CAROTID BODY ABLATION WITH A TRANSVENOUS ULTRASOUND IMAGING AND ABLATION CATHETER

• US 20150257779A1
• Filed: 03/12/2015
• Published: 09/17/2015
• Est. Priority Date: 03/12/2014
• Status: Active Grant

• Current Assignee: Cibiem, Inc.
• Original Assignee: Kenneth M. Martin, Mark Gelfand, Martin M. Grasse, Michael Brick Markham, Miriam H. Taimisto, Timothy A. Koss, Veijo T. Suorsa, Xian Wei, Yegor D. Sinelnikov
• Inventors: SINELNIKOV, Yegor D., ENGELMAN, Zoar Jacob, GELFAND, Mark, GRASSE, Martin M., KOSS, Timothy A., MARKHAM, Michael Brick, MARTIN, Kenneth M., SUORSA, Veijo T., TAIMISTO, Miriam H., WEI, Xian
• Granted Patent: US 9,955,946 B2
• Time in Patent Office: Days
• US Class Current: 1/1
• CPC Class Codes: A61B 2018/00023 closed, i.e. without wound contact by the fluid
• CPC Class Codes: A61B 2018/00029 open
• CPC Class Codes: A61B 2090/0472 against ultrasound energy
• CPC Class Codes: A61B 2090/378 using ultrasound
• CPC Class Codes: A61B 2090/3782 transmitter or receiver in catheter or minimal invasive instrument
• CPC Class Codes: A61B 2090/3784 both receiver and transmitter being in the instrument or receiver being also transmitter
• CPC Class Codes: A61B 2090/3925 ultrasonic
• CPC Class Codes: A61B 2090/3983 Reference marker arrangements for use with image guided surgery
• CPC Class Codes: A61B 8/0841 for locating instruments
• CPC Class Codes: A61B 8/0891 for diagnosis of blood vessels
• CPC Class Codes: A61B 8/12 in body cavities or body tracts, e.g. by using catheters catheters per se A61M25/00
• CPC Class Codes: A61B 8/445 Details of catheter construction
• CPC Class Codes: A61B 8/4477 using several separate ultrasound transducers or probes
• CPC Class Codes: A61B 8/481 involving the use of contrast agent, e.g. microbubbles introduced into the bloodstream analysis of echo signal exploiting properties of a contrast enhancer in devices for short-range imaging with acoustic waves G01S7/52039
• CPC Class Codes: A61B 8/488 involving Doppler signals
• CPC Class Codes: A61N 7/022 intracavitary

Abstract

Methods and devices for assessing, and treating patients having sympathetically mediated disease, involving augmented peripheral chemoreflex and heightened sympathetic tone by reducing chemosensor input to the nervous system via carotid body ablation.

Claims

1. An ultrasound ablation catheter configured to interact with an intravascular ultrasound (“

IVUS”

) imaging catheter, the ultrasound ablation catheter comprising;

a distal region and a proximal region;

an IVUS lumen to receive therethrough an IVUS imaging catheter extending from the proximal region to the distal region;

an echolucent chamber at the distal region; and

an ultrasound ablation transducer within the echolucent chamber,

wherein the IVUS lumen is configured to position the IVUS imaging catheter within a direction of aim of the ultrasound ablation transducer in a deployed state and out of the direction of aim in a retracted state.

2. A catheter of claim 1 further comprising a cooling fluid lumen for cooling the echolucent chamber.

3. A catheter of claim 1 wherein the direction of aim of the ultrasound ablation catheter is in a radial direction from the catheter within an imaging plane generated by the IVUS imaging catheter when in a deployed state.

4. A catheter of claim 1 further comprising a mating feature at the proximal region for coupling with the IVUS imaging catheter wherein the mating feature is associated with an actuator that transitions the IVUS imaging catheter between a deployed state and a retracted state.

5. A catheter of claim 1 wherein the catheter is configured for controllable deflection of the distal region, wherein a plane of deflection is coplanar with the ultrasound ablation transducer.

6. A catheter of claim 1 further comprising a lumen configured to receive a guidewire.

83. An ultrasound ablation catheter of claim 1 comprising an acoustic insulator to shield passage of ultrasound ablation energy, wherein the acoustic insulator comprises microspheres of air embedded in epoxy.

84. An ultrasound ablation catheter of claim 1 comprising a fiducial marker having a position with respect to the imaging transducer and the direction of aim of the ablation transducer.

7. An ultrasound ablation catheter configured to interact with an intravascular ultrasound imaging (“

IVUS”

) catheter having an ultrasound imaging transducer, the ultrasound ablation catheter comprising;

a distal region and a proximal region;

an IVUS lumen configured to receive therethrough an IVUS imaging catheter extending from the proximal region to the distal region;

an echolucent chamber at the distal region; and

an ultrasound ablation transducer within the echolucent chamber,

wherein the IVUS lumen is configured to position the ultrasound imaging transducer of the IVUS catheter distal to the ultrasound ablation transducer such that the ultrasound ablation transducer may deliver ablation energy while the ultrasound imaging transducer is transmitting and receiving waves to provide an image while ablating.

8. An ultrasound ablation catheter of claim 7 comprising an acoustic insulator to shield passage of ultrasound ablation energy, wherein the acoustic insulator comprises microspheres of air embedded in epoxy.

9. An ultrasound ablation catheter of claim 8 wherein the acoustic insulator has a thickness of about 200 to 300 microns and comprises microspheres having a diameter in a range of about 15 to 25 microns and microspheres having a diameter in a range of about 180 to 210 microns.

10. An ultrasound ablation catheter of claim 7 comprising a fiducial marker having a position with respect to the imaging transducer and the direction of aim of the ablation transducer.

11. An ultrasound ablation catheter of claim 10 wherein the fiducial marker is a hollow tube filled with air.

12. An ultrasound ablation catheter, comprising:

a distal assembly comprising an ultrasound ablation transducer, an echolucent shell, and an ablation direction fiducial marker, the echolucent shell at least partially defining a distal chamber, the ultrasound ablation transducer disposed within the distal chamber, the distal assembly adapted to house therein an ultrasound imaging transducer,

the ablation direction fiducial marker positioned relative to the ultrasound ablation transducer and adapted to, when an ultrasound imaging transducer is positioned and activated within the distal assembly, create an aiming artifact on an image created by the ultrasound imaging transducer, the aiming artifact adapted to be used to indicate a direction of ablation; and

an elongate shaft extending proximally from the distal assembly.

13. The catheter of claim 12 wherein the ablation direction fiducial marker is axially aligned with the ultrasound imaging catheter when the ultrasound image transducer is in an active position in the distal assembly.

14. The catheter of claim 12 wherein the ablation direction fiducial marker is disposed relative to the ultrasound ablation transducer such that the direction of the ablation energy emitted from the ultrasound ablation transducer can be determined based on the location of the indicator on the image.

15. The catheter of claim 14 wherein the ablation direction fiducial marker is secured to the echolucent shell.

16. The catheter of claim 15 wherein echolucent shell comprises first and second membranes, the ablation direction fiducial marker secured between the first and second membranes.

17. The catheter of claim 16 wherein the ablation direction fiducial marker has a curved configuration.

18. The catheter of claim 12 wherein the ablation direction fiducial marker has a curved configuration.

19. The catheter of claim 12 wherein the ablation direction fiducial marker has a configuration that is a partial tubular member.

20. The catheter of claim 12 wherein the ablation direction fiducial marker is an extension of a support member disposed proximal to the ablation direction fiducial marker.

21. The catheter of claim 12 wherein the ablation direction fiducial marker is an echo-opaque material.

22. The catheter of claim 21 wherein the ablation direction fiducial marker comprises stainless steel.

23. The catheter of claim 12 wherein the ultrasound ablation catheter is configured to be inserted through a jugular vein of a patient and wherein the ultrasound ablation transducer is configured to be placed in proximity to a target ablation site including a carotid body.

24. The catheter of claim 12 wherein the distal assembly further comprises a lumen therein configured to receive therethrough an ultrasound imaging catheter.

25. The catheter of claim 12 wherein the ultrasound ablation transducer is a flat transducer with an axial axis that is parallel to the longitudinal axis of the elongate shaft in a straight configuration.

26. The catheter of claim 25 wherein the flat transducer is disposed in an outer radial portion of the distal region.

27. The catheter of claim 12 wherein the echolucent shell has a first thickness at a first axial location of the ablation ultrasound transducer, and a second thickness greater than the first thickness at a second axial location distal to the ablation ultrasound transducer.

28. The catheter of claim 12 wherein the echolucent shell comprises at least first and second membrane sections that are affixed together in the second axial location.

29. The catheter of claim 12 further comprising a fluid lumen, the fluid lumen in fluid communication with the ultrasound ablation transducer, the fluid lumen also comprising an electrical connector in electrical communication with the ablation ultrasound transducer.

30. The catheter of claim 12 further comprising a manifold secured to and extending distally from at least a portion the elongate shaft, the ablation ultrasound transducer mounted to the manifold.

31. The catheter of claim 30 further comprising a wafer secured between the ablation ultrasound transducer and the manifold.

32. The catheter of claim 30 wherein the manifold further comprises a lumen adapted to receive an ultrasound imaging catheter therein.

33. The catheter of claim 30 wherein the manifold comprises at least one fluid exit lumen in communication with a proximal region of the catheter.

34. The catheter of claim 30 wherein the manifold comprises a recess defined by side edges and a back plate, the recess adapted to receive therein the ultrasound ablation transducer, wherein the ablation transducer is secured within the recess such that the side edges extend radially outward relative to the ablation transducer to allow the free flow of cooling fluid over the ablation transducer.

35. The catheter of claim 34 wherein the manifold is configured to induce turbulent flow of cooling fluid over the ablation transducer.

36-82. -82. (canceled)