THOMBOLYSIS AND CHRONIC ANTICOAGULATION THERAPY

• US 20080286327A1
• Filed: 12/03/2007
• Published: 11/20/2008
• Est. Priority Date: 11/01/2001
• Status: Active Grant

• Current Assignee: Boston Scientific Neuromodulation Corporation (Boston Scientific Corporation)
• Original Assignee: Boston Scientific Neuromodulation Corporation (Boston Scientific Corporation)
• Inventors: Whitehurst, Todd K., Thacker, James R., McClure, Kelly H.
• Granted Patent: US 7,877,137 B2
• Time in Patent Office: Days
• US Class Current: 424/423
• CPC Class Codes: A61M 2205/3507 with implanted devices, e.g. external control
• CPC Class Codes: A61M 2205/3523 using telemetric means
• CPC Class Codes: A61M 2205/8243 by induction
• CPC Class Codes: A61M 2230/005 Parameter used as control input for the apparatus
• CPC Class Codes: A61M 2230/04 Heartbeat characteristics, e.g. ECG, blood pressure modulation
• CPC Class Codes: A61M 2230/205 partial oxygen pressure (P-O2)
• CPC Class Codes: A61M 2230/30 Blood pressure A61M2230/04 takes precedence
• CPC Class Codes: A61M 5/14276 specially adapted for implantation
• CPC Class Codes: A61N 1/3629 in combination with non-electric therapy

Abstract

Method and systems of treating a patient with at least one of a myocardial infarction, a stroke, and a pulmonary embolism include providing a stimulator coupled to at least one electrode and a catheter, configuring one or more stimulation parameters to treat at least one of a myocardial infarction, a stroke, and a pulmonary embolism, programming the stimulator with the one or more stimulation parameters, delivering with the stimulator via the catheter at least one drug to at least one tissue in accordance with the one or more stimulation parameters, and limiting perfusion of the at least one tissue by delivering electrical stimulation with the stimulator via the at least one electrode to the at least one tissue.

Claims

1. A method of treating a patient with at least one of a myocardial infarction, a stroke, and a pulmonary embolism, said method comprising:

providing a stimulator coupled to at least one electrode and a catheter;

configuring one or more stimulation parameters to treat at least one of a myocardial infarction, a stroke, and a pulmonary embolism;

programming said stimulator with said one or more stimulation parameters;

delivering with said stimulator via said catheter at least one drug to at least one tissue in accordance with said one or more stimulation parameters, said at least one drug configured to provide at least one of thrombolytic and anticoagulation treatment to said at least one tissue; and

limiting perfusion of said at least one tissue by delivering electrical stimulation with said stimulator via said at least one electrode to said at least one tissue, wherein said electrical stimulation is configured to constrict at least one arteriole supplying said at least one tissue.

2. The method of claim 1, wherein said at least one tissue comprises at least one of a coronary artery, a coronary vein, a coronary sinus, a left ventricle, a left atrium, a surface of the myocardium, a pulmonary vein, a carotid artery, an anterior cerebral artery, a middle cerebral artery, a posterior cerebral artery, a circle of Willis, a meningeal artery, a basilar artery, a pulmonary artery, a superior vena cava, a inferior vena cava, a right ventricle, a right atrium, an aorta, a common iliac vessel, an internal iliac vessel, an external iliac vessel, a femoral vessel, a renal vessel, a celiac trunk, a middle colic artery, a superior mesenteric vessel, an inferior mesenteric vessel, a vessel that influences coronary circulation, a vessel that influences cerebral circulation, a vessel that influences pulmonary circulation, and a vessel that influences visceral circulation.

3. The method of claim 1, wherein the limiting of the perfusion of said at least one tissue is configured to increase an amount of time that said at least one drug remains in said at least one tissue.

4. The method of claim 1, wherein said delivery of said at least one drug is configured to provide acute treatment of said at least one of said myocardial infarction, said stroke, and said pulmonary embolism.

5. The method of claim 1, wherein said delivery of said at least one drug is configured to provide chronic treatment of said at least one of said myocardial infarction, said stroke, and said pulmonary embolism.

6. The method of claim 1, wherein said at least one drug comprises at least one of heparin, low molecular weight heparin, warfarin, aspirin, a platelet aggregation inhibitor, streptokinase, a streptokinase derivative, a tissue plasminogen activator (tPA), a plasminogen activator derivative, anistreplase, urokinase, and a urokinase derivative.

7. The method of claim 1, further comprising sensing at least one indicator related to at least one of said myocardial infarction, said stroke, and said pulmonary embolism, and using said at least one sensed indicator to adjust one or more of said stimulation parameters.

8. The method of claim 7, wherein said at least one sensed indicator comprises at least anticoagulation status.

9. The method of claim 7, wherein said at least on sensed indicator comprises at least one of an abnormal ECG event, an abnormal EEG event, an abnormal ultrasound echocardiogram event, an oxygen level, a flow level, a change in perfusion, a coagulation state, a left ventricular end diastolic pressure, a pulmonary capillary wedge pressure, a systemic blood pressure, a cardiac output, a Prothrombin Time (PT), an International Normalized Ratio (INR), a Partial Thromboplastin Time (PTT), an Activated Partial Thromboplastin Time (APTT), a Native Prothrombin Antigen Assay, a Specific Prothrombin Assay, an Anti-Xa Assay, a medication level, a hormone level, a D-dimer level, a lupus anticoagulant antibody level, an anti-cardiolipin antibody level, a Troponin-I level, a Troponin-T level, and a level of antibodies that bind to Troponin-I.

10. A method comprising:

implanting a stimulator at least partially within a patient;

providing at least one electrode and a catheter coupled to said stimulator;

configuring one or more stimulation parameters to treat at least one of a myocardial infarction, a stroke, and a pulmonary embolism;

programming said stimulator with said one or more stimulation parameters;

delivering with said stimulator via said catheter at least one drug to at least one tissue in accordance with said one or more stimulation parameters, said at least one drug configured to provide at least one of thrombolytic and anticoagulation treatment to said at least one tissue; and

limiting perfusion of said at least one tissue by delivering electrical stimulation with said stimulator via said at least one electrode to said at least one tissue, wherein said electrical stimulation is configured to constrict at least one arteriole supplying said at least one tissue;

wherein said at least one tissue comprises at least one of a coronary artery, a coronary vein, a coronary sinus, a left ventricle, a left atrium, a surface of the myocardium, a pulmonary vein, a carotid artery, an anterior cerebral artery, a middle cerebral artery, a posterior cerebral artery, a circle of Willis, a meningeal artery, a basilar artery, a pulmonary artery, a superior vena cava, a inferior vena cava, a right ventricle, a right atrium, an aorta, a common iliac vessel, an internal iliac vessel, an external iliac vessel, a femoral vessel, a renal vessel, a celiac trunk, a middle colic artery, a superior mesenteric vessel, an inferior mesenteric vessel, a vessel that influences coronary circulation, a vessel that influences cerebral circulation, a vessel that influences pulmonary circulation, and a vessel that influences visceral circulation.

11. The method of claim 10, wherein the limiting of the perfusion of said at least one tissue is configured to increase an amount of time that said at least one drug remains in said at least one tissue.

12. The method of claim 10, wherein said delivery of said at least one drug is configured to provide acute treatment of said at least one of said myocardial infarction, said stroke, and said pulmonary embolism.

13. The method of claim 10, wherein said delivery of said at least one drug is configured to provide chronic treatment of said at least one of said myocardial infarction, said stroke, and said pulmonary embolism.

14. The method of claim 10, wherein said at least one drug comprises at least one of heparin, low molecular weight heparin, warfarin, aspirin, a platelet aggregation inhibitor, streptokinase, a streptokinase derivative, a tissue plasminogen activator (tPA), a plasminogen activator derivative, anistreplase, urokinase, and a urokinase derivative.

15. The method of claim 10, further comprising sensing at least one indicator related to at least one of said myocardial infarction, said stroke, and said pulmonary embolism, and using said at least one sensed indicator to adjust one or more of said stimulation parameters.

16. The method of claim 15, wherein said at least one sensed indicator comprises at least anticoagulation status.

17. The method of claim 15, wherein said at least on sensed indicator comprises at least one of an abnormal ECG event, an abnormal EEG event, an abnormal ultrasound echocardiogram event, an oxygen level, a flow level, a change in perfusion, a coagulation state, a left ventricular end diastolic pressure, a pulmonary capillary wedge pressure, a systemic blood pressure, a cardiac output, a Prothrombin Time (PT), an International Normalized Ratio (INR), a Partial Thromboplastin Time (PTT), an Activated Partial Thromboplastin Time (APTT), a Native Prothrombin Antigen Assay, a Specific Prothrombin Assay, an Anti-Xa Assay, a medication level, a hormone level, a D-dimer level, a lupus anticoagulant antibody level, an anti-cardiolipin antibody level, a Troponin-I level, a Troponin-T level, and a level of antibodies that bind to Troponin-I.

18. A system for treating a patient with at least one of a myocardial infarction, a stroke, and a pulmonary embolism, said system comprising:

a stimulator configured to generate electrical stimulation and drug stimulation in accordance with one or more stimulation parameters adjusted to treat at least one of a myocardial infarction, a stroke, and a pulmonary embolism;

a programmable memory unit in communication with said stimulator and programmed to store said one or more stimulation parameters to at least partially define said electrical and drug stimulation such that said electrical and drug stimulation are configured to treat at least one of said myocardial infarction, said stroke, and said pulmonary embolism;

at least one electrode coupled to said stimulator; and

a catheter coupled to said stimulator;

wherein said stimulator is further configured to

deliver via said catheter at least one drug to at least one tissue in accordance with said one or more stimulation parameters, said at least one drug configured to provide at least one of thrombolytic and anticoagulation treatment to said at least one tissue, and

limit perfusion of said at least one tissue by delivering electrical stimulation via said at least one electrode to said at least one tissue, wherein said electrical stimulation is configured to constrict at least one arteriole supplying said at least one tissue.

19. The system of claim 18, wherein said at least one tissue comprises at least one of a coronary artery, a coronary vein, a coronary sinus, a left ventricle, a left atrium, a surface of the myocardium, a pulmonary vein, a carotid artery, an anterior cerebral artery, a middle cerebral artery, a posterior cerebral artery, a circle of Willis, a meningeal artery, a basilar artery, a pulmonary artery, a superior vena cava, a inferior vena cava, a right ventricle, a right atrium, an aorta, a common iliac vessel, an internal iliac vessel, an external iliac vessel, a femoral vessel, a renal vessel, a celiac trunk, a middle colic artery, a superior mesenteric vessel, an inferior mesenteric vessel, a vessel that influences coronary circulation, a vessel that influences cerebral circulation, a vessel that influences pulmonary circulation, and a vessel that influences visceral circulation.

20. The system of claim 18, wherein the stimulator is configured to limit the perfusion of said at least one tissue by increasing an amount of time that said at least one drug remains in said at least one tissue.