Apparatuses for bilateral renal neuromodulation

Abstract

Methods and apparatus are provided for bilateral renal neuromodulation, e.g., via a pulsed electric field, via a stimulation electric field, via localized drug delivery, via high frequency ultrasound, via thermal techniques, etc. Such neuromodulation may effectuate irreversible electroporation or electrofusion, necrosis and/or inducement of apoptosis, alteration of gene expression, action potential attenuation or blockade, changes in cytokine up-regulation and other conditions in target neural fibers. In some embodiments, neuromodulation is applied to neural fibers that contribute to renal function. In some embodiments, such neuromodulation is performed in a bilateral fashion. Bilateral renal neuromodulation may provide enhanced therapeutic effect in some patients as compared to renal neuromodulation performed unilaterally, i.e., as compared to renal neuromodulation performed on neural tissue innervating a single kidney.

1 - 17 . (canceled) 
     
     
         18 . An apparatus for bilateral renal neuromodulation via an intravascular approach, the apparatus comprising:
 a first field applicator configured to be positioned proximate to at least a first neural fiber that contributes to right renal function of a human patient;   a second field applicator configured to be positioned proximate to at least a second neural fiber that contributes to left renal function while the first field applicator is positioned proximate to the first neural fiber; and   a field generator external to the patient and coupled to the first and second field applicators,   wherein the field generator is configured to provide a first signal to the first field applicator and a second signal to the second field applicator.   
     
     
         19 . The apparatus of  claim 18 , wherein the first field applicator and the second field applicator comprise intravascular field applicators configured for placement within renal vasculature of the patient. 
     
     
         20 . (canceled) 
     
     
         21 . The apparatus of  claim 18 , wherein the first field applicator and the second field applicator comprise intra-to-extravascular field applicators configured for extravascular placement via an intra-to-extravascular approach. 
     
     
         22 . The apparatus of  claim 18 , wherein the first field applicator and the second field applicator comprise field applicators configured for a combination of placement within renal vasculature of the patient, placement in external proximity to renal vasculature of the patient or extravascular placement via an intra-to-extravascular approach. 
     
     
         23 . The apparatus of  claim 18 , wherein the field generator further comprises a pulsed electric field generator. 
     
     
         24 . The apparatus of  claim 18 , wherein the first field applicator and the second field applicator comprise electrodes configured for placement in proximity to the first and second neural fibers, and wherein the electrodes are coupled to the field generator for delivery of electric fields to the first and second neural fibers. 
     
     
         25 . The apparatus of  claim 24 , wherein the first field applicator and the second field applicator comprise a first bipolar electrode pair and a second bipolar electrode pair. 
     
     
         26 . The apparatus of  claim 24 , wherein the first field applicator and the second field applicator comprise a first monopolar electrode and a second monopolar electrode, the apparatus further comprising at least one ground pad configured for external attachment to the patient. 
     
     
         27 . The apparatus of  claim 24 , wherein the first field applicator comprises a bipolar electrode pair and the second field applicator comprises a monopolar electrode, the apparatus further comprising a ground pad configured for external attachment to the patient. 
     
     
         28 . The apparatus of  claim 24 , wherein the first field applicator comprises a monopolar electrode and the second field applicator comprises a bipolar electrode pair, the apparatus further comprising a ground pad configured for external attachment to the patient. 
     
     
         29 . The apparatus of  claim 18 , wherein the field generator is configured to concurrently provide a first signal to the first field applicator and a second signal to the second field applicator. 
     
     
         30 . The apparatus of  claim 18 , wherein the field generator is configured to sequentially provide a first signal to the first field applicator and a second signal to the second field applicator. 
     
     
         31 . The apparatus of  claim 18 , wherein the field generator is configured to continuously provide a first signal to the first field applicator and a second signal to the second field applicator. 
     
     
         32 . The apparatus of  claim 18 , wherein the field generator is configured to intermittently provide a first signal to the first field applicator and a second signal to the second field applicator. 
     
     
         33 - 47 . (canceled) 
     
     
         48 . An apparatus for bilateral renal neuromodulation via an intravascular approach, the apparatus comprising:
 a first drug delivery element configured to be positioned proximate to a first neural fiber that contributes to right renal function;   a second drug delivery element configured to be positioned proximate to a second neural fiber that contributes to left renal function while the first drug delivery element is positioned proximate to the first neural fiber; and   a drug reservoir comprising a neuromodulatory agent, the drug reservoir coupled to the first and second drug delivery elements,   wherein the drug reservoir is configured to deliver the neuromodulatory agent to the first drug delivery element and the second drug delivery element.   
     
     
         49 . The apparatus of  claim 48 , wherein the drug reservoir comprises an implantable drug pump. 
     
     
         50 . The apparatus of  claim 48 , wherein the drug reservoir comprises an external drug reservoir. 
     
     
         51 . The apparatus of  claim 48 , wherein the drug reservoir is configured to concurrently deliver the neuromodulatory agent to the first drug delivery element and the second drug delivery element. 
     
     
         52 . The apparatus of  claim 48 , wherein the drug reservoir is configured to sequentially deliver the neuromodulatory agent to the first drug delivery element and the second drug delivery element. 
     
     
         53 . The apparatus of  claim 48 , wherein the drug reservoir is configured to continuously deliver the neuromodulatory agent to the first drug delivery element and the second drug delivery element. 
     
     
         54 . The apparatus of  claim 48 , wherein the drug reservoir is configured to intermittently deliver the neuromodulatory agent to the first drug delivery element and the second drug delivery element. 
     
     
         55 . The apparatus of  claim 18 , further comprising a guide catheter having a lumen and a bifurcated distal region, the guide catheter being configured to be positioned in a vessel, and wherein the first field applicator is in the lumen and is configured to project out one side of the bifurcated distal region into a first renal artery of the patient and the second field applicator is in the lumen and is configured to project out an opposing side of the bifurcated distal region into a second renal artery.