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Numéro de publicationUS20070282376 A1
Type de publicationDemande
Numéro de demandeUS 11/422,421
Date de publication6 déc. 2007
Date de dépôt6 juin 2006
Date de priorité6 juin 2006
Autre référence de publicationEP2032202A2, US8369943, US20100042170, WO2007146517A2, WO2007146517A3
Numéro de publication11422421, 422421, US 2007/0282376 A1, US 2007/282376 A1, US 20070282376 A1, US 20070282376A1, US 2007282376 A1, US 2007282376A1, US-A1-20070282376, US-A1-2007282376, US2007/0282376A1, US2007/282376A1, US20070282376 A1, US20070282376A1, US2007282376 A1, US2007282376A1
InventeursAllan C. Shuros, Randy Westlund, Anthony V. Caparso
Cessionnaire d'origineShuros Allan C, Randy Westlund, Caparso Anthony V
Exporter la citationBiBTeX, EndNote, RefMan
Liens externes: USPTO, Cession USPTO, Espacenet
Method and apparatus for neural stimulation via the lymphatic system
US 20070282376 A1
Résumé
An implantable neural stimulation system includes an implantable medical device having a neural stimulation circuit and at least one implantable lead configured to allow one or more stimulation electrodes to be placed in one or more lymphatic vessels of a patient, such as the patient's thoracic duct and/or vessels branching from the thoracic duct. Neural stimulation pulses are delivered from the implantable medical device to one or more target regions adjacent to the thoracic duct or the vessels branching from the thoracic duct through the one or more stimulation electrodes.
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Revendications(33)
1. A system for delivering neural stimulation to a target region in a body having lymphatic vessels, the system comprising:
a first electrode assembly including a first electrode base configured to be implanted into one of the lymphatic vessels and a first stimulation electrode on the first electrode base, the first electrode base configured to cause a portion of the one of the lymphatic vessels to substantially alter its natural path to contact the target region and maintain the contact between the portion of the one of the lymphatic vessels and the target region after an implantation of the first electrode assembly; and
an implantable medical device including a neural stimulation circuit adapted to deliver neural stimulation pulses through the first stimulation electrode.
2. The system of claim 1, wherein the first electrode base comprises an elongate electrode base including one or more biases each configured to cause the portion of the one of the lymphatic vessels to substantially alter its natural path to contact the target region, the elongate electrode base having a stiffness allowing for maintaining the contact between the portion of the one of the lymphatic vessels and the target region after the implantation of the first electrode assembly.
3. The system of claim 1, wherein the first electrode base comprises an expandable electrode base configured to cause the portion of the one of the lymphatic vessels to substantially alter its natural path to contact the target region, after being expanded.
4. The system of claim 3, wherein the expandable electrode base comprises a stent, and the first electrode is incorporated into or integrated with the stent.
5. The system of claim 1, further comprising a first implantable lead having a first distal end, a first proximal end configured to be connected to the implantable medical device, and a first elongate lead body between the first distal end and the first proximal end, and wherein the first electrode assembly is incorporated into the first implantable lead.
6. The system of claim 5, wherein the first electrode assembly is incorporated into the first distal end.
7. The system of claim 5, wherein the first electrode assembly is incorporated into the first elongate lead body.
8. The system of claim 5, wherein the first electrode base further comprises a second stimulation electrode, and the neural stimulation circuit is adapted to deliver the neural stimulation pulses through the first stimulation electrode and the second stimulation electrode.
9. The system of claim 5, further comprising a second stimulation electrode configured to be placed in a location external to the lymphatic vessels, and wherein the neural stimulation circuit is adapted to deliver the neural stimulation pulses through the first stimulation electrode and the second stimulation electrode.
10. The system of claim 9, further comprising a second implantable lead configured to be subcutaneously implanted, the second implantable lead having a second distal end including the second stimulation electrode, a second proximal end configured to be connected to the implantable medical device, and a second elongate lead body between the distal end and the proximal end.
11. The system of claim 9, wherein the second stimulation electrode is incorporated onto the implantable medical device.
12. The system of claim 5, comprising a physiological sensor adapted to sense a physiological signal, and wherein the implantable medical device comprises:
a sensing circuit, coupled to the physiological sensor, to process the physiological signal; and
an implant control circuit adapted to control the delivery of the neural stimulation pulses using the physiological signal.
13. The system of claim 12, wherein the physiological sensor comprises an neural sensing electrode configured to sense a neural signal, the sensing circuit comprises a neural sensing circuit to process the neural signal, and the implant control circuit is adapted to control the delivery of the neural stimulation pulses using the processed neural signal.
14. The system of claim 13, wherein the neural sensing electrode is the first stimulation electrode.
15. The system of claim 13, wherein the implant control circuit comprises a closed-loop controller adapted to provide feedback control of the delivery of the neural stimulation pulses using the sensed neural signal as an input signal.
16. The system of claim 5, wherein the implantable medical device comprises an implant control circuit adapted to control the delivery of the neural stimulation pulses using a plurality of stimulation parameters, the implant control circuit including:
a parameter storage circuit to store values of the plurality of stimulation parameters; and
a parameter receiver to receive one or more programmed values of the plurality of stimulation parameters and to update the parameter storage circuit with the received one or more programmed values of the plurality of stimulation parameters.
17. The system of claim 16, wherein the implantable medical device comprises an implant telemetry circuit to receive the one or more programmed values of the plurality of stimulation parameters.
18. The system of claim 17, further comprising an external system communicatively coupled to the implantable medical device, the external system including:
a user input device adapted to allow programming of the one or more programmed values of the parameters; and
an external telemetry circuit to transmit the one or more programmed values of the plurality of stimulation parameters to the implantable medical device.
19. A method for delivering neural stimulation to a body having lymphatic vessels including a thoracic duct, the method comprising:
delivering neural stimulation pulses from an implantable medical device to at least a first stimulation electrode placed in one of the lymphatic vessels.
20. The method of claim 19, further comprising altering a natural path of the one of the lymphatic vessels to cause a portion of the one of the lymphatic vessels to contact a target region to which the neural stimulation are delivered using an electrode base configured to be implanted in the one of the lymphatic vessels, and wherein the first stimulation electrode is incorporated into or integrated with the electrode base.
21. The method of claim 19, wherein delivering the neural stimulation pulses comprises delivering the neural stimulation pulses through a stimulation electrode placed in the thoracic duct.
22. The method of claim 19, wherein delivering the neural stimulation pulses comprises delivering the neural stimulation pulses through a stimulation electrode placed in one of the vessels branching from the thoracic duct.
23. The method of claim 19, wherein delivering the neural stimulation pulses comprises delivering the neural stimulation pulses through the first stimulation electrode and a second stimulation electrode placed in the one of the lymphatic vessels.
24. The method of claim 19, wherein delivering the neural stimulation pulses comprises delivering the neural stimulation pulses through the first stimulation electrode and a second stimulation electrode placed in a location in the body external the lymphatic vessels.
25. The method of claim 19, further comprising:
sensing one or more physiological signals; and
controlling the delivery of the neural stimulation pulses using the one or more physiological signals.
26. The method of claim 25, wherein sensing the one or more physiological signals comprises sensing a neural signal using the first stimulation electrode, and controlling the delivery of the neural stimulation pulses comprises controlling the delivery of the neural stimulation pulses using the neural signal.
27. The method of claim 19, further comprising:
controlling the delivery of the neural stimulation pulses using a plurality of stimulation parameters;
receiving one or more values of the plurality of stimulation parameters; and
storing the received one or more values of the plurality of the stimulation parameters.
28. The method of claim 27, further comprising programming one or more values of the stimulation parameters according to a target to which the neural stimulation pulses are delivered, the target including one or more component of a nervous system.
29. The method of claim 28, wherein delivering the neural stimulation pulses comprises delivering the neural stimulation pulses to a parasympathetic nerve.
30. The method of claim 29, wherein delivering the neural stimulation pulses comprises delivering the neural stimulation pulses to a vagus nerve.
31. The method of claim 28, wherein delivering the neural stimulation pulses comprises delivering the neural stimulation pulses to a sympathetic nerve.
32. The method of claim 28, wherein delivering the neural stimulation pulses comprises delivering the neural stimulation pulses to a spinal cord.
33. The method of claim 28, wherein delivering the neural stimulation pulses comprises delivering the neural stimulation pulses to baroreceptors.
Description
    CROSS-REFERENCE TO RELATED APPLICATIONS
  • [0001]
    This application is related to co-pending, commonly assigned, U.S. patent application Ser. No. ______, entitled “METHOD AND APPARATUS FOR LYMPHATIC SYSTEM PACING AND SENSING,” filed on even date herewith (Attorney Docket No. 279.A69US1), U.S. patent application Ser. No. ______, entitled “METHOD AND APPARATUS FOR GASTROINTESTINAL STIMULATION VIA THE LYMPHATIC SYSTEM,” filed on even date herewith ______ (Attorney Docket No. 279.A66US1), U.S. patent application Ser. No. ______, entitled “METHOD AND DEVICE FOR LYMPHATIC SYSTEM MONITORING,” filed even date herewith (Attorney Docket No. 279.A05US1), and U.S. patent application Ser. No. ______, entitled “METHOD AND DEVICE FOR ENDO-LYMPHATIC STIMULATION,” filed on even date herewith (Attorney Docket No. 279.A04US1), which are hereby incorporated herein by reference in their entirety.
  • TECHNICAL FIELD
  • [0002]
    This document relates generally to medical devices and particularly to an implantable system that delivers neural stimulation via one or more lymphatic vessels.
  • BACKGROUND
  • [0003]
    Neural stimulation has been applied to treat various pathological conditions. Controlled delivery of electrical stimulation pulses to a nerve generates, modulates, or inhibits activities of that nerve, thereby restoring the functions of that nerve and/or regulating the functions of the tissue or organ innervated by that nerve. One specific example of neural stimulation is to regulate cardiac functions and hemodynamic performance by delivering electrical stimulation pulses to portions of the autonomic nervous system. The heart is innervated with sympathetic and parasympathetic nerves. Activities in these nerves, including artificially applied electrical stimuli, modulate cardiac functions and hemodynamic performance. Direct electrical stimulation of parasympathetic nerves can activate the baroreflex, inducing a reduction of sympathetic nerve activity and reducing blood pressure by decreasing vascular resistance. Sympathetic inhibition, as well as parasympathetic activation, has been associated with reduced arrhythmia vulnerability following a myocardial infarction, presumably by increasing collateral perfusion of the acutely ischemic myocardium and decreasing myocardial damage. Modulation of the sympathetic and parasympathetic nervous system with neural stimulation has been shown to have positive clinical benefits, such as protecting the myocardium from further remodeling and predisposition to fatal arrhythmias following a myocardial infarction.
  • [0004]
    Implantable medical systems are used to deliver neural stimulation. A typical implantable neural stimulation system includes an implantable neural stimulator that delivers electrical stimulation pulses through a plurality of stimulation electrodes. Depending on the location of the nerve to be stimulated, the stimulation electrodes may be incorporated onto the implantable neural stimulator and/or connected to the implantable neural stimulator using one or more implantable leads. In practice, the desirable stimulation sites may not be in a location with anatomical structure allowing for easy implantation of the implantable neural stimulator or easy access by the lead(s). The degree of risk associated with the implantation procedure increases with the degree of invasiveness. Therefore, given a desirable stimulation site, there is a need to minimize the invasiveness of implanting a system that delivers neural stimulation pulses to that stimulation site.
  • SUMMARY
  • [0005]
    An implantable neural stimulation system includes an implantable medical device having a neural stimulation circuit and at least one implantable lead configured to allow one or more stimulation electrodes to be placed in one or more lymphatic vessels of a patient, such as the patient's thoracic duct and/or vessels branching from the thoracic duct. Neural stimulation pulses are delivered from the implantable medical device to one or more target regions adjacent to the thoracic duct or the vessels branching from the thoracic duct through the one or more stimulation electrodes.
  • [0006]
    In one embodiment, a neural stimulation system includes an electrode assembly and an implantable medical device. The electrode assembly includes an electrode base configured to be implanted into a lymphatic vessel and a stimulation electrode on the electrode base. The electrode base is configured to cause a portion of the lymphatic vessel to substantially alter its natural path to contact a target region to which neural stimulation pulses are delivered and maintain the contact between the portion of the lymphatic vessel and the target region after the implantation of the electrode assembly. The implantable medical device includes a neural stimulation circuit that delivers the neural stimulation pulses through the stimulation electrode.
  • [0007]
    In one embodiment, a method for delivering neural stimulation is provided. Neural stimulation pulses are delivered from an implantable medical device to at least one stimulation electrode placed in a lymphatic vessel.
  • [0008]
    This Summary is an overview of some of the teachings of the present application and not intended to be an exclusive or exhaustive treatment of the present subject matter. Further details about the present subject matter are found in the detailed description and appended claims. Other aspects of the invention will be apparent to persons skilled in the art upon reading and understanding the following detailed description and viewing the drawings that form a part thereof. The scope of the present invention is defined by the appended claims and their legal equivalents.
  • BRIEF DESCRIPTION OF THE DRAWINGS
  • [0009]
    The drawings illustrate generally, by way of example, various embodiments discussed in the present document. The drawings are for illustrative purposes only and may not be to scale.
  • [0010]
    FIG. 1 is an illustration of an embodiment of a neural stimulation system and portions of an environment in which the neural stimulation system is used.
  • [0011]
    FIG. 2 is an illustration of another embodiment of the neural stimulation system and portions of the environment in which the neural stimulation system is used.
  • [0012]
    FIG. 3 is a block diagram illustrating an embodiment of an implantable medical device of the neural stimulation system.
  • [0013]
    FIG. 4 is a block diagram illustrating a specific embodiment of the implantable medical device.
  • [0014]
    FIG. 5 is a block diagram illustrating another specific embodiment of the implantable medical device.
  • [0015]
    FIG. 6 is a block diagram illustrating an embodiment of an external system of the neural stimulation system.
  • [0016]
    FIG. 7 is a block diagram illustrating an embodiment of the external system being a patient management system.
  • [0017]
    FIG. 8 is a flow chart illustrating a method for delivering neural stimulation via the thoracic duct.
  • [0018]
    FIG. 9 is an illustration of a lymphatic vessel and a target region for neural stimulation.
  • [0019]
    FIG. 10 is an illustration of an embodiment of an electrode assembly for placement in the lymphatic vessel to allow for the neural stimulation.
  • [0020]
    FIG. 11 is an illustration of an embodiment of another electrode assembly for placement in the lymphatic vessel to allow for the neural stimulation.
  • [0021]
    FIG. 12 is an illustration of an embodiment of another electrode assembly for placement in the lymphatic vessel to allow for the neural stimulation.
  • [0022]
    FIG. 13 is an illustration of an embodiment of another electrode assembly for placement in the lymphatic vessel to allow for the neural stimulation.
  • DETAILED DESCRIPTION
  • [0023]
    In the following detailed description, reference is made to the accompanying drawings which form a part hereof, and in which is shown by way of illustration specific embodiments in which the invention may be practiced. These embodiments are described in sufficient detail to enable those skilled in the art to practice the invention, and it is to be understood that the embodiments may be combined, or that other embodiments may be utilized and that structural, logical and electrical changes may be made without departing from the spirit and scope of the present invention. References to “an”, “one”, or “various” embodiments in this disclosure are not necessarily to the same embodiment, and such references contemplate more than one embodiment. The following detailed description provides examples, and the scope of the present invention is defined by the appended claims and their legal equivalents.
  • [0024]
    This document discusses an implantable neural stimulation system including an implantable medical device delivering neural stimulation through at least one stimulation delivery device placed in a lymphatic vessel, such as the thoracic duct, of a patient. In one embodiment, the implantable neural stimulation system includes a transluminal lead configured for insertion into a portion of the lymphatic vessel to allow one or more stimulation electrodes to be placed in the lymphatic vessel. The implantable medical device includes a neural stimulation circuit that generates electrical pulses. The electrical pulses are delivered to one or more target regions adjacent to the lymphatic vessel through the one or more stimulation electrodes placed in the lymphatic vessel. While the thoracic duct is specifically discussed in this document as an example of such a lymphatic vessel, neural stimulation pulses are delivered through any one or more lymphatic vessels, including, but not limited to, the thoracic duct, lymphatic vessels branching from the thoracic duct, the right lymphatic duct, and lymphatic vessels branching from the right lymphatic duct.
  • [0025]
    While electrical stimulation is specifically discussed in this document as an example, the present subject matter includes neurostimulation using any form of energy that is capable of stimulating one or more components of the nervous system via the lymphatic vessel such as the thoracic duct. In various embodiments, the stimulation delivery device placed in the lymphatic vessel generates or receives neural stimuli, which are then delivered to one or more neural stimulation sites via the lymphatic vessel. The neural stimuli are in one or more forms of energy that are capable of eliciting a neural response, such as electrical, magnetic, electromagnetic, thermal, and/or acoustic (including ultrasonic) energy.
  • [0026]
    FIG. 1 is an illustration of an embodiment of a neural stimulation system 100 and portions of an environment in which system 100 is used. System 100 includes an implantable medical device 110, a lead 112, an external system 130, and a telemetry link 125 providing for communication between implantable medical device 110 and external system 130.
  • [0027]
    System 100 delivers neural stimulation pulses through at least one electrode placed in a thoracic duct 105, which is part of the lymphatic system of a patient's body 101. The lymphatic system includes lymph tissue, nodes, and vessels. Interstitial fluid is absorbed from tissue, filtered through lymph nodes, and empties into lymphatic vessels. FIG. 1 illustrates portions of thoracic duct 105, a subclavian vein 102, a left external jugular vein 104, a left internal jugular vein 103, and a superior vena cava 106. Thoracic duct 105 connects to the venous system at the juncture of subclavian vein 102 and a left internal jugular vein 103. The fluid (lymph) from the lower body flows up to thoracic duct 105 and empties into subclavian vein 102 from thoracic duct 105. Thoracic duct 105 is located in the posterior mediastinal area of body 101, adjacent to the heart and various portions of the nervous system including portions of the vagus, sympathetic, and phrenic nerves. Electrical stimulation of such nerves is delivered by using one or more stimulation electrodes placed within thoracic duct 105. Thoracic duct 105 is used as a conduit for advancing the one or more stimulation electrodes to a location from which electrical stimulation can be delivered to a target region of the nervous system of body 101. This approach to the process of electrode placement for neural stimulation has the potential of reducing the invasiveness of implantation procedure under many circumstances.
  • [0028]
    Implantable medical device 110 generates neural stimulation pulses that are electrical pulses and delivers the neural stimulation pulses through lead 112. In one embodiment, implantable medical device 110 also senses neural activities using at least lead 112. In various embodiments, implantable medical device 110 is capable of sensing other physiological signals and/or delivering therapies in addition to the neural stimulation. Examples of such additional therapies include cardiac pacing therapy, cardioversion/defibrillation therapy, cardiac resynchronization therapy (CRT), cardiac remodeling control therapy (RCT), drug therapy, cell therapy, and gene therapy. In various embodiments, implantable medical device 110 delivers the neural stimulation in coordination with one or more such additional therapies. In one embodiment, in addition to lead 112, system 100 includes one or more endocardial and/or epicardial leads for delivering pacing and/or defibrillation pulses to the heart.
  • [0029]
    Lead 112 is an implantable neural stimulation lead including a proximal end 114, a distal end 116, and an elongate lead body 118 between proximal end 114 and distal end 116. Proximal end 114 is coupled to implantable medical device 110. Distal end 116 includes at least one stimulation electrode for delivering the neural stimulation pulses to a target region of the nervous system of body 101. In one embodiment, as illustrated in FIG. 1, distal end 116 includes stimulation electrodes 120 and 122. In various other embodiments, distal end 116 includes one stimulation electrode or three or more stimulation electrodes. In one embodiment, a reference electrode is incorporated onto implantable medical device 110. In a specific embodiment, implantable medical device 110 includes a hermetically sealed conductive housing that functions as the reference electrode. Neural stimulation pulses are delivered using (i) two stimulation electrodes in distal end 116 (electrodes 120 or 122), or (ii) a stimulation electrode (electrode 120 or 122) in distal end 116 and the reference electrode on implantable medical device 110. In various embodiments, one or more of the stimulation electrodes are also used for sensing one or more neural signals. The distal portion of elongate lead body 118 (a substantial portion of elongate lead body 118 coupled to distal end 116) is configured for placement in subclavian vein 102 and thoracic duct 105, such that distal end 116 is placed in thoracic duct 105. During the implantation of lead 112, distal end 116 is inserted into subclavian vein 102 through an incision, advanced in subclavian vein 102 toward thoracic duct 105, inserted into thoracic duct 105 from subclavian vein 102, and advanced in thoracic duct 105 until a predetermined location in thoracic duct 105 is reached. In one embodiment, the position of distal end 116 is adjusted by delivering test neural stimulation pulses and detecting evoked neural signals and/or other physiological responses. In one embodiment, lead 112 includes a fixation mechanism configured to stabilize distal end 116 in the determined position in thoracic duct 105. Implantable medical device 110 is connected to proximal end 114 and is subcutaneously implanted. One example of method and apparatus for accessing the lymphatic system is discussed in U.S. patent application Ser. No., ______, entitled “METHOD AND APPARATUS FOR LYMPHATIC SYSTEM PACING AND SENSING,” filed on even date herewith (Attorney Docket No. 279.A69 μl), assigned to Cardiac Pacemakers, Inc., which is incorporated herein by reference in its entirety. Specific examples of electrode configurations and placement are also discussed in detail below, with reference to FIGS. 9-12.
  • [0030]
    In one embodiment, lead 112 is configured such that distal end 116 can be further advanced into a lymphatic vessel branching from thoracic duct 105, such as the gastric branch, so that the stimulation electrode can be placed in close proximity of a desirable target region. After the distal end 116 is inserted into thoracic duct 105, it is advanced to the junction of thoracic duct 105 and the branching lymphatic vessel and inserted to the branching lymphatic vessel. While the placement of at least one stimulation electrode in the thoracic duct is specifically discussed as an example of providing for access to a target region, the present subject matter generally includes introducing one or more stimulus delivery devices such as one or more stimulation electrodes to a stimulation site via a lymphatic vessel. In various embodiments, neural stimulation pulses are delivered through one or more stimulation electrodes placed in the lymphatic vessel and/or one or more stimulation electrodes placed in a structure that is accessible through the lymphatic vessel, including another lymphatic vessel branching from the lymphatic vessel.
  • [0031]
    In one embodiment, system 100 includes two or more leads each including one or more stimulation electrodes arranged to be placed in thoracic duct 105. In another embodiment, a lead includes a plurality of electrodes arranged for delivering independently controllable neural stimulation pulses to two or more target regions.
  • [0032]
    External system 130 communicates with implantable medical device 110 and provides for access to implantable medical device 110 by a physician or other caregiver. In one embodiment, external system 130 includes a programmer. In another embodiment, external system 130 is a patient management system including an external device communicating with implantable medical device 110 via telemetry link 125, a remote device in a relatively distant location, and a telecommunication network linking the external device and the remote device. The patient management system allows access to implantable medical device 110 from a remote location, for purposes such as monitoring patient status and adjusting therapies. In one embodiment, telemetry link 125 is an inductive telemetry link. In another embodiment, telemetry link 125 is a far-field radio-frequency (RF) telemetry link. Telemetry link 125 provides for data transmission from implantable medical device 110 to external system 130. This includes, for example, transmitting real-time physiological data acquired by implantable medical device 110, extracting physiological data acquired by and stored in implantable medical device 110, extracting patient history data such as occurrences of predetermined types of pathological events and therapy deliveries recorded in implantable medical device 110, and/or extracting data indicating an operational status of implantable medical device 110 (e.g., battery status and lead impedance). Telemetry link 125 also provides for data transmission from external system 130 to implantable medical device 110. This includes, for example, programming implantable medical device 110 to acquire physiological data, programming implantable medical device 110 to perform at least one self-diagnostic test (such as for a device operational status), and/or programming implantable medical device 110 to deliver one or more therapies and/or to adjust the delivery of one or more therapies.
  • [0033]
    FIG. 2 is an illustration of an embodiment of a neural stimulation system 200 and portions of the environment in which system 200 is used. System 200 includes the components of neural stimulation system 100 and an additional lead. That is, neural stimulation system 200 includes implantable medical device 110, leads 112 and 232, external system 130, and telemetry link 125.
  • [0034]
    Lead 232 is an implantable neural stimulation lead including a proximal end 234, a distal end 236, and an elongate lead body 238 between proximal end 234 and distal end 236. Proximal end 234 is coupled to implantable medical device 110. Distal end 236 includes at least one electrode. In one embodiment, as illustrated in FIG. 2, lead 232 includes an electrode 240 at distal end 236. In another embodiment, lead 232 includes a plurality of stimulation electrodes. In one embodiment, lead 232 is configured for subcutaneous placement, external to thoracic duct 105. In one embodiment, electrode 240 is used as a reference electrode.
  • [0035]
    Lead 232 expands the range of target regions to which neural stimulation pulses can be delivered from implantable medical device 110. In various embodiments, neural stimulation pulses are delivered through any pair of electrodes of system 200 including (i) two stimulation electrodes in distal end 116 (electrodes 120 and 122), (ii) a stimulation electrode in distal end 116 (electrode 120 or 122) and electrode 240 (as the reference electrode), or (iii) a stimulation electrode in distal end 116 (electrode 120 or 122) and the reference electrode on implantable medical device 110. In one embodiment, distal ends 116 and 236 are positioned such as a target structure for the neural stimulation is approximately between a stimulation electrode in distal end 116 (electrode 120 or 122) and a reference electrode (electrode 240 or the reference electrode on implantable medical device 110). For example, the target structure is a portion of the spinal cord of body 101.
  • [0036]
    FIG. 3 is a block diagram illustrating an embodiment of an implantable medical device 310, which is a specific embodiment of implantable medical device 110. Implantable medical device 310 includes a neural stimulation circuit 346 and an implant control circuit 348. Neural stimulation circuit 346 delivers neural stimulation pulses to a pair of stimulation electrodes 342 and 344, through which the neural stimulation pulses are delivered to a target region in the nervous system. At least one of stimulation electrodes 342 and 344 is placed in thoracic duct 105. Implant control circuit 348 controls the delivery of the neural stimulation pulses from neural stimulation circuit 346.
  • [0037]
    In one embodiment, stimulation electrodes 342 and 344 are both in thoracic duct 105 and adjacent to the target region, such as electrodes 120 and 122. In another embodiment, stimulation electrode 342 is in thoracic duct 105 and adjacent to the target region, such as electrode 120 or 122, and stimulation electrode 344 is external to thoracic duct 105, such as electrode 240 or a reference electrode on implantable medical device 310. In one embodiment, the target region is approximately between stimulation electrodes 342 and 344.
  • [0038]
    In various embodiments, the target region includes one or more components of the nervous system that are adjacent to the thoracic duct in the posterior mediastinal region or abdominal region. Examples of the target region include the sympathetic nerves, the parasympathetic nerves (including the vagus nerve), the phrenic nerve, the spinal cord, the brain stem, the renal nerves, and the baroreceptors in the carotid artery and aorta. In one embodiment, cardiac functions are regulated by applying neural stimulation including one or more of sympathetic excitation, sympathetic inhibition, parasympathetic excitation, and parasympathetic inhibition. One example of a system capable of providing excitatory stimulation and inhibitory stimulation to both sympathetic nerves and parasympathetic nerves is discussed in U.S. patent application Ser. No. 11/124,791, entitled “METHOD AND APPARATUS FOR CONTROLLING AUTONOMIC BALANCE USING NEURAL STIMULATION,” filed on May 9, 2005, assigned to Cardiac Pacemakers, Inc., which is incorporated herein by reference in its entirety.
  • [0039]
    For illustration purposes, FIG. 3 shows the pair of stimulation electrodes 342 and 344. In various embodiments, neural stimulation circuit 346 delivers neural stimulation pulses through one or more pairs of stimulation electrodes selected from a plurality of stimulation electrodes. In one embodiment, neural stimulation circuit 346 includes two or more stimulation output channels each delivering neural stimulation pulses through a pair of stimulation electrodes. In another embodiment, an electrode array with a plurality of stimulation electrodes is placed in the thoracic duct, and one or more stimulation electrodes are selected for delivering neural stimulation pulses by testing the physiological effect of stimulation associated with each stimulation electrode.
  • [0040]
    FIG. 4 is a block diagram illustrating an embodiment of an implantable medical device 410, which is another specific embodiment of implantable medical device 110. Implantable medical device 410 includes neural stimulation circuit 346, a sensing circuit 452, an implant control circuit 448, and an implant telemetry circuit 458. One or more physiological sensors 450 are housed within implantable medical device 410, incorporated onto implantable medical device 410, and/or connected to implantable medical device 410 using a lead.
  • [0041]
    Physiological sensor(s) 450 sense one or more physiological signals indicative of neural function and/or physiological functions regulated by the components of the nervous system to be stimulated. Sensing circuit 452 processes the one or more physiological signals and produces signals indicative of a need to start, stop, or adjust the neural stimulation. Examples of such physiological signals include signals indicative of heart rate, heart rate variability (HRV), and blood pressure. In one embodiment, physiological sensor(s) 450 include one or both of stimulation electrodes 342 and 344, which are utilized as sensing electrodes.
  • [0042]
    Implant control circuit 448 is a specific embodiment of implant control circuit 348 and controls the delivery of the neural stimulation pulses from neural stimulation circuit 346 using a plurality of stimulation parameters. Implant control circuit 448 includes a parameter storage circuit 454 and a parameter receiver 456. Parameter storage circuit 454 stores values of the plurality of stimulation parameters. Examples of such stimulation parameters include pulse amplitude, pulse width, and pulse frequency (or inter-pulse interval). The values of the plurality of stimulation parameters are adjustable. Parameter receiver 456 receives values of the plurality of stimulation parameters and updates parameter storage circuit 454 with the received values. In one embodiment, implant control circuit 448 controls the delivery of the neural stimulation pulses from neural stimulation circuit 346 using one or more physiological signals sensed by physiological sensor(s) 450. In various embodiments, each sensed physiological signal is used as one or more of a triggering signal to start or stop the neural stimulation, a safety assurance signal to start, stop, or adjust the intensity of the neural stimulation, and a feedback signal to provide closed-loop neural stimulation.
  • [0043]
    Implant telemetry circuit 458 transmits and receives data via telemetry link 125. In one embodiment, the values of the plurality of stimulation parameters are externally programmable, and the programmed values are received from external system 130 through telemetry link 125.
  • [0044]
    FIG. 5 is a block diagram illustrating an implantable medical device 510, which is a specific embodiment of implantable medical device 410. Implantable medical device 510 includes neural stimulation circuit 346, a neural sensing circuit 552, an implant control circuit 548, and implant telemetry circuit 458.
  • [0045]
    Neural sensing circuit 552 is a specific embodiment of sensing circuit 452 and processes a neural signal sensed using neural sensing electrodes 562 and 564, which represent a specific embodiment of physiological sensor(s) 450. In one embodiment, neural sensing circuit 552 processes two or more neural signals sensed using additional neural sensing electrodes. In one embodiment, the neural signal is sensed from the same site to which the neural stimulation pulses are delivered, and stimulation electrodes 342 and 344 are used as neural sensing electrodes 562 and 564. In other words, stimulation electrodes 342 and 344 and neural sensing electrodes 562 and 564 are physically the same pair of electrodes. In another embodiment, the neural signal is sensed from a site different from the site to which the neural stimulation pulses are delivered. At least one of stimulation electrodes 342 and 344 is not used as any of neural sensing electrodes 562 and 564.
  • [0046]
    Implant control circuit 548 is a specific embodiment of implant control circuit 448 and includes a closed-loop controller 560, parameter storage circuit 454, and parameter receiver 456. Implant control circuit 548 controls the delivery of the neural stimulation pulses from neural stimulation circuit 346 using a plurality of stimulation parameters and the sensed and processed neural signal. Closed-loop controller 560 controls the delivery of the neural stimulation pulses using the sensed and processed neural signal as an input for feedback control. Examples of closed-loop neural stimulation are discussed in U.S. patent application Ser. No. 11/280,940, entitled “SYSTEM AND METHOD FOR CLOSED-LOOP NEURAL STIMULATION,” filed on Nov. 16, 2005, assigned to Cardiac Pacemakers, Inc., which is incorporated herein by reference in its entirety.
  • [0047]
    FIG. 6 is a block diagram illustrating an embodiment of an external system 630, which is a specific embodiment of external system 130. External system 630 includes an external telemetry circuit 670, an external controller 672, and a user interface 674. External telemetry circuit 670 transmits and receives data via telemetry link 125. External controller 672 controls the operation of external system 630. User interface 674 allows a user such as a physician or other caregiver to communicate with implantable medical device 110 through external system 630. User interface 674 includes a presentation device 676 and a user input device 678. User input device 678 allows for the programming of the values of the plurality of stimulation parameters. In one embodiment, presentation device 676 and user input device 678 are integrated or partially integrated to include an interactive screen allowing for programming of implantable medical device 110.
  • [0048]
    In one embodiment, external system 630 includes a programmer. In another embodiment, external system 630 includes a patient management system as discussed below with reference to FIG. 7.
  • [0049]
    FIG. 7 a block diagram illustrating an embodiment of an external system 730, which is a specific embodiment of external system 630. As illustrated in FIG. 7, external system 730 is a patient management system including an external device 780, a telecommunication network 782, and a remote device 784. External device 780 is placed within the vicinity of implantable medical device 110 and includes external telemetry system 670 to communicate with the implantable medical device via telemetry link 125. Remote device 784 is in a remote location and communicates with external device 780 through network 782. Remote device 784 includes user interface 674 to allow the physician or other caregiver to monitor and treat a patient from a distant location and/or allowing access to various treatment resources from the remote location.
  • [0050]
    FIG. 8 is a flow chart illustrating a method for delivering neural stimulation via the thoracic duct. In one embodiment, the method is performed using system 100 or system 200, including the various embodiments of their components discussed above.
  • [0051]
    A neural stimulation lead is inserted into a lymphatic vessel of a patient at 800. In one embodiment, this lymphatic vessel is the thoracic duct. The neural stimulation lead is an implantable transluminal lead having a proximal end configured for connection to an implantable medical device and a distal end including one or more stimulation electrodes. To insert the neural stimulation lead into the thoracic duct such that neural stimulation pulses can be delivered through the stimulation electrode(s), an opening is made on the subclavian vein, upstream from the junction of the subclavian vein and the ostium of the thoracic duct. The distal end of the neural stimulation lead is inserted into the subclavian vein through the opening and advanced toward the junction of the subclavian vein and the ostium of the thoracic duct downstream. Then, the neural stimulation lead is guided into the thoracic duct and advanced in the thoracic duct until the distal end reaches a region determined by the target to which the neural stimulation pulses are delivered. Examples of the target region include any nerve of other components of the nervous system in the mediastinal or abdominal region, adjacent to the thoracic duct, such as sympathetic nerves, parasympathetic nerves including the vagus nerve, the phrenic nerve, renal nerves, the spinal cord, the brain stem, and baroreceptors in the carotid artery and aorta. In one embodiment, to further approach a desirable target region, the distal end of the neural stimulation lead is guided into a lymphatic vessel branching from the thoracic duct.
  • [0052]
    The stimulation electrode(s) of the neural stimulation lead are positioned in the lymphatic vessel, such as the thoracic duct or the lymphatic vessel branching from the thoracic duct, at 810. In one embodiment, after the distal end of the neural stimulation lead reaches the region determined by the target, test neural stimulation pulses are delivered. The distal end is moved in the thoracic duct or the lymphatic vessel branching from the thoracic duct until it reaches a position identified by detecting satisfactory responses to the stimulation, such as evoked neural signals and/or other anticipated physiological effects. The distal end with the stimulation electrode(s) is then stabilized in that position. In another embodiment, the neural stimulation lead includes a plurality of stimulation electrodes. After the neural stimulation lead is inserted, test neural stimulation pulses are delivered to different stimulation electrodes or different combinations of the stimulation electrodes, one at a time. A stimulation electrode or a combination of stimulation electrodes is identified for an intended therapy based on the responses to the stimulation, such as evoked neural signals and/or other anticipated physiological effects.
  • [0053]
    One or more physiological signals are sensed at 820. In one embodiment, at least one physiological signal is sensed to indicate a need to start, stop, or adjust the delivery of the neural stimulation. In another embodiment, at least one physiological signal is sensed for monitoring, diagnostic, and/or therapeutic purposes other then the neural stimulation. In one embodiment, one or more neural signals are sensed. In a specific embodiment, a neural signal is sensed from the nerve to which the neural stimulation is delivered. In another embodiment, one or more signals each indicative of a physiological function regulated by the stimulated nerve are sensed.
  • [0054]
    Neural stimulation pulses are delivered using the stimulation electrode(s) positioned in the lymphatic vessel, such as the thoracic duct or the lymphatic vessel branching from the thoracic duct, at 830. In one embodiment, the neural stimulation pulses are delivered through two stimulation electrodes positioned in the thoracic duct or the lymphatic vessel branching from the thoracic duct. In another embodiment, the neural stimulation pulses are delivered using a stimulation electrode positioned in the thoracic duct or the lymphatic vessel branching from the thoracic duct and another stimulation electrode positioned in a location in the body external to the lymphatic vessels. In a specific embodiment, the neural stimulation pulses are delivered to a portion of the nervous system approximately between a pair of stimulation electrodes. The delivery of the neural stimulation pulses is controlled using a plurality of stimulation parameters. Examples of the stimulation parameters include pulse amplitude, pulse width, and pulse frequency (or inter-pulse interval). These stimulation parameters are adjustable. In one embodiment, a user such as a physician or other caregiver programs one or more values of the plurality of stimulation parameters. In one embodiment, the delivery of the neural stimulation pulses are also controlled using the one or more physiological signals, including the one or more neural signals.
  • [0055]
    The neural stimulation pulses are delivered via the thoracic duct or the lymphatic vessel branching from the thoracic duct to treat one or more clinical conditions each associated with a physiological function regulated by a nerve or other component of the nervous system that is adjacent the thoracic duct or the lymphatic vessel branching from the thoracic duct. Examples of such clinical conditions include respiratory disorders, abnormal blood pressure, cardiac arrhythmias, myocardial infarction or ischemic insult (angina), heart failure, epilepsy, depression, renal disorders, pain, migraine, obesity, movement disorders, and incontinence. Specific examples of the treatment include (i) treatment of hypertension by baroreceptor stimulation, (ii) treatment of heart failure by sympathetic inhibition or vagal excitation; (iii) control of post-myocardial infarction remodeling by sympathetic inhibition or vagal excitation, (iv) mitigation of chronic pain by neural activation or blocking, (v) treatment of vascular pain including refractory angina and peripheral vascular diseases (PVD) by spinal cord stimulation, (vi) treatment of rachidian pain including failed back surgery syndrome (FBSS), degenerative low back leg pain (LBLP), nerve root lesions, incomplete spine lesions and spinal stenosis by spinal cord stimulation, (vii) treatment of type 1 or type 2 chronic regional pain syndrome (CRPS) by spinal cord stimulation, and (viii) treatment of perineal pain and urological diseases by spinal cord stimulation, and restoration of lower extremity motor functions such as standing and walking after spinal cord injury by ventral spinal cord stimulation.
  • [0056]
    FIGS. 9-13 illustrate, by way of example, various embodiments of an electrode assembly for placement in the lymphatic vessel to allow for the neural stimulation. The electrode assembly includes one or more electrode bases. One or more stimulation electrodes are incorporated onto and/or integrated with each of the one or more electrode bases. In one embodiment, the one or more electrode bases each are formed as portion of a lead such as lead 112. In one specific embodiment, an electrode base is formed at distal end 116 of lead 112, and stimulation electrodes 120 and 122 are on that electrode base. In another specific embodiment, one or more electrode bases are formed in elongate lead body 118 of lead 112. In another embodiment, electrode bases are formed at distal end 116 and elongate lead body 118 of lead 112 to provide for delivery of the neural stimulation pulses to multiple target regions.
  • [0057]
    FIG. 9 is an illustration of a lymphatic vessel 905 and a target region 907 in their natural state. Target region 907 is a region in the nervous system to which the neural stimulation pulses are delivered. As illustrated in FIG. 9, lymphatic vessel 905 and target region 907 are not in direct contact, or not constantly in direct contact, with each other in their natural state. Electrode assemblies illustrated in FIGS. 10-13 each cause and maintain a substantially constant and direct contact between lymphatic vessel 905 and target region 907 by substantially altering the natural path of lymphatic vessel 905. Such a substantially constant and direct contact allows for a reliable delivery of neural stimulation pulses from one or more electrodes in lymphatic vessel 905 to target region 907. In various embodiments, lymphatic vessel 905 represents one of the thoracic duct, a vessel branching from the thoracic duct, or any lymphatic vessel suitable for placement of the one or more electrodes for the delivery of the neural stimulation pulses.
  • [0058]
    FIG. 10 is an illustration of an embodiment of an electrode assembly including an electrode base 1021 configured to be implanted in lymphatic vessel 905 and a stimulation electrode 1020 on electrode base 1021. Electrode base 1021 has an elongate shape and includes a bias configured to cause a portion of lymphatic vessel 905 to substantially alter its natural path to contact target region 907. The bias also allows electrode 1020 to be in contact with the inner wall of lymphatic vessel 905 for delivering the neural stimulation pulses to target region 907. Electrode base 1021 has a stiffness allowing for stabilizing the position of stimulation electrode 1020 in lymphatic vessel 905 and maintaining the contact between the portion of lymphatic vessel 905 and target region 907 after implantation. In one embodiment, electrode base 1021 is in a helical form. In one embodiment, electrode base 1021 includes an elongate body having shape memory characteristics such that it returns to its preformed shape after the implantation procedure during which a stylet or guide wire may be used. The shape memory characteristics are provided by using a shape memory polymer such as polyether polyurethane or a shape memory metal. In one embodiment, the electrode assembly is coupled to implantable medical device 110 via a lead such as lead 112. In a specific embodiment, electrode base 1021 is formed at distal end 116 of lead 112, with stimulation electrode 1020 being stimulation electrode 120. In other specific embodiments, two or more stimulation electrodes are incorporated into electrode base 1021.
  • [0059]
    FIG. 11 is an illustration of an embodiment of another electrode assembly including an electrode base 1121 configured to be implanted in lymphatic vessel 905 and stimulation electrodes 1120 and 1122, both on electrode base 1121. Electrode base 1121 has an elongate shape and includes a bias configured to cause a portion of lymphatic vessel 905 to substantially alter its natural path to contact target region 907. The bias also allows electrodes 1120 and 1122 to be in contact with the inner wall of lymphatic vessel 905 for delivering the neural stimulation pulses to target region 907 using either or both of electrodes 1120 and 1122. Electrode base 1121 has the stiffness allowing for stabilizing the positions of stimulation electrodes 1120 and 1122 in lymphatic vessel 905 and maintaining the contact between the portion of lymphatic vessel 905 and target region 907 after implantation. In one embodiment, electrode base 1121 is in a helical form. In one embodiment, electrode base 1121 includes an elongate body having shape memory characteristics such that it returns to its preformed shape after the implantation procedure during which a stylet or guide wire may be used. The shape memory characteristics are provided by using a shape memory polymer such as polyether polyurethane or a shape memory metal. In one embodiment, the electrode assembly is coupled to implantable medical device 110 via a lead such as lead 112. In a specific embodiment, electrode base 1121 is formed at distal end 116 of lead 112, with stimulation electrodes 1120 and 1122 being stimulation electrodes 120 and 122. In other specific embodiments, one stimulation electrode, or three or more stimulation electrodes, are incorporated into electrode base 1121.
  • [0060]
    FIG. 12 is an illustration of an embodiment of another electrode assembly including an electrode base 1121 with stimulation electrodes 1120 and 1122 and another electrode base 1221 with stimulation electrodes 1220 and 1222. Electrode bases 1121 and 1221 are both configured to be implanted in lymphatic vessel 905. Electrode bases 1121 has the elongate shape and includes the bias configured to cause a portion of lymphatic vessel 905 to substantially alter its natural path to contact target region 907. The bias also allows electrodes 1120 and 1122 to be in contact with the inner wall of lymphatic vessel 905 for delivering neural stimulation pulses to target region 907 using either or both of electrodes 1120 and 1122. Electrode bases 1221 has an elongate shape and includes a bias configured to cause a portion of lymphatic vessel 905 to substantially alter its natural path to contact a target region 1207. The bias also allows electrodes 1220 and 1222 to be in contact with the inner wall of lymphatic vessel 905 for delivering neural stimulation pulses to target region 1207 using either or both of electrodes 1220 and 1222. Electrode bases 1121 and 1221 each have a stiffness allowing for stabilizing the positions of the stimulation electrodes in lymphatic vessel 905 and maintaining the contact between the portion of lymphatic vessel 905 and target region 907 after implantation. In one embodiment, electrode bases 1121 and 1221 are each in a helical form. In one embodiment, electrode bases 1121 and 1221 each include an elongate body having shape memory characteristics such that it returns to its preformed shape after the implantation procedure during which a stylet or guide wire may be used. The shape memory characteristics are provided by using a shape memory polymer such as polyether polyurethane or a shape memory metal. In one embodiment, the electrode assembly is coupled to implantable medical device 110 via a lead such as lead 112. In a specific embodiment, electrode base 1121 is formed at distal end 116 of lead 112, with stimulation electrodes 1120 and 1122 being stimulation electrodes 120 and 122, and electrode base 1221 is formed in elongate lead body 118 of lead 112. In other specific embodiments, one stimulation electrode, or three or more stimulation electrodes, are incorporated into each of electrode bases 1121 and 1221.
  • [0061]
    FIG. 13 is an illustration of an embodiment of another electrode assembly including an electrode base 1321 and a stimulation electrode 1320. Electrode base 1321 is expandable. After being expanded, electrode base 1321 causes a portion of lymphatic vessel 905 to substantially expand to contact target region 907. The expansion of electrode base 1321 also allows electrode 1320 to be in stable contact with the inner wall of lymphatic vessel 905 for delivering neural stimulation pulses to target region 907. In one embodiment, electrode base 1321 includes a stent that is expanded in the lymphatic vessel to maintain patency of the vessel. In one embodiment, stimulation electrode 1320 is incorporated into the stent. In another embodiment, the stent is made of metal and functions as stimulation electrode 1320. In another embodiment, stimulation electrode 1320 is integrated into the stent to be a portion of its structure. The stent also stabilize the position of stimulation electrode 1320 in lymphatic vessel 905 and prevents obstruction of the lymphatic flow. In one embodiment, the electrode assembly is coupled to implantable medical device 110 via a lead such as lead 112. In a specific embodiment, the stent is incorporated into distal end 116 of lead 112. In another embodiment, the stent is incorporated into elongate lead body 118 of lead 112. In another embodiment, two or more stents are incorporated into elongate lead body 118 and/or distal end 116 of lead 112.
  • [0062]
    It is to be understood that the above detailed description is intended to be illustrative, and not restrictive. Other embodiments will be apparent to those of skill in the art upon reading and understanding the above description. The scope of the invention should, therefore, be determined with reference to the appended claims, along with the full scope of equivalents to which such claims are entitled.
Citations de brevets
Brevet cité Date de dépôt Date de publication Déposant Titre
US3814080 *13 nov. 19724 juin 1974Becton Dickinson CoVessel cannulator and clamp for lymphangiography
US3916875 *2 janv. 19744 nov. 1975Toch HerbertLymph duct cannulation facilitator
US4792330 *13 juil. 198720 déc. 1988Lazarus Medical Innovations, Inc.Combination catheter and duct clamp apparatus and method
US5188104 *1 févr. 199123 févr. 1993Cyberonics, Inc.Treatment of eating disorders by nerve stimulation
US5263480 *7 août 199223 nov. 1993Cyberonics, Inc.Treatment of eating disorders by nerve stimulation
US5391143 *12 mars 199321 févr. 1995Kensey Nash CorporationMethod and system for effecting weight reduction of living beings
US5655548 *16 sept. 199612 août 1997Circulation, Inc.Method for treatment of ischemic heart disease by providing transvenous myocardial perfusion
US5865744 *16 sept. 19962 févr. 1999Lemelson; Jerome H.Method and system for delivering therapeutic agents
US6024704 *30 avr. 199815 févr. 2000Medtronic, IncImplantable medical device for sensing absolute blood pressure and barometric pressure
US6129685 *27 juin 199710 oct. 2000The University Of Iowa Research FoundationStereotactic hypothalamic obesity probe
US6272370 *7 août 19987 août 2001The Regents Of University Of MinnesotaMR-visible medical device for neurological interventions using nonlinear magnetic stereotaxis and a method imaging
US6292695 *17 juin 199918 sept. 2001Wilton W. Webster, Jr.Method and apparatus for transvascular treatment of tachycardia and fibrillation
US6368274 *8 mai 20009 avr. 2002Medtronic Minimed, Inc.Reusable analyte sensor site and method of using the same
US6370417 *22 sept. 19999 avr. 2002Siemens AkiengesellschaftMethod for positioning a catheter in a vessel, and device for implementing the method
US6475223 *20 juil. 19995 nov. 2002Stereotaxis, Inc.Method and apparatus for magnetically controlling motion direction of a mechanically pushed catheter
US6741882 *4 déc. 200025 mai 2004Koninklijke Philips Electronics N.V.MR device and MR method for localizing and/or visualizing a medical instrument provided with a passive magnet device
US6767686 *16 nov. 200127 juil. 2004Sumitomo Chemical Company, LimitedChemically amplifying type positive resist composition
US6804558 *18 janv. 200112 oct. 2004Medtronic, Inc.System and method of communicating between an implantable medical device and a remote computer system or health care provider
US20010041870 *31 mars 199915 nov. 2001Edward M. GillisImplantable device for access to a treatment site
US20020029037 *6 sept. 20017 mars 2002Kim Young D.Method and apparatus for percutaneous trans-endocardial reperfusion
US20020123674 *27 févr. 20025 sept. 2002Gianni PlicchiProcess and implantable device for the intrapulmonary assessing of density dependant physical properties of the lung tissue
US20020188253 *7 juin 200112 déc. 2002Pharmaspec CorporationMethod and apparatus for drug delivery in veins
US20030018247 *24 juil. 200123 janv. 2003George GonzalezProcess for testing and treating aberrant sensory afferents and motors efferents
US20030036773 *2 août 200220 févr. 2003Whitehurst Todd K.Systems and methods for treatment of coronary artery disease
US20030105506 *4 déc. 20015 juin 2003Cardiac Pacemakers, Inc.Apparatus and method for stabilizing an implantable lead
US20030113303 *28 oct. 200219 juin 2003Yitzhack SchwartzHoming of embryonic stem cells to a target zone in tissue using active therapeutics or substances
US20030204185 *26 avr. 200230 oct. 2003Sherman Marshall L.System and method for monitoring use of disposable catheters
US20040102804 *17 janv. 200327 mai 2004Chin Albert K.Apparatus and methods for endoscopic surgical procedures
US20040106953 *6 oct. 20033 juin 2004Yomtov Barry M.Medical device for controlled drug delivery and cardiac monitoring and/or stimulation
US20040158297 *2 févr. 200412 août 2004George GonzalezProcess for testing and treating motor and muscle function, sensory, autonomic, cognitive and neurologic disorders
US20040193229 *19 mai 200330 sept. 2004Medtronic, Inc.Gastric electrical stimulation for treatment of gastro-esophageal reflux disease
US20040210118 *18 avr. 200321 oct. 2004Michel LetortIn situ detection of endoleak and endotension
US20050043675 *21 août 200324 févr. 2005Pastore Joseph M.Method and apparatus for modulating cellular metabolism during post-ischemia or heart failure
US20050043894 *22 août 200324 févr. 2005Fernandez Dennis S.Integrated biosensor and simulation system for diagnosis and therapy
US20050049472 *29 août 20033 mars 2005Medtronic, Inc.Implantable biosensor devices for monitoring cardiac marker molecules
US20050075701 *8 avr. 20047 avr. 2005Medtronic, Inc.Device and method for attenuating an immune response
US20050075702 *8 avr. 20047 avr. 2005Medtronic, Inc.Device and method for inhibiting release of pro-inflammatory mediator
US20050143765 *12 oct. 200430 juin 2005Endoart SaTelemetrically controlled band for regulating functioning of a body organ or duct, and methods of making, implantation and use
US20050143787 *13 janv. 200530 juin 2005Boveja Birinder R.Method and system for providing electrical pulses for neuromodulation of vagus nerve(s), using rechargeable implanted pulse generator
US20050149014 *15 févr. 20057 juil. 2005Quantumcor, Inc.Cardiac valve leaflet attachment device and methods thereof
US20050149141 *30 janv. 20047 juil. 2005Starkebaum Warren L.Gastric stimulation for altered perception to treat obesity
US20050149142 *30 janv. 20047 juil. 2005Starkebaum Warren L.Gastric stimulation responsive to sensing feedback
US20050187584 *22 avr. 200525 août 2005Stephen DenkerVagal nerve stimulation using vascular implanted devices for treatment of atrial fibrillation
US20050240239 *29 juin 200527 oct. 2005Boveja Birinder RMethod and system for gastric ablation and gastric pacing to provide therapy for obesity, motility disorders, or to induce weight loss
US20050240243 *25 févr. 200527 oct. 2005Giancarlo BarolatSystem and method for neurological stimulation of peripheral nerves to treat low back pain
US20050267440 *1 juin 20051 déc. 2005Herman Stephen JDevices and methods for measuring and enhancing drug or analyte transport to/from medical implant
US20050288730 *13 mai 200529 déc. 2005Mark DeemMethods and apparatus for renal neuromodulation
US20060020333 *5 mai 200526 janv. 2006Lashinski Randall TMethod of in situ formation of translumenally deployable heart valve support
US20070021731 *27 juin 200625 janv. 2007Garibaldi Jeffrey MMethod of and apparatus for navigating medical devices in body lumens
US20070282382 *6 juin 20066 déc. 2007Shuros Allan CMethod and device for lymphatic system monitoring
US20070282386 *6 juin 20066 déc. 2007Shuros Allan CMethod and apparatus for gastrointestinal stimulation via the lymphatic system
US20070282390 *6 juin 20066 déc. 2007Shuros Allan CAmelioration of chronic pain by endolymphatic stimulation
US20080009719 *6 juin 200610 janv. 2008Shuros Allan CMethod and apparatus for introducing endolymphatic instrumentation
Référencé par
Brevet citant Date de dépôt Date de publication Déposant Titre
US75263376 juin 200628 avr. 2009Cardiac Pacemakers, Inc.Method and device for lymphatic system monitoring
US7734341 *6 juin 20068 juin 2010Cardiac Pacemakers, Inc.Method and apparatus for gastrointestinal stimulation via the lymphatic system
US78949066 juin 200622 févr. 2011Cardiac Pacemakers, Inc.Amelioration of chronic pain by endolymphatic stimulation
US81265386 juin 200628 févr. 2012Cardiac Pacemakers, Inc.Method and apparatus for introducing endolymphatic instrumentation
US813137113 avr. 20066 mars 2012Ardian, Inc.Methods and apparatus for monopolar renal neuromodulation
US813137219 mars 20076 mars 2012Ardian, Inc.Renal nerve stimulation method for treatment of patients
US814531625 juil. 200527 mars 2012Ardian, Inc.Methods and apparatus for renal neuromodulation
US81453176 mars 200627 mars 2012Ardian, Inc.Methods for renal neuromodulation
US81505183 juin 20053 avr. 2012Ardian, Inc.Renal nerve stimulation method and apparatus for treatment of patients
US81505196 mars 20063 avr. 2012Ardian, Inc.Methods and apparatus for bilateral renal neuromodulation
US81505206 mars 20063 avr. 2012Ardian, Inc.Methods for catheter-based renal denervation
US81757116 mars 20068 mai 2012Ardian, Inc.Methods for treating a condition or disease associated with cardio-renal function
US836994322 oct. 20095 févr. 2013Cardiac Pacemakers, Inc.Method and apparatus for neural stimulation via the lymphatic system
US843342313 déc. 201030 avr. 2013Ardian, Inc.Methods for multi-vessel renal neuromodulation
US845459411 août 20094 juin 2013Medtronic Ardian Luxembourg S.A.R.L.Apparatus for performing a non-continuous circumferential treatment of a body lumen
US854860014 sept. 20121 oct. 2013Medtronic Ardian Luxembourg S.A.R.L.Apparatuses for renal neuromodulation and associated systems and methods
US85510696 mars 20068 oct. 2013Medtronic Adrian Luxembourg S.a.r.l.Methods and apparatus for treating contrast nephropathy
US862042314 mars 201131 déc. 2013Medtronic Ardian Luxembourg S.A.R.L.Methods for thermal modulation of nerves contributing to renal function
US862630011 mars 20117 janv. 2014Medtronic Ardian Luxembourg S.A.R.L.Methods and apparatus for thermally-induced renal neuromodulation
US86849989 mars 20121 avr. 2014Medtronic Ardian Luxembourg S.A.R.L.Methods for inhibiting renal nerve activity
US872163712 juil. 201313 mai 2014Medtronic Ardian Luxembourg S.A.R.L.Methods and apparatus for performing renal neuromodulation via catheter apparatuses having inflatable balloons
US872813712 févr. 201320 mai 2014Medtronic Ardian Luxembourg S.A.R.L.Methods for thermally-induced renal neuromodulation
US872813812 févr. 201320 mai 2014Medtronic Ardian Luxembourg S.A.R.L.Methods for thermally-induced renal neuromodulation
US874089612 juil. 20133 juin 2014Medtronic Ardian Luxembourg S.A.R.L.Methods and apparatus for performing renal neuromodulation via catheter apparatuses having inflatable balloons
US876847011 mai 20101 juil. 2014Medtronic Ardian Luxembourg S.A.R.L.Methods for monitoring renal neuromodulation
US877125220 mai 20058 juil. 2014Medtronic Ardian Luxembourg S.A.R.L.Methods and devices for renal nerve blocking
US877491314 nov. 20068 juil. 2014Medtronic Ardian Luxembourg S.A.R.L.Methods and apparatus for intravasculary-induced neuromodulation
US877492221 mai 20138 juil. 2014Medtronic Ardian Luxembourg S.A.R.L.Catheter apparatuses having expandable balloons for renal neuromodulation and associated systems and methods
US878446312 févr. 201322 juil. 2014Medtronic Ardian Luxembourg S.A.R.L.Methods for thermally-induced renal neuromodulation
US880554516 avr. 201312 août 2014Medtronic Ardian Luxembourg S.A.R.L.Methods and apparatus for multi-vessel renal neuromodulation
US88185142 juil. 201326 août 2014Medtronic Ardian Luxembourg S.A.R.L.Methods for intravascularly-induced neuromodulation
US88456295 avr. 201030 sept. 2014Medtronic Ardian Luxembourg S.A.R.L.Ultrasound apparatuses for thermally-induced renal neuromodulation
US885216328 juin 20137 oct. 2014Medtronic Ardian Luxembourg S.A.R.L.Renal neuromodulation via drugs and neuromodulatory agents and associated systems and methods
US888018611 avr. 20134 nov. 2014Medtronic Ardian Luxembourg S.A.R.L.Renal neuromodulation for treatment of patients with chronic heart failure
US88978786 mai 201025 nov. 2014Cardiac Pacemakers, Inc.Method and apparatus for gastrointestinal stimulation via the lymphatic system
US89059991 sept. 20069 déc. 2014Cardiac Pacemakers, Inc.Method and apparatus for endolymphatic drug delivery
US893497822 avr. 201413 janv. 2015Medtronic Ardian Luxembourg S.A.R.L.Methods and apparatus for renal neuromodulation
US894886515 nov. 20133 févr. 2015Medtronic Ardian Luxembourg S.A.R.L.Methods for treating heart arrhythmia
US895887114 janv. 201117 févr. 2015Medtronic Ardian Luxembourg S.A.R.L.Methods and apparatus for pulsed electric field neuromodulation via an intra-to-extravascular approach
US89744457 janv. 201010 mars 2015Recor Medical, Inc.Methods and apparatus for treatment of cardiac valve insufficiency
US898359521 nov. 201317 mars 2015Medtronic Ardian Luxembourg S.A.R.L.Renal neuromodulation for treatment of patients with chronic heart failure
US89862944 févr. 201024 mars 2015Medtronic Ardian Luxembourg S.a.rl.Apparatuses for thermally-induced renal neuromodulation
US902303723 avr. 20135 mai 2015Medtronic Ardian Luxembourg S.A.R.L.Balloon catheter apparatus for renal neuromodulation
US903724413 févr. 200819 mai 2015Virender K. SharmaMethod and apparatus for electrical stimulation of the pancreatico-biliary system
US907252715 juil. 20137 juil. 2015Medtronic Ardian Luxembourg S.A.R.L.Apparatuses and methods for renal neuromodulation
US910804026 juin 201418 août 2015Medtronic Ardian Luxembourg S.A.R.L.Methods and apparatus for multi-vessel renal neuromodulation
US912566117 oct. 20138 sept. 2015Medtronic Ardian Luxembourg S.A.R.L.Methods and apparatus for renal neuromodulation
US913197823 avr. 201415 sept. 2015Medtronic Ardian Luxembourg S.A.R.L.Methods for bilateral renal neuromodulation
US913828123 sept. 201322 sept. 2015Medtronic Ardian Luxembourg S.A.R.L.Methods for bilateral renal neuromodulation via catheter apparatuses having expandable baskets
US918619814 sept. 201217 nov. 2015Medtronic Ardian Luxembourg S.A.R.L.Ultrasound apparatuses for thermally-induced renal neuromodulation and associated systems and methods
US918621315 mai 201417 nov. 2015Medtronic Ardian Luxembourg S.A.R.L.Methods for renal neuromodulation
US918651223 sept. 200917 nov. 2015Cardiac Pacemakers, Inc.Method and apparatus for organ specific inflammation monitoring
US919271521 mars 201424 nov. 2015Medtronic Ardian Luxembourg S.A.R.L.Methods for renal nerve blocking
US20070282382 *6 juin 20066 déc. 2007Shuros Allan CMethod and device for lymphatic system monitoring
US20080195171 *13 févr. 200814 août 2008Sharma Virender KMethod and Apparatus for Electrical Stimulation of the Pancreatico-Biliary System
US20080234556 *20 mars 200725 sept. 2008Cardiac Pacemakers, Inc.Method and apparatus for sensing respiratory activities using sensor in lymphatic system
US20100076279 *25 mars 2010Shuros Allan CMethod and apparatus for organ specific inflammation monitoring
US20100228310 *9 sept. 2010Shuros Allan CSystems and methods for autonomic nerve modulation
US20100256700 *6 avr. 20107 oct. 2010Shuros Allan CMethod and apparatus for organ specific inflammation therapy
WO2010104700A1 *2 mars 201016 sept. 2010Cardiac Pacemakers, Inc.Systems for autonomic nerve modulation comprising electrodes implantable in a lymphatic vessel
Classifications
Classification aux États-Unis607/2
Classification internationaleA61N1/32
Classification coopérativeA61N1/36114
Classification européenneA61N1/36Z3J
Événements juridiques
DateCodeÉvénementDescription
11 août 2006ASAssignment
Owner name: CARDIAC PACEMAKERS, INC., MINNESOTA
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:SHUROS, ALLAN C.;WESTLUND, RANDY;CAPARSO, ANTHONY V.;REEL/FRAME:018097/0583;SIGNING DATES FROM 20060714 TO 20060717