# US 2014/0194784 A1 · Methods and devices for thermally induced hepatic neuromodulation

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- Number: US 2014/0194784 A1
- Document ID: US20140194784A1
- Status: Published application
- Kind: A1
- Application number: 14/207,511
- Filed: 2014-03-12
- Published: 2014-07-10
- Earliest claimed: 2009-10-12
- Assignees: Kona Medical, Inc.
- Applicants: Kona Medical, Inc.
- Inventors: Michael Gertner
- Web page: https://patentgrep.com/patent/US20140194784A1

## CPC

- A61N 7/00: Ultrasound therapy (lithotripsy A61B17/22, A61B17/225; massage using supersonic vibration A61H23/00 {; using ultrasound for introducing media into the body A61M37/0092})
- A61B 5/055: involving electronic [EMR] or nuclear [NMR] magnetic resonance, e.g. magnetic resonance imaging
- A61B 5/061: {Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body (A61B1/00158 takes precedence)}
- A61B 5/201: {Assessing renal or kidney functions}
- A61B 5/412: {Detecting or monitoring sepsis}
- A61B 5/4839: {combined with drug delivery}
- A61B 5/489: {Blood vessels}
- A61B 5/4893: {Nerves}
- A61B 6/032: {Transmission computed tomography [CT]}
- A61B 6/037: {Emission tomography}
- A61B 8/00: Diagnosis using ultrasonic, sonic or infrasonic waves
- A61B 8/06: Measuring blood flow
- A61B 8/08: Clinical applications (A61B8/02, A61B8/04, A61B8/06 take precedence)
- A61B 8/14: Echotomography
- A61N 5/0601: {Apparatus for use inside the body}
- A61N 5/062: {Photodynamic therapy, i.e. excitation of an agent}
- A61N 5/0622: {Optical stimulation for exciting neural tissue}
- A61N 7/02: Localised ultrasound hyperthermia
- A61B 5/0225: the pressure being controlled by electric signals, e.g. derived from Korotkoff sounds
- A61B 5/0263: {using NMR}
- A61B 5/4528: {Joints (A61B5/4533, A61B5/4538 take precedence)}
- A61B 6/03: Computed tomography [CT]
- A61B 6/487: {involving fluoroscopy}
- A61B 6/504: {for diagnosis of blood vessels, e.g. by angiography}
- A61B 6/506: {for diagnosis of nerves}
- A61B 8/0841: {for locating instruments}
- A61B 8/0891: {for diagnosis of blood vessels}
- A61B 8/4245: {involving determining the position of the probe, e.g. with respect to an external reference frame or to the patient}
- A61B 8/485: {involving measuring strain or elastic properties}
- A61B 8/488: {involving Doppler signals}
- A61B 90/37: {Surgical systems with images on a monitor during operation}
- A61B 2018/00404: {Blood vessels other than those in or around the heart}
- A61B 2018/00434: {Neural system}
- A61B 2018/00511: {Kidney}
- A61B 2090/374: {NMR or MRI}
- A61B 2090/3762: {using computed tomography systems [CT]}
- A61B 2090/378: {using ultrasound}
- A61N 2005/063: {comprising light transmitting means, e.g. optical fibres}
- A61N 2007/0026: {Stimulation of nerve tissue}
- A61N 2007/003: {Destruction of nerve tissue}
- A61N 2007/0052: {using the same transducer for therapy and imaging}
- A61N 2007/0078: {with multiple treatment transducers}
- A61N: ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY (measurement of bioelectric currents A61B; surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body A61B18/00; anaesthetic apparatus in general A61M; incandescent lamps H01K; infrared radiators for heating H05B)
- A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D)

## 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.

## Claims

### Claim at position 1

1-32. (canceled)

### Claim 33

A method of modulating a nerve associated with a hepatic or portal vessel comprising:
directing a therapeutic ultrasound energy applicator towards a target region comprising a nerve associated with a hepatic or portal vessel;
determining a position of the target region with respect to the energy applicator;
determining an ultrasound energy delivery pattern; and
delivering ultrasound energy with the energy applicator to the target region based on the determined ultrasound energy delivery pattern.

### Claim 34 (depends on 33)

The method of claim 33, wherein the delivery of ultrasound energy generates heat around the hepatic or portal vessel, but not inside a wall of the hepatic or portal vessel.

### Claim 35 (depends on 33)

The method of claim 33, wherein the delivery of ultrasound energy generates a temperature around the hepatic or portal vessel between 40 and 60 degrees Farenheit.

### Claim 36 (depends on 33)

The method of claim 33, wherein the delivery of ultrasound energy generates a temperature around the hepatic or portal vessel between 60 and 90 degrees Farenheit.

### Claim 37 (depends on 33)

The method of claim 33, wherein the method further comprises cooling a region that is being heated by the delivered ultrasound energy.

### Claim 38 (depends on 33)

The method of claim 33, wherein an intensity of the delivered ultrasound energy is between 50 mW/cm2 and 1 W/cm2.

### Claim 39 (depends on 33)

The method of claim 33, wherein a frequency of the delivered ultrasound energy is between 0.5 Mhz and 10 Mhz.

### Claim 40 (depends on 33)

The method of claim 33, wherein the delivered ultrasound energy comprises unfocused ultrasound energy.

### Claim 41 (depends on 33)

The method of claim 33, wherein the delivered ultrasound energy at least partially modulates the nerve.

### Claim 42 (depends on 33)

The method of claim 33, wherein the ultrasound energy is delivered to form a heated region having an approximately ellipsoidal shape.

### Claim 43 (depends on 33)

The method of claim 33, wherein the ultrasound energy is delivered to form a heated region having an approximately spherical shape.

### Claim 44 (depends on 33)

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.

### Claim 45 (depends on 33)

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.

### Claim 46 (depends on 33)

The method of claim 33, wherein the act of delivering ultrasound energy to the target region comprises delivering the ultrasound energy to the target region around a reference position associated with a hepatic artery.

### Claim 47 (depends on 33)

The method of claim 33, wherein the act of delivering ultrasound energy to the target region comprises delivering the ultrasound energy to the target region around a reference position associated with a portal vein.

### Claim 48 (depends on 33)

The method of claim 33, further comprising utilizing ultrasound imaging to identify the target region.

### Claim 49 (depends on 33)

The method of claim 33, further comprising utilizing Doppler flow based imaging to identify the target region.

### Claim 50 (depends on 33)

The method of claim 33, further comprising determining a position of an ultrasound imaging with respect to the energy applicator.