Cyberonics, Inc. Treatment of congestive heart failure and autonomic cardiovascular drive disorders
US6600956B2 (en) 2001-08-21 2003-07-29 Cyberonics, Inc. Circumneural electrode assembly
US20030050635A1 (en) 2001-08-22 2003-03-13 Csaba Truckai Embolization systems and techniques for treating tumors
ATE394499T1 (de) 2001-08-31 2008-05-15 Cyto Pulse Sciences Inc Dielektrophoresewellenform mit nichtlinearer amplitude zur zellfusion
US7778703B2 (en) 2001-08-31 2010-08-17 Bio Control Medical (B.C.M.) Ltd. Selective nerve fiber stimulation for treating heart conditions
US6761716B2 (en) 2001-09-18 2004-07-13 Cardiac Pacemakers, Inc. System and method for assessing electrode-tissue contact and lesion quality during RF ablation by measurement of conduction time
EP1429678B1 (en) * 2001-09-28 2006-03-22 Rita Medical Systems, Inc. Impedance controlled tissue ablation apparatus
EP1434621A2 (en) 2001-10-01 2004-07-07 AM Discovery, Incorporated Devices for treating atrial fibrilation
US8974446B2 (en) 2001-10-11 2015-03-10 St. Jude Medical, Inc. Ultrasound ablation apparatus with discrete staggered ablation zones
US7488313B2 (en) 2001-11-29 2009-02-10 Boston Scientific Scimed, Inc. Mechanical apparatus and method for dilating and delivering a therapeutic agent to a site of treatment
US20030125790A1 (en) 2001-12-27 2003-07-03 Vitaly Fastovsky Deployment device, system and method for medical implantation
US6893436B2 (en) 2002-01-03 2005-05-17 Afx, Inc. Ablation instrument having a flexible distal portion
US20060189941A1 (en) 2002-01-22 2006-08-24 Mercator Medsystems, Inc. Methods and kits for volumetric distribution of pharmaceutical agents via the vascular adventitia and microcirculation
US7155284B1 (en) 2002-01-24 2006-12-26 Advanced Bionics Corporation Treatment of hypertension
US6827715B2 (en) 2002-01-25 2004-12-07 Medtronic, Inc. System and method of performing an electrosurgical procedure
AU2003212870A1 (en) 2002-02-01 2003-09-02 The Cleveland Clinic Foundation Methods of affecting hypothalamic-related conditions
EP1476222A2 (en) 2002-02-01 2004-11-17 The Cleveland Clinic Foundation Neural stimulation delivery device with independently moveable delivery structures
US7477945B2 (en) 2002-02-01 2009-01-13 The Cleveland Clinic Foundation Delivery device for stimulating the sympathetic nerve chain
US6733498B2 (en) 2002-02-19 2004-05-11 Live Tissue Connect, Inc. System and method for control of tissue welding
US7236821B2 (en) 2002-02-19 2007-06-26 Cardiac Pacemakers, Inc. Chronically-implanted device for sensing and therapy
CN1652841A (zh) 2002-03-14 2005-08-10 布雷恩斯盖特有限公司 血压调节技术
US6882885B2 (en) 2002-03-19 2005-04-19 Solarant Medical, Inc. Heating method for tissue contraction
US6736835B2 (en) 2002-03-21 2004-05-18 Depuy Acromed, Inc. Early intervention spinal treatment methods and devices for use therein
EP1487536A4 (en) 2002-03-27 2009-12-02 Cvrx Inc DEVICES AND METHODS FOR CARDIOVASCULAR REFLEX CONTROL OF COUPLED ELECTRODES
US8774913B2 (en) 2002-04-08 2014-07-08 Medtronic Ardian Luxembourg S.A.R.L. Methods and apparatus for intravasculary-induced neuromodulation
US20080213331A1 (en) 2002-04-08 2008-09-04 Ardian, Inc. Methods and devices for renal nerve blocking
US8347891B2 (en) 2002-04-08 2013-01-08 Medtronic Ardian Luxembourg S.A.R.L. Methods and apparatus for performing a non-continuous circumferential treatment of a body lumen
US7617005B2 (en) 2002-04-08 2009-11-10 Ardian, Inc. Methods and apparatus for thermally-induced renal neuromodulation
US6978174B2 (en) 2002-04-08 2005-12-20 Ardian, Inc. Methods and devices for renal nerve blocking
US8145317B2 (en) 2002-04-08 2012-03-27 Ardian, Inc. Methods for renal neuromodulation
US7620451B2 (en) 2005-12-29 2009-11-17 Ardian, Inc. Methods and apparatus for pulsed electric field neuromodulation via an intra-to-extravascular approach
US8551069B2 (en) 2002-04-08 2013-10-08 Medtronic Adrian Luxembourg S.a.r.l. Methods and apparatus for treating contrast nephropathy
US8150519B2 (en) 2002-04-08 2012-04-03 Ardian, Inc. Methods and apparatus for bilateral renal neuromodulation
US8131371B2 (en) 2002-04-08 2012-03-06 Ardian, Inc. Methods and apparatus for monopolar renal neuromodulation
US7853333B2 (en) 2002-04-08 2010-12-14 Ardian, Inc. Methods and apparatus for multi-vessel renal neuromodulation
US8145316B2 (en) 2002-04-08 2012-03-27 Ardian, Inc. Methods and apparatus for renal neuromodulation
US7162303B2 (en) 2002-04-08 2007-01-09 Ardian, Inc. Renal nerve stimulation method and apparatus for treatment of patients
US20070135875A1 (en) 2002-04-08 2007-06-14 Ardian, Inc. Methods and apparatus for thermally-induced renal neuromodulation
US7756583B2 (en) 2002-04-08 2010-07-13 Ardian, Inc. Methods and apparatus for intravascularly-induced neuromodulation
US20070129761A1 (en) 2002-04-08 2007-06-07 Ardian, Inc. Methods for treating heart arrhythmia
ATE504330T1 (de) 2002-04-11 2011-04-15 Medtronic Vascular Inc Vorrichtungen für die transluminale oder transthorakale interstitielle elektrodenplatzierung
JP4499427B2 (ja) 2002-04-16 2010-07-07 サイト パルス サイエンシズ、インコーポレイテッド 電場の移動及び電極極性の反転で生体材料を処理する方法。
US7258688B1 (en) 2002-04-16 2007-08-21 Baylis Medical Company Inc. Computerized electrical signal generator
US20030199767A1 (en) 2002-04-19 2003-10-23 Cespedes Eduardo Ignacio Methods and apparatus for the identification and stabilization of vulnerable plaque
US20030199768A1 (en) 2002-04-19 2003-10-23 Cespedes Eduardo Ignacio Methods and apparatus for the identification and stabilization of vulnerable plaque
US20030199747A1 (en) 2002-04-19 2003-10-23 Michlitsch Kenneth J. Methods and apparatus for the identification and stabilization of vulnerable plaque
US20030236443A1 (en) 2002-04-19 2003-12-25 Cespedes Eduardo Ignacio Methods and apparatus for the identification and stabilization of vulnerable plaque
US7008417B2 (en) 2002-04-22 2006-03-07 Medtronics, Inc. Detecting coagulum formation
US20030204161A1 (en) 2002-04-25 2003-10-30 Bozidar Ferek-Petric Implantable electroporation therapy device and method for using same
US6748953B2 (en) 2002-06-11 2004-06-15 Scimed Life Systems, Inc. Method for thermal treatment of type II endoleaks in arterial aneurysms
US6730079B2 (en) 2002-07-22 2004-05-04 Medtronic Vidamed, Inc. Method for calculating impedance and apparatus utilizing same
US6855141B2 (en) 2002-07-22 2005-02-15 Medtronic, Inc. Method for monitoring impedance to control power and apparatus utilizing same
US20040193228A1 (en) 2003-03-31 2004-09-30 Gerber Martin T. Method, system and device for treating various disorders of the pelvic floor by electrical stimulation of the left and right pudendal nerves
US7063679B2 (en) 2002-09-20 2006-06-20 Flowmedica, Inc. Intra-aortic renal delivery catheter
WO2004107965A2 (en) 2002-09-20 2004-12-16 Flowmedica, Inc. Systems and methods for performing bi-lateral interventions or diagnosis in branched body lumens
US20050197624A1 (en) 2004-03-04 2005-09-08 Flowmedica, Inc. Sheath for use in peripheral interventions
AU2003294226A1 (en) 2002-09-20 2004-04-23 Flowmedica, Inc. Method and apparatus for intra aortic substance delivery to a branch vessel
US7150741B2 (en) 2002-09-20 2006-12-19 Advanced Neuromodulation Systems, Inc. Programmable dose control module
EP1539291A4 (en) 2002-09-20 2010-03-10 Flowmedica Inc METHOD AND DEVICE FOR SELECTIVE INFUSION BY CATHETER INTRA-RENAL
US7993325B2 (en) 2002-09-20 2011-08-09 Angio Dynamics, Inc. Renal infusion systems and methods
EP1624909A2 (en) 2002-09-20 2006-02-15 FlowMedica, Inc. Appartus and method for inserting an intra-aorta catheter trough a delivery sheath
AU2003278858A1 (en) 2002-09-20 2004-04-08 Flowmedica, Inc. Method and apparatus for selective drug infusion via an intraaortic flow diverter delivery catheter
ATE458534T1 (de) 2002-10-04 2010-03-15 Microchips Inc Medizinische vorrichtung zur gesteuerten arzneimittelverabreichung sowie herzüberwachung und/oder herzstimulation
WO2004033034A1 (en) 2002-10-04 2004-04-22 Microchips, Inc. Medical device for neural stimulation and controlled drug delivery
US7108694B2 (en) 2002-11-08 2006-09-19 Olympus Corporation Heat-emitting treatment device
US20040162590A1 (en) 2002-12-19 2004-08-19 Whitehurst Todd K. Fully implantable miniature neurostimulator for intercostal nerve stimulation as a therapy for angina pectoris
US7131445B2 (en) 2002-12-23 2006-11-07 Gyrus Medical Limited Electrosurgical method and apparatus
US6978180B2 (en) 2003-01-03 2005-12-20 Advanced Neuromodulation Systems, Inc. System and method for stimulation of a person's brain stem
US7167750B2 (en) 2003-02-03 2007-01-23 Enteromedics, Inc. Obesity treatment with electrically induced vagal down regulation
US7837676B2 (en) 2003-02-20 2010-11-23 Recor Medical, Inc. Cardiac ablation devices
US6923808B2 (en) 2003-02-24 2005-08-02 Boston Scientific Scimed, Inc. Probes having helical and loop shaped inflatable therapeutic elements
US7004911B1 (en) 2003-02-24 2006-02-28 Hosheng Tu Optical thermal mapping for detecting vulnerable plaque
WO2004075776A2 (en) 2003-02-24 2004-09-10 Plc Systems Inc. Method and system for prevention of radiocontrast nephropathy
US20040176699A1 (en) 2003-03-03 2004-09-09 Volcano Therapeutics, Inc. Thermography catheter with improved wall contact
EP1605875A3 (en) 2003-03-03 2005-12-28 Sinus Rhythm Technologies, Inc. Electrical block positioning devices and methods of use therefor
US7104985B2 (en) 2003-03-06 2006-09-12 Martinelli Michael A Apparatus and method for causing selective necrosis of abnormal cells
WO2004086992A1 (en) 2003-03-28 2004-10-14 C.R. Bard, Inc. Junction of catheter tip and electrode
US7517342B2 (en) 2003-04-29 2009-04-14 Boston Scientific Scimed, Inc. Polymer coated device for electrically medicated drug delivery
US7221979B2 (en) 2003-04-30 2007-05-22 Medtronic, Inc. Methods and apparatus for the regulation of hormone release
CA2524289C (en) 2003-05-01 2016-01-19 Sherwood Services Ag Method and system for programming and controlling an electrosurgical generator system
JP4212949B2 (ja) 2003-05-06 2009-01-21 朝日インテック株式会社 薬液注入装置
US20050021020A1 (en) 2003-05-15 2005-01-27 Blaha Derek M. System for activating an electrosurgical instrument
JP2006526464A (ja) 2003-06-05 2006-11-24 フローメディカ，インコーポレイテッド 分枝した身体管腔において両側介入または診断を行うためのシステムおよび方法
US7149574B2 (en) 2003-06-09 2006-12-12 Palo Alto Investors Treatment of conditions through electrical modulation of the autonomic nervous system
US7738952B2 (en) 2003-06-09 2010-06-15 Palo Alto Investors Treatment of conditions through modulation of the autonomic nervous system
US20060167437A1 (en) 2003-06-17 2006-07-27 Flowmedica, Inc. Method and apparatus for intra aortic substance delivery to a branch vessel
US20060269531A1 (en) 2003-07-18 2006-11-30 Eastern Virginia Medical School Apparatus for generating electrical pulses and methods of using the same
EP1659970A4 (en) 2003-08-05 2008-05-21 Flowmedica Inc SYSTEM AND METHOD FOR PREVENTING RADIO CONTRAST-INDUCED NEPHROPATHY
US7742809B2 (en) 2003-08-25 2010-06-22 Medtronic, Inc. Electroporation catheter with sensing capabilities
DE202004021951U1 (de) 2003-09-12 2013-06-19 Vessix Vascular, Inc. Auswählbare exzentrische Remodellierung und/oder Ablation von atherosklerotischem Material
US7502650B2 (en) 2003-09-22 2009-03-10 Cvrx, Inc. Baroreceptor activation for epilepsy control
US7435248B2 (en) 2003-09-26 2008-10-14 Boston Scientific Scimed, Inc. Medical probes for creating and diagnosing circumferential lesions within or around the ostium of a vessel
US20050153885A1 (en) 2003-10-08 2005-07-14 Yun Anthony J. Treatment of conditions through modulation of the autonomic nervous system
US7186209B2 (en) 2003-10-09 2007-03-06 Jacobson Jerry I Cardioelectromagnetic treatment
US7416549B2 (en) 2003-10-10 2008-08-26 Boston Scientific Scimed, Inc. Multi-zone bipolar ablation probe assembly
US7480532B2 (en) 2003-10-22 2009-01-20 Cvrx, Inc. Baroreflex activation for pain control, sedation and sleep
WO2005048809A1 (en) 2003-10-23 2005-06-02 Sherwood Services Ag Redundant temperature monitoring in electrosurgical systems for safety mitigation
SE0303124D0 (sv) 2003-11-25 2003-11-25 Elekta Instr Ab An apparatus for controlled directional monitoring and destruction of tissue
US7783353B2 (en) 2003-12-24 2010-08-24 Cardiac Pacemakers, Inc. Automatic neural stimulation modulation based on activity and circadian rhythm
ES2729378T3 (es) 2003-12-24 2019-11-04 Univ California Ablación de tejido con electroporación irreversible
US8396560B2 (en) 2004-11-18 2013-03-12 Cardiac Pacemakers, Inc. System and method for closed-loop neural stimulation
US20080015659A1 (en) 2003-12-24 2008-01-17 Yi Zhang Neurostimulation systems and methods for cardiac conditions
US8086315B2 (en) 2004-02-12 2011-12-27 Asap Medical, Inc. Cardiac stimulation apparatus and method for the control of hypertension
US7499747B2 (en) 2004-03-02 2009-03-03 Cvrx, Inc. External baroreflex activation
US20050209548A1 (en) 2004-03-19 2005-09-22 Dev Sukhendu B Electroporation-mediated intravascular delivery
JP2005278739A (ja) 2004-03-29 2005-10-13 Citizen Watch Co Ltd 採血装置
JP4750784B2 (ja) 2004-04-23 2011-08-17 ノヴォキュアー・リミテッド 異なる周波数の電界による腫瘍等の治療
EP1746976B1 (en) 2004-05-03 2017-01-11 Merrimack Pharmaceuticals, Inc. Liposomes useful for drug delivery
EP1750799A2 (en) 2004-05-04 2007-02-14 The Cleveland Clinic Foundation Methods of treating medical conditions by neuromodulation of the sympathetic nervous system
US7231260B2 (en) 2004-05-06 2007-06-12 Boston Scientific Scimed, Inc. Intravascular self-anchoring electrode body with arcuate springs, spring loops, or arms
JP2007537013A (ja) * 2004-05-14 2007-12-20 メドトロニック・インコーポレーテッド 高密度焦点式超音波を使用してアブレートした組織領域を形成する方法
JP2007537298A (ja) 2004-05-14 2007-12-20 フロウメディカ， インコーポレイテッド うっ血性心不全の処置およびｂｎｐ療法のための両側性局所腎臓送達
US20050261672A1 (en) 2004-05-18 2005-11-24 Mark Deem Systems and methods for selective denervation of heart dysrhythmias
WO2005123183A2 (en) 2004-06-11 2005-12-29 University Of South Florida Electroporation device and method for delivery to ocular tissue
US20050283148A1 (en) 2004-06-17 2005-12-22 Janssen William M Ablation apparatus and system to limit nerve conduction
US7226447B2 (en) 2004-06-23 2007-06-05 Smith & Nephew, Inc. Electrosurgical generator
US20060067972A1 (en) 2004-06-23 2006-03-30 Flowmedica, Inc. Devices for renal-based heart failure treatment
US20060004417A1 (en) 2004-06-30 2006-01-05 Cvrx, Inc. Baroreflex activation for arrhythmia treatment
WO2006012050A2 (en) 2004-06-30 2006-02-02 Cvrx, Inc. Connection structures for extra-vascular electrode lead body
US7076399B2 (en) 2004-07-19 2006-07-11 Baylis Medical Company Inc. Medical generator with hierarchical error logic
US7596469B2 (en) 2004-07-19 2009-09-29 Baylis Medical Company Inc. Method and apparatus for prioritizing errors in a medical treatment system
FR2873385B1 (fr) 2004-07-23 2006-10-27 Centre Nat Rech Scient Cnrse Surveillance et controle d'une electroporation
US20060025765A1 (en) 2004-07-30 2006-02-02 Jaime Landman Electrosurgical systems and methods
US7373204B2 (en) 2004-08-19 2008-05-13 Lifestim, Inc. Implantable device and method for treatment of hypertension
EP1796568A1 (en) 2004-09-09 2007-06-20 Vnus Medical Technologies, Inc. Methods and apparatus for treatment of hollow anatomical structures
JP4064388B2 (ja) * 2004-09-09 2008-03-19 オリンパス株式会社 治療システム
US7532938B2 (en) 2004-09-10 2009-05-12 The Cleveland Clinic Foundation Intraluminal electrode assembly
US20060069323A1 (en) 2004-09-24 2006-03-30 Flowmedica, Inc. Systems and methods for bi-lateral guidewire cannulation of branched body lumens
US20060074453A1 (en) 2004-10-04 2006-04-06 Cvrx, Inc. Baroreflex activation and cardiac resychronization for heart failure treatment
EP1809272A4 (en) 2004-10-18 2008-01-02 Maroon Biotech Corp METHOD AND COMPOSITIONS FOR TREATING DAMAGES THROUGH FREE RADICALS
US7524318B2 (en) 2004-10-28 2009-04-28 Boston Scientific Scimed, Inc. Ablation probe with flared electrodes
US20070083239A1 (en) 2005-09-23 2007-04-12 Denise Demarais Methods and apparatus for inducing, monitoring and controlling renal neuromodulation
US7937143B2 (en) 2004-11-02 2011-05-03 Ardian, Inc. Methods and apparatus for inducing controlled renal neuromodulation
US20060100618A1 (en) 2004-11-08 2006-05-11 Cardima, Inc. System and method for performing ablation and other medical procedures using an electrode array with flex circuit
US8617152B2 (en) 2004-11-15 2013-12-31 Medtronic Ablation Frontiers Llc Ablation system with feedback
US8332047B2 (en) 2004-11-18 2012-12-11 Cardiac Pacemakers, Inc. System and method for closed-loop neural stimulation
US7429261B2 (en) 2004-11-24 2008-09-30 Ablation Frontiers, Inc. Atrial ablation catheter and method of use
US20060116720A1 (en) 2004-12-01 2006-06-01 Penny Knoblich Method and apparatus for improving renal function
WO2006069313A1 (en) 2004-12-20 2006-06-29 Vnus Medical Technologies, Inc. Systems and methods for treating a hollow anatomical structure
WO2006069215A2 (en) 2004-12-21 2006-06-29 Ebr Systems, Inc. Leadless cardiac system for pacing and arrhythmia treatment
US20060161148A1 (en) 2005-01-13 2006-07-20 Robert Behnke Circuit and method for controlling an electrosurgical generator using a full bridge topology
US20060161147A1 (en) 2005-01-18 2006-07-20 Salvatore Privitera Method and apparatus for controlling a surgical ablation device
DE102005025946A1 (de) 2005-01-26 2006-08-03 Erbe Elektromedizin Gmbh HF-Chirurgieeinrichtung
US9833618B2 (en) 2005-02-04 2017-12-05 Palo Alto Investors Methods and compositions for treating a disease condition in a subject
US7548780B2 (en) 2005-02-22 2009-06-16 Cardiac Pacemakers, Inc. Cell therapy and neural stimulation for cardiac repair
ATE542486T1 (de) 2005-03-28 2012-02-15 Minnow Medical Llc Intraluminale elektrische gewebecharakterisierung und abgestimmte hf-energie zur selektiven behandlung von atherom und anderen zielgeweben
US7499748B2 (en) 2005-04-11 2009-03-03 Cardiac Pacemakers, Inc. Transvascular neural stimulation device
US7794455B2 (en) * 2005-04-29 2010-09-14 Medtronic Cryocath Lp Wide area ablation of myocardial tissue
US8696662B2 (en) 2005-05-12 2014-04-15 Aesculap Ag Electrocautery method and apparatus
US20070016274A1 (en) 2005-06-29 2007-01-18 Boveja Birinder R Gastrointestinal (GI) ablation for GI tumors or to provide therapy for obesity, motility disorders, G.E.R.D., or to induce weight loss
US7390894B2 (en) 2005-07-07 2008-06-24 Mayo Foundation For Medical Education And Research Glutathione S-transferase sequence variants
WO2007008954A2 (en) 2005-07-11 2007-01-18 Ablation Frontiers Low power tissue ablation system
DE202006021215U1 (de) 2005-07-21 2013-11-08 Covidien Lp Vorrichtung zum Behandeln einer hohlen anatomischen Struktur
US20070021803A1 (en) 2005-07-22 2007-01-25 The Foundry Inc. Systems and methods for neuromodulation for treatment of pain and other disorders associated with nerve conduction
US8657814B2 (en) 2005-08-22 2014-02-25 Medtronic Ablation Frontiers Llc User interface for tissue ablation system
US8712522B1 (en) 2005-10-18 2014-04-29 Cvrx, Inc. System for setting programmable parameters for an implantable hypertension treatment device
AU2006321574B2 (en) 2005-12-06 2012-07-19 St. Jude Medical, Atrial Fibrillation Division, Inc. Assessment of electrode coupling for tissue ablation
US20070156200A1 (en) 2005-12-29 2007-07-05 Lilian Kornet System and method for regulating blood pressure and electrolyte balance
US7887534B2 (en) 2006-01-18 2011-02-15 Stryker Corporation Electrosurgical system
CA2574935A1 (en) 2006-01-24 2007-07-24 Sherwood Services Ag A method and system for controlling an output of a radio-frequency medical generator having an impedance based control algorithm
CA2574934C (en) 2006-01-24 2015-12-29 Sherwood Services Ag System and method for closed loop monitoring of monopolar electrosurgical apparatus
US8147485B2 (en) 2006-01-24 2012-04-03 Covidien Ag System and method for tissue sealing
EP2289446B1 (en) 2006-01-24 2017-05-31 Covidien AG System for tissue sealing
US8571650B2 (en) 2006-03-03 2013-10-29 Palo Alto Investors Methods and compositions for treating a renal associated condition in a subject
US7322164B2 (en) 2006-03-10 2008-01-29 Tipper Tie, Inc. Clippers with translating gate members and cooperating stiffener assemblies and related methods, computer program products
US20080004673A1 (en) 2006-04-03 2008-01-03 Cvrx, Inc. Implantable extravascular electrostimulation system having a resilient cuff
US7651492B2 (en) 2006-04-24 2010-01-26 Covidien Ag Arc based adaptive control system for an electrosurgical unit
US20070282376A1 (en) 2006-06-06 2007-12-06 Shuros Allan C Method and apparatus for neural stimulation via the lymphatic system
US7647101B2 (en) 2006-06-09 2010-01-12 Cardiac Pacemakers, Inc. Physical conditioning system, device and method
US9049096B2 (en) 2006-06-19 2015-06-02 Qualcomm Incorporated Data routing via lower layers in a communication system
ATE536147T1 (de) 2006-06-28 2011-12-15 Ardian Inc Systeme für wärmeinduzierte renale neuromodulation
US8700176B2 (en) * 2006-07-27 2014-04-15 Pollogen Ltd. Apparatus and method for non-invasive treatment of skin tissue
US20080039904A1 (en) 2006-08-08 2008-02-14 Cherik Bulkes Intravascular implant system
US8486060B2 (en) 2006-09-18 2013-07-16 Cytyc Corporation Power ramping during RF ablation
US20080077126A1 (en) 2006-09-22 2008-03-27 Rassoll Rashidi Ablation for atrial fibrillation
US7799020B2 (en) 2006-10-02 2010-09-21 Conmed Corporation Near-instantaneous responsive closed loop control electrosurgical generator and method
US20080091255A1 (en) 2006-10-11 2008-04-17 Cardiac Pacemakers Implantable neurostimulator for modulating cardiovascular function
EP2455036B1 (en) 2006-10-18 2015-07-15 Vessix Vascular, Inc. Tuned RF energy and electrical tissue characterization for selective treatment of target tissues
WO2008049082A2 (en) 2006-10-18 2008-04-24 Minnow Medical, Inc. Inducing desirable temperature effects on body tissue
EP3257462B1 (en) 2006-10-18 2022-12-21 Vessix Vascular, Inc. System for inducing desirable temperature effects on body tissue
JP5198466B2 (ja) 2006-12-06 2013-05-15 ボストン サイエンティフィック リミテッド パルス変調された無線周波数エネルギーを用いる組織焼灼エネルギー発生器
US7846160B2 (en) 2006-12-21 2010-12-07 Cytyc Corporation Method and apparatus for sterilization
US7896871B2 (en) 2007-02-22 2011-03-01 Medtronic, Inc. Impedance computation for ablation therapy
US9265559B2 (en) 2007-02-25 2016-02-23 Avent, Inc. Electrosurgical method
AU2008217492B2 (en) 2007-02-25 2013-10-24 Avent, Inc. Methods for control of energy delivery to multiple energy delivery devices
WO2008128070A2 (en) 2007-04-11 2008-10-23 The Cleveland Clinic Foundation Method and apparatus for renal neuromodulation
US8496653B2 (en) 2007-04-23 2013-07-30 Boston Scientific Scimed, Inc. Thrombus removal
US20080275440A1 (en) * 2007-05-03 2008-11-06 Medtronic, Inc. Post-ablation verification of lesion size
US20080281386A1 (en) * 2007-05-09 2008-11-13 Tessaron Medical, Inc. Systems and methods for treating body tissue
US20080281318A1 (en) * 2007-05-09 2008-11-13 Tessaron Medical, Inc. Systems and methods for inductive heat treatment of body tissue
US8641704B2 (en) 2007-05-11 2014-02-04 Medtronic Ablation Frontiers Llc Ablation therapy system and method for treating continuous atrial fibrillation
US8630704B2 (en) 2007-06-25 2014-01-14 Cardiac Pacemakers, Inc. Neural stimulation with respiratory rhythm management
US8690823B2 (en) 2007-07-13 2014-04-08 Abbott Cardiovascular Systems Inc. Drug coated balloon catheter
AU2008279121B2 (en) 2007-07-24 2013-09-19 Boston Scientific Scimed, Inc. System and method for controlling power based on impedance detection, such as controlling power to tissue treatment devices
DE102008061418A1 (de) 2007-12-12 2009-06-18 Erbe Elektromedizin Gmbh Vorrichtung zur kontaktlosen Kommunikation und Verwendung einer Speichereinrichtung
US7848816B1 (en) 2007-12-27 2010-12-07 Pacesetter, Inc. Acquiring nerve activity from carotid body and/or sinus
US7949398B1 (en) 2007-12-27 2011-05-24 Pacesetter, Inc. Acquiring nerve activity from carotid body and/or sinus
US9204927B2 (en) 2009-05-13 2015-12-08 St. Jude Medical, Atrial Fibrillation Division, Inc. System and method for presenting information representative of lesion formation in tissue during an ablation procedure
WO2009140359A2 (en) 2008-05-13 2009-11-19 Medtronic, Inc. Tissue lesion evaluation
JP2010021134A (ja) 2008-06-11 2010-01-28 Sumitomo Chemical Co Ltd リチウム複合金属酸化物の製造方法
US8058771B2 (en) 2008-08-06 2011-11-15 Ethicon Endo-Surgery, Inc. Ultrasonic device for cutting and coagulating with stepped output
US8340763B2 (en) 2008-09-08 2012-12-25 Backbeat Medical, Inc. Methods and apparatus to stimulate heart atria
US8095212B2 (en) 2008-10-24 2012-01-10 Olympus Medical Systems Corp. High-frequency surgical apparatus and high-frequency surgical method for closure of patent foramen ovale
US8808345B2 (en) 2008-12-31 2014-08-19 Medtronic Ardian Luxembourg S.A.R.L. Handle assemblies for intravascular treatment devices and associated systems and methods
US8652129B2 (en) * 2008-12-31 2014-02-18 Medtronic Ardian Luxembourg S.A.R.L. Apparatus, systems, and methods for achieving intravascular, thermally-induced renal neuromodulation
US8333759B2 (en) 2009-01-12 2012-12-18 Covidien Lp Energy delivery algorithm for medical devices
US8152802B2 (en) 2009-01-12 2012-04-10 Tyco Healthcare Group Lp Energy delivery algorithm filter pre-loading
US8262652B2 (en) 2009-01-12 2012-09-11 Tyco Healthcare Group Lp Imaginary impedance process monitoring and intelligent shut-off
US8162932B2 (en) 2009-01-12 2012-04-24 Tyco Healthcare Group Lp Energy delivery algorithm impedance trend adaptation
US8211100B2 (en) 2009-01-12 2012-07-03 Tyco Healthcare Group Lp Energy delivery algorithm for medical devices based on maintaining a fixed position on a tissue electrical conductivity v. temperature curve
JP2010162163A (ja) 2009-01-15 2010-07-29 Sumitomo Bakelite Co Ltd 体内留置用バルーンカテーテル
DK2459096T3 (en) 2009-07-28 2015-01-19 Neuwave Medical Inc ablation device
US8388614B2 (en) 2009-09-29 2013-03-05 Covidien Lp Return electrode temperature prediction
US9050093B2 (en) 2009-10-09 2015-06-09 Ethicon Endo-Surgery, Inc. Surgical generator for ultrasonic and electrosurgical devices
US8568401B2 (en) 2009-10-27 2013-10-29 Covidien Lp System for monitoring ablation size
US20110112400A1 (en) * 2009-11-06 2011-05-12 Ardian, Inc. High intensity focused ultrasound catheter apparatuses, systems, and methods for renal neuromodulation
WO2011057243A2 (en) 2009-11-09 2011-05-12 University Of Central Florida Research Foundation, Inc. Administration of plant expressed oral tolerance agents
EP2525715A4 (en) 2010-01-19 2014-06-04 Medtronic Ardian Luxembourg S R L METHODS AND APPARATUS FOR RENAL NEUROMODULATION BY STEREOTACTIC RADIOTHERAPY
JP2011147758A (ja) 2010-01-22 2011-08-04 Olympus Corp 処置具
US20110190755A1 (en) 2010-01-29 2011-08-04 Medtronic Ablation Frontiers Llc Patient return electrode detection for ablation system
JP5483339B2 (ja) 2010-02-15 2014-05-07 三菱自動車工業株式会社 リヤシートのロック機構
CA2795229A1 (en) 2010-04-09 2011-10-13 Vessix Vascular, Inc. Power generating and control apparatus for the treatment of tissue
US8870863B2 (en) 2010-04-26 2014-10-28 Medtronic Ardian Luxembourg S.A.R.L. Catheter apparatuses, systems, and methods for renal neuromodulation
US8845631B2 (en) 2010-04-28 2014-09-30 Medtronic Ablation Frontiers Llc Systems and methods of performing medical procedures
US10631912B2 (en) 2010-04-30 2020-04-28 Medtronic Xomed, Inc. Interface module for use with nerve monitoring and electrosurgery
US8834388B2 (en) 2010-04-30 2014-09-16 Medtronic Ablation Frontiers Llc Method and apparatus to regulate a tissue temperature
US20120123400A1 (en) 2010-05-10 2012-05-17 David Francischelli Methods and devices for controlling energy during ablation
GB2480498A (en) 2010-05-21 2011-11-23 Ethicon Endo Surgery Inc Medical device comprising RF circuitry
US9155589B2 (en) 2010-07-30 2015-10-13 Boston Scientific Scimed, Inc. Sequential activation RF electrode set for renal nerve ablation
US8798950B2 (en) 2010-08-20 2014-08-05 Bio-Rad Laboratories, Inc. System and method for ultrasonic transducer control
US20120065506A1 (en) 2010-09-10 2012-03-15 Scott Smith Mechanical, Electromechanical, and/or Elastographic Assessment for Renal Nerve Ablation
WO2012054762A2 (en) 2010-10-20 2012-04-26 Medtronic Ardian Luxembourg S.A.R.L. Catheter apparatuses having expandable mesh structures for renal neuromodulation and associated systems and methods
US9066720B2 (en) * 2010-10-25 2015-06-30 Medtronic Ardian Luxembourg S.A.R.L. Devices, systems and methods for evaluation and feedback of neuromodulation treatment
JP6046631B2 (ja) 2010-11-19 2016-12-21 ボストン サイエンティフィック サイムド，インコーポレイテッドＢｏｓｔｏｎ Ｓｃｉｅｎｔｉｆｉｃ Ｓｃｉｍｅｄ，Ｉｎｃ． 腎神経の検出切除装置
US9023034B2 (en) 2010-11-22 2015-05-05 Boston Scientific Scimed, Inc. Renal ablation electrode with force-activatable conduction apparatus
US9532828B2 (en) 2010-11-29 2017-01-03 Medtronic Ablation Frontiers Llc System and method for adaptive RF ablation
US10016233B2 (en) 2010-12-06 2018-07-10 Biosense Webster (Israel) Ltd. Treatment of atrial fibrillation using high-frequency pacing and ablation of renal nerves
US20120150169A1 (en) 2010-12-09 2012-06-14 Medtronic, Inc. Impedance measurement to monitor organ perfusion or hemodynamic status
WO2012098523A2 (en) 2011-01-19 2012-07-26 Sendyne Corp. Converging algorithm for real-time battery prediction
US20120191079A1 (en) 2011-01-20 2012-07-26 Hansen Medical, Inc. System and method for endoluminal and translumenal therapy
US9265557B2 (en) 2011-01-31 2016-02-23 Medtronic Ablation Frontiers Llc Multi frequency and multi polarity complex impedance measurements to assess ablation lesions
US8909316B2 (en) 2011-05-18 2014-12-09 St. Jude Medical, Cardiology Division, Inc. Apparatus and method of assessing transvascular denervation
US20120296232A1 (en) 2011-05-18 2012-11-22 St. Jude Medical, Inc. Method and apparatus of assessing transvascular denervation
EP2709517B1 (en) 2011-05-18 2017-01-11 St. Jude Medical, Inc. Apparatus for assessing transvascular denervation
US9050089B2 (en) 2011-05-31 2015-06-09 Covidien Lp Electrosurgical apparatus with tissue site sensing and feedback control
EP2734259B1 (en) 2011-07-20 2016-11-23 Boston Scientific Scimed, Inc. Percutaneous device to visualize, target and ablate nerves
US8702619B2 (en) 2011-08-26 2014-04-22 Symap Holding Limited Mapping sympathetic nerve distribution for renal ablation and catheters for same
KR101862903B1 (ko) 2011-08-26 2018-05-30 사이맵 홀딩 리미티드 동맥벽 기능성 신경의 위치 확정과 식별에 사용하는 카테터 및 그 사용 방법
US9820811B2 (en) 2011-08-26 2017-11-21 Symap Medical (Suzhou), Ltd System and method for mapping the functional nerves innervating the wall of arteries, 3-D mapping and catheters for same
US9427579B2 (en) 2011-09-29 2016-08-30 Pacesetter, Inc. System and method for performing renal denervation verification
US9119600B2 (en) 2011-11-15 2015-09-01 Boston Scientific Scimed, Inc. Device and methods for renal nerve modulation monitoring
US9844405B2 (en) 2011-12-20 2017-12-19 Cardiac Pacemakers, Inc. Method and apparatus for monitoring and ablating nerves
CN104244856B (zh) 2011-12-23 2017-03-29 维西克斯血管公司 重建身体通道的组织或身体通路附近的组织的方法及设备
US20130172877A1 (en) 2011-12-28 2013-07-04 Boston Scientific Scimed, Inc. Balloon expandable multi-electrode rf ablation catheter
EP2797535B1 (en) 2011-12-29 2020-10-21 Boston Scientific Scimed, Inc. Device for renal nerve modulation monitoring
EP3915629A1 (en) 2012-01-26 2021-12-01 Autonomix Medical, Inc. Controlled sympathectomy and micro-ablation systems and methods
US9649064B2 (en) 2012-01-26 2017-05-16 Autonomix Medical, Inc. Controlled sympathectomy and micro-ablation systems and methods
US20130218029A1 (en) 2012-02-16 2013-08-22 Pacesetter, Inc. System and method for assessing renal artery nerve density
CN104271062B (zh) 2012-03-08 2017-07-07 美敦力Af卢森堡有限责任公司 采用神经调节装置的生物标志物取样和相关系统及方法
US9439598B2 (en) 2012-04-12 2016-09-13 NeuroMedic, Inc. Mapping and ablation of nerves within arteries and tissues
CA3158197A1 (en) 2012-05-29 2013-12-05 Autonomix Medical, Inc. Endoscopic sympathectomy systems and methods
US11357447B2 (en) 2012-05-31 2022-06-14 Sonivie Ltd. Method and/or apparatus for measuring renal denervation effectiveness
US9295842B2 (en) 2012-07-05 2016-03-29 Mc10, Inc. Catheter or guidewire device including flow sensing and use thereof
EP2866645A4 (en) 2012-07-05 2016-03-30 Mc10 Inc CATHETER DEVICE WITH FLOW MEASUREMENT
CN102743225B (zh) 2012-07-18 2014-04-02 深圳市惠泰医疗器械有限公司 肾动脉射频消融可控电极导管
CN103284693B (zh) 2012-08-24 2014-12-24 苏州信迈医疗器械有限公司 一种能够定位和识别血管壁内或外膜上神经的仪器及使用方法
TWI498101B (zh) 2012-08-30 2015-09-01 Univ Nat Chiao Tung 神經纖維分佈之分析方法及標準化誘發復合動作電位之量測方法
JP2014054430A (ja) 2012-09-13 2014-03-27 Nippon Koden Corp カテーテル
EP2906135A2 (en) 2012-10-10 2015-08-19 Boston Scientific Scimed, Inc. Renal nerve modulation devices and methods
EP2914192B1 (en) 2012-11-05 2019-05-01 Pythagoras Medical Ltd. Controlled tissue ablation
US9770593B2 (en) 2012-11-05 2017-09-26 Pythagoras Medical Ltd. Patient selection using a transluminally-applied electric current
CA3183802A1 (en) 2012-11-05 2014-05-08 Autonomix Medical, Inc. Systems, methods, and devices for monitoring and treatment of tissues within and/or through a lumen wall
US20140316496A1 (en) 2012-11-21 2014-10-23 NeuroTronik IP Holding (Jersey) Limited Intravascular Electrode Arrays for Neuromodulation
WO2014091401A2 (en) 2012-12-10 2014-06-19 Perseus-Biomed Inc. Dynamic denervation procedures and systems for the implementation thereof
JP6275158B2 (ja) 2012-12-10 2018-02-07 コーニンクレッカ フィリップス エヌ ヴェＫｏｎｉｎｋｌｉｊｋｅ Ｐｈｉｌｉｐｓ Ｎ．Ｖ． 腎除神経用のデジタル定規及びレチクル
WO2014124241A1 (en) 2013-02-08 2014-08-14 Covidien Lp System and method for lung denervation
US20140228829A1 (en) 2013-02-13 2014-08-14 St. Jude Medical, Cardiology Division, Inc. Laser-based devices and methods for renal denervation
US10028764B2 (en) 2013-02-21 2018-07-24 Boston Scientific Scimed, Inc. Ablation catheter with wireless temperature sensor
US10195467B2 (en) 2013-02-21 2019-02-05 Boston Scientific Scimed, Inc. Ablation catheter system with wireless radio frequency temperature sensor
US20140249524A1 (en) 2013-03-01 2014-09-04 Boston Scientific Scimed, Inc. System and method for performing renal nerve modulation
US20140246465A1 (en) 2013-03-03 2014-09-04 Joan Darnell Peterson Fish n stow
CA2903108A1 (en) 2013-03-08 2014-09-12 Symple Surgical Inc. Balloon catheter apparatus with microwave emitter
JP6122206B2 (ja) 2013-03-12 2017-04-26 ボストン サイエンティフィック サイムド，インコーポレイテッドＢｏｓｔｏｎ Ｓｃｉｅｎｔｉｆｉｃ Ｓｃｉｍｅｄ，Ｉｎｃ． 神経調節システム
US9510902B2 (en) 2013-03-13 2016-12-06 St. Jude Medical, Cardiology Division, Inc. Ablation catheters and systems including rotational monitoring means
US9131982B2 (en) 2013-03-14 2015-09-15 St. Jude Medical, Cardiology Division, Inc. Mediguide-enabled renal denervation system for ensuring wall contact and mapping lesion locations
US8876813B2 (en) 2013-03-14 2014-11-04 St. Jude Medical, Inc. Methods, systems, and apparatus for neural signal detection
EP2967725B1 (en) 2013-03-15 2019-12-11 Boston Scientific Scimed, Inc. Control unit for detecting electrical leakage between electrode pads and system comprising such a control unit
US9179973B2 (en) 2013-03-15 2015-11-10 St. Jude Medical, Cardiology Division, Inc. Feedback systems and methods for renal denervation utilizing balloon catheter
US9987070B2 (en) 2013-03-15 2018-06-05 St. Jude Medical, Cardiology Division, Inc. Ablation system, methods, and controllers
US9974477B2 (en) 2013-03-15 2018-05-22 St. Jude Medical, Cardiology Division, Inc. Quantification of renal denervation via alterations in renal blood flow pre/post ablation
US9186212B2 (en) 2013-03-15 2015-11-17 St. Jude Medical, Cardiology Division, Inc. Feedback systems and methods utilizing two or more sites along denervation catheter
US9561070B2 (en) 2013-03-15 2017-02-07 St. Jude Medical, Cardiology Division, Inc. Ablation system, methods, and controllers
AU2014241205B2 (en) 2013-03-27 2019-01-17 Autonomix Medical, Inc. Neurological traffic and receptor evaluation and modification: systems and methods
WO2014162660A1 (ja) 2013-04-01 2014-10-09 テルモ株式会社 モニタリングデバイス及びモニタリングデバイスキット
JP2016517750A (ja) 2013-05-02 2016-06-20 ハリントン ダグラス シー．ＨＡＲＲＩＮＧＴＯＮ， Ｄｏｕｇｌａｓ Ｃ． 大動脈腎動脈神経節の検出と治療のための装置及び方法
US20140330266A1 (en) 2013-05-03 2014-11-06 St. Jude Medical, Cardiology Division, Inc. Ablation system, methods, and controllers
JP2016517777A (ja) 2013-05-08 2016-06-20 ボストン サイエンティフィック サイムド，インコーポレイテッドＢｏｓｔｏｎ Ｓｃｉｅｎｔｉｆｉｃ Ｓｃｉｍｅｄ，Ｉｎｃ． アブレーション処置中の温度監視および制御のためのシステムおよび方法
AU2014284558B2 (en) 2013-07-01 2017-08-17 Boston Scientific Scimed, Inc. Medical devices for renal nerve ablation
US20150025524A1 (en) 2013-07-18 2015-01-22 St. Jude Medical, Cardiology Division, Inc. Renal denervation monitoring and feedback apparatus, system and method
US9931046B2 (en) 2013-10-25 2018-04-03 Ablative Solutions, Inc. Intravascular catheter with peri-vascular nerve activity sensors
CN105828709A (zh) 2014-01-03 2016-08-03 Mc10股份有限公司 包括流量感测的导管或导丝装置及其使用
US9848949B2 (en) 2014-01-21 2017-12-26 Oscor Inc. Renal denervation system
US20150223877A1 (en) 2014-02-12 2015-08-13 Perseus-Biomed Inc. Methods and systems for treating nerve structures
CN106659531A (zh) 2014-05-07 2017-05-10 毕达哥拉斯医疗有限公司 受控组织消融技术
US11382515B2 (en) 2014-08-07 2022-07-12 Verve Medical, Inc. Renal denervation using nerve fluorescing dye
US10231778B2 (en) 2014-10-20 2019-03-19 Biosense Webster (Israel) Ltd. Methods for contemporaneous assessment of renal denervation
US10383685B2 (en) 2015-05-07 2019-08-20 Pythagoras Medical Ltd. Techniques for use with nerve tissue
US20170007157A1 (en) 2015-07-08 2017-01-12 Rainbow Medical Ltd. Electrical-signal-based electrode-tissue contact detection
US10285751B2 (en) 2015-10-16 2019-05-14 Biosense Webster (Israel) Ltd. System and method for controlling catheter power based on renal ablation response

Patent Citations (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20020123738A1 (en) * 1998-06-11 2002-09-05 Target Therapeutics, Inc. Catheter with composite stiffener
EP1169976A1 (en) * 2000-07-07 2002-01-09 Biosense, Inc. Multi-electrode catheter, system and method
WO2006041881A2 (en) * 2004-10-05 2006-04-20 Ardian, Inc. Methods and apparatus for renal neuromodulation
US20060247618A1 (en) * 2004-11-05 2006-11-02 Asthmatx, Inc. Medical device with procedure improvement features
US20070208336A1 (en) * 2006-01-27 2007-09-06 David Kim Ablation device and system for guiding ablation device into body
US20080051704A1 (en) * 2006-08-28 2008-02-28 Patel Rajnikant V Catheter and system for using same
US20100168739A1 (en) * 2008-12-31 2010-07-01 Ardian, Inc. Apparatus, systems, and methods for achieving intravascular, thermally-induced renal neuromodulation
WO2010078175A1 (en) * 2008-12-31 2010-07-08 Ardian, Inc. Apparatus, systems and methods for achieving intravascular, thermally-induced renal neuromodulation

Also Published As

Publication number Publication date
EP2632373B1 (en) 2018-07-18
US9750560B2 (en) 2017-09-05
US20190183560A1 (en) 2019-06-20
US20150257815A1 (en) 2015-09-17
US10179020B2 (en) 2019-01-15
TW201221114A (en) 2012-06-01
EP2632373A1 (en) 2013-09-04
JP2013544130A (ja) 2013-12-12
CN103313671B (zh) 2017-06-06
WO2012061153A1 (en) 2012-05-10
US9066720B2 (en) 2015-06-30
JP6046041B2 (ja) 2016-12-14
US20170020597A1 (en) 2017-01-26
EP3449856B1 (en) 2023-06-28
US20180028256A1 (en) 2018-02-01
JP2017080420A (ja) 2017-05-18
US9345530B2 (en) 2016-05-24
CN107007348A (zh) 2017-08-04
JP6267774B2 (ja) 2018-01-24
EP3449856A1 (en) 2019-03-06
US20120101538A1 (en) 2012-04-26
CN103313671A (zh) 2013-09-18
US20210259760A1 (en) 2021-08-26
JP6522099B2 (ja) 2019-05-29
CN107007348B (zh) 2019-05-31
JP2018079334A (ja) 2018-05-24
US11006999B2 (en) 2021-05-18

Similar Documents

Publication Publication Date Title
TWI513451B (zh) 用於神經調節治療之估算及反饋的裝置、系統及方法
US11504184B2 (en) Current control methods and systems
EP2967713B1 (en) Systems for specialization of neuromodulation treatment
US20230000549A1 (en) Controlled irrigation for neuromodulation systems and associated methods
US20200146742A1 (en) Controlled neuromodulation systems and methods of use
US12035959B2 (en) Devices, systems and methods for evaluation and feedback of neuromodulation treatment

Legal Events

Date Code Title Description
MM4A Annulment or lapse of patent due to non-payment of fees