System and method for endoluminal and translumenal therapy

Abstract

A robotic instrument system comprises a controller configured to control actuation of at least one servo motor and an elongate instrument configured to move in response to actuation of the at least one servo motor, wherein the controller controls positioning of the instrument based at least in part upon an electroanatomic model of the neural plexus adjacent the renal artery.

1 . A robotic instrument system, comprising:
 a. a controller configured to control actuation of at least one servo motor; and   b. an elongate instrument configured to move in response to actuation of the at least one servo motor;   wherein the controller controls positioning of the instrument based at least in part upon an electroanatomic model of the neural plexus adjacent the renal artery.   
     
     
         2 . The system of  claim 1 , further comprising a master input device operatively coupled between the remotely-steerable elongate deployment member and the controller, the master input device configured to receive commands from an operator and produce control signals to be used by the controller to operate the elongate instrument. 
     
     
         3 . The system of  claim 1 , wherein the elongate instrument is an electromechanically steerable catheter. 
     
     
         4 . The system of  claim 1 , further comprising a robotic instrument driver operatively coupled between the elongate instrument and the controller, the robotic instrument driver being configured to move one or more control elements of the elongate instrument in response to signals transmitted from the controller to cause navigation movement of the elongate instrument. 
     
     
         5 . The system of  claim 1 , wherein the elongate instrument is coupled to a treatment element configured to be at least partially pierced into nearby tissue structures. 
     
     
         6 . The system of  claim 1 , further comprising one or more localization sensors coupled to a distal portion of the elongate instrument and configured to facilitate computation of a location of said distal portion relative to a coordinate system, wherein the localization sensor comprises an element selected from the group consisting of: an ultrasound transducer, an electromagnetic flux sensor, a fiber Bragg local deflection sensor, a resistive strain gauge, a potential difference sensor, and a current sensor. 
     
     
         7 . The system of  claim 1 , further comprising one or more imaging elements coupled to the elongate instrument selected from the group consisting of: an ultrasound transducer, an optical fiber, and an imaging chip. 
     
     
         8 . The system of  claim 7 , wherein one imaging element is an optical fiber, and wherein the system further comprises an interferometry system configured to analyze transmitted and reflected light signals. 
     
     
         9 . The system of  claim 8 , wherein the interferometry system is configured to create an OCT image of a portion of a targeted tissue structure. 
     
     
         10 . The system of  claim 1 , wherein the electroanatomic model comprises one or more spatial points of presence of neural fibers comprising the neural plexus relative to other nearby anatomy. 
     
     
         11 . The system of  claim 1 , wherein the controller is configured to advance the treatment element across at least one tissue wall toward the neural plexus. 
     
     
         12 . The system of  claim 1 , wherein the controller is configured to automatically move the elongate instrument based at least in part upon the electroanatomical model. 
     
     
         13 . The system of  claim 1 , wherein the controller is further configured to control positioning of the instrument based at least in part upon a renin level detected in the blood. 
     
     
         14 . The system of  claim 1 , wherein the controller is further configured to control a level of current flow to an ablation electrode operatively coupled to the instrument based at least in part upon a renin level detected in the blood. 
     
     
         15 . The system of  claim 1 , wherein the controller is configured to superimpose an anatomic map upon an electrical mapping to assist in the identification of electrical foci within the neural plexus adjacent the renal artery. 
     
     
         16 . A method for conducting a denervation process upon the neural plexus adjacent the renal artery, comprising:
 a. navigating a steerable catheter into the renal vein;   b. imaging targeted portions of the neural plexus from inside of the renal vein to create an anatomic map of the targeted portions;   c. creating an electrical mapping of one or more neural strands comprising the targeted portions; and   d. denervating the targeted portions utilizing a treatment element coupled to the steerable catheter, based at least in part upon the anatomic map and electrical mapping.   
     
     
         17 . The method of  claim 16 , wherein the steerable catheter is a robotic catheter operatively coupled to the control computing device and configured to move in response to control signals from a master input device configured to manually operated by an operator. 
     
     
         18 . The method of  claim 16 , wherein creating an electrical mapping comprises stimulating a first portion of a nerve strand and detecting conduction of the stimulation at a second portion of the nerve strand longitudinally displaced from the first portion. 
     
     
         19 . The method of  claim 18 , further comprising associating a nerve anatomical location with each of the first and second portions of the nerve strand. 
     
     
         20 . The method of  claim 19 , further comprising associating a renal vein anatomical location from the anatomic map with each of the nerve anatomical locations to form an electroanatomical map. 
     
     
         21 . The method of  claim 16 , wherein the treatment element comprises an electrode and denervating comprises passing current through the electrode. 
     
     
         22 . The method of  claim 21 , wherein denervating further comprises placing the electrode at an endolumenal location adjacent a targeted portion of the neural plexus. 
     
     
         23 . The method of  claim 21 , wherein denervating further comprises placing the electrode at a translumenal location adjacent a targeted portion of the neural plexus. 
     
     
         24 . The method of  claim 23 , further comprising advancing the treatment element relative to a distal portion of the steerable catheter. 
     
     
         25 . The method of  claim 16 , further comprising superimposing the anatomic map upon the electrical mapping to assist in the identification of electrical foci within the neural plexus adjacent the renal artery. 
     
     
         26 . The method of  claim 16 , wherein creating an electrical mapping comprises stimulating a first portion of a nerve strand and detecting conduction of the stimulation in any other portion of the associated neural plexus. 
     
     
         27 . A system for conducting a denervation of the neural plexus adjacent the renal artery, comprising:
 a. a remotely-steerable elongate deployment member configured to be navigated into the renal artery;   b. an expandable intravascular treatment member coupled to a portion of the elongate deployment member, the expandable member comprising one or more circuit elements operatively coupled to one or more tissue probing tips, such that upon expansion of the expandable member from a collapsed state to an expandable state, the probing tips protrude substantially perpendicularly from an outer surface of the expandable member and into one or more walls of the renal artery; and   c. an energy source operatively coupled to the circuit elements and probing tips, the energy source configured to cause current to flow from the probing tips and cause localized heating sufficient to denervate nearby neural tissue.   
     
     
         28 . The system of  claim 27 , wherein the remotely-steerable elongate deployment member is electromechanically actuated. 
     
     
         29 . The system of  claim 27 , further comprising one or more localization sensors coupled to a distal portion of the remotely-steerable elongate deployment member and configured to facilitate computation of a location of said distal portion relative to a coordinate system, wherein the localization sensor comprises an element selected from the group consisting of: an ultrasound transducer, an electromagnetic flux sensor, a fiber Bragg local deflection sensor, a resistive strain gauge, a potential difference sensor, and a current sensor. 
     
     
         30 . The system of  claim 27 , further comprising one or more imaging elements coupled to the remotely-steerable elongate deployment member selected from the group consisting of: an ultrasound transducer, an optical fiber, and an imaging chip. 
     
     
         31 . The system of  claim 30 , wherein one imaging element is an optical fiber, and wherein the system further comprises an interferometry system configured to analyze transmitted and reflected light signals. 
     
     
         32 . The system of  claim 31 , wherein the interferometry system is configured to create an OCT image of a portion of a targeted tissue structure. 
     
     
         33 . The system of  claim 31 , further comprising a lens optically coupled to the optical fiber. 
     
     
         34 . The system of  claim 33 , wherein the lens and optical fiber define a field of view that is oriented along a longitudinal axis of the elongate deployment member. 
     
     
         35 . The system of  claim 33 , wherein the lens and optical fiber define a field of view that is oriented substantially perpendicular to a longitudinal axis of the elongate deployment member. 
     
     
         36 . The system of  claim 27 , wherein the expandable intravascular treatment member comprises a stent. 
     
     
         37 . A method of closing a translumenal access port defined through a side of a lumen, comprising:
 a. applying a circumferential clip from the inside of the lumen to effect a temporary closure, the clip being urged into a closed position by an inflatable actuating member local to the clip and controlled remotely by an operator; and   b. deploying a stent over the closed position of the clip.   
     
     
         38 . The method of  claim 37 , further comprising imaging tissue structures adjacent the translumenal access port from inside of the lumen. 
     
     
         39 . The method of  claim 38 , wherein imaging comprises activating one or more ultrasound transducers. 
     
     
         40 . The method of  claim 37 , wherein the circumferential clip comprises a shape selected to circumferentially surround the translumenal access port. 
     
     
         41 . The method of  claim 37 , wherein applying the clip comprises urging one or more barb members of the clip into tissue surrounding the translumenal access port. 
     
     
         42 . The method of  claim 37 , wherein the inflatable actuating member comprises an inflatable bladder and wherein applying the clip comprises causing the bladder to inflate.