Systems and methods for modulatng nerves or other tissue

Abstract

According to various embodiments, systems, devices and methods for modulating targeted nerve fibers (e.g., hepatic neuromodulation) or other tissue are provided. The systems may be configured to access tortuous anatomy of or adjacent hepatic vasculature. The systems may be configured to target nerves surrounding (e.g., within adventitia of or within perivascular space of) an artery or other blood vessel, such as the common hepatic artery.

1 - 105 . (canceled) 
     
     
         106 . A method of ablating nerves surrounding a blood vessel comprising:
 inserting a neuromodulation device within a blood vessel, the neuromodulation device comprising a first electrode and a second electrode spaced apart distal of the first electrode along a distal end portion of the neuromodulation device and at least one lesion spacing indicator positioned distal of the second electrode;   causing the first electrode to contact an inner wall of the blood vessel at a first contact location and the second electrode to contact the inner wall of the blood vessel at a second contact location, wherein the first location and the second location are in different quadrants of the inner wall of the blood vessel and spaced apart axially from each other by a separation distance;   causing the first electrode and the second electrode to deliver radiofrequency energy to the inner wall of the blood vessel while at the contact locations;   repositioning the neuromodulation device axially within the blood vessel using the at least one lesion spacing indicator;   causing the first electrode to contact the inner wall of the blood vessel at a third contact location and the second electrode to contact the inner wall at a fourth contact location, wherein the third contact location and the fourth contact location are in different quadrants of the inner wall of the blood vessel and spaced apart axially from each other; and   removing the neuromodulation device from the blood vessel.   
     
     
         107 . The method of  claim 106 , wherein the at least one lesion spacing indicator is spaced apart axially from the second electrode by a distance that is equal to the separation distance. 
     
     
         108 . The method of  claim 106 , wherein the at least one lesion spacing indicator is spaced apart axially from the second electrode at distance that is twice the separation distance. 
     
     
         109 . The method of  claim 106 , wherein the first contact location and the second contact location are on opposite sides of the circumference of the blood vessel. 
     
     
         110 . The method of  claim 106 , wherein the first contact location and the second contact location are spaced apart circumferentially by about 180 degrees. 
     
     
         111 . The method of  claim 106 , wherein the first contact location and the second contact location are spaced apart circumferentially by between 120 degrees and 210 degrees. 
     
     
         112 . The method of  claim 106 , wherein the first contact location and the second contact location are spaced apart circumferentially by about 90 degrees. 
     
     
         113 . The method of  claim 106 , wherein the at least one spacing indicator comprises two lesion spacing indicators. 
     
     
         114 . The method of  claim 113 , wherein the two lesion spacing indicators are spaced apart axially along the neuromodulation device at a distance that is twice the separation distance. 
     
     
         115 . The method of  claim 113 , wherein the two lesion spacing indicators are spaced apart axially along the neuromodulation device by an amount equal to the separation distance. 
     
     
         116 . The method of  claim 113 , wherein repositioning the neuromodulation device axially within the blood vessel comprises aligning a distal one of the two spaced-apart lesion spacing indicators with a position of a proximal one of the two lesion spacing indicators prior to repositioning. 
     
     
         117 . The method of  claim 106 , wherein the separation distance is between 3 mm and 8 mm. 
     
     
         118 .- 153 . (canceled) 
     
     
         154 . A method of modulating nerves in a manner to reduce glucose production, the method comprising:
 identifying one or more locations along a hepatic artery within a specified distance from an adjacent dense structure using one or more ultrasound transducers adapted for imaging; and   delivering energy sufficient to modulate nerves to reduce a blood glucose level using the one or more ultrasound transducers.   
     
     
         155 . The method of  claim 154 , wherein a single ultrasound transducer is adapted for imaging and for delivering energy to modulate nerves. 
     
     
         156 . The method of  claim 154 , wherein the one or more transducers comprises a first one or more transducers adapted for imaging and a second one or more ultrasound transducers adapted for delivering energy to modulate nerves. 
     
     
         157 . (canceled) 
     
     
         158 . The method of  claim 154 , wherein the energy is sufficient to ablate the nerves. 
     
     
         159 . The method of  claim 154 , further comprising confirming modulation of the nerves. 
     
     
         160 . The method of  claim 154 , further comprising adjusting one or more parameters of the energy delivery based on imaging data received by the one or more ultrasound transducers. 
     
     
         161 . (canceled) 
     
     
         162 . (canceled) 
     
     
         163 . The method of  claim 154 , wherein the adjacent dense structures comprise organs that affect glucose production or storage. 
     
     
         164 . The method of  claim 163 , wherein the adjacent dense structures comprise at least a portion of one of: a liver, a pancreas, a stomach, or a small intestine. 
     
     
         165 - 193 . (canceled)