Flow directed heating of nervous structures

• US 8,556,834 B2
• Filed: 12/13/2010
• Issued: 10/15/2013
• Est. Priority Date: 10/12/2009
• Status: Active Grant

• Current Assignee: Otsuka Medical Devices Co., Ltd. (Otsuka Holdings Company Limited)
• Original Assignee: Kona Medical, Inc.
• Inventors: Gertner, Michael
• Primary Examiner(s): Chen, Tse
• Assistant Examiner(s): REMALY, MARK DONALD
• Application Number:
  US12/966,962
• Publication Number:
  US 20110172529A1
• Time in Patent Office: 1,037 Days
• Field of Search: 600407-475, 601 2- 4
• US Class Current: 601/2
• CPC Class Codes: A61B 17/320068 using mechanical vibrations, e.g. ultrasonic A61B17/22012 takes precedence; dental tooth drilling devices operated by vibration A61C3/03; removing intra-ocular material using mechanical vibrations A61F9/00745
• CPC Class Codes: A61B 18/14 Probes or electrodes therefor
• CPC Class Codes: A61B 18/18 by applying electromagnetic radiation, e.g. microwaves radiation therapy A61N5/00
• CPC Class Codes: A61B 2018/00404 Blood vessels other than those in or around the heart
• CPC Class Codes: A61B 2018/00434 Neural system
• CPC Class Codes: A61B 2018/00511 Kidney
• CPC Class Codes: A61B 2090/374 NMR or MRI
• CPC Class Codes: A61B 2090/3762 using computed tomography systems [CT]
• CPC Class Codes: A61B 2090/378 using ultrasound
• CPC Class Codes: A61B 5/0225 the pressure being controlled by electric signals, e.g. derived from Korotkoff sounds
• CPC Class Codes: A61B 5/055 involving electronic [EMR] or nuclear [NMR] magnetic resonance, e.g. magnetic resonance imaging
• CPC Class Codes: A61B 5/4035 Evaluating the autonomic nervous system
• CPC Class Codes: A61B 5/4041 Evaluating nerves condition
• CPC Class Codes: A61B 5/4047 afferent nerves, i.e. nerves that relay impulses to the central nervous system
• CPC Class Codes: A61B 5/4052 efferent nerves, i.e. nerves that relay impulses from the central nervous system
• CPC Class Codes: A61B 5/412 Detecting or monitoring sepsis
• CPC Class Codes: A61B 5/4528 Joints A61B5/4533, A61B5/4538 take precedence
• CPC Class Codes: A61B 5/4839 combined with drug delivery
• CPC Class Codes: A61B 5/489 Blood vessels
• CPC Class Codes: A61B 5/4893 Nerves
• CPC Class Codes: A61B 6/03 : Computed tomography [CT] echo-tomography A61B8/14
• CPC Class Codes: A61B 6/032 : Transmission computed tomography [CT]
• CPC Class Codes: A61B 6/037 : Emission tomography
• CPC Class Codes: A61B 6/506 : for diagnosis of nerves
• CPC Class Codes: A61B 8/00 : Diagnosis using ultrasonic, sonic or infrasonic waves imaging of objects using sonar G01S15/00
• CPC Class Codes: A61B 8/06 : Measuring blood flow measuring volume flow in general G01F, e.g. G01F1/66, G01F1/72; measuring speed of fluids in general G01P5/00
• CPC Class Codes: A61B 8/08 : Detecting organic movements or changes, e.g. tumours, cysts, swellings A61B8/02 - A61B8/06 take precedence
• CPC Class Codes: A61B 8/4245 : involving determining the position of the probe, e.g. with respect to an external reference frame or to the patient
• CPC Class Codes: A61B 8/485 : involving measuring strain or elastic properties
• CPC Class Codes: A61B 90/37 : Surgical systems with images on a monitor during operation
• CPC Class Codes: A61N 1/0551 : Spinal or peripheral nerve electrodes
• CPC Class Codes: A61N 2/006 : for magnetic stimulation of nerve tissue
• CPC Class Codes: A61N 2005/063 : comprising light transmitting means, e.g. optical fibres
• CPC Class Codes: A61N 2007/0026 : Stimulation of nerve tissue
• CPC Class Codes: A61N 2007/003 : Destruction of nerve tissue
• CPC Class Codes: A61N 2007/0078 : with multiple treatment transducers
• CPC Class Codes: A61N 2007/025 : interstitial
• CPC Class Codes: A61N 5/00 : Radiation therapy ultrasound therapy A61N7/00; devices or apparatus applicable to both therapy and diagnosis A61B6/00
• CPC Class Codes: A61N 5/0601 : Apparatus for use inside the body
• CPC Class Codes: A61N 5/062 : Photodynamic therapy, i.e. excitation of an agent
• CPC Class Codes: A61N 5/0622 : Optical stimulation for exciting neural tissue
• CPC Class Codes: A61N 7/00 : Ultrasound therapy lithotripsy A61B17/22, A61B17/225; massage using supersonic vibration A61H23/00 ; using ultrasound for introducing media into the body A61M37/0092
• CPC Class Codes: A61N 7/02 : Localised ultrasound hyperthermia hyperthermia in general A61F7/00

Abstract

In some examples, nerves surrounding arteries or leading to organs are targeted with energy sources to correct or modulate physiologic processes. In some examples, different types of energy sources are utilized singly or combined with one another. In some examples, bioactive agents or devices activated by the energy sources are delivered to the region of interest and the energy is enhanced by such agents or the agents are enhanced by the energy sources.

Claims

1. A treatment method, comprising:

placing a therapeutic ultrasonic energy source comprising a transducer external to a patient;

controlling the transducer using information from an imaging device to deliver ultrasonic energy from outside the patient to a target region containing a nerve next to a blood vessel, wherein the transducer is controlled to deliver the ultrasonic energy to different positions three-dimensionally around a reference position in the blood vessel, wherein the different positions are arranged approximately in a spherical or ellipsoidal configuration;

tracking the blood vessel to update a position of the target region containing the nerve; and

adjusting the delivery of the ultrasonic energy from outside the patient to the target region in response to the updated position of the target region.

2. The method of claim 1, wherein the transducer is controlled to create a heat zone having an annular configuration.

3. The method of claim 1, wherein the transducer is controlled to treat tissue that is at least ten millimeters away from the blood vessel.

4. The method of claim 1, wherein the transducer is controlled to treat tissue that comprises an adventitia surrounding the blood vessel.

5. The method of claim 1, wherein the target region is an autonomic nerve region, and the blood vessel leads to a kidney;

and

wherein the ultrasonic energy is delivered through a path from an external position posterior to the patient, the path intersecting the kidney while avoiding bone and bowel tissue.

6. The method of claim 1, wherein the reference position is at a center of the blood vessel, and one of the positions that are three-dimensionally around the reference position in the blood vessel is offset from the center of the blood vessel.

7. The method of claim 1, wherein the transducer is controlled to deliver the ultrasonic energy to a carotid body or a carotid sinus.

8. A medical method, comprising:

detecting a blood vessel using a doppler flow signal;

applying heat to a nerve region outside the blood vessel by delivering energy from outside a patient'"'"'s body to different positions around a reference position in the blood vessel, wherein the different positions are arranged approximately in a spherical or ellipsoidal configuration;

determining an effect of the heat being applied to the nerve region using an ultrasound signal, wherein the effect corresponds with a change in a tissue property at the nerve region outside the blood vessel.

9. The method of claim 8, wherein the heat is applied to tissue in the nerve region on at least two sides of the blood vessel.

10. The method of claim 8, wherein the act of applying heat comprises creating a zone of heat surrounding the blood vessel to create an annular region around the blood vessel to inhibit nerves surrounding the blood vessel.

11. The method of claim 8, further comprising creating a map that represents the effect of the heat.

12. The method of claim 8, further comprising modifying the application of heat in response to the determined effect of the heat.

13. The method of claim 8, wherein the effect comprises tissue elasticity.

14. The method of claim 8, wherein the effect comprises temperature.

15. The method of claim 8, further comprising altering an amount of the heat being applied through application of the energy in response to the change in the tissue property.

16. The method of claim 8, wherein the reference position is at a center of the blood vessel, and one of the positions that are three-dimensionally around the reference position in the blood vessel is offset from the center of the blood vessel.

17. The method of claim 8, wherein the heat is applied to a carotid body or a carotid sinus.

18. A treatment method, comprising:

obtaining a first signal associated with a first position of a blood vessel;

controlling a transducer at a location external to a patient to deliver ultrasonic energy to different positions three-dimensionally around the first position of the blood vessel to thereby treat a first nerve next to the blood vessel, wherein the different positions are arranged approximately in a spherical or ellipsoidal configuration;

obtaining a second signal associated with a second position of the blood vessel;

adjusting the delivery of the ultrasonic energy based on the second signal.

19. The method of claim 18, wherein the first signal is obtained from a fiducial located inside the blood vessel.

20. The method of claim 18, wherein the delivery of the ultrasonic energy is adjusted by changing a position of a focal point of the ultrasonic energy.

21. The method of claim 18, wherein the first nerve is at a first side of the blood vessel, and the ultrasonic energy is also delivered to treat a second nerve at a second side of the blood vessel.

22. The method of claim 18, wherein the transducer is controlled to create a heat zone having an annular configuration.

23. The method of claim 18, wherein the ultrasonic energy is delivered to the first nerve by aiming a focal point of the ultrasonic energy away from the first position of the blood vessel.

24. The method of claim 18, wherein the first signal comprises a Doppler flow signal.

25. The method of claim 18, wherein the first nerve comprises an autonomic nerve.

26. The method of claim 25, wherein the ultrasonic energy is delivered through a path from an external position posterior to the patient, the path intersecting a kidney while avoiding bone and bowel tissue.

27. The method of claim 18, wherein the first position of the blood vessel is a center of the blood vessel, and one of the positions that are three-dimensionally around the first position of the blood vessel is offset from the center of the blood vessel.

28. The method of claim 18, wherein the transducer is controlled to deliver the ultrasonic energy to a carotid body or a carotid sinus.