Method and apparatus for location and temperature specific drug action such as thrombolysis

Abstract

A method is provided of localizing a drug action where the drug is present throughout a vascular system. The localization occurs to within a volume of blood in a blood vessel, the vascular system having an initial temperature substantially within a first temperature range. A temperature-specific enzyme is delivered throughout a vascular system including a volume of blood in a blood vessel, the temperature-specific enzyme having a working temperature within a prespecified temperature range that does not substantially overlap the first temperature range. A heat transfer element is delivered to a blood vessel in fluid communication with the volume of blood. The temperature of the heat transfer element is adjusted such that the volume of blood in the blood vessel is heated or cooled to the prespecified temperature range. In this way, the action of the temperature-specific enzyme is substantially limited to the volume of blood heated or cooled. In an alternative embodiment, the temperature-specific enzyme is localized to the volume of blood in the blood vessel, and the heat transfer element is disposed in fluid communication with the volume of blood in the blood vessel. The enzyme localization may occur by way of direct injection or by way of injection through a lumen of a catheter. The injection lumen of the catheter may be disposed at least partially adjacent or in combination with the heat transfer element and its associated inlet and outlet lumens.

Description

[0001] This application is a divisional of U.S. patent application Ser. No. 09 / 232,177, filed Jan. 15, 1999, and entitled "Method and Apparatus for Location and Temperature Specific Drug Action Such as Thrombolysis", which is a continuation-in-part patent application of co-pending U.S. patent application Ser. No. 09 / 215,039, filed Dec. 16, 1998, and entitled "Method for Low Temperature Thrombolysis and Low Temperature Thrombolytic Agent with Selective Organ Temperature Control"; U.S. patent application Ser. No. 09 / 215,040, filed Dec. 16, 1998, and entitled "Method and Device for Applications of Selective Organ Cooling"; U.S. patent application Ser. No. 09 / 103,342, filed Jun. 23, 1998, and entitled "Selective Organ Cooling Catheter and Method of Using the Same"; U.S. patent application Ser. No. 09 / 047,012, filed Mar. 24, 1998, and entitled "Selective Organ Hypothermia Method and Apparatus"; and U.S. patent application Ser. No. 09 / 052,545, filed Mar. 31, 1998, and entitled "Circulatin...

AI Technical Summary

Problems solved by technology

However, the use of total body hypothermia risks certain deleterious systematic vascular effects.

For example, total body hypothermia may cause severe derangement of the cardiovascular system, including low cardiac output, elevated systematic resistance, and ventricular fibrillation.

Other side effects include renal failure, disseminated intravascular coagulation, and electrolyte disturbances.

In addition to the undesirable side effects, total body hypothermia is difficult to administer.

However, use of the Dato device implicates the negative effects of total body hypothermia described above.

However, such methods rely on conductive heat transfer through the skull and into the brain.

One drawback of using conductive heat transfer is that the process of reducing the temperature of the brain is prolonged.

Also, it is difficult to precisely control the temperature of the brain when using conduction due to the temperature gradient that must be established externally in order to sufficiently lower the internal temperature.

In addition, when using conduction to cool the brain, the face of the patient is also subjected to severe hypothermia, increasing discomfort and the likelihood of negative side effects.

It is known that profound cooling of the face can cause similar cardiovascular side effects as total body cooling.

From a practical standpoint, such devices are cumbersome and may make continued treatment of the patient difficult or impossible.

However, external circulation of blood is not a practical approach for treating humans because the risk of infection, need for anticoagulation, and risk of bleeding is too great.

Further, this method requires cannulation of two vessels making it more cumbersome to perform particularly in emergency settings.

Even more, percutaneous cannulation of the carotid artery is difficult and potentially fatal due to the associated arterial wall trauma.

Finally, this method would be ineffective to cool other organs, such as the kidneys, because the feeding arteries cannot be directly cannulated percutaneously.

Perfusion of a cold solution has a number of drawbacks, including a limited time of administration due to excessive volume accumulation, cost, and inconvenience of maintaining the perfusate and lack of effectiveness due to the temperature dilution from the blood.

Temperature dilution by the blood is a particular problem in high blood flow organs such as the brain.

Drug administration is occasionally problematic as some sensitive patients encounter adverse reactions to drugs.

Moreover, there is a risk of hemorrhage when these drugs are given intravenously.

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