CAROTID SEPTUM ABLATION WITH ULTRASOUND IMAGING AND ABLATION CATHETERS
Methods and devices for assessing, and treating patients having sympathetically mediated disease, involving augmented peripheral chemoreflex and heightened sympathetic tone by reducing chemosensor input to the nervous system via carotid body ablation.
1 . A method of ablating tissue within a carotid septum with an ultrasound ablation catheter, comprising:
providing an ultrasound ablation catheter comprising a diagnostic ultrasound transducer axially spaced from, and with a fixed position relative to, an ultrasound ablation transducer;
positioning the ablation catheter within a lumen in a patient's vasculature proximate a carotid septum;
using the diagnostic imaging transducer to generate an ultrasound image of an anatomical landmark that includes at least one of a bifurcation of a common carotid artery, an internal carotid artery, and an external carotid artery;
using the imaged anatomical landmark to confirm an ablation position of the ultrasound ablation transducer within the lumen; and
while the ultrasound ablation transducer is in the ablation position, directing ultrasound ablation energy from the ultrasound ablation transducer towards the tissue within the carotid septum to ablate the tissue within the carotid septum and treat at least one of heart failure and hypertension.
2 . The method of claim 1 wherein the diagnostic ultrasound transducer is proximal to the ultrasound ablation transducer, and using the diagnostic imaging transducer to generate an ultrasound image of an anatomical landmark comprises using the diagnostic imaging transducer to generate an ultrasound image of a bifurcation of a common carotid artery, and wherein using the imaged anatomical landmark to confirm an ablation position of the ultrasound ablation transducer within the lumen comprises using the imaged bifurcation of a common carotid artery to confirm an ablation position of the ultrasound ablation transducer within the lumen.
3 . The method of claim 1 wherein the diagnostic ultrasound transducer is distal to the ultrasound ablation transducer, and using the diagnostic imaging transducer to generate an ultrasound image of an anatomical landmark comprises using the diagnostic imaging transducer to generate an ultrasound image of at least one of an internal carotid artery and an external carotid artery, and wherein using the imaged anatomical landmark to confirm an ablation position of the ultrasound ablation transducer within the lumen comprises using the at least one imaged carotid artery to confirm an ablation position of the ultrasound ablation transducer within the lumen.
4 . The method of claim 1 , wherein the positioning step comprises positioning the ablation catheter within an internal jugular vein or one of its tributaries and proximate the carotid septum, and wherein using the imaged anatomical landmark to confirm an ablation position of the ablation catheter within the lumen comprises using the imaged anatomical landmark to confirm an ablation position of the ablation catheter within the internal jugular vein or one of its tributaries.
5 . The method of claim 4 further comprising targeting carotid septum tissue for ablation by reconfiguring the catheter within the internal jugular vein or one of its tributaries to move the ultrasound ablation transducer closer to the carotid septum.
6 . The method of claim 1 further comprising targeting carotid septum tissue for ablation with the ultrasound ablation energy by rotating the ultrasound ablation transducer as needed to aim the ultrasound ablation energy towards the tissue within the carotid septum.
7 . The method of claim 6 wherein using the imaged anatomical landmark to confirm an ablation position of the ultrasound ablation transducer within the lumen comprises using the imaged anatomical landmark to confirm a direction of aim of the ultrasound ablation energy.
8 . The method of claim 1 further comprising targeting carotid septum tissue for ablation with the ultrasound ablation energy by controlling the ultrasound ablation energy delivery parameters.
9 . An ultrasound ablation catheter, comprising:
an ultrasound ablation transducer axially spaced from, and with a fixed position relative to, an ultrasound diagnostic transducer, and an echolucent chamber in which the ultrasound ablation transducer is disposed.
10 . The ultrasound ablation catheter of claim 9 , further comprising a fluid delivery lumen in fluid communication with the echolucent chamber.
11 . The ultrasound ablation catheter of claim 9 , where the echolucent chamber includes a thin membrane and a manifold, wherein the manifold comprises a cavity.
12 . The ultrasound ablation catheter of claim 9 , wherein the ultrasound diagnostic transducer comprises a plurality of ultrasound imaging transducers disposed around the circumference of the catheter but not disposed at a location on the circumference that is opposite a direction of aim of the ultrasound ablation transducer.
13 . The ultrasound ablation catheter of claim 9 , wherein the ultrasound diagnostic transducer comprises a plurality of ultrasound imaging transducers disposed around the circumference of the catheter.
14 . The ultrasound ablation catheter of claim 13 , further comprising an imaging artifact disposed on the catheter opposite a direction of aim of the ultrasound ablation catheter.
15 . The ultrasound ablation catheter of claim 9 , wherein the ultrasound ablation transducer is distal to the ultrasound diagnostic transducer.
16 . The ultrasound ablation catheter of claim 9 , wherein the ultrasound ablation transducer is proximal to the ultrasound diagnostic transducer.
17 . The ultrasound ablation catheter of claim 9 , further comprising an inflatable membrane with a deployed state in which the inflatable member extends further radially than an outer catheter shaft.
18 . The ultrasound ablation catheter of claim 9 , wherein the echolucent chamber comprises a membrane with a plurality of perforations therethrough.
19 . The ultrasound ablation catheter of claim 9 , further comprising a guidewire lumen.
20 . The ultrasound ablation catheter or claim 9 , wherein the ultrasound diagnostic transducer is a rotating ultrasound diagnostic transducer.
21 . A method of imaging a direction of aim of an ultrasound ablation transducer, comprising
providing an ultrasound ablation catheter comprising an ultrasound ablation transducer axially spaced from, and with a fixed position relative to, a diagnostic ultrasound transducer;
emitting a non-ablative ultrasound signal from the ultrasound ablation transducer; and
imaging the non-ablative ultrasound signal and at least one anatomical landmark with the diagnostic ultrasound transducer to thereby image the direction of aim of the ultrasound ablation transducer with respect to the at least one anatomical landmark.
22 . The method of claim 21 , further comprising sending a synchronized signal to both the diagnostic ultrasound transducer and the ultrasound ablation transducer.
23 . The method of claim 21 , wherein the ultrasound ablation transducer has a different resonant frequency than the diagnostic ultrasound transducer.
24 . The method of claim 21 , further comprising rotating the ultrasound ablation transducer until the emitted non-ablative signal is directed toward target tissue.
25 . The method of claim 21 wherein the at least one anatomical landmark is at least one of an internal carotid artery, an external carotid artery, a carotid bifurcation, and a common carotid artery.