Minimally invasive access for renal nerve ablation

Abstract

An elongated flexible medical device is inserted into a patient's body via a natural orifice, and advanced through the natural orifice to a location proximate innervated tissue that influences renal sympathetic nerve activity. The medical device can be advanced into a body organ and to a location within the organ proximate the innervated tissue. The organ may comprise an organ of the gastrointestinal tract or urinary tract. The medical device may be advanced through and beyond an access hole in a wall of the organ, and situated at a location proximate the innervated tissue. One or both of imaging and ablation energy is delivered from a distal end of the medical device to the innervated tissue. Innervated renal tissue can be ablated using various forms of energy, including RF energy, ultrasound energy, optical energy, and thermal energy.

1 .- 22 . (canceled) 
     
     
         23 . A method, comprising:
 inserting an elongated flexible medical device into a patient's body via a natural orifice of the body and through a natural pathway of the body;   advancing the medical device through the natural pathway to a location proximate innervated tissue that influences renal sympathetic nerve activity; and   delivering energy from a distal end of the medical device to one or both of image and ablate the innervated tissue.   
     
     
         24 . The method of  claim 23 , wherein the location is a position in the natural pathway adjacent to a renal artery of the patient. 
     
     
         25 . The apparatus of  claim 23 , further comprising advancing the elongated flexible medical device into an organ of the patient's body via the natural orifice and natural pathway. 
     
     
         26 . The method of  claim 23 , further comprising advancing the elongated flexible medical device from the natural pathway through an access point in the natural pathway to a deployment site in the body outside of the natural pathway. 
     
     
         27 . The method of  claim 23 , wherein the elongated flexible medical device is advanced through at least a portion of the patient's digestive system via a gastrointestinal access pathway. 
     
     
         28 . The method of  claim 23 , wherein delivering energy from the distal end of the medical device comprises delivering energy of sufficient power or intensity to ablate the innervated tissue, the method further comprising imaging tissue of or proximate the innervated tissue using an external imaging device. 
     
     
         29 . A method, comprising:
 inserting an elongated flexible medical device into a patient's body via a natural orifice of the body and through an internal pathway of the body;   wherein the internal pathway includes a portion of the gastrointestinal tract of the patient;   advancing the medical device through the portion of the gastrointestinal tract to a location proximate innervated tissue that influences renal sympathetic nerve activity; and   delivering energy from a distal end of the medical device to one or both of image and ablate the innervated tissue.   
     
     
         30 . The method of  claim 29 , wherein the portion of the gastrointestinal tract includes the upper gastrointestinal tract and the natural orifice includes the mouth or nose of the patient. 
     
     
         31 . The method of  claim 30 , wherein the medical device is advanced in the upper gastrointestinal tract through the patient's esophagus, stomach and duodenum, to the location proximate the innervated tissue that is one or more of the ascending colon, descending colon or transverse colon. 
     
     
         32 . The method of  claim 29 , wherein the portion of the gastrointestinal tract includes the lower gastrointestinal tract and the natural orifice includes the anus of the patient. 
     
     
         33 . The method of  claim 32 , wherein the medical device is advanced in the lower gastrointestinal tract through the patient's rectum to the location proximate the innervated tissue that is one or more of the ascending colon, descending colon or transverse colon. 
     
     
         34 . The method of  claim 29 , wherein delivering energy from the distal end of the medical device comprises delivering energy of sufficient power or intensity to ablate the innervated tissue. 
     
     
         35 . The method of  claim 29 , wherein delivering energy from the distal end of the medical device comprises delivering energy of sufficient power or intensity to selectively image the innervated tissue and ablate the innervated tissue. 
     
     
         36 . The method of  claim 34 , wherein delivering energy from the distal end of the medical device comprises ablating the innervated tissue using at least one of RF energy, microwave energy, ultrasound energy, optical energy, thermal energy, and cryotherapy energy. 
     
     
         37 . An apparatus, comprising:
 an elongated flexible medical device configured for insertion into a patient's body via a natural orifice of the body and through an internal pathway of the body, the internal pathway including a portion of the gastrointestinal tract of the patient, the medical device being configured for and having a length sufficient for advancement through the portion of the gastrointestinal tract to a location at or proximate to innervated tissue that influences renal sympathetic nerve activity; and   an energy delivery device provided at a distal end of the medical device and configured to communicate energy to the location at or proximate the innervated tissue to one or both of image and ablate the innervated tissue.   
     
     
         38 . The apparatus of  37 , wherein the location is a position adjacent to a renal artery of the patient. 
     
     
         39 . The apparatus of  claim 37 , wherein the energy delivery device comprises at least one of a radiofrequency ablation device, a microwave ablation device, an ultrasound ablation device, an optical ablation device, a thermal ablation device, and a cyroablation device. 
     
     
         40 . The apparatus of  claim 37 , further comprising:
 a second elongated flexible medical device configured for insertion into the patient's body, the second medical device having a length sufficient for advancement to a second location at or proximate to the innervated tissue; and   a second energy delivery device provided at a distal end of the second medical device.   
     
     
         41 . The apparatus of  claim 40 , wherein the energy delivery device comprises an ablation device and the second energy delivery device comprises an imaging device. 
     
     
         42 . The apparatus of  claim 40 , wherein one of the energy delivery device of the medical device and the second energy delivery device of the second medical device comprises an ablation device, and the other of the energy delivery device of the medical device and the second energy delivery device of the second medical device comprises an imaging device.