Methods and devices to modulate the autonomic nervous system with ultrasound

Abstract

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

1 - 19 . (canceled) 
     
     
         20 . A method of treating a patient comprising:
 identifying a marker in the vicinity of a target region;   obtaining imaging data relating to the marker and the target region using an imaging device;   generating a three-dimensional representation of the target region;   mapping the three-dimensional representation of the target region into a coordinate reference frame;
 delivering a pattern of ultrasound energy from an external therapeutic applicator to the target region, wherein the external therapeutic applicator is controllably linked to the imaging device; 
 tracking the movement and position of the target region by re-imaging the marker and the target region; and 
   generating re-imaging data, and based on the re-imaging data, redirecting the position of the therapeutic applicator,   wherein the target region comprises a portion of the autonomic nervous system, and the delivered pattern of ultrasound energy at least partially inhibits the function of that portion of the autonomic nervous system.   
     
     
         21 . The method of  claim 20 , wherein the target region comprises an autonomic nerve. 
     
     
         22 . The method of  claim 21 , wherein the autonomic nerve comprises a renal nerve. 
     
     
         23 . The method of  claim 20 , wherein the target region comprises a blood vessel. 
     
     
         24 . The method of  claim 23 , wherein the blood vessel is a renal artery. 
     
     
         25 . The method of  claim 24 , wherein the pattern of ultrasound energy is delivered up to ten millimeters away from the renal artery to reach the renal nerve. 
     
     
         26 . The method of  claim 20 , wherein the pattern of ultrasound energy creates a circumferential lesion around the blood vessel. 
     
     
         27 . The method of  claim 26 , wherein the circumferential lesion is a circle. 
     
     
         28 . The method of  claim 26 , wherein the circumferential lesion is an elliptical ring. 
     
     
         29 . The method of  claim 20 , wherein the delivered pattern of energy at least partially ablates the carotid sinus. 
     
     
         30 . The method of  claim 20 , wherein the delivered pattern of energy at least partially ablates the carotid body. 
     
     
         31 . The method of  claim 20 , wherein the marker comprises an internal fiducial. 
     
     
         32 . The method of  claim 31 , wherein the internal fiducial comprises an intravascular catheter. 
     
     
         33 . The method of  claim 31 , wherein the internal fiducial comprises an intravascular balloon. 
     
     
         34 . The method of  claim 31 , wherein the internal fiducial comprises bone or an internal organ. 
     
     
         35 . The method of  claim 20 , wherein the imaging device is an ultrasound transducer, a MRI device, or a CT imaging device. 
     
     
         36 . The method of  claim 20 , wherein the imaging device is an ultrasound transducer. 
     
     
         37 . The method of  claim 20 , wherein the delivered pattern of ultrasound energy is used to treat hypertension. 
     
     
         38 . The method of  claim 20 , further comprising creating a temperature map of the blood vessel, the target region, or both. 
     
     
         39 . The method of  claim 20 , further comprising measuring a physiologic parameter and adjusting the dose of delivered ultrasound energy based on the physiologic parameter. 
     
     
         40 . The method of  claim 39 , wherein the physiologic parameter is blood pressure. 
     
     
         41 . The method of  claim 39 , wherein the physiologic parameter is a blood norepinephrine level. 
     
     
         42 . The method of  claim 39 , wherein the physiologic parameter is a kidney norepinephrine level. 
     
     
         43 . The method of  claim 20 , wherein the intensity of the delivered ultrasound energy is greater than 1000 mW/cm 2 . 
     
     
         44 . The method of  claim 20 , wherein the intensity of the delivered ultrasound energy is between 50 mW/cm 2  and 1000 mW/cm 2 . 
     
     
         45 . The method of  claim 20 , wherein the step of delivering a pattern of ultrasound energy comprises delivering focused ultrasound energy. 
     
     
         46 . The method of  claim 20 , wherein the imaging device is also the therapeutic applicator. 
     
     
         47 . The method of  claim 20 , further comprising delivering a bioactive agent to the target region.