CN103536350A - Neural regulation cold therapy device and relevant system - Google Patents

Abstract

The utility model discloses a neural regulation cold therapy device and a relevant system. The cold therapy device configured according to a particular embodiment of the technique can comprise a rod, a supply cavity and a cooling component, the rod is provided with a distal portion, the supply cavity is arranged along at least one part of the rod, the distal portion of the rod can be placed on a therapy portion close to a renal artery or nephrostome in a blood vessel, the supply cavity can be used for receiving liquid refrigerant, the cooling component is positioned on the distal portion of the rod and can comprise an applicator which is communicated with the supply cavity through liquid, and the applicator is used for delivering low-temperature refrigeration towards nerves close to a target portion when the cooling component is expanded.

Description

Neuroregulation cold therapy equipment and related system and method

The cross reference of association request

The application requires the priority of following pending application:

(a) U.S. Provisional Application that the application number of submitting on October 26th, 2010 is 61/406,968;

(b) U.S. Provisional Application that the application number of submitting on August 26th, 2011 is 61/528,091;

(c) U.S. Provisional Application that the application number of submitting on August 29th, 2011 is 61/528,684;

(d) U.S. Provisional Application that the application number of submitting on October 12nd, 2011 is 61/546,510;

(e) U. S. application that the application number of submitting on October 23rd, 2011 is 13/279,330;

(f) U. S. application that the application number of submitting on October 23rd, 2011 is 13/279,328;

(g) U. S. application that the application number of submitting on October 23rd, 2011 is 13/279,327;

(h) U. S. application that the application number of submitting on October 23rd, 2011 is 13/279,326;

(i) U. S. application that the application number of submitting on October 23rd, 2011 is 13/279,325;

(j) U. S. application that the application number of submitting on October 23rd, 2011 is 13/279,312;

(k) U. S. application that the application number of submitting on October 23rd, 2011 is 13/279,316;

(l) U. S. application that the application number of submitting on October 23rd, 2011 is 13/279,321;

(m) U. S. application that the application number of submitting on October 23rd, 2011 is 13/279,324;

(n) international application that the application number of submitting on October 24th, 2011 is PCT/US2011/057514.

The integral body of all above-mentioned applications is incorporated to the application by reference.Further, in the application being incorporated to by reference the component of disclosed embodiment and feature can with the application in disclose with each component and feature merging of advocating right.

The association request being incorporated to by reference

The application number that on October 7th, 2011 submits to is 61/545,052 U.S. Provisional Application, the application number that on August 5th, 2011 submits to is 13/204,504 U.S. Patent application, the PCT international application that the application number of submitting on August 5th, 2011 is PCT/US2011/46845, and the application number of submitting on August 5th, 2010 U.S. Provisional Patent Application that is 61/371,110, relevant to the application, the integral body of above-mentioned application is incorporated to the application by reference.Similarly, in the application being incorporated to by reference the component of disclosed embodiment and feature can with the application in disclose with each component and feature merging of advocating right.

Technical field

Present technique relates generally to cold therapy equipment.Particularly, some embodiment are cold therapy equipment and related system and the method for neuroregulation in blood vessel.

Background technology

Sympathetic nervous system (SNS) is the imperious health control system that is mainly being substantially associated with stress.Tissue in almost each tract of the fiber domination human body of SNS, and can affect characteristics such as pupil diameter, intestinal peristalsis promoting and voided volume.It is this that to be adjusted in holder inner equilibrium or to make health be that environmental factors is made and in fast reaction, had adaptability application.But the chronic activation of SNS is the untoward reaction that can promote PD.Especially the overactivity of kidney SNS is regarded as the state (for example heart failure) of hypertensive complicated Pathophysiology, volume load and the inducement likely of carrying out property nephropathy on experiment and human body.Kidney norepinephrine (NE) flood rate of the increase of for example, tracer dilution is verified primary hypertension patient.

The heart-kidney sympathetic nerve is hyperfunction can be particularly remarkable in heart failure patient.For example, these patients often occur that the NE from heart and kidney to polyplasmia overflows.The SNS activation having improved has chronic and feature end-stage renal disease substantially.In nephrotic, plasmal NE level more than intermediate value has been proved to be the omen of cardiovascular disease and several causes of the death late.Like this too to suffering from the patient of diabetes or radiographic contrast nephropathy.Evidence shows, from the sensation input signal of pathological changes kidney, is the main cause that causes and keep the output of maincenter sympathetic nerve to raise.

Kidney sympathetic nerve ends at blood vessel, juxtaglomerular apparatus and renal tubules.The orthosympathetic stimulation of kidney can cause increase, the sodium (Na of renin release ⁺) minimizing of re-absorbed increase and renal blood flow.These neuroregulation part of renal function be take the morbid state that the sympathetic nerve that improves is feature to stimulate significantly, and probably promotes hyperpietic's hypertension.Kidney sympathetic activities stimulates reducing of the renal blood flow cause and glomerular filtration rate, is likely the basis of the heart-kidney syndrome (be renal insufficiency, it is the carrying out property syndrome of chronic heart failure) middle kidney afunction.For stoping the pharmacology strategy of the consequence of sympathetic stimulation to comprise maincenter sympathetic nerve medicine, beta-blocker (being intended to reduce renin release), angiotensin converting enzyme inhibitor and receptor blocking agent (the aldosterone activation that is intended to stop the action of Angiotensin II and comes with renin release), and diuretic (being intended to tackle the retention of sodium and water of kidney sympathetic nerve mediation).Yet these medicine strategies exist significant limitation, comprise limited curative effect, compliance problem, side effect and other.Therefore, public health has urgent demand to instead therapeutic strategy.

Accompanying drawing explanation

A lot of aspect disclosed by the invention can be understood better with reference to the following drawings.Parts in figure needn't be proportional.On the contrary, focus on and clearly demonstrate in principle disclosed by the invention.In addition, the parts in some view can be shown transparent, and this is only to describe for clear, but not shows that the parts that illustrate must be transparent.

Fig. 1 shows according to the cold therapy system of present technique embodiment.

Fig. 2 A is amplification sectional view, and it shows according to the embodiment of the distal portions of for example, the bar in sending state (, the configuration of low profile or contraction) of present technique embodiment and cooling package.

Fig. 2 B is the sectional view of the cooling package amplification of (for example, the configuration of expansion) when deployed condition in Fig. 2 A.

Fig. 2 C and 2D are side cross-sectional view and the end section figure showing according to the amplification of the cooling package of another embodiment configuration of present technique.

Fig. 2 E is according to the near-end of cold therapy equipment and the amplification sectional view of distal portions of the another embodiment configuration of present technique.

Fig. 3 A shows the cold therapy system of using according to present technique embodiment kidney nerve is carried out to freezing adjusting.

Fig. 3 B shows according to any embodiment of present technique, kidney nerve to be carried out the block diagram of the method for freezing adjusting.

Fig. 4 A and 4B are according to the sectional view of the amplification of the cold therapy equipment with stepped distal portions of several embodiment configurations of present technique.

Fig. 5 A is according to the part schematic diagram of the cold therapy system of another embodiment configuration of present technique.

Fig. 5 B is according to the sectional view of the amplification of the distal portions of the bar in deployed condition of present technique embodiment and cooling package.

Fig. 6 A is the plane graph showing according to the pre-cooling assembly of present technique embodiment configuration.

Fig. 6 B is the sectional view that shows the pre-cooling assembly in Fig. 6 A.

Fig. 7 is the sectional view showing according to the pre-cooling assembly with valve of present technique embodiment configuration.

Fig. 8 A is the sectional view illustrating according to the pre-cooling assembly with stream separator of present technique embodiment configuration.

Fig. 8 B is the sectional view that the pre-cooling assembly in Fig. 8 A is shown.

Fig. 9 A is the sectional view illustrating according to the pre-cooling assembly with stream separator of another embodiment configuration of present technique.

Fig. 9 B is the sectional view that shows the pre-cooling assembly in Fig. 9 A.

Figure 10 is the part schematic diagram showing according to the tubular element of the pre-cooling assembly coiling round outlet in handle of present technique embodiment configuration.

Figure 11 is the part schematic diagram showing according to the tubular element of the pre-cooling assembly coiling near outlet in handle of present technique embodiment configuration.

Figure 12 is the sectional view showing according to the cooling package of the supply pipe with the distal portions that comprises inclination of present technique embodiment configuration.

Figure 13 is the sectional view showing according to the cooling package with supply pipe of present technique embodiment configuration, and wherein supply pipe has and is wrapped in passing away spiral part around.

Figure 14 is the sectional view showing according to the cooling package with supply pipe of present technique embodiment configuration, and wherein supply pipe has and is wrapped in passing away spiral part around.

Figure 15 A is the sectional view showing according to the cooling package with interior balloon of present technique embodiment configuration, and wherein interior balloon has interior balloon aperture.

Figure 15 B is the sectional view that shows cooling package in Figure 15 A.

Figure 16 A is the sectional view showing according to the cooling package with interior balloon and outer balloon of present technique embodiment configuration, and wherein interior balloon has interior balloon aperture, and outer ball has the spiral part of rising.

Figure 16 B is the sectional view that shows the cooling package in Figure 16 A.

Figure 17 A is the sectional view showing according to the cooling package of the heat insulating component with prolongation of present technique embodiment configuration.

Figure 17 B is the sectional view that shows the cooling package in Figure 17 A.

Figure 18 A is the sectional view showing according to the cooling package of the heat insulating component with prolongation of another embodiment configuration of present technique.

Figure 18 B is the sectional view that shows the cooling package in Figure 18 A.

Figure 19 A is the profile diagram showing according to the cooling package with spiral type heat insulating component of present technique embodiment configuration.

Figure 19 B and 19C are the sectional view that shows cooling package in Figure 19 A.

Figure 20 A is the profile diagram showing according to the cooling package with the double-helical heat insulating component that is similar to mutual winding of present technique embodiment configuration.

Figure 20 B and 20C are the sectional view that shows the cooling package in Figure 20 A.

Figure 21 A is the sectional view showing according to the cooling package of the heat insulating component with the prolongation that can move in balloon of another embodiment configuration of present technique.

Figure 21 B is the sectional view that shows the cooling package in Figure 21 A.

Figure 21 C is the cooling package sectional view in sending state in sending cover showing in Figure 21 A.

Figure 22 A is the sectional view showing according to the cooling package of the heat insulating component with the prolongation that can move in balloon of present technique embodiment configuration.

Figure 22 B is the sectional view that shows the cooling package in Figure 22 A.

Figure 23 A is the profile diagram showing according to the cooling package with a plurality of part circumference balloons of present technique embodiment configuration.

Figure 23 B is the isometric view that shows the cooling package in Figure 23 A.

Figure 24 A is the profile diagram showing according to the cooling package with a plurality of part circumference balloons of another embodiment configuration of present technique.

Figure 24 B is the isometric view that shows the cooling package in Figure 24 A.

Figure 25 is the profile diagram showing according to the cooling package with helical groove of present technique embodiment configuration.

Figure 26 is the profile diagram showing according to the cooling package of the spaced recess of tool of present technique embodiment configuration.

Figure 27 A is the profile diagram showing according to the cooling package of the spaced recess of tool of another embodiment configuration of present technique.

Figure 27 B is the sectional view that shows the cooling package in Figure 27 A.

Figure 27 C is the isometric view that shows the cooling package in Figure 27 A.

Figure 28 is the profile diagram showing according to the cooling package of the spaced recess of tool of present technique embodiment configuration.

Figure 29 is the profile diagram showing according to the cooling package with the helical form balloon that is wrapped in passing away of present technique embodiment configuration.

Figure 30 is the profile diagram with the cooling package that is wrapped in the helical form balloon of supplying chamber showing according to present technique embodiment configuration.

Figure 31 is the profile diagram showing according to the cooling package with the helical form balloon that is wrapped in supply chamber of another embodiment configuration of present technique.

Figure 32 A is the profile diagram showing according to the cooling package with shaped component of present technique embodiment configuration, and wherein shaped component has shape memory.

Figure 32 B is the sectional view that shows the cooling package in Figure 32 A.

Figure 33 A is the profile diagram showing according to the cooling package with crooked along its length balloon of present technique embodiment configuration.

Figure 33 B and 33C are the sectional view that shows the cooling package in Figure 33 A.

Figure 33 D is the sectional view that shows the cooling package in Figure 33 A, wherein cooling package in sending cover in sending state.

Figure 34 is the sectional view showing according to the cooling package with crooked along its length balloon of present technique embodiment configuration.

Figure 35 A is the profile diagram showing according to the cooling package with balloon of present technique embodiment configuration, and wherein balloon has confined length part.

Figure 35 B is the sectional view that shows the cooling package in Figure 35 A.

Figure 36 is the profile diagram showing according to the cooling package with balloon of another embodiment configuration of present technique, and wherein balloon has confined length part.

Figure 37 is the profile diagram showing according to the cooling package with ring-type balloon of present technique embodiment configuration.

Figure 38 A is the profile diagram showing according to the cooling package of the balloon with a plurality of elongations of present technique embodiment configuration.

Figure 38 B is the sectional view that shows the cooling package in Figure 38 A.

Figure 39 A is the profile diagram showing according to the cooling package of the balloon with a plurality of elongations of another embodiment configuration of present technique.

Figure 39 B and 39C are the sectional view that shows the cooling package in Figure 39 A.

Figure 40 is the sectional view showing according to the cooling package of the balloon with a plurality of elongations of another embodiment configuration of present technique.

Figure 41 is the profile diagram showing according to the cooling package with a plurality of helical form balloons of present technique embodiment configuration.

Figure 42 is the profile diagram showing according to the cooling package with a plurality of helical form balloons of another embodiment configuration of present technique.

Figure 43 A is the profile diagram showing according to the cooling package of the balloon with a plurality of elongations that are connected in shaped component of present technique embodiment configuration.

Figure 43 B is the sectional view that shows the cooling package in Figure 43 A.

Figure 43 C is the profile diagram that shows the cooling package in Figure 43 A, and wherein shaped component is retracted.

Figure 44 A is the profile diagram showing according to the cooling package of the balloon with a plurality of elongations that are connected in shaped component of present technique embodiment configuration.

Figure 44 B is the sectional view that shows the cooling package in Figure 44 A.

Figure 44 C is the profile diagram that shows the cooling package in Figure 44 A, and wherein shaped component is retracted.

Figure 45 A is the profile diagram showing according to the cooling package of the balloon with a plurality of heteroid elongations of present technique embodiment configuration.

Figure 45 B is the sectional view that shows the cooling package in Figure 45 A, and wherein cooling package extends to the first sectional dimension.

Figure 45 B-1 is the sectional view that shows the amplification of the division in Figure 45 B.

Figure 45 C is the sectional view that shows the cooling package in Figure 45 A, and wherein cooling package extends to the second sectional dimension that is greater than the first sectional dimension.

Figure 46 is the profile diagram showing according to the cooling package of the balloon with a plurality of heteroid elongations of another embodiment configuration of present technique.

Figure 46-1 is for showing the sectional view of the amplification of the division shown in Figure 46.

Figure 47 is the profile diagram showing according to the cooling package with the main balloon of helical form of present technique embodiment configuration, and wherein main balloon wraps up less important balloon.

Figure 48 A is the profile diagram showing according to the cooling package with the main balloon of helical form in less important balloon of present technique embodiment configuration.

Figure 48 B is the sectional view that shows the cooling package in Figure 48 A.

Figure 49 is the profile diagram showing according to the cooling package with the main balloon of helical form that is wound around less important balloon of another embodiment configuration of present technique.

Figure 50 is the profile diagram showing according to the cooling package with the main balloon of helical form that is wound around less important balloon of another embodiment configuration of present technique.

Figure 51 is the profile diagram showing according to the cooling package with the main balloon of helical form that is wound around less important balloon of another embodiment configuration of present technique.

Figure 52 A is the profile diagram showing according to the distal portions of the cold therapy equipment that comprises cooling package and obstruction component of present technique embodiment configuration.

Figure 52 B is the sectional view that shows the distal portions in Figure 52 A.

Figure 53 is the sectional view showing according to the distal portions of the cold therapy equipment that comprises cooling package and obstruction component of another embodiment configuration of present technique.

Figure 54 is the sectional view showing according to the cooling package of present technique embodiment configuration, and this cooling package can be without phase transformation for the circulation of cold-producing medium.

Figure 55 is the sectional view showing according to the cooling package of another embodiment configuration of present technique, and this cooling package can be without phase transformation for the circulation of cold-producing medium.

Figure 56 is that sympathetic nervous system (SNS) and brain are how by sympathetic nerve, to carry out the conceptual illustration communicating with health.

Figure 57 is the neural amplification internal anatomy around the kidney clump (plexus) of left renal artery with formation that left kidney is innervated.

Figure 58 A and 58B are respectively internal anatomy and the conceptual illustration of human body, and the nerve of having described between brain and kidney imports into and spreads out of.

Figure 59 A and 59B are respectively the arterial vessel of human body and the internal anatomy of vein vascular.

Describe in detail

Detail and some embodiment of present technique below with reference to Fig. 1-59B, have been introduced.Although a lot of embodiment are for using equipment, system and method in the blood vessel regulating in the blood vessel for kidney nerve of cold therapy means, other application outside described herein and other embodiment are also within the scope of present technique.In addition, some other embodiment of present technique can have and different configuration described herein, parts or process.Therefore, those of ordinary skills correspondingly understand, and present technique can have other embodiment that comprises additional element, or present technique can have and do not possess the some features that illustrate and introduce referring to Fig. 1-59B.

As for the term in this description " far-end " and " near-end ", except as otherwise noted, this term can refer to that part on cold therapy equipment and/or relevant delivery device is with respect to the relative position of the position in operator and/or blood vessel.For example, near-end can refer to more close equipment operator position or enter the otch of vascular system, far-end can refer to from the farther position of the operator of equipment or along vascular system from the farther position of otch.

kidney neuroregulation

Kidney neuroregulation is that the part or all of anergy of the neurocyte that kidney innervates or other are effectively damaged.This anergy can be long-term (for example, permanent or lasting several months, several years or many decades) or (for example, continuing several minutes, a few hours, a couple of days or several weeks) in short-term.Kidney neuroregulation is hoped effectively to treat some clinical symptoms, these clinical settings be take whole sympathetic activity, and to strengthen particularly that kidney sympathetic activity strengthens be feature, for example, improper fluid retention, the heart-kidney syndrome and the sudden death of hypertension, metabolism syndrome, insulin resistant, diabetes, left ventricular hypertrophy, chronic and end-stage renal disease, heart failure.The minimizing of the nerve signal importing into contributes to systematicness to reduce sympathetic tone/drive, and kidney neuroregulation will contribute to treatment and the hyperfunction relevant several symptoms of whole body sympathetic nerve.Kidney neuroregulation may be conducive to the various organs by sympathetic innervation and body structure.For example, the meeting that reduces of maincenter sympathetic nerve drive reduces the insulin resistant that torment suffers from metabolic syndrome and type ii diabetes patient.In addition, osteoporosis can cause by sympathetic nerve, and benefits from the downward of the sympathetic nerve drive of following kidney neuroregulation.Relevant patient's anatomy and physiology's more detailed description are below provided.

Many technology can be used for making such as the neurocyte that kidney is innervated anergy partially or completely.For example, cryotherapy comprises by regulating the mode of function of nervous system to carry out the tissue on cooling target site.The mechanism of freezing tissue damage comprises, for example, and directly cell damage (for example, necrosis), blood vessel injury (for example, by damage supply vessels, make cell lack nutrient substance and dead) and with follow-up apoptotic sub-fatal low temperature.Be exposed to the cell death that refrigated cooling can cause acute cell death (for example, after exposure at once) and/or postpone (for example,, during organizing between frost free period and follow-up transition pays close attention to).Some embodiment of present technique comprise in or near the structure of the inner surface of renal artery wall, carry out cooling, thereby nearest (for example, being close to) tissue is reached to the cooling of the kidney sympathetic nerve place degree of depth.For example, the cooling degree of cooling structure causes effective low the kidney warming-neuroregulation in treatment.The orthosympathetic at least a portion of kidney is carried out to the fully cooling conduction that is hoped to slow down or may block nerves signal, to produce the long-term or permanent minimizing of kidney sympathetic activity.

Cold therapy has certain feature, and these features are conducive to endovascular kidney neuroregulation.For example, cools tissue can provide analgesic effect rapidly, makes cold therapy not have the bright erosion of high temperature to organize so painful.Therefore, compare with the heat erosion treatment operation of burning, cold therapy in operation process for to make patient keep comfortable required analgesic less.In addition, ease the pain and relaxed patient's motion, thereby improved the success of operative doctor and reduced postoperative complication.Cold therapy can not cause significant collagen protein to tighten substantially yet, so cold therapy is generally not relevant to angiostenosis.

Cold therapy is substantially operated in and makes cold therapy applicator (applicator) adhere to the temperature of moistening tissue.This has promoted stable, the continuous contact of making peace in therapeutic process, because of but useful.The common condition for the treatment of can make it to become attractive feature, and for example, patient can move in therapeutic process, and the conduit associated with applicator can move, and/or breathing can cause the rising of kidney and decline and movable kidney tremulous pulse thus.In addition, blood flow is beaten, and can cause arteriorenal beating.In shorter renal artery, more difficult realization in stable blood vessel located, and the adhesion associated with frozen cooling can be also favourable.

the selected embodiment of kidney refrigeration system

Fig. 1 figure has released according to the cold therapy system 100 of some embodiment configurations of present technique.Cold therapy system 100 can comprise operation bench 102 and freezing equipment 120.In the embodiment shown in fig. 1, operation bench 102 comprise cold-producing medium 106 in supply container 104, supply container 104 and with supply container 104 between become fluid to be communicated with supply control valve 108.Supply container 104 can be disposable container or comprise the larger container that deal is enough to carry out the cold-producing medium 106 of Repeated Operation.For instance, larger supply container can be the cylinder that can refill.Supply container 104 is configured to preserve cold-producing medium 106 with required pressure.For example, in one embodiment, liquid N ₂o is included in supply container 104 with 750 pound per square inches (psi) or higher pressure, so it is fluid state at ambient temperature at least substantially.In other embodiments, cold-producing medium 106 can comprise carbon dioxide, hydrofluorocarbon (" HFC ", for example

r-410A, etc.) and/or other suitable compressed or concentrated cold-producing medium, this cold-producing medium can be take that sufficiently high pressure remains in supply container 104 so that this cold-producing medium 106 to keep be at ambient temperature fluid state (for example, being about 210psi for R-410A) at least substantially.

Supply control valve 108 is coupled to the supply line 110 that is configured to cold-producing medium 106 to be transported to freezing equipment 120.Supply control valve 108 can be by artificial or automatic operation.Operation bench 102 can comprise pump 111 alternatively, for example vacuum pump or direct current (DC) power pump and/or back-pressure control valve 113, and it is coupled to and is configured to receive the discharge line 115 from the discarded cold-producing medium 117 of freezing equipment 120.Pump 111 can reduce the back-pressure of the cold-producing medium of vaporization, and, in conjunction with supply flowing velocity, improve refrigeration work consumption.In other embodiments, the cold-producing medium 117 of expansion can be vented to environmental stress.

Operation bench 102 may further include optional controller 118, controller 118 operation supply control valve 108 and back-pressure control valves 113.Controller 118 for instance, can be processor or the special circuit of realizing the computerized algorithm for automatically performing the operation.Operation bench 102 can also comprise optional reception user input and/or provide the user interface of information and/or for example, for monitoring the circuit of optional sensor (, pressure or temperature), if there is in freezing equipment 120 to user.In one embodiment, controller 118 operation back-pressure control valves 113 are controlled the negative pressure amount that is applied to the discarded cold-producing medium 117 returning from freezing equipment 120.This has regulated the back-pressure of the cold-producing medium of vaporizing to control the temperature in cold therapy equipment 120.In another embodiment, supply control valve 108 and/or back-pressure control valve 113 can be for strengthening the back-pressure of discarded cold-producing medium 117.The back-pressure that increases discarded cold-producing medium 117 can improve the boiling point of cold-producing medium.For example,, at N ₂in the example of O, back-pressure is elevated to 2 atmospheric a little increases from 1 atmospheric pressure and can makes boiling point rise to approximately-75 ℃ from approximately-88 ℃, back-pressure is elevated to 3 atmospheric pressure and makes the elevation of boiling point to approximately-65 ℃.

In certain embodiments, cold therapy system 100 also can be carried out pre-cooling to cold-producing medium 106, thereby before cold-producing medium 106 arrives cooling system, for cold-producing medium 106 provides more powerful refrigeration work consumption.For instance, system 100 can comprise the precooler 119 (being shown dotted line) in operation bench 102.In other embodiments, system 100 can comprise along the precooler of supply line 110, and it is positioned at the handle at the proximal end region place of system 100, or is positioned at other place of being coupled to freezing equipment 120.

Freezing equipment 120 comprises bar 122, and bar 122 has proximal part 124, is positioned at the handle 125 of the proximal end region of this proximal part 124, and the distal portions 126 distad extending with respect to proximal part 124.Freezing equipment 120 may further include the cooling package 130 on the distal portions 126 of bar 122.Bar 122 is configured to described distal portions 126 in blood vessel, to be positioned at for example, treatment position near near (, therein or it) renal artery or nephrostome, and cooling package 130 is configured to provide medicable freezing kidney-neuroregulation.

Fig. 2 A for example, in sending state (showing, low profile or collapsed configuration) the distal portions 126 of bar 122 and the sectional view of the amplification of cooling package 130, Fig. 2 B is the sectional view of the amplification of for example, cooling package 130 in deployed condition (, the configuration of expansion).In the embodiment shown in Fig. 2 A, the distal portions 126 of bar 122 can comprise the first district 127a, and the Second Region 127b caving inward with respect to the first district 127a (being separated by broken broken line).The first district 127a and Second Region 127b can be divided by ladder 128, and ladder 128 is notch (for example, being configured to coordinate annular or other circumferential groove of another member) for example.The first district 127a correspondingly can have the first external dimensions or the first sectional dimension (for example, area or diameter), and Second Region 127b can have the second external dimensions or the second sectional dimension that is less than first size.Bar 122 for example can be sized to be arranged on, in the sheath 150 of 8Fr or less (, the lead sheath of 6Fr) to adapt to little renal artery.

Freezing equipment 120 can also comprise along the supply pipe of at least a portion of bar 122 or chamber 132 and discharge pipe or chamber 134.Supply chamber 132 can be for being configured under high pressure cold-producing medium be remained on the tubule of fluid state.The internal diameter in supply chamber 132 is selected so that at least a portion of the cold-producing medium of arrival cooling package 130 is fluid state at far-end 135 places in supply chamber 132.Discharge side 134 can be outer tube, and supply chamber 132 can be along at least distal portions 126 extensions of bar 126 in discharge side 134.As following, will be described in further detail, some embodiment of freezing equipment 120 may further include the one or more sensors 138 that are coupled to controller 118 (Fig. 1) by lead-in wire 139, for example temperature sensor or pressure transducer.In some embodiment, cold therapy system 100 can be configured to the suitable calibration of test sensors 138 before cold therapy.For example, cold therapy system 100 can its start one start circulation time automatically by temperature sensor measurement to measurement temperature and room temperature compare, to check whether temperature sensor works well.

The embodiment of the cooling package 130 shown in Fig. 2 A and 2B can have applicator 140, it comprise balloon or other type definition be configured to seal completely the expandable members of the expansion chambers of renal artery or nephrostome.Balloon 142 can be relatively short (for example, 10mm or shorter) for example, (to adapt to arteriorenal length and bending, between 4-6cm), and can in expansion configuration, for example there is enough large diameter, so that it is enough to touch the major part (, diameter is between 3-10mm) on arteriorenal interior week.In following other embodiments, balloon can be configured to only partly seal renal artery or nephrostome.Balloon 142 can comprise the combination of flexible material, non-flexible material and/or flexible and non-flexible material.In various embodiments, for example, balloon 142 can be by polyurethane and/or other flexible or half flexible material make, these materials can expand and with blood vessel wall one show seal various sizes completely blood vessel (for example, vessel diameter is from about 3mm to about 10mm, or in application-specific from about 4mm to about 8mm).In other embodiments, balloon 142 can be made by nylon and/or other non-flexible material, and its size is determined to adapt to the blood vessel in concrete size range.For example, the nylon balloon of inflexibility can be sized to adaptation and there is about 3mm to the blood vessel of about 6mm internal diameter, and the size of larger inflexibility nylon balloon can be determined to adapt to the blood vessel with about 7mm to 10mm internal diameter.

In Fig. 2 A and the illustrated embodiment of 2B, the distal portions of balloon 142 is not connected to supporting mechanism's (for example, supply chamber 132 and/or other are supported), and can therefore be pressed down mould and/or otherwise form and have continuous distal portions.The continuous distal portions of balloon 142 provides mild surface, with this surface, contacts blood vessel wall to avoid tearing, pierce through and/or injured blood vessel wall otherwise.In addition, the cooling package 130 shown in Fig. 2 B can have the shorter overall length of balloon connecting than far-end, and it can be conducive to for example, in shorter blood vessel (, length is 6cm or shorter renal artery) location cooling package 130.

Cooling package 130 may further include with expansion chambers between the aperture 144 that is communicated with of fluid.In one embodiment, aperture 144 can be determined by the far-end that is inserted into the capillary tube 146 in the far-end 135 of supplying chamber 132.Mode, supplies the opening at far-end 135 places in chamber 132 and can determine aperture as an alternative.The diameter in capillary tube 146 and/or aperture 144 can be less than supply chamber 132, to hinder near the flowing of the cold-producing medium of expansion chambers, increases thus the pressure drop of the cold-producing medium 106 that enters expansion chambers and converges cooling capacity at cooling package 130 places.In other embodiments, supply chamber 132 can have substantially invariable internal diameter (for example, 0.008 inch (0.203mm), 0.009 inch (0.023mm), 0.010 inch (0.254mm) etc.), so the minimum equal diameters with supplying chamber 132 of the diameter in aperture 144.Cold therapy equipment 120 (for example may further include extra hardware in handle 125 (Fig. 1) and/or operation bench 102 (Fig. 1), valve, flow velocity and pressure gauge, Deng) and/or software, in order to control by the flow velocity of the cold-producing medium 106 in supply chamber 132, and the distal portions 126 to bar 122 converges by refrigeration work consumption.

The size in aperture 144 can be determined with respect to area and/or the length of the discharge side 134 at distal portions 126 places of bar 122, so that enough cold-producing medium flow velocitys to be provided, in expansion chambers, produce enough pressure drops, and allow to discharge fully discarded cold-producing medium 117 by discharge side 134.In one embodiment, the diameter in aperture 144 can be about 0.003 inch (0.076mm) or larger, for example approximately 0.004 inch (0.101mm) to approximately 0.009 inch (0.229mm).In different embodiment, the ratio of the sectional area in the internal diameter of discharge side 132 and/or sectional area and/or aperture 144 can be greatly between 4: 1 to 10: 1.For example, the internal diameter of discharge side 132 can be between approximately 0.030 inch (0.762mm) and approximately 0.050 inch (1.27mm), and the diameter in aperture 144 is that approximately 0.003 inch (0.0762mm) is to approximately 0.008 inch of ((0.203mm; For example, 0.004 inch (0.101mm)).In other embodiments, discharge side 134 and aperture 144 can have other suitable size.In a further embodiment, bar 122 (for example can comprise the extra chamber that extends through there or equipment, pressure induction cavity, extra fluid passage, etc.) and the ratio of the occupied total sectional dimension of the sectional dimension of discharge side 132 and other member in supply chamber and/or bar 122 can be approximated to be 4: 1 and 10: 1.

Can also supply the flow velocity that chamber 132 and capillary tube 146 length are relative to each other controlled coolant 106 by change.For example, in certain embodiments, the length of capillary tube 146 can be at most 1/3 of supply chamber 132 length.In various embodiments, the length of capillary tube 146 can be between 2 inches (5.08cm) and 30 inches (76.2cm) and the size in supply chamber 132 can correspondingly determine.In other embodiments, capillary tube 146 is shorter or longer than supply chamber 132, and/or capillary tube 146 can be omitted.

When sending in configuration shown in Fig. 2 A, cooling package 130 is passed to the target site T in blood vessel V in blood vessel.With reference to Fig. 2 B, cooling package 130 and sheath 150 are then relatively moved makes cooling package 130 surpass sheath 150 to remote extension.For example, can draw sheath 150 and/or push away cooling package 130 to far-end to near-end.In operation, cold-producing medium 106, by supply chamber 132, by aperture 144, and enters the expansion chambers being defined by balloon 142.When cold-producing medium 106 is by aperture 144, its expansion enters gas phase (gaseous phase), makes thus balloon expansion and causes significant hypothermal in expansion chambers.In applicator 140, the part of the tissue at contact target T place can be conduction of heat scope 149 or heat conduction area, and it,, with together with cold-producing medium 106 in expansion chambers, causes medicable freezing kidney-neuroregulation.Discarded cold-producing medium 117 passes discharge side 134 on proximal direction.In various embodiments, the length of bar 122 can be minimized to reduce to flow through the loss (for example, frictional dissipation) of the cold-producing medium of supplying chamber 132 and discharge side 134, improves thus the efficiency of refrigeration work consumption and cooling package 130.For instance, the extra frictional dissipation meeting being caused by the discharge side of more growing suppresses the discharge of discarded cold-producing medium 117, and the pressure and the temperature that raise thus in balloon 142.Therefore, bar 122 can be configured to have be less than 90cm overall length (for example, 80cm to 85cm, 70cm to 80cm, etc.).In other embodiments, bar 122 can be longer and/or be comprised that extra feature is to strengthen the refrigeration work consumption of cooling package 130.

The embodiment of the cooling package 130 shown in Fig. 2 A and 2B has sealed blood vessel V completely, and in target site T generation full circle week treatment (be also, the continuous scope blood vessel V being cooled whole interior Zhou Yanshen planar, this plane is horizontal or vertical with respect to the length direction of the blood vessel V on the T of position).Fully sealing blood vessels V has limited the heating of blood to heat conduction scope 149, makes the cooling capacity of cold-producing medium more effectively act on target T.Although kidney blood vessel is closed with excessively for a long time to the ischemia that may cause kidney, have been found that renal blood flow can enough be carried out completely freezing (for example, 2-5 minute) to target T by the complete totally enclosed time.Controller 118 (Fig. 1) can be programmed with electronics or mechanical timer valve is controlled to limit the time (for example, 2-5 minute) of flow of refrigerant.Mode as an alternative, timer can be integrated in the handle 125 (Fig. 1) or other parts of cold therapy equipment 120.If existed, sensor 138 can provide feedback to regulate or control system 100 to controller 118.In certain embodiments, may need control algolithm full automation, but in other embodiments, the treatment user input of carrying out.The capacity of the cold-producing medium that in a further embodiment, the flowing time of cold-producing medium can be in supply container 104 is limited.As hereinafter introduced more in detail, in other embodiments, cooling package 130 can be configured to partly seal blood flow.

In various embodiments, sensor 138 can be for being placed in the thermocouple on the outer surface of balloon 142, and be configured to provide the real time temperature reading of the external temperature of balloon 142.Therefore, can pass through controller 118 (for example, using software control circulation) and regulate cold therapy system 100, for example, so that its outer balloon temperature based on real-time and predetermined treatment temperature are (,-40 ℃ ,-60 ℃, etc.) between difference carry out the output of oblique ascension or oblique deascension cooling power.For example, can respond the temperature recording comes, in each stage of cold therapy, valve (for example, supply control valve 108 and/or back-pressure control valve 113) is opened or closed to regulate cooling power output.In other embodiments, can usage ratio control to regulate cooling power output, wherein the conveying pressure of cold-producing medium 106 and/or the flow velocity of vacuum pump 111 can respond the outer balloon temperature recording and change.Therefore, external heat galvanic couple allows cold therapy system 100 to compensate affect the cooling variable of target site T, and above-mentioned variable is the variation, the variation that the blood flow that flows through tremulous pulse changes and/or flow through near the blood flow of other blood vessel of renal artery of artery diameter for example.

Fig. 2 C-2E is according to the sectional view of the amplification of the distal portions 126 of the cold therapy equipment 120 of other embodiment configurations of present technique.With reference to Fig. 2 C, the distal portions 152 of balloon 142 can be connected to distal connector 162 by heat bonding, binding agent and/or other suitable connection mechanism.Distal connector 162 can have as shown in Figure 2 C crooked, the tip of bullet shaped, or be configured to be provided for guiding by vascular system can antisitic defect tip.

In illustrated embodiment, cold therapy equipment 120 further comprises guidewire lumen 133a, and the distal portions that wire 133b can be received with guide rod 122 by this guidewire lumen 133a passes through vascular system.In the illustrated embodiment of Fig. 2 C, on line in (OTW) configuration, guidewire lumen 133a from the proximal open that is positioned at adapter 201 of bar 122 (for example, at handle 125 places shown in Fig. 1) extend through whole bar 122 to the distal openings of crossing bar 122, and in the illustrated embodiment of Fig. 2 E, in exchange (RX) configures fast, guidewire lumen 133a only extends through a part for bar 122.Although the near-end of guidewire lumen 133a extends through the sidewall of bar 122 in Fig. 2 E at distal portions 126, in other embodiments, the near-end of guidewire lumen 133a all can approach at the near-end of bar 122 and any position between far-end.Guidewire lumen 133a shown in Fig. 2 C-2E or its distortion, can be included in each embodiment introducing herein so that the guiding in vascular system.It is 545 that suitable OTW and RX conductor configurations are disclosed in the patent No. of submitting on October 27th, 1994,134 United States Patent (USP), the patent No. that submit to May 23 nineteen ninety-five is 5,782,760 United States Patent (USP), the United States Patent (USP) that the publication number of submitting to August 23 calendar year 2001 is 2003/0040769 is open, and the publication number of submitting on October 17th, 2006 United States Patent (USP) that is 2008/0171979 open in, wherein each its integral body is incorporated to the application by reference.

Fig. 3 A figure has released with the embodiment of system 100 and has come low temperature to regulate kidney neural.Cold therapy equipment 120 provides by leading to path P in the blood vessel of corresponding renal artery RA the entrance that leads to kidney clump.As shown in the figure, one section of the proximal part 124 of bar 122 is exposed to outside patient body.Proximal part 124 by path P in blood vessel with external control lever 122, care-giver can catch bar 122 by path P in crooked blood vessel (for example, by femoral artery or radial artery) and remote control distal portions 126 (for example,, with the actuator in handle 125).For example, bar 122 may further include one or more bracing wires or other guiding device passes through vascular system for guiding distal portions 126.Image-guided, for example computed tomography (CT), radiography, intravascular ultrasonic imaging (IVUS), optical coherence tomography (OCT) or other suitable guiding form, or its combination, can be for helping care-giver's operation.In cooling applicator 140, be suitably placed in after renal artery RA or nephrostome, can use operation bench 102 (Fig. 1), handle 125 (Fig. 1), and/or other device expands or launches cooling applicator 140, until the inwall of applicator 140 contact renal artery RA.From the autotelic application of the refrigerating capacity of applicator 140, will be used to tissue to bring out the neuroregulation effect of the one or more needs in the adjacent domain of regional area on renal artery and kidney clump, described kidney clump is positioned among described arteriorenal tunica adventitia of artery, adjacent with described arteriorenal tunica adventitia of artery, or very approaching with described arteriorenal tunica adventitia of artery.The autotelic application of neuroregulation effect can realize along the neuroregulation of all or part kidney clump.

Neuroregulation effect be substantially applicator 140, applicator 140 at least in part with blood vessel wall between contact, when cooling the idle hours of applicator, the quantity of cooling cycle (for example,, by the one or more cooling cycles that add thermoperiod and separate) and the function that passes through the blood flow of blood vessel.The cooling effect needing can comprise to applicator carry out the cooling temperature that makes target neural fiber lower than required threshold value to realize low temperature alteration (cryo alteration) or to melt (ablation).For example, the refrigerant gas in applicator 140 can be cooled to the temperature of approximately-88 ℃ to approximately-60 ℃, or in other embodiments, the temperature of the gas in applicator 140 can be-80 ℃ to approximately-40 ℃.

In each embodiment, neuroregulation effect volume can occur in 100 seconds that chilled applicator 140 put in one or more cooling cycles to renal artery RA or kidney clump (for example, 90 seconds, 75 seconds, 60 seconds, 30 seconds etc.).In one embodiment, this process can comprise that two by the cooling cycle that adds thermoperiod and separate, but in other embodiments, and this process can have the cooling cycle that is added thermoperiod and separate more than two.The length of cooling cycle can be identical or different, and for example each was from about 10 seconds to about 90 seconds.The length that adds thermoperiod can be enough to partly or entirely dissolve the material freezing on cooling contact surface.In some embodiment, the length that adds thermoperiod can be from approximately 5 seconds to approximately 90 seconds.Each between cooling cycle adds thermoperiod can continue identical time or different time.Cooling cycle and the length that adds thermoperiod can pre-determine and be programmed for algorithm, or this system can comprise the automatic control algorithm that uses feedback control loop, and this feedback control loop is based on temperature on balloon exterior face and/or balloon interior and/or pressure.For example, control algolithm can estimate that the material freezing fully melts based on pressure and/or temperature survey, thereby stops adding thermoperiod and beginning to cool down the cycle.The quantity and the length that depend on the cooling cycle, for example, from (launching cooling package 130, as shown in Figure 2 B) to cooling package being recovered to sending state, (for example, total operating time as shown in Figure 2 A) can shorter than 5 minutes (for example, short than 3 minutes).After two renal artery RA all handle, from cooling package 130 being deployed in the first renal artery RA, to reorientation, expansion in the second renal artery and regain cooling package 130, can less than 12 minutes (for example, 10 minutes, 6 minutes, etc.).In certain embodiments, can for example, by applicator 140 being set to the whole circumference (, along same plane or along laterally spaced parallel plane) around renal artery RA, and in single application, carry out neuroregulation to shorten operating time.In other embodiments, applicator 140 can act on and is less than the whole circumference of renal artery RA and/or acts in more than one application.

Fig. 3 B is that figure has released by basis above with reference to block diagram described in Fig. 1-3A or carry out the method 300 of low temperature adjusting kidney nerve according to the system 100 of another following suitable embodiment of present technique.With reference to Fig. 1-3B, method 300 can be included in renal artery or nephrostome (frame 305) cooling package 130 is set to sending state (for example, as shown in Figure 2 A) in blood vessel in the lump.Cold therapy equipment 120 and/or the part on it (for example, cooling package 130) can be inserted into guide catheter (for example, the sheath shown in Fig. 2 A-2C 150) so that the endovascular delivery of described cooling package 130.In certain embodiments, for example, cold therapy equipment 120 can be configured to be arranged in 8FR or less guide catheter (for example, 7Fr, 6Fr, etc.) to approach little external perihaemal canal.Enter the above, OTW or RX wire also can be used for controlling and promoting the control to bar 122 and cooling package 130.

Method 300 may further include cold therapy equipment 120 is connected to operation bench 102 (frame 310), and the expansible assembly (for example, balloon 142) that partly or entirely makes cooling package 130 expands to determine the whether tram (frame 315 and 320) on target site of cooling package 130.Can through supply chamber 132 by the cold-producing medium of the supply container 104 from operation bench 102 places and/or from described distensible assembly between other suitable fluid (for example, air) of the second fluid supply bin that is communicated with of fluid make described expandable members expansion.If cooling package 130 is not in desired position, at least some pressure in expandable members can be released (frame 325).In certain embodiments, for example, can be by cold therapy equipment 120 and operation bench 102 are disconnected, and described expandable members is manually exitted through the proximal part of bar 122 with syringe, thereby expansible assembly is exitted up hill and dale.In other embodiments, cold therapy equipment 120 can keep being connected in operation bench 102, and syringe can for example, be exitted to this expandable members along the length direction connection (, piston injector) of bar 122.In a further embodiment, the controller 118 at operation bench 102 places can comprise for described expandable members being carried out to the partly or entirely algorithm of venting.In embodiment further, can cooling package 130 be positioned to target site with the impenetrable labelling of ray and/or sign.

Once cooling package 130 is suitably placed in the first renal artery or its nephrostome, can operate operation bench 102 and start the cooling of cooling package 130 places, described cooling adjusting kidney nerve is to cause the part or all of denervation (frame 330) of kidney.Sub-cooled can act on one or more cycles (for example, to 30 seconds increments, 60 seconds increments, 90 seconds increments, etc.) on one or more positions of the circumference along the first renal artery or the first nephrostome and/or length.In certain embodiments, for example, can use two cycles of 90 seconds.In each embodiment, expandable members can keep all or part of expansion the position of cooling package 130 is remained on to target site between the cooling cycle.

After first arteriorenal kidney-neuroregulation, method 300 may further include and makes expandable members venting and cooling package 130 is recovered to sending state (frame 335).Can be by cold therapy equipment 120 is separated and syringe or other suitable equipment connection that detaches are come manually described expandable members 120 to be exitted to the near-end of bar 122 from operation bench 102.In other embodiments, syringe can connect and that cold therapy equipment 120 is separated from operation bench 102 along the length of bar 122, or expandable members can for example, by automatically venting (, via controller 118).In certain embodiments, after expandable members is deflated, cooling package 130 may be withdrawn in guide catheter.Alternatively, cooling package 130 can be in reorientation and is stored in aseptic position (for example,, in saline) time temporarily and is removed from guide catheter.

Then, cooling package 130 can be positioned to (frame 340) in the second renal artery or the second nephrostome, and expandable members can be expanded to the position (frame 345) of consolidating cooling package 130.In the embodiment selecting, contrast medium can distally feed over cooling package 130 and fluoroscopy and/or other applicable imaging technique can be used to locate the second renal artery.If needed, supply container 104 in operation bench 102 used can heavily be filled out or be removed and be used new supply container (for example to replace, disposable cold-producing medium cylinder), for the kidney-neuroregulation at the second renal artery or the second nephrostome place provides enough cold-producing mediums.Those operation bench 102 in the repositioning process of cooling package 130 by embodiment separated from cold therapy equipment 120 in, operation bench 102 can be reconnected to cold therapy equipment 120, makes method 300 continue the cooling kidney-neuroregulation (frame 350) that completes the second renal artery or the second nephrostome place of application of cold temperature.

In other embodiments, each step of method 300 can be modified, omits and/or add extra step.For example, operation bench 102 can be opened and load the supply container 104 outside the sterile field in carrying out cold therapy, and is placed in sterile bag or shell, and it can be brought in this sterile field.If supply container 104 must be reloaded or heavily fill out in cold therapy process, operation bench 102 can be removed from sterile field, reloads, then is put back to (for example,, in sterile bag or shell) in sterile field.In other embodiments, empty supply container 104 can remove and throw aside the sterile bag or shell around operation bench 102 from operation bench 102, new supply container can be connected to operation bench 102 in described sterile bag or shell, so operation bench 102 does not leave sterile field in therapeutic process.In a further embodiment, operation bench 102 can remain on the outer also operated from a distance of sterile field.

Fig. 4 A is according to the sectional view of the amplification of the distal portions 426 of the cold therapy equipment 420 of another embodiment configuration of present technique.This cold therapy equipment 420 comprises the basic similarly feature of feature with cold therapy equipment 120 above with reference to described in Fig. 1-3B.For example, cold therapy equipment 420 comprises the bar 122 of elongation, and supply and eliminating chamber 132 and 134 at least a portion along bar 122 are extended, and cooling package 130 is positioned at the distal portions 426 of bar 102.Cooling package 130 comprises expandable members, for example balloon 142 or other applicable expandable members, and it has been determined at least a portion of expansion chambers and has received via aperture 144 is the cold-producing medium 106 of gas phase at least substantially.

In illustrated embodiment, the distal portions 452 that the far-end 135 in supply chamber 132 is coupled to balloon 142 provides extra support and/or control for cooling package 130, and aperture 144 is the opening (for example,, not in supplying far-end 135 or the end capillaceous in chamber 132) of arranging along the length in supply chamber 132.Can use binding agent (for example, thermal), securing member and/or other applicable adhesion mechanism known in the art that the distal portions 452 of supply chamber 132 and balloon 142 is linked together.In other embodiments, supply chamber 132 can end at expansion chambers or wherein, and/or cold therapy equipment 420 may further include support member (not shown), and this support member at least extends to the distal portions 452 of balloon 142 from bar 122.

As shown in Figure 4 A, cold therapy equipment 420 may further include the adapter 454 of the proximal part that is positioned at balloon 142, and it can be connected the top of the distal portions 426 of bar 122, and thus balloon 142 is coupled to bar 122.Adapter 454 can be by the proximal part of balloon 142 (for example, the cervical region of balloon 142) definition, as shown in Figure 4 A, described proximal part and described expansible part one, or, described adapter 454 can be for being independent of and being different from the parts of balloon 142, for example the axle collar or other applicable keeper.Adapter 454 can be thermally bonded, binding agent, chain surface (for example, line), friction is fixing, the distal portions 426 that interlock is fixed, suction and/or other applicable attachment mechanism are connected to bar 122, or adapter 454 can be integrally formed with distal portions 426.

In illustrated embodiment, adapter 4545 is placed close to ladder 128 and above the second area 127b of the distal portions 426 of bar 122.As shown in Figure 4 A, the first area 127a of distal portions 426 can have the first outer cross section size or diameter OD ₁and second area 127b can have the second outer cross section size or diameter OD ₂, it is less than the first outer cross section size OD ₁.The external dimensions of distal portions 426 reduces to have formed caving inward with respect to first area 127a ladder 128 places, the proximal part of the expansible part of at least a portion of described adapter 454 and described balloon 142 can be arranged in described depression, reduces thus the profile of the distal portions of bar 122.In certain embodiments, the size of ladder 128 can be made the outer surface 455 of first area 127a at least substantially concordant with the outer surface 457 of adapter 454 by definite.Therefore, the external diameter OD of second area 127b ₂can equal the external diameter OD of first area 127a ₁deduct the thickness of the adapter 454 of 2 times.In other embodiments, the external diameter OD of second area 127b ₂can be greater than or less than 2 times of adapter 454 thickness.

In the embodiment selecting, adapter 454 is not expansible, for example, so (,, in the time of as shown in Figure 4 A), adapter 454 remains in depression and/or substantially and flushes with the outer surface 455 of first area 127a when cooling package 130 moves to deployed condition.In other embodiments, adapter 454 can be distensible and when cooling package 130 moves to deployed condition increasing section long-pending.

In the embodiment shown in Fig. 4 A, discharge side (for example, by the inner surface of bar 122, determined) sectional area also at the transition position of first area 127a and second area 127b, reduce, so the distal portions 426 of bar 122 has the first inner section size or diameter ID at 127a place, first area ₁and at less the second inner section size or the diameter ID at second area 127b place ₂.For fear of the insufficient discharge by neck formula discharge side 134, cause the pressure in expansion chambers to raise, second area 127b can only be placed in the distal-most end near the bar 122 of expansion chambers, and discarded cold-producing medium 117 density are the highest there.For example, second area 127b can have 4cm or shorter length (for example, 2cm, 1cm, etc.).Discarded cold-producing medium 117 is also by the discharging and be not subject to excessive restriction compared with little inner diameter, ID 2 of second area 127b, because second area 127b can be quite short along the length of the longitudinal axis of bar 122.For example, the length of second area 127b can minimize, with abundant matching connector 454.Therefore, the less discharge chamber 134 at second area 127b place can mainly transport highdensity discarded cold-producing medium 117, and can when discarded cold-producing medium 117 density reduce, be driven and send the larger discharge side 134 that is positioned at first area 127a to, be convenient to thus the second less inner diameter, ID via second area 127b ₂suitably aerofluxus.

In operation, the second area 127b caving inward can reduce bar 122 distal portions 426 profile and/or the roughly level and smooth transition from bar 122 to adapter 454 is provided, and can not jeopardize the discharge characteristic of discharge side 134.The distal portions 426 of the low profile of bar 122 also contributes to fluid contrast medium between bar 122 and sheath 150 from proximal part 124 (Fig. 1) the sending to distal portions 426 of bar 122, described contrast medium at sending state (for example, as shown in Figure 2 A), around cooling package 130, with the target in vascular system, carry out imaging and location (for example, using fluoroscopy).As shown in Figure 4 A, for example, the second area 127b of depression provides around one or more paths or the channel C of the distal portions 426 of bar 122, and it enough surmounts cooling package 130 to send comparison agent to far-end greatly, and the adapter that can not be highlighted or balloon retardance.In certain embodiments, can be at the first and second corresponding region 127a and the first external diameter OD of 127b ₁with the second external diameter OD ₂difference be that contrast medium forms enough channel C while being less than 0.01 inch (0.254mm).In other embodiments, the external dimensions OD of the first and second region 127a and 127b ₁and OD ₂difference can be greater or lesser.After using in kidney-neuroregulation process, the first renal artery can surmount cooling package 130 and locates by send contrast medium through channel C to far-end under sending state.After the kidney-neuroregulation at the first renal artery place, cooling package 130 can be retracted to sending state from deployed condition, wherein can to far-end, send extra contrast medium through channel C and surmount cooling package 130 to locate the second renal artery.

In other embodiments, the distal portions 426 of bar 122 does not comprise the discharge side 134 progressively lowering shown in Fig. 4 A, instead, can have substantially unified sectional dimension.Such discharge side can adapt to guidewire lumen (for example, shown in Fig. 2 C-2E) relatively like a cork, thereby wire can be extended cooling package 130 is positioned to the target site T in blood vessel V by this guidewire lumen.In this embodiment, after wire is contracted, can to far-end, send for example, contrast medium for target site (, two renal artery) is carried out to imaging through guidewire lumen.

Fig. 4 B is according to the sectional view of the amplification of the distal portions 456 of the cold therapy equipment 460 of another embodiment configuration of present technique.Described cold therapy equipment 460 comprises and is combined the basic similarly feature of feature of the cold therapy equipment 460 described in Fig. 4 A above.For example, the distal portions 456 of bar 122 has ladder 128, and described ladder 128 is divided first area 127a and a less second area 127b to come.But in the embodiment shown in Fig. 4 B, second area 127b is by being determined from bar 122 outstanding independent pipes 459.Be similar to the progressively inside part of the bar 122 shown in Fig. 4 A, manage 459 sectional areas at second area 127b reduction discharge side 134.

As shown in Figure 4 B, cold therapy equipment 460 may further include the proximal connector 458 that balloon 142 is connected to the distal portions 456 of bar 122.Unlike being substantially arranged in the adapter 456 shown in Fig. 4 A of the depression being formed by ladder 128, the proximal connector 458 shown in Fig. 4 B extends to the outer surface 455 of first area 127a above second area 127b.By extend proximal connector 456 above the 127a of first area, having increased can be for being connected to balloon 142 surface area of the distal portions 456 of bar 122.Therefore, for example can shorten the length of second area 127b, so that the competent neck shape discharge side 134 (, as shown in Fig. 4 A and 4B) that passes through carrys out discharging refrigerant 117.

In certain embodiments, proximal connector 458 is unaugmentable, then its launch and sending state under all keep basic low profile and against the outer surface 455 of first area 127a.This can reduce or prevent that proximal connector 458 from when configuration retract being hooked sheath 150 from launching configuration to sending at it.In other embodiments, at least one part of proximal connector 458 can be expanded, but is configured to keep during in sending state at cooling package 130 low profile of distal portions 456.Therefore, cold therapy equipment 460 with the proximal connector 458 extending can provide low profile roughly at little external perihaemal canal (for example to come, renal artery) in by cooling package 130 at endovascular delivery to target site and/or one or more channel C can be provided, fluid contrast medium can be sent to far-end and be surmounted cooling package 130 by this channel C.

As Fig. 4 B further illustrates, cold therapy equipment 460 also comprises distal connector 462, it keeps the distal portions 452 of balloon 142 and the support member 433 that extends through balloon 142, and this support member 433 supports balloon 142 in described sending state and deployed condition.Distal connector 462 can also be connected to (for example, passing through thermal) from it to the atraumatic tip 464 of remote extension or be integrally formed with it.Atraumatic tip 464 can for example be extended about 0.5cm, to 5cm (, about 1-2cm) from distal connector 462, and has the external diameter between approximately 0.010 inch (0.254mm) to approximately 0.050 inch (1.27mm).In one embodiment, for example, atraumatic tip 464 can have the length of about 2cm and the external diameter of at least 0.035 inch (0.889mm) (for example, 0.038 inch (0.965mm)).In other embodiments, atraumatic tip 464 can have other suitable length and/or external diameter.Atraumatic tip 464 can be used as fixed guide to facilitate the guiding by vascular system.In some embodiment, the angle of atraumatic tip 464 and/or direction of rotation can for example, be adjusted by control line 467 (, bracing wire), and this control line 467 extends through at least a portion of bar 122.User can control control line 467 twist deflection or otherwise mobile atraumatic tip 464 so that the distal portions of bar 122 456 is directed to target site T.In other embodiments, atraumatic tip 464 can for example, be determined by the distal portions of wire (, the wire 133b shown in Fig. 2 C), and this wire extends through bar 122 and crosses distal connector 462.

Atraumatic tip 464 can be by essentially smooth and submissive material or support structure, so that when cold therapy equipment 460 is controlled vascular system, atraumatic tip 464 can contact and depart from blood vessel wall lightly, and therefore avoid running through and/or otherwise wound by atraumatic tip 464 therein through the blood vessel of guiding.For example, atraumatic tip 464 can for example, for example, be made by the soft coil (, platinum coil) on core or line (, stainless steel wire).In each embodiment, described line can be configured to retreat to gradually from the proximal part 469a of atraumatic tip 464 the distal portions 469b of atraumatic tip 464.Taper, for example, at proximal part 469a, can be circular and (for example there is external diameter between approximately 0.005 inch (0.127mm) and 0.015 inch (0.381mm), 0.009 inch (0.229mm)), and can be flattened to the thickness (0.127mm having between approximately 0.001 inch (0.025mm) and 0.005 inch towards distal portions 469, for example, 0.003 inch (0.076mm)).In the embodiment selecting, about length of 1/3 to 1/2 of the atraumatic tip 464 starting from proximal extremity makes described line flat.In other embodiments, described atraumatic tip 464 can have the cross section of circular taper or non-taper from start to finish.In some embodiment, atraumatic tip 464 (for example, be wound around the coil of described line) at least a portion can be by platinum and/or other radiopaque material (for example, platinum/iridium alloy) make, the cold therapy equipment 460 of its imaging technique known in the art easy to use is guided through vascular system.In aspect some of present technique, balloon 142 can also comprise that the radiopaque labelling and/or the radiopaque sign (for example, being made by radiopaque ink) that are positioned at its proximal part and distal portions are further beneficial to guiding and launch.In other embodiments, material and structure that atraumatic tip 464 can be deflectable and flexible by other are made, for example macromolecular material (as

polymer, nylon etc.), macromolecular material tinsel (for example, stainless steel silk), and/or other suitable material.

In the illustrated embodiment of Fig. 4 B, atraumatic tip 464 is by molding and/or otherwise form curve or sloping portion.Atraumatic tip 464 by plastic material (for example, rustless steel, platinum, etc.) make, atraumatic tip 464 can form and/or be restructured as required flexibility.In other embodiments, atraumatic tip 464 can be in advance by being pre-formed by shaping material, so it has nonadjustable, fixing curve.The described curve of atraumatic tip 464 can further contribute to the guiding of vascular system.For example, described curve can help by cooling package 130 remain on required sequential in (for example, renal artery) prevent that its side from propping up (side braches).

Pressure in cold therapy system monitors

Fig. 5 A is that Fig. 5 B is the amplification sectional view of the distal portions of the system 500 in Fig. 5 A according to the part schematic diagram of the cold therapy system 500 of another embodiment configuration of present technique.The feature that cold therapy system 500 comprises can be similar to the feature of the cold therapy system 100 of above combination Fig. 1-3B introduction substantially.With reference to Fig. 5 A, for example, cold therapy system 500 can comprise cold therapy equipment 520 and operation bench 502.Operation bench 502 can comprise cold-producing medium supply container 504 and the supply control valve 508 that is coupled to supply circuit 510, and supply circuit 510 is configured to cold-producing medium 506 to be transported to cold therapy equipment 520.Operation bench 502 can also comprise pump 511 and/or back-pressure control valve 513 alternatively, and it is coupled to the pumping-out line 515 that is configured to receive from cold therapy equipment 520 cold-producing medium 517 of vaporization.Controller 518 can operationally be coupled to supply control valve 508 and/or back-pressure control valve 513, regulates the cold-producing medium by cold therapy equipment 520 to flow.In illustrated embodiment, cold therapy equipment 520 comprises bar 522, be positioned at the handle 525 of proximal end region of proximal part of bar 522 and the distal portions 526 of freezing assembly 530 with the remote area of the distal portions 526 that is positioned at bar 522.

As Fig. 5 A further illustrates, operation bench 502 (for example may further include pressure transducer or sensor 570, Omega Engineering of Stanmford, the PX209-100G5V pressure transducer that CT produces), it is coupled to for example, pressure in the part (, expansion chambers) that pressure circuit 571 monitors cooling package 530 in refrigerating process.In different embodiment, pressure transducer 570 can be coupled to controller 518 and be used as feedback mechanism to control supply control valve 508 and/or back-pressure control valve 513, and the pressure sensing corresponding to cooling package 530 places thus regulates and goes to and/or from the cold-producing medium stream of cooling package 530.For example, pressure transducer 570 can be configured to point out the pressure (for example,, within the scope of the burst pressure in expansion chambers) higher than subscribing threshold value.As response, controller 518 can be by cutting out supply control valve 508 and/or for example, by (reducing back-pressure in pumping-out line 515 at least in part, use vacuum pump 511) increase the refrigerant flow from cooling package 530, reduce or stop refrigerant flow.In other embodiments, pressure transducer 570 can be directly coupled to supply control valve 508 and/or back-pressure control valve 513 and in response to the pressure sensing, carrys out the open and/or closed of control valve 508 automatically and 513.In some embodiment, cold therapy system 500 can be configured to confirm that pressure transducer 570 was suitably calibrated before freezing.For example, when system 500 energising, system 500 can be automatically by the function that relatively checks pressure transducer 570 from reading and the environmental stress of pressure transducer 570.

Referring now to Fig. 5 B, the remote area of cold therapy equipment 520 can comprise the feature similar with the feature of the cold therapy equipment 120 of introducing above with reference to Fig. 2 A-2E.For example, cold therapy equipment 520 comprises the supply chamber 132 of being coupled to supply circuit 510 (Fig. 5 A), be coupled to the discharge side 134 of pumping-out line 515 (Fig. 5 A), and comprise the applicator 140 of determining the balloon 142 of expansion chambers or the expandable members of other types.

As illustrated in Fig. 5 B, cold therapy equipment 520 may further include pressure and monitors chamber 572, and it is coupled to pressure transducer 570 (Fig. 5 A) via pressure circuit 571 (Fig. 5 A).Pressure monitor chamber 572 can extend through bar 522 and have with expansion chambers (for example, being determined by balloon 142) between the distal openings 574 that is communicated with of fluid.The size in pressure supervision chamber 572 (for example, sectional area, internal diameter and/or external diameter) thus can enough with enough accuracies, carry out the pressure readings in sensing expansion chambers greatly, but enough little with reduce or eliminate and cold-producing medium stream by discharge side 134 between interference.For example, supply chamber 132 and pressure monitor that chamber 572 can (for example together have the first sectional dimension, the first sectional area) and discharge side 134 (for example can there is the second sectional dimension, the second sectional area), then the ratio of the second sectional dimension and the first sectional dimension between 4: 1 to 10: 1.In certain embodiments, pressure monitors that chamber 572 can have and is not more than 0.03 inch of (0.762mm; For example, 0.015 inch (0.381mm), 0.010 inch (0.762mm) etc.) internal diameter, and external diameter is not more than 0.060 inch of (1.52mm; For example, 0.02 inch (0.508mm), 0.015 inch (0.381mm), etc.), and the size of discharge chamber 134 can correspondingly be adjusted.In the illustrated embodiment of Fig. 5 B institute, pressure monitors that chamber 572 ended at bar 522 at external diameter before the second area 127b of distal portions 520 place's indentation.This configuration can be used in such embodiments, the internal diameter indentation of its king-rod 522 (for example,, as shown in Fig. 4 A and 4B) thus be not limited in the discharge of cold-producing medium 517 of the expansion at less second area 127b place.In other embodiments, pressure monitors that the opening 574 in chamber 572 can be in balloon 542 or therein.

Thereby pressure monitors that chamber 572 can also have sufficiently long length and opening 574 is positioned at together with cooling package 530 to target site T renal artery or the nephrostome of femoral artery or radial artery (for example, through) in blood vessel.For example, pressure monitors that chamber 572 can have the length identical with the whole length of bar 522 (for example, at least 48 inches (122cm)).In other embodiments, pressure monitors that chamber 572 can have different length and/or size that other is applicable to.For example, pressure monitors that chamber 572 can have the first length and the pressure circuit 571 that is connected thereto (for example can have the second length, 48 inches (122cm), 30 inches (76cm), 12 inches (30cm), etc.), thereby pressure is monitored to chamber 572 extends to pressure transducer 570, allow thus by operation bench 502 in cold therapy process for example, as for desired position (, on table).

In cold therapy, pressure monitors that chamber 572 and pressure transducer 570 (Fig. 5 A) can be configured to provide the signal of the pressure change in indication expansion chambers.For example, pressure transducer 570 can be configured to point out the threshold value pressure under the burst pressure in balloon 142, thereby reduce the probability that balloon breaks in cold therapy process.Balloon 142 can have the burst pressure of the manufactured materials that depends at least partly balloon 142.Flexible material (for example, polyurethane), for example, generally have the burst pressure for example, than non-flexible material (, nylon) lower (for example, 80psi, 100psi, 200psi, etc.), the burst pressure of non-flexible material is 300psi or higher.Pressure transducer 570 can be configured to monitoring threshold pressure, and this threshold value pressure can equal to be positioned at the pressure values under burst pressure, and it provides the sufficient response time before balloon 142 breaks, pressure change to be made a response.In other embodiments, pressure transducer 570 can be configured to (for example, 20-60psi) provide indication in addition time when balloon 142 is operated in its required operating pressure.

The pressure of expansion chambers monitors the pressure at opening 574 places in chamber 572 and the volume that the time delay between the pressure readings at pressure transducer 570 places can be depended on pressure supervision chamber 572.Therefore, pressure monitors that the volume in chamber 572 can have the abundant response time (for example,, before balloon 142 breaks) of the pressure change in expansion chambers being made to appropriate reaction.In certain embodiments, for example, pressure transducer 570 has the response time that is less than 1.5 seconds, for example, is less than the response time of 1 second, and 0.2 second, 0.1 second, or 15 milliseconds.In order to improve the accuracy of pressure readings and to reduce response time of pressure transducer 570, pressure monitors that the length in chamber 572 can be shortened, and the pressure before being connected to pressure transducer 570 monitors that the obvious increase of the volume in chamber 572 can be reduced.For example, the pressure circuit 571 of the proximal part 524 (for example, being positioned at handle 525) (Fig. 5 A) that is positioned at bar 522 can be coupled in pressure supervision chamber 572, and pressure circuit 571 can have the sectional area that is similar to pressure supervision chamber 572.In other embodiments, pressure transducer 570 can (be for example coupled at handle 525 places in pressure supervision chamber 572, omit pressure circuit 571), to shorten to the total length of the pressure pipe of pressure transducer 570, electric wire can be coupled to pressure transducer 570 and pass the signal to operation bench 502.

To returning with reference to Fig. 5 A and 5B, in certain embodiments, pressure circuit 571 and/or pressure supervision chamber 572 can be assembled by use (fitting) or adapter 576 (for example, quick connect adapter) and be coupled to pressure transducer 570.In the illustrated embodiment of Fig. 5 A, for example, adapter 576 comprises interior storage or passage 578, and it is connected to pressure transducer 570 by pressure circuit 571 with fluid mode of communicating.Passage 578 can have fully little volume, then the pressure difference of unlikely destruction from pressure circuit 571 to pressure transducer 570, and the accuracy of enhancing pressure measurement.For example, in one embodiment, passage 578 can have the internal volume that is not more than 0.1cc.In other embodiments, passage 578 can have larger internal volume.In a further embodiment, adapter 576 can monitor pressure that chamber 572 is coupled to bar 522 or other locational pressure lines 571 near bar 522 proximal parts 524.It is separated that therefore adapter 576 allows pressure to monitor that chamber 572 and/or pressure circuit 571 come pressure transducer 570 after cold therapy, make pressure monitor that chamber 572 can be thrown aside and pressure transducer 570 (for example can be stored, with handle 525 together with/operation bench 502) for the use of follow-up cold therapy, and can not destroy the accuracy of the pressure readings at pressure transducer 570 places.

To returning with reference to Fig. 5 B, in various other embodiment, cold therapy equipment 520 may further include the extra gas supply chamber 579 of being coupled to supply container 504 (Fig. 5 A), or other transmit the gas supply container of additional gas to expansion chambers, and regulate thus the temperature of applicator 140.For example, gas supply chamber 579 can be before sending cold-producing medium 506 via aperture 144 or for example by cold-producing medium 506 (simultaneously, nitrous oxide) and/or other pressurization or uninflated gas (for example, air) be delivered in balloon 142, to increase the pressure (for example,, from about 5psi to about 60psi) in balloon 142.Extra gas in balloon 142 has reduced the pressure drop of the cold-producing medium 506 in expansion chambers, and has improved thus the temperature in balloon 142.Therefore, the extra gas that gas supply chamber 579 can be used to start, restriction and/or postpone enters expansion chambers (for example, use valve), and regulate the temperature of balloon 142, and without the complex component in operation bench 502 (for example, pressure regulator, sub-refrigerator, etc.) pressure drop in balloon 142 changed.Additionally, for example, when independent gas container (is coupled in gas supply chamber 579, gas supply), gas supply chamber 579 can be used to before cold-producing medium 506 ground are sent to as balloon 142 by gas send balloon 142 to, monitor the position of the applicator 142 on target site T.

In a further embodiment, pressure regulator is (not shown, for example, air relief valve) can be added to the cold-producing medium 517 that limits vaporization on discharge side 134 leaves balloon 142 and/or is limited in discharge side 134, for example, until the pressure in balloon 142 is predetermined value (, when using pressure to monitor that chamber 572 senses).In embodiment further, coolant treatment equipment 520 can comprise the pressure regulator for discharge side 134 and gas supply chamber 579, so the pressure in balloon 142 can be conditioned in cold therapy process.

pre-cooling in cold therapy system

In low the kidney warming neuroregulation, can be limited for cooling refrigerant volume.Therefore, the cooling capacity of increase cold-producing medium is useful.Be to make in cooling package before cold-producing medium expansion cold-producing medium to carry out the example that pre-cooling is the process of a cooling capacity that can increase cold-producing medium.Even mainly occur by phase transformation when cooling, before phase transformation, use colder cold-producing medium can improve cooling amount.In addition, if supply pipe is to exchange with discharge pipe heat, the temperature of the cold-producing medium in reduction supply pipe can be carried out the cold-producing medium waste gas in the discharge Central Shanxi Plain cooling, and it can reduce the back-pressure in the cooling package being associated, and the cooling package place of further wild phase association thus is cooling.Pre-cooling can reduce the required refrigerant volume of the kidney warming neuroregulation, and it can allow in vascular system to use less and bar more flexibly.Pre-cooling can also relax with cold therapy system in the going down of cooling capacity of other part relation, for example heat insulating component in applicator and the coaxial screw pipe valve (in-line solenoid valve) that dispels the heat in operation process.

The cold-producing medium of the pressurization of using in low the kidney warming neuroregulation generally at room temperature provides (for example,, from room temperature Dewar flask) from vascular system outside.When the cold-producing medium of pressurization is when advance in vascular system along supply pipe, its can through and warm blood and the heat exchange between the tissue temperature that raises.For example, for example, when the cold-producing medium of for example, pressurization approximately room temperature (, about 23 ℃) provides passes through the vascular system (, about 37 ℃) in body temperature, the temperature of the cold-producing medium of pressurization can be elevated to approximately 25 ℃ to 37 ℃ before arriving cooling package.According to the cold therapy equipment of some embodiment configurations of present technique, can comprise pre-cooling assembly, it is configured to, before the cold-producing medium of pressurization is expanded in associated cooling package, it be carried out to pre-cooling.For example, thereby can being cooled in associated cooling package, the cold-producing medium of pressurization there is the temperature (for example,, lower than 20 ℃ or lower than 10 ℃) lower than body temperature before expansion.Such pre-cooling assembly can be configured to outside vascular system, and/or uses identical cold-producing medium supply with associated cooling package.In the some embodiment that configure according to present technique, pre-cooling contributes to cold-producing medium to maintain liquid state until it arrives the subcooled cooling package of needs.For example, can be lowered with the vaporization being associated of heating of the cold-producing medium of part by near the cold therapy equipment of cooling package.In this joint, term " closely " or " far " can refer to the position with respect to the cryogen source of pressurization.For example, closely can refer to the position of the cryogen source of more close pressurization, and far can refer to further from the position of the cryogen source of pressurization.

Fig. 6 A-6B figure has released cold therapy equipment 600, and it comprises pre-cooling assembly 602, determines the bar 604 of the elongation of passing away, and the concentrator between pre-cooling assembly and bar 606.Pre-cooling assembly 602 comprises flexible tubular element 608, and it extends in concentrator 606 and is configured to be connected between the adapter 610 of cryogen source (not shown) of pressurization.Described concentrator 606 can comprise the main connector 612 that is connected to bar 604, leads to the outlet 614 of atmosphere, is connected to the first branch 616 of tubular element 608, and the second branch 618 that is connected to control line conduit 620.In some embodiment, concentrator 606 can comprise one or more extra branches, for example comprise with fluid connection mode be connected to near-end syringe adapter pipe (for example, near-end syringe adapter, it comprise be configured to by the broken barrier film of the acupuncture of syringe) branch.For instance, such structure is favourable for introducing packing material near the introducing contrast medium cooling package in vascular system and/or the filling chamber for the cooling package in vascular system.Packing material will be described in further detail.

Refer again to Fig. 6 A-6B, two control lines 621 (Fig. 6 B) can extend from control line conduit 620, by concentrator 606, enter bar 604.Concentrator 606 can determine that be straight main discharge stream via outlet 614 to the basic of atmosphere from bar 604.Tubular element 608 comprises the tubulose proximal part 622 that is positioned at adapter 610 and the tubular distal 624 that is positioned at the first branch 616.As being clearly shown that in Fig. 6 B, tubulose proximal part 622 can comprise the first plug 626 and the second plug 628, and adapter 610 can comprise the opening 630 near the second plug 628.Adapter 610 can comprise that various applicable structures are to be connected to the cryogen source of pressurization, for example screw device, compressor or thorn line apparatus.

In the illustrated embodiment of Fig. 6 B, equipment 600 comprises the main supply pipe 632 of having determined main supply chamber, and pre-cooling assembly 602 comprises the pre-cooling supply pipe 634 of having determined pre-cold supply chamber.Main supply pipe 632 and pre-cooling supply pipe 634 can comprise respectively main supply proximal openings 636 and pre-cold supply proximal openings 638 at the second plug 628 places.Main supply proximal openings 636 and pre-cold supply proximal openings 638 are connected respectively to by main supply pipe 632 and pre-cooling supply pipe 634 passage of being determined by opening 630 in fluid connection mode.From the second plug 628, main supply pipe 632 and pre-cooling supply pipe 634 extend through tubulose proximal part 622 and fill in 626 by first.Tubular distal 624 has been determined pre-cooling expansion chambers, and it extends to main discharge stream from the first plug 626.Pre-cooling supply pipe 634 extends slightly by the first plug 626 and in pre-cooling expansion chambers, ends at pre-cooling distal openings 640.Therefore with between stream by pre-cooling supply pipe 634 pre-cooling expansion chambers becomes fluid connection, so stream is discharged in pre-cooling, from pre-cooling distal openings 640, extends to main discharge stream.Main supply pipe 632 extends through pre-cooling expansion chambers, by concentrator 606 and enter bar 604.The part that extends to bar from main supply proximal openings 636 of main supply pipe 632 is the first of main supply pipe 632.The second portion (not shown) of main supply pipe 632 is approximately the cooling package (not shown) being configured in vascular system.

The cold-producing medium that makes pressurization enters pre-cooling expansion chambers from pre-cooling supply pipe 634 expansion can cooling pre-cooling expansion chambers, and the liquid refrigerant in cooling main supply pipe 632 and main supply pipe thus.For example, if pre-cooling (is carried out in the place of the inlet point away from vascular system, if the cold-producing medium of pressurization was cooled at operation bench place before being sent to the inlet point that enters vascular system), from the heat of atmosphere, can cause the cold-producing medium through pressurization of pre-cooling to carry out unfavorable heating.Pre-cooling expansion chambers is orientated as near concentrator and can be reduced this unfavorable heating.According to the pre-cooling assembly of the some embodiment configuration of present technique, can there is enough length to allow the cold-producing medium of expansion in pre-cooling expansion chambers and the heat exchange between the cold-producing medium of the pressurization in a part for the main supply pipe in pre-cooling expansion chambers.For example, according to the fore-cooling room of some embodiment configurations of present technique, can there is the length that is greater than about 10cm, for example, be greater than about 15cm, or be greater than about 25cm.According to the fore-cooling room of some embodiment configurations of present technique, there is the length from about 20cm to about 30cm.

Main supply pipe 632 is carried out cooling after, from the cold-producing medium of pre-cooling expansion chambers, can join from being expelled to atmosphere among the stream of passing away and from outlet 614.Fig. 6 B shows the first arrow 642, and it has been indicated by the flow direction of the cold-producing medium of outlet 614, also shows the second arrow 644, and it has been indicated by the flow direction of the cold-producing medium of pre-cooling expansion chambers.The flow direction of the cold-producing medium by outlet 614 generally aligns with passing away.On the contrary, the flow direction of the flow direction of the cold-producing medium by pre-cooling expansion chambers discord passing away or the cold-producing medium by outlet 614 aligns.

Fig. 7 figure has released a part for the cold therapy equipment 700 of the cold therapy equipment 600 being similar in Fig. 6 A-6B, and difference is between pre-cooling expansion chambers that equipment 700 has and passing away not fluid connection.Cold therapy equipment 700, for example, comprises pre-cooling assembly 702, comprising making between the interior section of pre-cooling expansion chambers and bar 604 and concentrator 606 not the valve 704 of fluid connection and the 3rd plug 706.Main supply pipe 632 extends through the 3rd plug 706 and enters bar 604.

Arrow 708 has been indicated when valve 704 is opened by the flow direction of the cold-producing medium of pre-cooling expansion chambers.But when valve 704 cuts out, the pressure in pre-cooling expansion chambers can increase until itself and pre-cooling supply pipe 634 balances make to stop by the mobile of pre-cooling supply pipe thus.By this way, open and close valve 704 and can open and close pre-cooling.Partly opening valve 704 can regulate the pressure in pre-cooling expansion chambers and regulate thus cold-producing medium stream and the associated precooling temperature by pre-cooling supply pipe 634.For example, actuator 710 can be operatively attached to valve 704 and is configured to the signal that reception carrys out self processor 712.The signal that processor 712 can be configured to receive from user interface 714 and/or sensor 716 instructs actuator 710 to open or close valve completely or step by step.Sensor 716 for example, can be the temperature sensor of associated cooling package.In one embodiment, temperature sensor can be to processor 712 transmitted signals, make by valve 704 (a) if the cooling package detecting or near the temperature of the tissue of cooling package higher than required value, open and increase pre-cooling, if or (b) cooling package or near the temperature detecting of the tissue of cooling package lower than required value, close and reduce pre-cooling.

Fig. 8 A-8B figure has released according to a part for the cold therapy equipment 800 with precooler 802 of another embodiment configuration of present technique.The interior section that approaches tubular element 608 forms the first plug 626 of pre-cooling assembly 602 (Fig. 6 A-6B) may be challenging.Get the first plug 626 and pre-cooling supply pipe 634 (Fig. 6 B) and the ground in generation, precooler 802 can comprise diverter, and it is connected to main supply pipe.For example, precooler 802 can comprise and is connected to the diverter 804 of main supply pipe 806 and has container proximal part 810 and the container 808 of container distal portions 812.In this embodiment, diverter 804 is divided into container proximal part 810 and container distal portions 812 by container 802.Container proximal part 810 has been determined near-end chamber between opening 630 and diverter 804 or the supply chamber of merging, and container distal portions 812 has been determined pre-cooling expansion chambers.As Fig. 8 B is clearly shown that, diverter 804 has been determined with fluid mode of communicating and has been connected to the main channel 814 of main supply pipe 804 and along the pre-cooling passage 816 of diverter 804 peripheries.

Continuation is with reference to Fig. 8 B, and the size of described pre-cooling passage 816 is determined to cause enough pressure drops to expand cold-producing medium cooling pre-cooling expansion chambers.Diverter 804 comprises tubular sections 818 and diverter plug 820.Diverter plug 820 is positioned between the outer surface of main supply pipe 806 and the inner surface of container 808.Tubular sections 818 can be selected to have the outer sectional dimension (for example, diameter) of the interior sectional dimension (for example, diameter) that is slightly less than container 808.Diverter 820 can comprise, for example, cohesive material, is configured to the outer surface of main supply pipe 806 to be incorporated into the inner surface of container 808.

In one embodiment, for example, in floating sound of sighing the container 808 of diverter 804 (, it is not fixed in container 808), so pre-cooling passage 816 is the annular spaces between diverter 804 and the inner surface of container 808.In other embodiments, diverter can have different configurations.For example, diverter can be fixed to container and pre-cooling passage can be around a peripheral part for diverter only, and for example curved portion, extends through diverter.In other again embodiment, diverter can be connected to container around the whole periphery of container, and the opening that diverter inwardly can comprise and separate the periphery of diverter.For example, diverter can comprise inside opening, is configured to make cold-producing medium expansion to enter pre-cooling expansion chambers.

Fig. 9 A-9B figure has released and the similar cold therapy equipment 900 of cold therapy equipment 800 shown in Fig. 8 A-8B, and difference is to have different diverters and the configuration of main supply pipe.Cold therapy equipment 900 comprises main supply pipe 902 and precooler 904, and precooler 904 comprises the diverter 906 that is connected to main supply pipe 902.Precooler 904 can also comprise having the container proximal part 910 of the opposite side that is positioned at diverter 906 and the container 908 of container distal portions 912.In this embodiment, diverter 906 does not comprise tubular sections and can be by, for example, material (for example, rubber, polymer, metal or other material) cylindrical block construct, this cylindrical block has hole, and described main supply pipe 902 is connected by bolt by described hole or otherwise installs.As Fig. 9 B is clearly shown that, diverter 906 can be determined along the pre-cooling passage 914 of diverter 906 peripheries.Main supply pipe 902 can extend through diverter 906 and can be connected to the inner surface near the container proximal part 910 of opening 630.The approached part that main supply pipe 906 is connected to container proximal part 910 can contribute to prevent that diverter and main supply pipe 902 from vertically moving during in high pressure in near-end chamber.

According to the pre-cooling assembly of some embodiment configurations of present technique, can be arranged as compact configuration.For example, at least one part of such pre-cooling assembly can the handle in cold therapy equipment in.Figure 10 figure has released and has comprised the pre-cooling assembly 1002 of handle 1006 and the cold therapy equipment 1000 of concentrator 1004 of being arranged in.Pre-cooling assembly 1002 comprises flexible tubular element 1008, and it extends from concentrator 1004, by the bottom 1010 of handle 1008, arrives adapter 1012, and adapter 1012 is configured to be connected to the cryogen source (not shown) of pressurization.Concentrator 1004 can comprise the outlet 1014 of elongation, and it extends through bottom 1010, and control line conduit 1016 can extend through bottom 1010 from concentrator 1014.In one embodiment, tubular element 1008 is coiled in around outlet 1014.Handle 1006 can also be by heat insulation, to prevent heat loss arrival wherein and to improve pre-cold efficiency.

Figure 11 shows the cold therapy equipment 1100 that has in handle and have replacement scheme configuration around.Cold therapy equipment 1100 comprises pre-cooling assembly 1102 and the concentrator 1104 that is arranged in handle 1106.Pre-cooling assembly 1102 comprises flexible tubular element 1108, and it extends and pass through the bottom 1110 of handle 1106 from concentrator 1104.Concentrator 1104 can comprise the outlet 1112 of the elongation that extends through bottom 1110, and control line conduit 1114 can extend through bottom 1110 from concentrator 1104.In one embodiment, tubular element 1108 comprises the helical form part 1116 of separating with outlet 1112.Handle 1106 can also be by heat insulation, to prevent heat loss arrival wherein and to improve pre-cold efficiency.

cold therapy part of appliance

Having understood according to after the above-mentioned explanation of the cold therapy equipment of some embodiment configurations of present technique, come to be below introduced with reference to Figure 12-55 pair various cooling package, obstruction component and other cold therapy part of appliance.Will be understood that, the specific features of the cold therapy part of appliance of hereinafter introducing and/or following cold therapy part of appliance can with cold therapy equipment 100 couplings described in Fig. 1, be used in handheld device independent or self-supporting, or with other applicable system coupling.For ease of reference, run through the disclosure, identical reference number is used to refer to for similar or analogous parts or feature, but the use of same reference numbers is not implying that it is identical that these parts are appreciated that.Really, in many examples as herein described, the part that indicates same numbers distinguishes in structure and/or function.

Some embodiment of following cold therapy part of appliance can be configured to be conducive to the one or more therapeutic purposes relevant to low temperature god neuroregulation.For example, some embodiment of following applicator are configured to apply sub-cooled in the local or overall therapeutic modality of needs.Required topical therapeutic mode can comprise, for example, carries out partly circumferentially cooling on one or more longitudinal paragraph of renal artery or nephrostome.Required overall therapeutic modality can be included in the combination of the topical therapeutic mode for the treatment of site.For example, required overall therapeutic modality can be part side face or all-round the therapeutic modality in the plane perpendicular to renal artery or nephrostome.In order to be beneficial to required local or overall therapeutic modality, according to the applicator of some embodiment configurations of present technique, can there is more than one hot transmitting portions, for example main hot transmitting portions and less important hot transmitting portions.When comprising that the cooling package of such applicator operates in deployed condition, the main hot transmitting portions of applicator can have the heat transfer rate that is enough to cause medicable low the kidney warming neuroregulation.The less important hot transmitting portions of applicator is in operation and can has lower heat transfer rate, for example, is not enough to bring the heat transfer rate of medicable low the kidney warming neuroregulation.Main and secondary wants the location of hot transmitting portions can be corresponding to required local or overall therapeutic modality.

Some embodiment of following applicator comprise that configuration affects the feature that main and secondary is wanted the location of hot transmitting portions.Such feature can comprise, for example, to following relevant feature: (a) convective heat transfer of the difference in applicator, (b) conductive heat transfer of the difference by applicator, and/or (c) contacting or interval of applicator and renal artery at therapentic part or the difference between nephrostome.The feature relevant to the convective heat transfer of difference can comprise, for example, is configured to optionally to the different piece of applicator, guide cold-producing medium supply pipe and the aperture of the expansion of cold-producing medium.The feature relevant to the conductive heat transfer of difference by applicator can comprise, for example, extra balloon (for example, non-cooling balloon and the balloon with lower cooling level), the formation of difference (for example, low heat conductivity and high thermal conductivity material), the thickness of difference (for example, and heat insulation structural (for example, in balloon or be connected to the heat insulating component of the elongation on balloon wall) balloon wall thickness).The feature relevant to the contact of difference between applicator and renal artery or nephrostome or interval can comprise, for example, extra balloon, and the characteristic of complicated balloon, for example shape (for example, helical form, shaped form, longitudinal asymmetric and radial asymmetrical), surface differences (for example, depression, groove, projection and outstanding), and the expansion of difference (for example, the limited expansion of part).

Some embodiment of following applicator also configure to be convenient to determining of size, for example, sending and being suitable for carrying out determining of size to thering is the renal artery of different size and/or expansion that nephrostome provides medicable treatment (, the low profile) sectional dimension reducing for example.For example, some embodiment of following applicator comprise balloon, and described balloon subsides during in sending state at least in part when relevant cooling package, and expand at least in part during in deployed condition at relevant cooling package.Determine that to size relevant feature comprises, for example, balloon forms (for example, flexibility or non-flexible material), extra balloon and the characteristic of complicated balloon, for example shape (for example, flexible and inflexibility shape).Non-flexible material (for example, polyethylene terephthalate) can have flexibility (for example elasticity), for example, and from approximately 0% to approximately 30%.Flexible material (for example, polyurethane or other thermoplastic elastomer (TPE)) can have flexibility, for example, and from 30% to 500%.Non-flexible material generally has the intensity higher than flexible material (for example, higher pressure rating).Some embodiment of following applicator can be configured to be beneficial to the required inaccessible level of renal artery and/or nephrostome.For example, some embodiment of following applicator are configured to part occlusive, thereby in the situation that not stoping blood flow to cross therapentic part, apply kidney neuroregulation on therapentic part medicable cooling.Comprise to the inaccessible relevant feature of part, for example, the characteristic of complicated balloon, for example expansion (for example, the limited expansion of part) of shape (for example, helical form, shaped form, longitudinally asymmetric and radially asymmetric) and difference.Entirely shut, for example complete or approach complete prevention blood flow and cross renal artery or nephrostome, for some treatment, need.Comprise to the relevant feature of entirely shutting, for example, any and size are determined relevant suitable feature.As mentioned below, according to the cold therapy equipment of some embodiment configurations of present technique, can comprise obstruction component, the for example expandable members of freezing assembly (for example, determining the balloon of expansion chambers) or independently obstruction component (for example,, near cooling package).Obstruction component can provide inaccessible with incompatible the combination with the feature that is associated with applicator of any applicable applicator as herein described.

According to the cooling package of present technique configuration, can comprise by contribute to the structure of the one or more therapeutic purposes relevant to low the kidney warming neuroregulation near the freezing and/or liquid blood of applicator.Near the freezing and/or liquid blood of applicator, can affect such as heat transmission, size and the factor such as inaccessible.For example, thus some embodiment can configure near the blood coming freezing applicator causes all or part of obturation.In these examples, medicable cooling for example, by freezing blood (, a layer thickness is less than about 0.8mm, 1mm, or the frozen blood of the 1.2mm) generation of one deck.Between main hot transmitting portions and renal artery or nephrostome that balloon can be configured to make frozen blood be formed on balloon, the thickness of wherein said frozen blood makes can occur by this thickness medicable cooling.Above-mentioned layer, for example, can contribute to determine size or required inaccessible level.In addition, balloon can be configured to make form frozen blood between less important hot transmitting portions and renal artery or nephrostome, and the thickness of wherein said frozen blood makes cannot occur medicablely coolingly (for example, to be greater than about 0.8mm by described thickness, 1mm, or the thickness of 1.2mm).Such balloon can comprise, for example, and part depression or nonpitting and other suitable structures described in detail below.

convective heat transfer

Figure 12-16B figure has released some embodiment of cold therapy equipment, and this cold therapy equipment can affect treatment by the convective heat transfer of difference.The feature relevant to convective heat transfer in applicator can be conducive to one or more therapeutic purposes of low the kidney warming neuroregulation, and example is local or overall therapeutic modality as required.Such feature can comprise, for example, is configured to optionally to the different piece of applicator, guide cold-producing medium supply pipe and the aperture of the expansion of cold-producing medium.

Figure 12 figure has released a part for cold therapy equipment 1200.This cold therapy equipment 1200 comprises the cooling package 1202 of dry 1206 the distal portions 1204 that is positioned at elongation, and it has determined passing away.As mentioned above, this distal portions 1204 can have ladder 1208 and cooling package 1202 can comprise the applicator 1210 with a plurality of hot transmitting portions (being expressed as 1211a-d).Applicator 1210 can also comprise the balloon 1212 with far-end neck 1214, and balloon 1212 has been determined and is configured to produce and send subcooled expansion chambers.Equipment 1200 may further include the guiding elements 1216a of elongation, determines first supply pipe 1218 in the first supply chamber, and the second supply pipe 1220 of determining the second supply chamber.Guiding elements 1216a can determine guidewire lumen, and this guidewire lumen is finalized to hold wire 1216b, as above described ground in detail.The guiding elements of setting forth in conjunction with other cold therapy part of appliance as herein described can be configured similarly, although for illustrated clearness, associated wire is not generally shown.In illustrated embodiment, guiding elements 1216a has straight end and extends to far-end neck 1214.Mode as an alternative, guiding elements 1216a can comprise round end and/or extend across the end of far-end neck 1214.Similarly, in other cold therapy part of appliance as herein described, leaving the guiding elements of distal portions of balloon and/or illustrated certain section of supply pipe can have various applicable shapes (for example, antisitic defect shape) and can extend various distances with respect to the far-end neck of balloon.

The first supply pipe 1218 can comprise the first beveled distal end part 1222, and cooling package 1202 can comprise the first aperture 1224 that is positioned at the first beveled distal end part 1222 places.Similarly, the second supply pipe 1220 can comprise the second beveled distal end part 1226, and described cooling package can comprise the second aperture 1228 that is positioned at the second beveled distal end part 1226 places.Described the first and second beveled distal end parts 1222,1226 that figure releases embodiment along or roughly along the length of cooling package 1202, longitudinally and radially separate.In some other embodiment, the first and second beveled distal end parts 1222 and 1226 have identical longitudinal and/or radial position, or other configurations.When cooling package 1202 is during in deployed condition, cold-producing medium can flow through respectively the first and second supply pipes 1218,1220, flows through the first and second beveled distal end parts 1222,1226, flows out respectively the first and second apertures 1224,1228.The first and second beveled distal end parts 1222,1226 can be respectively by cold-producing medium guiding thermotropism transmitting portions 1211a and the 1211d of expansion.As a result of, when cold-producing medium flows out the first and second apertures 1224,1228, it is higher and than the special convective heat transfer speed of other hot transmitting portions of applicator 1210 that hot transmitting portions 1211a and 1211d can have the overall situation.This variation of heat transfer rate can be corresponding to the required type of cooling, for example, in some or all longitudinal part side face types of cooling in section of applicator 1210.The difference of heat transfer rate can change according to the distance of interior-heat transmitting portions 1211a and 1211d.Functional significant difference on heat transfer rate can be separated hot transmitting portions 1211a and hot transmitting portions 1211c, and wherein hot transmitting portions 1211c faces toward hot transmitting portions 1211a with circumference substantially.Similarly, the functional significant difference on heat transfer rate can be separated hot transmitting portions 1211d and hot transmitting portions 1211b, and wherein hot transmitting portions 1211d faces toward hot transmitting portions 1211b with circumference substantially.In some embodiment, the heat transfer rate that hot transmitting portions 1211a and 1211d have is enough to cause medicable kidney neuroregulation, and the heat transfer rate of hot transmitting portions 1211b and 1211c is not enough to cause medicable kidney neuroregulation.

For example, the first and second supply pipes 1218,1220 can be configured to guide the expansion of cold-producing medium in the angle of length approximately 45 degree that departs from applicator 1210 or cooling package 1202.In some other embodiment, one or more supply pipes are configured on the angle of approximately 90 degree, guide cold-producing medium at approximately 15 degree of the length with respect to applicator or cooling package, for example, and from approximately 30 degree to approximately 45 degree, or from approximately 30 degree to approximately 40 degree.In addition, the first supply pipe 1218 can be in the angle different from the second supply pipe 1220.According to the first aperture 1224 of cooling package and the fore-and-aft distance in the second aperture 1228 of some embodiment configurations of present technique, can be, for example, from about 1mm to about 20mm, for example, from about 2mm to about 15mm, or from about 3mm to about 10mm.

As a kind of alternative, according to the cooling package of some embodiment configurations of present technique, can comprise thering is supply pipe or chamber crooked and/or helical form part.Figure 13 figure has released the cold therapy equipment 1300 of the cooling package 1302 of the distal portions 1304 that comprises the bar 1306 that is positioned at elongation, and it has determined the passing away of opening in distal portions 1304 ends.Described distal portions 1304 can have ladder 1307, and cooling package 1302 can comprise the applicator 1308 with the first hot transmitting portions 1309 and the second hot transmitting portions 1310.The first and second hot transmitting portions the 1309, the 1310th, extend and around the length radial separation of cooling package 1302.Applicator 1308 can also have balloon 1311, and it is determined and to be configured to produce and to transmit subcooled expansion chambers.Equipment 1300 may further include the guiding elements 1312 of elongation and the supply pipe 1313 extending along the length of bar 1306.In balloon 1311, supply pipe 1313 can comprise the helical form part 1314 (for example, distal portions 1304 can be determined the axis of helical form part 1314) of leaving distal portions 1304 and being wound around distal portions 1304.Cooling package 1302 can comprise along a plurality of apertures of helical form part 1314 lateral spacings (being labeled as respectively 1316a-e).In illustrated embodiment, if helical form part 1314 is straightened, aperture 1316a-e is radially aligned roughly.In this embodiment, the shape of helical form part 1314 makes aperture 1316a-e point to different radial direction.In other embodiments, helical form part 1314 can have the aperture 1316a-e in varying number and/or direction.

Helical form part 1314 is positioned as aperture 1316a-e such as fruit supply pipe 1312 is straight time more close balloons 1311.This can contact 1311 so that cold-producing medium leaves aperture 1316a-e at faster speed, and is increased in the convection current amount of cooling water in the hot transmitting portions of correspondence of balloon 1311.This also provides cold-producing medium has been contacted to the size at balloon 1311 places and the more control at interval first.The cooling package configuring according to some embodiment of present technique can be included in cooling package when deployed condition, center longitudinal axis apart from cooling package (for example surpasses about 0.01mm, be greater than about 0.1mm, be greater than about 0.5mm, or be greater than about 1mm) aperture.For example, the aperture in some embodiment is at cooling package during in deployed condition, and the distance between the center longitudinal axis of cooling package can be at about 0.01mm between about 4mm, or at about 0.1mm between about 2mm.Similarly, the cooling package configuring according to some embodiment of present technique can be included in cooling package when deployed condition, and the distance between balloon is less than the about 4mm aperture of (for example, be less than about 2mm, be less than about 1mm, or be less than about 0.5mm).For example, the aperture in some embodiment can be at cooling package during in deployed condition, and the distance between balloon at about 0.1mm between about 4mm, or at about 0.5mm between about 2mm.In addition, according to the cooling package of some embodiment configurations of present technique, can comprise aperture, its be placed so that the distance between the central longitudinal axis of cooling package and aperture be not more than again longitudinal axis between the inner surface of balloon at aperture place perpendicular to the distance in the plane of central longitudinal axis 20% (for example, be not less than 25%, 40% or 60%).

In illustrated embodiment, aperture 1316a, 1316c, 1316e point to the first half of balloon 1311 substantially, and aperture 1316b, 1316d point to the Lower Half of balloon 1311 substantially.When cooling package 1302 is during in deployed condition, the cold-producing medium that flows through aperture 1316a, 1316c and 1316e produces the first hot transmitting portions 1309, and the cold-producing medium that flows through aperture 1316b, 1316d produces the second hot transmitting portions 1310.As the result of flow of refrigerant, it is higher and with respect to the special convective heat transfer speed of other hot transmitting portions of applicator 1308 that the first and second hot transmitting portions 1309,1310 can have the overall situation.This variation of heat transfer rate can be corresponding to the required type of cooling, for example the part side face type of cooling on the part or all of length section of applicator 1308.In some embodiment, the heat transfer rate that the first and second hot transmitting portions 1309,1310 have is enough to cause medicable kidney neuroregulation, and the heat transfer rate having described in the part of applicator 1308 between the first and second hot transmitting portions 1309,1310 is not enough to produce medicable kidney neuroregulation.

Figure 14 figure has released and mainly aspect discharging configuration, has been different from a part for the cold therapy equipment 1400 of the equipment 1300 in Figure 13.Equipment 1400 comprises the cold therapy equipment 1400 of cooling package 1402 of the distal portions 1404 of the bar 1406 that is positioned at the elongation of determining passing away.Distal portions 1404 can have ladder 1407, a plurality of outlet openings 1408, and circular distal 1409.Cooling package 1402 can comprise the applicator 1410 that is positioned at balloon 1411, and balloon 1411 has far-end neck 1412 and can determine and is configured to produce and transmits subcooled expansion chambers.Equipment 1400 may further include the supply pipe 1413 that extends into balloon 1411 along dry 1406 length.In balloon 1411, supply pipe 1413 can comprise the helical form part 1414 (for example, distal portions 1404 can be determined the axis of helical form part 1414) of leaving distal portions 1404 and being wound around distal portions 1404.The spiral winding of helical form part 1414 can be between outlet opening 1408.Cooling package 1402 can comprise along a plurality of apertures of helical form part 1414 lateral spacings (being labeled as respectively 1416a-e).In illustrated embodiment, distal portions 1404 is enough narrow does not generally extend across the diameter near the bar 1406 of distal portions 1404 to allow helical form part 1414 coiling distal portions 1404.Therefore, the cooling package 1402 under deployed condition can be configured to be fixed in delivery sheath, and the size of delivery sheath is determined according to bar 1406.Described a plurality of outlet opening 1408 can promote delivery flow and alleviate any flow restriction with the Size dependence of distal portions 1404.Therefore, as mentioned above, the relatively high density of cold-producing medium that enters the expansion of expanding channel can allow the size of distal portions to lower and can not cause necessarily the unsuitable rising of back-pressure.

Be similar to the aperture 1316a-e of the equipment 1300 in Figure 13, figure releases aperture 1416a-d in embodiment along helical form part 1414 interval in side direction.But different from the aperture 1316a-e of equipment 1300 in Figure 13, the aperture 1416a-d that figure releases in embodiment is configured to guide in the radial direction cold-producing medium in the difference of the length around cooling package 1402.Particularly, aperture 1416a-d is configured to guide cold-producing medium in directions that space increment is diametrically approximately 90 degree.The size of aperture 1416a-d is determined to that corresponding hot transmitting portions is had and is greater than approximately 90 angles of circumference of spending.As a result of, corresponding to the outstanding periphery of the hot transmitting portions of aperture 1416a-d, be generally entirely circumference, and be part circumference on specific longitudinal section of cooling package 1402.

As described in reference to Figure 13, main cold-producing medium extended region determined and can contribute to convective heat transfer near balloon.Figure 15 A-15B figure has released the cold therapy equipment 1500 that same configuration makes the more close balloon of main cold-producing medium extended region.This equipment 1500 comprises the cooling package 1502 at distal portions 1504 places of the bar 1506 that is positioned at the elongation of having determined passing away.Distal portions 1504 can have ladder 1507, and cooling package 1502 can comprise the applicator 1508 with outer balloon 1510, and this outer balloon 1510 can be determined and is configured to produce and transmit subcooled expansion chambers.Equipment 1500 may further include supply pipe 1512 and interior balloon 1514.Supply pipe 1512 has circular distal 1516 and can extend and pass through along the length of bar 1506 distal portions of outer balloon 1510.Interior balloon 1514 extends around a part for supply pipe 1512 in balloon 1510 outside.In some other embodiment that configure according to present technique, supply pipe 1512 terminates in interior allotter, interior balloon 1514 for example, and/or can comprise that the equipment of guiding elements, this guiding elements can extend through interior balloon 1514 and by the distal portions of outer balloon.Referring again to the embodiment of the equipment 1500 shown in Figure 15 A-15B, the part that supply pipe 1512 is positioned at balloon 1514 can comprise supply pipe aperture 1518.On the includable balloon 1514 of cooling package 1502, be distributed as helical form layout or other applicable interior balloon aperture 1520 of arranging.Interior balloon aperture 1520 can be, for example, and the cut hole on interior balloon 1514.When cooling package 1502 is during in sending state, outer balloon 1510 and interior balloon 1514 can subside to be fixed in delivery sheath at least in part.

When cooling package 1502 is during in sending state, cold-producing medium can flow from supply pipe 1512, by supply pipe aperture 1518, and enters interior balloon 1514.Thereby there is not the liquid phase transformation to gaseous state in the supply pipe aperture 1518 enough large major part (for example, the great majority of liquid refrigerant) that allows cold-producing medium to enter interior balloon 1514 and liquid refrigerant.For example, under deployed condition, the absolute vapour pressure of cold-producing medium in interior balloon 1514 outside supply pipe 1512 can be approximately 40% to approximately 100%, for example approximately 20% to approximately 100%, or approximately 33% to approximately 100% of the absolute vapour pressure of cold-producing medium in the part of supply pipe in interior balloon 1514.The the first clear passage area that equals total clear passage area in interior balloon aperture 1520 can be less than the second clear passage area, and wherein the second clear passage area equals total clear passage area in supply pipe aperture 1518.The size in interior balloon aperture 1520 and/or quantity can be selected to control the first clear passage area.Similarly, the size in supply pipe aperture 1518 and/or quantity also can be selected to control the second clear passage area.From interior balloon 1514, cold-producing medium can extend through interior balloon 1520 with the one or more corresponding hot transmitting portions of cooling applicator 1508.Particularly, interior balloon aperture 1520 can be configured to the cooling hot transmitting portions that is generally spiral dress.

Figure 16 A-16B figure has released and cooling package 1500 in Figure 15 A different cold therapy equipment 1600 in balloon outside.This equipment 1600 comprises cooling package 1602, and cooling package 1602 comprises the applicator 1604 with the helical form part 1608 of rising and the outer balloon 1606 of female 1610.The inner surface of the helical form part 1608 raising can be configured to hold the cold-producing medium from the expansion in interior balloon aperture 1520, and the shape of the inner surface of the helical form part 1608 raising can help the cooling helical form part 1608 that focuses on rising of convection current.Female 1610 renal artery or the nephrostome contact that is generally configured to get along well.The cooling helical form part 1606 that focuses on rising of the convection current of enhancing can be promoted to cooling effectiveness and cool position selectivity.The helical form part 1608 raising can be corresponding to the hot transmitting portions with the heat transfer rate higher than other hot transmitting portions of applicator 1604, for example, corresponding to the hot transmitting portions of female 1610.For example, be in operation, corresponding your heat transfer rate of hot transmitting portions of helical form part raising is enough to produce medicable kidney neuroregulation, for example, and the heat transfer rate of another hot transmitting portions of applicator the hot transmitting portions of the part 1610 raising (, corresponding to) is not enough to produce medicable kidney neuroregulation.

Conductive heat transfer

Figure 17-22B figure has released the some embodiment that affect the cold therapy equipment for the treatment of by the conductive heat transfer of difference.The feature being associated with conductive heat transfer by applicator can contribute to one or more therapeutic purposes of low the kidney warming neuroregulation, and example is local or overall therapeutic modality as required.In some embodiment, this equipment is controlled conduction with heat insulating component.The feature relevant to the conductive heat transfer of difference by applicator can comprise, for example, extra balloon (for example, non-cooling balloon and the balloon with lower cooling level), the formation of difference (for example, low heat conductivity and high thermal conductivity material), the thickness of difference (for example, and heat insulation structural (for example, balloon interior or be connected to the heat insulating component of the elongation on balloon wall) balloon wall thickness).

Figure 17 A-17B figure has released the part of cold therapy equipment 1700 for the cooling package of the distal portions 1704 that comprises the bar 1706 that is positioned at the elongation of determining passing away.Distal portions 1704 can have ladder 1707, and freezing assembly 1702 can comprise having the applicator 1708 being configured to renal artery or the dark mouthful of balloon 1710 contacting.Applicator 1708 may further include the heat insulating component 1711 of a plurality of elongations, and the length of these heat insulating components is in substantially parallel relationship to the length of cooling package 1702 and around the side face of cooling package 1702 interval diametrically.Balloon 1710 can be determined and is configured to produce and transmit subcooled expansion chambers.Equipment 1700 may further include supply pipe 1712, and its length along bar 1706 is extended and entered balloon 1710, and cooling package 1702 can comprise the aperture 1714 of the end that is positioned at supply pipe 1712.In operation, when cooling package 1702 is during in deployed condition, heat insulating component 1711 can reduce by the conductivity of closing on part of balloon 1710 cooling.For example, the thermal conduction rate of the part of balloon 1710 between heat insulating component 1711 can be enough to produce medicable kidney neuroregulation, and the part of balloon at heat insulating component 1711 places can have lower heat transfer rate, for example, be not enough to produce the heat transfer rate of medicable kidney neuroregulation.Heat insulating component 1711 can be length that extend and the continuous each several part along applicator 1708 of cardinal principle.Therefore corresponding to balloon 1710, in the hot transmitting portions of the part between heat insulating component 1711, on longitudinal section at cooling package 1702, be, generally on-circular.

Heat insulating component 1711 can comprise main material, and the heat conductivity of this main material is less than or equal to the heat conductivity of the main material of balloon 1710.In some embodiment, heat insulating component 1711 can have the formation different from balloon 1710, and is connected to the inner surface of balloon 1710.Some other embodiment can be included in and form upper and balloon 1710 similar (for example, identical) or different heat insulating components 1711.According to the suitable main material of the heat insulating component of some embodiment configurations of present technique, comprise heat insulation foam of polymers (for example, polyurethane foam).In some embodiment, heat insulating component 1711 can form or be connected to balloon 1710 with balloon 1710.

Figure 18 A-18B figure has released a part for the cold therapy equipment 1800 of the equipment 1700 being similar in Figure 17 A-17B, and its difference is the configuration of heat insulating component.Heat insulation attribute according to the heat insulating component of some embodiment configurations of present technique under sending state can be different from deployed condition.For example, heat insulating component can be configured to be filled material under deployed condition and is full of.Equipment 1800 comprises the cooling package 1802 with applicator 1804, and applicator 1804 has can determine the balloon 1806 that is configured to produce and transmit subcooled expansion chambers.Applicator 1804 also comprises a plurality of heat insulating components 1808.Equipment 1800 may further include filling tube 1810, and heat insulating component 1808 can be configured to via filling tube 1810, be full of under deployed condition.In illustrated embodiment, filling tube 1810 comprises major part 1812 He Sige branches 1814, and wherein each branch is connected in heat insulating component 1808 in the mode of fluid connection by major part.Between heat insulating component 1808 and filling tube 1810 and expansion chambers in balloon 1806, on-liquid is communicated with.

Filling tube 1810 has the packing material source (not shown) being configured to from vascular system and receives packing material.Filling tube 1810 and heat insulating component 1808 can be configured under sending state fully, substantially, or partly to subside.This contributes to allow to import liquid packing material under sending state and does not need to discharge substituted gas.Some other embodiment can comprise generally not folding filling tube, and the heat insulating component that is configured to receive from such filling tube substituted gas.According to the proximal part of the filling tube of some embodiment configurations of present technique, can be connected in the mode of fluid connection tucker mouth, the tucker mouth that for example comprises syringe adapter, the syringe adapter that for example comprises barrier film, the pin of the syringe that described diaphragm configuration is involved packing material is punctured.Such tucker mouth can be configured to, for example, before packing material passes through, during and/or reduce afterwards passing through of (for example, preventing) air.But in some embodiment, air can become suitable packing material.According to other parts that comprise filling tube of the cold therapy equipment of some embodiment of present technique (comprising these embodiment as herein described) configuration, also can be configured similarly.Be suitable for and comprise liquid (for example, saline), gas (for example, air), bio-inert material, and radiopaque material (for example inner, contrast medium) according to the packing material of the cold therapy equipment coupling of some embodiment configurations of present technique.

Although 4 heat insulating components have been shown in Figure 17 A-18B, according to the cooling package of the some embodiment configuration of the present technique heat insulating component of right quantity arbitrarily, for example at least one or more heat insulating components.In addition, according to the heat insulating component of some embodiment configurations of present technique, can be independent component substantially, or the various piece of discrete component, and can there are various suitable shapes.

Figure 19 A-19C figure has released a part for cold therapy equipment 1900.With reference to Figure 19 A, equipment 1900 can comprise in having determined the cooling package 1902 of distal portions 1904 of bar 1906 of the elongation of passing away.Distal portions 1904 can have ladder 1907, and cooling package 1902 can be included in the applicator 1908 in balloon 1910, and balloon 1910 has been determined and is configured to produce and transmit subcooled extended cavity.Equipment 1900 may further include the supply pipe 1912 that extends into balloon 1910 along the length of bar 1906, and cooling package 1902 can comprise the aperture 1914 of the end that is positioned at supply pipe 1912.Equipment 1900 may further include helical form heat insulating component 1916, for instance, this heat insulating component 1916 can be the thicker part of balloon 1910, its inner surface place at balloon 1910 has additional thickness and (is also, the outer surface of balloon 1910 can be level and smooth substantially, or near helical form heat insulating component 1916 places and helical form heat insulating component 1916, is even level and smooth).In operation, when cooling package 1902 is in deployed condition, helical form heat insulating component 1916 can having than the hot transmitting portions of the lower heat transfer rate of the other parts of applicator 1908 corresponding to applicator 1908.For example, the heat transfer rate of the part away from helical form heat insulating component 1916 of applicator 1908 can be enough to produce medicable kidney neuroregulation in operation, and the heat transfer rate of the part in helical form heat insulating component 1916 places of applicator 1908 can be not enough to produce medicable kidney neuroregulation.Figure 19 B and 19C are the sectional view of the applicator 1908 in different longitudinal position.As shown in Figure 19 B and 19C, the side face position of helical form heat insulating component 1916 changes along the length of cooling package 1902, so balloon 1910 is on-circular away from the part of helical form heat insulating component 1916 substantially on longitudinal section of the length along cooling package 1902.

Figure 20 A-20C figure has released the cold therapy equipment 2000 of the equipment 1900 being similar in Figure 19 A-19C, and difference is the shape of heat insulating component.With reference to Figure 20 A, equipment 2000 comprises cooling package 2002, and cooling package 2002 comprises the applicator 2004 with balloon 2006, and described balloon 2006 has been determined and is configured to produce and send subcooled expansion chambers.Applicator 2004 also comprises the double-helical heat insulating component 2008 (for example, the right-handed helix of winding and left hand helix) that is substantially similar to winding.Applicator 2004 is kept apart the hot transmitting portions of applicator 2004 and heat insulating component 2008 substantially in the hot transmitting portions at heat insulating component 2008 places.Heat insulating component 2008 can be configured to balloon 2006, subside and/or expand when cooling package 2002 moves between sending state and deployed condition.For example, if balloon 2006 is generally flexible and inflexibility, heat insulating component 2008 can or be generally flexible and flexibility or inflexibility.If balloon 2006 is generally flexible, heat insulating component 2008 can be generally flexible, thereby extends flexibly and contact in conjunction with balloon 2006.The illustrated heat insulating component 1716,1808 of Figure 17 A-18B, and the illustrated helical form heat insulating component 1916 of Figure 19 A-19B, can configure similarly with respect to corresponding balloon 1710,1806 and 1910.In some embodiment of present technique, heat insulating component has approximately 50% and the about coefficient of elasticity between 150% in the coefficient of elasticity of corresponding balloon, for example, between approximately 20% and 140%, or approximately 33% and approximately between 130%.

According to the heat insulating component of the extra embodiment configuration of present technique, can completely or partially be connected to corresponding balloon, or in other embodiments, heat insulating component is free of attachment to balloon.When heat insulating component is only partly connected to or is free of attachment to corresponding balloon, the expansion of corresponding balloon and/or contraction phase are independent of heat insulating component over the ground.Figure 21 A-21C figure has released the part of cold therapy equipment 2100 for the cooling package 2102 at distal portions 2104 places that comprise the bar 2106 that is positioned at the elongation of determining passing away.Described distal portions 2104 can have ladder 2107 and circular edge 2108.Cooling package 2102 can comprise the applicator 2109 with balloon 2110, and balloon 2110 has far-end neck 2111 and can determine and is configured to produce and transmit subcooled expansion chambers.Equipment 2100 may further include the guiding elements 2112 of elongation and the supply pipe 2114 that extends into balloon 2110 along the length of bar 2106.Cooling package 2102 can comprise the aperture 2116 that is positioned at supply pipe end.In illustrated embodiment, guiding elements 2112 extends through far-end neck 2111.Applicator 2109 further comprises the heat insulating component 2118 of the first elongation, and the second heat insulating component 2120 extending.The first and second heat insulating components 2118,2120 that extend are free of attachment to balloon 2110.Instead, the first and second heat insulating components 2118,2120 that extend are connected to the inner surface of distal portions 2104.

When cooling package 2102 is during in deployed condition, the first and second heat insulating components 2118,2120 can move with respect to balloon 2110 in response to gravity.The first and second heat insulating components 2118,2120 can move when they are placed in balloon above circular edge 2108.As shown in Figure 21 A, the first and second heat insulating components 2118,2120 can settling compared with lower part along balloon 2110.As shown in Figure 21 B, the first and second heat insulating components 2118,2120 have the sectional area that is similar to round triangle (rounded triangles).In other embodiments, similarly heat insulating component can have different sectional areas.Circle triangular-section is long-pending can be particularly advantageous in the contact area increasing between the cardinal principle side of unconnected heat insulating component and the inner surface of balloon, and prevents that unconnected a plurality of heat insulating components are overlapped substantially.With reference to Figure 21 C, equipment 2100 is shown in delivery sheath 2122 in sending state.As shown in Figure 21 C, the first and second heat insulating components 2118,2120 can subside with balloon 2110 under sending state.

Figure 22 A-22B figure has released the cold therapy equipment 2200 of the equipment 2100 being similar in Figure 21 A-21C, and difference is the configuration of heat insulating component.Equipment 2200 comprises cooling package 2202, and cooling package 2202 comprises the applicator 2204 with balloon 2206, and balloon can be determined and is configured to produce and send subcooled expansion chambers.Applicator 2204 also comprises heat insulating component 2208 and second heat insulating component 2210 of the first elongation.This equipment 2200 may further include filling tube 2212, and the first and second heat insulating components 2208,2210 can be configured to via filling tube 2212, fill under deployed condition.Filling tube 2212 can comprise concentrator 2214, and filling tube 2212 branches into the first and second heat insulating components 2208,2210 at concentrator 2214 places.As described in the heat insulating component 1808 of the equipment 1800 as shown in reference to Figure 18 A-18B, the first and second heat insulating components 2208,2210 and filling tube 2212 can and balloon 2206 between there is not fluid connection.Filling tube 2212 can have proximal part (not shown), is configured to receive the packing material from vascular system outside.Filling tube 2212 and the first and second heat insulating components 2208,2210 can be configured to when cooling package 2202 during in sending state fully, mostly or partly subside.

According to the cooling package of some embodiment configurations of present technique, can comprise one or more heat insulating components, these heat insulating components have various applicable shapes and produce around the variety of way of the hot transmitting portions of applicator.For example, can selection mode, thereby so that the continuous hot transmitting portions of the cardinal principle at heat insulating component place can be enough greatly for kidney neuroregulation effective in cure concentrate cooling (for example, making can not stride across for the medicable cooling cardinal principle of kidney neuroregulation the hot transmitting portions at heat insulating component place).Additionally or instead, for example, mode can be selected, make with the hot transmitting portions at heat insulating component interval enough medicable cooling to kidney neuroregulation to realize greatly.Heat transmission is proportional to area, if therefore too little with the hot transmitting portions of heat insulating component separation, the total amount of heat of transmitting by hot transmitting portions can be not enough to produce medicable cooling to kidney neuroregulation.

complicated balloon

Figure 23 A-37 figure has released some embodiment of cold therapy equipment, this cold therapy equipment comprises complicated balloon, complicated balloon can be conducive to the one or more therapeutic purposes relevant to low the kidney warming neuroregulation, example as required local or overall therapeutic modality, size is determined and part obturation.Complicated balloon can have various applicable characteristics, for example shape (for example, helical form, shaped form, longitudinally asymmetric and radially asymmetric), surface differences (for example, depression, groove, outstanding and projection) and the expansion (for example, the limited expansion of part) of difference.

Figure 23 A-23B figure has released cold therapy equipment 2300, and it comprises the cooling package 2302 of the distal portions 2304 of the bar 2306 that is positioned at the elongation of having determined passing away.Described distal portions 2304 can have ladder 2307, first row outlet 2308, second row outlet 2309, and circular distal 2310.Cooling package 2302 can comprise applicator 2311, and applicator 2311 has the first balloon 2312 of having determined the first expansion chambers and the second balloon 2313 of having determined the second expansion chambers.The first balloon 2312 and the second balloon 2313 by first row export 2308 and second row outlet 2309 be connected to respectively passing away fluid connection.Equipment 2300 may further include the supply pipe 2314 extending along the length of bar 2306, and cooling package 2302 may further include the first aperture 2316 and the second aperture 2318.Align with first row outlet 2308 in the first aperture 2316, make cold-producing medium export 2308 expansions by first row and enter the first balloon 2312, and the second aperture 2318 and second row outlet 2309 is alignd, make cold-producing medium export 2309 by second row and expand and enter the second balloon 2313.

The first and second balloons 2312,2313 are separated mutually along the length of cooling package 2302, and are configured to lateral spread through the arc of the different part circumference of the length along cooling package 2302.When cooling package 2302 is during in deployed condition, the first balloon 2312 can be configured to contact with first's circumferential section of the inner surface of renal artery or nephrostome, and the second balloon 2313 can be configured to contact with the second portion circumferential section of the inner surface of renal artery or nephrostome.The first and second part circumferential sections can have merging outstanding of the complete circumference in the plane perpendicular to renal artery or nephrostome.Therefore,, when treatment requires the overall type of cooling of the cooling and complete circumference of part circumference in longitudinal section, cooling package 2302 can be configured to be conducive to such treatment, and need in therapeutic process, not reorientate cooling package 2302.

When the first and second balloons 2312,2313 are during all in deployed condition, they can drive each other towards the relative side of cardinal principle of the inner surface of renal artery or nephrostome.For example, distal portions 2304 can be between the first and second balloons 2312,2313 transmission power and bar 2306 near the part of distal portions, distal portions is remained substantially to the length that is parallel to renal artery or nephrostome.In this or other operation, cooling package 2302 can be configured to (also, deficiency entirely shut renal artery or nephrostome) of non-obturation.For example, the percentage ratio that cooling package 2302 can be configured to allow normal blood flow amount for example, by renal artery or nephrostome (, normal blood flow amount at least about 1%, at least about 10%, or at least about 25%).

Figure 24 A-24B figure has released mainly and has discharged a part that is different from the cold therapy equipment 2400 of the equipment 2300 shown in Figure 23 A-23B in configuration.Equipment 2400 comprises cooling package 2402, and it is positioned at the distal portions 2404 of the bar 2406 of the elongation of having determined passing away.Distal portions 2404 can have ladder 2407, first row outlet 2408, second row outlet 2409, and circular distal 2410.Cooling package 2402 can comprise having the first balloon 2412 of having determined the first expansion chambers and the applicator 2411 of having determined the second balloon 2413 of the second expansion chambers.The first balloon 2412 and the second balloon 2413 liquid communication ground respectively by first count export 2408 and second row export 2409 and be connected to passing away.Equipment 2400 may further include the supply pipe 2414 with the first lateral branching 2416 and the second lateral branching 2418 extending along the length of bar 2406.Cooling package 2402 may further include first aperture 2420 of opening to the first balloon 2412 that is positioned at the first lateral branching 2416 ends, and the second aperture 2422 that is positioned at the second lateral branching 2418 ends and opens to the second balloon 2413.Be different from the equipment 2300 shown in Figure 23 A-23B, equipment 2400 comprises that the cold-producing medium supply for the first and second balloons 2412,2413 and the cold-producing medium on the side face opposite side of distal portions 2404 discharge.The first and second balloons 2412,2413, around the longitudinally section extension of complete side face of distal portions 2404, are expanded asymmetrically but be connected to distal portions 2404 and be finalized near distal portions 2404.

The cooling package configuring according to some embodiment of present technique can comprise the part circumference balloon with cooling package 2302,2402 varying numbers shown in Figure 23 A-24B.For example, in some embodiment, cooling package 2302 can comprise the first balloon 2312 or the second balloon 2313, but not comprises both.Similarly, cooling package 2402 can comprise the first balloon 2412 or the second balloon 2413 but not comprise both.Cooling package 2302,2402 shown in Figure 23 A-24B can also comprise more balloon, for example the balloon of 3 or 4 separations that make progress in longitudinal and footpath.In addition, the size of balloon can change.For example, in some embodiment, the first and second balloons 2312,2313 of cooling package 2302, or the first and second balloons 2412,2413 of cooling package 2402 can be configured to provide the overall type of cooling of part side face.

According to the cooling package of some embodiment configurations of present technique, can comprise the applicator with balloon, wherein balloon has multiple applicable surface characteristic, the part circumference being for example configured to be convenient to separately in longitudinal section is cooling, or itself and the combination of the overall type of cooling of full circumferences.Figure 25 figure has released the part of cold therapy equipment 2500 for the cooling package 2502 at distal portions 2504 places that comprise the bar 2506 that is positioned at the elongation of having determined passing away.Described distal portions 2504 can have ladder 2507, and cooling package 2502 can be included in the applicator 2508 in balloon 2510, and wherein balloon has been determined expansion chambers and had far-end neck 2511, helical form depression 2512 and lands 2513.Equipment 2500 may further include the guiding elements that extends through far-end neck 1,511 2514 of elongation, and the supply pipe 2516 that extends and enter balloon 2510 along the length of bar 2506.Cooling package 2502 may further include the aperture 2518 of the far-end that is positioned at supply pipe 2516.When cooling package 2502 is during in sending state, helical form depression 2512 can be corresponding to the hot transmitting portions in applicator 2508 with the heat transfer rate lower than the part away from helical form depression 2512 of applicator 2508.

Helical form depression 2512 and interval between the renal artery for the treatment of site or the inner surface of nephrostome can make heat between the part of renal artery or the most close helical form depression 2512 of nephrostome and the cryogenic temperature in balloon 2510 isolate.For example, the blood that freeze or liquid state in this interval can provide heat isolation.Helical form depression 2512 can with respect to the degree of depth of lands 2513, for example, for example, corresponding to the thickness of material (, liquid state or the blood freezing), wherein said thickness is enough to heat isolation between the sub-cooled in a part for renal artery or nephrostome and balloon 2510.For example, the described degree of depth can be between about 0.2mm and about 2mm, for example, between about 0.3mm and about 1.5mm.The female of the balloon of cold therapy part of appliance as herein described in some other embodiment can have with respect to the lands of balloon the similar degree of depth.

Figure 26 figure has released the part of another embodiment of cold therapy equipment 2600 for the cooling package 2602 of the distal portions 2604 that comprises the bar 2606 that is positioned at the elongation that has formed passing away.Distal portions 2604 can have ladder 2607, and freezing assembly 2602 can comprise the applicator 2608 with balloon 2610, and balloon 2610 has been determined expansion chambers and had far-end neck 2611, a plurality of depression 2612 and lands 2613.Female 2612 can be arranged as the helical form mode around the side face of balloon 2610.Cooling package 2602 may further include the guiding elements 2614 of elongation, and it extends through far-end neck 2611.Equipment 2600 can also comprise supply pipe 2616, and its length along bar 2606 is extended and entered balloon 2610.Cooling package 2602 may further include the aperture 2618 of the far-end that is positioned at supply pipe 2616.When cooling package 2602 is during in deployed condition, cave in 2612 and lands 2613 helical form depression 2512 and the lands 2513 that can be similar to the equipment 2500 shown in Figure 25 work.

Figure 27 A-27C figure has released a part for the cold therapy equipment 270 of the equipment 2600 being similar in Figure 26, but equipment 2700 is configured to compare in renal artery or nephrostome more not inaccessible with the equipment 2600 in Figure 26.Equipment 2700 comprises the cooling package 2702 of the distal portions 2704 of the bar 2706 that is positioned at the elongation of having determined passing away.Distal portions 2704 can have ladder 2707, and cooling package 2702 can comprise the applicator 2708 that is arranged in balloon 2710, balloon 2710 has been determined expansion chambers and has been had near-end branch 2711, tubular body portion 2712, far-end branch 2713, a plurality of depression 2714 and lands 2716.Described a plurality of depression 2714 can be arranged as around the helical form mode of balloon 2710 side faces.When cooling package 2702 is during in deployed condition, cave in 2714 and lands 2716 depression 2612 and the lands 2613 that can be similar to the equipment 2600 shown in Figure 26 work.Near-end branch 2711 can be configured to fluid connection tubular body portion 2712 is connected to passing away.Equipment 2700 may further include the guiding elements 2718 of elongation, it can extend and be connected to far-end branch 2713 along the length of bar 2706, and the supply pipe 2720 extending along the length of bar 2706, it is by one in near-end branch 2711 and enter tubular body portion 2712.Near-end branch 2711 can be configured to tubular body portion 2712 separated with guiding elements 2718 with far-end branch 2713.Cooling package 2702 may further include the aperture 2722 of the far-end that is positioned at supply pipe 2720.

When cooling package 2702 is in deployed condition, cooling package 2702 can be determined outer surface and the flow path between balloon 2710 (for example, blood flow paths) of guiding elements 2718.For example, described flow path can extend around near-end branch 2711, for example, by described tubular body portion 2712 (, between guiding elements 2718 and the inner surface of tubular body portion 2712), and around far-end branch 2713.As shown in Figure 27 B, described tubular body portion 2712 can comprise the heat insulation interior part 2724 around flow path.Described heat insulation interior part 2724 can be configured at least in part that the sub-cooled in the liquid on flow path and tubular body portion 2712 is isolated.In illustrated embodiment, heat insulation interior part 2724 can having than the part of the larger thickness of other parts of balloon 2710 for balloon 2710.In some other embodiment, in heat isolation, part 2724 has the formation different from the other parts of balloon 2710, and/or comprises one or more independently heat insulation structurals.Mode as an alternative, balloon 2710 can comprise the tubular body portion 2712 with interior part, the thermal insulation of wherein said interior part is not better than the other parts of balloon 2710.

Figure 28 figure has released a part for the cold therapy equipment 2800 of the equipment 2600 being similar in Figure 26, and difference is the configuration of depression and lands.Equipment 2800 comprises the cooling package 2802 with applicator 2804, and applicator 2804 has the balloon 2806 that can determine expansion chambers.Balloon 2806 comprises a plurality of outstanding 2808 and non-protuberance 2810.Outstanding 2808 can be arranged as helical form mode or around other applicable modes of the side face of balloon 2806.When cooling package 2802 is during in sending state, non-ledge 2810 can be corresponding to the hot transmitting portions with the heat transfer rate that the part at outstanding 2808 places is lower than applicator of applicator 2804.The renal artery of non-protuberance 2810 and treatment site or the interval between nephrostome can be by renal artery or nephrostome, the part of close non-protuberance is isolated with the cryogenic temperature in balloon 2806.For example, in this interval freeze or liquid blood heat isolation can be provided.

There is difform balloon and can be conducive to the therapeutic purposes relevant to low the kidney warming neuroregulation.For example, be spiral-shapedly beneficial to required the therapeutic modality local or overall situation.Figure 29 figure has released a part for the cold therapy equipment 2900 that comprises cooling package 2902, and cooling package 2902 is positioned at distal portions 2904 places of the bar 2906 of the elongation of having determined passing away.Distal portions 2904 can have ladder 2907, portal 2908 and outlet 2909.Cooling package 2902 can comprise the applicator 2910 with spiral balloon 2911, and balloon 2911 has been determined expansion chambers and had balloon proximal part 2912 and balloon distal portions 2914.Balloon proximal part 2912 has by 2908 less important (minor) liquid with between passing away of portalling and is connected.Balloon distal portions 2914 is connected to around the outer surface of the distal portions 2904 of outlet opening 2909, thus spiral balloon 2911 is connected to passing away in fluid connection mode.Spiral balloon 2911 is wrapped in (for example, distal portions 2904 can be determined the central axis of spiral balloon 2911) around distal portions 2904.Equipment 2900 may further include supply pipe 2916, and supply pipe 2916 has been determined supply chamber and had the main part 2918 of extending along the length of bar 2906 and by 2908 distal portions 2920 that leave the inclination of bar 2906 that portal.Cooling package 2902 can also comprise the aperture 2922 of the far-end of the distal portions 2920 that is positioned at inclination.Supply pipe 2916 and aperture 2922 can be configured to the expansion of cold-producing medium to guide into proximal part 2912 in the direction corresponding to longitudinal orientation of balloon proximal part 2912 in cardinal principle.When cooling package 2902 is during in deployed condition, cold-producing medium can flow to balloon distal portions 2914 from balloon proximal part 2912, then along passing away to near-end, flows.After arriving balloon distal portions 2914, cold-producing medium can use up part, major part or whole of its sub-cooled ability.

Figure 30 figure has released and mainly in flow of refrigerant direction, has been different from a part for the cold therapy equipment 3000 of the equipment 2900 in Figure 29.Equipment 3000 comprises the cooling package 3002 of the distal portions 3004 of the bar 3006 that is positioned at the elongation of determining passing away.Distal portions 3004 can have ladder 3007, and cooling package 3002 can comprise the applicator 3008 with spiral balloon 3014, and balloon 3014 has been determined expansion chambers and had balloon proximal part 3016 and balloon distal portions 3018.Balloon proximal part 3016 can be connected to the outer surface of distal portions 3004 near the far-end of distal portions 3004, and the mode with fluid connection is connected to passing away by spiral balloon 3014 thus.Equipment 3000 may further include the supply pipe 3019 with crooked distal portions 3020.Spiral balloon 3014 can be wrapped in (for example, supply pipe 3019 can be determined the central axis of spiral balloon 3014) around supply pipe 3019.Supply pipe 3019 can extend along the length of bar 3006, extends rod, extends balloon proximal part 3016, along the central axis of spiral balloon 3014, and enters balloon distal portions 3018.Balloon distal portions 3016 is can be near supply pipe 3019 sealed and be connected at least in part crooked distal portions 3020.Cooling package 3002 may further include and supply pipe 3019 is connected to the aperture 3021 of balloon distal portions 3018 in the mode of fluid connection.Supply pipe 3019 and aperture 3021 can be configured in cardinal principle guide cold-producing medium expansion to enter balloon distal portions 3018 in the direction corresponding to longitudinal orientation of balloon distal portions 3018.When cooling package 3002 is during in deployed condition, cold-producing medium can flow to balloon proximal part 3016 from balloon distal portions 3018, and flows along passing away.

Figure 31 figure has released a part for the cold therapy equipment 3100 of the equipment 3000 being similar in Figure 30, and its difference is the shape of spiral balloon.Equipment 3100 comprises the cooling package 3102 of the distal portion 3104 of the bar 3106 that is positioned at the elongation of having determined passing away.Distal portions 3104 can have ladder 3108, and cooling package 3102 can comprise the applicator 3110 with spiral balloon 3112, and balloon 3112 has been determined expansion chambers and had balloon proximal part 3114 and balloon distal portions 3116.Balloon proximal part 3114 can be connected to the outer surface of distal portions 3104 near the far-end of distal portions 3104, and the mode with fluid connection is connected to passing away by spiral balloon 3112 thus.Equipment 3100 may further include the supply pipe 3117 of the distal portions 3118 with inclination.Spiral balloon 3112 can be wrapped in supply pipe 3117 around but separate with supply pipe 3117 diametrically.Supply pipe 3117 can extend along the length of bar 3106, extends rod 3106, extends balloon proximal part 3114, along the central axis of spiral balloon 3112, and enters balloon distal portions 3116.Balloon distal portions 3116 can be sealed near supply pipe 3117.Cooling package may further include and supply pipe 3117 is connected to the aperture 3119 of balloon distal portions 3116 in the mode of fluid connection.When cooling package 3102 is during in deployed condition, cold-producing medium can flow to balloon proximal part 3114 from balloon distal portions 3116, and flows along passing away.The wider screw diameter of spiral balloon 3112 can be conducive to part obturation.For example, when cooling package 3102 is during in deployed condition, cooling package 3102 can be determined outer surface and the flow path between spiral balloon 3112 (for example, blood flow paths) of supply pipe 3117.

Figure 32 A-32B figure has released the part that can have corresponding to the cold therapy equipment 3200 of the complicated shape of standard element, and standard element for example has the standard element of shape memory.As mentioned above, can be from when corresponding cooling package subsiding at least partly during in sending state according to the balloon in the cold therapy equipment of the some embodiment configuration of present technique, mobile is when at least part of expansion of cooling component during in deployed condition.After expansion under deployed condition, complicated balloon can have predetermined shape (for example, being incorporated to the global shape of balloon by molding or alternate manner) or corresponding to the shape of independent stereotyped structure.Cold therapy equipment 3200 shown in Figure 32 A-32B comprises the cooling package 3202 of the distal portions 3204 of the bar 3206 that is positioned at the elongation of determining passing away.Distal portions 3204 can have ladder 3207, and cooling package 3202 can comprise applicator 3208.Equipment 3200 may further include the standard element 3210 of elongation and has the supply pipe 3212 of the distal portions 3214 of inclination.Applicator 3208 can comprise the balloon 3216 with distal seal 3217.Balloon 3216 can extend and can determine expansion chambers around the standard element 3210 extending.Distal seal 3217 can be the smooth part of balloon 3216, is sealed to together (for example,, with hot mode and/or with binding agent) at the wall of this part place balloon 3216.The end of closing can according to the balloon of some embodiment configurations of present technique with other type.As mentioned above, balloon can be closed near the structure of for example guiding elements and/or supply pipe.Balloon can also be closed near valve.In addition, balloon can have the complete far-end of closing.For example, balloon can be for example, by molding (, dip mold) for having the complete far-end of closing.

Standard element 3210 can be configured to have linear configurations substantially during in sending state and have curved configuration during in deployed condition when cooling package 3202 when cooling package 3202.Cooling package 3202 can also comprise the aperture 3218 of the far-end of the distal portions 3214 that is positioned at inclination.Supply pipe 3212 and aperture 3218 can be configured to the expansion of cold-producing medium in the direction corresponding to longitudinal orientation of the balloon 3216 near aperture 3218, to guide air inlet ball 3216 in cardinal principle.As shown in Figure 32 A, the shape of balloon 3216 under deployed condition is at least in part corresponding to the curved configuration of standard element 3210.Illustrated curved configuration is roughly helical form, but also can be other shapes, the roundabout shape of for example wriggling.Standard element 3210 can have shape memory (for example, one-way shape memory or bidirectional shape memory) and can comprise shape-memory material, for example Nitinol (for example, Nitinol (nitinol)).Shape memory can allow standard element 3210 and balloon 3216 under deployed condition, to move into the configuration (for example, crooked, curve, spiral or the roundabout configuration of wriggling) of preliminary election.Configuration can be selected, and for example, allows applicator 3208 to apply required local or overall therapeutic modality.Similarly, spiral-shaped and other shape shown in Figure 32 A can be selected to provide the inaccessible grade on therapentic part, and for example part is inaccessible but not entirely shut.Shape-memory material can lose its part or all of sizing attribute when being exposed to cryogenic temperature.According to the cooling package 3202 of some embodiment configurations of present technique, can comprise balloon 3216, balloon 3216 moves into the preconfigured corresponding to the shape of standard element 3210 before sub-cooled or in initial sub-cooled process.When sub-cooled causes standard element to lose its part or all of sizing attribute, balloon 3216 for example, can finish so that balloon 3216 at least remains to freezing bonding by its preconfigured with the freezing bonding (cryo-adhesion) between exterior material (, blood and/or tissue).

In the illustrated embodiment of Figure 32 A-32B, standard element 3210 is substantially shown and is centered close in balloon, and also, balloon 3216 is substantially uniformly around standard element 3210 expansions.Mode as an alternative, standard element 3210 can have the different position in balloon 3216 at cooling package 3202 during in deployed condition.For example, standard element 3210 can be near the inner surface of balloon 3216.When the wall of standard element 3210 and balloon 3216 is separated, balloon 3216 can disperse renal artery or nephrostome applied pressure.As shown in Figure 32 A, standard element 3210 can extend through distal seal 3217.Mode as an alternative, standard element 3210 can be free of attachment to balloon 3216 and/or end at the part of the close distal seal 3217 of balloon 3216.In addition, the distal portions of standard element 3210 can be configured to cooling package 3202 during in deployed condition away from renal artery or nephrostome.In certain embodiments, balloon 3216 is configured to substantially around standard element 3210 expansions, not need inner supporting structure uniformly.Mode as an alternative, balloon 3216 can comprise the internal structure (for example net) that extends across balloon 3216 internal diameters, this standard element 3210 can be connected with the position at balloon 3216 inner surface intervals with internal structure again.This internal structure is the interval of different balloons (for example,, as discussed with reference to Figure 45 A-46) for example.In certain embodiments, cooling package comprises the structure of extending along the central axis of the balloon 3216 under deployed condition.For example, distal portions 3204 can extend along the central axis of the balloon 3216 under deployed condition and balloon 3216 and standard element 3210 can be connected to the lateral openings of distal portions 3204.As another example, distal portions 3204 can comprise the prolongation that the diameter that extends along the central axis of balloon 3216 reduces, and separated with the prolongation of reduced another opening of passing away that balloon 3216 is connected in the mode of fluid connection.The structure of extending along the central axis of balloon 3216 can comprise chamber (for example, being configured to hold the chamber of wire or control line), protector (for example, filter) and/or monitoring arrangement (for example, thermal coupling or pressure converter).

Equipment 3200 can also be modified for non-cold therapy application.For example, supply pipe 3212 can be removed and equipment 3200 can be applied to benefit from other application of not entirely shutting of therapentic part.In applying in the application of kidney neuroregulation with other, balloon 3216 can be non-obturation under deployed condition, for example, can form blood flow paths along the central axis of balloon 3216.In some non-cold therapy application, distal portions 3204 can be supported a structure, and this structure is configured to treat (for example, thrombectomy) in blood vessel, and balloon 3216 is fixed to blood vessel wall by equipment 3200.In these or other embodiment, balloon 3216 can advantageously maintain endovascular center by distal portions 3204.

Figure 33 A-33D figure has released a part can in launching configuration with the cold therapy equipment 3300 of predetermined curved shape.Equipment 3300 comprises the cooling package 3302 at distal portions 3304 places of the bar 3306 that is positioned at the elongation of having determined passing away.Distal portions 3304 can have ladder 3307, and cooling package 3302 can comprise the applicator 3308 with the balloon 3310 that can determine expansion chambers.Balloon 3310 can have balloon proximal part 3312, balloon mid portion 3314 and balloon distal portions 3316.Equipment 3300 further comprises the supply pipe 3318 extending along bar 3306, and cooling package 3302 can have far-end and the aperture in balloon proximal part 3,312 3320 in supply pipe 3318.When cooling package 3302 is in deployed condition lower time, balloon 3310 is crooked and have first wall 3322 (being shown the bottom of balloon in Figure 33 A) of the depression of being generally and be generally nonpitting (for example, convex surface) second wall 3324 (being shown the top of balloon in Figure 33 A) along its length direction.

Balloon proximal part 3312, balloon mid portion 3314, and balloon distal portions 3316 can be configured to contact the part circumferential surface sections of renal artery or nephrostome.For example, balloon mid portion 3314 can be configured at cooling package 3302 during in deployed condition, generally along the second wall 3324 and substantially along the first wall 3322 contact renal artery or nephrostomes.Balloon proximal part 3312 and balloon distal portions 3316, for example, can be configured to when cooling package during in deployed condition generally along the first wall 3322 and substantially along the second wall 3324 contact renal artery or nephrostomes.Due to this uneven way of contact, the crooked shape of balloon 3310 can contribute to required local or overall therapeutic modality.

As being clear that in Figure 33 B-33C, balloon 3310 can be included in balloon mid portion 3314 places and reduce part 3326 along the elasticity of the first wall 3322.In illustrated embodiment, it can be the thicker part of balloon 3310 that described elasticity reduces part 3326.As shown in Figure 33 D, balloon 3310 can partly subside during in sending state at cooling package 3302, to be applicable to being in delivery sheath 3328.When cooling package 3302 is during in sending state, elasticity reduces part 3326 can keep some curvatures.Mode as an alternative, elasticity reduces part 3326 and can be roughly smooth.When cooling package 3302 is during in deployed condition, on balloon 3310, be different from the part that elasticity reduces part 3326, especially the part along the second wall 3324 at balloon mid portion 3314 places of balloon 3310, can be configured to expansion (for example, flexibly expansion) and reduce the degree that part 3326 is larger for elasticity.In some embodiment, it is flexible that elasticity reduces being roughly along the part of the second wall 3324 at balloon mid portion 3314 places of that part 3326 is roughly inflexibility and balloon 3310.When cooling package 3302 is during in deployed condition, reduce with elasticity the bending that the associated restriction of part 3326 can contribute to balloon 3310.When cooling package 3302 is in deployed condition, elasticity reduces part 3326 and can be configured to respect to renal artery or nephrostome depression, and not around thering is the hot transmitting portions that is enough to cause the heat transfer rate that has the kidney of therapeutic effect neuroregulation.Except reducing elasticity, the thickness that elasticity reduces part 3326 can lower its heat conductivity, and this can promote cooling effectiveness and/or further be conducive to required local or whole therapeutic modalities.

Figure 34 figure has released a part for the cold therapy equipment 3400 of the equipment 3300 being similar in Figure 33 A-33D, and its difference is the distinguishing support configuration of tool.Equipment 3400 comprises the cooling package 3402 with applicator 3404, and applicator 3404 comprises the balloon 3406 of determining expansion chambers.Cooling package 3402 also comprises the support member 3408 of elongation, and it has crooked far-end 3410.The support member 3408 of extending and other support member as herein described can help balloon with cooling package, to move when corresponding cooling package moves between sending state and deployed condition.For example, the support member 3408 of elongation can help prevent balloon 3406 in therapeutic process, block or reverse.Alternatively, the support member of elongation can be connected to the distal portions of corresponding balloon.This for, for example, balloon is maintained can be useful in extended configuration.

Figure 35 A-35B figure has released cold therapy equipment 3500, wherein causes at least in part complicated balloon with the interaction of guiding elements.In some other embodiment, complicated balloon is at least in part by for example, shaping with the interaction of other cold therapy part of appliance (, bar or supply pipe).The illustrated equipment 3500 of Figure 35 A-35B comprises in determining the cooling package 3502 of distal portions 3504 of bar 3506 of the elongation of passing away.Equipment 3500 can comprise guiding elements 3508 and the supply pipe 3512 of elongation, and cooling package can comprise the aperture 3514 of the far-end that is positioned at supply pipe 3512.Cooling package may further include the applicator 3510 in balloon 3516, the far-end integral neck 3522 that balloon 3516 can be determined expansion chambers and have balloon proximal part 3518, is connected to the near-end integral neck of distal portions 3504 and is connected to guiding elements 3508.Balloon 3516 can also have restricted longitudinal component 3524 (Figure 35 B) and distensible longitudinal component 3526 (Figure 35 B).Limited longitudinal component 3524 can be connected to guiding elements 3508 at least in part.For example, from far-end integral neck 3522 to balloon proximal part 3518, the inner surface of balloon 3516 can be connected to guiding elements 3508.Distensible longitudinal component 3526 can be at cooling package 3502 during in deployed condition and guiding elements 3508 isolated.The limited shape of part of balloon 3516 can be used for contributing to required local or overall therapeutic modality.In addition, limited longitudinal component 3524 can be determined at least a portion of longitudinal flow path (for example, blood flow paths).For example, this is conducive to the inaccessible level of therapentic part, and for example part is inaccessible but not all inaccessible.

Figure 36 figure has released the cold therapy equipment 3600 of the cold therapy equipment 3500 being similar in Figure 35 A-35B, and difference is to have the different connected mode between balloon and guiding elements.Figure 36 can regard substituting of Figure 35 B as, and to scheme to release different embodiment, wherein all elements of the cold therapy equipment 3500 shown in Figure 35 A-35B, except being shown in Figure 36 than different those elements of Figure 35 B, are similar.Cold therapy equipment 3600 comprises guiding elements 3602 and the balloon 3604 of elongation, balloon 3604 have interval diametrically restricted longitudinal component 3506 and radially with the longitudinal component 3508 of the expansion at that interval.Although Figure 36 shows the longitudinal component 3608 of two limited longitudinal components 3606 and two expansions, the longitudinal component 3608 of the limited longitudinal component 3606 of greater number and/or expansion can form by for example balloon 3604 being connected to guiding elements 3602 at the radial section place of the varying number of guiding elements 3602.In addition, the distribution of the longitudinal component 3608 of limited longitudinal component 3606 and expansion can be symmetrical or asymmetrical (for example,, along the axis that is parallel to the length of guiding elements 3602).

Figure 37 figure has released a part for the cold therapy equipment 3700 that comprises annular balloon.Equipment 3700 comprises the cooling package 3702 of the distal portions 3704 of the bar 3706 that is positioned at the elongation of determining passing away, and supply pipe 3708.Cooling package 3702 comprises the aperture 3710 of the far-end that is positioned at supply pipe 3708, and the applicator 3712 with balloon 3714, and wherein balloon 3714 has the first balloon section 3716 and the second balloon section 3718.The first balloon section 3716 has the first proximal part 3720 and the first distal portions 3722.The second balloon section 3718 has the second proximal part 3724 and the second distal portions 3726.The first balloon distal portions 3722 is connected to the second distal portions 3726 in the mode of fluid connection.When cooling package 3702 is during in deployed condition, cold-producing medium can flow to the first distal portions 3722 from the first proximal part 3720, then to the second distal portions 3726.After arriving the second distal portions 3726, cold-producing medium can have been used up its sub-cooled ability partly, mostly or fully.Therefore, the second balloon section 3718 can eject the cold-producing medium from the first distal portions 3722 by Main Function, and has hot transmitting portions, and the heat transfer rate of this hot transmitting portions is lower than the heat transfer rate of the hot transmitting portions of the first balloon section 3716.In some alternate embodiments, the first balloon section 3716 and the second balloon section 3718 are balloons independently, have the connection of fluid connection at its far-end.In another embodiment, the first and second balloon sections can be the part of folding single balloon.Be similar to following non-cooling balloon, the second balloon section 3718 can be thermally isolated from a part for the renal artery for the treatment of site or nephrostome the cryogenic temperature in the first balloon section 3716.For example, this can be useful for helping required local or overall therapeutic modality.

a plurality of balloons

Figure 38-51 figure has released some embodiment of the freezing equipment that comprises a plurality of balloons, described a plurality of balloon can contribute to the one or more therapeutic purposes relevant to low the kidney warming neuroregulation, and example as required local or overall therapeutic modality, size is determined and entirely shuts.In the cold therapy equipment configuring according to some embodiment of present technique, main balloon be configured to produce or transmit to kidney neuroregulation medicable cooling (for example, comprise main hot transmitting portions), main balloon can with inferior balloon coupling, inferior balloon is configured to prevent or be suppressed at the medicable chilling temperature on selected location.In some embodiment, inferior balloon comprises time hot transmitting portions.For instance, inferior balloon can be that warm up, heat insulation, non-cooling or have a lower cooling level.Mode as an alternative, some embodiment comprise a plurality of balloons, comprising main hot transmitting portions and tool, are with or without time balloon.

Figure 38 A-38B figure has released a part for the cold therapy equipment 3800 can with a plurality of main balloons.Equipment 3800 comprises the cooling package 3802 of the distal portions 3804 of the bar 3806 that is positioned at the elongation of determining passing away.Distal portions 3804 can have ladder 3807, and equipment 3800 can comprise guiding elements 3808 and the supply pipe 3810 of elongation.Cooling package 3802 can comprise the aperture 3811 of the far-end that is positioned at supply pipe 3810, and the applicator 3812 with the balloon 3814 of elongation, and wherein balloon 3814 is placed in parallel with the length of cooling package 3802 substantially.Balloon 3814 has shared proximal part 3816 and otherwise around guiding elements 3808, on side face, distributes.Aperture 3811 is arranged in shared proximal part 3816, and balloon 3814, in conjunction with shared proximal part 3816, can determine expansion chambers.When cooling package 3802 is during in deployed condition, from the cold-producing medium of supply pipe 3810 expansions can enter shared proximal part 3816 and balloon 3814 circulation caused the expansion of balloon and cooling.Cold-producing medium can also leave balloon 3814 by shared proximal part 3816 and flow along passing away to far-end.Balloon 3814 can be configured to the part (for example, the longitudinal component of separation) that contact is positioned at the renal artery of therapentic part or the separation of nephrostome.This can contribute to required local or overall therapeutic modality.In addition, at least a portion in the longitudinal flow path (for example, blood flow paths) around balloon 3814 can be determined in the space between balloon 3814.This can contribute to, for example, the inaccessible level of therapentic part, for example part is inaccessible but not entirely shut.

Figure 39 A-39C figure has released a part for the cold therapy equipment 3900 can with a plurality of balloons, and wherein a plurality of balloons have different cooling levels.Equipment 3900 comprises the cooling package 3902 of the distal portions 3904 of the bar 3906 that is positioned at elongation, the guiding elements 3907 of elongation, and a plurality of supply pipe (being expressed as 3908a-d).Cooling package 3902 can comprise a plurality of apertures (being expressed as 3910a-d) of the far-end that is positioned at supply pipe 3908a-d, and the applicator 3912 that comprises the balloon (being expressed as 3914a-d in Figure 39 A and 39C) of a plurality of elongations.Balloon 3914a-d distributes on side face around guiding elements 3907 and comprises separately and can balloon 3914a-d be connected in fluid connection mode to the near-end neck 3916 (Figure 39 A) of passing away.Aperture 3910a, 3910d have the clear passage area larger than aperture 3910b, 3910c.Similarly, supply pipe 3908a, 3908d have the clear passage area less than supply pipe 3908b, 3908d.Balloon 3914a-d substantially size equates and has an inside and outside surface area substantially equating.Ratio between the aperture of balloon 3914a, 3914d and/or supply pipe clear passage area and interior surface area can be greater than balloon 3914b and 3914c.This can cause cooling with respect to the difference of balloon 3914b, 3914c of balloon 3914a, 3914d.For example, balloon 3914a, 3914d can be configured to circulating temperature lower than the gaseous refrigerant of balloon 3914b, 3914c.Mode ground additionally or as an alternative, balloon 3914a, 3914d can be configured to limited cooling of the large body surface area of cooling package 3902 when deployed condition, and balloon 3914b, 3914c are configured to limited cooling of the large cryogen of cooling package 3902 when deployed condition.For example, near the tissue medicable kidney neuroregulation region pointed provides certain cooling (, low-level cooling, for example be not enough to carry out low temperature god neuroregulation) can be useful, for example, reduce the heat from the surrounding tissue acquisition in medicable kidney neuroregulation region pointed.To the use of a plurality of balloons, can also contribute to required local or overall therapeutic modality and/or the required inaccessible level on therapentic part, for example, part is inaccessible but not entirely shut.

Figure 40 figure has released the cold therapy equipment 4000 of the cold therapy equipment 3900 being similar in Figure 39 A-39C, and its difference is to have the cooling mechanism of different difference.Figure 40 can regard substituting of Figure 39 B as, and to scheme to release independently embodiment, wherein all elements of the cold therapy equipment 3900 shown in Figure 39 A-39C, except being shown in Figure 40 than different those elements of Figure 39 B, are similar.Cold therapy equipment 4000 comprises bar 4002, and bar 4002 has the inwall 4004 that bar 4002 is divided into the separated passing away of fluid connection, and lays respectively at the supply pipe 4006 in passing away.Supply pipe 4006 has substantially identical size, also has aperture (not shown), and described aperture has substantially identical size.Cold therapy equipment 4000 also comprise with passing away between a plurality of pressure regulators (being expressed as 4008a-d) of being communicated with of fluid.Pressure regulator 4008a-d can be configured to be positioned at outside vascular system.Regulate the back-pressure in passing away can cause the temperature change in corresponding balloon (not shown).For example, pressure regulator 4008a, 4008d can keep the first back-pressure in corresponding passing away and balloon, and pressure regulator 4008b, 4008c can keep in corresponding passing away and balloon second, different back-pressure.In this way, can realize the cooling similar difference of difference being similar to reference to described in the equipment 3900 shown in Figure 39 A-39C cooling.

Figure 41 figure has released a part for the cold therapy equipment 4100 can with a plurality of spiral balloons.Equipment 4100 comprises the cooling package 4101 at distal portions 4102 places of the bar 4103 that is positioned at the elongation of having determined passing away, supply pipe 4104, and filling tube 4105.Cooling package 4101 can comprise the first supply aperture 4106, the second supply aperture 4107 and the filling aperture 4108 that is positioned at the far-end of filling tube 4105.Cooling package 4101 also comprises the applicator 4109 with a plurality of spiral balloons.In one embodiment, applicator 4109 comprises having the first spiral balloon 4110 of the first distal portions 4112 and the first proximal part 4114, the second spiral balloon 4116 (release and be shown dot-dash for ease of figure) with the second distal portions 4118 and the second proximal part 4120 and the triple helical balloon 4122 with the 3rd distal portions 4124 and the 3rd proximal part 4126.First and second supply apertures 4106,4107 can be connected respectively to communicatively the first distal portions 4112 and the 3rd distal portions 4124 by fluid, and first and triple helical balloon 4110,4112 can determine expansion chambers.The second balloon proximal part 4120 can be also connected to filling aperture 4108 and the second spiral balloon 4116 around filling tube 4107 sealings fluid connection can determine filled chamber.When cooling package 4101 is during in deployed condition, the second spiral balloon 4116 can be configured to be full of via filling tube 4105.Cold-producing medium can be expanded and enter the first distal portions 4112 and the 3rd distal portions 4124, and first and triple helical balloon 4110,4122 mainly cooling under the spiral way of spiral way independently or merging can be provided.The second spiral balloon 4116 can by the part of renal artery or nephrostome with first and the sub-cooled of triple helical balloon 4110,4122 isolated.For instance, this is useful to helping required local or overall therapeutic modality.In addition, at least a portion of longitudinal flow path (for example, blood flow paths) can be determined in the inner space between supply pipe 4004 and first, second and triple helical balloon 4110,4116,4112.For instance, this is useful to helping the inaccessible level of therapentic part, for example, be that part is inaccessible but not all inaccessible.

Figure 42 figure has released the cold therapy equipment 4200 of the equipment 4100 being similar in Figure 41, but in spiral balloon, has the supply after change and discharge configuration.Equipment 4200 comprises the cooling package 4202 at distal portions 4203 places of the bar 4204 that is positioned at the elongation of determining passing away, guiding elements 4205 and the supply pipe 4206 extending.Cooling package 4202 can comprise the supply aperture 4207 that is positioned at supply pipe 4206 far-ends and the applicator 4208 with a plurality of spiral balloons.In one embodiment, applicator 4208 comprises having the first spiral balloon 4210 of the first distal portions 4212 and the first proximal part 4214, the second spiral balloon 4216 (release and be shown dot-dash for ease of figure) with the second distal portions 4218 and the second proximal part 4220 and the triple helical balloon 4222 with the 3rd distal portions 4224 and the 3rd proximal part 4226.The first distal portions 4212 and the 3rd distal portions 4224 fluids are communicatively connected to the other side and the second distal portions 4218.The first proximal part 4214 and the 3rd proximal part 4226 fluids are communicatively connected to passing away.When cooling package 4202 is during in deployed condition, cold-producing medium can be expanded and enter the second proximal part 4220, and the second spiral balloon 4216 can provide mainly cooling in spiral way.First and triple helical balloon 4210,4222 can receive from the discarded cold-producing medium of the second distal portions 4218 can the part of renal artery or nephrostome is isolated with the sub-cooled in the second spiral balloon 4216.With respect to the cold therapy equipment 4200 shown in Figure 41, during the greater distance of equipment 4100 between still less cooling of needs and/or main cooling region, be useful.In some other embodiment, warm, heat insulation, the non-spiral balloon cooling or that have lower cooling level of varying number are wound around with various layouts, wherein spiral balloon is configured to provide mainly cooling, for example, help required local or overall therapeutic modality.

Figure 43 A-43C figure has released a part for the cold therapy equipment 4300 that can comprise the balloon that can move with respect to the other parts of cooling package.Equipment 4300 comprises the cooling package 4301 at distal portions 4302 places of the bar 4303 that is positioned at the elongation of determining passing away, and the standard element 4304, the first supply pipe 4305 and the second supply pipe 4306 that extend.Distal portions 4302 can have ladder 4307, and cooling package 4301 can comprise the first aperture 4308 of the distal portions that is positioned at the first supply pipe 4305, and the second aperture 4309 that is positioned at the far-end of the second supply pipe 4306.Cooling package 4301 further comprises applicator 4310, and applicator 4310 has the first balloon 4311 extending of having determined the first expansion chambers and the second balloon 4312 extending of having determined the second expansion chambers.The first balloon 4311 has the first proximal part 4314, the first mid portion 4315 and the first distal portions 4316.The second balloon 4312 has the second proximal part 4318, the first mid portion 4319 and the first distal portions 4320.The first and second balloons 4311,4312 have the inner side 4322 of the most close standard element 4304 and the outside 4324 relative with inner side 4322.The first distal portions 4316 and the second distal portions 4320 are connected to standard element 4304.In some embodiment, standard element 4304 has also been determined guidance cavity, and wire can pass by this guidance cavity.

As shown in Figure 43 C, when cooling package 4301 is during in deployed condition, with respect to bar 4303, regaining standard elements 4304 can be so that the first mid portion 4315 and the second mid portion 4319 laterally moves away standard element 4304.A part for a part for the first mid portion 4315 and/or the second mid portion 4319 can be weakened (for example, by folding, heat treatment so that its fragility and/or attenuation) or be otherwise configured to determine preferential bending direction.As shown in Figure 43 C, after standard element 4304 is retracted in the inner side 4322 of the first mid portion 4315 of caving on its length direction and the second mid portion 4319, when the outside 4324 of the first mid portion 4315 and the second mid portion 4319 is generally along its length depression.For instance, the controlled deflection of balloon determines that with the lower risk that applies excessive expansion pressure to renal artery or nephrostome size is particularly favourable to helping.That when one or more balloons of applicator, be roughly inflexibility and/or cannot be expanded to realize size and determined by flexibility time, controlled deflection be particularly favourable.

Figure 44 A-44C figure released with Figure 43 A-43B in the parts of cold therapy equipment 4300 similar cold therapy equipment 4400, but have greater number elongation balloon and comprise time balloon.Equipment 4400 comprises the having ladder 4405 and determined the distal portions 4402 of passing away of bar 4404 of elongation, is positioned at the cooling package 4406 of distal portions 4402, and the standard element 4408 extending.Standard element 4304 can for rigidity maybe can determine a chamber, guidance cavity for example, wire can pass by guidance cavity.Equipment 4400 further comprises the first supply pipe 4410, the second supply pipe 4414, the three supply pipe (not shown) and filling tubes 4416.Cooling package 4406 can comprise the first supply aperture 4418 of the far-end that is positioned at the first supply pipe 4410, be positioned at the second aperture 4420 of the far-end of the second supply pipe 4414, be positioned at the 3rd aperture (not shown) of far-end of the 3rd supply pipe and the tucker aperture 4422 that is positioned at the far-end of filling tube 4416.Cooling package 4406 also comprises applicator 4424, applicator 4424 has the first balloon 4426 extending of having determined the first expansion chambers, determine the second balloon 4428 extending of the second expansion chambers, determined the 3rd balloon 4430 (Figure 44 B) extending of the 3rd expansion chambers and the 4th balloon 4432 extending of definite filled chamber.Be connected to first, second, and third supply aperture 4418,4,420 first, second, third balloon 4426,4428,4430 fluid connections.Be connected near tucker aperture 4422 sealed filling tube 4416 the 4th balloon fluid connection.The first, second, third and the 4th balloon 4426,4428,4430,4432 is connected to standard element 4408, so, as shown in Figure 44 C, when cooling package 4406 is during in deployed condition, with respect to bar 4404, regain standard element 4408 and make applicator 4424 lateral spreads.First, second, and third balloon 4426,4428 and 4430 can have hot transmitting portions, and the heat transfer rate of this hot transmitting portions enough produces medicable kidney neuroregulation.First, second, and third balloon 4426,4428,4430 can be configured to provide mainly cooling.The 4th balloon 4432 can be inferior balloon.In some other embodiment, during the main balloon that is with or without time balloon of varying number can be included in and similarly configure with the cold therapy equipment 4400 shown in the cold therapy equipment 4300 shown in Figure 43 A-43B and Figure 44 A-44C.Except size is determined, these configurations can contribute to other therapeutic purposes, and example is local or overall therapeutic modality as required.

Figure 45 A-45B figure has released a part that comprises the cold therapy equipment 4500 can with the different main balloons that form and time balloon.Equipment 4500 comprises the cooling package 4502 of the distal portions 4504 of the bar 4506 that is positioned at the elongation of having determined passing away, supply pipe 4508, and filling tube 4509.Cooling package 4502 can comprise the supply aperture 4510 of the far-end that is positioned at supply pipe 4508, is positioned at the tucker aperture 4514 of the far-end of filling tube 4509.Cooling package 4502 also comprises applicator 4516, and applicator 4516 has the first balloon of having determined expansion chambers and the second balloon 4520 that can determine filled chamber.The first balloon 4518 have be arranged in distal portions 4504 by the first balloon 4508 fluid connections be connected to the near-end neck 4522 of passing away.The second balloon is connected to sealed and fluid connection and fills aperture 4514 near filling tube 4509.When cooling package 4502 is in deployed condition, the first balloon 4518 can be configured to send main cooling and the second balloon 4520 can be inferior balloon.

In some embodiment, the first balloon 4518 has level of flexibility and/or the elasticity lower than the second balloon 4520.For example, first balloon 4518 can be roughly inflexibility, and the second balloon can be roughly flexible.In addition, the first balloon 4518 can be for flexibility for the second balloon of inflexibility.Non-flexible material has higher intensity (for example, higher pressure rating) than flexible material conventionally.Because of this and/or other reason, flexible material can be suitable for being configured to directly from aperture, receiving the cold-producing medium of expansion and/or discharging kidney neuroregulation medicable cooling substantially.The flexible material of cardinal principle can also be suitable for being expanded to different sizes and adapt to renal artery and the nephrostome with different cross section size.Equipment 4500 shown in Figure 45 A-45B and some other cold therapy equipment as herein described can be configured to utilize the two different qualities of inflexibility and flexible material.Figure 45 B and 45C are the sectional view of equipment 4500, and wherein the size of equipment 4500 is determined to adapt to and is in the renal artery or nephrostome of different cross section size.The first balloon 4518 substantially has identical size in Figure 45 B and Figure 45 C.But the second balloon 4520 is expanded to than degree larger in Figure 45 B flexibly in Figure 45 C.Even the expansion that is roughly inflexibility of the first balloon 4518, the expansion variable, flexibility of the second balloon 4520 can move to the first balloon with the inner surface of renal artery or nephrostome and contact.The flexibility expansion of the second balloon 4520 can carefully be controlled to prevent to occur on renal artery or nephrostome excessive expansionary force by filling tube 4509.

Amplification in Figure 45 B-1 shows the spacer 4524 that comprises non-flexible material layer 4526 and flexible material layer 4528.Non-flexible material layer 4526 can be a part for the second balloon 4520 for the part flexible material layer 4528 of the first balloon 4518.In one embodiment, the first balloon 4518 can connect together at spacer 4524 places with the second balloon 4520, but in other embodiments, the first and second balloons 4518 are together with 4520 are free of attachment to.

Figure 46 figure has released the cold therapy equipment 4600 of the cold therapy equipment 4500 being similar in Figure 45 A-45C, but has different spacers.Figure 46 can regard substituting of Figure 45 B as, and to scheme to release independently embodiment, wherein all elements of the cold therapy equipment 4500 shown in Figure 45 A-45C, except being shown in Figure 46 than different those elements of Figure 45 B, are similar.Cold therapy equipment 4600 comprises the first balloon 4602, the second balloon 4604 and the volume spacer 4606 between the first balloon 4602 and the second balloon 4604.As shown in the amplification in Figure 46-1, spacer 4606 comprises monolayer, and described monolayer can be the inflexibility layer of the first balloon.In another embodiment, spacer 4606 can be included as the monolayer of the flexible layer of the second balloon 4604.For structure equipment 4600, submissive balloon part (for example substantially, incomplete balloon) can be connected to substantially not flexible balloon, to form substantially submissive balloon, it has at least partly in ， cross section, the determined chamber of the not flexible balloon of described cardinal principle, as shown in figure 46, the first balloon 4602 can be roughly the balloon of D type, and the second balloon 4604 can be roughly the balloon of C type, and it is connected to the balloon that is roughly D type.

According to the cold therapy equipment of the some embodiment configuration of present technique, can comprise that spiral lives balloon and non-helical balloon.Figure 47 figure has released the cold therapy equipment 4700 that comprises cooling package 4702, and wherein cooling package 4702 is positioned at distal portions 4704 places of the bar 4706 of the elongation of having determined passing away.Equipment 4700 also comprises supply pipe 4707.Cooling package 4702 comprises applicator 4708, and applicator 4708 has helical form the first balloon 4710, and balloon 4710 has the first proximal part 4712 and the first distal portions 4714 and determines expansion chambers.Supply pipe 4707 can be expanded and enter the first proximal part 4712, and cooling package 4702 can have the aperture 4718 that is positioned at the far-end of supply pipe 4707 in the first proximal part 4712.The first proximal part 4712 is sealed near supply pipe 4707.Cooling package 4702 further comprises the second balloon 4720, and it has the second proximal part 4722 and the second distal portions 4724 and has determined discharge chamber.The second distal portions 4724 can be connected to the first distal portions 4714 fluid connection, and the first balloon 4710 can be wrapped in around the second balloon 4720.The second proximal part 4722 can be connected to passing away fluid connection.When cooling package 4702 is during in deployed condition, cold-producing medium can flow to the first distal portions 4714 from the first proximal part 4712, more then to near-end, flows through the second balloon 4720.Back-pressure from cold-producing medium can for example, so that the second balloon 4720 be expanded (, expansion flexibly), and the screw diameter of the first balloon 4710 that this can be increases.For instance, this determines it is favourable for size.Additionally, the spiral-shaped of the first balloon 4710 can be useful for required local or overall therapeutic modality.

Figure 48 A-48B figure has released a part for the cold therapy equipment 4800 with the different main balloon of spiral of configuration and non-helical balloon.Equipment 4800 comprises the cooling package 4802 at distal portions 4804 places of the bar 4806 that is positioned at the elongation of having determined passing away.Distal portions 4804 can have ladder, and cooling package 4802 can comprise applicator 4808, and applicator 4808 has helical form the first balloon 4810 of having determined expansion chambers and having comprised the first proximal part 4812 and the first distal portions 4814.Equipment 4800 can also comprise supply pipe 4816, and it extends into the first proximal part 4812, and cooling package 4802 can have the aperture 4818 of the far-end that is positioned at the first proximal part 4812 endogenous supply pipes 4816.The first proximal part 4812 is sealed near supply pipe 4816.Cooling package 4802 may further include the second balloon 4820, and it has the whole near-end neck 4822 that is connected to distal portions 4804.The second balloon 4820 can be determined discharge chamber, and discharge chamber is configured to expand (for example, flexible expansion) in response to the back-pressure of the cold-producing medium of discharging from the first balloon 4810.The first balloon 4810 can be connected to the inner surface of the second balloon 4820.The expansion of the second balloon 4820 (for example, flexible expansion) can be so that the screw diameter of the first balloon 4810 increases, so the crooked part of the first balloon 4810 moves to the inner surface of more close renal artery or nephrostome.For instance, the first balloon 4810 being placed among the second balloon 4820 is useful for the redundancy capacity of cold-producing medium is provided in vascular system.

Figure 49 figure has released a part for the cold therapy equipment 4900 that comprises the main balloon of spiral and non-helical balloon in another configuration.Equipment 4900 comprises the cooling package 4902 at distal portions 4904 places of the bar 4905 that is positioned at the elongation of having determined passing away.Distal portions 4904 can have ladder 4906 and a plurality of outlet opening 4907.Cooling package 4902 can comprise applicator 4908, applicator 4908 has helical form the first balloon 4910. equipment 4900 of having determined expansion chambers and having had the first proximal part 4912 and the first distal portions 4914 can also comprise the supply pipe 4916 that extends into the first proximal part 4912, and cooling package 4902 can have the aperture 4918 of the far-end that is positioned at supply pipe 4916.The first proximal part 4912 can be by near sealing supply pipe 4916.Cooling package 4902 may further include the second balloon 4920, and it is placed near distal portions 4904 and has the whole near-end neck 4922 that is connected to distal portions 4904.The first balloon 4910 can be wrapped in the second balloon 4920 around and the first distal portions 4914 can be connected to the distal portions 4904 in the second balloon 4920 distally fluid connection.When cooling package 4902 is during in deployed condition, the second balloon 4920 can be configured to from passing away, receive passively cold-producing medium by outlet opening 4907, and can be configured to the back-pressure producing in response to the cold-producing medium of being discharged by the first balloon 4910 and expand (as, expansion flexibly).The expansion of the second balloon 4920 (for example, expansion flexibly) can be so that the screw diameter of the first balloon 4910 increases, and this makes the part (for example, crooked part) of the first balloon 4910 move to the inner surface of more close renal artery or nephrostome.

Figure 50 figure has released a part for the cold therapy equipment 5000 in another configuration that comprises the main balloon of helical form and non-helical balloon.Equipment 5000 comprises the cooling package 5002 at distal portions 5003 places of the bar that is positioned at the elongation of having determined passing away, and filling tube 5004 is positioned at the filling aperture 5005 of the far-end of filling tube 5004 and supply pipe 5006.Cooling package 5002 comprises the supply aperture 5007 of the far-end that is positioned at supply pipe 5006.Supply pipe 5006 can comprise turning 5008, and elbow for example, near supply aperture 5007.Cooling package 5002 further comprises applicator 5009, and it has helical form the first balloon 5010 of having determined expansion chambers and having had the first proximal part 5011 and the first distal portions 5012.Cooling package 5002 can also comprise the second balloon 5014, and it has the second proximal part 5016 and the second distal portions 5018.The second proximal part 5016 can be connected to fluid connection fills near aperture 5005 sealed filling tube 5004.The second distal portions 5018 can by near supply pipe 5006 sealing, but with supply pipe 5024 and the first balloon 5010 between without fluid, be communicated with.The first balloon 5010 can claim that around the second balloon 5014 and be configured to receive the cold-producing medium from supply pipe 5006 around, and cold-producing medium is entered to passing away by the first proximal part 5011 discharges.The second balloon 5014 can be configured to receive packing material from filling tube 5004, and expansion (for example, expansion flexibly) cause the screw diameter increase of the first balloon 5010, this makes the part (for example, sweep) of the first balloon 5010 move to the inner surface of more close renal artery or nephrostome.

Figure 51 figure has released a part for the cold therapy equipment 5100 that comprises the main balloon of helical form and non-helical shape time balloon in another configuration.Equipment 5100 comprises the cooling package 5101 at distal portions 5102 places of the bar 5103 that is positioned at the elongation of having determined passing away, supply pipe 5106, and filling tube 5108.Distal portions 5102 can have ladder 5104 and portal 5106.Cooling package 5101 can comprise the supply aperture 5107 of the far-end that is positioned at supply pipe 5106, and the filling aperture 5109 that is positioned at the far-end of filling tube 5108.Cooling package 5101 may further include applicator 5110, and it has helical form the first balloon 5111, and it has been determined expansion chambers and has had the first proximal part 5112 and the first distal portions 5114.Supply pipe 5106 can be from portalling 5105 extensions extend into the first proximal part 5112, and the first proximal part 5112 can be sealed near supply pipe 5106.Cooling package 5101 may further include the second balloon 5116 around distal portions 5102, and it has the whole near-end neck 5118 that is connected to distal portions 5102.The second balloon 5116 can be configured to receive packing material and (for example expand from filling tube 5108, expansion flexibly) so that the screw diameter of the first balloon 5111 increases, this makes the part (for example, sweep) of the first balloon 5111 move to the inner surface of more close renal artery or nephrostome.

near-end time balloon

The main balloon of near-end and time balloon can be opened along the length direction longitudinal subdivision of the part of the cold therapy equipment as described in embodiment as several in the present invention.For example, inferior balloon can be a part for obstruction component, and described obstruction component is configured to inaccessible renal artery and/or nephrostome.Accompanying drawing 52A-53 shows several specific embodiments of the cold therapy equipment that comprises near-end time balloon.

Accompanying drawing 52A-52B shows cold therapy equipment 5200 parts that comprise a cooling package 5202 and obstruction component 5204, and described cooling package 5202 and obstruction component 5204 are opened along bar 5206 longitudinal subdivisions of the elongation of a definite passing away.Described bar 5206 has one first to be dwindled gradually part 5208 and dwindles gradually that 5209, one second of cooling package outlets in part 5208 are dwindled part 5210 gradually and in the second obstruction component outlet 5211 of dwindling gradually in part 5210 described first.Described cooling package 5202 and described obstruction component 5204 can be arranged at respectively described first and dwindle gradually part 5208 and second and dwindle gradually in part 5210.Described cold therapy equipment 5200 can comprise a supply pipe 5212, and described cooling package 5202 can have at the end of described supply pipe 5212 aperture 5213.Described cooling package 5202 also can comprise that one with the applicator 5214 of the first balloon 5215, to determine an extended cavity.Described supply pipe 5212 can tilt away to go forward side by side into the first balloon 5215 from described bar 5206.Described obstruction component 5204 can comprise second balloon 5216 of having determined an inaccessible chamber.Described the second balloon 5216 can be configured to passively and by obstruction component outlet 5211, receives cold-producing medium from passing away, and can be configured to expansion to respond the rear portion pressure of the cold-producing medium of discharging from described cooling package 5202.Described cooling package 5202 and described obstruction component 5204 are can sending state detachable at least partly, and with expansion state and deployed condition, illustrate respectively in accompanying drawing 52A-52B.Under described expansion state, described obstruction component 5204 can have a cross section size that is configured to abundant inaccessible renal artery and/or nephrostome.

As shown in accompanying drawing 52B, described device 5200 can comprise the control member 5220 that the control member 5218, the second of the first elongation extends further, with the control valve 5222 of the first far-end branch 5224 and the second far-end branch 5226.Described bar 5206 can comprise the first far-end junction point 5228, the second far-end junction points 5230 further, and first, dwindles gradually part 5208 and second and dwindle gradually the flexible portion 5232 between part 5210.The described first control member 5218 extending can extend along described control valve 5222 and the first far-end branch 5224, and is attached to described the first far-end junction point 5228.The described second control member 5220 extending can extend along described control valve 5222 and the second far-end branch 5226, and is attached to the second far-end junction point 5230.Described equipment 5200 can be configured to, the increase of described the first control member 5218 and/or the second control member 5220 or reduce the deflection that tension force can control valve 5206.Described pipe 5206 can flexible portion 5232 to blood vessel wall against or mouthful the first balloon position be flexible.Except abundant occluding vascular or mouth, replace described abundant occluding vascular or mouthful, described obstruction component 5204 can be configured to expansion state to support described pipe 5206 among a renal artery or nephrostome, so that the reset of controlled described cooling package 5202 to be provided among described renal artery or nephrostome.For example, described cooling package 5202 can be reset to excite neural adjustment of medicable freezing kidney in the different piece of renal artery and/or nephrostome.

Accompanying drawing 53 shows cold therapy equipment 5300, and it is similar to the cold therapy equipment 5200 shown in accompanying drawing 53A-53B, but described equipment 5300 has the cooling configuration of extra far-end and different supply and control configurations.Described equipment 5300 comprises that managing 5306 described in the cooling package 5302 that longitudinally separates along the pipe 5306 of the elongation of a definite passing away and obstruction component 5304. has far-end junction point 5307 and the distal tip 5308 of determining a far-end extended cavity.Described cooling package 5302 comprises having applicator 5310, and described applicator 5310 is determined the first balloon 5312 of an extended cavity, and described obstruction component 5304 has the second balloon 5314, and described the second balloon 5314 is determined the inaccessible chamber separating with passing away.Described equipment 5300 further comprises a filling tube 5316 that extends described the second balloon 5314, have the supply pipe 5318 of the side branches 5320 that extends described the first balloon 5312 and extend obstruction component 5304 described in the beveled distal end part 5322. of described distal tip 5308 and comprise that is filled an aperture 5324, packing material can be supplied to described the second balloon 5314 by it.Cooling package 5302 further comprises the first supply aperture 5326, and it is configured to guide cold-producing medium to expand in the first balloon, and described cooling package 5302 further comprises the second supply aperture 5328, and it is configured to guide cold-producing medium to expand in distal tip 5308.

Equipment 5300 further comprises control member 5330 and the control valve 5332 of elongation.Described control member 5330 can extend and be attached to far-end junction point 5307 along described control valve 5332.Described equipment 5300 can be configured to, the deflection that the increase of described control member 5330 or the tension force of minimizing can control valves 5306.Except abundant occluding vascular or mouthful, replace described abundant occluding vascular or mouthful, obstruction component 5304 can be configured to expansion state with stay pipe 5306 within renal artery or nephrostome, so that the controlled reset of described cooling package 5302 to be provided at renal artery or nephrostome.For example, described cooling package 5302 can reset, to excite the medicable low the kidney warming neuroregulation in the different piece of renal artery and/or nephrostome.

substitute the type of cooling

The chiller according to the cooling package described in several specific embodiments of the present invention with deployed condition, it does not relate to cold-producing medium evaporation.For example, this embodiment can comprise that cooling package is configured to, and liquid or the postcritical cold-producing medium of circulation under chilling temperature, to cause convection current and the conductive cooling main hot transmitting portions through applicator.In above-mentioned applicator, the flow impedance of supply can be generally equal to the flow impedance of discharge.For example, the cross section in supply chamber can be generally equal to the cross section of passing away.In certain embodiments, cold therapy equipment has and is configured to not need phase transformation to propagate the cooling package of cold-producing medium, can have and help be supplied to cooling package and/or the cold-producing medium of cold-producing medium to discharge the feature of described cooling package.For example, can comprise that the first pump is for increasing the pressure that flows to the cold-producing medium of cooling package, and/or vacuum source (that is, the second pump) is for reducing the pressure of the cold-producing medium that flows out cooling package.Except described the first pump or alternately, cold-producing medium can be from a pressurized source supply.Consideration based on operation, that is, cold-producing medium viscosity and the flow impedance of the supply of cold therapy equipment, discharge and hot transmitting portions can be selected, to excite the cold-producing medium of different in flow rate.Described flow velocity can be selected, and for example, meets heat transfer speed fully to excite medicable low the kidney warming neuroregulation.

Figure 54 shows a part for cold therapy equipment 5400, and it can be configured to the convective heat transfer that does not need cold-producing medium phase transformation.Described equipment 5400 comprises the cooling package 5402 on the distal portions 5404 of pipe 5406 of the elongation of determining passing away.Cooling package 5402 comprises that one with the applicator 5408 of balloon 5410, and it has determined a flowing lumen.Described equipment 5400 also comprises that the length along described pipe 5406 extends the supply pipe 5412 among described balloon 5410, and cooling package 5402 comprises the aperture 5414 on the far-end of supply pipe 5412.In several embodiment, described supply pipe 5412 is quite large, and is configured to transport liquid cold-producing medium, and aperture 5414 is not to be configured to cause that pressure drop is with vaporized refrigerant fully.When cooling package 5402 is during in deployed condition, balloon 5410 can be configured at least one substantial liquid line and has been full of cold-producing medium.Cold-producing medium can be supplied to passing away from supply pipe 5412.Accompanying drawing 54 comprises that indication is through the arrow 5416 of the direction of the cold-producing medium of balloon 5410.Described cold-producing medium can be the have low-freezing liquid of (that is, ethyl group ethanol), and can under cryogenic temperature, transport through supply pipe 5412.Convective heat transfer between coolant and balloon 5410 can cooling renal artery or nephrostome, and to excite, medicable kidney is neural to be adjusted.

Accompanying drawing 55 shows a part for cold therapy equipment 5500, and it also configures in order not need the convective heat transfer of cold-producing medium phase transformation.Described equipment 5500 is included in the cooling package 5502 on the distal portions 5504 of pipe 5506 of elongation, and bar 5506 comprises bar 5506 is divided into the bar spacer 5508 of determining supply first longitudinal component 5510 in chamber and the second longitudinal component 5512 of definite passing away.Cooling package 5502 comprises the applicator 5514 with balloon 5516, and balloon 5516 comprises the balloon spacer 5518 of having determined the U-shaped chamber in balloon 5516.Balloon 5516 can be configured to make liquid refrigerant circulation from the first longitudinal component 5510, by U-shaped chamber, and enters the second longitudinal component 5512.Figure 55 comprises the arrow 5520 of the direction while pointing out that flow of refrigerant is passed through balloon 5516.

In some embodiment, the cooling package supercritical liq (for example, supercritical nitrogen or water) that is configured to circulate.Supercritical liq can provide sufficient cooling and not undergo phase transition, but conventionally must maintain under relatively high pressure.The cooling package of supercritical liq of being configured to circulate can comprise that supply, the heat with high pressure grade transmits and discharge structure.For example, such cooling package can comprise not expansible applicator (for example, having metallic walls).Such applicator can move the diverse location that contacts renal artery or nephrostome in therapeutic process.

extra embodiment

Above-mentioned and in Fig. 1-5B and 12-55 illustrated cold therapy equipment can be changed to form according to the extra embodiment of present technique configuration.For example, in Figure 17 A-17B illustrated cold therapy equipment 1700 and above-mentioned and in Fig. 1-5B and 12-55 illustrated other cold therapy equipment without guiding elements can comprise near or the guiding elements that extends of distal portions by balloon.Similarly, above-mentioned and in Fig. 1-5B and 12-55 illustrated cold therapy equipment can comprise the control member that is configured to containing control (for example, bracing wire).Control line can be used to, and for example, from vascular system outside, controls (for example, deflection, inclination, location or guiding) cooling package, applicator or other cold therapy part of appliance.

Above-mentioned and in Fig. 1-5B and 12-55 illustrated cold therapy equipment comprise the balloon with various features.In some instances, producing consideration and other factors perhaps makes some adjustment be required more or less.For example, some material may more adapt to pressing operation than molded operation, and vice versa.Similarly, some balloon are used some production process more easily to form than other production process of use.For example, there is the balloon of the far-end of complete sealing, in some instances, can be difficult to form with compacting.Above-mentioned and in Fig. 1-5B and 12-55 the balloon in illustrated cold therapy part of appliance and balloon feature can change or exchange according to these factors.For example, far-end neck (for example, the far-end neck of sealing) can by above-mentioned and in Fig. 1-5B and 12-55 the far-end of the integrally closed in illustrated balloon replace.So this is favourable for the more compatible compacting production process of balloon.

The feature of above-mentioned cold therapy part of appliance can also be exchanged to form other embodiment of present technique.For example, the interior balloon 1514 of the cooling package 1502 in Figure 15 A can merge in the cooling package 1902 shown in Figure 19 A-19C.As another example, first supply pipe 1218 with the first beveled distal end part 1222 of the cold therapy equipment 1200 shown in Figure 12 can and the cooling package as shown in Figure 17 A-17B 1702 in, the first beveled distal end part 1222 is configured to guide cold-producing medium in the expansion of 1711 of heat insulating components.

relevant anatomy and physiology

Sympathetic nervous system (SNS) is a branch of autonomic nervous system and the Nervous system parasympathetic nervous system of unifying.It is movable (being called sympatheticotonia) and during stress time, become more movable in foundation level all the time.Be similar to neural other parts, sympathetic nervous system operates by the neuron of a series of interconnection.Sympathetic neuron is usually regarded as a part of peripheral nervous system (PNS), although many in central nervous system (CNS).The sympathetic neuron of spinal cord (it is a part of CNS) is communicated by letter with sympathetic neuron around via a series of sympathetic ganglion.In neuroganglion, spinal cord sympathetic neuron is incited somebody to action sympathetic neuron around by synapse and is engaged.Therefore, spinal cord sympathetic neuron is called to presynaptic (or before joint) neuron, around sympathetic neuron is called postsynaptic (or after joint) neuron simultaneously.

Synapse place in sympathetic ganglion, SPN discharges acetylcholine, binds and makes the chemical messenger of the nicotine receptor on postganglionic neuron excited.In response to this, stimulate, postganglionic neuron mainly discharges noradrenalin (element on new kidney).The excitement extending can cause that epinephrine is from medulliadrenal release.

Once be released, on new kidney, element and epinephrine are bundled in adrenoreceptor in surrounding tissue.Be tied to adrenoreceptor and cause neuron and hormone reaction.Physiological performance comprises platycoria, heart rate increase, sporadic vomiting and hypertension.Due to the binding of the cholinoceptor of boerhaave'a glands, also seeing perspires increases.

Sympathetic nervous system is responsible for constant mechanism in the many bodies in organs of living beings to regulate up and down.From the fiber of SNS, the tissue in each tract is almost innervated, to as pupil diameter, internal organs power diversified every provide at least some regulatory function the same as urinary volume.This reaction also referred to as human body sympathetic-adrenal gland reaction, because sympathetic fiber (but also having all other sympathetic fibers) is secreted acetylcholine before ending at the joint in adrenal medulla, this activates adrenergic secretion and in less degree, secretes noradrenalin (element on new kidney).Therefore, directly via regulating Main Function this reaction on cardiovascular system by sympathetic nervous system and the pulse that indirectly transmits via the catecholamine from adrenal medulla secretion.

Scientific research is considered as automatic regulating system by SNS conventionally, and in the situation that does not have the intervention of thought consciously to operate.Some theory of evolution theoretician proposes sympathetic nervous system and in organism, operates to keep survival in early days, because sympathetic nervous system is responsible for making human body in advance along getting action ready.In this pre-prepd example moment before wakeing up, wherein sympathetic nerve effluent increases to prepare to move by the light of nature.

1. sympathetic chain

As shown in Figure 56, SNS provides the neutral net that allows brain to communicate by letter with health.Sympathetic nerve stems from spinal column inside, towards intermedio-lateral cell column (or intermedio-lateral cell column), at the first pereonite place of spinal cord, starts, and thinks and extend to second or third lumbar vertebra section.Because its cell starts in the breast of spinal cord and waist, so SNS is said into, be to there is breast waist effluent.These neural aixs cylinders are left spinal cord by front/root.At spine, (near sense organ neuroganglion, pass through, it enters front of spinal nerves there for it.Yet, being different from somatic nerve domination, it is separated by near (it is aorta bifurcation) ganglionic white rami junctional complex before the spinal column that is connected near spinal column other (it is spinal column) or extends on spinal column side rapidly.

In order to arrive Target organ and gland, the aixs cylinder very long distance of should advancing in vivo, and for this reason, many aixs cylinders are transmitted its message relay to the second cell by synapse.The dendron that the end leap space of aixs cylinder, synapse are connected to the second cell.The first cell (presynaptic cell) transsynaptic gap sends neurotransmitter, and it activates the second cell (postsynaptic cell) there.Then this message be carried to final destination.

In other ingredient of SNS and peripheral nervous system, produce these synapses being called ganglionic position.The cell that sends its fiber is called cell before joint, and its fiber leaves ganglionic cell and is called cell after joint.As previously mentioned, before the joint of SNS, cell is positioned between the first breast (T1) section and third lumbar vertebra (L3) section of spinal cord.After joint, cell makes its cyton be sent to Target organ or gland in neuroganglion and by its aixs cylinder.

Neuroganglion not only comprises sympathetic trunk, and comprises cervical ganglia (above, under neutralization) (it is sent to head and chest manifold by sympathetic fiber) and abdominal cavity and mesentery neuroganglion (it is sent to internal organs by sympathetic fiber).

2. the innervation of kidney

As shown in Figure 57, by the kidney clump RP being associated nearly with renal artery, kidney is innervated.Kidney clump RP is around renal artery and is embedded into the autonomic plexuses in arteriorenal adventitia.Kidney clump RP extends until it arrives the entity place of kidney along renal artery.The fiber that kidney clump RP is contributed to some extent stem from ganglia coeliaca, superior mesenteric ganglion, aortic nerve joint and aorta from.Kidney clump RP also referred to as kidney nerve is mainly formed partly and is formed by sympathetic nerve.There is not the parasympathetic innervation of (or at least considerably less) kidney.

Preganglionic neuron cyton is arranged in the intermedio-lateral cell column of spinal cord.Before joint, aixs cylinder becomes little visceral nerve, minimum visceral nerve, the first lumbar splanchnic nerves, the second lumbar splanchnic nerves through spinal column paraganglion (it does not form synapse), and marches to ganglia coeliaca, superior mesenteric ganglion and aortic nerve joint.Postganglionic neuron cyton is left ganglia coeliaca, superior mesenteric ganglion and aortic nerve joint and is arrived kidney clump RP and be distributed to kidney blood vessel.

3. kidney sympathetic activity

Message is passed through SNS in bidirectional flow.Spread out of the variation that message can side by side trigger the different piece of human body.For example, sympathetic nervous system can cardioacceleration; Widen bronchial; Reduce the motion (motion) of large internal organs; Vasoconstrictive; Increase the wriggling in esophagus; Cause pupil dilation, piloerection (goose pimples) and diaphoresis (perspiration); And raising blood pressure.The various organs from human body are carried to other organ and particularly brain with sensation receptor by signal to import message into.

Hypertension, heart failure and chronic nephropathy are several in the numerous disease state that causes of the long-term excitement by SNS, especially kidney sympathetic nervous system.The long-term excitement of SNS is the inadaptable reaction that drives the progress of these morbid states.The drug control of renin angiotensin aldosterone system has been the method for poor efficiency for reducing for a long time hyperactive of SNS but a little.

As mentioned above, experimentally with human body in, kidney sympathetic nervous system has been identified as the main contributions person of the complicated pathophysiology of hypertension, volume overload (for example heart failure) state and carrying out property nephropathy.The research that adopts radiotracer dilution process to measure plain overflow the new kidney from kidney to blood plasma demonstrates element (NE) relief flow rate on the new kidney of kidney of increase in having the patient body of essential hypertension, particularly in young hypertension object, this is consistent with the NE overflow from heart increasing, distribute unanimously with the hematodinamics of conventionally seeing in hypertension in early days, and it is characterized in that heart rate, cardiac output and the renal vascular resistance of increase.Present known essential hypertension is generally neuronic, is usually attended by obvious sympathetic nervous system hyperkinesia.

The excitement of heart kidney sympathetic activity is even more obvious in heart failure, as indicated in this patient population from heart and kidney to the excessive increase of the NE overflow of blood plasma.Idea is consistent therewith is to have kidney sympathetic activation in the patient body of the congestive heart failure up-to-date proof to the strong negative predictive value of full cause mortality rate and heart transplantation, and it is irrelevant with overall sympathetic activity, glomerular filtration rate and left ventricular ejection fraction.These treatment regimeies of find supporting to be designed to reduce kidney sympathetic stimulation have the potentiality of the survival that improves the patient with heart failure.

Chronic and feature end-stage renal disease is all the sympathetic activation of strengthening.In having the patient body of crooked nephropathy, on the new kidney more than intermediate value, the blood plasma level of element has been proved to be full cause of the death silk screen and because of the dead omen of cardiovascular disease.Like this equally for the patient who stands patient of diabetes or radiographic contrast nephropathy.There is very convictive proof, the sensation input signal that its proposition stems from disease kidney is the initiation of flowing out of the maincenter sympathetic nerve that improves and the main contributions person of maintenance in this patient population, this has promoted the generation of the well-known negative consequence that chronic sympathetic activity is excessive, such as hypertension, left ventricular hypertrophy, ventricular arrhythmia, sudden cardiac death, insulin resistant, diabetes and metabolic syndrome.

(i) kidney sympathetic activities is movable

Sympathetic nerve to kidney stops in blood vessel, juxtaglomerular apparatus and renal tubules.The orthosympathetic stimulation of kidney causes that the renin release of increase, the sodium of increase (Na+) heavily absorb and the minimizing of renal blood flow.These ingredients of the neuroregulation of renal function are stimulated considerably take under the morbid state that the sympatheticotonia that improves is feature, and clearly the hypertension in hypertension human body are contributed to some extent.Because kidney sympathetic activities stimulates the renal blood flow cause and the reduction of glomerular filtration rate, it may be the basis of the renal function loss in Cardiorenal syndrome, Cardiorenal syndrome is the complicated renal dysfunction gradually as chronic heart failure, has conventionally the clinical course rising and falling along with patient's clinical state and treatment.Obstruct kidney to spread out of the tactful central action sympathetic nerve of pharmacology medicine, beta-blocker (intention reduces renin release), angiotensin converting enzyme inhibitor and receptor blocking agent (intention stops the action as the Angiotensin II of the result of renin release and aldosterone activation) and the diuretic (intention antagonism kidney sympathetic nerve sympathetic nerve mediation sodium and water keep) of the consequence of sympathetic stimulation.Yet current pharmacology's strategy has obvious restriction, comprise limited effect, accordance problem, side effect etc.

(ii) kidney sensation nervus centripetalis is movable

Kidney channel by kidney sensation nervus centripetalis the overall structure in central nervous system communicate by letter.A plurality of forms of " injury of kidney " can cause the activation of sensation input signal.For example, renal ischaemia, stroke volume or renal blood flow reduce or abundant adenosinase can trigger the activation that nervus centripetalis is communicated by letter.As shown in Figure 58 A and 58B, this imports communication into may be from kidney to brain, or may be from a kidney to another kidney (via central nervous system).These input signals are integrated by central authorities, and can cause the sympathetic nerve increasing to outflow.Kidney is pointed in this sympathetic nerve excitation, thereby activates RAAS and cause renin secretion, sodium retention, capacity and the blood-vascular system disease increasing.Maincenter sympathetic activity excessively also affects by sympathetic nerve and makes other organ and the body structure that innervate, such as heart and peripheral vessels, causes the described adverse effect of sympathetic activation, and its many aspects are also contributed to some extent to increased blood pressure.

Therefore, physiology suggestion (i) has the denervation that spreads out of orthosympathetic tissue will reduce the minimizing of unsuitable renin release, salt retention and renal blood flow, and (ii) have the denervation of importing sensorineural tissue into by the direct impact on posterior hypothalamus also contralateral kidney reduces the system of hypertension and the Other diseases that is associated with the maincenter sympatheticotonia increasing is contributed by it.Except importing the maincenter effect of easing stress of kidney denervation into, can anticipate that various other makes the minimizing of the expectation that the maincenter sympathetic nerve of the organ (such as heart and blood vessel) that innervates flows out sympatheticly.

B. the additional clinical benefit of kidney denervation

As above provided, kidney denervation is probably valuable in the treatment of the totally and particularly a plurality of clinical diseases of kidney sympathetic activity to increase, inappropriate fluid maintenance, Cardiorenal syndrome and sudden death in described kidney sympathetic activity such as hypertension, metabolic syndrome, insulin resistant, diabetes, left ventricular hypertrophy, chronic end-stage renal disease, heart failure.Because the minimizing of nervus centripetalis signal is contributed to some extent to the systematicness reduction of sympatheticotonia/excitement, so kidney neuromodulation also may be useful when treating with the hyperfunction Other diseases being associated of systemic sympathetic nerve.Therefore, kidney denervation can also intend to make by sympathetic nerve other organ and the body structure that innervate, is included in those that identify in Figure 56.For example, as previously discussed, the minimizing of maincenter sympathetic drive can reduce the insulin resistant that torments patient with metabolic syndrome and type ii diabetes.In addition, have osteoporotic patient can be sympathetic ground excited, and may benefit from the downward adjusting of the sympathetic drive of following kidney denervation.

C. realize entering in arteriorenal blood vessel

According to present technique, can be by entering to realize the neuromodulation of left and/or right kidney clump RP (it is associated with a left side and/or right renal artery nearly) in blood vessel.As shown in Figure 59 A, by aorta, from the left ventricle of heart, carry the blood being moved by the contraction of heart.Aorta drops in the renal artery of left and right by Xiong He branch.Below renal artery, aorta is at left and right iliac artery punishment fork.Left and right ilium declines by left and right lower limb respectively and adds left and right femoral artery.

As shown in Figure 59 B, blood collecting is in vein and be back in heart, by femoral vein to iliac vein and in postcava.Postcava is branched off into left and right renal veins.On renal veins, postcava rises with the right atrium pumping blood to heart.From right atrium, blood is pumped out in lung by right ventricle, and it is combined with oxygen there.The blood of being combined with oxygen is transported to left atrium from lung.The blood of being combined with oxygen is carried and is got back to aorta from left atrium by left ventricle.

As described in detail later, just place, the bottom of the femoral triangle below the mid point of inguinal ligament enters and conduit is inserted to femoral artery.Can insert conduit by this entry site, via skin enter femoral artery and lead to iliac artery and aorta in, enter left or right renal artery.This comprises provides path in the blood vessel that each renal artery and/or other renovascular minimally-invasive are entered.

Wrist, upper arm and shoulder region other position for conduit is introduced to Arterial system.In selection situation, can utilize the conduit of radius, buttocks or axillary artery to insert.The shadowgraph technique of use standard, can make the conduit introduced via these inlet points in left side through subclavian artery (or under clavicle on right side and brachiocephalic artery), by aortic arch, along descending aorta downwards and enter renal artery.

D. renovascular character and characteristic

Due to according to present technique by entering to realize the neuromodulation of left and/or right kidney clump RP in blood vessel, so renovascular character and characteristic can impose restriction and/or the information about this design is provided the design of equipment, system and method.Some leap patient crowd in these character and characteristic and/or leap time are in specific patient body and in response to morbid state, become described morbid state such as hypertension, chronic nephropathy, angiopathy, end-stage renal disease, insulin resistant, diabetes, metabolic syndrome etc.As explained herein, these shapes and characteristic can have meaning to the effect of the program of endovascular device and particular design.Interested character can comprise for example material/machinery, space, hydrodynamics/hematodinamics and/or macroscopic property.

As discussed previously, can make conduit advance to left or right renal artery via skin via path in minimally-invasive blood vessel.Yet, it may be challenging that minimally-invasive renal artery enters, for example, because compare with some other tremulous pulse that is used by convention conduit to enter to compare, renal artery is usually extremely tortuous, may have relatively little diameter and/or may have relatively short length.In addition, atherosclerosis of renal artery is common in many patients, especially has those of cardiovascular disease.Renal artery dissection feature can also be explained for different patients aobvious different, further makes minimally-invasive enter and becomes complicated.For example, aspect relevant flexibility, diameter, length and/or atheromatous plaque burden and divide from aorta at renal artery aspect the deflecting angle of out branch and can see between significant patient and changing.When minimally-invasive while entering renal artery, for realize the equipment of kidney neuromodulation, these and other aspect that system and method should be considered renal artery dissection feature and the patient crowd's of leap variation thereof via access in blood vessel.

Except renal artery being entered become complexity, the details of kidney anatomical features also makes neuromodulation equipment become complicated with the stable establishment contacting between surface, arteriorenal chamber or wall.When neuromodulation equipment comprises energy delivery element (such as electrode), it is important that energy delivery element applies for predictability with consistent location between tube wall and contact force.Yet navigation is subject to the obstruction of the flexibility of tight quarters in renal artery and tremulous pulse.In addition, moving patients, breathing and/or Cardiac cycle may cause that renal artery is with respect to aortal remarkable movement, and Cardiac cycle can make renal artery diastole (impelling the wall of tremulous pulse to beat) momently, further make the establishment of stable contact become complicated.

Even after entering renal artery and promoting stable contact the between the wall surface of neuromodulation equipment and tremulous pulse, the adventitia neutralization that must modulate safely tremulous pulse via neuromodulation equipment nerve around.When the given potential clinical complication being associated with this type for the treatment of, from effectively applying thermal therapeutical in renal artery, be significant.For example, arteriorenal inner membrance and medium are very easy to be subject to hot injury.As discussed in more detail hereinafter, lumen of vessels inner membrance-dielectric thickness of membrance separation from it is meaned to targeted kidney nerve can be apart from several millimeters, the wall surface of tremulous pulse.Should be by enough energy delivery to targeted kidney nerve not make the situation modulated targeted kidney of tube wall superheated and mummification neural.Another the potential clinical complication being associated with superheated is from the thrombosis of solidifying blood flow that flows through tremulous pulse.Consider that this thrombosis can cause renal infarction, thereby kidney is caused to irreversible damage, should apply modestly the thermal therapeutical from carrying out in renal artery.Those of hot transferring power that therefore, be present in complicated fluid machinery and thermodynamic condition in renal artery during treating, particularly may affect treatment site for example, may be important when applying energy (, heat energy) in renal artery.

The position for the treatment of neuromodulation equipment should be configured to allow the capable of regulating of energy delivery element in renal artery locate and reorientate, because also may affect clinical efficacy.For example, considering that kidney nerve can be circumferentially spaced apart around at renal artery, may be interesting from applying completely circumferentially treatment in renal artery.Yet, may be caused that by continuous circumferential treatment wholecircle scar can produce the risk of the renal artery stenosis of raising, thereby negate any other treatment benefit of kidney neuromodulation.Therefore, more complicated scar may be expected to reorientating of a plurality for the treatment of positions along formation and/or the neuromodulation equipment of arteriorenal longitudinal dimension via network structure as herein described.Yet, it should be noted that the benefit that produces circumferential ablation can surpass the risk of renal artery stenosis, or can alleviate this risk with some embodiment or in some patient, and to produce circumferential ablation can be target.In addition, renal artery is tortuous especially or wherein have distal branch blood vessel away from the main blood vessel of renal artery, make in the challenging situation of some locational treatment therein, the variable location of neuromodulation equipment and reorientate and can prove useful.The manipulation of device in renal artery also should be considered the mechanical damage being applied on renal artery by device.Device in tremulous pulse such as causing mechanical damage owing to inserting, handling, overcoming the motion causing such as crooked, such as cutting, perforation, corrode inner membrance or damage internal elastic membrane.

Can be interim inaccessible in short time in minimum or uncomplicated situation by arteriorenal blood flow.Yet the obturation of plenty of time should be avoided preventing from causing the damage to kidney, such as ischemia.If avoiding together inaccessible or inaccessible is of value to embodiment to make the inaccessible persistent period for example be confined to be no more than 2-5 minute may be useful.

Based on (1) renal artery, get involved, (2) the consistent and stable placement that treatment member abuts tube wall, (3) treatment of leap tube wall effectively applies, (4) therapeutic equipment is positioned to and reorientates to have allowed potentially a plurality for the treatment of positions, and (5) avoid or limit the above-mentioned challenge of the persistent period of blood flow obturation, may interested renovascular various independence and accessory charactor for example comprise (a) blood vessel diameter, length of vessel, inner membrance-dielectric thickness, coefficient of friction and flexibility; (b) diastolic dimension of tube wall, consistency and elasticity modulus; (c) peak value heart contraction and diastole blood flow rate in latter stage, average heart contraction-diastole Maximum velocity and average/maximum blood flow rate of measuring volume; (d) thermal convection current of the heat conductivity of the specific heat capacity of blood and/or tube wall, blood and/or tube wall and/and blood flow by tube wall therapentic part and/or radiant heat transfer; (e) moving with respect to aortal renal artery and by breathing, moving patients and/or blood flow pulsation initiation; (f) and renal artery with respect to aortal deflecting angle.To these character be described in more detail with respect to renal artery.Yet according to the equipment, the system and method that are used for realizing kidney neuromodulation, arteriorenal this type of character can also instruct and/or constrained designs characteristic.

As mentioned above, be positioned the geometry that equipment in renal artery should meet tremulous pulse.Renal artery blood vessel diameter DRA is conventionally in the scope of about 2～10mm, and the DRA of most patients is from about 4mm to the about 6mm of about 8mm average out to.Renal artery length of vessel LRA (between mouth and its far-end branch at it at aorta/renal artery junction point) is conventionally in the scope at about 5～70mm, and very large a part of patient is in the scope of about 20～50mm.Because targeted kidney clump is embedded in arteriorenal adventitia, so compound inner membrance-dielectric thickness IMT (from the surface, chamber of tremulous pulse to the radially outward distance of the adventitia that comprises target nerve structure) is also significant, and conventionally, in the scope of about 0.5～2.5mm, be on average about 1.5mm.Although the treatment of certain depth is important for arriving target neural fiber, treatment should excessively dark (for example,, apart from arteriorenal inwall > 5mm) to avoid non-destination organization and the anatomical structure such as renal veins.

May interested arteriorenal additional character be by the degree with respect to aortal kidney motion of breathing and/or blood flow pulsation causes.The kidney that is positioned at the patient of arteriorenal far-end can reach 4 along with breathing to drift about to move to cranium side ".This can give significant motion to connecting the renal artery of aorta and kidney, thus from neuromodulation equipment requirements hardness and flexible peculiar balance with contacting during breath cycle between maintenance thermal therapeutical element and tube wall.In addition, renal artery may be obviously different between patient from the deflecting angle between aorta, and can for example due to kidney motion, in patient body, dynamically change.Deflecting angle conventionally can be within the scope of approximately 30 °-135 °.

Above-described embodiment of cold therapy equipment be configured to by thigh approach, oar approach or other applicable approach come accurately low temperature applicator to be placed among renal artery and/or nephrostome or near.In the arbitrary above-described embodiment with reference to Fig. 1-55, it is about 3mm to about 8mm that single balloon can be configured to expand into diameter, a plurality of balloons can be configured to uniformly expand into diameter be about 3mm to 8mm, and in some embodiment for 4mm arrives 8mm.In addition, in any embodiment with reference to described in Fig. 1-55, balloon can be individually and/or is had uniformly about 8mm to the length of about 15mm, and is 10mm in certain embodiments.For example, some specific embodiments of the equipment in Fig. 1-55 can have the long balloon of 10mm, and it is configured to expand into diameter is that 4mm is to 8mm.Size with reference to the bar of the equipment in any embodiment described in Fig. 1-55 can be confirmed as adapting in 6Fr sheath, for example, and 4Fr bar size.

example

1. a cold therapy equipment, comprising:

The bar with the elongation of distal portions, wherein said bar be configured to by described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of at least a portion of described bar, described supply chamber is configured to receive liquid refrigerant; And

Be positioned at the cooling package of the described distal portions of described bar, described cooling package has sending state and deployed condition, described cooling package comprises applicator, described applicator at least have and described supply chamber between the first hot transmitting portions and the second hot transmitting portions of fluid connection, in described deployed condition, described the first hot transmitting portions is configured under described deployed condition has the first heat transfer rate when described cooling package receives cold-producing medium, and described the second hot transmitting portions is configured under described deployed condition, when described cooling package receives cold-producing medium, to have second heat transfer rate lower than described the first heat transfer rate, and wherein said the first hot transmitting portions is non-side face on longitudinal section of the length along described cooling package.

2. the cold therapy equipment in example 1, wherein said cooling package has central longitudinal axis and comprises the aperture from wherein flowing through for cold-producing medium, described applicator comprises the balloon with inner surface, the described central longitudinal axis under described deployed condition to the distance in described aperture be not less than under described deployed condition from described central longitudinal axis to described inner surface described aperture perpendicular to approximately 20% of the distance in the plane of described central longitudinal axis.

3. the cold therapy equipment in example 1, further comprise along the passing away of at least a portion of described bar, wherein said cooling package comprises the aperture from wherein flowing through for cold-producing medium, described supply chamber has and comprises the spiral helicine part of being roughly of described aperture, described spiral helicine part is wrapped in around described passing away, and described aperture is configured to guide cold-producing medium directly to expand from described supply chamber towards described the first hot transmitting portions.

4. the cold therapy equipment in example 3, wherein said cooling package has central longitudinal axis, and surpasses about 0.1mm in aperture described in described deployed condition and described central longitudinal axis interval.

5. the cold therapy equipment in example 3, wherein said applicator comprises the balloon with inner surface, and described aperture about 1mm of inner surface described in distance under described deployed condition.

6. the cold therapy equipment in example 3, wherein said cooling package comprises that a plurality of cold-producing mediums can be from the aperture of wherein flowing through, and described a plurality of aperture is arranged on the different side face position of described spiral helicine part.

7. the cold therapy equipment in example 1, further comprises the heat insulating component near described the second hot transmitting portions.

8. the cold therapy equipment in example 7, wherein said applicator comprises the balloon with inner surface, the part that described the second hot transmitting portions is described balloon, and described heat insulating component is near described inner surface.

9. the cold therapy equipment in example 8, wherein said the first and second hot transmitting portions are roughly helical form.

10. the cold therapy equipment in example 7, wherein said applicator comprises balloon, the first with the first average thickness that described the first hot transmitting portions is described balloon, the second portion with the second average thickness that described the second hot transmitting portions is described balloon, and described the first average thickness is less than described the second average thickness.

Cold therapy equipment in 11. examples 1, further comprises the heat insulating component of the first elongation and the heat insulating component of the second elongation, wherein---

Described applicator under described deployed condition, has the 3rd heat transfer rate and described cooling package receives the cold-producing medium higher than described the second heat transfer rate,

Described applicator has the 4th heat transfer rate and described cooling package and receives lower than described first and the cold-producing medium of the 3rd heat transfer rate under described deployed condition,

Described the first heat insulating component is near described the second hot transmitting portions,

Described the second heat insulating component is near described the 4th hot transmitting portions,

And

Described the 3rd hot transmitting portions alone or on longitudinal section in the length along described cooling package, be non-side face together with described the first hot transmitting portions.

Cold therapy equipment in 12. examples 11, wherein said the first and second heat insulating components have been determined filling chamber, described filling chamber is configured to receive packing material, and described filling chamber has subside configuration and expansion configuration.

Cold therapy equipment in 13. examples 11, wherein said the first and second heat insulating components are in substantially parallel relationship to the length of described cooling package in described deployed condition.

Cold therapy equipment in 14. examples 1, further comprises the heat insulating component of elongation, and wherein said applicator comprises balloon, and at least a portion of described heat insulating component is not connected to described balloon and can under described deployed condition, in described balloon, moves.

Cold therapy equipment in 15. examples 14, wherein said heat insulating component has and is roughly leg-of-mutton sectional area.

Cold therapy equipment in 16. examples 14, the described partial configuration of wherein said heat insulating component for to move in described balloon in response to gravity under described deployed condition.

Cold therapy equipment in 17. examples 14, wherein said heat insulating component has been determined the filling chamber that is configured to receive packing material, and described filling chamber has subside configuration and expansion configuration.

Cold therapy equipment in 18. examples 1, further comprise determined and described supply chamber between the interior balloon chamber of fluid connection, wherein said applicator comprises outer balloon, described interior balloon is in described outer balloon, described interior balloon comprises the aperture from wherein flowing through for cold-producing medium, and described interior balloon has subside configuration and expansion configuration.

Cold therapy equipment in 19. examples 18, the part in wherein said supply chamber extends through described interior balloon.

Cold therapy equipment in 20. examples 18, wherein said interior balloon comprises the locational a plurality of apertures of different side faces that are arranged in around described interior balloon.

Cold therapy equipment in 21. examples 20, wherein said a plurality of apertures are arranged as helical pattern.

Cold therapy equipment in 22. examples 18, wherein said outer ball has female and lands, and described the first hot transmitting portions comprises described lands, and described the second hot transmitting portions comprises described female.

Cold therapy equipment in 23. examples 22, wherein said lands is roughly helical form.

Cold therapy equipment in 24. examples 18, wherein said outer balloon has been determined outer balloon chamber, total fluid connection connection between described interior balloon and described outer balloon has the first clear passage area, described supply chamber is connected and has the second clear passage area with total fluid connection between described interior balloon chamber, and described the first clear passage area is less than described the second clear passage area.

25. 1 kinds of cold therapy equipment, comprising:

The bar with the elongation of distal portions, wherein said bar be configured to by described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Be positioned at the cooling package of the described distal portions of described bar, described cooling package has sending state and deployed condition, described cooling package has applicator and a plurality of aperture of cold-producing medium from wherein flowing through that supply, wherein said a plurality of aperture is arranged about described applicator, cold-producing medium stream is directed to the discrete region in described applicator, and described discrete region provides non-side face whole sub-cooled pattern.

Cold therapy equipment in 26. examples 25, further comprise and be configured to cold-producing medium to be transported to along described bar the supply chamber of described cooling package, extend at least in part in described applicator in wherein said supply chamber, and described a plurality of aperture is the separate hole along the part in the described supply chamber in described applicator.

Cold therapy equipment in 27. examples 26, the described part in wherein said supply chamber is that linear pipe and described hole are arranged on the different side face position in described supply chamber.

Cold therapy equipment in 28. examples 26, the described part in wherein said supply chamber is serpentine pipe, and described hole is arranged as the Outboard Sections along described serpentine pipe.

Cold therapy equipment in 29. examples 26, further comprise the first supply branch of inclination and the second supply branch of inclination, a far-end that is positioned at described the first supply chamber in wherein said a plurality of aperture, and another in described a plurality of aperture is positioned at the far-end of described the second supply branch, and described the first and second supply branches separate in the vertical along the length of described cooling package.

Cold therapy equipment in 30. examples 29, further comprise the first supply chamber and the second supply chamber, wherein the first and second supply chambeies are configured to, along described bar, cold-producing medium is transported to described cooling package, described the first supply branch has determined the distal portions in described the first supply chamber, and described the second supply branch has determined the distal portions in described the second supply chamber.

31. 1 kinds of cold therapy equipment, comprising:

The bar with the elongation of distal portions, wherein said bar be configured to by described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber has first-class impedance,motional and is configured to transport liquid and/or supercritical refrigerant;

Along the passing away of the described bar of at least a portion, described passing away has second impedance,motional and is configured to transport liquid and/or supercritical refrigerant;

Be positioned at the cooling package of the described distal portions of described bar, described cooling package has sending state and deployed condition, described cooling package comprises the applicator with balloon, fluid connection between described balloon and described supply chamber and described passing away, and wherein said first-class impedance,motional equals described second impedance,motional substantially.

32. 1 kinds of cold therapy equipment, comprising:

The bar with the elongation of distal portions, wherein said bar be configured to by described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant; And

Be positioned at the cooling package of described distal portions, described cooling package has sending state and deployed condition, described cooling package comprises aperture and applicator, described applicator comprises the first balloon and the second balloon, fluid connection between described aperture and described supply chamber, described the first balloon have and described aperture between the hot transmitting portions of fluid connection, wherein said the second balloon subsides at least in part under described sending state, wherein said hot transmitting portions has the heat transfer rate that is enough to cause medicable freezing kidney neuroregulation under described deployed condition when described cooling package receives cold-producing medium, and wherein said hot transmitting portions is non-side face on longitudinal section of the length along described cooling package.

33. 1 kinds of cold therapy equipment, comprising:

The bar with the elongation of distal portions, wherein said bar be configured to by described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant; And

Be positioned at the cooling package of described distal portions, described cooling package has sending state and deployed condition, described cooling package comprises aperture and applicator, described applicator comprises the first balloon and the second balloon, fluid connection between described aperture and described supply chamber, described the first balloon have and described aperture between the first hot transmitting portions of fluid connection, described the second balloon has the second hot transmitting portions, and described the second balloon subsides at least in part under described sending state, wherein said the first hot transmitting portions is substantially be not as flexible as described the second hot transmitting portions, wherein said the first hot transmitting portions has the first heat transfer rate that is enough to cause medicable freezing kidney neuroregulation under described deployed condition when described cooling package receives cold-producing medium, wherein said the second hot transmitting portions has second heat transfer rate lower than described the first heat transfer rate under described deployed condition when described cooling package receives cold-producing medium, and wherein said the first hot transmitting portions is non-side face on longitudinal section of the length along described cooling package.

Cold therapy equipment in 34. examples 33, wherein said the first balloon is not as described the second balloon flexibility.

Cold therapy equipment in 35. examples 33, wherein said the first balloon is roughly the second balloon inflexibility and described and is roughly flexible.

Cold therapy equipment in 36. examples 33, wherein:

Described the first balloon has the sectional area that is roughly D type,

Described the first hot transmitting portions is roughly inflexibility,

Described the second balloon has and is roughly the sectional area joint area of C type to the region of the sectional area that is roughly D type of described the first balloon, and

Described the second hot transmitting portions is roughly flexible.

Cold therapy equipment in 37. examples 33, wherein said applicator is distensible and is configured to renal artery or the nephrostome with different cross section size fully inaccessible.

Cold therapy equipment in 38. examples 33, wherein described the second balloon in described deployed condition is configured to heat isolation between a part for described therapentic part and described the first balloon.

Cold therapy equipment in 39. examples 33, wherein said applicator comprises the spacer between described the first balloon and described the second balloon, described spacer is roughly inflexibility.

Cold therapy equipment in 40. examples 33, wherein said the first balloon has been determined the first Room, described the second balloon has been determined the second Room, between described the first Room and described the second Room, be that liquid separates, described equipment further comprises the filling chamber along at least a portion of described bar, and described filling chamber is configured to described the second Room supply packing material.

Cold therapy equipment in 41. examples 33, wherein-

Described cooling package has the first length,

Described the first balloon for extend and there is the second length,

Described the second balloon for extend and there is the 3rd length, and,

Described first, second, and third length is substantially parallel under described deployed condition.

42. 1 kinds of cold therapy equipment, comprising:

The bar with the elongation of distal portions, wherein said bar be configured to by described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

The supply chamber of at least a portion of described bar, described supply chamber is configured to receive liquid refrigerant; With

Be positioned at the applicator of the described far-end of described bar, described applicator has sending state and deployed condition and comprises the first Room and the second Room, described the first Room have and described supply chamber between the first hot transmitting portions of being communicated with of fluid, and described the second Room has the second hot transmitting portions, wherein said the first hot transmitting portions is substantially be not as flexible as described the second hot transmitting portions, wherein said the first hot transmitting portions has the first heat transfer rate that is enough to cause medicable freezing kidney neuroregulation under described deployed condition when described cooling package receives cold-producing medium, wherein said the second hot transmitting portions has second heat transfer rate lower than described the first heat transfer rate under described deployed condition when described cooling package receives cold-producing medium, and wherein said the first hot transmitting portions is extended in the plane perpendicular to described length around the complete side face of the described applicator of deficiency.

43. 1 kinds of cold therapy equipment, comprising:

The bar with the elongation of distal portions, wherein said bar be configured to by described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant; With

Be positioned at the cooling package of described distal portions, described cooling package has sending state and deployed condition, described cooling package comprises aperture and applicator, described applicator comprises the first balloon and the second balloon, fluid connection between described aperture and described supply chamber, described the first balloon determine the first Room and have and described aperture between the first hot transmitting portions of fluid connection, described the second balloon is determined the second Room and is had the second hot transmitting portions, described the second balloon subsides at least partly under described sending state, wherein said the first hot transmitting portions has the first heat transfer rate that is enough to cause medicable freezing kidney neuroregulation under described deployed condition when described cooling package receives cold-producing medium, wherein said the second hot transmitting portions has second heat transfer rate lower than described the first heat transfer rate under described deployed condition when described cooling package receives cold-producing medium, and wherein said the first hot transmitting portions is non-side face on longitudinal section of the length along described cooling package,

Along the first passing away of the described bar of at least a portion, described the first passing away is configured to transport cold-producing medium from described the first Room; And

Along the second passing away of the described bar of at least a portion, described the second passing away be configured to from described the second Room transport cold-producing medium not with described the first passing away between fluid be communicated with.

Cold therapy equipment in 44. examples 43, further comprises:

With the first pressure regulator that between described the first passing away, fluid is communicated with; And

And the second pressure regulator of fluid connection between described the second passing away.

Cold therapy equipment in 45. examples 43, wherein-

Described the first balloon has the first internal surface area,

Described the second balloon has the second internal surface area,

Described aperture is first aperture with the first clear passage area,

Fluid connection between described the first Room and described the first aperture,

Described cooling package further comprises second aperture with the second clear passage area,

Fluid connection between described the second Room and described the second aperture, and

Ratio between described the first clear passage area and described first surface are long-pending is greater than the ratio of described the second clear passage area between amassing with described second surface.

Cold therapy equipment in 46. examples 43, wherein---

Described aperture is the first aperture,

Fluid connection between described the first Room and described the first aperture,

Described cooling package further comprises the second aperture,

Fluid connection between described the second Room and described the second aperture,

For limited cooling described the first aperture and described the first Room of configuring of the surface area substantially under deployed condition, and

For limited cooling described the second aperture and described the second Room of configuring of the cold-producing medium substantially under deployed condition.

Cold therapy equipment in 47. examples 43, wherein the described cooling package under described deployed condition is configured under the first mean temperature at described the first indoor circulation cold-producing medium, and under the second mean temperature at described the second indoor circulation cold-producing medium, described the first mean temperature is lower than described the second mean temperature.

Cold therapy equipment in 48. examples 43, wherein said applicator comprises the 3rd balloon, described the first and second balloons are arranged in described the 3rd balloon.

Cold therapy equipment in 49. examples 43, wherein---

Described cooling package has the first length,

Described the first balloon be extend and there is the second length,

Described the second balloon be extend and there is the 3rd length, and

Described first, second, and third length is parallel under described middle deployed condition substantially.

50. 1 kinds of cold therapy equipment, comprising:

The bar that comprises the elongation of the distal portions with length, described bar be configured to by described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant;

Be positioned at the applicator of the described distal portions of described bar, described applicator has sending state and deployed condition and comprises at least the first chamber and the second Room, described the first Room have and described supply chamber between the hot transmitting portions of fluid connection, and wherein said hot transmitting portions is extended in the plane perpendicular to described length around the described complete side face around the described applicator of deficiency;

First discharges assembly, is configured to transport cold-producing medium from described the first Room, makes described the first Room under described deployed condition, when described cooling package receives cold-producing medium, have the first heat transfer rate that is enough to cause medicable freezing kidney neuroregulation; And

Second discharges assembly, be configured to transport cold-producing medium from described the second Room, make described the second Room under described deployed condition, when described cooling package receives cold-producing medium, have second heat transfer rate lower than described the first heat transfer rate, wherein said second discharges assembly not and described first discharges fluid connection between assembly.

51. 1 kinds of cold therapy equipment, comprising:

The bar with the elongation of distal portions, described bar be configured to by described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant; And

Be positioned at the cooling package of the described distal portions of described bar, described cooling package has sending state and deployed condition, described cooling package comprises aperture and applicator, described applicator comprises the first balloon and the second balloon, fluid connection between described aperture and described supply chamber, described the first balloon has the hot transmitting portions of helical form, the hot transmitting portions of described helical form crooked near described the second balloon and and described aperture between fluid connection, and described the second balloon subsides at least in part under described sending state, wherein said hot transmitting portions has the heat transfer rate that is enough to cause medicable freezing kidney neuroregulation under described deployed condition when described cooling package receives cold-producing medium.

Cold therapy equipment in 52. examples 51, wherein said the first balloon is substantially the second balloon inflexibility and described and is roughly flexible.

Cold therapy equipment in 53. examples 51, wherein said the first balloon is substantially flexible and described the second balloon and is roughly inflexibility.

Cold therapy equipment in 54. examples 51, wherein said the first balloon and the second balloon are substantially flexible.

Cold therapy equipment in 55. examples 51, wherein said the first and second balloons are substantially inflexibility.

Cold therapy equipment in 56. examples 51, wherein said hot transmitting portions is the first hot transmitting portions, described heat transfer rate is the first heat transfer rate, described the second balloon has the second hot transmitting portions, and described the second hot transmitting portions has second heat transfer rate lower than described the first heat transfer rate under described deployed condition when described cooling package receives cold-producing medium.

Cold therapy equipment in 57. examples 51, wherein said applicator is distensible and is configured to entirely shut and has renal artery or the nephrostome of different cross section size.

Cold therapy equipment in 58. examples 51, wherein said hot transmitting portions has screw diameter, and described the second balloon is roughly flexible, expands described the second balloon and under described deployed condition, increases described screw diameter.

Cold therapy equipment in 59. examples 51, wherein said the first balloon has been determined the first Room, described the second balloon has been determined the second Room, between described the first Room and described the second Room, be that liquid separates, described equipment further comprises the filling chamber along at least a portion of described bar, and described filling chamber is configured to provide packing material to described the second Room.

Cold therapy equipment in 60. examples 51, wherein said the first balloon comprises helical form part, described the second balloon has and is roughly circular sectional dimension under described deployed condition, is configured to inaccessible described renal artery or nephrostome, and described spiral part is wound around described the second balloon.

Cold therapy equipment in 61. examples 51, wherein said the second balloon has outer wall surface and described the first balloon embeds described outer wall surface at least in part.

Cold therapy equipment in 62. examples 51, wherein said the second balloon has inner wall surface and described the first balloon in described inner wall surface.

Cold therapy equipment in 63. examples 51, wherein said the first balloon has been determined the first Room, described the second balloon is determined the second Room, and described the first Room is connected to described the second Room in fluid connection mode, and described the second Room is configured to receive cold-producing medium from described the first Room.

64. 1 kinds of cold therapy equipment, comprising:

The bar with the elongation of distal portions, described bar be configured to by described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant; And

Be positioned at the applicator of described distal portions, described applicator has the first Room and the second Room, fluid connection between wherein said the first Room and described supply chamber, described the first Room have and described supply chamber between the hot transmitting portions of fluid connection, and described the first Room is included near crooked spiral part described the second Room, wherein said spiral part has the heat transfer rate that is enough to cause medicable freezing kidney neuroregulation under described deployed condition when described cooling package receives cold-producing medium.

65. 1 kinds of cold therapy equipment, comprising:

The bar that comprises the elongation of the distal portions with length, described bar be configured to by described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant;

Be positioned at the cooling package of described distal portions, described cooling package has sending state and deployed condition, described cooling package comprises aperture and applicator, described applicator comprises the first spiral balloon and the second spiral balloon, described aperture and described supply chamber and described the first balloon fluid connection, and described the first and second spiral balloons are wound around a part for described bar and interweave at least in part, wherein said the first spiral balloon has the first heat transfer rate that is enough to cause medicable freezing kidney neuroregulation under described deployed condition when described cooling package receives cold-producing medium, and wherein said the second spiral balloon has second heat transfer rate lower than described the first heat transfer rate under described deployed condition when described cooling package receives cold-producing medium.

Cold therapy equipment in 66. examples 65, wherein said equipment further comprises along the passing away of the described bar of at least a portion, and wherein said the first and second spiral balloons are wound around described passing away.

Cold therapy equipment in 67. examples 65, wherein said the first spiral balloon has been determined the first Room, described the second spiral balloon has been determined the second Room, between described the first Room and described the second Room, be that liquid separates, described equipment further comprises the filling chamber along at least a portion of described bar, and described filling chamber is configured to provide packing material to described the second Room.

Cold therapy equipment in 68. examples 65, wherein said the first spiral balloon has been determined the first Room, described the second spiral balloon has been determined the second Room, fluid connection between described the first Room and described the second Room, and described the second Room is configured to receive cold-producing medium from described the first Room.

Cold therapy equipment in 69. examples 65, wherein said applicator comprises triple helical balloon, described triple helical balloon has three heat transfer rate lower than described the first heat transfer rate under described deployed condition when described cooling package receives cold-producing medium, and wherein said triple helical balloon interweaves with described the first and second spiral balloons at least in part.

Cold therapy equipment in 70. examples 69, wherein---

Described cooling package has length,

Described the first spiral balloon has the first sweep,

Described the second spiral balloon has the second sweep,

Described triple helical balloon has the 3rd sweep, and

The opposite side along described length of the described second and the 3rd sweep in described the first sweep.

Cold therapy equipment in 71. examples 69, wherein said the first spiral balloon has been determined the first Room, described the second spiral balloon has been determined the second Room, described triple helical balloon has been determined the 3rd Room, described the first Room is that liquid separates with the described second and the 3rd Room, described equipment further comprises the filling chamber along at least a portion of described bar, and described filling chamber is configured to described the second Room, the 3rd Room or the two supply packing material.

Cold therapy equipment in 72. examples 69, wherein said the first spiral balloon has been determined the first Room, described the second spiral balloon has been determined the second Room, described triple helical balloon has been determined the 3rd Room, described the first Room and the described second and the 3rd Room fluid connection, described second, third chamber is configured to receive cold-producing medium from described the first Room.

Cold therapy equipment in 73. examples 65, wherein said applicator comprises triple helical balloon, described triple helical balloon has the 3rd heat transfer rate that is enough to cause medicable freezing kidney neuroregulation under described deployed condition when described cooling package receives cold-producing medium, and wherein said triple helical balloon interweaves with described the first and second spiral balloons at least in part.

Cold therapy equipment in 74. examples 73, wherein---

Described cooling package has length,

Described the first spiral balloon has the first sweep,

Described the second spiral balloon has the second sweep,

Described triple helical balloon has the 3rd sweep, and

The opposite side along described length of the described first and the 3rd sweep in described the second sweep.

Cold therapy equipment in 75. examples 73, wherein said the first spiral balloon has been determined the first Room, described the second spiral balloon has been determined the second Room, described triple helical balloon has been determined the 3rd Room, described the second Room not with the described first and the 3rd Room fluid connection, described equipment further comprises the filling chamber along the described bar of at least a portion, and described filling chamber is configured to described the second Room supply packing material.

Cold therapy equipment in 76. examples 73, wherein said the first spiral balloon has been determined the first Room, described the second spiral balloon has been determined the second Room, described triple helical balloon has been determined the 3rd Room, the described first and the 3rd Room is connected to described the second Room in the mode of fluid connection, and described the second Room is configured to receive cold-producing medium from described the first Room.

77. 1 kinds of cold therapy equipment, comprising:

The bar that comprises the elongation of the distal portions with length, described bar be configured to by described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant;

Be positioned at the applicator of described distal portions, described applicator has sending state and deployed condition and comprises the first Room and the second Room, described the first Room has the hot transmitting portions with described supply chamber fluid connection, described the first Room comprises the first cardinal principle helical form part, described the second Room comprises the second cardinal principle helical form part, and described the first and second cardinal principle spiral parts interweave at least in part, wherein said hot transmitting portions has the heat transfer rate that is enough to cause medicable freezing kidney neuroregulation under described deployed condition when described cooling package receives cold-producing medium, and wherein said hot transmitting portions is extended in the plane perpendicular to described length around the complete side face of the described applicator of deficiency.

78. 1 kinds of cold therapy equipment, comprising:

The bar with the elongation of distal portions, wherein said bar be configured to by described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant;

Be positioned at the cooling package of described distal portions, described cooling package has sending state and deployed condition, described cooling package comprises aperture and applicator, described applicator comprises the first balloon of having determined the first Room and the second balloon of having determined the second Room, fluid connection between described aperture and described supply chamber, described the first balloon have and described aperture between the first hot transmitting portions of fluid connection, described the second balloon has the second hot transmitting portions, described the second balloon subsides at least in part under described sending state, described the second Room described the first Room fluid connection of getting along well, wherein said the first hot transmitting portions has the first heat transfer rate that is enough to cause medicable freezing kidney neuroregulation under described deployed condition when described cooling package receives cold-producing medium, wherein said the second hot transmitting portions has second heat transfer rate lower than described the first heat transfer rate under described deployed condition when described cooling package receives cold-producing medium, and wherein said the first hot transmitting portions is non-side face on longitudinal section of the length along described cooling package,

Along the filling chamber of at least a portion of described bar, described filling chamber is configured to described the second Room supply packing material.

Cold therapy equipment in 79. examples 78, it is that it has fixing volume that wherein said the first balloon can not collapse over.

Cold therapy equipment in 80. examples 78, wherein said the first hot transmitting portions comprises metal fever transmission member.

Cold therapy equipment in 81. examples 78, wherein said the second balloon is in described the first balloon.

Cold therapy equipment in 82. examples 78, wherein---

Described distal portions has length,

Described the second balloon is configured to preferentially substantially on the first direction with respect to described length, expand,

Described aperture is configured to the expansion of the cold-producing medium from described supply chamber in the second direction with respect to described length, to guide to described the first hot transmitting portions, and

Angle between described first direction and described second direction is that approximately 15 degree are to approximately 180 degree.

Cold therapy equipment in 83. examples 78, wherein said the second balloon has that inner surface and described filling chamber are substantially inflexibility and is connected to described inner surface.

Cold therapy equipment in 84. examples 78, wherein said applicator is distensible and is configured to entirely shut and has renal artery or the nephrostome of different cross section size.

Cold therapy equipment in 85. examples 78, wherein described the second balloon under described deployed condition is configured to a part for described therapentic part and described the first balloon heat isolation.

86. 1 kinds of cold therapy equipment, comprising:

The bar that comprises the elongation of the distal portions with length, described bar be configured to by described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant;

Be positioned at the applicator of described distal portions, described applicator has sending state and deployed condition and comprises the first Room and the second Room, described the first Room have and described supply chamber between the first hot transmitting portions of fluid connection, described the second Room has the second hot transmitting portions, and described the second Room and described the first Room are that liquid separates

Wherein said the first hot transmitting portions has the first heat transfer rate that is enough to cause medicable freezing kidney neuroregulation under described deployed condition when described cooling package receives cold-producing medium, wherein said the second hot transmitting portions has second heat transfer rate lower than described the first heat transfer rate under described deployed condition when described cooling package receives cold-producing medium, and wherein said the first hot transmitting portions is extended in the plane perpendicular to described length around the complete side face of the described applicator of deficiency; And

Along the filling chamber of the described bar of at least a portion, described filling chamber is configured to described the second Room supply packing material.

87. 1 kinds of cold therapy equipment, comprising:

The bar with the elongation of distal portions, wherein said bar be configured to by described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant; With

Be positioned at the cooling package of the described distal portions of described bar, described cooling package has sending state and deployed condition, described cooling package comprises aperture and applicator, described applicator comprises has determined the first balloon of the first Room and the second balloon of having determined the second Room, fluid connection between described aperture and described supply chamber, described the first balloon have and described supply chamber between the hot transmitting portions of fluid connection, described the second balloon has the second hot transmitting portions, described the second balloon subsides at least in part under described sending state, described the second Room and described the first Room fluid connection, wherein said the second Room is configured to receive cold-producing medium from described the first Room, wherein said the first hot transmitting portions has the first heat transfer rate that is enough to cause medicable freezing kidney neuroregulation under described deployed condition when described cooling package receives cold-producing medium, wherein said the second hot transmitting portions has second heat transfer rate lower than described the first heat transfer rate under described deployed condition when described cooling package receives cold-producing medium, and wherein said the first hot transmitting portions is non-side face on longitudinal section of the length along described cooling package.

Cold therapy equipment in 88. examples 87, wherein said the first Room has the first cold-producing medium retention time in described deployed condition, described the second Room has second refrigerant retention time in described deployed condition, and wherein said the first cold-producing medium retention time is shorter than described second refrigerant retention time.

Cold therapy equipment in 89. examples 87, wherein said equipment further comprises along the passing away of the described bar of at least a portion, and described the first and second Room are connected to described passing away in the mode of fluid connection.

Cold therapy equipment in 90. examples 87, wherein said equipment further comprises along the passing away of the described bar of at least a portion, described passing away has passing away distal portions, and described the first Room is connected to described the second Room in fluid connection mode by described passing away distal portions.

Cold therapy equipment in 91. examples 87, wherein said the second balloon is configured to from the cold-producing medium of described the first balloon, be expanded passively.

Cold therapy equipment in 92. examples 87, wherein said applicator is distensible and is configured to entirely shut and has renal artery or the nephrostome of different cross section size.

Cold therapy equipment in 93. examples 87, wherein described the second balloon in described deployed condition is configured to heat isolation between a part for described therapentic part and described the first balloon.

Cold therapy equipment in 94. examples 87, wherein---

Described cooling package has the first length,

Described the first balloon be extend and there is the second length,

Described the second balloon be extend and there is the 3rd length, and

Described first, second, and third length is parallel under described middle deployed condition substantially.

95. 1 kinds of cold therapy equipment, comprising:

The bar that comprises the elongation of the distal portions with length, described bar be configured to by described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant; With

Be positioned at the applicator of described distal portions, described applicator has sending state and deployed condition and comprises the first Room and the second Room, described the first Room has the first hot transmitting portions with described supply chamber fluid connection, described the second Room has the second hot transmitting portions, and described the second Room and described the first Room fluid connection, wherein said the second Room is configured to receive cold-producing medium from described the first Room, wherein said the first hot transmitting portions has the first heat transfer rate that is enough to cause medicable freezing kidney neuroregulation under described deployed condition when described cooling package receives cold-producing medium, wherein said the second hot transmitting portions has second heat transfer rate lower than described the first heat transfer rate under described deployed condition when described cooling package receives cold-producing medium, and wherein said the first hot transmitting portions is extended in the plane perpendicular to described length around the complete side face of the described applicator of deficiency.

Cold therapy equipment in 96. examples 95, further comprise along the passing away of the described bar of at least a portion, and described passing away is configured to transport cold-producing medium from described the first Room, wherein said the second Room is configured to cold-producing medium to be transported to described passing away from described the first Room.

Cold therapy equipment in 97. examples 96, wherein---

Described the first Room has the first Room distal portions and the first Room proximal part, and is configured to cold-producing medium to be transported to described the first Room distal portions from described the first Room proximal part,

Described the second Room has the second Room distal portions and the second Room proximal part,, and be configured to cold-producing medium to be transported to described the second Room proximal part from described the second Room distal portions.

Cold therapy equipment in 98. examples 96, wherein said applicator has the mobile path of main refrigerant, and from described the first Room to described passing away, and described main refrigerant flows path by described the second Room.

99. 1 kinds of cold therapy equipment, comprising:

The bar that comprises the elongation of the distal portions with length, described bar be configured to by described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant;

Be positioned at the applicator of the described distal portions of described bar, described applicator has sending state and deployed condition and comprises the first Room and the second Room, described the first Room have and described supply chamber between the hot transmitting portions of fluid connection, wherein said the first hot transmitting portions has the heat transfer rate that is enough to cause medicable freezing kidney neuroregulation under described deployed condition when described cooling package receives cold-producing medium, and wherein said hot transmitting portions is extended in the plane perpendicular to described length around the complete side face of the described applicator of deficiency; And

Along the passing away of the described bar of at least a portion, described passing away is configured to transport cold-producing medium from described the first Room, and wherein said the second Room is configured to described passing away, transport cold-producing medium from described the first Room.

100. one kinds of cold therapy equipment, comprising:

The bar with the elongation of distal portions, wherein said bar be configured to by described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant;

Be positioned at the cooling package of described distal portions, described cooling package has sending state and deployed condition, described cooling package comprises aperture and applicator, described applicator comprises the applicator balloon of having determined applicator chamber, fluid connection between described aperture and described supply chamber, described applicator balloon have and described aperture between the hot transmitting portions of fluid connection, wherein said applicator is configured to when described cooling package receives cold-producing medium, cause medicable freezing kidney neuroregulation under described deployed condition; And

Obstruction component to near-end away from described applicator, described obstruction component has collapsed mode and expansion state, and the sectional dimension that wherein said obstruction component has is configured to the renal artery and/or the nephrostome that under described expansion state, entirely shut near described therapentic part.

Cold therapy equipment in 101. examples 100, wherein said inaccessible assembly comprises the inaccessible balloon of having determined inaccessible chamber, described inaccessible chamber is connected to described applicator chamber in the mode of fluid connection.

Cold therapy equipment in 102. examples 101, further comprises along the passing away of the described bar of at least a portion, wherein said inaccessible chamber is connected to described passing away in the mode of fluid connection.

Cold therapy equipment in 103. examples 101, wherein said applicator chamber had for the first cold-producing medium holding time under described deployed condition, wherein said inaccessible chamber has the second refrigerant holding time under described expansion state, and wherein said the first cold-producing medium holding time is shorter than the described second refrigerant holding time.

Cold therapy equipment in 104. examples 101, further comprise along the filling chamber of the described bar of at least a portion, wherein said filling chamber is connected to described inaccessible chamber in the mode of fluid connection, and wherein said inaccessible chamber is that liquid separates with described supply chamber.

Cold therapy equipment in 105. examples 100, wherein said obstruction component is distensible and is configured to entirely shut under described expansion state and has renal artery or the nephrostome of different-diameter.

Cold therapy equipment in 106. examples 100, wherein said obstruction component comprises inaccessible balloon, described inaccessible balloon is flexible substantially.

Cold therapy equipment in 107. examples 100, further comprise handle, described bar has the proximal part that is positioned at described handle, wherein said bar comprises the control member of the elongation in control chamber and described control chamber, and wherein said control member is operationally coupled to described distal portions and described handle, thereby increase or the tension force that reduces described control member is controlled the deflection of at least one section of the distal portions of described obstruction component.

Cold therapy equipment in 108. examples 100, wherein said applicator has applicator sectional dimension under described deployed condition, it is less than the sectional dimension of described obstruction component under described expansion state, so renal artery and/or the nephrostome of described applicator incomplete inaccessible described therapentic part under described deployed condition.

Cold therapy equipment in 109. examples 100, wherein said cooling package comprises the support member of elongation, and wherein said applicator chamber comprises helical form balloon, described balloon is wound around at least a portion of described support member.

Cold therapy equipment in 110. examples 100, wherein---

Described cooling package has length,

The shape of described applicator balloon under described deployed condition comprises a plurality of females and around the non-sunk area of described a plurality of females,

Described non-sunk area is determined described hot transmitting portions at least in part, and

Described hot transmitting portions is being non-side face on longitudinal section of described length.

Cold therapy equipment in 111. examples 110, the shape of wherein said applicator balloon under described deployed condition is roughly cylindrical.

Cold therapy equipment in 112. examples 100, wherein---

Described cooling package has length,

The shape of described applicator balloon under described deployed condition comprises a plurality of outstanding and around described a plurality of outstanding non-outburst areas,

Described a plurality of outstanding described hot transmitting portions of determining at least in part, and

Described hot transmitting portions is being non-side face on longitudinal section of described length.

Cold therapy equipment in 113. examples 100, wherein---

Described cooling package has length and along the support member of the elongation of the described length of at least a portion,

Described applicator balloon comprises non-circumferential surface sections and coupling part,

Described coupling part is connected to described support member,

Described non-circumferential surface sections is separated with described support member under described deployed condition,

Described non-circumferential surface sections is determined described hot transmitting portions at least in part, and

Described hot transmitting portions is being non-side face on longitudinal section of described length.

Cold therapy equipment in 114. examples 113, wherein---

Described coupling part is the first pontes,

Described non-circumferential surface sections is the first non-circumferential surface sections,

Described applicator balloon comprises the second coupling part that is installed to described support member,

Described applicator balloon comprises the second non-circumferential surface sections, and it separates with described support member under described deployed condition,

Described the first non-circumferential surface sections between described the first and second coupling parts,

Described the second non-circumferential surface sections is separated around described length with described first non-all faces between described the first and second coupling parts and diametrically, and

Described the first and second non-circumferential surface sections are determined described hot transmitting portions at least in part.

Cold therapy equipment in 115. examples 113, wherein---

Described applicator balloon is the first applicator balloon,

Described coupling part is the first pontes,

Described non-circumferential surface sections is the first non-circumferential surface sections,

Described applicator comprises the second applicator balloon, and it is opened along described length and described the first applicator balloon longitudinal subdivision,

Described the second applicator balloon comprises the second non-circumferential surface sections and the second coupling part,

Described the second coupling part is connected to described support member,

Described the second non-circumferential surface sections is opened along described length and described support member longitudinal subdivision under described deployed condition, and

Described the first and second non-circumferential surface sections are determined described hot transmitting portions at least in part.

Cold therapy equipment in 116. examples 100, wherein---

Described cooling package has length,

Described applicator balloon has spiral female and spiral lands,

Described spiral lands is determined described hot transmitting portions at least in part, and

Described hot transmitting portions is non-side face along described length in longitudinal section.

Cold therapy equipment in 117. examples 100, wherein---

Described applicator balloon for extend and there is length, the applicator balloon proximal part along described length, applicator balloon mid portion and applicator balloon distal portions,

So described applicator balloon has the first wall part and the second wall part along the described applicator balloon of described curved in length, under described deployed condition, described the first wall part has the curve that is roughly spill along described length, it is not the curve of spill that described the second wall part has along the cardinal principle of described length

Described applicator balloon mid portion is configured to and generally along described the second wall part, along described second, than renal artery and/or the nephrostome of part, does not contact with cardinal principle under described deployed condition,

Described the second wall part at described applicator balloon mid portion is determined described hot transmitting portions at least in part, and,

Described hot transmitting portions is being non-side face on longitudinal section of described length.

Cold therapy equipment in 118. examples 117, wherein said the first wall part has the first thickness, and wherein said the second wall part has the second thickness than described the first thin thickness.

Cold therapy equipment in 119. examples 100, wherein---

Described applicator balloon for extend and there is length,

Described cooling package comprises along the standard element of the elongation of the described length of at least a portion,

Described standard element has linear configurations substantially under described sending state, and has curved configuration under described deployed condition, and

Described applicator balloon has at least in part the shape corresponding to described curved configuration under described expansion shape body.

Cold therapy equipment in 120. examples 119, the shape of wherein said applicator balloon under described deployed condition is roughly helical form.

Cold therapy equipment in 121. examples 119, the shape of wherein said applicator balloon under described deployed condition is roughly sinuous roundabout.

Cold therapy equipment in 122. examples 100, wherein---

Described cooling package has length,

Described equipment comprises the standard element of elongation, can vertically move with respect to described bar,

Described applicator balloon has the first balloon proximal part along described length, the first balloon mid portion and the first balloon distal portions,

Described applicator comprises the balloon of the second elongation, and it has the second balloon proximal part, the second balloon mid portion and the second balloon distal portions along described length,

Described the first balloon distal portions and the second balloon distal portions are connected to described standard element, make to make described the first and second balloons along described curved in length with respect to the described bar described standard element of retracting, and make described the first balloon mid portion and described the second balloon mid portion shifted laterally away from described standard element

Described the first balloon mid portion has the first outside, and described the first outside has under described deployed condition the non-concave curve of cardinal principle along described length,

Described the second balloon mid portion has the second outside, and described the second outside has under described deployed condition the non-concave curve of cardinal principle along described length,

Described hot transmitting portions is determined in described the first and second outsides at least in part, and

Described hot transmitting portions is being non-side face on longitudinal section of described length.

123. one kinds of cold therapy equipment, comprising:

The bar with the elongation of distal portions and proximal part, described bar be configured to by described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part, described proximal part is configured to outside described vascular system;

Be positioned at the sub-cooled assembly of the described distal portions of described bar;

Along the main supply chamber of the described bar of at least a portion, it has first and second portion, and the described second portion in wherein said main supply chamber is near described sub-cooled assembly; And

Pre-cooling assembly, it is configured in outside described vascular system, described pre-cooling assembly comprise pre-cooling support chamber and and described pre-cooling support the pre-cooling expansion chambers of fluid connection between chamber, make to support the liquid refrigerant in chamber to expand in described pre-cooling expansion chambers from described pre-cooling, and the described first in described main supply chamber extends through described pre-cooling expansion chambers.

124. one kinds of cold therapy equipment, comprising:

The bar with the elongation of distal portions and proximal part, described bar be configured to by described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Cooling package in described distal portions;

Along the main supply chamber of the described bar of at least a portion, it is configured to receive liquid refrigerant; With

Outside described vascular system around the pre-cooling assembly of the part in described main supply chamber, described pre-cooling assembly comprises pre-cooling support chamber, is configured to support chamber to receive the fore-cooling room of the elongation of cold-producing medium from described pre-cooling, and outlet, described fore-cooling room has the length that is greater than about 10cm, and the proximal part in wherein said main supply chamber extends through described fore-cooling room.

Cold therapy equipment in 125. examples 124, further comprises that wherein said outlet is connected to described passing away in fluid connection mode along the passing away of the described bar along at least a portion.

Cold therapy equipment in 126. examples 125, the concentrated portion that further comprises the intersection between described pre-cooling assembly and described bar, described passing away has substantially straight discharge flow path by described concentrated portion, the described discharge flow path alignment of getting along well of wherein said length.

Cold therapy equipment in 127. examples 124, further comprises adapter, and it is configured to described main supply chamber and described pre-cold supply chamber to be connected to liquid refrigerant source.

Cold therapy equipment in 128. examples 127, further comprises tubular element, and it has tubulose proximal part and tubular distal, and described tubulose proximal part comprises that pre-cooling supports chamber, and described tubular distal comprises fore-cooling room, wherein---

Described adapter comprises described tubulose proximal part in described tubular element and the plug between described tubular distal,

Described main supply chamber and described pre-cold supply chamber extend through described plug,

Described main supply chamber has the opening in described tubulose proximal part,

Described pre-cold supply chamber has the opening that is arranged in described tubulose proximal part, and

Described tubulose proximal part is configured to be connected to described liquid refrigerant source.

Cold therapy equipment in 129. examples 124, wherein said length is from about 20cm to about 30cm.

Cold therapy equipment in 130. examples 124, at least one section of the part of wherein said main supply chamber in described fore-cooling room is roundabout for wriggling at least partly.

Cold therapy equipment in 131. examples 124, further comprises the handle that is positioned at described proximal part, and at least a portion of wherein said pre-cooling assembly is in described handle.

Cold therapy equipment in 132. examples 124, wherein said outlet comprises valve.

Cold therapy equipment in 133. examples 132, wherein said fore-cooling room substantially with between described passing away, be that liquid separates.

134. one kinds of cold therapy equipment, comprising:

The bar with the elongation of distal portions and proximal part, described bar be configured to by described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part, and described proximal part is placed in outside described vascular system;

Be positioned at the cooling package of described distal portions;

The main supply chamber that is configured to receive liquid refrigerant along the described bar of at least a portion;

Along the passing away of the described bar of at least a portion, described passing away is configured to gaseous refrigerant to transport from described cooling package; And

Be positioned at the proximal part in described main supply chamber and the pre-cooling assembly outside described vascular system, described pre-cooling assembly comprises fore-cooling room, be arranged in the manifold of proximal part of described fore-cooling room and the pre-cooling discharger that leaves described manifold to far-end, wherein said manifold has and is coupled to the main channel in described main supply chamber and from the radially outer peripheral channel in described main channel, and wherein said pre-cooling arrangement of components is for making described liquid refrigerant expand and carry out cooling to described fore-cooling room from described pre-cold supply chamber.

135. one kinds of cold therapy equipment, comprising:

The bar with the elongation of distal portions and proximal part, described bar be configured to by described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part, described proximal part is configured to outside described vascular system;

Be positioned at the sub-cooled assembly of the described distal portions of described bar;

Along the main supply chamber of the described bar of at least a portion, it has first and second portion, and the described second portion in wherein said main supply chamber is near described sub-cooled assembly; And

Precooler, its have be configured to receive the container, the diverter in described container of liquid refrigerant stream, along peripheral pre-cooled dose of passage and the pre-cooling expansion chambers in described container of described diverter, described pre-cooling expansion chambers has the proximal part of being determined by described diverter, wherein said diverter has the main channel of the described first that is connected to described main supply chamber, make the part of liquid refrigerant flow through described main channel and arrive described main supply chamber, and another part of liquid refrigerant flows through described precooling agent passage and enters described pre-cooling expansion chambers.

Cold therapy equipment in 136. examples 135, wherein said main supply chamber is included in the opening in described pre-cold supply chamber.

Cold therapy equipment in 137. examples 135, wherein said container has inner surface and described main supply chamber is not fixed to described inner surface.

Cold therapy equipment in 138. examples 135, further comprises the main feed line of determining described main supply chamber, and described main feed line has the outer surface of at least a portion of determining described peripheral channel.

Cold therapy equipment in 139. examples 135, further comprise the main feed line of determining described main supply chamber, described main feed line has outer surface, wherein said chamber has inner surface, and described diverter is fixed to described main feed line on the outer surface between described pre-cold supply chamber and described fore-cooling room, and wherein said diverter has been determined at least a portion of described precooling agent passage.

Cold therapy equipment in 140. examples 135, wherein said main feed line has the mean outside diameter in described fore-cooling room, and the wherein said diverter part that is described main feed line, and has the external diameter larger than described mean outside diameter.

Cold therapy equipment in 141. examples 135, wherein said container has inner surface, and described pre-cooling passage is included in the crooked gap between described diverter and described inner surface.

Cold therapy equipment in 142. examples 135, wherein said container has inner surface, and described precooling agent passage is included in the annular gap between described diverter and described inner surface.

143. one kinds of cold therapy equipment, comprising:

The bar with the elongation of distal portions, described bar be configured to by described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant;

Be positioned at the cooling package of described distal portions, described cooling package has sending state and deployed condition, described cooling package comprises aperture and applicator, described applicator has balloon, described balloon has circumferential skimble-scamble shape under described deployed condition, fluid connection between supply chamber is told by described aperture and institute, described balloon have and described aperture between the hot transmitting portions of fluid connection, wherein said hot transmitting portions has the heat transfer rate that is enough to cause medicable freezing kidney neuroregulation under described deployed condition when described cooling package receives cold-producing medium.

144. one kinds of cold therapy equipment, comprising:

The bar with the elongation of distal portions, described bar be configured to by described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant;

Be positioned at the cooling package of described distal portions, described cooling package has sending state and deployed condition, described cooling package comprises aperture and applicator, described applicator comprises balloon, the shape of described balloon under described deployed condition has a plurality of females and around the non-sunk area of described a plurality of females, fluid connection between described aperture and described supply chamber, described balloon have and described aperture between the hot transmitting portions of fluid connection, described non-sunk area has been determined described hot transmitting portions at least in part, wherein said hot transmitting portions has the heat transfer rate that is enough to cause medicable freezing kidney neuroregulation under described deployed condition when described cooling package receives cold-producing medium.

Cold therapy equipment in 145. examples 144, wherein said a plurality of females have the even distribution of circumferential asymmetry in described applicator.

Cold therapy equipment in 146. examples 144, the shape of wherein said balloon is roughly cylindrical.

Cold therapy equipment in 147. examples 144, the shape of wherein said balloon is roughly tubulose and has longitudinal axis, and the shape of wherein said balloon has been determined along at least a portion of the blood flow paths of described longitudinal axis.

Cold therapy equipment in 148. examples 144, wherein said cooling package has length, and wherein said hot transmitting portions is non-side face on longitudinal section of the described length along described cooling package.

149. one kinds of cold therapy equipment, comprising:

The bar with the elongation of distal portions, described bar be configured to by described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive described liquid refrigerant; And

Be positioned at the cooling package of described distal portions, described cooling package has sending state and deployed condition, described cooling package comprises aperture and applicator, described applicator comprises balloon, the shape of described balloon in described deployed condition has a plurality of outstanding and around described a plurality of outstanding non-outburst areas, fluid connection between described aperture and described supply chamber, described balloon have and described aperture between the hot transmitting portions of fluid connection, described a plurality of outstanding described hot transmitting portions of having determined at least in part, wherein said hot transmitting portions has the heat transfer rate that is enough to cause medicable freezing kidney neuroregulation under described deployed condition when described cooling package receives cold-producing medium.

Cold therapy equipment in 150. examples 149, wherein said a plurality of outstanding inhomogeneous distributions on side face that have in described applicator.

Cold therapy equipment in 151. examples 149, the shape of wherein said balloon is roughly cylindrical.

Cold therapy equipment in 152. examples 149, the shape of wherein said balloon is roughly tubulose and has longitudinal axis, and the shape of wherein said balloon has been determined along at least a portion of the blood flow paths of described longitudinal axis.

Cold therapy equipment in 153. examples 149, wherein said cooling package has length, and wherein said hot transmitting portions is non-side face on longitudinal section of the length along described cooling package.

154. one kinds of cold therapy equipment, comprising:

The bar with the elongation of distal portions, described bar be configured to by described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant; With

Be positioned at the cooling package of described distal portions, described cooling package has sending state and deployed condition, described cooling package comprises aperture and applicator, described applicator has spiral balloon, fluid connection between described aperture and described supply chamber, suffered spiral balloon have and described aperture between the hot transmitting portions of fluid connection, wherein said hot transmitting portions has the heat transfer rate that is enough to cause medicable freezing kidney neuroregulation under described deployed condition when described cooling package receives cold-producing medium.

Cold therapy equipment in 155. examples 154, wherein said spiral balloon has helical form axis and has determined along at least a portion of the blood flow paths of described helical form axis.

Cold therapy equipment in 156. examples 154, wherein said cooling package has length, and wherein said hot transmitting portions is non-side face on longitudinal section of the length along described cooling package.

Cold therapy equipment in 157. examples 154, further comprises along the passing away of the described bar of at least a portion, wherein---

Described passing away is configured to transport the cold-producing medium of gaseous state,

Described spiral balloon has proximal openings and distal openings,

Described spiral balloon is connected to described supply chamber in fluid connection mode in described distal openings, and

Described spiral balloon is connected to described passing away in fluid connection mode in described proximal openings.

Cold therapy equipment in 158. examples 154, wherein said cooling package comprises the support member of elongation, and wherein said spiral balloon is wound around at least a portion of described supporting member.

Cold therapy equipment in 159. examples 158, wherein said support member comprises the part in described supply chamber.

Cold therapy equipment in 160. examples 154, wherein said cooling package has length, and wherein said spiral balloon comprises the first spiral winding and the second spiral winding, and wherein said the first and second spiral windings are separated along described length.

161. one kinds of cold therapy equipment, comprising:

The bar with the elongation of distal portions, described bar be configured to by described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant; With

Be positioned at the cooling package of described distal portions, described cooling package has sending state and deployed condition, described cooling package has aperture and applicator, described applicator comprises balloon, described balloon has spiral female and spiral lands under described deployed condition, fluid connection between described aperture and described supply chamber, described balloon have and described aperture between the hot transmitting portions of fluid connection, described spiral lands has been determined described hot transmitting portions at least in part, wherein said hot transmitting portions has the heat transfer rate that is enough to cause medicable freezing kidney neuroregulation under described deployed condition when described cooling package receives cold-producing medium.

Cold therapy equipment in 162. examples 161, wherein said cooling package has length, and wherein said hot transmitting portions is non-side face on longitudinal section of the length along described cooling package.

163. one kinds of cold therapy equipment, comprising:

The bar with the elongation of distal portions, described bar be configured to by described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant; With

Be positioned at the cooling package of described distal portions, described cooling package has sending state and deployed condition, described cooling package comprises aperture and applicator, described applicator comprises the balloon of elongation, described balloon has length, balloon proximal part along described length, balloon mid portion and balloon distal portions, so described, execute balloon and there is the first wall part and the second wall part along the described applicator balloon of described curved in length, under described deployed condition, described the first wall part has the curve that is roughly spill along described length, it is not the curve of spill that described the second wall part has along the cardinal principle of described length, wherein said balloon mid portion is configured to generally along described the second wall part and cardinal principle, along described the first wall part, not contact with described renal artery and/or nephrostome under described deployed condition, described balloon has the hot transmitting portions with described aperture fluid connection, wherein at described second wall part of described balloon mid portion, determined at least in part described hot transmitting portions, and wherein said hot transmitting portions has the heat transfer rate that is enough to cause medicable freezing kidney neuroregulation under described deployed condition when described cooling package receives cold-producing medium.

Cold therapy equipment in 164. examples 163, wherein said freezing assembly has length, and wherein said hot transmitting portions is non-side face on longitudinal section of the length along described cooling package.

Cold therapy equipment in 165. examples 163, wherein described the first wall part at described balloon mid portion has the first thickness, and wherein at described second wall part of described balloon mid portion, has the second thickness than described the first thin thickness.

Cold therapy equipment in 166. examples 163, wherein said balloon distal portions is configured to generally along described the first wall part and cardinal principle, along described the second wall part, not contact with described renal artery and/or nephrostome under described deployed condition.

Cold therapy equipment in 167. examples 166, has wherein determined described hot transmitting portions at least in part at described first wall part of described balloon distal portions.

Cold therapy equipment in 168. examples 167, the nearly section of wherein said balloon partial configuration is generally along described the first wall part and cardinal principle, along described the second wall part, not contact with described renal artery and/or nephrostome under described deployed condition.

Cold therapy equipment in 169. examples 168, has wherein determined described hot transmitting portions at least in part at described first wall part of the nearly section part of described balloon.

170. one kinds of cold therapy equipment, comprising:

The bar with the elongation of distal portions, described bar be configured to by described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant; With

Be positioned at the cooling package of described distal portions, described cooling package has sending state and deployed condition, described cooling package comprises the support member of elongation, aperture, and applicator, fluid connection between described aperture and described supply chamber, described applicator has balloon, described balloon has distensible longitudinal component and restricted longitudinal component, described restricted longitudinal component is connected to described support member, described distensible longitudinal component is separated mutually with described support member under described deployed condition, described balloon have and described aperture between the hot transmitting portions of fluid connection, wherein said distensible longitudinal component has been determined described transmitting portions at least in part, and wherein said hot transmitting portions has the heat transfer rate that is enough to cause medicable freezing kidney neuroregulation under described deployed condition when described cooling package receives cold-producing medium.

Cold therapy equipment in 171. examples 170, wherein said cooling package has length, and wherein said hot transmitting portions is non-side face on longitudinal section of the length along described cooling package.

Cold therapy equipment in 172. examples 170, wherein said cooling package has length, and wherein said restricted longitudinal component has been determined along at least a portion of the blood flow paths of the length of described cooling package.

Cold therapy equipment in 173. examples 170, wherein said support member comprises at least a portion in described supply chamber.

Cold therapy equipment in 174. examples 170, wherein---

Described cooling package has length,

Described restricted longitudinal component is the first restricted longitudinal component,

Described distensible longitudinal component is the first expansible longitudinal component,

Described balloon comprises the second restricted longitudinal component, and it is connected to described support member,

Described balloon comprises the second expansible longitudinal component, and it separates mutually with described support member under described deployed condition,

Described the first expansible longitudinal component between described the first and second restricted longitudinal components,

Described the second expansible longitudinal component, between described the first and second restricted longitudinal components, and is separated around described length with described the first expansible longitudinal component diametrically, and

Described the first and second expansible longitudinal components are determined described hot transmitting portions at least in part.

Cold therapy equipment in 175. examples 174, wherein said the first and second restricted longitudinal components extend along described length.

176. one kinds of cold therapy equipment, comprising:

The bar with the elongation of distal portions, described bar be configured to by described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant; With

Be positioned at the cooling package of described distal portions, described cooling package has length, sending state and deployed condition, described cooling package comprises aperture and applicator, described applicator comprises along separated the first balloon of described length and the second balloon, fluid connection between described aperture and described supply chamber, described the first balloon has under described deployed condition and separated the first non-circumferential surface sections of described support member, described the second balloon has under described deployed condition and separated the second non-circumferential surface sections of described support member, wherein said applicator has hot transmitting portions, described hot transmitting portions has the heat transfer rate that is enough to cause medicable freezing kidney neuroregulation under described deployed condition when described cooling package receives cold-producing medium, and wherein said the first and second non-circumferential surface sections are determined described hot transmitting portions at least in part.

Cold therapy equipment in 177. examples 176, wherein said the first non-circumferential surface sections has been determined first longitudinal section of described hot transmitting portions, wherein said the second non-circumferential surface sections has been determined second longitudinal section of described hot transmitting portions, cuts wherein said first and second longitudinal sections and along described length, separates and have the complete side face projections of the cardinal principle in the plane perpendicular to described length.

Cold therapy equipment in 178. examples 176, wherein said aperture be the first aperture cut and described the first non-circumferential surface sections between fluid connection, and wherein said cooling package comprises and described the second non-circumferential surface sections between the second aperture of fluid connection.

179. one kinds of cold therapy equipment, comprising:

The bar with the elongation of distal portions, described bar be configured to by described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant; With

Be positioned at the cooling package of described distal portions, described cooling package has sending state and deployed condition, described cooling package comprises the standard element of elongation, aperture, and applicator, described applicator comprises balloon, described standard element comprises shape memory, the second configuration under under described sending state first configuration and described deployed condition, the shape of described balloon under described deployed condition is at least in part to configuring for described second, fluid connection between described aperture and described supply chamber, described balloon have and described aperture between the hot transmitting portions of fluid connection, wherein said hot transmitting portions has the heat transfer rate that is enough to cause medicable freezing kidney neuroregulation under described deployed condition when described cooling package receives cold-producing medium.

Cold therapy equipment in 180. examples 179, wherein said the first configuration is stretched longlyer than described the second configuration.

Cold therapy equipment in 181. examples 179, wherein said cooling package has length, and wherein said hot transmitting portions is non-side face on longitudinal section of the length along described cooling package.

Cold therapy equipment in 182. examples 179, wherein said standard element comprises Nitinol.

Cold therapy equipment in 183. examples 179, the shape of wherein said balloon under described deployed condition is roughly helical form.

184. one kinds of therapeutic equipments, comprising:

The bar with the elongation of distal portions, described bar is configured to, in blood vessel, described distal portions is placed in to therapentic part; And

Be positioned at the curative component of described distal portions, described curative component has sending state and deployed condition, described curative component comprises qualitative member and the balloon of elongation, described sizing builds the second configuration having under the configuration of first under shape memory, described sending state and described deployed condition, and the shape of wherein said balloon under described deployed condition is at least in part corresponding to described the second configuration.

185. one kinds of cold therapy equipment, comprising:

Elongation dry with distal portions, described bar be configured to by described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid refrigerant; With

The standard element chamber of part at least along described bar;

The standard element of the elongation at least a portion in described standard element chamber, described standard element can move with respect to described bar in the vertical; And

Be positioned at the cooling package of described distal portions, described cooling package has length, sending state, and deployed condition, described cooling package comprises aperture and applicator, described applicator comprises the first balloon of elongation and the second balloon of elongation, described the first balloon has the first balloon proximal part along described length, the first balloon mid portion, and the first balloon distal portions, the second balloon of described elongation has the second balloon proximal part along described length, the second balloon mid portion and the second balloon distal portions, described the first balloon distal portions and described the second balloon distal portions are connected to described standard element, make to pull described standard element to cause described the first balloon mid portion and described the second balloon mid portion shifted laterally away from described standard element with respect to described bar, described the first balloon mid portion has the first outside, described the first outside has along the non-concave curve of the cardinal principle of described length under described deployed condition, described the second balloon mid portion has the second outside, described the second outside has along the non-concave curve of the cardinal principle of described length under described deployed condition, wherein said applicator has hot transmitting portions, described hot transmitting portions has the heat transfer rate that is enough to cause medicable freezing kidney neuroregulation under described deployed condition when described cooling package receives cold-producing medium, and described hot transmitting portions is determined in wherein said the first outside at least in part.

Cold therapy equipment in 186. examples 185, wherein said hot transmitting portions is non-side face on longitudinal section of the length along described cooling package.

Cold therapy equipment in 187. examples 185, wherein said the first balloon has the priority bending position along described length, and wherein with respect to described bar, pulls described standard element can cause described the first balloon crooked on described preferential position along described length.

Cold therapy equipment in 188. examples 185, wherein said priority bending position comprises fold.

Cold therapy equipment in 189. examples 185, wherein said the first balloon proximal part and described the second balloon proximal part are connected to described bar.

Cold therapy equipment in 190. examples 185, further comprises along the passing away of at least a portion of described bar, wherein---

Described passing away is configured to transport the cold-producing medium of gaseous state,

Described the first balloon has the first distal openings and the first proximal openings,

Described the second balloon has the second distal openings and the second proximal openings,

Described the first balloon is connected to described supply chamber in fluid connection mode in described the first distal openings,

Described the second balloon is connected to described supply chamber in fluid connection mode in described the second distal openings,

Described the first balloon is linked to described passing away in fluid connection mode in described the first distal openings, and

Described the second balloon is linked to described passing away in fluid connection mode in described the second distal openings.

Cold therapy equipment in 191. examples 185, further comprise along the filling chamber of at least a portion of described bar, wherein said filling chamber is configured to described the second balloon supply packing material, wherein said the first balloon is connected to described supply chamber in fluid connection mode, and wherein said the first balloon and described the second balloon are that liquid separates.

192. one kinds of cold therapy equipment, comprising:

The bar with distal portions, wherein said bar is configured in blood vessel, described distal portions is placed at least near renal artery or nephrostome;

Be positioned at the cooling package of the distal portions of described bar, described cooling package comprises expansion chambers, and described expansion chambers has burst pressure and lower than the threshold value pressure of described burst pressure;

Pressure along the described bar of at least a portion monitors chamber, and described pressure monitors that chamber has the first opening of the distal portions that is positioned at described bar and is positioned at the second opening of the proximal part of described bar, fluid connection between wherein said the first opening and described expansion chambers; And

Be configured to be placed in the pressure transducer outside patient body, it is operationally coupled to described pressure and monitors chamber, and wherein said pressure monitors that chamber and described pressure transducer are configured to provide signal, the pressure change described in described signal designation in expansion chambers.

Cold therapy equipment in 193. examples 192, wherein:

Described pressure monitors that the length in chamber at least equals the length of described bar; And

Described pressure monitors that chamber is configured to the response time of 0.5 second at the most from described expansion chambers to described pressure transducer.

Cold therapy equipment in 194. examples 192, further comprises:

Along the supply chamber of the described bar of at least a portion, fluid connection between described supply chamber and described expansion chambers;

Along the discharge side of the described bar of at least a portion, fluid connection between described discharge side and described expansion chambers;

Valve, it is coupled to described supply chamber and described pressure transducer, and

Wherein---

Described expansion chambers comprises balloon,

Described valve is configured to record pressure in described expansion chambers on described threshold value pressure time when sensor, reduces at least in part by the refrigerant flow in described supply chamber,

Described pressure monitors that chamber has internal diameter and external diameter, and described internal diameter is configured to measure exactly the pressure in described expansion chambers, and described outer diameter configuration is for to ignore on the impact of the cold-producing medium discharge by described discharge side, and

Described pressure monitors that chamber is configured to provide the response time of 1 second of being less than from described expansion chambers to described pressure transducer.

Cold therapy equipment in 195. examples 192, further comprises:

Along the supply chamber of the described bar of at least a portion, it is liquid cold-producing medium that described supply chamber is configured to receive at least basic;

Along the discharge side of the described bar of at least a portion, fluid connection between described discharge side and described expansion chambers, and

Wherein---

Described discharge side has interior sectional dimension,

Described supply chamber and described pressure monitor that chamber has the outer cross section size of the described distal portions that is positioned at described bar jointly, and

The ratio of described interior sectional dimension and outer sectional dimension is between 4: 1 and 10: 1.

Cold therapy equipment in 196. examples 192, wherein:

Described bar has the first length; And

Described pressure monitors that chamber has the internal diameter that is approximately 0.010, the external diameter of about 0.015 inch (0.381mm), and the second length that at least equals described first length of described bar.

Cold therapy equipment in 197. examples 196, wherein said bar is configured to be suitable for being in the guide sheath of 6Fr, and the first length of described bar is 120cm at least.

Cold therapy equipment in 198. examples 192, further comprise the controller that is coupled to described bar and described pressure transducer, wherein said controller is configured to measure described threshold value pressure or more during High Voltage, be reduced at least in part the refrigerant flow of described expansion chambers when described pressure transducer.

Cold therapy equipment in 199. examples 192, further comprises adapter, and it has the passage between described sensor and described pressure supervision chamber, and wherein said passage has the volume that is not more than 0.1cc.

Cold therapy equipment in 200. examples 192, wherein said expansion chambers comprises having at least flexible material of the burst pressure of 300psi.

Cold therapy equipment in 201. examples 192, wherein said expansion chambers comprises having the flexible material of the burst pressure of 200psi at the most.

Cold therapy equipment in 202. examples 192, wherein:

Described bar is configured to be suitable for being in 6Fr guide sheath; And

Described cooling package comprises expandable members, and it has sending state and expansion state, and at least a portion of described expandable members is determined described expansion chambers, and wherein said expandable members has the external diameter from about 3mm to about 10mm under described expansion state.

203. one kinds of cold therapy equipment, comprising:

The bar with proximal part and distal portions;

Be positioned at the cooling component of the described distal portions of described bar, wherein said cooling package comprise and the described distal portions of described bar between the expansion chambers of fluid connection; And

The described proximal part of described bar and and described expansion chambers between the pressure transducer of fluid connection, what make pressure change in described expansion chambers and described pressure transducer place records time delay between pressure within the response time of avoiding expansion chambers to break.

Cold therapy equipment in 204. examples 203, wherein said response time is less than 0.01 second.

Cold therapy equipment in 205. examples 203, further comprises that pressure monitors chamber, its have be coupled to described pressure transducer proximal part and and described expansion chambers between the distal portions of fluid connection.

Cold therapy equipment in 206. examples 205, wherein said pressure monitors that chamber has the internal diameter that is not more than 0.030 inch (0.762mm) and the external diameter that is not more than 0.060 inch (1.52mm).

Cold therapy equipment in 207. examples 205, wherein said pressure monitors that chamber has the length of at least 48 inches (122cm).

Cold therapy equipment in 208. examples 205, further comprises adapter, and it is coupling in described pressure transducer and described pressure monitors that between chamber, wherein said adapter has the internal capacity that is less than 0.1cc.

Cold therapy equipment in 209. examples 203, wherein:

Described response time is less than 0.1 second; And

Described cold therapy equipment further comprises that pressure monitors chamber, its have be coupled to described pressure transducer proximal part and and described expansion chambers between the distal portions of fluid connection, described pressure monitors that chamber has at least length of 120cm.

Cold therapy equipment in 210. examples 203, wherein:

Described bar is configured to be suitable for being in the guide sheath of 6Fr; And

Described cooling package comprises expandable members, this expandable members has sending state and expansion state, at least a portion of described expandable members is determined described expansion chambers, and wherein said expandable members has the maximum outside diameter of 10mm and has the length of 10mm at the most under described expansion state.

211. one kinds of cold therapy equipment, comprising:

The bar that comprises proximal part and distal portions, wherein said distal portions comprises the depression inside with respect to described proximal part;

Discharge side along the described bar of at least a portion;

Supply chamber along the described bar of at least a portion; And

Cooling package, it comprise be connected near the expandable members of the depression of described distal portions and and described supply chamber and discharge side between the expansion chambers of fluid connection, described expansion chambers is determined by least a portion of described expandable members and is had sending state and a deployed condition, wherein when described expansion chambers is during in described sending state, at least a portion of described expandable members is in the described depression of described distal portions of described bar.

Cold therapy equipment in 212. examples 211, wherein said expandable members further comprises adapter, described adapter is connected to described expandable members near described depression.

Cold therapy equipment in 213. examples 212, wherein said expandable members is balloon, and wherein said adapter is determined by the proximal part of described balloon.

Cold therapy equipment in 214. examples 212, wherein:

The described distal portions of described bar comprises first area, away from the second area of described first area and the ladder determining described inside depression and described first area and described second area are demarcated; With

Described adapter is at least partially in described ladder and top, described first area, and the external diameter of described adapter under described deployed condition is similar to described sending state substantially.

Cold therapy equipment in 215. examples 212, wherein:

The described distal portions of described bar comprises first area, away from the second area of described first area and the ladder determining described inside depression and described first area and described second area are demarcated; With

At least a portion of described adapter is arranged in the described depression near described ladder.

Cold therapy equipment in 216. examples 214, wherein:

Described expandable members comprises distal portions; And

Described cold therapy equipment further comprises atraumatic tip, and its distal portions from described expandable members extends.

217. one kinds of cold therapy equipment, comprising:

Bar, it has the distal portions that is configured to be arranged in kidney blood vessel, the described distal portions of described bar comprises the first area with the first external dimensions and the second area with the second external dimensions that is less than described the first external dimensions, and wherein said second area is away from described first area;

Discharge side along the described bar of at least a portion; And

Be positioned at the cooling package of the described distal portions of described bar, wherein said cooling package is included in the expandable members of the described second area top of described distal portions, described expandable members has expansion chambers, described expansion chambers be configured to receive expansion cold-producing medium and and described discharge side between fluid connection.

Cold therapy equipment in 218. examples 217, wherein:

The described distal portions of described bar comprises the ladder that described first area and described second area are demarcated; And

Described expandable members comprises the adapter being positioned near the described second area top of described ladder, and described expandable members is from described adapter to remote extension.

Cold therapy equipment in 219. examples 217, wherein:

The described distal portions of described bar comprises the ladder that described first area and described second area are demarcated; And

Described expandable members is included in the adapter of top of the described first area of at least a portion, and described expandable members is from described adapter to remote extension.

Cold therapy equipment in 220. examples 217, wherein:

The first area with the first outer surface of described distal portions;

Described distal portions further comprises the ladder that described first area and described second area are demarcated;

Described expandable members is included in the adapter of the described second area top of described distal portions;

The described adapter of described expandable members at least flushes with described the first outer surface during in described sending state substantially near described ladder and in described expansion chambers.

Cold therapy equipment in 221. examples 217, wherein:

The described distal portions of described bar further comprises the ladder that described first area and described second area are demarcated;

Described expansion chambers has the deployed condition that has the sending state of the first volume and have the second volume that is greater than described the first volume; And

Described expandable members comprises adapter, and described adapter has substantially invariable external diameter in described deployed condition and described sending state.

Cold therapy equipment in 222. examples 221, wherein said adapter is above described ladder.

Cold therapy equipment in 223. examples 217, wherein:

Described discharge side has the first internal diameter in described first area; And

Described discharge side has the second internal diameter that is less than described the first internal diameter at described second area.

Cold therapy equipment in 224. examples 217, wherein:

At least a portion of described expansion chambers has treatment temperature; And

Described discharge side the described second area of described distal portions have be configured to when described cold-producing medium by described discharge side when described second area is discharged, at least basic volume that keeps described treatment temperature.

Cold therapy equipment in 225. examples 224, the described second area of the described distal portions of wherein said bar has the length that is not more than about 4cm.

Cold therapy equipment in 226. examples 217, wherein said expansion chambers comprises a balloon, described balloon has an adapter, and wherein said adapter is connected to the top of the described second area of described distal portions.

Cold therapy equipment in 227. examples 217, wherein:

Described expandable members is included in the adapter of described second area top, and described adapter has thickness;

The described first area of described distal portions has the first external diameter; And

The second external diameter that the described second area of the described distal portions of described bar has equals to be not more than twice poor that described the first diameter deducts the thickness of described coupling part.

Cold therapy equipment in 228. examples 217, the described distal portions of wherein said bar comprises the notch that described first area and described second area are demarcated.

229. one kinds of cold therapy equipment, comprising:

The bar that comprises distal portions, wherein said bar is configured to be suitable in the guide sheath of 6Fr; And

Be positioned at the cooling package of the described distal portions of described bar, described cooling package has the length between about 8cm and about 15cm and has the expandable members of sending state and expansion state, and wherein said expandable members has the external diameter between about 3mm and about 10mm under described expansion state.

Cold therapy equipment in 230. examples 229, the described distal portions of wherein said bar comprises the first area with the first external diameter and the second area with the second external diameter that is less than described the first external diameter.

Cold therapy equipment in 231. examples 230, further comprises the ladder of dividing described first area and described second area.

Cold therapy equipment in 232. examples 231, wherein said expandable members comprises the adapter near the ladder between described the first and second regions.

Cold therapy equipment in 233. examples 229, wherein:

At least a portion of described expandable members has treatment temperature; And

Described cold therapy equipment further comprises along the discharge side of at least a portion of described bar, described discharge side has the first internal diameter and at described second area, has the second internal diameter that is less than described the first internal diameter in described first area, wherein said discharge side is configured to pass through described discharge side when described second area is discharged when cold-producing medium, at least the described treatment temperature of basic maintenance.

Cold therapy equipment in 234. examples 229, wherein said bar has 4Fr bar size.

Cold therapy equipment in 235. examples 229, wherein expandable members comprises at least one balloon, and wherein said balloon has the length of 10cm at the most and the external diameter of 8mm at the most under expansion state.

236. one kinds of cold therapy equipment, comprising:

The bar with the elongation of distal portions, wherein said bar is configured to, in blood vessel, described distal portions is placed in to therapentic part;

Along the supply chamber of the described bar of at least a portion, it is liquid cold-producing medium that described supply chamber is configured to receive at least basic;

Along the discharge side of the described bar of at least a portion, described discharge side has the first diameter of being convenient to transport described cold-producing medium after expansion; And

Be positioned at the cooling package of the described distal portions of described bar, described cooling package has aperture and expansion chambers, described aperture have Second bobbin diameter and and described supply chamber between fluid connection, fluid connection between described expansion chambers and described aperture, the ratio of described the first and second diameters is between 4: 1 and 10: 1, and it is the cold-producing medium of gaseous state that wherein said aperture is configured to transport substantially to described expansion chambers.

Cold therapy equipment in 237. examples 236, wherein:

Described discharge side has the internal diameter between approximately 0.030 inch (0.762mm) and approximately 0.05 inch (1.27mm); And

Described cooling package further comprises the flow restriction chamber of described supply intracavity, described flow restriction chamber has the distal portions in described expansion chambers, wherein said aperture is near the described distal portions in described flow restriction chamber, and described aperture and described flow-control chamber have the internal diameter between approximately 0.0030 inch (0.076mm) and approximately 0.0080 (0.203mm).

Cold therapy equipment in 238. examples 236, is further included in described supply chamber and the flow restriction chamber of opening to described expansion chambers, and the length in wherein said flow restriction chamber is between approximately 2 inches (5.1cm) and approximately 30 inches (76.2cm).

Cold therapy equipment in 239. examples 236, wherein:

Described therapentic part is at least one in renal artery and nephrostome;

Described supply chamber has the first internal diameter and the first length; And

Described cooling package further comprises capillary tube in described supply chamber and open to described expansion chambers, described capillary tube has the second external diameter that is less than described the first internal diameter and the second length that is less than described the first length, wherein said capillary tube comprises the distal portions of determining described aperture, and wherein said cold-producing medium flows to described capillary tube and leaves described aperture with at least part of gaseous state under at least substantially for liquid state from described supply chamber; And

Described expansion chambers comprises applicator, and it is configured to produce medicable low the kidney warming neuroregulation.

Cold therapy equipment in 240. examples 236, the distal portions in wherein said supply chamber has been determined described aperture, and wherein said supply chamber has the internal diameter between approximately 0.0040 inch (0.102mm) and approximately 0.010 inch (0.254mm).

Cold therapy equipment in 241. examples 236, further comprise flow restriction chamber, it is at least in part in described expansion chambers, wherein said flow restriction chamber comprises the distal portions of determining described aperture, and wherein said supply chamber has the first length and described flow restriction chamber has 1/3 the second length that is at most described the first length.

Cold therapy equipment in 242. examples 236, wherein said bar is configured to just described distal portions in blood vessel and inserts renal artery or arteriorenal mouth.

Cold therapy equipment in 243. examples 236, wherein said bar has the first area and described supply chamber has occupied second area in described bar, and described the first area is to arrive less than 10: 1 at 4: 1 with the ratio of described second area.

Cold therapy equipment in 244. examples 236, further comprises the wire of the described bar that extends through at least a portion.

Cold therapy equipment in 245. examples 244, wherein:

Described bar has the near-end that comprises proximal openings and the far-end that comprises distal openings; And

Described guidewire lumen is extended between at least described near-end and distal openings.

Cold therapy equipment in 246. examples 244, wherein:

Described bar has the length between near-end and far-end; And

Described guidewire lumen has in the described near-end of described bar and the proximal openings between described far-end.

247. one kinds of cold therapy equipment, comprising:

The bar with the elongation of distal portions, wherein said bar is configured to described distal portions at least one therapentic part in blood vessel is built at least near renal artery and nephrostome;

Along the supply chamber of the described bar of at least a portion, described supply chamber is configured to receive liquid cold-producing medium;

Along the passing away of the described bar of at least a portion, described passing away has the cross section opening of the cold-producing medium that is configured to transport expansion; And

Be positioned at the cooling package of the described distal portions of described bar, described cooling package has the expansion chambers that is configured to receive from that chamber of described supply the basic cold-producing medium for gaseous state, wherein said passing away in the cross section of described cooling package opening and described supply chamber at the ratio of the sectional dimension at described cooling package place between 4: 1 and 10: 1.

Cold therapy equipment in 248. examples 247, the capillary tube that is further included in described supply intracavity and opens to described expansion chambers, wherein said capillary tube has opening, and the diameter of described opening is at least 0.004 inch (0.102mm).

Cold therapy equipment in 249. examples 248, wherein said supply chamber has the first length and described capillary tube and has 1/3 the second length that is at most described the first length.

Cold therapy equipment in 250. examples 247, is further included as on the line of described cooling package and sends configured guidewire lumen.

Cold therapy equipment in 251. examples 247, further comprises quick exchange guidewire lumen.

Cold therapy equipment in 252. examples 247, wherein said passing away has the first area, and that chamber of described supply occupied the second area in described passing away, and the ratio of wherein said the first area and described second area is 4.1 to less than 10: 1.

253. one kinds of cold therapy equipment, comprising:

The bar with the elongation of distal portions, wherein said bar is configured to described distal portions to be built in therapentic part at blood vessel;

The cooling package of the described distal portions in described bar, described cooling package has the expansion chambers that sending state, deployed condition and cold-producing medium are expanded therein; And

Wherein said cold therapy equipment is configured to be less than the automatic intra-operative that stops in 5 minutes, and wherein said intra-operative is at described cooling package when described sending state moves to described deployed condition, and described intra-operative stops stopping when described expansion chambers is sent cold-producing medium at described cooling package.

Cold therapy equipment in 254. examples 253, wherein:

Described therapentic part is near at least one in renal artery or nephrostome;

Described cooling package further comprises applicator, and it is configured under described deployed condition, to have the heat transfer rate that is enough to cause medicable kidney neuroregulation in 100 seconds; And

Described cold therapy equipment further comprises---

Along the supply chamber of at least a portion of described bar, it is liquid cold-producing medium that described supply chamber is configured to receive at least basic, and fluid connection between described supply chamber and described expansion chambers; And

Along the discharge side of at least a portion of described bar, fluid connection between described discharge side and described expansion chambers.

Cold therapy equipment in 255. examples 253, wherein said intra-operative is shorter than 2 minutes.

Cold therapy equipment in 256. examples 253, wherein said cooling package further comprises applicator, described applicator has hot transmitting portions, this hot transmitting portions is extended around the whole side face of the described applicator of deficiency, and wherein said hot transmitting portions is configured to, when described cooling package is during in described deployed condition, at described therapentic part, send medicable low temperature neuroregulation.

Cold therapy equipment in 257. examples 253, wherein said cooling package further comprises applicator, it has the hot transmitting portions of extending around the whole side face of described applicator, and wherein said heat transmitting portions is configured to, when described cooling package is during in described deployed condition, at described therapentic part, send medicable low temperature neuroregulation.

Cold therapy equipment in 258. examples 253, wherein said cooling package further comprises applicator, it is configured at described therapentic part, send medicable low temperature neuroregulation in described perioperative single application.

Cold therapy equipment in 259. examples 258, wherein said therapentic part is external perihaemal canal, and wherein said applicator is configured to around the whole environment of described external perihaemal canal, send medicable low temperature neuroregulation in single application.

Cold therapy equipment in 260. examples 258, wherein said therapentic part is external perihaemal canal, and wherein said applicator is configured in described single application as to send medicable low temperature neuroregulation around at least two of described external perihaemal canal separate part circumferential surface sections.

Cold therapy equipment in 261. examples 253, wherein said intra-operative stops when described cooling system when described deployed condition moves to described sending state.

Cold therapy equipment in 262. examples 253, the cold-producing medium that wherein said cold therapy equipment is configured to based on reservation capacity stops described intra-operative automatically.

Cold therapy equipment in 263. examples 253, further comprises controller, and it comprises and makes described controller at ticket reserving time interval, automatically stop described perioperative instruction.

sum up

The above detailed description of the embodiment of present technique be not intended be exclusiveness or make present technique be confined to above disclosed precise forms.Although described for illustration purposes in this article specific embodiment and the example of present technique, as related fields such as art will recognize, can realize equivalent modifications in the scope of present technique.For example, although according to proposed each step to definite sequence, alternative embodiment can be according to different order execution steps.Can also combine to provide other embodiment by various embodiment as herein described.

According to aforementioned content, will be appreciated that the characteristic embodiment that has described in this article present technique for illustrational object, but not shown or describe well-known 26S Proteasome Structure and Function in detail to avoid unnecessarily making the explanation of embodiment of present technique confused.In the situation that context allows, odd number or plural number can also comprise respectively plural number or singular references.

In addition, unless word "or" is confined to only mean the single project relevant with two or more projects of string clearly, do not comprise other project, should be by "or" any single project of the use in this type of list in being interpreted as comprising in (a) list, (b) all items in list or (c) any combination of the project in list.In addition, term " comprises " and is used for from start to finish meaning to comprise at least described feature, makes not get rid of the same characteristic features of any more big figure and/or the further feature of addition type.Also will be appreciated that herein and in illustrational object, described specific embodiment, but can carry out various modifications without prejudice to present technique in the situation that.In addition, although described the advantage being associated with some embodiment of present technique in the context of those embodiment, but other embodiment also can demonstrate this type of advantage, and not all embodiment must demonstrate this type of advantage to drop in the scope of present technique.Therefore, the disclosure and corresponding technology can be contained other embodiment that does not illustrate clearly or describe herein.

Claims (31)

1. a cold therapy equipment, comprising:

The bar with the elongation of distal portions, wherein said bar be configured to by described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of at least a portion of described bar, described supply chamber is configured to receive liquid refrigerant; And

Be positioned at the cooling package of the described distal portions of described bar, described cooling package has sending state and deployed condition, described cooling package comprises applicator, described applicator at least have and described supply chamber between the first hot transmitting portions and the second hot transmitting portions of fluid connection, in described deployed condition, described the first hot transmitting portions is configured under described deployed condition has the first heat transfer rate when described cooling package receives cold-producing medium, and described the second hot transmitting portions is configured under described deployed condition, when described cooling package receives cold-producing medium, to have second heat transfer rate lower than described the first heat transfer rate, and wherein said the first hot transmitting portions is non-side face on longitudinal section of the length along described cooling package.

2. the cold therapy equipment in claim 1, wherein said cooling package has central longitudinal axis and comprises the aperture from wherein flowing through for cold-producing medium, described applicator comprises the balloon with inner surface, the described central longitudinal axis under described deployed condition to the distance in described aperture be not less than under described deployed condition from described central longitudinal axis to described inner surface described aperture perpendicular to approximately 20% of the distance in the plane of described central longitudinal axis.

3. the cold therapy equipment in claim 1, further comprise along the passing away of at least a portion of described bar, wherein said cooling package comprises the aperture from wherein flowing through for cold-producing medium, described supply chamber has and comprises the spiral helicine part of being roughly of described aperture, described spiral helicine part is wrapped in around described passing away, and described aperture is configured to guide cold-producing medium directly to expand from described supply chamber towards described the first hot transmitting portions.

4. the cold therapy equipment in claim 3, wherein said cooling package has central longitudinal axis, and surpasses about 0.1mm in aperture described in described deployed condition and described central longitudinal axis interval.

5. the cold therapy equipment in claim 3, wherein said applicator comprises the balloon with inner surface, and described aperture about 1mm of inner surface described in distance under described deployed condition.

6. the cold therapy equipment in claim 3, wherein said cooling package comprises that a plurality of cold-producing mediums can be from the aperture of wherein flowing through, and described a plurality of aperture is arranged on the different side face position of described spiral helicine part.

7. the cold therapy equipment in claim 1, further comprises the heat insulating component near described the second hot transmitting portions.

8. the cold therapy equipment in claim 7, wherein said applicator comprises the balloon with inner surface, the part that described the second hot transmitting portions is described balloon, and described heat insulating component is near described inner surface.

9. the cold therapy equipment in claim 8, wherein said the first and second hot transmitting portions are roughly helical form.

10. the cold therapy equipment in claim 7, wherein said applicator comprises balloon, the first with the first average thickness that described the first hot transmitting portions is described balloon, the second portion with the second average thickness that described the second hot transmitting portions is described balloon, and described the first average thickness is less than described the second average thickness.

Cold therapy equipment in 11. claim 1, further comprises the heat insulating component of the first elongation and the heat insulating component of the second elongation, wherein---

Described applicator under described deployed condition, has the 3rd heat transfer rate and described cooling package receives the cold-producing medium higher than described the second heat transfer rate,

Described applicator has the 4th heat transfer rate and described cooling package and receives lower than described first and the cold-producing medium of the 3rd heat transfer rate under described deployed condition,

Described the first heat insulating component is near described the second hot transmitting portions,

Described the second heat insulating component is near described the 4th hot transmitting portions,

And

Described the 3rd hot transmitting portions alone or on longitudinal section in the length along described cooling package, be non-side face together with described the first hot transmitting portions.

Cold therapy equipment in 12. claim 11, wherein said the first and second heat insulating components have been determined filling chamber, described filling chamber is configured to receive packing material, and described filling chamber has subside configuration and expansion configuration.

Cold therapy equipment in 13. claim 11, wherein said the first and second heat insulating components are in substantially parallel relationship to the length of described cooling package in described deployed condition.

Cold therapy equipment in 14. claim 1, further comprises the heat insulating component of elongation, and wherein said applicator comprises balloon, and at least a portion of described heat insulating component is not connected to described balloon and can under described deployed condition, in described balloon, moves.

Cold therapy equipment in 15. claim 14, wherein said heat insulating component has and is roughly leg-of-mutton sectional area.

Cold therapy equipment in 16. claim 14, the described partial configuration of wherein said heat insulating component for to move in described balloon in response to gravity under described deployed condition.

Cold therapy equipment in 17. claim 14, wherein said heat insulating component has been determined the filling chamber that is configured to receive packing material, and described filling chamber has subside configuration and expansion configuration.

Cold therapy equipment in 18. claim 1, further comprise determined and described supply chamber between the interior balloon chamber of fluid connection, wherein said applicator comprises outer balloon, described interior balloon is in described outer balloon, described interior balloon comprises the aperture from wherein flowing through for cold-producing medium, and described interior balloon has subside configuration and expansion configuration.

Cold therapy equipment in 19. claim 18, the part in wherein said supply chamber extends through described interior balloon.

Cold therapy equipment in 20. claim 18, wherein said interior balloon comprises the locational a plurality of apertures of different side faces that are arranged in around described interior balloon.

Cold therapy equipment in 21. claim 20, wherein said a plurality of apertures are arranged as helical pattern.

Cold therapy equipment in 22. claim 18, wherein said outer ball has female and lands, and described the first hot transmitting portions comprises described lands, and described the second hot transmitting portions comprises described female.

Cold therapy equipment in 23. claim 22, wherein said lands is roughly helical form.

Cold therapy equipment in 24. claim 18, wherein said outer balloon has been determined outer balloon chamber, total fluid connection connection between described interior balloon and described outer balloon has the first clear passage area, described supply chamber is connected and has the second clear passage area with total fluid connection between described interior balloon chamber, and described the first clear passage area is less than described the second clear passage area.

25. 1 kinds of cold therapy equipment, comprising:

The bar with the elongation of distal portions, wherein said bar be configured to by described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Be positioned at the cooling package of the described distal portions of described bar, described cooling package has sending state and deployed condition, described cooling package has applicator and a plurality of aperture of cold-producing medium from wherein flowing through that supply, wherein said a plurality of aperture is arranged about described applicator, cold-producing medium stream is directed to the discrete region in described applicator, and described discrete region provides non-side face whole sub-cooled pattern.

Cold therapy equipment in 26. claim 25, further comprise and be configured to cold-producing medium to be transported to along described bar the supply chamber of described cooling package, extend at least in part in described applicator in wherein said supply chamber, and described a plurality of aperture is the separate hole along the part in the described supply chamber in described applicator.

Cold therapy equipment in 27. claim 26, the described part in wherein said supply chamber is that linear pipe and described hole are arranged on the different side face position in described supply chamber.

Cold therapy equipment in 28. claim 26, the described part in wherein said supply chamber is serpentine pipe, and described hole is arranged as the Outboard Sections along described serpentine pipe.

Cold therapy equipment in 29. claim 26, further comprise the first supply branch of inclination and the second supply branch of inclination, a far-end that is positioned at described the first supply chamber in wherein said a plurality of aperture, and another in described a plurality of aperture is positioned at the far-end of described the second supply branch, and described the first and second supply branches separate in the vertical along the length of described cooling package.

Cold therapy equipment in 30. claim 29, further comprise the first supply chamber and the second supply chamber, wherein the first and second supply chambeies are configured to, along described bar, cold-producing medium is transported to described cooling package, described the first supply branch has determined the distal portions in described the first supply chamber, and described the second supply branch has determined the distal portions in described the second supply chamber.

31. 1 kinds of cold therapy equipment, comprising:

The bar with the elongation of distal portions, wherein said bar be configured to by described distal portions blood vessel be built in renal artery or nephrostome or near therapentic part;

Along the supply chamber of the described bar of at least a portion, described supply chamber has first-class impedance,motional and is configured to transport liquid and/or supercritical refrigerant;

Along the passing away of the described bar of at least a portion, described passing away has second impedance,motional and is configured to transport liquid and/or supercritical refrigerant;

Be positioned at the cooling package of the described distal portions of described bar, described cooling package has sending state and deployed condition, described cooling package comprises the applicator with balloon, fluid connection between described balloon and described supply chamber and described passing away, and wherein said first-class impedance,motional equals described second impedance,motional substantially.

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