Pulmonary hypertension treatment
Disclosed herein is a therapeutically active agent usable in the treatment of pulmonary arterial hypertension (PAH), for use in the treatment of pulmonary arterial hypertension, as well as methods of treating PAH, said treatment and methods comprising administering such an active agent and effecting pulmonary artery denervation in the subject. In some aspects, a sub-therapeutically effective amount of the active agent is administered. In some aspects, the method is devoid of administering such an active agent for at least one month subsequent to the denervation. Further disclosed is a method of treating PAH comprising determining a responsiveness of the subject to at least one therapeutically active agent usable in treating PAH; and effecting pulmonary artery denervation in a subject responsive to the active agent(s).
1. A method of treating pulmonary arterial hypertension in a subject in need thereof, the method comprising:
a) determining a responsiveness of the subject to at least one anticoagulant usable in treating pulmonary arterial hypertension; and
b) effecting pulmonary artery denervation in a subject responsive to said at least one anticoagulant,
thereby treating the pulmonary arterial hypertension.
2. The method of claim 1 , wherein said anticoagulant is selected from the group consisting of warfarin, acenocoumarol, dicoumarol, ethylbiscoumacetate, phenprocoumon, tecarfarin, anisindione, fluindione, phenindione, atromentin, a heparin, fondaparinux, idraparinux, idrabiotaparinux, apixaban, betrixaban, darexaban, edoxaban, eribaxaban, letaxaban, otamixaban, rivaroxaban, hirudin, lepirudin, bivalirudin, desirudin, argatroban, inogatran, dabigatran, melagatran, ximelagatran, antithrombin, batroxobin, hementin, and vitamin E.
3. The method of claim 1 , wherein effecting said pulmonary artery denervation comprises thermally damaging nerve tissue associated with a main pulmonary artery.
4. The method according to claim 3 , wherein said thermally damaging nerve tissue comprises selectively damaging nerves that are not coated by myelin, by emitting energy at a frequency, intensity and duration sufficient to damage only nerves that are not coated by myelin, by producing a predetermined temperature profile in the treated tissue, said temperature profile ranging between 47-57° C.
5. The method according to claim 3 , wherein said thermally damaging nerve tissue is effected by cryotherapy and/or by emitting energy from at least one energy-emitting device introduced into the body.
6. The method according to claim 5 , wherein said energy is selected from the group consisting of ultrasound energy and monopolar or bipolar radiofrequency energy.
7. The method according to claim 6 , wherein said energy comprises unfocused ultrasound energy.
8. The method according to claim 5 , wherein effecting said pulmonary artery denervation comprises introducing a catheter device comprising said at least one energy-emitting device into a main pulmonary artery lumen.
9. The method according to claim 5 , wherein said energy-emitting device is a transceiver, and effecting said pulmonary artery denervation further comprises:
receiving, using said at least one energy-emitting transceiver, echo signals reflected from non-targeted tissue following emission of energy by said at least one transceiver;
analyzing said received echo signals to identify at least one of a type and location of said non-targeted tissue relative to said at least one transceiver; and
emitting energy from said at least one transceiver in accordance with said analyzing, to modify nerve activity without substantially damaging said identified non-targeted tissue.
10. The method according to claim 5 , wherein effecting said pulmonary artery denervation further comprises:
positioning said at least one energy-emitting device within the left pulmonary artery, right pulmonary artery and/or pulmonary artery trunk at a location which is in between the first bifurcation of the left pulmonary artery and the first bifurcation of the right pulmonary artery,
wherein said thermally damaging nerve tissue comprises emitting energy having parameters selected to damage nerves only within a distance window of between 0.2 mm and 10 mm from the intimal aspect of the pulmonary artery wall when said at least one device is positioned at said location.
11. The method of claim 1 , wherein said anticoagulant is selected from the group consisting of warfarin, acenocoumarol, dicoumarol, ethylbiscoumacetate, phenprocoumon, tecarfarin, anisindione, fluindione, phenindione, and atromentin.
12. The method of claim 1 , wherein said anticoagulant is selected from the group consisting of bemiparin, nadroparin, reviparin, enoxaparin, parnaparin, certoparin, dalteparin, tinzeparin, fondaparinux, idraparinux, and idrabiotaparinux.
13. The method of claim 1 , wherein said anticoagulant is selected from the group consisting of rivaroxaban, apixaban, betrixaban, darexaban, edoxaban, eribaxaban, letaxaban, and otamixaban.
14. The method of claim 1 , wherein said anticoagulant is selected from the group consisting of hirudin, bivalirudin, lepirudin, desirudin, argatroban, inogatran, melagatran, and dabigatran.