Devices and methods for detection and treatment of the aorticorenal ganglion

Abstract

Modifying a state of a patient involving advancing a treatment catheter system within the patient to an anatomic region associated with a location at which one or more ganglia is thought to exist and modifying tissue proximate to the anatomic region with the treatment catheter system while the treatment catheter system is advanced to the anatomic region to permanently change the tissue and/or kidney nerve activity.

What is claimed is: 
     
         1 . A method for modifying a state of a patient, comprising:
 advancing a treatment catheter system within the patient to an anatomic region associated with a location at which one or more ganglia is thought to exist; and   modifying tissue proximate to the anatomic region with the treatment catheter system while the treatment catheter system is advanced to the anatomic region to permanently change at least one of: the tissue, and kidney nerve activity.   
     
     
         2 . The method of  claim 1 , wherein advancing the treatment catheter system within the patient to the anatomic region associated with the location at which the one or more ganglia is thought to exist comprises advancing the treatment catheter system within the patient to one of:
 an origin of a renal artery from an abdominal aorta where the one or more ganglia is thought to exist;   a location in a renal artery in proximity to where the one or more ganglia is thought to exist;   a body lumen in proximity to the one or more ganglia including one of: an abdominal aorta, a vena cava, a renal vein, and an ostia;   a postganglionic axon; and   a preganglionic axon including one of: the lesser thoracic splanchnic nerve, and the least thoracic splanchnic nerve.   
     
     
         3 . The method of  claim 2 , wherein the one or more ganglia comprises an aorticorenal ganglion. 
     
     
         4 . The method of  claim 1 , wherein modifying tissue proximate the anatomic region with the treatment catheter system while the treatment catheter system is advanced to the anatomic region comprises modifying one or more of:
 tissue proximate to an origin of a renal artery from an abdominal aorta;   tissue proximate to a renal artery in proximity to the location at which the one or more ganglia is thought to exist;   tissue proximate to a body lumen in proximity to the location as which the one or more ganglia is thought to exist including one of: an abdominal aorta, a vena cava, a renal vein, and an ostia;   tissue proximate to one of: a lesser thoracic splanchnic nerve and a least thoracic splanchnic nerve; and   tissue located at one of: superior, anterior, and inferior, to the renal artery;   nerve tissue;   a postganglionic axon including renal nerve tissue;   a preganglionic axon including one of: the lesser thoracic splanchnic nerve tissue and the least thoracic splanchnic nerve;   tissue of the one or more ganglia; and   tissue of an aorticorenal ganglion.   
     
     
         5 . The method of  claim 1 , wherein modifying tissue proximate the anatomic region with the treatment catheter system while the treatment catheter system is advanced to the anatomic region comprises modifying tissue via one or more of: thermal energy-, cryogenic-, electrical energy-, chemical destruction-, radiation exposure-, pharmacological-, ultrasonic energy-, radiofrequency energy-, microwave energy-, and mechanical-based tissue modification techniques. 
     
     
         6 . The method of  claim 1 , wherein advancing the treatment catheter system within the patient to the anatomic region associated with the location at which the one or more ganglia is thought to exist, comprises searching for the one or more ganglia via one or more of: intravascular and external ultrasound, magnetic resonance imaging (MRI), electromyography (EMG), nerve conduction velocity testing (NCV), somatosensory evoked potential (SSEP), x-ray computed tomography (CT scan), and fluoroscopy. 
     
     
         7 . The method of  claim 1 , wherein the treatment catheter system comprises one or more tissue stimulation elements and a corresponding one or more tissue modification elements; and
 wherein advancing the treatment catheter system within the patient to the anatomic region associated with a location at which the one or more ganglia is thought to exist comprises:
 advancing the treatment catheter system comprising one or more tissue stimulation elements and one or more tissue modification elements within the patient to the anatomic region; 
 stimulating the patient with a first of the one or more tissue stimulation elements at the anatomic region without resulting in a permanent change to tissue proximate the anatomic region or a permanent change to kidney nerve activity; 
 detecting a first physiological response of the patient that indicates the first of the one or more stimulation elements is not in proximity to the location at which the one or more ganglia actually exists, responsive to stimulating the patient with the first of the one or more tissue stimulation elements at the anatomic region; 
 stimulating the patient with a second of the one or more tissue stimulation elements at the anatomic region without resulting in a permanent change to tissue proximate the anatomic region or a permanent change to kidney nerve activity; and 
 detecting a second physiological response of the patient that indicates the second of the one or more tissue stimulation elements is in proximity to the location at which the one or more ganglia actually exists, responsive to stimulating the patient with the second of the one or more tissue stimulation elements at the anatomic region. 
   
     
     
         8 . The method of  claim 7 , wherein the steps of:
 stimulating the patient with the second of the one or more tissue stimulation elements at the anatomic region without resulting in a permanent change to tissue proximate the anatomic region or a permanent change to kidney nerve activity; and   detecting the second physiological response of the patient that indicates the second of the one or more tissue stimulation elements is in proximity to the location at which the one or more ganglia actually exists, responsive to stimulating the patient with the second of the one or more tissue stimulation elements at the anatomic region;   
       occur after the steps of:
 stimulating the patient with the first of the one or more tissue stimulation elements at the anatomic region without resulting in a permanent change to tissue proximate the anatomic region or a permanent change to kidney nerve activity; and 
 detecting the first physiological response of the patient that indicates the first of the one or more stimulation elements is not in proximity to the location at which the one or more ganglia actually exists, responsive to stimulating the patient with the first of the one or more tissue stimulation elements at the anatomic region. 
 
     
     
         9 . The method of  claim 7 , wherein the one or more tissue stimulation elements and the one or more tissue modification elements are the same one or more elements. 
     
     
         10 . The method of  claim 7 , wherein the one or more tissue stimulation elements comprise one or more electrical tissue stimulation elements, and
 wherein stimulating the patient with the first or second of the one or more tissue stimulation elements at the anatomic region without resulting in a permanent change to tissue proximate the anatomic region or a permanent change to kidney nerve activity comprises electrically stimulating the patient with the first or second of the one or more electrical tissue stimulation elements at the anatomic region without resulting in a permanent change to tissue proximate the anatomic region or a permanent change to kidney nerve activity.   
     
     
         11 . The method of  claim 7 , wherein modifying tissue proximate the anatomic region with the treatment catheter system while the treatment catheter system is advanced to the anatomic region to permanently change at least one of: the tissue, and kidney nerve activity, comprises:
 modifying the tissue proximate the anatomic region with a corresponding second of the one or more tissue modification elements when:
 detecting the first physiological response of the patient that indicates the first of the one or more stimulation elements is not in proximity to the location at which one of: the one or more ganglia, and nerve tissue, actually exist, and 
 detecting the second physiological response of the patient that indicates the second of the one or more tissue stimulation elements is in proximity to the location at which one of: the one or more ganglia, and nerve tissue, actually exist. 
   
     
     
         12 . The method of  claim 11 , wherein the one or more tissue modification elements is selected from a group consisting of: one or more electrical energy-, radiofrequency energy-, ultrasound energy-, thermal energy-, cryogenic-, radiation exposure-, pharmacological or drug delivery-, microwave energy-, and mechanical-based tissue modification techniques
 wherein modifying the tissue proximate the anatomic region with a corresponding second of the one or more tissue modification elements comprises modifying the tissue proximate the anatomic region with a corresponding second of the selected one or more of the above enumerated tissue modification elements.   
     
     
         13 . An apparatus to modify a state of a patient, comprising:
 a treatment catheter system to insert within the patient to an anatomic region associated with a location at which one or more ganglia is thought to exist, the treatment catheter system comprising one or more tissue modification elements;   a control box in electronic communication with the treatment catheter system to activate the one or more tissue modification elements, while the treatment catheter system is inserted within the patient to the anatomic region associated with the location at which the one or more ganglia is thought to exist, to modify tissue proximate to the anatomic region to permanently change at least one of: the tissue, and kidney nerve activity.   
     
     
         14 . The apparatus of  claim 13 , wherein the one or more tissue modification elements is selected from a group of tissue modification elements consisting of: a thermal energy-, a cryogenic-, an electrical energy-, a chemical-, a radiation exposure-, a pharmacological-, an ultrasonic energy-, a radiofrequency energy-, a microwave energy-, and a mechanical-based tissue modification element. 
     
     
         15 . The apparatus of  claim 13 , further comprising a means for searching device, and wherein the control box is further in communication with the means for searching device to activate the means for searching device to search for the anatomic region associated with the location at which the one or more ganglia is thought to exist. 
     
     
         16 . The apparatus of  claim 15 , wherein the means for searching device is selected from a group of devices consisting of: an intravascular ultrasound device, an external ultrasound device, a magnetic resonance imaging (MRI) device, an electromyography (EMG) device, a nerve conduction velocity testing (NCV) device, a somatosensory evoked potential (SSEP) device, and an x-ray computed tomography (CT scan) device. 
     
     
         17 . The apparatus of  claim 13 , wherein the treatment catheter system comprises:
 one or more tissue stimulation elements corresponding to the one or more tissue modification elements; and
 a physiological measurement element; 
   wherein the control box in electronic communication with the catheter system to:
 activate a first of the one or more tissue stimulation elements to stimulate the patient at the anatomic region without resulting in a permanent change to tissue proximate the anatomic region or a permanent change to kidney nerve activity; 
 measure with the physiological measurement element a first physiological response of the patient that indicates the first of the one or more stimulation elements is not in proximity to the location at which the one or more ganglia actually exists; 
 activate a second of the one or more tissue stimulation elements to stimulate the patient at the anatomic region without resulting in a permanent change to tissue proximate the anatomic region or a permanent change to kidney nerve activity; and 
 measure with the physiological measurement element a second physiological response of the patient that indicates the second of the one or more tissue stimulation elements is in proximity to the location at which the one or more ganglia actually exists. 
 activate a second of the tissue modification elements to modify the tissue proximate the anatomic region when the physiological measurement element measures the second physiological response of the patient that indicates the second of the one or more tissue stimulation elements is in proximity to the location at which the one or more ganglia actually exists. 
   
     
     
         18 . The apparatus of  claim 17 , wherein the one or more tissue stimulation elements and the one or more tissue modification elements are the same one or more elements. 
     
     
         19 . The apparatus of  claim 17 , wherein the control box to measure with the physiological measurement element the first or the second physiological response in the human comprises the control box to measure with the physiological measurement element one or more physiological responses changes consisting of: renal vasoconstriction, decreased renal blood flow, reduced glomerular filtration rate, pulsation of a kidney, vascular blood pressure, and pulsation of renal vasculature. 
     
     
         20 . The apparatus of  claim 13 , wherein the treatment catheter system is selected from a group consisting of: an expandable balloon-, a helical member-, an expandable cage-, a plurality of arms-, and an extendable needle-type of treatment catheter system. 
     
     
         21 . The apparatus of  claim 13 , wherein the tissue modification element is configured to direct tissue modifying energy in one of a radial direction and an axial direction toward the tissue.