CN103813745A - 用以可视化、对准和消融神经的经皮装置及方法 - Google Patents

用以可视化、对准和消融神经的经皮装置及方法 Download PDF

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CN103813745A
CN103813745A CN201280045755.2A CN201280045755A CN103813745A CN 103813745 A CN103813745 A CN 103813745A CN 201280045755 A CN201280045755 A CN 201280045755A CN 103813745 A CN103813745 A CN 103813745A
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T.朔伊尔曼
张达人
R.N.哈斯廷斯
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Boston Scientific Scimed Inc
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Abstract

公开了一种用于识别神经组织的设备和用于制作和使用所述设备的方法。示例性设备可包括长形轴（124），其具有构造成经皮配置在患者内的远侧区（120）。有效成像结构（112，114）可设置在远侧区上。有效成像结构可构造成通过从经皮位置在神经组织中激发信号且从经皮位置接收信号来使神经组织远程地成像。有效成像结构可包括一个或多个探针（102）。

Description

用以可视化、对准和消融神经的经皮装置及方法
相关申请的交叉引用
本申请基于35 U.S.C. $ 1 19请求享有2011年7月20日提交的美国临时专利申请序列第61/509,954号的优先权，该申请的全部内容通过引用并入本文中。
技术领域
本发明涉及用于可视化、对准和消融包括交感神经活动分裂的神经的系统及方法。本发明的一些实施例涉及用于通过神经调制来改善肾和/或心脏功能的系统及方法。
背景技术
神经调制疗法如神经消融对于某些情况有益。例如，与充血性心力衰竭有关的肾交感神经活动可引起不期望的症状，如流体潴留。中断该交感神经活动可缓解这些症状。用于中断肾交感神经活动的一种技术在于消融部分地围绕肾动脉设置的交感神经。典型肾神经消融疗法涉及将消融导管引入肾动脉中，以及在沿动脉的各种纵向和径向位置处消融动脉。该程序在没有识别神经组织的特定位置或识别神经组织的情况下完成。
发明内容
能够识别神经组织可允许更有针对性且因此较少创伤的疗法。识别神经组织的疗法连同(即，之前、期间和/或之后)神经调制技术（如消融）可用于此类肾程序以及在身体别处的程序。
一个实施例属于一种用于经皮识别神经组织的设备，其包括用于经皮配置的长形轴，以及设置在长形轴的远侧区上的有效成像结构。成像结构可构造成通过从经皮位置在神经组织中激发信号且从经皮位置接收信号来使神经组织远程地成像。成像结构可包括用于激发信号的第一经皮探针和用于接收信号的第二经皮探针，或可包括既激发且又接收信号的单个经皮探针。在另一个备选方案中，信号激发可通过体外装置提供，且探针可接收由体外探针激发的信号。
长形轴还可包括在远侧区中的固定元件，固定元件具有收缩构造和膨胀构造。此类固定元件的实例包括可充胀的气囊和自膨胀支架状结构。一个或多个探针可安装在远侧区处的模块上，且模块可相对于长形轴旋转和/或沿纵向和/或径向移动。模块可位于固定元件内，在此情况下，模块也可相对于固定元件旋转或沿纵向或沿径向移动。促动装置可操作地连接到模块上来提供此类移动。
探针可为声光传感器，其包括射频发射器，如，发光体和换能器的相控阵。发光体可构造成朝限定位置发射光，且关于探针改变发射的强度和发射的位置。发光体可包括元件，其可发射离散光脉冲，且可包括可发射相干光的发光元件的相控阵。信号处理器优选为可操作地连接到探针上。信号处理器可用于处理来自于探针的信号，且可结合探针使用来使神经组织成像，且可构造成使用来自于探针的信号来测量温度。
长形轴还可包括远侧区中的神经调制元件，例如，如消融元件。消融元件优选为构造成将能量聚焦在离神经调制元件一定距离处，使得能量可穿过第一组织来调制神经组织。神经调制元件可为超声波消融元件，且可构造成消融神经组织。
一个实施例属于一种神经调制方法，其包括的步骤有从身体中的经皮位置识别待调制的神经组织和从经皮位置改变神经组织。待识别的神经组织可与进行识别的探针间隔开，且可通过介入组织与探针间隔开。该方法还可包括在神经组织的调制期间识别精神组织的变化如温度变化的步骤。
在该方法的一些变型中，优选为使神经组织染色或在其它情况下由神经组织吸收的染料引入相关区中。因此，神经组织的识别可由该染料协助，染料可比神经组织自身对激发信号响应更大。在识别期间待使用的一种构想出的传感器为声光传感器。
神经组织的调制可通过与神经组织间隔开的探针来完成。能量可非破坏地穿过第一组织来集中在神经组织上以对准和消融神经组织。包括换能器的相控阵的超声波消融体可用于聚焦超声波能量来用于神经调制。
在上文所述的实施例的结构内，且从这些实施例扩展，构想出了多种备选方案。下文将描述这些备选实施例的元件。
例如，长形轴可为构造成用于经皮配置的导管、触针或针。激发探针可为单独元件，其为另一个经皮部件，或在设计成在体外且结合长形轴上的接收探针使用的部件上。大体上，该设备可构造成用以经皮配置、血管内配置或经由天然或人工的任何身体开口或内腔配置。
探针可构造成优选在神经组织中激发信号，同时在其它身体组织如血管壁的非神经组织中大致不激发信号。为了优选地激发此类信号，探针可构造成在光谱的适合部分中如在光谱的红外区、近红外区、可见光区或紫外区中发射光、相干光或激光，且因此可从神经组织激发荧光或其它返回信号。
在一些构造中，设备可与已经施加到相关区中的染料一起工作。染料可为优选为使神经组织中发现的较大浓度的神经组织或分子染色且优选为不使非神经组织染色的染料，探针可激发来自于此类染料的荧光。相反，染料可为优选为避开神经组织的染料。当通过发荧光或其它手段来从此类染料激发图像时，探针因此可产生神经组织的一种负像。
探针可构造成接收光信号或声信号。在一些情况下，激发信号为光信号，如激光，且接收信号为光信号。在一些情况下，激发信号为光信号，如，激光或RF信号，且接收信号为声信号(例如，声光)。在一些情况下，激发信号为声信号，且接收信号为声信号(例如，超声波)。
当探针构造成生成声信号时，信号可为超声波信号。超声波信号可具有小于100MHz的频率，或小于90MHz的频率，或小于80MHz的频率，且还可具有大于20MHz的频率或大于40MHz的频率，或大于60MHz的频率，或具有其它适合的频率。探针还可用于生成适用于消融的超声波频率。
设备大体上可包括联接到探针和联接到接收器探针的驱动器电子装置。可存在控制器，控制器联接到驱动器电子装置上，且构造成控制探针的触动。
在一些情况下，探针可包括发射体的相控阵，且控制器可构造成控制发射体的相控阵中的各个发射体的触动。控制器可构造成通过相控阵中的独立发射体的选择性和定时的触动来以电子方式调整发射体的相控阵的焦点深度。发射体的相控阵的焦点的位置可以以类似方式调整。例如，控制可构造成相对于导管纵向地移动发射体的相控阵的焦点，且/或构造成相对于导管径向地移动发射体的相控阵的焦点。此外，控制器可调整焦点的角定向。
接收探针可包括可操作地连接到控制器上的接收单元的相控阵。接收元件的相控阵的焦点的焦点深度、径向、纵向和角向位置可通过控制器调整。发射体、接收元件和/或统一的探针元件可为换能器或适于使用的感测技术的其它元件。
设备可包括探针促动器，其用于使导管上的探针径向地和/或纵向地和/或旋转地移动。此外，任何相控阵都可包括用于独立地调整相控阵中的元件的多个元件促动器。
设备还可包括定位元件如定心元件，其将导管的远侧区固定在血管的中心或抵靠管壁。定位元件可包括气囊、非闭塞气囊如多叶气囊，或包括可膨胀的螺旋元件的气囊。气囊可具有透明的气囊壁，且可具有透明的膨胀流体。备选定位元件可为自膨胀定位元件，如，被偏压至膨胀状态的多个支柱或支架状元件。
探针可位于任何方便的位置。例如，探针可定位在定心元件的近端与远端之间，定心元件的远端的远侧，或定心元件的近端的近侧。探针和接收探针可沿导管的纵轴线纵向地重叠。
一些实施例还包括设置在远侧区中的消融元件。消融元件可构造成通过产生能量来将能量聚焦在一定距离处，能量穿过第一身体组织且消融预定点处的第二身体组织。大体上，能量聚焦在预定点处，且因此在第一身体组织的区域中过于分散，以调制或以其它方式影响第一组织。消融元件可使用任何适合的消融技术如超声波、电磁能如射频、微波能、激光或低温能。大体上，超声波和光为与最适合结合将消融能量聚焦在一定距离来穿过介入组织的系统一起使用的技术。消融元件可包括能量元件阵列，其构造成协作使用来消融靶组织，如，换能器的相控阵。对于探针功能和消融功能有可能使用相同的换能器。相控阵具有焦点，焦点可如前文所述那样调整。
一个示例性实施例为针或其它经皮装置，其具有肾调制元件和感测元件，如超声波元件或声光元件，或声光元件的一部分。在声光元件的情况下，激发元件可在探针上，或可为单独的构件。肾神经调制元件可为超声波元件或其它适合的元件，如上文所述的那些或药物输送元件。
自然，上文所述的任何设备都可用于在使设备的远侧区经皮移动至相关区、激发信号和接收信号的方法中使用。此外步骤优选为包括处理接收信号，以及从设备传输接收到的信号，例如，通过将接收信号显示在电子显示器上。显示信号的方式包括将接收信号显示在图中或相关区的图像上。接收信号的通信还可包括提供可听指示。
探针可在触动探针激发信号时旋转地和/或纵向地移动穿过相关区。在一些实施例中，探针在将定位和/或固定元件移动至膨胀位置后移动，且探针关于定位元件移动。
探针的触动大体上包括激发神经组织中的信号。例如，信号可为神经组织发荧光或声信号。在一些方法中，优选为连结到神经组织上的染料设在相关区中。染料可经皮、血管内或经口提供，且可通过单独的注射系统提供。
探针的触动可包括生成光，如激光、紫外光、红外光或其它适合的光或射频能量，或生成超声波能量。超声波能量可以以小于大约100MHz或80MHz的频率下提供，且/或以大于20MHz、40MHz或60MHz的频率下提供。触动探针还可包括例如通过朝焦点发射能量来调制发射能量。人们可选择在离探针一定距离处的预定位置处的焦点，且发射能量来最大限度增大预定位置处的能量。人们可通过朝焦点发射能量同时改变焦点的特征来调制(例如，改变焦点与探针的径向距离、改变关于探针的纵向位置、改变关于探针的径向位置、改变焦点处的能量的强度、加宽焦点，或改变焦点处的能量的强度可包括增大或减小由探针发射的能量)。
接收信号的步骤可包括接收声波的步骤。控制器可用于有选择地处理接收的信号来确定与接收元件间隔开的位置处的组织的特征。例如，使用接收单元的相控阵，人们可集中于接收来自于远离相控阵间隔开的特定地点的信号。该位置可如上文所述那样改变，且可与激发信号的焦点同步。
在包括消融元件的那些实施例的情况下，方法还可包括触发消融元件的步骤。消融元件可具有上文的焦点类激发元件，且焦点可以以类似方式改变。人们可跟踪一定时间内的信号的变化，且识别信号中的差异。这可有助于识别任何消融的位置和消融程序的有效性。人们可在消融治疗之前使区域成像，且在有些情况下在消融程序期间继续区域的成像，或在消融治疗期间或之间间断地使区域成像。在一些方法中，人们可使用超声波信号来测量温度。人们因此可确定治疗位置，且然后在治疗位置处消融，且然后按期望重复该过程。
这些方法可使用身体的任何区中，包括但不限于，肾动脉、冠状动脉、静脉、降主动脉、器官、胃、结肠、气管或其它相关区域。
一些示例性实施例的以上概述并不旨在描述本发明的各个公开的实施例或每个实施方式。 
附图说明
连同附图来考虑各种实施例的以下详细描述可更完整地理解本发明的实施例，在附图中：
图1为示例性神经成像和调制导管的示图；
图2为示出在导管的远端处的细节的断面图；
图3A示出了原位的示例性导管的远端；
图3B示出了原位的图3A的示例性导管的远端。
尽管已经通过举例的方式在附图中示出且将详细描述其细节，但本发明易于进行各种改型和备选形式。然而，应当理解的是，并不旨在将本发明的方面限于所述特定实施例。相反，旨在覆盖落入本发明的精神和范围内的所有改型、等同方案和备选方案。 
具体实施方式
对于下文限定的用语，将应用这些定义，除非不同的定义在权利要求中或在此说明书的别处给出。
所有数值在本文中假定为通过用语"大约"修饰，而不论是否明显指出。用语"大约"大体上表示本领域的技术人员将所认为的等同于叙述的值(即，具有相同功能或结果)的数字范围。在许多情况下，用语"大约"可表示为包括四舍五入至最接近的有效数的数字。
由端点叙述的数字范围包括在该范围内的所有数字(例如，1到5包括1、1.5、2、2.75、3、3.80、4和5)。
尽管公开了适于各种构件、特征和/规格的一些适合的大小范围和/或值，但本领域的技术人员通过本公开内容的指导将理解期望的大小、范围和/或值可偏离明确公开的那些。
如本说明书和所附权利要求中使用的单数形式"一个"、"一种"和"该"包括复数对象，除非内容清楚地另外指出。如本说明书和所附权利要求中使用的用语"或"大体上以其包括"和/或"的意义使用，除非内容清楚地另外指出。
用语"优选"和"优选地"意思是修饰的元件关于其它元件不相称地影响。例如，短语"优选激发神经组织中的信号"意思是神经组织中的信号的激发大于其它组织中的。这相比于仅在神经组织中激发信号，这可被理解为意味着其它组织可同样被激发，或非优选地激发神经组织中的信号，这可被理解为意思是其它组织同样地被激发。
以下详细描述应当参照附图来阅读，其中不同的图中相似的元件标号相同。详细描述和不必成比例的附图绘出了示范性实施例，且不旨在限制本发明的范围。绘出的示范性实施例仅旨在为示例性的。任何示范性实施例的所选特征可并入附加实施例中，除非清楚地相反指出。
图1为示例性成像和神经调制导管100的示图，其可用于识别神经组织和向神经组织输送局部疗法。如一个实施例方式中所示，导管100包括远侧可充胀气囊部分102，其可被发送至患者内的治疗部位来成像和输送疗法至该治疗部位；近端104，其在治疗期间保留在患者外，且便于各种设备连接到导管100上；以及长形部件或导管轴106，其将近端设备联接到远侧可充胀气囊部分上。
导管的长形部件106可包括一个或多个内腔(图1中未示出)。内腔允许充胀流体从外部充胀流体源108向远侧输送至气囊102的内室。长形部件106还包括导体(未示出)，其从构件如感测元件(例如，感测元件112a/112b，这可在图2中看到)和气囊102中的消融元件(例如，消融元件114，这可在图2中看到)传送电信号至导管100的近端处的信号处理器110。
信号处理器110可处理电信号来使来自于感测元件112a/112b的信号电性地特征化。具体而言，在一些实施方式中，信号处理器110生成视觉显示，如，组织的等时图或等电位图，内科医生可使用视觉显示来识别身体组织中的位置处的异常电路径，这可为内科医生可使用来用于识别神经组织的神经调制或图的候选物。视觉显示可设在用户界面116(例如，平板显示器或其它适合的输出装置)中。
信号处理器110可包括电路，其用于接收声信号或光信号或生物电势信号(例如，感测生物电势信号且它们放大至可在进一步处理中使用的水平的差动放大器或其它放大器)，且以一种方式处理信号使得允许其随后的分析，例如，通过医学专业人员输送或考虑输送疗法至患者。
在一些实施方式中，信号处理器110包括专用电路(例如，离散逻辑元件和一个或多个微处理器；专用集成电路(ASIC)；或特别配置的可编程装置，例如，如，可编程逻辑装置(PLD)或现场可编程门阵列(FPGA))来用于处理生物电势信号和在用户界面中显示信号的图解表现。在一些实施方式中，信号处理器110包括通用微处理器和/或专用微处理器(例如，数字信号处理器或DSP，其可优化成用于处理图像或生物计量信息)，其执行指令来接收、分析和显示与接收信号相关联的信息。在此实施方式中，信号处理器110可包括程序指令，其在被执行时，执行信号处理的一部分。例如，程序指令可包括由微处理器或微控制器执行的固件、微代码或应用代码。上述实施方式仅为示例性的，且读者将认识到信号处理器110可采用任何适合的形式。
在近端处的控制器118可控制感测元件112a/112b和/或神经调制元件114来生成探针信号和/或治疗发射。在一些实施例中，单独的控制器可用于控制神经调制元件114。控制器118自身可采用许多不同形式。在一些实施方式中，控制器118为使用各种传感器、逻辑元件和促动器的专用电路。在其它实施方式中，控制器118为基于计算机的系统，其包括可编程元件如微控制器或微处理器，其可执行储存在对应的一个或多个存储器中的程序指令。此类基于计算机的系统可采用许多形式，包括输入和输出装置(例如，用户界面和与计算机系统相关联的其它常见输入和输出装置，如，键盘、指针装置、触摸屏、离散开关和控制器、打印机、网络连接、指示灯等)，且可与其它系统功能整体结合，如，监测设备、计算机网络、通常在程序期间使用的其它装置，等。例如，单个基于计算机的系统可包括处理器，其执行指令来提供控制器功能、显示与程序(例如，来自于成像装置)相关联的成像信息；显示压力、温度和时间信息(例如，自从开始治疗的给定阶段的过去的时间)；以及用作与导管100的总体接口。大体上，各种类型的控制器是可能的和可构想出的，且可使用任何适合的控制器118。此外，在一些实施方式中，控制器118和信号处理器110可为单个基于计算机的系统的一部分，且控制和信号处理功能两者可至少部分地通过在单个基于计算机的系统中执行程序指令来提供。
 图1中所示的导管100为线上类型的导管。此类导管100使用从导管100的远端延伸的导线120。在一些实施方式中，导线120可预先定位在患者身体内；一旦导线120适当定位，则气囊102(处于泄放状态)和长形部件106可在导线120上导送至治疗部位。在一些实施方式中，导管100的导线120和气囊部分102可在患者身体内一起前移至治疗部位，其中导线120按一定距离(例如，若干英寸)引导气囊102。当导线部分120达到治疗部位时，气囊102然后可在导线120上前移，直到其也到达治疗部位。还可构想出其它实施方式，如，不使用导线的可操纵的导管。此外，一些实施方式包括引入护套，其可类似于导线作用，且具体而言，其可首先前移到靶部位，此后其其它导管部分可前移穿过移入护套。
导管100可包括操纵器(未示出)，通过操纵器，执业医生可导引导线120和/或气囊102穿过患者身体到达治疗部位。在一些实施方式中，低温流体释放到冷却室中可使气囊102充胀至类似于图1中所示那样的形状。在其它实施例中，压力源108可独立于低温流体释放到气囊102的内腔中来使气囊102充胀。压力源108还可用于充胀导线120端部上的锚定部件(未示出)。
导管100包括用于连接到用户界面116、控制器118和信号处理器110上的连接器。用户界面可包括监测设备，例如，监测设备可用于监测导管100的远端处的温度或压力。如上文所述，监测设备可整体结合到单个系统中，该系统还提供控制器和信号处理器。为了有助于将导管100的气囊102定位在患者身体内，各种标记带(未示出)还可设置在导管100的远端和近端处。当通过X射线或其它成像技术来查看导管时，标记带可为不透辐射的。可构想出导管100中的其它变化。导线可不同于所示那样布置，且可从导管的气囊部分单独地控制。此外，在一些实施方式中，可不使用导线。
图2示出了气囊102的一些内部细节。气囊102包括气囊壁122，其可由聚合物形成，包括但不限于聚烯烃共聚物、聚酯、聚对苯二甲酸乙二醇酯、聚乙烯、聚醚嵌段酰胺、聚酰胺、聚酰亚胺、尼龙、乳胶或氨基甲酸乙酯。气囊壁122优选为透明的，且还优选为顺应性的。气囊102包括内模块124，其可承载感测元件112a/112b和神经调制元件114。内模块124可为圆柱形，且可相对于气囊可旋转地安装。电促动元件126可允许内模块124相对于气囊旋转。
感测元件112a/112b可构造成识别神经组织，且可包括声光元件、超声波元件、光传感器或其它适合的神经检测元件。
声光成像使用由样本产生的声波的物理现象，其使用电磁能来激励。大体上，使用高强度光脉冲或射频能量来照射组织。这些脉冲优选为较短的(1ns-100ns)。光脉冲的波长可变化，且在一些实施例中，可在大约400nm至500nm的范围内(例如，450nm)，或在一些其它实施例中，可为大约1200nm或更大。这些仅是实例。然后，宽带声波从照射体积内的组织中的能量吸收生成。短(例如，毫微秒)脉冲可生成高分辨率声音返回信号。声音返回信号可使用超声波检测器来检测，且随后被处理来提供空间构造以生成靶组织的图像。声音返回信号的强度关于相关光的脉冲的强度和波长，且还关于靶组织的局部光吸收系数。使用声光成像，有可能以高分辨率水平(例如，大约20微米至200微米的数量级)来在不同组织类型之间分辨。使用具有高光吸收系数的优选对比染料，声光成像技术可在细胞和分子水平上执行。
感测元件112a可构造成发射相干光脉冲(例如，具有大约400nm至500nm的范围内的波长，或具有大约1200nm或更大的波长)，且感测元件112b可构造成接收由神经组织中的相干光的脉冲生成的声信号。例如，传感器元件112a可为激光二极管，且传感器元件112b可为换能器。传感器元件112a优选为构造成将相干光聚焦在焦点处。焦点可为预定焦点或可为可动的。例如，焦点可通过使用各个传感器元件112a下的元件促动器(未示出)、通过将传感器元件112a用作相控阵，通过使用一个或多个透镜或其它适合的手段来移动。传感器元件112b(接收元件)可构造为相控阵，其允许元件或控制器118或信号处理器110确定反射信号来自何处。以此方式，包括穿过管壁的深度的三维图可产生，以识别神经组织的存在。
在一些实施例中，传感器元件112b还可测量温度和检测温度变化。在组织中生成的超声波信号为组织的材料性质的函数。相关性质为穿过随温度变化的材料的声速，以及材料随温度的热膨胀。这些性质随温度变化而变化，且以可预知的方式影响由组织生成的超声波。因此，信号处理器110可构造成测量组织深处的温度和/或检测组织中的温度变化。此类测量可用于随温度变化的神经调制技术来确定位置处的温度和那些位置处的组织经历特定温度的时间量。
优选附接到神经组织上或附接到神经组织中发现的较高浓度的分子上的染料可结合感测元件112使用。染料可具有预定频率下的高光吸收系数，且感测元件112a可发射该频率下的相干光。以此方式，系统对颜料和对应的神经组织的敏感性可加强，导致神经组织的更有效或更深的成像。此类染料可在将导管引入患者身体中之前通过单独的针注射到相关区域中，可通过导管的内腔引入身体脉管中，或可通过另一种适合的方式如局部地或经口地引入。
其它聚焦元件如通过引用以其全部公开内容并入本文中的共同拥有的美国专利申请序列第61/324,164号和/或美国专利申请公告第US 2011/0257523号中所述的那些，可结合任一感测元件112a,112b使用，或如下文所述结合消融元件114使用。
内模块124也包括消融元件114。作为优选，使用可在一定深度消融而不破裂介入组织的消融元件。此类消融元件可包括激光消融元件和超声波消融元件。在一些实施例中，感测元件112a或112b也可作用为消融元件。然而，还可使用其它消融元件如射频消融元件或低温消融元件。在图2中所示的实施例中，消融元件114为超声波消融元件，且为相控阵的形式，这允许消融元件在所选焦点深度处对准组织，且还可允许焦点被侧向地移动。
在使用中，导管可经皮地或在血管内配置到相关区，且气囊102可膨胀来在程序期间将导管的远端固定就位。气囊优选为可使用清晰的膨胀流体如盐水来膨胀。然后，感测元件112a/112b可被触动来产生优选识别神经组织的相关区的图像。例如，在肾动脉中，神经组织大体上位于2mm至8mm之间的深度处。内模块124可在成像期间旋转来产生气囊的所有侧上的身体脉管的图像来识别邻近气囊的区中的神经组织。一旦识别到神经组织，内模块可旋转来将消融元件114瞄准在神经组织处。神经组织然后可通过触动消融元件114来消融。消融元件114可聚焦来仅消融目标神经组织。
图3A示出了身体脉管内腔中的示例性导管200的远侧部分。导管200包括气囊102和模块124。模块124可使用促动元件126旋转。模块124包括超声波相控阵130和发光元件132。发光元件132发射短光脉冲134，其选择成优选地激发神经组织136。因此，任何神经组织136发射声波138，其可由超声波阵列130拾取。模块可在该过程期间旋转来识别相关区域的神经组织。如图3B中所示，一旦已经识别到神经组织，则超声波阵列可将消融能量140聚焦至焦点142来消融神经组织136。模块124可旋转来消融附加的神经组织。焦点的景深可取决于神经组织的深度和位置来改变。
本领域的技术人员将认识到本发明可体现为除本文描述和构想的特定实施例之外的多种形式。因此，可在不脱离如所附权利要求中描述的本发明的范围和精神的情况下产生形式和细节上的偏离。

Claims (15)

1.一种用于识别神经组织的设备，所述设备包括：
长形轴，其具有构造成经皮配置在患者内的远侧区；
设置在所述远侧区上的有效成像结构，所述有效成像结构构造成通过从经皮位置激发神经组织中的信号且从经皮位置接收所述信号来使神经组织远程地成像；以及
其中所述有效成像结构包括一个或多个探针。
2.根据权利要求1所述的设备，其特征在于，所述有效成像结构包括用于激发所述信号的第一经皮探针和用于接收所述信号的第二经皮探针。
3.根据权利要求1所述的设备，其特征在于，所述有效成像结构包括用于激发和接收所述信号的单个经皮探针。
4.根据权利要求1至权利要求3中任一项所述的设备，其特征在于，所述长形轴包括所述远侧区中的固定元件，所述固定元件具有收缩构造和膨胀构造。
5.根据权利要求4所述的设备，其特征在于，所述导管还包括设置在所述远侧区中的模块，以及其中所述一个或多个探针设置在所述模块上，且其中所述模块可相对于所述固定元件旋转。
6.根据权利要求5所述的设备，其特征在于，所述固定元件为可膨胀的气囊，以及所述模块设置在所述气囊的腔内。
7.根据权利要求1至权利要求6中任一项所述的设备，其特征在于，所述一个或多个探针包括声光传感器，所述声光传感器包括发光体和换能器的相控阵。
8.根据权利要求7所述的设备，其特征在于，所述发光体包括激光二极管。
9.根据权利要求7所述的设备，其特征在于，所述发光体构造成朝焦点发射相干光。
10.根据权利要求9所述的设备，其特征在于，所述发光体构造成改变所述焦点的焦点深度。
11.根据权利要求9所述的设备，其特征在于，所述发光体包括发光元件的相控阵。
12.根据权利要求1至权利要求11中任一项所述的设备，其特征在于，所述设备还包括构造成使用信号来测量温度的信号处理器。
13.根据权利要求1至权利要求12中任一项所述的设备，其特征在于，所述设备还包括消融元件，所述消融元件构造成将能量聚焦在离所述消融元件的一定距离处，使得能量可穿过第一组织来消融第二组织。
14.根据权利要求13所述的设备，其特征在于，所述消融元件为超声波消融元件。
15.一种用于有选择地识别和消融神经组织的医疗装置，所述装置包括：
具有远侧区的导管轴；
附接到所述远侧区上的气囊；
可旋转地设置在所述气囊内的模块，所述模块包括用于有选择地识别神经的成像部件和用于消融神经的消融部件。
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