Patent Publication Number: US-2021161594-A1

Title: Peri-vascular tissue access catheter with locking handle

Description:
INCORPORATION BY REFERENCE TO ANY PRIORITY APPLICATIONS 
     This application is a continuation of U.S. patent application Ser. No. 16/039,234, filed Jul. 18, 2018, which is hereby incorporated by reference in its entirety. Any and all applications for which a foreign or domestic priority claim is identified in the Application Data Sheet as filed with the present application are hereby incorporated by reference under 37 CFR 1.57. 
    
    
     FIELD 
     Some aspects of the invention are applicable to the field of devices to advance a needle-like structure for sensing nerve activity, tissue ablation or injection a fluid into a volume tissue outside of the inside wall of a target vessel of a human body. Applications include the treatment of hypertension, congestive heart failure, BPH and prostate cancer, prevention of restenosis after PCI and other disorders. 
     BACKGROUND 
     Fischell et al. in U.S. Pat. No. 9,056,185 describes an intravascular fluid injection catheter with a proximal handle having a gap between the two components of the handle and adjustment tools configured to adjust the gap. The gap can be used to limit the penetration depth of an injector tube with a distal needle beyond a guide tube that expands outward against the wall of a target vessel. This handle is workable but can lack a locking mechanism to prevent motion of the guide tubes or injector tubes. U.S. Pat. No. 9,056,185 is incorporated by reference in its entirety. 
     In U.S. Pat. Nos. 9,179,962, 9,254,360, 9,301,795, 9,320,850, 9,526,827, 9,539,047, and 9,554,849, which are incorporated by reference in their entireties, Fischell et al. show in FIG. 11, an improved handle with separate unlock mechanisms for the motion of the guide tubes and injector tubes with distal needles. A similar handle is shown by Fischell et al. in U.S. Pat. Nos. 9,931,046 and 9,949,652, incorporated by reference in their entireties, can be used to advance electrodes into and beyond the inside wall of a target vessel for nerve sensing, electrical stimulation and energy based tissue ablation. 
     Both sets of patents mentioned above use needle guiding elements in the form of guide tubes to support the advancement and penetration through the inside wall of a target vessel of needles/wires with sharpened distal ends. Such a structure can be important in some cases to allow use of small diameter needles/wires that may not cause blood loss when retracted for use in a blood vessel. 
     Throughout this specification any of the terms fluid or solution will be used interchangeably to include a liquid or a gaseous substance delivered into a volume of tissue in a human body with the intention of medicating, damaging, killing or ablating nerves or tissue within that volume of tissue. 
     Also throughout this specification, the term inside wall or interior surface applied to a blood vessel, vessel wall, artery or arterial wall mean the same thing which is the inside surface of the vessel wall inside of which is the vessel lumen. Also the term injection egress is defined as the distal opening in a needle from which a fluid being injected will emerge. With respect to the injection needle, either injection egress or distal opening may be used here interchangeably. 
     The terminology “deep to” a structure is defined as beyond or outside of the structure so that “deep to the inside wall of a target vessel” refers to a volume of tissue outside of the or inside surface of the vessel. 
     SUMMARY 
     The use of guide tubes as needle guiding elements of the catheters, such as the Peri-vascular Tissue Ablation Catheters (PTAC) of U.S. Pat. Nos. 9,056,185, 9,179,962, 9,254,360, 9,301,795, 9,320,850, 9,526,827, 9,539,047, and 9,554,849 can be utilized or modified for use with systems and methods as disclosed herein. Such guiding elements can be important in some cases for the support of small diameter needles to access the volume of tissue deep to the inside wall of a target vessel. 
     Some embodiments of handle features as disclosed herein can also be used or modified for use with, for example, the Sympathetic Nerve Sensing Catheter (SNSC) and Peri-vascular Nerve Sensing and Ablation Catheter (PNASC) embodiments described by Fischell et al. in U.S. Pat. Nos. 9,931,046 and 9,949,652 which include a guide tube/needle structure similar to for placing needles and/or electrodes deep to the inside wall of a target vessel. 
     Although not included in any of the above applications, a prototype handle using rings with a pin and slot mechanism was contemplated. While such handles can be used in some embodiments, they can in some cases be hard to use and requires hard to see visual verification of the pin location to see where the guide tubes or injector tubes are positioned. 
     Some embodiments of a catheter can include an improved handle that greatly simplifies the operation of the catheter allowing a single slider on the handle to sequentially advance and then retract the guide tubes and needles (or electrodes or other peripheral effectors) from an a pre-deployment state to where the guide tubes are deployed to where the needles are extended beyond the distal ends of the guide tubes into the desired volume of tissue and then back. A single unlock mechanism that may be in the form of a button or other control, can ensure that the system will under normal operation relock itself after each step. 
     The handle itself may have one or more additional physical features. These can include any number of:
         An ergonomic shape with a finger detent to help properly position the user&#39;s hand for handle operation.   Marker lines or other indicia to easily verify the position of the guide tubes and needles/electrodes associated with the position of the slider, and   Icons viewable on the handle surface to further verify the position of the guide tubes and needles/electrodes associated with the position of the slider.   An optional special fast retraction mode where using 2 hands, the needles and then guide tubes may be completely retracted in a single motion of the slider.   The addition of an unlock override to relock the device if it is unlocked in error.       

     As with the other handles referenced in the Fischell et al. patents, some embodiments of the present invention can include a fluid injection port and one or more flushing ports to flush air out of catheter lumens by the injection of saline. As described in U.S. Pat. No. 9,320,850, a handle may use a non-standard connector on the injection port to prevent accidental injection of the injectable fluid into a flushing port. 
     Throughout this specification the term injector tube with distal injection needle can be used to specify a tube with a sharpened distal end that penetrates into tissue and is used to inject a fluid into that tissue. Such a structure could also be called a hypodermic needle, an injection needle or simply a needle. In addition, the terms element and structure may be used interchangeably within the scope of this application. The term Luer fitting may be used throughout this application to mean a tapered Luer fitting without a screw cap or a Luer Lock fitting that has a screw cap. 
     These and other features and advantages of embodiments of the invention will become obvious to a person of ordinary skill in this art upon reading of the detailed description including the associated drawings and the claims. 
     In some embodiments, a catheter for fluid delivery to a volume of tissue in outside of the inside wall of a target lumen, e.g., vessel in a human body is provided. In some embodiments, the catheter can include a catheter body having a central axis extending in a longitudinal direction. The catheter can include a distal portion including at least one guide tube having a distal end, at least one guide tube expandable between a first position within the catheter body and a second position inclined away from the catheter body with the distal end in proximity to the inside wall of the target vessel. In some embodiments, the catheter can include at least one sharpened needle having an injection lumen with distal injection egress, a portion of the at least one injector tube located coaxially inside of the at least one guide tube. In some embodiments, the catheter can include a proximal handle having a top surface, two side surfaces and a bottom surface adapted to advance and retract the guide tubes and needles. In some embodiments, the handle can include an unlock mechanism having a locked state and an unlocked state. In some embodiments, the handle can include a movement mechanism configured to allow the relative longitudinal movement of the at least one guide tube with respect to the catheter body and the at least one needle with respect to the at least one guide tube, the movement subject to the unlock mechanism being in the unlocked state, and movement is prevented when the unlock mechanism is not in the unlocked state. 
     In some embodiments, the catheter can include three guide tubes and three sharpened needles. In some embodiments, the at least one needle is hollow and includes fluid egress near the distal end of the needle and the catheter can include an injection lumen in fluid communication with the fluid egress of the at least one needle. In some embodiments, the at least one needle has a distal end that forms an electrode. In some embodiments, the catheter body further including a wire that runs the length of the catheter to conduct electrical signals between the at least one electrode and a connector near the proximal end of the catheter. In some embodiments, the connector is adapted to connect the wire to external equipment. In some embodiments, the external equipment includes electronic systems selected from the group of: sensors configured to measure electrical signals, sensors to measure electrical signals sensed by the electrodes of the at least one needle, a signal generator configured to provide electrical stimulation signals to the electrodes of the at least one needle, or an energy delivery effector to provide energy based ablation through the electrodes of the at least on needle. In some embodiments, the proximal handle includes at least one marker line associated with the position of the movement mechanism denoting the catheter state selected from the group of: the position of the movement mechanism where the at least one guide tube and at least one injector tubes are both retracted, the position of the movement mechanism where the at least one guide tube is advanced but the at least one injector tube is retracted, or the position of the movement mechanism where the at least one guide tube and at least one injector tube are both advanced. In some embodiments, 2 or more marker lines are included on the proximal handle. In some embodiments, the proximal handle can include a first marker line denoting the position of the movement mechanism where the at least guide tube and at least one injector tube are both retracted, a second marker line denoting the position of the movement mechanism where the at least one guide tube is advanced but the at least one injector tube is retracted and a third marker line denoting the position of the movement mechanism where the at least one guide tube and at least one injector tubes are both advanced. In some embodiments, the proximal handle includes at least one icon associated with the state of the catheter chose from the group of: the position of the movement mechanism where the at least one guide tube and at least one injector tubes are both retracted, the position of the movement mechanism where the at least one guide tube is advanced but the at least one injector tube is retracted, or the position of the movement mechanism where the at least one guide tube and at least one injector tube are both advanced. In some embodiments, the proximal handle includes a first icon denoting the position of the movement mechanism where the at least guide tube and at least one injector tube are both retracted, a second icon denoting the position of the movement mechanism where the at least one guide tube is advanced but the at least one injector tube is retracted and a third icon denoting the position of the movement mechanism where the at least one guide tube and at least one injector tubes are both advanced. In some embodiments, the proximal handle includes two of each of the three icons. In some embodiments, the handle includes at least one flushing port. In some embodiments, the handle includes a finger detent to aid in positioning the operators hand for operating the handle. In some embodiments, the movement mechanism is a slide switch. In some embodiments, there is at least one marker line on the top surface of the handle. In some embodiments, there are at least two marker lines on the top surface of the handle. In some embodiments, the at least one icon is placed in a location chosen from: the top surface of the handle, one of the side surfaces of the handle, both side surfaces of the handle, or a chamfer or filleted surface between the top surface and a side surface of the handle. 
     In some embodiments, a method for delivery of a fluid outside of the inside wall of a target vessel of a human body is provided. In some embodiments, the method can include advancing into the vessel a catheter. In some embodiments, the catheter can include having a catheter body, a fluid injection lumen, a proximal handle including an unlock mechanism, a longitudinal movement mechanism and distal portion including at least one guide tube having a distal end and at least one injector tube with distal needle located coaxially within the at least one guide tube. In some embodiments, the at least one guide tube is extendable away from the catheter body. In some embodiments, the injector tubes is extendable beyond the distal end of at least one guide tube. In some embodiments, the distal needle of the at least one injector tube has fluid egress in fluid communication with the catheter fluid injection lumen. In some embodiments, the method can include activating the unlock mechanism on the handle. In some embodiments, the method can include operating the longitudinal movement mechanism to advance a preset distance at least one guide tube away from the catheter body until the distal end of the at least one guide tube is in proximity to the inside wall of the vessel. In some embodiments, the unlock mechanism is deactivated when the at least one guide tube is advanced the preset distance. In some embodiments, the method can include re-activating the unlock mechanism. In some embodiments, the method can include operating the longitudinal movement mechanism to extend the at least one injector tube a preset distance beyond the distal end of at least one guide tube, causing the at least one injector tube to penetrate through the inside wall of the target vessel placing the fluid egress of the at least one needle into a volume of tissue outside of the inside wall of the target vessel. In some embodiments, the method can include attaching a fluid source to the catheter. In some embodiments, the method can include injecting fluid through the catheter injection lumen and out of the needle fluid egress into a volume of tissue outside of the inside wall of the vessel. 
     In some embodiments, the distal portion of the catheter includes three guide tubes and three injector tubes with distal needles. In some embodiments, the method can include re-activating the unlock mechanism. In some embodiments, the method can include operating the longitudinal movement mechanism to retract the at least one injector tube back within the at least one guide tube deactivating the unlock mechanism. In some embodiments, the method can include re-activating the unlock mechanism. In some embodiments, the method can include operating the longitudinal movement mechanism to retract the at least one guide tube with retracted injector tube back within the catheter body deactivating the unlock mechanism. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is a longitudinal cross-section of a distal portion of the prior art PTAC shown in FIG. 3 of Fischell et al. U.S. Pat. Nos. 9,179,962, 9,254,360, 9,301,795, 9,320,850, 9,526,827, 9,539,047, and 9,554,849 in its open position as it would be configured for delivery of fluid into a volume of tissue outside of the inside wall of a target vessel. 
         FIG. 2  is a side view of an embodiment of the proximal handle designed for use with, for example, the PTAC of  FIG. 1 . 
         FIG. 3  shows a close up view of the section  223  of  FIG. 2 . 
         FIG. 4  shows a top view of the handle. 
         FIGS. 5A through 5I  illustrate non-limiting steps in a method of using the handle  200  to deploy and retract the guide tubes and injector tubes with needles of the PTAC of  FIG. 1 . 
         FIG. 6  is a longitudinal cross-section of a distal portion of the prior art SNSC/PNASC  10  as shown in FIG. 2 of U.S. Pat. Nos. 9,931,046 and 9,949,652. 
         FIG. 7  is a side view of an embodiment of the proximal handle designed for use with the SNSC/PNASC of  FIG. 6 . 
     
    
    
     DETAILED DESCRIPTION 
       FIG. 1  is a longitudinal cross-section of a distal portion of a Peri-vascular Tissue Ablation Catheter PTAC  100  as shown in FIG. 3 of Fischell et al. U.S. Pat. Nos. 9,179,962, 9,254,360, 9,301,795, 9,320,850, 9,526,827, 9,539,047, and 9,554,849. 
       FIG. 1  is a longitudinal cross-section of the expanded distal portion.  FIG. 1  shows the fully open position with the guide tubes  115  with coaxial injector tubes  116  with sharpened distal injection needles  119  and needle distal opening  117  which is the injection egress deployed outward beyond the distal end of the guide tubes  115 . It should be understood there can be any number of injector tubes and guide tubes. The guide tubes  115  are the guiding elements that help support the thin and flexible injector tubes  116 . In some embodiments, the injector tubes include injection needles. In some embodiments, the injector tubes include electrodes. In some embodiments, the injector tubes are supported as they are advanced into the wall of a target vessel. 
     In some embodiments, it is envisioned that a portion of the injector tube(s)  116  and/or a portion of the guide tube(s)  115  are marked with a radiopaque material such as gold or tantalum, or a piece of radiopaque material may be used to form or be located within the injector tubes  116  or the sharpened needles  119  to provide better visualization of the deployment using standard fluoroscopy.  FIG. 1  shows a radiopaque wire placed within the injector tube  116  to allow fluoroscopy to be used by the operator to clearly identify the position of the injector tubes  116 . The material for the radiopaque wire can be selected from well-known radiopaque metals such as platinum, tantalum or gold or an alloy of that type of metal. 
       FIG. 1  also shows the memory configuration for the fully opened guide tubes  15 . The preformed radius of curvature of the injector tubes  116  can correspond to that of the guide tubes  115  so that the guide tubes  115  will maintain their position against the interior wall of the target vessel as the injector tubes  116  are advanced coaxially there through to penetrate the wall of the target vessel. 
     Still referring to  FIG. 1 , also shown is an outer tube  102 , outer tube extension  104  having distal openings  131  through which the guide tubes  115  with radiopaque markers  122  are advanced outward from the body of the PTAC  100 . Also shown is the tapered section  106  and fixed guide wire  110  with distal tip  109 . The injector tubes  116  with distal injection needles  119  and needle distal openings  117  are shown in their fully deployed positions. The openings  131  support the sides of the guide tubes  115  as the guide tubes  115  are advanced outward before the advancement of the injector tubes  16  with distal injector needles  119 . The PTAC  100  of  FIG. 1  has three guide tubes with the third tube hidden behind the catheter and not visible in this schematic view. Although the PTAC  100  of  FIG. 1  has three guide tubes  115 , it is envisioned that other embodiments could have as few as one or as many as eight guide tubes or more, with 2, 3, 4, 5, 6, 7, 8, or ranges including any two of the aforementioned values being also possible. A larger diameter target vessel might suggest the use of as many as 4 to 8 or more guide tubes  115  and injector tubes  116 . 
     Different shapes are envisioned for the distal openings (or windows)  131  in the outer tube extension  104  where the guide tubes  115  exit. These possible shapes include a racetrack design with curved (e.g., round) proximal and distal ends and straight sides in the axial direction, and oval or round shapes. It is also envisioned that there could be a movable flap covering the opening  131  or a slit that could be opened to make the outer surface of the PTAC smooth for better delivery into the desired target lumen, such as the renal artery in some cases. 
     The proximal end of  FIG. 1  shows the three concentric tubes, the outer tube  102 , middle tube  103  and inner tube  105  which form the central portion and most of the length of the PTAC  100 . The outer tube  102  is attached to the outer tube extension  104  which is in turn attached to the tapered section  106 . The fixed guide wire  110  with core wire  111  and outer layer  113  extends distally from the distal end of the tapered section  106 . It should be noted that only part of the length of the guide wire  110  is shown in  FIG. 1 . 
       FIG. 1  shows the guide tube  115  with radiopaque marker  122  in its fully advanced position placed through the opening  131  in the outer tube extension  104 . The interior surface of the outer tube extension  104  forms part of the tubular shaft  120  can in some cases be made from a stiff material such as a metal or high durometer plastic so that it will be relatively rigid as the guide tubes  115  are advanced and retracted. 
     Some embodiments of a PTAC  100  can use a plurality, e.g., four (or two, three, five, or another number) different tubular structures instead of just an outer tube  102  and outer tube extension  104 . Specifically, the proximal section could be a first tubular structure, such as a metal hypotube in some cases. The metal hypotube could connect at its distal end to a second tubular structure, such as a relatively stiff plastic tube about 20 cm long or more or less that would in turn connect to a third tubular structure, such as a softer more flexible plastic tube about 10 cm long or more or less which connect to the fourth tubular structure, which could be the tube  102  shown in  FIG. 1 . Other number of tubular structures are contemplated, includes tubular structures of the same or different length, and/or the same or different materials. The plastic tubes can have the same inner and outside diameters in some cases. The outer tube extension  104  which is the distal end section of the catheter body typically has a slightly larger inside diameter than the soft outer tube  102 , such as no more than about 20%, 15%, 10%, 5%, 3%, 2%, 1%, larger in inside diameter, or ranges incorporating any two of the aforementioned values. The manifold  125  that connects the inner tube  105  to the injector tubes  116  is coaxially within the plastic tubes and at least several centimeters proximal to the outer tube extension  104  which is the distal end section of the catheter body of the PTAC  100 . 
     In a preferred embodiment, the middle tube  103  attaches to, a proximal metal hypotube and the inner tube  105  would also attach to proximal portion formed from a metal hypotube. 
     The central buttress  121  shown in  FIG. 1 , which can be a mechanical, non-expandable, non-inflatable central buttress in some cases, supports the guide tube  115  both as it is pushed distally and after it is fully deployed. This central buttress  121  also provides radial support for the advanced guide tubes  115  that prevents the guide tubes  115  from backing away from the interior wall of the target vessel as the injector tubes  116  are advanced through the guide tubes  115  forward to their desired position, e.g., about 2-4 mm beyond the interior wall of the target vessel. In exceptional cases, the injection needles  119  at the distal ends of the injector tubes  116  might be advanced as deep as 8 mm or more beyond the interior wall of the target vessel. Additional lateral support for the guide tubes  115  is provided by the sides of the openings  131  that in combination with the central buttress  121  can be highly advantageous to the radial and circumferential/lateral support both during guide tube  115  advancement and outward expansions, and as backup during delivery of the injection needles  119  through the interior wall of the target vessel. The buttress may comprise a deflection surface such as a curved or linear ramp, which may in a curved embodiment correspond to the radius of curvature of the distal surface of the guide tube  115 . The guide tubes  115  can slide along a deflection surface such as the curved ramp  144  of the central buttress  121  (shown in  FIG. 4 ) as they are pushed. The guide tubes  115  advance toward the distal end of the PTAC  100  toward the openings  131 . The guide tubes  115  can interact with a deflection surface such as the curved ramp  144  of the central buttress  121  as they are guided toward the openings  131 . 
     The preformed radius of curvature of the injector tubes  116  can be similar to that of the guide tubes  115  so that the guide tubes  115  will maintain their position against the interior wall of the target vessel as the injector tubes  116  are advanced to penetrate the interior wall of the target vessel. Specifically, the radius of curvature of the central axis of the distal portion of the injector tube  116  can be approximately the same as the radius of curvature of the central axis of the guide tube  115 . In some embodiments, the guide tubes have atraumatic, blunt distal ends such that they are not configured to penetrate through the interior wall of the target lumens. 
     As seen in  FIG. 1  the inner tube  105  with fluid injection lumen  133  connects through the manifold  125  to the three injector tubes  116 , thus the lumens of the injector tubes  116  are in fluid communication with the lumen  133 . The inner tube  105  and manifold  125  can slide along the longitudinal axis of the PTAC  100  inside of the middle tube  103  which is shown with uniform diameter over its length including the portion coaxially outside of the manifold  125 . 
     The manifold  125  is located within the lumen of the inner tube  105  in a portion of the tube  105  that is proximal to the distal end of the tube  105 . The inner tube  105  and manifold  125  are both located coaxially within the outer tube  102  of the PTAC  100  at a position proximal to the outer tube extension  104  which is the distal end section of the outer body of the PTAC  100 . 
     The proximal end of the injector tube  116  is in fluid communication with the injection lumen  133  of the inner tube  105 . Longitudinal motion of the inner tube  105  within the uniform diameter middle tube  103  causes the manifold  125  and attached injector tubes  116  to also move longitudinally. This longitudinal motion caused by control mechanisms near the proximal end of the PTAC  100  will advance and retract the injector tubes  116  through the lumens of the guide tubes  115  to expand outwardly to penetrate the wall of the target vessel to facilitate delivery of the ablative fluid. 
     The guide tube connector  132  connects the three guide tubes  115  to the middle tube  103  that provides the impetus for advancement and retraction of the three guide tubes  115 . The motion of the middle tube  103  is produced by the motion of control mechanisms at the proximal end of the PTAC  100 . The manifold  125  lies inside of the distal portion of the inner tube  105  and connects together the three injector tubes  116  so that advancement and retraction of the inner tube  105  provides simultaneous advancement and retraction of the injector tubes  116 . Also shown are the flushing spaces between the several tubes. Specifically shown is the outer annular space between the middle tube  103  and the outer tube  102  and the inner annular space between the inner tube  105  and the middle tube  103 . Each of these spaces is to be flushed through with normal saline solution prior to insertion of the PTAC  100  into the patient&#39;s body. 
     The guide tubes  115  and guide tube connector  132  are attached coaxially within the distal section of the middle tube  103 . Thus longitudinal motion of the middle tube  103  will cause longitudinal motion of the guide tube connector  132  and guide tubes  115  thus allowing the mechanism at the proximal section of the PTAC  100  to advance and retract the guide tubes  115  with respect to the outer tube  102  and outer tube extension  104 . The guide tube connector  132  and connects together the three guide tubes  115  so that advancement and retraction of the middle tube  103  provides simultaneous advancement and retraction of the guide tubes  115 . 
     In some embodiments, a penetration depth limitation could be a mechanism that limits the forward motion of the distal end of the inner tube  105  with respect to the guide tube connector  132 . In some embodiments, a penetration depth limitation can be a mechanism at the proximal section of the PTAC  100 , such as distinct positions of the slider as described herein. 
     In some embodiments, one or more components of the PTAC  100  are typically made from plastic materials such as polyamide, polyurethane, nylon or tecothane. These include the outer tube  102 , middle tube  103  and inner tube  105 , the outer tube extension  104 , inner layer and/or outer layer of the guide tubes  115 , the tapered section  106 , the buttress  121 , the guide tube connector  132  and the manifold  125 . The manifold  125  can be a molded part or be epoxy or another resin that is injected to glue the injector tubes together within the lumen of the inner tube  105 . It is also envisioned that any or all of the inner tube  105 , middle tube  103  or outer tube  102  could also be a metal hypotube or a metal reinforced plastic tube. The injector tubes  116  would typically be made of a springy or shape memory metal such as nitinol. The radiopaque wire  118  and guide tube radiopaque marker  122  would be made of a radiopaque material such as gold, platinum or tantalum or an alloy of these or similar metals. 
       FIG. 2  is a side view of an embodiment of the control handle  200  designed for use with the PTAC  100  of  FIG. 1 . The handle  200  can be designed to simplify the operation of the PTAC  100  while including appropriate failsafe features. 
     The main body  210  of the handle  200  can be any shape. In the illustrated embodiment, the main body  210  is of relatively rectangular or rounded cross section with beveled or rounded edges where the side surface of the handle  211  meets the bottom of the handle  215 . A finger detent  212  can be provided to improve the comfort of holding the handle  200  and is positioned so that the operator&#39;s hand is situated to be able to best operate the primary controls of the handle  200 . The controls of the handle  200  can include the unlock button  222 , the unlock release button  226 , and the slider  224 . The slider  224  is an example of a longitudinal movement mechanism that can advance and retract the PTAC  100  guide tubes  115  of  FIG. 1  with respect to the PTAC  100  catheter body and can also advance and retract the PTAC  100  injector tubes  116  with needles  119  with respect to the guide tubes  115 . Controls could include, for example, buttons, dials, switches, sliders, and the like. 
     In some embodiments, the release button  226  is optional. In some embodiments, the release button  226  is a manual lock of the unlock button  222 . In some embodiments, the release button  226  is a manual lock of the slider  224 . In some embodiments, the unlock button  222  is a switch or toggle such that the user can move between the locked and the unlocked state. In some embodiments, the unlock button  222  can be pushed down or pulled up such that the user can move between the locked and the unlocked state. In some embodiments, the unlock button  222  can automatically pop up when released. In some embodiments, the unlock button  222  can remain depressed when depressed. In some embodiments, the release button  226  is distal to the unlock button  222  which is in turn distal to the slider axially along the main body  210  of the handle  200  as shown. Other configurations are contemplated which enable the unlock button  222  to be in a locked state and an unlocked state. 
     As described herein, the slider  224  can sequentially deploy the guide tubes  115  first and the injector tubes  116  second. As described herein, the slider  224  can also sequentially retract the injector tubes  116  first and the guide tubes  115  second. As described herein, the slider  224  can deploy and retract all guide tubes  115  simultaneously. As described herein, the slider  224  can deploy and retract all injector tubes  116  simultaneously. 
     As described herein, the slider  224  can engage the manifold  125  that connects the inner tube  105  to the injector tubes  116 . The slider  224  can move the manifold forward and backward to deploy the injector tubes  116 . As described herein, the slider  224  can engage the guide tube connector  132  that connects the middle tube  103  to the guide tubes  115 . The slider  224  can move the guide tube connector  132  forward and backward to deploy the guide tubes  115 . The three guide tubes  115  are attached to each other near their proximal ends by the guide tube connector  132 . 
     The unlock button  222  can include locked and unlocked states. In some embodiments, the unlock button  222  can be depressed such that the unlock button  222  is up when locked and down when unlocked. When depressed and released the unlock button  222  can stay in the unlocked (down) state and can allow longitudinal motion of the slider  224 . If the operator depresses the unlock button  222  in error and wishes to pop it back up returning it to the locked (up) state, this can be accomplished by depressing the unlock release button  226 . 
     In some embodiments, the unlock button  222  can allow movement of the slider  224  in the unlocked state and prevent movement of the slider  224  in the locked state. In some embodiments, the unlock button  222  can stay in the unlocked state until movement of the slider  224  causes the unlock button to enter the locked state. In some embodiments, the unlock button  222  can stay in the unlocked state until the release button  226  is depressed. In some embodiments, the unlock button  222  can stay in the locked state until the unlock button  22  is depressed. In some embodiments, the unlock button  222  can be overridden by continuously depressing the unlock button  222  such that the unlock button  222  does not enter the locked state. Other configurations are contemplated. 
     In some embodiments, the operator can activate the unlock button  222  on the handle such as by depressing the unlock button  222 . In some embodiments, the operator can move the slider  224  in a distal direction to advance at least one guide tube away from the catheter body until the distal end of the at least one guide tube is in proximity to the inside wall of the vessel. In some embodiments, the slider  224  will move a preset distance. In some embodiments, the slider  224  will cause the at least one guide tube to move a preset distance. In some embodiments, the unlock button  222  is deactivated when the at least one guide tube is advanced by the slider  224 . In some embodiments, the unlock button  222  is unlocked when the at least one guide tube is advanced by the slider  224 . In some embodiments, motion of the slider  224  causes the unlock button  222  to enter the locked state. In some embodiments, motion of the slider  224  causes the unlock button  222  to automatically pop up. In some embodiments, the slider  224  moves stepwise only between preset stops as described; in other embodiments, the slider  224  can move continuously through a working range. 
     In some embodiments, the operator can re-activate the unlock button  222 , such as by depressing the unlock button  222 . In some embodiments, the operator can move the slider  224  to extend the at least one injector tube beyond the distal end of at least one guide tube. In some embodiments, the slider  224  will move a preset distance. In some embodiments, the slider  224  will cause the at least one injector tube to move a preset distance. In some embodiments, the slider  224  will cause the at least one injector tube to penetrate through the inside wall of the target vessel. In some embodiments, the slider  224  will place the fluid egress of the at least one needle into a volume of tissue outside of the inside wall of the target vessel. In some embodiments, the operator can attach a fluid source to the catheter. In some embodiments, the operator can inject fluid through the catheter injection lumen and out of the needle fluid egress into a volume of tissue outside of the inside wall of the vessel. In some embodiments, motion of the slider  224  causes the unlock button  222  to enter the locked state. 
     In some embodiments, the operator can re-activate the unlock button  222 , such as by depressing the unlock button  222 . In some embodiments, the operator can move the slider  224  to retract the at least one injector tube into the distal end of at least one guide tube. In some embodiments, motion of the slider  224  causes the unlock button  222  to enter the locked state. 
     In some embodiments, the operator can re-activate the unlock button  222 , such as by depressing the unlock button  222 . In some embodiments, the operator can move the slider  224  to retract the at least one guide tube into the catheter body. In some embodiments, motion of the slider  224  causes the unlock button  222  to enter the locked state. 
     In some embodiments, the marker indicia lines  232 ,  234 , and  236  with corresponding catheter state icons  242 ,  244 , and  246  can indicate positions of the slider  224 . In some embodiments, the marker lines  232 ,  234 , and  236  with corresponding catheter state icons  242 ,  244 , and  246  can indicate positions wherein the unlock button  222  enters the locked state. In some embodiments, the marker lines  232 ,  234 , and  236  with corresponding catheter state icons  242 ,  244 , and  246  can indicate positions wherein further movement of the slider  224  is prevented by the unlock button  222  until the unlock button  222  is activated such as by depressing the unlock button  222 . In some embodiments, the unlock button can maintain the position of the slider  224 , and thus the guide tubes. In some embodiments, the unlock button can maintain the position of the slider  224 , and thus the injector tubes. In some embodiments, the slider  224  can have exactly three positions corresponding to the three indicia shown in  FIGS. 5A-5I . 
     The controls of the handle  200  including the unlock button  222 , the unlock release button  226 , and the slider  224  can be placed on the upper side of the handle  200 . The controls can face the user when the user grips the handle  200 . The upper side of the handle  200  includes a rounded or beveled surface  208 . A relock button or unlock release button  226  can be placed on the top surface of the handle  200 . The controls of the handle  200  including the unlock button  222 , the unlock release button  226 , and the slider  224  can be placed in any order. In the illustrated embodiment, release button  226  is distal to the unlock button  222 . In the illustrated embodiment, unlock button  222  is distal to the slider  224 . Other arrangements are contemplated such as any order, coaxial, offset, etc. 
     Distal to the main body  210  is a tapered section  206 . Distal to the tapered section  206  is a strain relief section  204  which is outside of the outer tube  102  of PTAC  100  shown in  FIG. 1 . 
     Proximal to the main body  210  is the proximal tapered section  214 . Proximal to the proximal tapered section  214  is a connector  202  for attaching a syringe (not shown) or other fluid dispensing mechanism. The connector  202  can be a standard Luer or Luer lock connector or it may be a non-standard connector. The lumen of the connector  202  is in fluid communication with the lumen  133  of the inner tube  105  of the PTAC  100  of  FIG. 1 . A flushing tube  252  with Luer connector  254  is in fluid communication with two spaces: 1) the space between the inner tube  105  and middle tube  103  and 2) the space between the middle tube  103  and outer tube  102  shown in  FIG. 1  and used to flush the catheter with saline before operation of the PTAC  100 . 
       FIG. 3  shows a close up view of the section  223  of  FIG. 2  with the unlock button  222 , the release button  226 , and the slider  224 . Also shown are the marker lines  232 ,  234 , and  236  with corresponding catheter state icons  242 ,  244 , and  246 . These marker lines and catheter state icons are placed to clearly show the operator the current state of the PTAC  100  distal end. The marker line  232  corresponds to the closed position of the PTAC  100  as illustrated by the icon  242 . The marker line  234  corresponds to the PTAC  100  position where the guide tubes  115  are deployed but the injector tubes  116  with needles  119  are still retracted. The icon  244  illustrates this position. The marker line  236  corresponds to the PTAC  100  position where the guide tubes  115  are deployed and the injector tubes  116  with needles  119  deployed as shown in  FIG. 1 . The icon  246  illustrates this state. The marker lines  232 ,  234  and  236  and the catheter state icons  242 ,  244  and  246  may be etched, engraved or printed onto the surface  208 , or presented on one or more displays in some embodiments. The slider  224  can align with the marker lines and catheter state icons at various stages of operation of the PTAC  100 . The distal edge of the slider  224  can align with the marker line  232  when the PTAC  100  is closed. The distal edge of the slider  224  can align with the marker line  234  when the guide tubes  115  are deployed. The distal edge of the slider  224  can align with the marker line  236  when the injector tubes  116  are deployed. In the illustrated embodiment, the icons are pictorial shapes that illustrate the shape of the catheter. Other icons are completed, e.g., shapes, words, letters, numbers, indicia, images, colors, etc. In some embodiments, instead or in addition of visual indicia, moving the slider  224  could result in audible and/or tactile (e.g., haptic) feedback to alert the operator to the different slider  224  positions. 
       FIG. 4  shows a top view of the handle  200  looking down on the top surface  218  of the handle  200 .  FIG. 4  shows the main body  210 , with top surface  218 , outer tube  102  of the PTAC  100  of  FIG. 1 , distal tapered section  206 , strain relief section  204 , proximal tapered section  214 , connector  202 , buttons  226  and  222 , slider  224 , and marker lines  232 ,  234  and  236 . The catheter state icons are shown but not labeled. 
     It can be seen that between the side surface of the handle  211  of  FIG. 2  and the top surface  218  of the handle  200  are the rounded (filleted) or beveled (chamfered) surfaces  208  and  209 . The advantage of a beveled or rounded surface in some cases is to allow visualization of at least one set of catheter state icons  242 ,  244  and  246  if the handle  200  is operated either with the top side  218  up or with either side (such as  211 ) of the main body facing up. If a bevel rather than a rounded (filleted) edge is used, in some embodiments, an angle of 10 to 80 degrees may function but an angle closer to 45 degrees may be optimal. 
       FIGS. 5A through 5I  illustrate stages of some embodiments of a method of using the handle  200  to deploy and retract the guide tubes  115  and injector tubes  116  with needles  119  of the PTAC  100  of  FIG. 1  where the distal end configurations are shown in FIG. 8 through 10 of U.S. Pat. Nos. 9,179,962, 9,254,360, 9,301,795, 9,320,850, 9,526,827, 9,539,047, and 9,554,849. 
     Some embodiments of a method for using the handle  200  after the PTAC  100  disclosed here can begin after one or more of the following:
         1. the PTAC is removed from its package,   2. flushed with saline or other media,   3. the injection lumen  133  of  FIG. 1  has been filled with the fluid,   4. the PTAC  100  is placed in its closed configuration as shown, for example, in FIG. 8 of Fischell et al. U.S. Pat. Nos. 9,179,962, 9,254,360, 9,301,795, 9320,850, 9,526,827, 9,539,047, and 9,554,849 with the handle controls as shown in  FIG. 5A . In some embodiments, all or just some of the steps are performed. In some embodiments, the steps that are performed are performed in the order above, or a different order.       

     The steps for use of the device to deliver a fluid outside of the inside wall of a target vessel can include one or more of the following:
         1. In the closed configuration of  FIG. 5A  where the distal end of the slider  224  is aligned with the marker line  232 , the PTAC  100  is delivered to the desired site in the human body.   2. The operator depresses the unlock button  222  and releases it. The button  222  will then stay depressed in the unlock position. This permits distal movement of the slider  224  which is advanced distally until it comes to a stop at the marker line  234  and the unlock button of the handle  200  automatically pops back up relocking the slider  224  in this position as shown in  FIG. 5C . Here the icon  244  indicates to the operator that the guide tubes  115  have been deployed as shown in FIG. 9 of Fischell et al. U.S. Pat. Nos. 9,179,962, 9,254,360, 9,301,795, 9,320,850, 9,526,827, 9,539,047. The operator then can confirm the guide tubes  115  are deployed by angiography or another imaging technique.   3. The PTAC  100  injector tubes  116  with needles  119  of  FIG. 1  for example can be deployed by depressing the unlock button  222  as in step  2  and advancing the slider  224  distally until the slider  224  comes to a stop as shown in  FIG. 5E  with the slider&#39;s  224  distal end aligned with marker line  246 . The unlock button  222  once again pops back up relocking the slider  224  in place. In this state, the PTAC  100  injector tubes  116  with needles  119  are fully deployed as indicated by the icon  246  and as shown in FIG. 10 of Fischell et al. U.S. Pat. Nos. 9,179,962, 9,254,360, 9,301,795, 9,320,850, 9,526,827, 9,539,047. The operator then can confirm the injector tubes  116  are deployed by angiography or other imaging techniques.   4. A fluid source (e.g. a syringe not shown) is attached to, e.g., the connector  202  of  FIGS. 2 and 4  and the fluid is delivered through the needles  119  into the desired location in the human body.   5. The fluid source is removed from the connector  202  of  FIGS. 2 and 4 .   6. The operator then depresses and releases the unlock button  222  as shown in  FIG. 5F  and retracts the slider  224  in the proximal direction until distal end of the slider  224  reaches marker line  234  as seen in  FIG. 5G  where it will stop and the unlock button  222  will pop up relocking the mechanism. This step retracts the PTAC  100  injector tubes  116  with needles  119  whose state with guide tubes  115  deployed is shown, for example, in FIG. 9 of Fischell et al. U.S. Pat. Nos. 9,179,962, 9,254,360, 9,301,795, 9,320,850, 9,526,827, 9,539,047 corresponding to the icon  244 .   7. The operator once again will depress and release the unlock button  222  which will remain in the unlocked position as shown in  FIG. 5H . The operator can then retract the slider  224  proximally until the distal end of the slider  224  is aligned with marker line  232  as shown in  FIG. 5I  putting the PTAC  100  back where it began in step  1  in its closed position corresponding to the icon  242 . In some embodiments, all steps or just some of the steps are performed. In some embodiments, the steps that are performed are performed in the order above, or a different order.       

     It is envisioned that an additional feature of a handle according to some embodiments is that it allows the operator to go from (using one or two hands) the state of  FIG. 5E  to the state of  FIG. 5I  by holding down the unlock button  222  so that it will not pop up and retracting the slider  224  from having its distal end aligned with marker line  236  all the way back until the slider distal end is aligned with marker line  232 . Using 2 hands, the operator can use one finger to depress the unlock button  222  and use another finger (e.g., of the same or a different hand) to slide the slider  224  proximally. 
     While one could by holding down the unlock button  222  go sequentially from  FIG. 5A  through  FIGS. 5B, 5C and 5D to 5E  in some embodiments, this method may not be recommended in some cases. 
     Fischell et al. in U.S. Pat. Nos. 9,931,046 and 9,949,652 describe a Sympathetic Nerve Sensing Catheter (SNSC) and a Peri-vascular Nerve Ablation and Sensing Catheter (PNASC) that can be used for sensing nerve activity, stimulating nerve activity, and/or ablating nerve activity by chemical or energy ablation.  FIG. 6  is a longitudinal cross-section of a distal portion of the prior art SNSC/PNASC  10  as shown in FIG. 2 of U.S. Pat. Nos. 9,931,046 and 9,949,652, which are hereby incorporated by reference in their entireties. 
       FIG. 6  is a schematic view of the distal portion of a Nerve Sensing Catheter (NSC)  10  that is designed to sense energy from extra-vascular tissue within a human body, stimulate with electrical energy, and/or deliver electrical energy to tissue, for example, to provide for obtaining and assessing evoked activity. The NSC  10  is shown in its open position, showing an inner tube  11 , middle tube  12 , outer tube  13 , outer tube extension  14  having distal openings  15  through which the guide tubes  30  with radiopaque markers  36 , distal tip  34  and outer layer  32  are advanced outwardly from the body of the NSC  10 . Also shown is the tapered section  16  and fixed guide wire  40  with distal tip  42 . The NSC includes three conduits  20  with outer insulation  22 , and sharpened wire  24 , with 2 of the three guide tubes and conduits shown in their fully deployed positions (the third is not shown). The sharpened wires  24  can be made from or coated with a radiopaque material such as gold or platinum. 
     The conduits  20  run all the way to the proximal end of the NSC  10  where they interface with electronic equipment  500  that provides energy. The distal tips  24  of the conduits  20  are shown here in the distal portion of the NSC  10 . The conduits  20  extend through the catheter body within the lumen of the inner tube  11 . In some embodiments, the insulation  22  that insulates the conduits within the catheter body does not extend around the most distal portion of the conduit  20  since this portion terminates as a sharpened wire/needle  24  which will penetrate the vascular wall and can act as an electrode. 
     The openings  15  in the distal portion of the catheter support the guide tubes  30  as the guide tubes  30  are advanced outwardly in order to provide structural support during the subsequent deployment of the sharpened wire  24 . Although the NSC  10  of  FIG. 6  has three guide tubes  30 , it is envisioned that other embodiments could have as few as one or as many as eight or more guide tubes (e.g., 1, 2, 3, 4, 5, 6, 7, 8, or more, or ranges including any two of the aforementioned values) with an optimum number typically being three or four in the case of renal denervation. A larger diameter target vessel might suggest the use of as many as 4 to 8 guide tubes  30  and conduits  20 . 
     In addition to providing electrical conductivity from the proximal end of the NSC to the distal sharpened wires  24 , the conduits  20  may be adapted to be hollow to also provide a passageway for fluid injection near the tip of the sharpened wires  24 . A modified version of the NSC is disclosed herein, that provides both nerve sensing and nerve ablation capabilities. This dual function catheter will be called a Perivascular Nerve Ablation and Sensing Catheter (PNASC). The catheters described herein can provide one or more of the following: 
     Provide both electrical sensing and stimulation using the sharpened wires  24  which act as electrodes to both sense nerve activity and provide energy to tissue; 
     Provide electrical energy such as RF to the sharpened wires  24  that act as electrodes provide energy based ablation; 
     Have a fluid passageway in the conduits  20  with an egress near the distal end of the sharpened wires  24  for injection of an ablative fluid for chemical nerve ablation and or dispensing an anesthetic/analgesic agent such as lidocaine; and/or 
     Provide an ultrasound transducer either within the body of the PNASC or in the distal portion of the conduits  20  to provide energy based ablation, such as ablation at perivascular sites that is delivered by the conduits  20 . 
     Different shapes are envisioned for the distal openings (or windows)  15  in the outer tube extension  14  where the guide tubes  30  exit. These possible shapes include and oval or round shapes such as a racetrack design with curved (e.g., round) proximal and distal ends and straight sides in the axial direction. It is also envisioned that there could be a movable flap (not shown) covering each opening  15 , or a slit that could be opened to make the outer surface of the NSC smooth for better delivery through a guiding catheter into the renal artery. Such a moveable flap could be operated under the control of the catheter handle in the proximal section of the catheter. The mechanical operation of the catheter can function so that the flaps are retracted prior to the guide tubes  30  being deployed. Alternatively the flaps may be made flexible and soft enough that these are simply pushed aside by the guide tubes  30  upon deployment. 
     It can be a feature of some embodiments of the invention that the guide tubes  30  serve as needle or conduit guiding elements that provide structural support for the ultra-thin conduits  20 . The three conduits  20 , sensors  24  and guide tubes  30  are spaced uniformly around the circumference of the catheter  10  at approximately 120 degrees separation. The uniform spacing improves the sensing performance of the NSC  10 . It is also envisioned that the spacing might be non-uniform for example two might be 50 degrees while the third could be 155 degrees from either of the first two. In an alternative embodiment, a catheter for sensing the activity from nerves outside of the lumen of a target vessel of a human body can only include one conduit  20 . For the single conduit  20  embodiment, a portion of the body of the NSC10 such as the outer tube extension  14  will typically be pushed against the inside wall of the artery diametrically opposed to the contact point where the needle guiding element/guide tube  30  expands outward to contact the wall of the artery. 
     The proximal end of  FIG. 6  shows the three concentric tubes, the outer tube  13 , middle tube  12  and inner tube  11  which form the central portion of the SNSC/PNASC  10 . The outer tube  13  is attached at its distal end to the outer tube extension  14  which is in turn attached to the tapered section  16 . The fixed guide wire  40  with core wire  42  and outer layer  44  extends distally from the distal end of the tapered section  16 . 
       FIG. 6  shows the guide tube  30  with outer layer  32 , distal tip  34 , and radiopaque marker  36  in its fully deployed position as advanced through the opening  15  in the outer tube extension  14 . The interior surface of the outer tube extension  14  forms part of the tubular shaft  21 . In some embodiments, the tubular shaft  21  is preferably made from a stiff material such as a metal or high durometer plastic so that it will be relative rigid as the guide tubes  30  are advanced and retracted. 
     Coaxially within the lumen of the guide tube  30  is the insulated wire  20  with insulated outer layer  22 A and core wire  24 . As described herein, in some embodiments, the core wire  24  is hollow allowing for the delivery of fluids, and in some embodiments the core wire  24  is solid. The uninsulated distal portion of the wire  20  forms the electrode  25 . The electrode  25  can act as a sensor that in combination with either or both of the other two electrodes  25  at the ends of the other two sharpened wires  20 , or with a remote electrode in electrical communication with the patient. The electrode  25  can be used to measure activity of the sympathetic nerves in the perivascular space outside of the renal artery. The electrode  25  can be used to stimulate nerves. The electrode  25  can be used to deliver energy to ablate nerves. 
     The central buttress  19  shown in  FIG. 6 , supports the guide tube  30  both as it is pushed distally and after it is fully deployed. This central buttress  19  also provides radial support for the advanced guide tubes  30  that prevents the guide tubes  30  from backing away from the interior wall of the target vessel as the sharpened wires  20  are advanced through the guide tubes  30  forward to their desired position in the peri-adventitial space 2-10 mm beyond the interior wall of the target vessel. Additional lateral support for the guide tube  30  is provided by the sides of the openings  15  that in combination with the central buttress  19  provide both radial and circumferential/lateral support both during guide tube  30  advancement and outwardly expansion as well as providing backup during delivery of the wires  20  through the interior wall of the target vessel. The buttress may comprise a deflection surface such as a curved or linear ramp, which may in a curved embodiment correspond to the radius of curvature of the outer surface of the guide tube  30 . 
     Another possible feature of the SNSC/PNASC  10  is that each sharpened wire  20  has a central axis with the same, or nearly the same, radius of curvature as the central axis of the corresponding guide tube  30  when measured in an unconstrained state. In addition, the length of the guide tubes  30  is preferably at least as long as the distal curved portion of the sharpened wires  20 . This design constrains the curved portion of each sharpened wire  20  within the lumen of the guide tube  30  so that the sharpened wire  20  cannot twist or change position. 
     As seen in  FIG. 6  the cylinder or manifold  17  attaches the inner tube  11  to the three sharpened wires  20 . The cylinder can be formed of any material such as plastic. The inner tube  11  and cylinder  17  can slide along the longitudinal axis of the SNSC/PNASC  10  inside of the middle tube  12 . The middle tube is shown with uniform diameter over its length including the portion coaxially outside of the cylinder  17 . 
     Some embodiments of the SNSC/PNASC  10  uses four different tubular structures instead of just an outer tube  13  and outer tube extension  14 . Specifically, the proximal section can be a metal hypotube. The metal hypotube can connect at its distal end to a relatively stiff plastic tube about 20 cm long that would in turn connect to a softer more flexible plastic tube about 10 cm long which can be the tube  13  shown in  FIG. 6 . 
     In a preferred embodiment, the middle tube  12  attaches to, a proximal metal hypotube and the inner tube  11  would also attach to a proximal portion formed from a metal hypotube. The SNSC/PNASC  10  and the PTAC  100  can have any features described herein, and/or any features described in the patents which are incorporated by reference. 
       FIG. 7  is a side view of some embodiments of the control handle  300  designed for use with the SNSC/PNASC  10  of  FIG. 6 . The handle  300  can be designed to simplify the operation of the SNSC/PNASC  10  while including appropriate failsafe features. The control handle  200  and the control handle  300  can have any of the features described herein. 
     The main body  310  of the handle  300  can include any shape. The main body  310  is configured to be gripped by at least one hand of the operator of the device. The main body  310  can be of relatively rectangular or rounded cross section with beveled or rounded edges where the side surfaces of the handle  311  meets the bottom of the handle  315 . In some embodiments, a finger detent  312  improved the comfort of holding the handle  300  and is positioned so that the operator&#39;s hand is situated to be able to best operate the primary controls of the handle including an unlock button  322 , an unlock release button  326  and a slider  324 . The slider  324  is an example of a longitudinal movement mechanism that can advance and retract the SNSC/PNASC  10  guide tubes  30  of  FIG. 6  with respect to the SNSC/PNASC  10  catheter body and can also advance and retract the SNSC/PNASC  10  wires  20  with respect to the guide tubes  30 . 
     The unlock button  322  has locked (up) and unlocked (down) states. When depressed and released the unlock button  322  can stay in the unlocked (down) state, which can allow the operator to engage in longitudinal motion of the slider  324 . If the operator depresses the unlock button  322  in error and wishes to pop it back up returning it to the locked (up) state, this can be accomplished by depressing the unlock release button  326 . 
     Also shown are the marker lines with corresponding catheter state icons. These marker lines and catheter state icons are placed to clearly show the operator the current state of the SNSC/PNASC  10  distal end. One marker line corresponds to the closed position of the SNSC/PNASC  10 . One marker line corresponds to the SNSC/PNASC  10  position where the guide tubes  30  are deployed but the wires  20  with electrodes  25  are still retracted. One marker line corresponds to the SNSC/PNASC  10  position where the guide tubes  30  are deployed and the wires  20  with electrodes  25  are deployed as shown in  FIG. 6 . The marker lines and the catheter state icons may be etched, engraved or printed onto the handle  200 . The slider  324  can align with the marker lines and catheter state icons at various stages of operation of the SNSC/PNASC  10 . In the illustrated embodiment, the icons are pictorial shapes that illustrate the shape of the catheter. Other icons are completed, e.g., shapes, words, letters, numbers, indicia, images, colors, etc. as well as other non-visual indicia as described elsewhere herein. 
     The upper side of the handle  300  includes a rounded or beveled surface  308 . A relock button or release button  326  is also placed on the top of the handle  300 . Distal to the main body  310  is a tapered section  306 , and distal to that is a strain relief section  304  which is outside of the outer tube  13 . 
     Proximal to the main body  310  is the proximal tapered section  314 . Proximal to the proximal tapered section  314  is a connector  302  for attaching a syringe (not shown) or other fluid dispensing mechanism. The connector  302  may be a standard Luer or Luer lock connector or it may be a non-standard connector. The lumen of the connector  302  is in fluid communication with the lumen  333  of the inner tube  11  of the SNSC/PNASC  10  of  FIG. 6 . A flushing tube  352  with Luer connector  354  is in fluid communication with two spaces: 1) the space between the inner tube  11  and middle tube  12  and 2) the space between the middle tube  12  and outer tube  13  shown in  FIG. 6  and used to flush the catheter with saline before operation of the SNSC/PNASC  10 . 
       FIG. 7  also shows the externalization of the wires  365 A through  365 C used to connect external equipment to the wires  20  of  FIG. 6 . Each wire  365 A- 365 C can connect to an independent electrode. In some embodiments, the wire  365 A connects to the electrode  25  of a first wire  20 , the wire  365 B connects to the electrode  25  of a second wire  20 , and/or the wire  365 C connects to the electrode  25  of a third wire  20 . The wires  365 A- 365 C can be connected to external equipment  364 . As described herein, the external equipment  364  can be for sensing electrical energy, stimulating with electrical energy and/or supplying electrical energy. Other energy modalities such as magnetic, ultrasound, vibrational, thermal, or cryo energy sources can be applied alone or in combination. 
     In some embodiments, the unlock button  322  can allow movement of the slider  324  in the unlocked state and prevent movement of the slider  324  in the locked state. In some embodiments, the unlock button  322  can stay in the unlocked state until movement of the slider  324  causes the unlock button to enter the locked state. In some embodiments, the unlock button  322  can stay in the unlocked state until the release button  326  is depressed. In some embodiments, the unlock button  322  can stay in the locked state until the unlock button  322  is depressed. In some embodiments, the unlock button  322  can be overridden by continuously depressing the unlock button  322  such that the unlock button  322  does not enter the locked state. Other configurations are contemplated. 
     In some embodiments, the operator can activate the unlock button  322  on the handle such as by depressing the unlock button  322 . In some embodiments, the operator can move the slider  324  in a distal direction to advance at least one guide tube away from the catheter body until the distal end of the at least one guide tube is in proximity to the inside wall of the vessel. 
     In some embodiments, the operator can re-activate the unlock button  322 , such as by depressing the unlock button  222 . In some embodiments, the operator can move the slider  324  to extend the at least one wire  20  beyond the distal end of at least one guide tube  30 . In some embodiments, the slider  224  will cause the at least one injector tube to penetrate through the inside wall of the target vessel. In some embodiments, the slider  224  will place the electrode  25  of at least one wire  20  into a volume of tissue outside of the inside wall of the target vessel. In some embodiments, the operator can apply energy to the electrode to ablate tissue. In some embodiments, the operator can apply energy to the electrode to sense nerves. In some embodiments, the operator can apply energy to the electrode to stimulate tissue. 
     Various other modifications, adaptations, and alternative designs are of course possible in light of the above teachings. Therefore, it should be understood at this time that within the scope of the appended claims the invention may be practiced otherwise than as specifically described herein. 
     Certain features that are described in this specification in the context of separate embodiments also can be implemented in combination in a single embodiment. Conversely, various features that are described in the context of a single embodiment also can be implemented in multiple embodiments separately or in any suitable subcombination. Moreover, although features may be described above as acting in certain combinations and even initially claimed as such, one or more features from a claimed combination can in some cases be excised from the combination, and the claimed combination may be directed to a subcombination or variation of a subcombination. 
     The foregoing description and examples has been set forth to illustrate the disclosure according to various embodiments and are not intended as being unduly limiting. The headings provided herein are for organizational purposes only and should not be used to limit embodiments. Each of the disclosed aspects and examples of the present disclosure may be considered individually or in combination with other aspects, examples, and variations of the disclosure. In addition, unless otherwise specified, none of the steps of the methods of the present disclosure are confined to any particular order of performance. References cited herein are incorporated by reference in their entirety. The description of an embodiment as “preferred” does not limit the use or scope of alternative embodiments. 
     While the methods and devices described herein may be susceptible to various modifications and alternative forms, specific examples thereof have been shown in the drawings and are herein described in detail. It should be understood, however, that the embodiments disclosed should cover modifications, equivalents, and alternatives falling within the spirit and scope of the various embodiments described herein and the appended claims. 
     Depending on the embodiment, one or more acts, events, or functions of any of the algorithms, methods, or processes described herein can be performed in a different sequence, can be added, merged, or left out altogether (e.g., not all described acts or events are necessary for the practice of the algorithm). In some examples, acts or events can be performed concurrently, e.g., through multi-threaded processing, interrupt processing, or multiple processors or processor cores or on other parallel architectures, rather than sequentially. 
     The use of sequential, or time-ordered language, such as “then,” “next,” “after,” “subsequently,” and the like, unless specifically stated otherwise, or otherwise understood within the context as used, is generally intended to facilitate the flow of the text and is not intended to limit the sequence of operations performed. 
     The various illustrative logical blocks, modules, processes, methods, and algorithms described in connection with the embodiments disclosed herein can be implemented as electronic hardware, computer software, or combinations of both. To clearly illustrate this interchangeability of hardware and software, various illustrative components, blocks, modules, operations, and steps have been described above generally in terms of their functionality. Whether such functionality is implemented as hardware or software depends upon the particular application and design constraints imposed on the overall system. The described functionality can be implemented in varying ways for each particular application, but such implementation decisions should not be interpreted as causing a departure from the scope of the disclosure. 
     Conditional language used herein, such as, among others, “can,” “might,” “may,” “e.g.,” and the like, unless specifically stated otherwise, or otherwise understood within the context as used, is generally intended to convey that some examples include, while other examples do not include, certain features, elements, and/or states. Thus, such conditional language is not generally intended to imply that features, elements, blocks, and/or states are in any way required for one or more examples or that one or more examples necessarily include logic for deciding, with or without author input or prompting, whether these features, elements and/or states are included or are to be performed in any particular embodiment. 
     The methods disclosed herein may include certain actions taken by a practitioner; however, the methods can also include any third-party instruction of those actions, either expressly or by implication. For example, actions such as “positioning an electrode” include “instructing positioning of an electrode.” 
     The ranges disclosed herein also encompass any and all overlap, sub-ranges, and combinations thereof. Language such as “up to,” “at least,” “greater than,” “less than,” “between,” and the like includes the number recited. Numbers preceded by a term such as “about” or “approximately” include the recited numbers and should be interpreted based on the circumstances (e.g., as accurate as reasonably possible under the circumstances, for example ±5%, ±10%, ±15%, etc.). For example, “about 1 hour” includes “1 hour.” Phrases preceded by a term such as “substantially” include the recited phrase and should be interpreted based on the circumstances (e.g., as much as reasonably possible under the circumstances). For example, “substantially perpendicular” includes “perpendicular.” Unless stated otherwise, all measurements are at standard conditions including temperature and pressure. The phrase “at least one of” is intended to require at least one item from the subsequent listing, not one type of each item from each item in the subsequent listing. For example, “at least one of A, B, and C” can include A, B, C, A and B, A and C, B and C, or A, B, and C.