Energetic modulation of nerves

• US 9,199,097 B2
• Filed: 05/16/2013
• Issued: 12/01/2015
• 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): REMALY, MARK DONALD
• Application Number:
  US13/896,247
• Publication Number:
  US 20130281889A1
• Time in Patent Office: 929 Days
• US Class Current: 1/1
• 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 5/0066 Optical coherence imaging
• CPC Class Codes: A61B 5/015 By temperature mapping of body part
• 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 5/412 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 6/032 Transmission computed tomography [CT]
• CPC Class Codes: A61B 6/037 Emission tomography
• CPC Class Codes: A61B 6/487 involving fluoroscopy
• CPC Class Codes: A61B 6/504 for diagnosis of blood vessels, e.g. by angiography
• CPC Class Codes: A61B 6/506 for diagnosis of nerves
• CPC Class Codes: A61B 6/5247 : combining images from an ionising-radiation diagnostic technique and a non-ionising radiation diagnostic technique, e.g. X-ray and ultrasound
• 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 8/0841 : for locating instruments
• CPC Class Codes: A61B 8/0891 : for diagnosis of blood vessels
• 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 8/488 : involving Doppler signals
• CPC Class Codes: A61B 90/37 : Surgical systems with images on a monitor during operation
• 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 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

A method to apply a nerve inhibiting cloud surrounding a blood vessel includes creating a treatment plan, wherein the treatment plan prescribes application of the nerve inhibiting cloud towards at least a majority portion of a circumference of a blood vessel wall, and applying the nerve inhibiting cloud towards the majority portion of the circumference of the blood vessel wall for a time sufficient to inhibit a function of a nerve that surrounds the blood vessel wall.

Claims

1. A method to apply focused ultrasound to a hilum region of a kidney in a patient, comprising:

obtaining an image using an ultrasound imaging transducer, the image having an image of a blood vessel;

verifying that the blood vessel travels to a kidney by identifying a kidney in the image that has the image of the blood vessel;

determining a target region which encompasses nerves surrounding the blood vessel;

applying pulses of focused ultrasound to the target region using an ultrasound therapy transducer, wherein a feature in the image is used as a fiducial during the application of the pulses of the focused ultrasound to ensure delivery of the pulses of focused ultrasound to the target region.

2. The method of claim 1, wherein at least one of the pulses of the focused ultrasound is less than 10 seconds in duration, and has an intensity that is approximately 200 W/cm².

3. The method of claim 1, wherein at least one of the pulses of the focused ultrasound achieves an intensity of at least 200 W/cm² by about 2 seconds.

4. The method of claim 1, wherein the method further comprises moving the ultrasound therapy transducer.

5. The method of claim 4, wherein the ultrasound therapy transducer is moved so that a region aimed at by the ultrasound therapy transducer moves along an anterior-to-posterior axis with respect to the blood vessel.

6. The method of claim 4, wherein the ultrasound transducer is moved so that a region aimed at by the ultrasound therapy transducer moves from one side of the blood vessel to another side of the blood vessel.

7. The method of claim 1, further comprising tracking a motion of the blood vessel using a motion tracking system.

8. The method of claim 1, further comprising providing an image of the target region in a display.

9. The method of claim 8, further comprising presenting a graphic in the display showing a therapy progress.

10. The method of claim 1, wherein the act of obtaining the image comprises delivering imaging energy from a posterior position of the patient, and wherein the pulses of the focused ultrasound are applied from the posterior position of the patient.

11. The method of claim 1, wherein the method further comprises moving the ultrasound therapy transducer in response to a movement of the blood vessel.

12. The method of claim 1, further comprising quantifying a degree of movement of the blood vessel.

13. The method of claim 12, wherein the degree of the movement of the blood vessel is quantified with respect to the target region.

14. The method of claim 1, further comprising determining a distance between a region in which treatment was applied and the target region.

15. The method of claim 11, further comprising determining whether a treatment is successful or not based at least in part on the determined distance.

16. The method of claim 15, wherein the treatment is determined to be successful if the distance is within a prescribed distance.

17. The method of claim 15, wherein the treatment is determined to be unsuccessful if the distance is not within a prescribed distance.

18. The method of claim 1, further comprising:

determining a response of an autonomic nervous system; and

determining treatment parameters based at least in part on the determined response.

19. The method of claim 1, after the act of applying the pulses, further comprising performing one of:

determining a norepinephrine level, performing a tilt test, determining a carotid sinus reactivity, determining a blood pressure, and performing a microneurography.

20. The method of claim 1, further comprising:

determining a thickness of one or more tissue(s) along an energy delivery path to the hilum region.

21. The method of claim 20, wherein the one or more tissue(s) comprises at least one of:

a skin, a muscle, and a kidney.

22. The method of claim 1, wherein the feature is a feature in the kidney.

23. The method of claim 1, wherein the feature comprises a Doppler flow signal.