Non-invasive or minimally invasive paraspinal and pre-aortic sympathetic ablation for the treatment of hypertension

Abstract

A system for treatment includes a focused ultrasound energy source for placement outside a patient, wherein the focused ultrasound energy source is configured to deliver ultrasound energy towards a blood vessel with a surrounding nerve that is a part of an autonomic nervous system inside the patient, and wherein the focused ultrasound energy source is configured to deliver the ultrasound energy from outside the patient to the nerve located inside the patient to treat the nerve.

1 - 32 . (canceled) 
     
     
         33 . A method of treating a patient, comprising: directing an energy applicator towards a target region comprising a nerve, and delivering ultrasound energy to the target region around a reference position associated with an aorta using the energy applicator. 
     
     
         34 . The method of  claim 33 , wherein the delivery of ultrasound energy generates heat around the aorta, but not inside a wall of the aorta. 
     
     
         35 . The method of  claim 33 , wherein the delivery of ultrasound energy generates a temperature around the aorta between 40 and 60 degrees Fahrenheit. 
     
     
         36 . The method of  claim 33 , wherein the delivery of ultrasound energy generates a temperature around the aorta between 60 and 90 degrees Fahrenheit. 
     
     
         37 . The method of  claim 33 , wherein the method further comprises cooling a region that is being heated by the delivered ultrasound energy. 
     
     
         38 . The method of  claim 33 , wherein an intensity of the delivered ultrasound energy is between 50 mW/cm 2  and 1 W/cm 2 . 
     
     
         39 . The method of  claim 33 , wherein a frequency of the delivered ultrasound energy is between 0.5 Mhz and 10 Mhz. 
     
     
         40 . The method of  claim 33 , wherein the delivered ultrasound energy comprises unfocused ultrasound energy. 
     
     
         41 . The method of  claim 33 , wherein the delivered ultrasound energy at least partially modulates the nerve. 
     
     
         42 . The method of  claim 33 , wherein the ultrasound energy is delivered to form a heated region having an approximately ellipsoidal shape. 
     
     
         43 . The method of  claim 33 , wherein the ultrasound energy is delivered to form a heated region having an approximately spherical shape. 
     
     
         44 . The method of  claim 33 , wherein the act of directing the energy applicator comprises directing the energy applicator from outside the patient towards the target region inside the patient. 
     
     
         45 . The method of  claim 33 , wherein the act of directing the energy applicator comprises directing the energy applicator from inside the patient towards the target region. 
     
     
         46 . The method of  claim 33 , wherein the act of delivering the ultrasound energy comprises using flow in the aorta for targeting. 
     
     
         47 . The method of  claim 33 , wherein the energy applicator further comprises ultrasound imaging. 
     
     
         48 . The method of  claim 33 , further comprising imaging said energy applicator with external imaging. 
     
     
         49 . The method of  claim 48 , wherein the external imaging comprises magnetic resonance imaging. 
     
     
         50 . The method of  claim 33 , wherein the energy applicator is directed towards the target region using a surgically placed laparoscopic device. 
     
     
         51 . The method of  claim 33 , wherein the energy applicator is an external focused ultrasound applicator. 
     
     
         52 . The method of  claim 33 , wherein the energy applicator is a part of a system that includes an ultrasound imaging device. 
     
     
         53 . The method of  claim 33 , wherein the target region is proximate a celiac ganglion or a mesenteric ganglion. 
     
     
         54 . The method of  claim 33 , wherein the ultrasound energy from the energy applicator is applied through a wall of a stomach. 
     
     
         55 . The method of  claim 33 , where in the target region comprises pre-ganglionic nerve fibers in an abdomen of a patient. 
     
     
         56 . The method of  claim 55 , wherein the energy applicator is an external focused ultrasound applicator. 
     
     
         57 . The method of  claim 55 , further comprising guiding the energy applicator inside the patient utilizing external imaging. 
     
     
         58 . The method of  claim 55 , further comprising placing the energy applicator inside the patient transcutaneously. 
     
     
         59 . The method of  claim 33 , further comprising placing the energy applicator inside the patient percutaneously, and positioning the energy applicator under external image guidance. 
     
     
         60 . A method of treating a patient, comprising:
 disabling one or more pre-aortic ganglion cells within a pre-aortic ganglion to improve a physiologic parameter associated with the patient.   
     
     
         61 . The method of  claim 60 , wherein the pre-aortic ganglion is a celiac ganglion, a mesenteric ganglion, a suprarenal ganglion, an inter-mesenteric ganglion, an aortico-renal ganglion, or a combination of two or more of the foregoing. 
     
     
         62 . The method of  claim 60 , wherein the act of disabling comprises:
 providing an energy delivery device;   positioning the energy delivery device within a vessel proximate the pre-aortic ganglion; and   delivering energy through a wall of the vessel.   
     
     
         63 . The method of  claim 60 , wherein the one or more pre-aortic ganglion cells are associated with a ganglia located proximate a dorsal or ventral nerve roots along a spinal column. 
     
     
         64 . The method of  claim 60 , further comprising:
 stimulating the one or more pre-aortic ganglion cells; and   monitoring a physiologic response related to the physiologic parameter;   wherein the act of disabling comprises applying ablative energy to the one or more pre-aortic ganglion cells.   
     
     
         65 . The method of  claim 64 , wherein the ablative energy is comprises ultrasound energy. 
     
     
         66 . The method of  claim 64 , wherein the ablative energy comprises externally applied focused ultrasound energy. 
     
     
         67 . The method of  claim 60 , wherein the act of disabling comprises applying energy through a wall of a gastrointestinal tract of the patient to one or more paraspinal ganglia; and
 wherein the method further comprises advancing an endoscope into the gastrointestinal tract of the patient.   
     
     
         68 . The method of  claim 67 , wherein the paraspinal ganglia are located close to vertebrae T9-T11. 
     
     
         69 . The method of  claim 64 , further comprising utilizing external imaging to assist the application of ablative energy. 
     
     
         70 . The method of  claim 69 , wherein the external imaging is ultrasound imaging. 
     
     
         71 . The method of  claim 69 , wherein the external imaging is magnetic resonance imaging. 
     
     
         72 . The method of  claim 69 , wherein the external imaging is computer aided tomography. 
     
     
         73 . The method of  claim 69 , wherein the external imaging is X-ray fluoroscopy. 
     
     
         74 . The method of  claim 60 , wherein the act of disabling comprises delivering focused ultrasound energy through a skin of the patient to disable the one or more pre-aortic ganglion cells. 
     
     
         75 . A method of treating a patient, comprising:
 percutaneously or transcutaneously disabling one or more pre-aortic ganglion cells within a pre-aortic ganglion via an approach from below a diaphragm of the patient.   
     
     
         76 . The method of  claim 75 , wherein the disabling is performed using a chemical substance.