Intravascular tissue disruption

Abstract

Disrupting tissue and devices and systems for disrupting tissue. The disclosure describes ways to deliver moieties to a target tissue, where the target tissue in general is not at the point of introduction, in such a way that minimal damage is produced in the tissue at the point of introduction. In some embodiments this is accomplished by jetting fluid at high velocity into the target tissue. The disclosure further describes novel agents deliverable in such systems for use in remodeling tissues. Some of these agents comprise a liquid while others do not. Additionally, although not specifically described in detail much of the disclosure may additionally be used in the delivery of therapeutic drugs.

1 .- 7 . (canceled) 
     
     
         8 . A method for treating a human patient with diagnosed hypertension, the method comprising:
 positioning an elongate delivery member having a distal fluid delivery region within a renal blood vessel and proximate to renal nerves of the patient;   transforming the fluid delivery region from a low-profile delivery configuration to an expanded treatment configuration,   wherein the fluid delivery region comprises a plurality of tubular elements, and wherein, in the expanded treatment configuration, each tubular element is bent along a bending region of the respective tubular element to position a portion of the individual tubular elements in contact with a wall of the renal blood vessel;   delivering a neuromodulatory fluid via one or more of the tubular elements to attenuate or block neural signaling along the renal nerves; and   removing the elongate delivery member and fluid delivery region from the patient after delivering the neuromodulatory fluid to conclude the procedure.   
     
     
         9 . The method of  claim 8  wherein positioning the elongate delivery member having the distal fluid delivery region within a renal blood vessel comprises intravascularly delivering the elongate delivery member and fluid delivery region through an abdominal aorta to a renal artery of the patient. 
     
     
         10 . The method of  claim 8  wherein positioning the elongate delivery member having the distal fluid delivery region within a renal blood vessel comprises delivering the elongate delivery member to the renal blood vessel via a guidewire. 
     
     
         11 . The method of  claim 8  wherein the fluid delivery region of the elongate delivery member comprises a control member axially movable with respect to the elongate delivery member, and wherein distal and proximal end regions of the tubular elements are fixed to the control member, and further wherein:
 transforming the fluid delivery region from a low-profile delivery configuration to an expanded treatment configuration comprises actuating the control member in a proximal direction to urge the distal and proximal end regions of the individual tubular elements toward each other, thereby causing the tubular elements to bend along the corresponding bending regions outward away from the control member and toward the wall of the renal blood vessel. 
 
     
     
         12 . The method of  claim 11 , further comprising actuating the control member in a distal direction after delivering the neuromodulatory fluid to urge the distal and proximal end regions of the individual tubular elements away from each other, thereby transforming the fluid delivery region from the expanded treatment configuration back to the low-profile delivery configuration before removing the elongate delivery member and fluid delivery region from the patient. 
     
     
         13 . The method of  claim 8  wherein the tubular elements each include one or more ports for delivery of the neuromodulatory fluid therethrough, and wherein each tubular element is in fluid communication with a fluid source configured to store the neuromodulatory fluid. 
     
     
         14 . The method of  claim 13  wherein, when the fluid delivery region is in the expanded treatment configuration, each port is in contact with or facing the wall of the renal blood vessel. 
     
     
         15 . The method of  claim 13  wherein:
 when the fluid delivery region is in the treatment configuration, each of the ports faces in a direction different from the direction it faces in when the fluid delivery region is in the delivery configuration. 
 
     
     
         16 . The method of  claim 13  wherein delivering a neuromodulatory fluid via one or more of the tubular elements to attenuate or block neural signaling along the renal nerves comprises delivering the neuromodulatory fluid simultaneously through the ports. 
     
     
         17 . The method of  claim 8  wherein delivering the neuromodulatory fluid to attenuate or block neural signaling along the renal nerves results in a therapeutically beneficial reduction in one or more symptoms associated with the hypertension of the patient. 
     
     
         18 . The method of  claim 8  wherein delivering a neuromodulatory fluid to attenuate or block neural signaling along the renal nerves comprises delivering the neuromodulatory fluid to at least partially ablate the renal nerves. 
     
     
         19 . The method of  claim 8  wherein delivering a neuromodulatory fluid to attenuate or block neural signaling along the renal nerves comprises delivering the neuromodulatory fluid to tissue external to the renal blood vessel of the patient and in contact with or adjacent to the renal nerves. 
     
     
         20 . The method of  claim 8  wherein delivering a neuromodulatory fluid to attenuate or block neural signaling along the renal nerves comprises delivering alcohol. 
     
     
         21 . The method of  claim 8  wherein delivering a neuromodulatory fluid to attenuate or block neural signaling along the renal nerves comprises delivering a neurotoxin. 
     
     
         22 . The method of  claim 8  wherein delivering a neuromodulatory fluid to attenuate or block neural signaling along the renal nerves comprises delivering botulinum toxin. 
     
     
         23 . The method of  claim 8  wherein the renal blood vessel is a first renal artery and the renal nerves are first renal nerves, and wherein the method further comprises:
 after delivering the neuromodulatory fluid to attenuate or block neural signaling along the first renal nerves, introducing the elongate delivery member to a second renal artery of the patent and proximate to second renal nerves; 
 delivering the neuromodulatory fluid via one or more of the tubular elements to attenuate or block neural signaling along the second renal nerves; and 
 after delivering the neuromodulatory fluid to the second renal nerves, removing the elongate delivery member and fluid delivery region from the patient to conclude the procedure. 
 
     
     
         24 . The method of  claim 8  wherein, when the fluid delivery region is in the expanded treatment configuration, it does not occlude the renal blood vessel. 
     
     
         25 . An apparatus for controllably releasing fluid within a hypertensive human patient, the apparatus comprising:
 an elongate shaft having a distal portion configured for intravascular placement within a renal artery of the patient; and   a fluid delivery assembly including a plurality of tubular elements at the distal portion of the catheter, wherein the fluid delivery assembly is selectively transformable between a low-profile, delivery configuration and a deployed configuration sized to fit within the renal artery of the patient,
 wherein, when the fluid delivery assembly is in the delivery configuration, the tubular elements are generally straight and in alignment with a longitudinal axis of the elongate shaft, 
 wherein, when the fluid delivery assembly is in the deployed configuration, the assembly is arranged in a basket-like shape adapted to allow blood to flow therethrough and the tubular elements are each bent outwardly away from the longitudinal axis such that a portion of each tubular element is in apposition with a wall of the renal artery; and 
   wherein each tubular element comprises a fluid delivery aperture and is configured when the fluid delivery assembly is in the deployed configuration to deliver a fluid agent via the respective aperture to target renal nerves of the patient in an amount sufficient to modulate neural function of the targeted renal nerves.   
     
     
         26 . The apparatus of  claim 25  wherein the tubular elements are composed of nitinol. 
     
     
         27 . The apparatus of  claim 25  wherein the distal portion of the elongate shaft is configured for intravascular placement within the renal artery over a guidewire. 
     
     
         28 . The apparatus of  claim 25  wherein each of the plurality of fluid delivery apertures is adapted to be selectively addressable to regulate a volume of the fluid agent delivered via the respective fluid delivery apertures.