Controlled energy dispersion for nerve ablation

Abstract

Methods and devices for treatment of tissues outside of vascular bodies to apply energy to the target location without causing unintended damage within the vessel.

Description

CONTROLLED ENERGY DISPERSION FOR NERVE ABLATIONCROSS-REFERENCE TO RELATED APPLICATIONS

[0001] This application claims benefit to U.S. Provisional application number 63 / 649,368 filed May 18, 2024, the entirety of which is incorporated by reference.FIELD OF THE INVENTION

[0002] Methods and devices for treatment of tissues outside of vascular bodies to apply energy to the target location without causing unintended damage within the vessel.BACKGROUND OF THE INVENTION

[0003] A number of therapies involve the use of an energy delivery device within the vasculature of an individual, where the energy delivery device applies energy to ablate tissues outside of the vessel, for example, during nerve ablation procedures, treatment of malignant tissue, etc. In many cases, the application of ablative energy through the vessel requires preventing the applied energy from having an undesired effect on the vessel wall or heating of blood passing through the vessel. In many cases, the flow of blood is used as a cooling mechanism to prevent undesired heating of tissue. However, there are cases where there is a need to position a device within a small vessel to treat tissue outside of the vessel but due to the size of the vessel and lack of sufficient blood flow, applying energy within the vessel creates a large heat effect zone that causes undesired damage to the vessel or heats blood, that could ultimately cause blockage of the vessel or thrombosis. Also, when the target for the energy is several millimeters from the vessel, then large amounts of energy might need to be used to reach the contact location, often undesirably heating up the nearby tissues and body structures and sometimes causing unintended collateral damage.

[0004] In one such example, middle meningeal artery (MMA) embolization is currently used to treat chronic subdural hematoma. In such cases, creation of the embolization in the MMA is often painful and requires injection of an analgesic or numbing agent into the nerves adjacent to the MMA. It was found that treating the nerves can temporarily treat pain from chronic headaches. However, the size, location (deep within the brain), and other anatomical characteristics of the MMA prevent current devices from being able to treat the adjacent nerves using a vascular approach. FIG. 1 provides a partial illustration of the middlemeningeal artery 10 located within brain of an individual 12. Accordingly, there remains a need to access a small or delicate vessel to treat tissues outside of that vessel in a manner that does not cause unwanted trauma within the vessel or excessive heat to blood flowing within that vessel.SUMMARY OF THE INVENTION

[0005] Variations of the present disclosure include a therapeutic device for use with an energy source, the therapeutic device including: a device body having a helically shaped working end including a plurality of helical turns, wherein when deployed within a vessel, the helically shaped working end is configured to expand against a wall of the vessel, and where the plurality of helical turns are configured to conform to one or more bends in the vessel; an energy transfer region coupled to the energy source and on at least a portion of the plurality of helical turns, where the energy transfer region is configured to direct energy in a radially outward direction from the helically shaped working end in a dispersion pattern that expands in the radially outward direction such that a constructive energy region is formed when the dispersion pattern from the energy transfer region on a first helical turn intersects the dispersion pattern from the energy transfer region on an adjacent helical turn, wherein tissue exposed to the constructive energy region reaches a greater temperature than tissue immediately adjacent to the plurality of helical turns, wherein the constructive energy region formed from the plurality of helical turns creates a unidirectional energy dispersion spaced from the helically shaped working end.

[0006] In variations of the device, the helically shaped working end can be compressible and / or extendable along a longitudinal axis.

[0007] Variations of the present disclosure include a therapeutic device, further including a tension member extending from a distal end of the helically shaped working end in a proximal direction, wherein the tension member is configured to compress the helically shaped working end along the longitudinal axis.

[0008] Variations of the present disclosure include a therapeutic device, further including a sheath, wherein the device body and helically shaped working end are positionable within the sheath in a deployment configuration, and the helically shaped working end is advanceable from the sheath when in a deployed configuration. The helically shaped workingend can be configured to self-expand in the deployed configuration. Alternatively, the helically shaped working end is actuated to expand in the deployed configuration.

[0009] Variations of the present disclosure include a therapeutic device, wherein the helically shaped working end includes a conductive member surrounded by a dielectric covering, wherein the energy transfer region includes an opening in the dielectric covering.

[0010] Variations of the present disclosure include a therapeutic device, wherein the energy transfer region includes one or more energy emitting portions positioned on or in the plurality of helical turns.

[0011] Variations of the present disclosure include a therapeutic device, wherein the energy source is selected from the group consisting of a microwave energy source, an RF energy source (either bipolar or monopolar), and an ultrasound energy source. The energy source used for the devices described herein can also be energy that is above or below typical RF frequency ranges. In those variations using ultrasound energy as the source, the devices and methods can reflect ultrasound energy off the skull base and into the target area (e.g., the trigeminal nerve bundle).

[0012] The present disclosure also includes a therapeutic device for use with an energy source, where a device body includes a working end configured for deployment within a vessel; and an energy transfer region coupled to the energy source and on at least a portion of the working end, where the energy transfer region is configured to direct energy in a radially outward direction from the working end to ablate tissue outside of the vessel and reduce injury to the vessel. Variations of the device can be configured to prevent or minimize the transfer of energy to the vessel.

[0013] Another variation of a therapeutic device for use with an energy source includes a device body having a working end configured for deployment within a vessel; and an energy transfer region coupled to the working end and configured to direct energy away from the working end in one or more dispersion patterns, wherein the working end is configured to reposition at least a portion of the energy transfer region to such that a constructive energy region is formed when the one or more dispersion patterns overlap, wherein tissue exposed to the constructive energy region reaches a greater temperature than tissue immediately adjacent to the working end.

[0014] In an additional variation, the therapeutic device can be used with an energy source and includes a device body having a working end configured for deployment within a vessel; and an energy transfer region coupled to the working end and configured to direct energy away from the working end in one or more dispersion patterns, wherein the working end is configured to reposition at least a portion of the energy transfer region to such that a constructive energy region is formed when the one or more dispersion patterns overlap and repositioning of least the portion of the energy transfer region moves the constructive energy region radially relative to the vessel, wherein tissue exposed to the constructive energy region reaches a greater temperature than tissue immediately adjacent to the working end.

[0015] Variations of the present disclosure include methods of treating a region of tissue external to and spaced from a wall of a vessel. In one example such a method can include advancing a device body into the vessel, the device body having a helically shaped working end including a plurality of helical turns, where the plurality of helical turns are configured to conform to one or more bends in the vessel, the helically shaped working end includes an energy transfer region on at least a portion of the plurality of helical turns, where the energy transfer region is configured to direct energy in a radially outward direction from the helically shaped working end in a dispersion pattern that expands in the radially outward direction such that a constructive energy regions is formed when the dispersion pattern from the energy transfer region on a first helical turn intersects the dispersion pattern from the energy transfer region on an adjacent helical turn, wherein tissue exposed to the constructive energy region reaches a greater temperature than tissue immediately adjacent to the plurality of helical turns, wherein the constructive energy regions formed from the plurality of helical turns creates a unidirectional energy dispersion spaced from the helically shaped working end; applying energy from an energy source to the energy transfer region such that the region of tissue external to and spaced from the wall of the vessel is ablated.BRIEF DESCRIPTION OF THE FIGURES

[0016] FIG. 1 provides a partial illustration of the middle meningeal artery located within brain of an individual.

[0017] FIG. 2A illustrates an example of a therapeutic device coupled to an energy source.

[0018] FIG. 2B illustrates partial deployment of the device within the vessel where the device body includes a helically shaped working end formed from a number of helical turns.

[0019] FIG. 2C shows an example of the therapeutic device deployed within the vessel.

[0020] FIG. 2D shows a variation of the device where the helically shaped working end is compressed along an axis of the helical shape such that the distance between adjacent turns decreases.

[0021] FIGS. 3 A and 3B show variations of therapeutic devices having a helically shaped working end with different types of energy transfer regions.

[0022] FIG. 3C shows a magnified view of the portion marked 3C in FIG. 3B to illustrate one variation of an energy transfer region on at least a portion of a helical turn of the device shown in FIG. 3B.

[0023] FIG. 3D shows a cross-sectional view taken along the line of 3D-3D in FIG. 3B to conceptually illustrate an energy dispersion pattern that expands in a radially outward direction.

[0024] FIGS. 4 A and 4B provide illustrations of overlapping dispersion patterns that form one or more constructive energy regions when the dispersion patterns on adjacent helical turns intersect.

[0025] FIGS. 5 A and 5B are illustrations of a therapeutic device where the helically shaped working end emits a number of energy dispersion patterns that overlap to form constructive energy regions, where FIG. 5B shows the helically shaped working end in an axially compressed configuration.

[0026] FIGS. 6 A and 6B illustrate another variation of applying therapy to the MM A to address chronic headaches.

[0027] FIG. 7 illustrates another variation of a working end of a treatment device where the working end comprises a plurality of basket legs forming an expandable basket configuration.

[0028] FIGS. 8 A and 8B show another variation of a device having telescoping shafts with electrodes to apply therapeutic energy to a region that is spaced from the vessel.DETAILED DESCRIPTION

[0029] The present disclosure discusses methods and devices for applying energy within any blood vessel, such as the middle meningeal artery, to produce a therapeutic effect on tissues outside of the middle meningeal artery (MM A), including but not limited to the otic ganglion. In one variation, the devices and methods can treat the trigeminal nerve bundle. However, the devices and methods can deliver energy from any vessel in the body, and target any structure within the body with energy.

[0030] Application of energy in this manner can be a long-term therapeutic treatment for chronic headaches. Treatment of tissues through devices placed in the MMA is one example of the application of improved methods and devices described herein. It is noted that the devices and methods described herein can be applied in a variety of small vessels having tortuous pathways where treatment of tissue outside of the vessel is desired while preserving tissues within the vessel itself.

[0031] FIG. 2A illustrates an example of a therapeutic device 100 coupled to an energy source 130. The energy source can comprise an external power supply or can be integrated into a handle or other portion of the device 100. FIG. 2 A shows the therapeutic device 100 having a device body 102 that is positioned within a vessel 30 (including, but not limited to the MMA), using a sheath or catheter 40. FIG. 2B illustrates partial deployment of the device 100 within the vessel 30 where the device body 102 includes a helically shaped working end formed from a number of helical turns 104 having an energy transfer region 120. As discussed below, the energy transfer region 120 provides omnidirectional energy in an outward direction from the spiral shape to concentrate ablative energy at a distance from the vessel 30. When deployed within a vessel, the helically shaped working end can be configured to expand against a wall of the vessel 30 and to conform to one or more bends in the vessel 30. Deployment of the device 100 can include advancing the device 100 out of the sheath 40. Alternatively, the sheath 40 can be withdrawn relative to the device body 102.Variations include the device body 102 assuming the helical configuration passively (e.g., via a pre-determined shape set into the device 100). Alternatively, the device body 102 can be actuated to assume the helical shape using mechanical and / or electro-mechanical means.

[0032] FIG. 2C shows an example of the therapeutic device 100 deployed within the vessel 30. The device 100 includes a helically shaped working end 110 formed from a plurality of helical turns 104, where at least a portion of the helical turns 104 include an energy transfer region 120, that, as discussed below, is configured to direct energy in aradially outward direction from the helically shaped working end 110 in a dispersion pattern that expands in the radially outward direction such that a constructive energy region is formed when the dispersion pattern from the energy transfer region on a first helical turn intersects the dispersion pattern from the energy transfer region on an adjacent helical turn, wherein tissue exposed to the constructive energy region reaches a greater temperature than tissue immediately adjacent to the plurality of helical turns, wherein the constructive energy regions formed from the plurality of helical turns creates a unidirectional energy dispersion spaced from the helically shaped working end 1 10. As shown, the helically shaped working end 110 can expand against a wall of the vessel 30. However, variations of devices can include a helically shaped working end that does not engage a wall of the vessel. In addition, the properties of the helically shaped working end 110 allow the device 100 to conform to a curvature of the vessel 30. Benefits of the devices and method described herein allow for application of energy radially outward, so that heat is not accumulated inside the vessel.Another benefit is that energy can be concentrated constructively to control the concentration distance.

[0033] FIG. 2D shows a variation of the device 100 where the helically shaped working end 110 can be compressed along an axis of the helical shape such that the distance between adjacent turns 104 decreases. This compression can occur using a tensioning member 116 or can use any structure that allows axially lengthening / shortening of the helically shaped working end 110. The device 100 can be designed such that the helically shaped working end 110 reverts to its original configuration after removing tension from the tensioning member 116. In additional variations of the device, the tensioning member 116 or other pull wire can be used to form the device into a curve shape to move the vessel closer to a desired target or nerve. In some variations, the helically shaped working end can include a shape memory alloy that allows for axially lengthening / shortening by applying a current to the shape memory alloy.

[0034] FIGS. 3 A and 3B show variations of therapeutic devices having a helically shaped working end 110 with different types of energy transfer regions 120, 122. FIG. 3 A shows the energy transfer regions 122 as being point sources of energy (e.g., a transducer, an exposed region forming an electrode, etc.). In both cases, the energy transfer regions 120, 122 are oriented to direct energy in an outward direction and over at least a portion of the helically shaped working end 110.

[0035] FIG. 3C shows a magnified view of the portion marked 3C in FIG. 3B to illustrate one variation of an energy transfer region 120 on at least a portion of a helical turn 104 of the device shown in FIG. 3B. As illustrated, the energy transfer region 120 includes a thin opening or slit 106 formed in a covering 128 that surrounds an energy transfer element 126. The covering 128 can comprise a dielectric covering, insulation, or other type of shielding that affects The energy transfer element 126 can comprise any modality of energy transfer structures, including but not limited to an RF electrode, an ultrasound element, a microwave antenna, where the shielding / cover 128 directs emission or application of energy in a desired direction away from the outer side of the helical turn 104. As noted below, this construction allows for unidirectional energy dispersion, improved control of the energy profile, and reduces an undesired heat effect zone that would otherwise form within the vessel.

[0036] FIG. 3D shows a cross-sectional view taken along the line of 3D-3D in FIG. 3B to conceptually illustrate an energy dispersion pattern 140 that expands in a radially outward direction (e.g., it is narrower closer to the device and spreads out away from the device). As noted below, this configuration allows formation of a constructive energy region when adjacent dispersion patterns overlap / intersect. The constructive energy region reaches a greater temperature than tissue immediately adjacent to the plurality of helical turns. The energy dispersion pattern creates a unidirectional energy dispersion spaced from the helically shaped working end of the device. FIG. 3D illustrates the shielding / cover 128 positioned over the energy transfer element 126 with an opening 106 to direct the energy dispersion pattern 140. FIG. 3D also shows the use of an optional adhesive or filler 108 located between the shielding / cover 128 and the energy transfer element 126.

[0037] FIGS. 4 A and 4B provide illustrations of overlapping dispersion patterns 140 that form one or more constructive energy regions 142, 144 when the dispersion patterns on adjacent helical turns intersect. FIG. 4A shows a cross sectional view of two adjacent helical turns 140 that produce dispersion patterns 104 that intersect to form a constructive energy region 142 that delivers a greater amount of energy to tissue in region 142, which results in an increased temperature at this region 142 relative to the regions immediately adjacent to the helical turns 104. FIG 4B shows a variation where three adjacent helical turns 104 each form dispersion patterns that result in constructive energy regions 142 where the dispersion patterns of two turns overlap and another constructive energy region 144 where the emission profile of three turns 104 overlap to where the constructive energy region reaches a greater temperature than tissue immediately adjacent to the plurality of helical turns.

[0038] FIGS. 5 A and 5B are illustrations of a therapeutic device 100 within a vessel 100 where the helically shaped working end 110 emits a number of energy dispersion patterns 50 that overlap to form constructive energy regions 142, 146 to treat regions 28 (such as the nerves described above) that are spaced from the vessel 30. FIG. 5B shows a helically shaped working end being compressed in an axial direction to increase the number of constructive energy regions 142 (two overlapping energy dispersion patterns), 144, (three overlapping energy dispersion patterns), and 146 (four overlapping energy dispersion patterns) The constructive energy regions 142, 144, and 146 deliver increased amounts of energy to the target tissues (e.g., 28) to direct treatment away from the vessel 30. FIG. 5 A illustrates the energy treatment patterns as being omnidirectional about a circumference of the helically shaped working end 110. However, variations of the device can include configurations where the dispersion patterns are not omnidirectional but are directed to a desired side or orientation of the device 100. In addition, the device 100 can include various features to direct the emission profile in a desired direction. For example, portions of the helically shaped working end can be covered with a surface that redirects energy away from a particular structure of the device. For example, the device can be configured such that the interior of the helically shaped working end is backed with a reflective surface to redirect energy away from the helically shaped working end 110. In addition, as discussed above, the axial length of the helically shaped working end 110 can be extendable and / or compressible (see e.g., FIG. 2D) to move adjacent turns of the helical structure together to shift or increase power density at regions that are spaced from the helically shaped working end 110.

[0039] FIGS. 5 A and 5B also show another feature of the device 100 where increasing the density of the helical turns 104 can adjust a distance of the constructive energy regions from the vessel 30. FIG. 5A shows region 142 at height Hl and region 144 at height H2. FIG. 5B, which includes an axially compressed helically shaped working end 110 where the coils 104 are spaced closer than in FIG. 5A. Accordingly, the constructive energy regions are at height H3 and H4, which are closer than the heights shown in FIG. 5A.

[0040] FIG. 5A also shows that the device allows energy to extend radially outward and not inward, thus sending energy to a desired location without undesirably sending energy to the interior of the vessel. Also, the energy zones that can be concentrated and the distance of energy concentration from the vessel can be changed in vivo by altering the stretch / compression of the coil. As noted herein, and as shown in FIG. 5B, the device 100 can be configured to deliver energy to less than a full circumference of the device.

[0041] FIGS. 6 A and 6B illustrate another variation of applying therapy to the MM A to address chronic headaches. In this variation, a stent or expandable frame 150 is positioned within the MM A where drug-eluting properties of the structure 150 can deliver drugs or other substances over months (lidocaine, BTX, etc.). The structure 150 is configured to allow blood flow through the MMA and can be permanent or absorbable. In an additional variation, the stent structure 150 can include one or more spike structures 152 that are configured to penetrate a vessel wall for delivery of substances into or beyond the wall. FIG. 6A shows a stent structure 150 with the spikes 152 compressed with the struts 154 of the stent. FIG. 6B shows the stent body 154 expanded with the spikes 152 reoriented to protrude from the body 154. In additional variations, the spikes can remain in place without the stent remaining in place.

[0042] FIG. 7 illustrates another variation of a working end of a treatment device 160 where the working end comprises a plurality of basket legs 162 forming an expandable basket configuration. The basket 160 can be compressed or collapsed for delivery and expanded via self-expansion or using a wire 164. The basket legs 162 can be similar to the coil designs described above (e.g., having an energy transfer region) for focusing energy.

[0043] FIGS. 8 A and 8B show another variation of a device 180 for applying therapeutic energy to a region that is spaced from the vessel 30. As shown, the device 180 can include any number of telescoping shafts 182, 186, 190 with one or more electrodes 184, 188, 192 on each shaft 182, 186, 190. The shafts 182, 186, 190 can axially translate independently to increase or decrease a distance between the electrodes 184, 188, 192. In addition, the conductive path 196 between electrodes can be altered to affect the flow of current between electrodes.

[0044] As for other details of the present invention, materials and manufacturing techniques may be employed within the level of those with skill in the relevant art. The same may hold true with respect to method-based aspects of the invention in terms of additional acts that are commonly or logically employed. In addition, though the invention has been described in reference to several examples, optionally incorporating various features, the invention is not to be limited to that which is described or indicated as contemplated with respect to each variation of the invention.

[0045] Various changes may be made to the invention described and equivalents (whether recited herein or not included for the sake of some brevity) may be substitutedwithout departing from the true spirit and scope of the invention. Also, any optional feature of the inventive variations may be set forth and claimed independently, or in combination with any one or more of the features described herein. Accordingly, the invention contemplates combinations of various aspects of the embodiments or combinations of the embodiments themselves, where possible. Reference to a singular item, includes the possibility that there are plural of the same items present. More specifically, as used herein and in the appended claims, the singular forms “a,” “and,” “said,” and “the” include plural references unless the context clearly dictates otherwise.

[0046] It is important to note that where possible, aspects of the various described embodiments, or the embodiments themselves can be combined. Where such combinations are intended to be within the scope of this disclosure.

Claims

CLAIMSWe claim:

1. A therapeutic device for use with an energy source, the therapeutic device comprising: a device body having a helically shaped working end comprising a plurality of helical turns, wherein when deployed within a vessel, the helically shaped working end is configured to expand against a wall of the vessel, and where the plurality of helical turns are configured to conform to one or more bends in the vessel; and an energy transfer region coupled to the energy source and on at least a portion of the plurality of helical turns, where the energy transfer region is configured to direct energy in a radially outward direction from the helically shaped working end in a dispersion pattern that expands in the radially outward direction such that a constructive energy region is formed when the dispersion pattern from the energy transfer region on a first helical turn intersects the dispersion pattern from the energy transfer region on an adjacent helical turn, wherein tissue exposed to the constructive energy region reaches a greater temperature than tissue immediately adjacent to the plurality of helical turns, wherein the constructive energy region formed from the plurality of helical turns creates a unidirectional energy dispersion spaced from the helically shaped working end.

2. The therapeutic device of claim 1, wherein the helically shaped working end is compressible along a longitudinal axis.

3. The therapeutic device of claim 2, further comprising a tension member extending from a distal end of the helically shaped working end in a proximal direction, wherein the tension member is configured to compress the helically shaped working end along the longitudinal axis.

4. The therapeutic device of claim 2, wherein compressing the helically shaped working end comprises use of a shape memory alloy.

5. The therapeutic device of claim 1, further comprising a sheath, wherein the device body and helically shaped working end are positionable within the sheath in a deployment configuration.

6. The therapeutic device of claim 5, wherein the helically shaped working end is advanceable from the sheath when in a deployed configuration.

7. The therapeutic device of claim 6, wherein the helically shaped working end is configured to self-expand in the deployed configuration.

8. The therapeutic device of claim 7, wherein the helically shaped working end is actuated to expand in the deployed configuration.

9. The therapeutic device of claim 1 , wherein the helically shaped working end comprises a conductive member surrounded by a dielectric covering, wherein the energy transfer region comprises an opening in the dielectric covering.

10. The therapeutic device of claim 1, wherein the energy transfer region comprises one or more energy emitting portions positioned on or in the plurality of helical turns.

12. The therapeutic device of claim 1 , wherein the energy source is selected from the group consisting of a microwave energy source, an RF energy source, an ultrasound energy source.

13. The therapeutic device of claim 1, wherein increasing or decreasing an axial length of the helically shaped working end alters a distance of the constructive energy region from the wall of the vessel.

14. The therapeutic device of claim 1, wherein increasing or decreasing an axial length of the helically shaped working end alters a density of the constructive energy region.

15. A method of treating a region of tissue external to and spaced from a wall of a vessel, the method comprising: advancing a device body into the vessel, the device body having a helically shaped working end comprising a plurality of helical turns, where the plurality of helical turns are configured to conform to one or more bends in the vessel, the helically shaped working end includes an energy transfer region on at least a portion of the plurality of helical turns, where the energy transfer region is configured to direct energy in a radially outward direction from the helically shaped working end in a dispersion pattern that expands in the radially outward direction such that a constructive energy region is formed when the dispersion pattern from the energy transfer region on a first helical turn intersects the dispersion pattern from the energy transfer region on an adjacent helical turn, wherein tissue exposed to the constructive energy region reaches a greater temperature than tissue immediately adjacent to the plurality of helical turns, wherein the constructive energy regions formed from the plurality of helical turns creates a unidirectional energy dispersion spaced from the helically shaped workingend; applying energy from an energy source to the energy transfer region such that the region of tissue external to and spaced from the wall of the vessel is ablated.

16. The method of claim 15, wherein the vessel comprises a middle meningeal artery.

17. The method of claim 15, further comprising adjusting a distance of the constructive energy region from the vessel by axially extending or compressing the helically shaped working end.

18. The method of claim 15, wherein the energy source is selected from the group consisting of a microwave energy source, an RF energy source, an ultrasound energy source.

19. The method of claim 18, wherein when the energy source is the ultrasound energy source application of ultrasound energy is reflected off of a skull base causing a concentration of ultrasound energy at a nerve bundle.

20. A therapeutic device for use with an energy source, the therapeutic device comprising: a device body having a working end configured for deployment within a vessel; and an energy transfer region coupled to the energy source and on at least a portion of the working end, where the energy transfer region is configured to direct energy in a radially outward direction from the working end to ablate tissue outside of the vessel and reduce injury to the vessel.

21. A therapeutic device for use with an energy source, the therapeutic device comprising: a device body having a working end configured for deployment within a vessel; and an energy transfer region coupled to the working end and configured to direct energy away from the working end in one or more dispersion patterns, wherein the working end is configured to reposition at least a portion of the energy transfer region such that a constructive energy region is formed when the one or more dispersion patterns overlap, wherein tissue exposed to the constructive energy region reaches a greater temperature than tissue immediately adjacent to the working end.

22. A therapeutic device for use with an energy source, the therapeutic device comprising: a device body having a working end configured for deployment within a vessel; andan energy transfer region coupled to the working end and configured to direct energy away from the working end in one or more dispersion patterns, wherein the working end is configured to reposition at least a portion of the energy transfer region to such that a constructive energy region is formed when the one or more dispersion patterns overlap and repositioning of least the portion of the energy transfer region moves the constructive energy region radially relative to the vessel, wherein tissue exposed to the constructive energy region reaches a greater temperature than tissue immediately adjacent to the working end.

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