NEUROMODULATION FOR METABOLIC CONDITIONS OR SYNDROMES
According to some embodiments, a method of treating a subject having diabetes or symptoms associated with diabetes is provided. The method includes delivering a neuromodulation catheter within a vessel (e.g., hepatic artery) having surrounding nerves that innervate the liver (e.g., sympathetic nerves of the hepatic plexus). The method may also include modulating (e.g., disrupting, ablating, stimulating) the nerves by mechanical compression, energy delivery, or fluid delivery.
1 - 2 . (canceled)
3 . A method comprising:
positioning at least one therapeutic element of a neuromodulation device within a hepatic artery of a subject;
causing at least one of energy or a chemical agent to be delivered by the at least one therapeutic element to nerves surrounding the hepatic artery of the subject, wherein the at least one of the energy or the chemical agent is sufficient to ablate at least some of the nerves surrounding the hepatic artery of the subject;
positioning the at least one therapeutic element of the neuromodulation device within a renal artery; and
causing the at least one of energy or the chemical agent to be delivered by the at least one therapeutic element to nerves surrounding the renal artery, wherein the at least one of the energy or the chemical agent is sufficient to ablate at least some of the nerves surrounding the renal artery.
4 . The method of claim 3 , wherein the renal artery comprises a first renal artery, the method further comprising:
positioning the at least one therapeutic element of the neuromodulation device within a second renal artery; and
causing the at least one of energy or the chemical agent to be delivered by the at least one therapeutic element of the neuromodulation device to nerves surrounding the second renal artery, wherein the at least one of the energy or the chemical agent is sufficient to ablate at least some of the nerves surrounding the second renal artery.
5 . The method of claim 3 , wherein:
the nerves surrounding the hepatic artery comprise sympathetic nerves of a hepatic plexus, and
the nerves surrounding the renal artery comprise sympathetic nerves surrounding the renal artery.
6 . The method of claim 3 , wherein causing at least one of energy or the chemical agent to be delivered by the at least one therapeutic element comprises causing energy to be delivered by the at least one therapeutic element, and wherein the energy comprises at least one of radiofrequency energy, high-intensity focused ultrasound energy, low-intensity focused ultrasound energy, electroporation energy, ionizing energy, cryogenic energy, or microwave energy.
7 . The method of claim 3 , wherein causing at least one of energy or the chemical agent to be delivered by the at least one therapeutic element comprises causing the chemical agent to be delivered by the at least one therapeutic element, and wherein the chemical agent comprises at least one of a muscarinic receptor agonist, an anticholinesterase agent, a nicotinic receptor agonist, a nicotine receptor antagonist, a neurotoxin, an alcohol, guanethidine, or zinc sulfate.
8 . The method of claim 3 , wherein ablating at least some of the nerves surrounding the hepatic artery and ablating at least some of the nerves surrounding the renal artery treats hypertension.
9 . The method of claim 3 , wherein:
positioning the at least one therapeutic element within the hepatic artery comprises intravascularly advancing the at least one therapeutic element into the hepatic artery; and
positioning the at least one therapeutic element within the renal artery comprises intravascularly advancing the at least one therapeutic element into the renal artery.
10 . The method of claim 9 , further comprising accessing vasculature of the subject via a femoral access point.
11 . The method of claim 9 , further comprising accessing vasculature of the subject via a radial access point.
12 . The method of claim 3 , wherein causing at least one of energy or the chemical agent to be delivered by the at least one therapeutic element comprises causing at least one of energy or the chemical agent to be preferentially delivered by the at least one therapeutic element to sympathetic nerves surrounding the hepatic artery.
13 . The method of claim 12 , wherein causing at least one of energy or the chemical agent to be preferentially delivered by the at least one therapeutic element to sympathetic nerves surrounding the hepatic artery comprises causing the at least one therapeutic element to deliver the at least one of energy or the chemical agent in a proximal portion of the hepatic artery.
14 . The method of claim 13 , wherein the proximal portion of the hepatic artery comprises a common hepatic artery.
15 . The method of claim 3 , wherein the neuromodulation device is configured to exert a contact force by the at least one therapeutic element against a wall of the hepatic artery of about 1 g/mm 2 to about 500 g/mm 2 .
16 . The method of claim 3 , wherein the neuromodulation device comprises a catheter comprising a distal portion configured to bend with a bend radius of less than about 10 mm.
17 . The method of claim 3 , wherein the hepatic artery comprises at least one of a common hepatic artery, a proper hepatic artery, a right hepatic artery, or a left hepatic artery.
18 . The method of claim 3 , wherein the hepatic artery comprises a common hepatic artery.