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Kafe 바로가기국가/구분 | United States(US) Patent 등록 |
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국제특허분류(IPC7판) |
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출원번호 | US-0902133 (2010-10-11) |
등록번호 | US-9174065 (2015-11-03) |
발명자 / 주소 |
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출원인 / 주소 |
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대리인 / 주소 |
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인용정보 | 피인용 횟수 : 0 인용 특허 : 283 |
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 activa
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.
1. A method of treatment, comprising: placing an energy source outside a patient; imaging a region inside the patient with ultrasound delivered from outside the patient, the region having a blood vessel with nerves around it, the nerves being parts of an autonomic nervous system;identifying a tracki
1. A method of treatment, comprising: placing an energy source outside a patient; imaging a region inside the patient with ultrasound delivered from outside the patient, the region having a blood vessel with nerves around it, the nerves being parts of an autonomic nervous system;identifying a tracking target in the region;tracking the tracking target in the region;obtaining a defined pattern that includes multiple treatment locations, at least one of the multiple treatment locations having a spatial relationship with respect to the tracking target that is based on an estimated nerve position relative to the tracking target; andoperating the energy source to deliver treatment energy for treating the nerves inside the patient;wherein the act of operating the energy source comprises using the energy source to deliver the treatment energy sequentially from outside the patient to multiple treatment areas corresponding with the defined multiple treatment locations in accordance with the tracking target in the region. 2. The method of claim 1, wherein the treatment energy comprises focused energy. 3. The method of claim 1, wherein the treatment energy comprises non-focused energy. 4. The method of claim 1, wherein the treatment energy comprises HIFU energy. 5. The method of claim 1, wherein the treatment energy comprises LIFU energy. 6. The method of claim 1, wherein the treatment energy is delivered to the nerves to achieve partial ablation of the nerves. 7. The method of claim 1, wherein the treatment energy is delivered to the nerves to achieve complete ablation of the nerves. 8. The method of claim 1, wherein the treatment energy is delivered to achieve paralysis of the nerves. 9. The method of claim 1, wherein the treatment energy is delivered to the nerves that lead to a kidney. 10. The method of claim 9, wherein the treatment energy is delivered to the nerves that comprise renal nerves. 11. The method of claim 9, wherein the treatment energy is delivered to the nerves that comprise sympathetic nerves connected to the kidney. 12. The method of claim 9, wherein the treatment energy is delivered to the nerves that comprise afferent nerves connected to the kidney. 13. The method of claim 9, wherein the treatment energy is delivered to the nerves at a renal hilum. 14. The method of claim 1, wherein the treatment energy is delivered to the nerves that comprise nerve trunks adjacent to a vertebra. 15. The method of claim 1, wherein the treatment energy is delivered to the nerves that comprise a ganglion adjacent to a vertebra. 16. The method of claim 1, wherein the treatment energy is delivered to the nerves that comprise dorsal root nerves. 17. The method of claim 1, wherein the treatment energy is delivered to the nerves that lead to an adrenal gland. 18. The method of claim 1, wherein the treatment energy is delivered to the nerves that comprise motor nerves. 19. The method of claim 1, wherein the treatment energy is delivered to the nerves that are next to a kidney. 20. The method of claim 1, wherein the treatment energy is delivered to the nerves that are behind an eye. 21. The method of claim 1, wherein the treatment energy is delivered to the nerves that comprise a celiac plexus. 22. The method of claim 1, wherein the treatment energy is delivered to the nerves that are within or around a vertebral column. 23. The method of claim 1, wherein the treatment energy is delivered to the nerves that extend to a facet joint. 24. The method of claim 1, wherein the treatment energy is delivered to the nerves that comprise a celiac ganglion. 25. The method of claim 1, wherein the act of operating the energy source comprises positioning the energy source. 26. The method of claim 1, wherein the energy source comprises an ultrasound energy source. 27. The method of claim 26, wherein the ultrasound energy source is used to deliver the treatment energy to the nerves from multiple directions outside the patient. 28. The method of claim 1, wherein the treatment energy is delivered to modulate the nerves without damaging the nerves. 29. The method of claim 1, wherein the blood vessel comprises a renal vessel, the method further comprising determining a position of the renal vessel using the imaged region. 30. The method of claim 29, wherein the position of the renal vessel is used to determine one of the treatment locations that has a probability of including a nerve. 31. The method of claim 1, further comprising determining a position of one of the treatment locations. 32. The method of claim 31, wherein the act of determining the position of the one of the treatment locations comprises determining a position of a renal vessel. 33. The method of claim 32, wherein the act of determining the position of the renal vessel comprises determining a position of a renal artery. 34. The method of claim 31, wherein the act of determining the position of the one of the treatment areas comprises using a Doppler triangulation technique. 35. The method of claim 1, wherein the pattern has a spherical configuration. 36. The method of claim 1, wherein the pattern has a cigar shape. 37. The method of claim 1, wherein the treatment energy comprises HIFU energy. 38. The method of claim 1, wherein the treatment energy is delivered to a kidney to decrease a sympathetic stimulus to the kidney, decrease an afferent signal from the kidney to the autonomic nervous system, or both. 39. The method of claim 1, further comprising delivering testing energy to the patient to determine if there is a reaction resulted therefrom, wherein the testing energy is delivered before the treatment energy is delivered from the energy source. 40. The method of claim 39, wherein the testing energy comprises heat or vibratory energy, and the method further comprises performing a test to detect sympathetic nerve activity. 41. The method of claim 39, wherein the testing energy comprises a stimulus applied to a skin, and the method further comprises detecting an output from the patient. 42. The method of claim 41, wherein the output comprises a heart rate. 43. The method of claim 39, wherein the test energy is delivered to stimulate a baroreceptor complex, and wherein the method further comprises: applying pressure to a carotid artery; anddetermining whether a blood pressure decreases after application of the pressure to the carotid artery. 44. The method of claim 43, wherein the test energy is delivered using an ultrasound device that is placed outside the patient. 45. The method of claim 43, wherein the treatment energy from the energy source is delivered if the blood pressure decreases or if the blood pressure decreases at a rate that is above a prescribed threshold. 46. The method of claim 1, wherein the treatment energy is delivered to treat hypertension. 47. The method of claim 1, wherein the treatment energy is delivered to treat glaucoma. 48. The method of claim 1, wherein the energy source is operated so that the energy source aims at a direction that aligns with the blood vessel. 49. The method of claim 1, wherein the act of tracking the tracking target comprises tracking the blood vessel. 50. The method of claim 1, wherein an energy delivery path of the energy source is aimed towards one of the treatment areas using a position of the blood vessel. 51. The method of claim 1, further comprising: delivering a device inside the patient; andusing the device to determine a position of the blood vessel inside the patient;wherein the energy source is operated using the determined position so that the treatment energy is delivered to one of the treatment areas having a coordinate that is offset from the determined position. 52. The method of claim 51, wherein the device is placed inside the blood vessel. 53. The method of claim 1, wherein the treatment energy is delivered to form a heat region having a cloud configuration. 54. A system for treatment, comprising: an energy source for placement outside a patient, wherein the energy source is configured to deliver treatment energy for treating nerves that are parts of an autonomic nervous system inside the patient; anda processor configured to identify a tracking target in a region, the region having a blood vessel with the nerves around it,track the tracking target in the region, andobtain a defined pattern that includes multiple treatment locations, at least one of the multiple treatment locations having a spatial relationship with respect to the tracking target that is based on an estimated nerve position relative to the tracking target;wherein the energy source is configured to deliver the treatment energy from outside the patient to multiple treatment areas sequentially and in accordance with the tracking target being tracked. 55. The system of claim 54, wherein the energy source is configured to provide focused energy. 56. The system of claim 54, wherein the energy source is configured to provide non-focused energy. 57. The system of claim 54, wherein the energy source is configured to provide HIFU energy. 58. The system of claim 54, wherein the energy source is configured to provide LIFU energy. 59. The system of claim 54, wherein the energy source is configured to provide the treatment energy to achieve partial ablation of the nerves. 60. The system of claim 54, wherein the energy source is configured to deliver the treatment energy to achieve complete ablation of the nerves. 61. The system of claim 54, wherein the energy source is configured to deliver the treatment energy to achieve paralysis of the nerves. 62. The system of claim 54, wherein the energy source comprises an ultrasound energy source. 63. The system of claim 62, wherein the ultrasound energy source is configured to deliver the treatment energy to the nerves from multiple directions outside the patient while the ultrasound energy source is stationary relative to the patient. 64. The system of claim 54, wherein the energy source is configured to deliver the treatment energy to modulate the nerves without damaging tissues that are within a path of the treatment energy to the nerves. 65. The system of claim 54, wherein the nerves comprise renal nerves, and wherein the processor is located outside the patient and is configured for: receiving an input from an imaging device;determining an output related to a position of one of the treatment locations; andproviding the output to control the energy source to deliver the treatment energy from the outside of the patient to the one of the treatment areas. 66. The system of claim 65, wherein the imaging device comprises a MRI device. 67. The system of claim 65, wherein the imaging device comprises a CT device. 68. The system of claim 65, wherein the treatment energy comprises HIFU energy, and the imaging device comprises a MRI device. 69. The system of claim 54, wherein the blood vessel comprises a renal vessel, the renal vessel being the tracking target, and the processor is configured to track the renal vessel by determining a position of the renal vessel. 70. The system of claim 69, wherein the processor is configured to determine the position of the renal vessel based on an image signal from an imaging device. 71. The system of claim 70, wherein the imaging device comprises a CT device, a MRI device, a thermography device, an infrared imaging device, an optical coherence tomography device, a photoacoustic imaging device, a PET imaging device, a SPECT imaging device, or an ultrasound device. 72. The system of claim 69, wherein the position of the renal vessel is used during the treatment energy delivery. 73. The system of claim 69, wherein the position of the renal vessel is determined using a Doppler triangulation technique. 74. The system of claim 69, wherein the position of the renal vessel comprises a position of a renal artery, and the processor is configured to determine the position of the renal artery. 75. The system of claim 54, wherein treatment energy is delivered to a kidney to decrease a sympathetic stimulus to the kidney, decrease an afferent signal from the kidney to the autonomic nervous system, or both. 76. The system of claim 54, wherein the energy source is also configured to deliver testing energy to the patient to determine if there is a reaction resulted therefrom. 77. The system of claim 54, wherein the energy source is configured to deliver the treatment energy to treat hypertension. 78. The system of claim 54, wherein the energy source is configured to deliver the treatment energy to treat glaucoma. 79. The system of claim 54, wherein the energy source has an orientation so that the energy source aims at a direction that aligns with the blood vessel. 80. The system of claim 54, wherein the energy source is configured to aim at one of the treatment areas that has a probability of including a nerve by aiming at a position next to the tracking target. 81. The system of claim 54, wherein the processor is configured for determining a position of the tracking target; andwherein the processor is configured to operate the energy source to aim an energy delivery path towards one of the treatment areas that is offset from the determined position. 82. The system of claim 81, further comprising a tracking device sized for insertion into the blood vessel. 83. The method of claim 54, wherein the imaging device comprises a CT device, an MRI device, a thermography device, an infrared imaging device, an optical coherence tomography device, a photoacoustic imaging device, a PET imaging device, a SPECT imaging device, or an ultrasound device. 84. The system of claim 54, wherein the energy source is configured to deliver the treatment energy to form a heat region having a cloud configuration. 85. The system of claim 81, further comprising a detector that is external to the patient. 86. The system of claim 85, wherein the detector is configured to receive signals reflected from the patient. 87. A system to deliver energy from a position outside a skin of a patient to treatment areas adjacent a blood vessel in a region inside the patient, comprising: a processor configured to receive image signal, and determine a three dimensional coordinate of the region containing the blood vessel using the image signal; andan energy source configured to deliver energy from the position outside the skin of the patient to multiple treatment areas sequentially, the multiple treatment areas comprising nerves adjacent the blood vessel;wherein the processor is also configured totrack a tracking target in the region, andobtain a defined pattern that includes multiple treatment locations, at least one of the multiple treatment locations having a spatial relationship with respect to the tracking target that is based on an estimated nerve position relative to the tracking target, andcontrol the energy source in accordance with the defined pattern and a position of the tracking target. 88. The system of claim 87, further comprising an imaging device for providing the image signal. 89. The system of claim 88, wherein the imaging device comprises a MRI device. 90. The system of claim 88, wherein the imaging device comprises an ultrasound device. 91. The system of claim 87, wherein the energy comprises focused energy. 92. The system of claim 87, wherein the energy comprises focused ultrasound. 93. The system of claim 87, wherein the energy source comprises an ultrasound array that is aligned with the vessel. 94. The system of claim 87, further comprising an imaging device for providing a B-mode ultrasound for imaging the blood vessel. 95. The system of claim 87, wherein the energy source is configured to deliver the energy to form a heat region having a cloud configuration. 96. A system to deliver energy from a position outside a skin of a patient to a plurality of treatment areas next to a blood vessel comprising: a fiducial for placement inside the blood vessel;a detection device to detect the fiducial inside the blood vessel;a processor configured to obtain a defined pattern that includes multiple treatment locations, at least one of the multiple treatment locations having a spatial relationship with respect to a tracking target that is based on an estimated nerve position relative to the tracking target, the tracking target comprising the fiducial, andtrack the fiducial using an output of the detection device, wherein the processor is configured to track the fiducial by determining a three dimensional coordinate of the detected fiducial; andan energy source configured to sequentially transmit energy through the skin to multiple treatment areas at the treatment locations, at least one of the treatment areas having a nerve;wherein the processor is configured to operate the energy source in accordance with the defined pattern and the tracked fiducial. 97. The system of claim 96, wherein the energy source comprises an ultrasound device, and wherein the blood vessel is a renal artery. 98. The system of claim 96, further comprising an ultrasound imaging system. 99. The system of claim 96, wherein the fiducial is attached to an intravascular catheter. 100. The system of claim 96, wherein the fiducial is a passive fidicial that is configured to respond to an external signal. 101. The system of claim 96, wherein the fiducial is an active ficucial, transmitting its position to the detection device. 102. A method to treat hypertension in a patient comprising: planning a delivery of energy from outside the patient to multiple treatment areas in a region in the patient, wherein the act of planning results in a defined pattern that includes multiple treatment locations, at least one of the multiple treatment locations having a spatial relationship with respect to a tracking target that is based on an assumed nerve position relative to the tracking target;tracking the tracking target in the region that includes a blood vessel, wherein the act of tracking the tracking target comprises determining a location of the tracking target in the region; anddelivering energy sequentially to the treatment areas corresponding with the treatment locations from outside a skin of the patient in accordance with the planned delivery and the tracked tracking target, wherein at least some of the energy is delivered to an autonomic nerve in the region that contains the blood vessel. 103. The method of claim 102, further comprising selectively modulating an afferent nerve within a sympathetic nerve bundle. 104. The method of claim 102, further comprising performing microneurography after the delivery of the energy to determine an effect of the energy delivery on a sympathetic nervous system. 105. The method of claim 102, wherein the energy is delivered to the autonomic nerve surrounding the blood vessel that extends to or from a kidney. 106. A system to modulate an autonomic nerve in a patient utilizing transcutaneous energy delivery, the system comprising: a processor comprising: an input for receiving information regarding a tracking target in a region that includes a vessel and a nerve; andan output for outputting a signal;wherein the processor is configured for obtaining a defined pattern that includes multiple treatment locations, at least one of the multiple treatment locations having a spatial relationship with respect to the tracking target that is based on an assumed nerve position; andwherein the processor is configured to track the tracking target by determining a position of the tracking target based on the received information;a therapeutic energy device comprising: a transducer for delivering energy from outside the patient;a controller to control an aiming of the transducer using at least the signal from the processor; andan imaging system coupled to the processor or the therapeutic energy device;wherein the therapeutic energy device is configured to sequentially deliver the energy to multiple treatment areas corresponding to the respective multiple treatment locations. 107. The system of claim 106, wherein the processor is configured to determine the position during an operation of the therapeutic energy device. 108. The system of claim 106, further comprising a patient interface configured to position the therapeutic device so that the transducer is aimed toward a blood vessel connected to a kidney from a position between ribs superiorly, a iliac crest inferiorly, and a vertebral column medially. 109. The system of claim 106, wherein the therapeutic energy device is configured to deliver focused ultrasound. 110. The system of claim 106, wherein the tracking target is at least a portion of a blood vessel traveling to or from a kidney, and the nerve is a renal nerve. 111. The system of claim 110, wherein the transducer is configured to focus energy at a distance from 6 cm to 18 cm. 112. The system of claim 106, wherein the transducer is configured to deliver the energy in a form of focused ultrasound at an angle ranging between about −10 degrees and about −48 degrees relative to an axis intersecting two or more transverse processes of a spinal column. 113. The system of claim 106, wherein the energy from the therapeutic energy device ranges between 100 W/cm2 and 2500 W/cm2. 114. The system of claim 106, wherein the tracking target is an indwelling vascular catheter. 115. The system of claim 106, wherein the imaging system is a magnetic resonance imaging system and the therapeutic energy device is an ultrasound device. 116. The system of claim 106, wherein the imaging system is an ultrasound imaging system. 117. The system of claim 106, wherein the processor is a part of the therapeutic energy device. 118. The system of claim 106, wherein the processor is a part of the imaging system. 119. A method to deliver energy from a position outside a skin of a patient to multiple treatment areas inside the patient, comprising: placing a device inferior to ribs, superior to an iliac crest, and lateral to a spine;using the device to maintain an energy delivery system at a desired position relative to the patient so that the energy delivery system can deliver energy through the skin without traversing bone, wherein the device comprises a mechanism for coupling to a patient support; andtracking a tracking target in a region inside the patient, andobtaining a defined pattern that includes multiple treatment locations, at least one of the multiple treatment locations having a spatial relationship with respect to the tracking target that is based on an assumed nerve position; andusing the energy delivery system to sequentially deliver energy to the multiple treatment areas in accordance with the defined pattern, at least one of the treatment areas having a probability of including a nerve. 120. The method of claim 119, wherein the energy delivery system comprises a focused ultrasound delivery system. 121. The method of claim 119, wherein the energy delivery system delivers the energy to form a heat region having a cloud configuration. 122. A device for use in a system to deliver focused ultrasound energy, comprising: a processing unit configured to track a tracking target in a region inside a patient, andobtain a defined pattern that includes multiple treatment locations, at least one of the multiple treatment locations having a spatial relationship with respect to the tracking target that is based on an assumed nerve position;an energy delivery system configured to deliver ultrasound energy to multiple treatment areas corresponding to the treatment locations in the region inside the patient, at least one of the treatment areas comprising a nerve;a positioning device configured to maintain the energy delivery system at a desired position relative to the patient so that the energy delivery system can deliver energy through a skin without traversing bone, wherein the positioning device comprises a mechanism for coupling to a patient support;wherein the positioning device is configured to be placed inferior to ribs, superior to an iliac crest, and lateral to a spine. 123. The device of claim 122, wherein the energy delivery system comprises a focused ultrasound delivery system. 124. The device of claim 123, wherein the positioning device is configured to maintain an angle of the focused ultrasound delivery system such that bony structures are not include in an ultrasound field. 125. The device of claim 122, wherein the energy delivery system is configured to deliver the energy to form a heat region having a cloud configuration. 126. A system for treatment, comprising: a treatment device configured to deliver energy from outside a patient to a nerve inside the patient;a catheter configured for placement inside a vessel, the catheter configured to transmit a signal; anda processor configured to obtain a defined pattern that includes multiple treatment locations, at least one of the multiple treatment locations having a spatial relationship with respect to the tracking target that is based on an estimated nerve position, the tracking target comprising the vessel, andtrack the tracking target by receiving the signal and determining a reference position in the vessel;wherein the treatment device is configured to sequentially deliver the energy to treatment areas corresponding with the treatment locations in accordance with the defined pattern and the tracked tracking target, one of the treatment areas having a probability of including the nerve. 127. The system of claim 126, wherein the treatment device comprises an ultrasound device. 128. The system of claim 126, wherein the treatment device is configured to deliver the energy to form a heat region having a cloud configuration. 129. A method of inhibiting a function of a nerve traveling with an artery in a patient, the method comprising: tracking the artery to account for movement of the artery, wherein the act of tracking the artery comprises using an external imaging modality to determine a location of the artery;obtaining a defined pattern that includes multiple treatment locations, at least one of the multiple treatment locations having a spatial relationship with respect to the artery that is based on an assumed nerve position; andsequentially delivering therapeutic energy from the therapeutic energy source through a skin of the patient to multiple treatment areas that are around the artery in accordance with the defined pattern and the tracked artery, one of the treatment areas having a probability of including the nerve. 130. The method of claim 129, wherein the imaging modality is one of: ultrasound, MRI, and CT. 131. The method of claim 129, wherein the therapeutic energy is ultrasound. 132. The method of claim 129, wherein the artery is a renal artery. 133. The method of claim 129, wherein the location of the artery is determined using a doppler ultrasound signal. 134. The method of claim 129, further comprising: utilizing a fiducial wherein the fiducial is placed internal to the patient. 135. The method of claim 134, wherein said fiducial is temporarily placed in a position internal to the patient. 136. The method of claim 134, wherein said fiducial is a catheter placed in the artery of the patient. 137. The method of claim 136, wherein said catheter is detectable using a radiofrequency signal and said imaging modality is ultrasound. 138. The method of claim 129, wherein the therapeutic energy from the energy source is delivered in a distribution along a length of the artery. 139. The method of claim 129, wherein the therapeutic energy is ionizing radiation. 140. A system to inhibit a function of nerves traveling with a renal artery comprising: a detector configured to track the renal artery to account for movement of the renal artery, wherein the detector is configured to communicate with a fiducial placed in the renal artery to determine a location of the renal artery;a processor configured to obtain a defined pattern that includes multiple treatment locations, at least one of the multiple treatment locations having a spatial relationship with respect to the renal artery that is based on an assumed nerve position relative to the renal artery; andan ultrasound component to sequentially deliver therapeutic energy through a skin to multiple treatment areas that comprise nerves around the renal artery in accordance with the defined pattern and the tracked renal artery;wherein the processor is configured to execute a modeling algorithm that receives a position of the ultrasound component as a first input, and the location of the renal artery as a second input. 141. The system of claim 140, wherein the fiducial is a passive reflector of ultrasound. 142. The system of claim 140, wherein the fiducial generates radiofrequency energy. 143. The system of claim 140, wherein the fiducial is activated to transmit energy in response to a signal from an ultrasound or magnetic field generator. 144. The system of claim 140, wherein the processor is configured to control the ultrasound component to deliver a lesion in which a major axis of the lesion is longitudinal along a length of the renal artery. 145. The system of claim 144, wherein the the processor is configured to control the ultrasound component to deliver multiple lesions around the renal artery. 146. The system of claim 140, wherein the the processor is configured to control the ultrasound component to deliver a circumferential lesion around the renal artery. 147. The system of claim 140, wherein the processor is configured to control the ultrasound component to deliver a lesion around the renal artery just proximal to a bifurcation of the renal artery in a hilum of a kidney. 148. The system of claim 140, wherein the ultrasound component is configured to deliver the therapeutic energy to form a heat region having a cloud configuration. 149. A method to stimulate or inhibit the function of a nerve traveling to or from the kidney comprising: identifying an acoustic window at a posterior region of a torso of a patient in which the renal arteries can be visualized;transmitting a first energy through the skin of a patient from the posterior region of the patient;imaging an arterial region using the first transmitted energy;applying a second transmitted energy to the arterial adventitia after the act of imaging, wherein the second transmitted energy is applied sequentially to multiple treatment areas, one of the treatment areas having a probability of including the nerve. 150. The method of claim 149, wherein the second transmitted energy is applied to form a heat region having a cloud configuration.
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