Systems, assemblies, and methods for treating a bronchial tree

Abstract

Systems, assemblies, and methods to treat pulmonary diseases are used to decrease nervous system input to distal regions of the bronchial tree within the lungs. Treatment systems damage nerve tissue to temporarily or permanently decrease nervous system input. The treatment systems are capable of heating nerve tissue, cooling the nerve tissue, delivering a flowable substance that cause trauma to the nerve tissue, puncturing the nerve tissue, tearing the nerve tissue, cutting the nerve tissue, applying pressure to the nerve tissue, applying ultrasound to the nerve tissue, applying ionizing radiation to the nerve tissue, disrupting cell membranes of nerve tissue with electrical energy, or delivering long acting nerve blocking chemicals to the nerve tissue.

1 - 67 . (canceled) 
     
     
         68 . An energy delivery device for treating an airway in a patient, the energy delivery device comprising:
 an elongated support configured to be passed through a lumen of a scope;   a compliant inflatable member attached to the elongated support, the inflatable member being configured to move between a collapsed configuration and an expanded configuration; and   a flexible conductive element carried by the inflatable member, wherein the flexible conductive element extends along a path and is configured to expand and contract longitudinally relative to the path as the inflatable member moves between the expanded and collapsed configurations.   
     
     
         69 . The energy delivery device of  claim 68  wherein the flexible conductive element is elastic. 
     
     
         70 . The energy delivery device of  claim 68  wherein the flexible conductive element has:
 a first resistance when the inflatable member is collapsed and the conductive element is in an initial state; and 
 a second resistance less than ten times the first resistance when the inflatable member is expanded and the conductive element is in a stretched state. 
 
     
     
         71 . The energy delivery device of  claim 68  wherein the airway comprises tissue, and wherein the flexible conductive element has a conductivity that is greater than a conductivity of the airway tissue when the inflatable member is in the expanded position and the conductive element is in a stretched state. 
     
     
         72 . The energy delivery device of  claim 68  wherein the flexible conductive element is attached to an outer surface of the inflatable member in a helical or ring arrangement. 
     
     
         73 . The energy delivery device of  claim 68  wherein the flexible conductive element is attached to an outer surface of the inflatable member in an interdigitated arrangement having transverse finger portions and one or more longitudinal finger portions. 
     
     
         74 . The energy delivery device of  claim 68 , further comprising a non-elongatable conductive element attached to the inflatable member and in electrical contact with the flexible conductive element. 
     
     
         75 . The energy delivery device of  claim 74  wherein the non-elongatable conductive element comprises a wire attached to the inflatable member and coupled to a distal end of the flexible conductive element. 
     
     
         76 . The energy delivery device of  claim 68  wherein the flexible conductive element is inelastic but expandable. 
     
     
         77 . The energy delivery device of  claim 76  wherein the flexible conductive element is a wire wrapped in a serpentine path around the inflatable member, and wherein the wire is configured to expand and contract longitudinally relative to the path in an accordion-like fashion as the inflatable member moves between the expanded and collapsed configurations. 
     
     
         78 . The energy delivery device of  claim 68  wherein the inflatable member is a non-conductive, non-porous balloon. 
     
     
         79 . The energy delivery device of  claim 68 , wherein the flexible conductive element has a length in the range from about 5 mm to about 15 mm. 
     
     
         80 . The energy delivery device of  claim 68 , further comprising a power source that provides RF energy in bipolar fields between adjacent flexible conductive elements. 
     
     
         81 . An energy delivery device for treating an airway in a patient, the energy delivery device comprising:
 an elongated support configured to be passed through a lumen of a scope;   a compliant inflatable member attached to the elongated support, the compliant inflatable member being configured to move between a collapsed configuration and an expanded configuration through a range of diameters of at least approximately 2 mm to 10 mm; and   an expandable electrode carried by the inflatable member, wherein the expandable electrode comprises a binder and a conductive material dispersed in the binder.   
     
     
         82 . The energy delivery device of  claim 81  wherein the expandable electrode is configured to longitudinally expand and contract with the compliant inflatable member between the expanded and collapsed configurations. 
     
     
         83 . The energy delivery device of  claim 81  wherein:
 the binder is composed of an elastic polymer material; and 
 the conductive material is composed of gold, copper, carbon, or silver in the form of flakes, fibers, strands, spheres, rods, cylinders, strips, pellets or combinations thereof. 
 
     
     
         84 . The energy delivery device of  claim 81  wherein the conductive material dispersed in the binder includes a plurality of conductive particles at least approximately aligned with each other to minimize the resistance of the expandable electrode when the compliant inflatable member is in the expanded configuration. 
     
     
         85 . The energy delivery device of  claim 81  wherein the expandable electrode is disposed on an outer surface of the compliant inflatable member in a helical or ring arrangement. 
     
     
         86 . The energy delivery device of  claim 81  wherein the expandable electrode is disposed on an outer surface of the compliant inflatable member in an interdigitated arrangement having transverse finger portions and one or more longitudinal finger portions. 
     
     
         87 . An energy delivery device for treating an airway in a patient, the energy delivery device comprising:
 an elongated support configured to be passed through a lumen of a scope;   a compliant inflatable member attached to the elongated support, wherein the inflatable member is configured to move between a collapsed configuration and an expanded configuration; and   a stretchable electrode deposited directly on the inflatable member, wherein the stretchable electrode is configured to increase in length as the inflatable member moves from the collapsed configuration to the expanded configuration.   
     
     
         88 . An energy delivery device for use in a body passageway, the energy delivery device comprising:
 an elongated body having a proximal portion and a distal portion; and   an energy delivery unit at the distal portion of the elongated body, wherein the energy delivery unit comprises:
 a compliant inflatable member moveable between a retracted configuration and an expanded configuration; and 
 one or more elongatable conductive elements disposed on an outer surface of the inflatable member, wherein the one or more conductive elements are positioned to contact a treatment area within the passageway when the inflatable member is in the expanded configuration. 
   
     
     
         89 . A method for treating asthma, the method comprising:
 inserting an energy delivery unit into an airway in a lung of a patient, the energy delivery unit including a compliant inflatable member attached to a distal portion of an elongated support and a flexible conductive element carried by the inflatable member, wherein the flexible conductive element is configured to expand and contract with the inflatable member as the inflatable member moves between a collapsed configuration and an expanded configuration;   expanding the inflatable member such that the flexible conductive element contacts a wall of the airway; and   delivering RF energy to the wall of the airway via the flexible conductive element in a bipolar manner.   
     
     
         90 . The method of  claim 89  wherein inserting an energy delivery unit into an airway and expanding the inflatable member comprises moving the inflatable member through a range of diameters of at least approximately 2 mm to 10 mm. 
     
     
         91 . The method of  claim 89  wherein delivering RF energy to the wall of the airway comprises circumferentially and longitudinally heating target tissue at a temperature in a range from about 65° C. to about 70° C. for an activation time period in a range from about 2 seconds to about 3 seconds. 
     
     
         92 . The method of  claim 91  wherein the target tissue comprises airway smooth muscle. 
     
     
         93 . The method of  claim 89  wherein delivering RF energy to the wall of the airway reduces airway smooth muscle tissue. 
     
     
         94 . The method of  claim 89 , further comprising cooling a tissue layer adjacent to target tissue of the airway. 
     
     
         95 . The method of  claim 89  wherein cooling a tissue layer comprises at least partially filling the inflatable member with a liquid or a gas. 
     
     
         96 . An energy delivery device for treating an airway in a subject, the energy delivery device comprising:
 an elongated shaft configured to be passed through a lumen of a delivery assembly;   an inflatable expandable member coupled to the elongated shaft, the inflatable expandable member being configured to move between a collapsed configuration and an expanded configuration; and   a flexible conductive element carried by the inflatable expandable member, wherein the flexible conductive element extends along a path and is configured to expand and contract longitudinally relative to the path as the inflatable expandable member moves between the expanded and collapsed configurations.   
     
     
         97 . The energy delivery device of  claim 96  wherein the flexible conductive element is resilient. 
     
     
         98 . The energy delivery device of  claim 96  wherein the flexible conductive element has:
 a first resistance when the inflatable expandable member is collapsed and the conductive element is in a collapsed state; and 
 a second resistance less than ten times the first resistance when the inflatable expandable member is expanded and the conductive element is in an expanded state. 
 
     
     
         99 . The energy delivery device of  claim 96  wherein the airway comprises tissue, and wherein the flexible conductive element has a conductivity that is greater than a conductivity of the airway tissue when the inflatable expandable member is in the expanded configuration and the conductive element is in a expanded state. 
     
     
         100 . The system of  claim 96  wherein the flexible conductive element is coupled to an outer surface of the inflatable expandable member, at least a portion of the flexible conductive element is in a helical or ring arrangement. 
     
     
         101 . The energy delivery device of  claim 96  wherein the flexible conductive element is coupled to an outer surface of the inflatable expandable member having transverse finger portions and one or more longitudinal finger portions. 
     
     
         102 . The energy delivery device of  claim 96 , further comprising a non-elongatable conducting element coupled to the inflatable expandable member and in electrical contact with the flexible conductive element. 
     
     
         103 . The energy delivery device of  claim 102  wherein the non-elongatable conducting element comprises a wire attached to the inflatable expandable member and coupled to a distal end of the flexible conductive element. 
     
     
         104 . The energy delivery device of  claim 96  wherein the flexible conductive element is resilient but expandable. 
     
     
         105 . The energy delivery device of  claim 104  wherein the flexible conductive element is a wire wrapped in a serpentine path around the inflatable expandable member, and wherein the wire is configured to expand and contract longitudinally relative to the path in an accordion-like fashion as the inflatable expandable member moves between the expanded and collapsed configurations. 
     
     
         106 . The energy delivery device of  claim 96  wherein the inflatable expandable member comprises an electrically insulating balloon. 
     
     
         107 . The energy delivery device of  claim 96 , wherein the flexible conductive element has a length that is smaller than a longitudinal length of the inflatable expandable member. 
     
     
         108 . The energy delivery device of  claim 96 , further comprising a RF electrical generator that provides RF energy to the flexible conductive element. 
     
     
         109 . An energy delivery device for treating an airway in a patient, the energy delivery device comprising:
 an elongated shaft configured to be passed through a lumen of a delivery assembly;   an inflatable distensible member coupled to the elongated shaft, the inflatable distensible member being configured to move between a collapsed configuration and an expanded configuration through a range of diameters; and   an expandable electrode carried by the inflatable distensible member, wherein the expandable electrode comprises a first material and a conductive material disposed in the first material;   wherein the range of diameters in sufficient to bring the electrode in contact with or proximate to an airway wall when positioned in the airway.   
     
     
         110 . The energy delivery device of  claim 109  wherein the expandable electrode is configured to longitudinally expand and contract with the inflatable distensible member between the expanded and collapsed configurations. 
     
     
         111 . The energy delivery device of  claim 109  wherein the first material forms a coating and the conductive material comprises a wire composed of copper which is coated by the coating. 
     
     
         112 . The energy delivery device of  claim 109  wherein the conductive material is coated by the first material and includes a plurality of conductive portions at least approximately aligned with each other to minimize the resistance of the expandable electrode when the inflatable distensible member is in the expanded configuration. 
     
     
         113 . The energy delivery device of  claim 109  wherein the expandable electrode is disposed on an outer surface of the inflatable distensible member, wherein at least a portion of the distensible electrode is in a helical or ring arrangement. 
     
     
         114 . The energy delivery device of  claim 109  wherein the expandable electrode is disposed on an outer surface of the inflatable distensible member in an alternating arrangement having transverse finger portions and one or more longitudinal finger portions. 
     
     
         115 . An energy delivery device for treating an airway in a patient, the energy delivery device comprising:
 an elongated shaft configured to be passed through a lumen of a delivery assembly;   an inflatable distensible member coupled to the elongated shaft, wherein the inflatable distensible member is configured to move between a collapsed configuration and an expanded configuration; and   a resilient electrode disposed directly on the inflatable distensible member, wherein the resilient electrode is configured to increase in length as the inflatable distensible member moves from the collapsed configuration to the expanded configuration.   
     
     
         116 . An energy delivery device for use in a body passageway, the energy delivery device comprising:
 an elongated shaft having a proximal portion and a distal portion; and   an energy delivery assembly at the distal portion of the elongated shaft, wherein the energy delivery assembly comprises:
 an inflatable distensible member moveable between a retracted configuration and an expanded configuration; and 
 one or more expandable conductive elements disposed on an outer surface of the inflatable distensible member, wherein the one or more expandable conductive elements are positioned to contact a treatment area within the passageway when the distensible member is in the expanded configuration. 
   
     
     
         117 . A method for treating asthma, the method comprising:
 inserting an energy delivery assembly into an airway in a lung of a patient, the energy delivery assembly including an inflatable expandable member coupled to a distal portion of an elongated shaft and a flexible conductive element carried by the inflatable expandable member, wherein the flexible conductive element is configured to expand and contract with the inflatable expandable member as the inflatable expandable member moves between a collapsed configuration and an expanded configuration;   expanding the inflatable expandable member such that the flexible conductive element contacts a wall of the airway; and   delivering RF energy to the wall of the airway via the flexible conductive element in a bipolar manner.   
     
     
         118 . The method of  claim 117  wherein inserting an energy delivery assembly into an airway and expanding the inflatable expandable member comprises moving the inflatable expandable member through a range of diameters sufficient to bring the flexible conductive element in contact with or proximate to a wall of the airway when the energy delivery assembly is positioned therein. 
     
     
         119 . The method of  claim 117  wherein delivering RF energy to the wall of the airway comprises circumferentially and longitudinally heating target tissue at a temperature in a range from about 40° C. to about 99° C. for an activation time period in a range from about 1 second to about 120 seconds. 
     
     
         120 . The method of  claim 119  wherein the target tissue comprises airway smooth muscle. 
     
     
         121 . The method of  claim 117  wherein delivering RF energy to the wall of the airway reduces airway smooth muscle tissue. 
     
     
         122 . The method of  claim 117 , further comprising cooling a tissue layer adjacent to target tissue of the airway. 
     
     
         123 . The method of  claim 117  wherein cooling a tissue layer comprises at least partially filling the inflatable expandable member with a liquid or a gas.