Systems and methods for sympathetic cardiopulmonary neuromodulation

Abstract

Methods, devices and systems are described for decreasing the activity of the sympathetic nervous innervation to and from the lungs and the vessels supplying the lungs to treat pulmonary medical conditions such as asthma. In one embodiment, the method may involve advancing an intravascular instrument to a target location in a blood vessel within the intercostal vasculature to ablate either or both the sympathetic afferent and efferent nerves lying within the paravertebral gutter including the visceral fibers that travel to the cardiothoracic cavity and abdominopelvic viscera and the T1 to T4/5 sympathetic chain. In another embodiment, an intravascular instrument may be advanced to the bronchial vessels to ablate either or both the sympathetic afferent and efferent nerves in and around the posterior pulmonary plexus. In one embodiment the ablative agent is a neurolytic agent delivered in a gel. This approach may be utilized to treat other cardiac and pulmonary diseases.

1 - 21 . (canceled) 
     
     
         22 . A method of modulating sympathetic nerves of a patient, comprising:
 accessing a paravertebral gutter of the patient; and   neuromodulating sympathetic nerves within the paravertebral gutter, wherein neuromodulating comprises flowing a gel comprising a therapeutic agent into the paravertebral gutter.   
     
     
         23 - 66 . (canceled) 
     
     
         67 . A system configured for sympathetic neuromodulation, comprising:
 a catheter configured for being positioned percutaneously within a blood vessel directly proximate the paravertebral gutter and for delivering a therapeutic agent to the target nerve or target neurons within the paravertebral gutter; and   a first hydrogel comprising a neurolytic agent.   
     
     
         68 - 72 . (canceled) 
     
     
         73 . A hydrogel for use in sympathetic neuromodulation by delivery to the paravertebral gutter of a patient, comprising:
 a therapeutic agent comprising a neurolytic active agent; and   a biodegradable polymer,   wherein the hydrogel has a porosity of less than about 50 μm.   
     
     
         74 . The hydrogel of  claim 73 , wherein the neurolytic active agent comprises an alcohol. 
     
     
         75 . The hydrogel of  claim 73 , wherein the gel has a porosity of less than about 20 μm. 
     
     
         76 . The hydrogel of  claim 73 , wherein the gel comprises a biodegradable polymer. 
     
     
         77 . The hydrogel of  claim 73 , wherein the gel comprises an injectable hydrogel. 
     
     
         78 . The hydrogel of  claim 73 , wherein the gel is in situ forming. 
     
     
         79 . The hydrogel of  claim 73 , wherein the gel comprises PEG-NHS. 
     
     
         80 . The hydrogel of  claim 73 , wherein the gel comprises PEG-ester. 
     
     
         81 . The hydrogel of  claim 73 , wherein the gel comprises a PEG hydrogel. 
     
     
         82 . The hydrogel of  claim 73 , wherein the gel is shear-thinning. 
     
     
         83 . The hydrogel of  claim 73 , wherein the gel comprises hyaluronic acid.