Renovascular treatment device, system, and method for radiosurgically alleviating hypertension
A radiosurgical method for treating cardiorenal disease of a patient, the method including directing radiosurgery radiation from outside the patient towards one or more target treatment regions encompassing sympathetic ganglia of the patient so as to inhibit the cardiorenal disease. In an exemplary embodiment, the method further includes acquiring three dimensional planning image data encompassing the first and second renal arteries, planning an ionizing radiation treatment of first and second target regions using the three dimensional planning image data so as to mitigate the hypertension, the first and second target regions encompassing neural tissue of or proximate to the first and second renal arteries, respectively, and remodeling the target regions by directing the planned radiation from outside the body toward the target regions.
1. A radiosurgical method for treating a patient body having a renovascular system including a first renal artery and a second renal artery, the patient having hypertension, the method comprising:
acquiring three dimensional planning image data encompassing an outer reference surface on at least one of the first and the second renal arteries, the image data based on a time sequence of three dimensional tissue volumes;
planning an ionizing bilateral radiation treatment dose for first and second target regions of the at least one of the first and the second renal arteries using the image data so as to mitigate the hypertension, the first and second target regions comprising two spatially separated non-contiguous regions and encompassing neural tissue of or proximate to the first and second renal arteries, respectively, wherein the planning of the radiation treatment dose further comprises determining an estimated lesion of the renovascular system based on the planned radiation treatment dose, and reviewing a graphical representation of the estimated lesion; and
remodeling the target regions by bilaterally directing a plurality of radiation beams from outside the body toward the target regions to deliver the planned radiation treatment dose to the target regions.
2. The method of claim 1 , further comprising:
prior to the planning of the radiation treatment dose, implanting one or more position surrogates within the body, said one or more surrogates comprising a series of fiducials deployable in a non-colinear configuration in the first and the second renal arteries, wherein the non-colinear configuration facilitates defining a three-dimensional offset between the fiducials and the target regions,
wherein the action of remodeling the target regions includes directing the plurality of radiation beams from outside the body toward the target regions with reference to the one or more implanted surrogates and with aid of the three-dimensional offset.
3. The method of claim 2 , wherein the one or more surrogates are biodegradable and remains implanted in the body for at least a year or until dissolution.
4. The method of claim 2 , wherein the action of implanting one or more surrogates within the body includes implanting passive fiducial seeds within the body, and wherein the fiducial seeds comprise substantially non-toxic seeds with an electron density visible on Computed Tomography (CT) and/or guidance imaging.
5. The method of claim 2 , wherein the action of implanting one or more surrogates within the body includes inserting a needle tip percutaneously to a position where the one or more surrogates are to be implanted, and implanting the one or more surrogates by ejecting the one or more surrogates out of the needle tip.
6. The method of claim 2 , further comprising monitoring movement of at least one of the first and the second renal arteries due to a heart beat cycle of the patient or a blood pressure component and/or a displacement component of the heart beat cycle of the patient, wherein the remodeling of the target regions is performed by:
monitoring the heart beat cycle of the body, and
tracking at least a portion of the movement of the at least one of the first and the second renal arteries due to the heart beat cycle to compensate for the movement while directing the plurality of radiation beams towards the target regions.
7. The method of claim 2 , further comprising monitoring a heart beat cycle from the body while acquiring the image data, and acquiring from said image data a time series of three dimensional image data sets distributed throughout the heart beat cycle that indicates movement of the target regions during the heart beat cycle;
wherein the planning of the radiation treatment dose comprises:
identifying radiation sensitive collateral tissue, and
determining a series of radiation beams, of the plurality of radiation beams, suitable for providing the planned radiation treatment dose in the target regions without excessively irradiating the collateral tissue; and
wherein the remodeling of the target regions is performed by:
monitoring the heart beat cycle of the body, and
tracking, using the time series of datasets, at least a portion of the movement of the target regions during the monitored heart beat cycle while directing the series of radiation beams towards the target region.
8. The method of claim 1 , wherein the remodeling of the target regions via the bilateral delivery of the planned radiation treatment dose aids in inhibiting the hypertension.
9. The method of claim 8 , wherein the planned radiation treatment dose is bilaterally delivered to the two regions in separate treatment procedures on separate days.
10. The method of claim 1 , wherein the target regions includes distinct regions that are generally cylindrical in shape.
11. The method of claim 1 , wherein the action of remodeling the target regions results in renal denervation, wherein the renal denervation results in a reduction of a cardiac infarct size expansion.
12. The method of claim 1 , wherein the action of directing the plurality of radiation beams from outside the body toward the targets regions results in respective absorbed radiation dose distributions of at least one unit dose of absorbed radiation in the target regions and absorbed radiation dose distributions of at least ⅔rds of the at least one unit dose of absorbed radiation in respective first outer regions located outside of or proximate to the target regions, the respective first outer regions having a volume of about 1.5 to 4.0 times the volume of the corresponding target regions.
13. The method of claim 1 , wherein the first target region surrounds a majority of a perimeter of the first renal artery, wherein the first renal artery has a first lumen adjacent the perimeter, the first lumen defined by a first wall of the first renal artery, and wherein a collateral dose of the planned radiation treatment dose in the first wall is sufficiently less than a dose of the radiation of the planned radiation treatment dose in the first target region so as to inhibit tissue response-induced occlusion of the first renal artery.
14. The method of claim 1 , further comprising:
implanting a position surrogate from within an inferior vena cava of the body prior to acquiring the image data;
monitoring a breathing cycle of the patient while acquiring the image data;
monitoring the breathing cycle while directing the plurality of radiation beams towards the target regions; and
controlling the directing of the plurality of radiation beams in response to the monitored breathing cycle while directing the plurality of beams towards the target regions to deliver the planned radiation treatment dose,
wherein no position surrogate is implanted within at least the first renal artery; and
wherein the directing of the plurality of beams towards the target regions to deliver the planned radiation treatment dose is performed without tracking movement of at least the first renal artery in response to the breathing cycle.
15. The method of claim 1 , further comprising using one or more surrogate structures comprising natural tissue structures that are imaged or visualized.
16. The method of claim 1 , further comprising: prior to the planning of the radiation treatment dose, introducing a position surrogate comprising one or more bioresorbable fiducials into the body, wherein said one or more bioresorbable fiducials are configured to bind to tissue in or near the target regions for tracking and localization of said target regions.
17. The method of claim 16 , wherein said one or more bioresorbable fiducials comprise one or more binding reagents that facilitate the binding to the tissue in or near the target regions.
18. The method of claim 16 , wherein said one or more bioresorbable fiducials include imageable materials comprising metal particles, nanoparticles or polymer beads that are used for the tracking and localization of said target regions.
19. The method of claim 1 , wherein delivering the planned radiation treatment dose comprises (i) delivering a full dose of radiation to the first and second target region sequentially or (ii) delivering a partial dose of radiation to the first and second target regions in an alternating pattern.
20. The method of claim 1 , wherein the step of planning the radiation treatment dose further comprises displaying one or more doses of radiation estimated to be imparted into the target regions as a result of the planned radiation treatment dose.