Devices and methods for treating cardiovascular and metabolic disease

Abstract

Devices and methods described herein may, among other uses, favorably cause the activation and/or deactivation of vascular baroreceptors in order to achieve a desired impact on a physiological condition, such as baroreflex-regulated conditions, hypertension, hypotension, nervous system disorders, metabolic disorders, cardiovascular disease, heart failure, cardiac arrhythmia, renal disease, respiratory disease, diabetes, and insulin resistance. The devices and methods may be used in concert with each other and/or other treatments, medications, interventions, or behavioral regimens. They may also be used in concert with devices and methods that perform or assist with assessing or measuring a mammal's blood pressure, assessing, measuring, or predicting the impact of the described methods and devices on the patient's condition (including blood pressure), and/or protecting the surrounding anatomy from adverse effects.

1 . A method of stimulating a baroreceptor in an internal carotid artery of a patient, the method comprising:
 delivering a treatment to increase strain in a region of a wall of the internal carotid artery in a vicinity of the baroreceptor,   wherein delivering the treatment increases strain more in a first 180-degree circumferential portion of the wall of the artery that is closer to an external carotid artery than in a second 180-degree circumferential portion of the wall of the artery that is farther from the external carotid artery.   
     
     
         2 . A method as in  claim 1 , wherein the strain comprises a peak strain measured at a location along a longitudinal axis of the artery. 
     
     
         3 . A method as in  claim 1 , wherein the strain comprises a mean strain measured at a location along the longitudinal axis of the artery. 
     
     
         4 . A method as in  claim 1 , wherein delivering the treatment comprises changing a tissue property of a portion of the wall of the internal carotid artery to activate a baroreceptor in or adjacent a wall of the artery. 
     
     
         5 . A method as in  claim 1 , wherein delivering the treatment comprises delivering an implant for mechanical activation of a baroreceptor. 
     
     
         6 . A method as in  claim 1 , wherein delivering the treatment comprises rotating a treatment device to position a portion of the treatment device to face the external carotid artery. 
     
     
         7 . A method as in  claim 1 , further comprising, before delivering the treatment, assessing a likelihood of success of the method. 
     
     
         8 . An implantable medical device for stimulating baroreceptors in an artery, the device comprising:
 at least two longitudinal struts, wherein each of the struts has an outward facing surface and an inward facing surface, and wherein at least some of the longitudinal struts include at least one of a recess on the outward facing surface or an aperture extending from the outward facing surface to the inward facing surface; and   at least two circumferential connectors attached to the longitudinal stmts.   
     
     
         9 . A device as in  claim 8 , wherein at any location along a central longitudinal axis of the implantable medical device, a plane normal to the central longitudinal axis of the device intersects at least one of: the aperture: the recess; a pair of struts that subtend an angle in the plane, originating at the central longitudinal axis, of less than thirty degrees. 
     
     
         10 . A device as in  claim 8 , wherein contacting the wall of the artery with the baroreceptor activation device induces tissue ingrowth into at least one recess or aperture. 
     
     
         11 . A device as in  claim 8 , wherein the at least one recess or aperture increases a flexibility of the device while reducing a stress concentration. 
     
     
         12 . A method of stimulating a baroreceptor in an artery of a patient, the method comprising:
 advancing a baroreceptor activation device into the artery through one or more blood vessels of the patient, using a delivery catheter; and   releasing the baroreceptor activation device from constraint within the delivery catheter to allow it to expand to contact the wall of the artery, wherein the baroreceptor activation device comprises:   at least two longitudinal struts, wherein each of the struts has an outward facing surface and an inward facing surface, and wherein at least some of the longitudinal struts include at least one of a recess on the outward facing surface or an aperture extending from the outward facing surface to the inward facing surface; and   at least two circumferential connectors attached to the longitudinal struts.   
     
     
         13 . A method as in  claim 12 , wherein contacting the wall of the artery with the baroreceptor activation device induces tissue ingrowth into at least one recess or aperture. 
     
     
         14 . A method as in  claim 12 , wherein the at least one recess or aperture increases a flexibility of the device while reducing a stress concentration. 
     
     
         15 . A method as in  claim 12 , wherein at any location along a central longitudinal axis of the implantable medical device, a plane normal to the central longitudinal axis of the device intersects at least one of: the aperture; the recess; a pair of struts that subtend an angle in the plane, originating at the central longitudinal axis, of less than thirty degrees. 
     
     
         16 . A method as in  claim 12 , further comprising, before advancing the baroreceptor activation device, assessing a likelihood of success of the method.