|OA TAI EI US009855317B2TO KAMARRATU WA KITU (12 ) United States Patent ( 10 ) Patent No. : US 9 , 855 ,317 B2 Bright (45 ) Date of Patent: Jan . 2 , 2018 ( 54 ) SYSTEMS AND METHODS FOR ( 56 ) References Cited SYMPATHETIC CARDIOPULMONARY NEUROMODULATION U . S . PATENT DOCUMENTS 4 ,029 ,793 A 6 / 1977 Adams et al. (71 ) Applicant : Reflex Medical, Inc. , Los Altos Hills , 4 , 582 , 865 A 4 / 1986 Balazs et al. CA (US ) 6 , 545, 067 B1 4 / 2003 Büchner et al. 6 , 746, 464 B1 6 / 2004 Makower 6 , 932, 971 B2 8 / 2005 Bachmann et al. ( 72 ) Inventor: Corinne Bright , Los Altos Hills , CA 6 , 937 , 896 B1 8 / 2005 Kroll (US ) 7 , 928 ,141 B2 4 / 2011 Li 8 , 175 , 711 B2 5 / 2012 Demarais et al . ( 73 ) Assignee : Reflex Medical , Inc ., Los Altos Hills , 8 , 206 , 299 B2 6 / 2012 Foley et al . 8 , 211 , 017 B2 7 / 2012 Foley et al . CA (US ) 8 ,465 , 752 B2 6 / 2013 Seward 8 , 480, 651 B2 7 / 2013 Abuzaina et al . ( * ) Notice : Subject to any disclaimer, the term of this 8 , 708, 995 B2 4 / 2014 Seward et al. patent is extended or adjusted under 35 9 , 011 , 879 B2 4 / 2015 Seward U . S . C . 154 (b ) by 0 days. 9 , 199 ,065 B2 12 /2015 Seward 2002 /0037919 AL 3 / 2002 Hunter 2005 /0228460 A110 / 2005 Levin et al . ( 21 ) Appl. No. : 15 /140 ,254 2005 /0261672 AL 11 /2005 Deem et al . (22 ) Filed : Apr. 27 , 2016 2006 /0280797 Al 12 /2006 Shoichet et al. (Continued ) (65 ) Prior Publication Data US 2016 /0317621 A1 Nov . 3 , 2016 FOREIGN PATENT DOCUMENTS WO WO 2013165714 * 7 /2013 Related U . S . Application Data OTHER PUBLICATIONS (60 ) Provisional application No . 62 / 179, 027 , filed on Apr. Boezaart 2008 " atlas of peripheral nerve blocks and anatomy for 27 , 2015 . orthopaedic anesthesia ” p . 218published by Elsevier health sci (51 ) Int. CI. ences . * A61K 38 /21 ( 2006 .01 ) (Continued ) A61K 45 /06 ( 2006 .01 ) A61K 31 /55 ( 2006 .01 ) A61B 18 / 14 ( 2006 .01 ) Primary Examiner — Adam Weidner A61B 8 /08 ( 2006 .01 ) ( 74 ) Attorney , Agent, or Firm — Knobbe Martens, Olson A61N 5 / 02 ( 2006 . 01 ) & Bear, LLP A61N 7/ 02 ( 2006 .01 ) A61B 90 / 30 ( 2016 . 01 ) A61B 17 /34 ( 2006 .01 ) (57 ) ABSTRACT A61B 8 / 12 ( 2006 . 01 ) A61B 18 / 18 ( 2006 .01 ) Methods, devices and systems are described for decreasing A61K 31/ 4422 ( 2006 .01 ) the activity of the sympathetic nervous innervation to and A61K 31 /475 ( 2006 . 01) from the lungs and the vessels supplying the lungs to treat A61B 18 /00 ( 2006 .01 ) pulmonary medical conditions such as asthma. In one (52 ) U .S . CI. embodiment, the method may involve advancing an intra CPC . .. .. .. A61K 38 /217 ( 2013 .01 ) ; A61B 8 / 12 ( 2013 . 01 ) ; A61B 173403 ( 2013 .01 ) ; A61B vascular instrument to a target location in a blood vessel 18 / 1492 ( 2013 .01 ) ; A61B 18 / 1815 ( 2013 . 01 ) ; within the intercostal vasculature to ablate either or both the A61B 90 / 30 ( 2016 . 02 ) ; A61K 31/ 4422 sympathetic afferent and efferent nerves lying within the ( 2013 .01 ) ; A61K 31/ 475 ( 2013 . 01 ) ; A61K paravertebral gutter including the visceral fibers that travel 31/ 55 (2013 . 01 ) ; A61K 45 / 06 ( 2013 .01 ) ; A61N to the cardiothoracic cavity and abdominopelvic viscera and 5 / 022 ( 2013 .01 ) ; A61N 7 / 02 (2013 .01 ) ; A61B the T1 to T4 / 5 sympathetic chain . In another embodiment , 8 /0808 ( 2013 . 01 ) ; A61B 2017 / 3413 ( 2013 . 01 ) ; an intravascular instrument may be advanced to the bron A61B 2018 / 0022 ( 2013 .01 ) ; A61B 2018 / 00023 ( 2013 .01 ) ; A61B 2018 / 0044 ( 2013 .01 ) ; A61B chial vessels to ablate either or both the sympathetic afferent 2018 / 00434 ( 2013 .01 ) ; A61B 2018 /00577 and efferent nerves in and around the posterior pulmonary ( 2013 .01 ) ; A61B 2018 / 1861 (2013 . 01) ; A61B plexus. In one embodiment the ablative agent is a neurolytic 2018 / 1869 (2013 .01 ) ; A61B 2090 /306 agent delivered in a gel . This approach may be utilized to ( 2016 .02 ) treat other cardiac and pulmonary diseases. (58 ) Field of Classification Search None See application file for complete search history . 18 Claims, 17 Drawing Sheets US 9 ,855 ,317 B2 Page 2 ( 56 ) References Cited Dimitrov - Szokodi, D . , G . Balogh , et al . ( 1957 ) . “ Lung denervation in the therapy of intractable bronchial asthma. 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