Systems and methods for sympathetic cardiopulmonary neuromodulation
Methods, devices and systems are described for decreasing the activity of the sympathetic nervous innervation to and from the lungs and the vessels supplying the lungs to treat pulmonary medical conditions such as asthma. In one embodiment, the method may involve advancing an intravascular instrument to a target location in a blood vessel within the intercostal vasculature to ablate either or both the sympathetic afferent and efferent nerves lying within the paravertebral gutter including the visceral fibers that travel to the cardiothoracic cavity and abdominopelvic viscera and the T1 to T4/5 sympathetic chain. In another embodiment, an intravascular instrument may be advanced to the bronchial vessels to ablate either or both the sympathetic afferent and efferent nerves in and around the posterior pulmonary plexus. In one embodiment the ablative agent is a neurolytic agent delivered in a gel. This approach may be utilized to treat other cardiac and pulmonary diseases.
1. A method of modulating nerves of a patient, comprising:
inserting a catheter percutaneously into a first blood vessel;
advancing the catheter into a second blood vessel;
penetrating a wall of the second blood vessel with a portion of the catheter, thereby accessing the paravertebral gutter; and
modulating nerves within the paravertebral gutter by delivering a gel comprising a therapeutic agent into the paravertebral gutter.
2. The method of claim 1 , wherein the second blood vessel is selected from the group consisting of: an azygous vein, a hemiazygous vein, an accessory hemiazygous vein, a superior intercostal vein, an intercostal vein other than the superior intercostal vein, a costocervical trunk, and a subclavian artery.
3. The method of claim 1 , wherein the modulating comprises delivering a hydrogel comprising a therapeutic agent to modulate nerves in the paravertebral space.
4. The method of claim 3 , wherein the hydrogel comprises an in situ crosslinking hydrogel or an injectable hydrogel slurry.
5. The method of claim 1 , wherein the modulating comprises reducing the signs or symptoms of asthma or pulmonary hypertension.
6. The method of claim 1 , wherein the modulating comprises reducing the signs or symptoms of cardiogenic pain.
7. The method of claim 1 , wherein the modulating comprises reducing the signs or symptoms of cardiac arrhythmias.
8. The method of claim 1 , wherein the nerves comprise one or more of sympathetic visceral efferent, sympathetic peripheral efferent, visceral afferent, somatic afferent and somatic efferent, and wherein the nerves reside proximate the C7 to T5 spinal levels.
9. The method of claim 1 , wherein the nerves comprise one or more of communicating rami, the sympathetic ganglia, the sympathetic chain, intermediate or accessory ganglia, the spinal nerve, and the intercostal nerve.
10. The method of claim 1 , further comprising delivering the gel to the dorsal or ventral roots.
11. The method of claim 1 , wherein the gel comprises polyethylene glycol.
12. The method of claim 1 , wherein the therapeutic agent comprises a neurolytic.
13. The method of claim 1 , wherein the neurolytic reduces the release of norepinephrine.
14. The method of claim 1 , wherein the gel comprises polyethylene glycol.
15. A method of selectively modulating nerves of a patient, comprising:
inserting a catheter percutaneously into a first blood vessel;
advancing the catheter into a second blood vessel;
penetrating a wall of the second blood vessel with a portion of the catheter, thereby accessing the paravertebral gutter of the patient; and
protecting a first group of nerves or neurons within the paravertebral gutter from neurolysis, wherein protecting comprises delivering a first hydrogel into the paravertebral gutter in a first direction; and
neuromodulating a first group of nerves or neurons within the paravertebral gutter, wherein neuromodulating comprises delivering a second hydrogel into the paravertebral gutter.
16. The method of claim 15 , wherein the first hydrogel comprises a neuroprotectant.
17. The method of claim 15 , wherein the first hydrogel is released proximate the first rib toward the inferior cervical ganglion or the region of the stellate ganglion comprising the inferior cervical ganglion.
18. The method of claim 15 , wherein the second hydrogel comprises a neurolytic agent.