Source: http://www.google.com/patents/US20070021796?dq=7,346,539
Timestamp: 2016-05-01 18:03:27
Document Index: 5976012

Matched Legal Cases: ['art 11', 'art 11', 'art 11', 'art 11', 'art 11', 'art 11', 'art 11', 'art 11', 'art 11']

Patent US20070021796 - Baroreflex modulation to gradually decrease blood pressure - Google PatentsSearch Images Maps Play YouTube News Gmail Drive More »Sign inPatentsThe present invention is a baroreceptor stimulator, including, a pulse generator to provide a baroreceptor stimulation signal through an electrode and a modulator to modulate the baroreceptor stimulation signal to increase the baroreceptor stimulation therapy by a predetermined rate of change to lower...http://www.google.com/patents/US20070021796?utm_source=gb-gplus-sharePatent US20070021796 - Baroreflex modulation to gradually decrease blood pressureAdvanced Patent SearchPublication numberUS20070021796 A1Publication typeApplicationApplication numberUS 11/482,225Publication dateJan 25, 2007Filing dateJul 7, 2006Priority dateSep 27, 2000Also published asUS7499742, US7813812, US8060206, US8712531, US8718789, US8880190, US9044609, US20040010303, US20070021790, US20070021792, US20070021794, US20070021797, US20070021798, US20070021799, US20070038255, US20070038262, US20070106340, US20080097540, US20080167694, US20090228065, US20100191303, US20100222831, US20110172734, US20120130447, US20120232613, US20130090700, US20150238763Publication number11482225, 482225, US 2007/0021796 A1, US 2007/021796 A1, US 20070021796 A1, US 20070021796A1, US 2007021796 A1, US 2007021796A1, US-A1-20070021796, US-A1-2007021796, US2007/0021796A1, US2007/021796A1, US20070021796 A1, US20070021796A1, US2007021796 A1, US2007021796A1InventorsRobert Kieval, Matthew Burns, David SerdarOriginal AssigneeCvrx, Inc.Export CitationBiBTeX, EndNote, RefManPatent Citations (99), Referenced by (144), Classifications (25), Legal Events (2) External Links: USPTO, USPTO Assignment, EspacenetBaroreflex modulation to gradually decrease blood pressure
DETAILED DESCRIPTION OF THE INVENTION [0059] The following detailed description should be read with reference to the drawings in which similar elements in different drawings are numbered the same. The drawings, which are not necessarily to scale, depict illustrative embodiments and are not intended to limit the scope of the invention. [0060] To better understand the present invention, it may be useful to explain some of the basic vascular anatomy associated with the cardiovascular system. Refer to FIG. 1 which is a schematic illustration of the upper torso of a human body 10 showing some of the major arteries and veins of the cardiovascular system. The left ventricle of the heart 11 pumps oxygenated blood up into the aortic arch 12. The right subclavian artery 13, the right common carotid artery 14, the left common carotid artery 15 and the left subclavian artery 16 branch off the aortic arch 12 proximal of the descending thoracic aorta 17. Although relatively short, a distinct vascular segment referred to as the brachiocephalic artery 22 connects the right subclavian artery 13 and the right common carotid artery 14 to the aortic arch 12. The right carotid artery 14 bifurcates into the right external carotid artery 18 and the right internal carotid artery 19 at the right carotid sinus 20. Although not shown for purposes of clarity only, the left carotid artery 15 similarly bifurcates into the left external carotid artery and the left internal carotid artery at the left carotid sinus. [0061] From the aortic arch 12, oxygenated blood flows into the carotid arteries 18/19 and the subclavian arteries 13/16. From the carotid arteries 18/19, oxygenated blood circulates through the head and cerebral vasculature and oxygen depleted blood returns to the heart 11 by way of the jugular veins, of which only the right internal jugular vein 21 is shown for sake of clarity. From the sub clavian arteries 13/16, oxygenated blood circulates through the upper peripheral vasculature and oxygen depleted blood returns to the heart by way of the subclavian veins, of which only the right subclavian vein 23 is shown, also for sake of clarity. The heart 11 pumps the oxygen depleted blood through the pulmonary system where it is reoxygenated. The re-oxygenated blood returns to the heart 11 which pumps the re-oxygenated blood into the aortic arch as described above, and the cycle repeats. [0062] Within the arterial walls of the aortic arch 12, common carotid arteries 14/15 (near the right carotid sinus 20 and left carotid sinus), subclavian arteries 13/16 and brachiocephalic artery 22 there are baroreceptors 30. For example, as best seen in FIG. 2A, baroreceptors 30 reside within the vascular walls of the carotid sinus 20. Baroreceptors 30 are a type of stretch receptor used by the body to sense blood pressure. An increase in blood pressure causes the arterial wall to stretch, and a decrease in blood pressure causes the arterial wall to return to its original size. Such a cycle is repeated with each beat of the heart. Because baroreceptors 30 are located within the arterial wall, they are able to sense deformation of the adjacent tissue, which is indicative of a change in blood pressure. The baroreceptors 30 located in the right carotid sinus 20, the left carotid sinus and the aortic arch 12 play the most significant role in sensing blood pressure that affects the baroreflex system 50, which is described in more detail with reference to FIG. 2B. [0063] Refer now to FIG. 2B, which shows a schematic illustration of baroreceptors 30 disposed in a generic vascular wall 40 and a schematic flow chart of the baroreflex system 50. Baroreceptors 30 are profusely distributed within the arterial walls 40 of the major arteries discussed previously, and generally form an arbor 32. The baroreceptor arbor 32 comprises a plurality of baroreceptors 30, each of which transmits baroreceptor signals to the brain 52 via nerve 38. The baroreceptors 30 are so profusely distributed and arborized within the vascular wall 40 that discrete baroreceptor arbors 32 are not readily discernable. To this end, those skilled in the art will appreciate that the baroreceptors 30 shown in FIG. 2B are primarily schematic for purposes of illustration and discussion. [0064] Baroreceptor signals are used to activate a number of body systems which collectively may be referred to as the baroreflex system 50. Baroreceptors 30 are connected to the brain 52 via the nervous system 51. Thus, the brain 52 is able to detect changes in blood pressure, which is indicative of cardiac output. If cardiac output is insufficient to meet demand (i.e., the heart 11 is unable to pump sufficient blood), the baroreflex system 50 activates a number of body systems, including the heart 11, kidneys 53, vessels 54, and other organs/tissues. Such activation of the baroreflex system 50 generally corresponds to an increase in neurohormonal activity. Specifically, the baroreflex system 50 initiates a neurohormonal sequence that signals the heart 11 to increase heart rate and increase contraction force in order to increase cardiac output, signals the kidneys 53 to increase blood volume by retaining sodium and water, and signals the vessels 54 to constrict to elevate blood pressure. The cardiac, renal and vascular responses increase blood pressure and cardiac output 55, and thus increase the workload of the heart 11. In a patient with heart failure, this further accelerates myocardial damage and exacerbates the heart failure state. [0065] To address the problems of hypertension, heart failure, other cardiovascular disorders and renal disorders, the present invention basically provides a number of devices, systems and methods by which the baroreflex system 50 is activated to reduce excessive blood pressure, autonomic nervous system activity and neurohormonal activation. In particular, the present invention provides a number of devices, systems and methods by which baroreceptors 30 may be activated, thereby indicating an increase in blood pressure and signaling the brain 52 to reduce the body's blood pressure and level of sympathetic nervous system and neurohormonal activation, and increase parasypathetic nervous system activation, thus having a beneficial effect on the cardiovascular system and other body systems. [0066] With reference to FIG. 3, the present invention generally provides a system including a control system 60, a baroreceptor activation device 70, and a sensor 80 (optional), which generally operate in the following manner. The sensor(s) 80 optionally senses and/or monitors a parameter (e.g., cardiovascular function) indicative of the need to modify the baroreflex system and generates a signal indicative of the parameter. The control system 60 generates a control signal as a function of the received sensor signal. The control signal activates, deactivates or otherwise modulates the baroreceptor activation device 70. Typically, activation of the device 70 results in activation of the baroreceptors 30. Alternatively, deactivation or modulation of the baroreceptor activation device 70 may cause or modify activation of the baroreceptors 30. The baroreceptor activation device 70 may comprise a wide variety of devices which utilize electrical means to activate baroreceptors 30. Thus, when the sensor 80 detects a parameter indicative of the need to modify the baroreflex system activity (e.g., excessive blood pressure), the control system 60 generates a control signal to modulate (e.g. activate) the baroreceptor activation device 70 thereby inducing a baroreceptor 30 signal that is perceived by the brain 52 to be apparent excessive blood pressure. When the sensor 80 detects a parameter indicative of normal body function (e.g., normal blood pressure), the control system 60 generates a control signal to modulate (e.g., deactivate) the baroreceptor activation device 70. [0067] As mentioned previously, the baroreceptor activation device 70 may comprise a wide variety of devices which utilize electrical means to activate the baroreceptors 30. The baroreceptor activation device 70 of the present invention comprises an electrode structure which directly activates one or more baroreceptors 30 by changing the electrical potential across the baroreceptors 30. It is possible that changing the electrical potential across the tissue surrounding the baroreceptors 30 may cause the surrounding tissue to stretch or otherwise deform, thus mechanically activating the baroreceptors 30, in which case the stretchable and elastic electrode structures of the present invention may provide significant advantages. [0068] All of the specific embodiments of the electrode structures of the present invention are suitable for implantation, and are preferably implanted using a minimally invasive surgical approach. The baroreceptor activation device 70 may be positioned anywhere baroreceptors 30 are present. Such potential implantation sites are numerous, such as the aortic arch 12, in the common carotid arteries 18/19 near the carotid sinus 20, in the subclavian arteries 13/16, in the brachiocephalic artery 22, or in other arterial or venous locations. The electrode structures of the present invention will be implanted such that they are positioned on or over a vascular structure immediately adjacent the baroreceptors 30. Preferably, the electrode structure of the baroreceptor activation device 70 is implanted near the right carotid sinus 20 and/or the left carotid sinus (near the bifurcation of the common carotid artery) and/or the aortic arch 12, where baroreceptors 30 have a significant impact on the baroreflex system 50. For purposes of illustration only, the present invention is described with reference to baroreceptor activation device 70 positioned near the carotid sinus 20. [0069] The optional sensor 80 is operably coupled to the control system 60 by electric sensor cable or lead 82. The sensor 80 may comprise any suitable device that measures or monitors a parameter indicative of the need to modify the activity of the baroreflex system. For example, the sensor 80 may comprise a physiologic transducer or gauge that measures ECG, blood pressure (systolic, diastolic, average or pulse pressure), blood volumetric flow rate, blood flow velocity, blood pH, O2 or CO2 content, mixed venous oxygen saturation (SVO2), vasoactivity, nerve activity, tissue activity, body movement, activity levels, respiration, or composition. Examples of suitable transducers or gauges for the sensor 80 include ECG electrodes, a piezoelectric pressure transducer, an ultrasonic flow velocity transducer, an ultrasonic volumetric flow rate transducer, a thermodilution flow velocity transducer, a capacitive pressure transducer, a membrane pH electrode, an optical detector (SVO2), tissue impedance (electrical), or a strain gauge. Although only one sensor 80 is shown, multiple sensors 80 of the same or different type at the same or different locations may be utilized. [0070] An example of an implantable blood pressure measurement device that may be disposed about a blood vessel is disclosed in U.S. Pat. No. 6,106,477 to Miesel et al., the entire disclosure of which is incorporated herein by reference. An example of a subcutaneous ECG monitor is available from Medtronic under the trade name REVEAL ILR and is disclosed in PCT Publication No. WO 98/02209, the entire disclosure of which is incorporated herein by reference. Other examples are disclosed in U.S. Pat. Nos. 5,987,352 and 5,331,966, the entire disclosures of which are incorporated herein by reference. Examples of devices and methods for measuring absolute blood pressure utilizing an ambient pressure reference are disclosed in U.S. Pat. No. 5,810,735 to Halperin et al., U.S. Pat. No. 5,904,708 to Goedeke, and PCT Publication No. WO 00/16686 to Brockway et al., the entire disclosures of which are incorporated herein by reference. The sensor 80 described herein may take the form of any of these devices or other devices that generally serve the same purpose. [0071] The sensor 80 is preferably positioned in a chamber of the heart 11, or in/on a major artery such as the aortic arch 12, a common carotid artery 14/15, a subclavian artery 13/16 or the brachiocephalic artery 22, such that the parameter of interest may be readily ascertained. The sensor 80 may be disposed inside the body such as in or on an artery, a vein or a nerve (e.g. vagus nerve), or disposed outside the body, depending on the type of transducer or gauge utilized. The sensor 80 may be separate from the baroreceptor activation device 70 or combined therewith. For purposes of illustration only, the sensor 80 is shown positioned on the right subclavian artery 13. [0072] By way of example, the control system 60 includes a control block 61 comprising a processor 63 and a memory 62. Control system 60 is connected to the sensor 80 by way of sensor cable 82. Control system 60 is also connected to the baroreceptor activation device 70 by way of electric control cable 72. Thus, the control system 60 receives a sensor signal from the sensor 80 by way of sensor cable 82, and transmits a control signal to the baroreceptor activation device 70 by way of control cable 72. [0073] The system components 60/70/80 may be directly linked via cables 72/82 or by indirect means such as RF signal transceivers, ultrasonic transceivers or galvanic couplings. Examples of such indirect interconnection devices are disclosed in U.S. Pat. No. 4,987,897 to Funke and U.S. Pat. No. 5,113,859 to Funke, the entire disclosures of which are incorporated herein by reference. [0074] The memory 62 may contain data related to the sensor signal, the control signal, and/or values and commands provided by the input device 64. The memory 62 may also include software containing one or more algorithms defining one or more functions or relationships between the control signal and the sensor signal. The algorithm may dictate activation or deactivation control signals depending on the sensor signal or a mathematical derivative thereof. The algorithm may dictate an activation or deactivation control signal when the sensor signal falls below a lower predetermined threshold value, rises above an upper predetermined threshold value or when the sensor signal indicates a specific physiologic event. The algorithm may dynamically alter the threshold value as determined by the sensor input values. [0075] As mentioned previously, the baroreceptor activation device 70 activates baroreceptors 30 electrically, optionally in combination with mechanical, thermal, chemical, biological or other co-activation. In some instances, the control system 60 includes a driver 66 to provide the desired power mode for the baroreceptor activation device 70. For example, the driver 66 may comprise a power amplifier or the like and the cable 72 may comprise electrical lead(s). In other instances, the driver 66 may not be necessary, particularly if the processor 63 generates a sufficiently strong electrical signal for low level electrical actuation of the baroreceptor activation device 70. [0076] The control system 60 may operate as a closed loop utilizing feedback from the sensor 80, or other sensors, such as heart rate sensors which may be incorporated or the electrode assembly, or as an open loop utilizing reprogramming commands received by input device 64. The closed loop operation of the control system 60 preferably utilizes some feedback from the transducer 80, but may also operate in an open loop mode without feedback. Programming commands received by the input device 64 may directly influence the control signal, the output activation parameters, or may alter the software and related algorithms contained in memory 62. The treating physician and/or patient may provide commands to input device 64. Display 65 may be used to view the sensor signal, control signal and/or the software/data contained in memory 62. [0077] The control signal generated by the control system 60 may be continuous, periodic, alternating, episodic or a combination thereof, as dictated by an algorithm contained in memory 62. Continuous control signals include a constant pulse, a constant train of pulses, a triggered pulse and a triggered train of pulses. Examples of periodic control signals include each of the continuous control signals described above which have a designated start time (e.g., beginning of each period as designated by minutes, hours, or days in combinations of) and a designated duration (e.g., seconds, minutes, hours, or days in combinations of). Examples of alternating control signals include each of the continuous control signals as described above which alternate between the right and left output channels. Examples of episodic control signals include each of the continuous control signals described above which are triggered by an episode (e.g., activation by the physician/patient, an increase/decrease in blood pressure above a certain threshold, heart rate above/below certain levels, etc.). [0078] The stimulus regimen governed by the control system 60 may be selected to promote long term efficacy. It is theorized that uninterrupted or otherwise unchanging activation of the baroreceptors 30 may result in the baroreceptors and/or the baroreflex system becoming less responsive over time, thereby diminishing the long term effectiveness of the therapy. Therefore, the stimulus regimen maybe selected to activate, deactivate or otherwise modulate the baroreceptor activation device 70 in such a way that therapeutic efficacy is maintained preferably for years. [0079] In addition to maintaining therapeutic efficacy over time, the stimulus regimens of the present invention may be selected reduce power requirement/consumption of the system 60. As will be described in more detail hereinafter, the stimulus regimen may dictate that the baroreceptor activation device 70 be initially activated at a relatively higher energy and/or power level, and subsequently activated at a relatively lower energy and/or power level. The first level attains the desired initial therapeutic effect, and the second (lower) level sustains the desired therapeutic effect long term. By reducing the energy and/or power levels after the desired therapeutic effect is initially attained, the energy required or consumed by the activation device 70 is also reduced long term. This may correlate into systems having greater longevity and/or reduced size (due to reductions in the size of the power supply and associated components). [0080] A first general approach for a stimulus regimen which promotes long term efficacy and reduces power requirements/consumption involves generating a control signal to cause the baroreceptor activation device 70 to have a first output level of relatively higher energy and/or power, and subsequently changing the control signal to cause the baroreceptor activation device 70 to have a second output level of relatively lower energy and/or power. The first output level may be selected and maintained for sufficient time to attain the desired initial effect (e.g., reduced heart rate and/or blood pressure), after which the output level may be reduced to the second level for sufficient time to sustain the desired effect for the desired period of time. [0081] For example, if the first output level has a power and/or energy value of X1, the second output level may have a power and/or energy value of X2, wherein X2 is less than X1. In some instances, X2 may be equal to zero, such that the first level is “on” and the second level is “off”. It is recognized that power and energy refer to two different parameters, and in some cases, a change in one of the parameters (power or energy) may not correlate to the same or similar change in the other parameter. In the present invention, it is contemplated that a change in one or both of the parameters may be suitable to obtain the desired result of promoting long term efficacy. [0082] It is also contemplated that more than two levels may be used. Each further level may increase the output energy or power to attain the desired effect, or decrease the output energy or power to retain the desired effect. For example, in some instances, it may be desirable to have further reductions in the output level if the desired effect may be sustained at lower power or energy levels. In other instances, particularly when the desired effect is diminishing or is otherwise not sustained, it may be desirable to increase the output level until the desired effect is reestablished, and subsequently decrease the output level to sustain the effect. [0083] The transition from each level may be a step function (e.g., a single step or a series of steps), a gradual transition over a period of time, or a combination thereof. In addition, the signal levels may be continuous, periodic, alternating, or episodic as discussed previously. [0084] In electrical activation using a non modulated signal, the output (power or energy) level of the baroreceptor activation device 70 may be changed by adjusting the output signal voltage level, current level and/or signal duration. The output signal of the baroreceptor activation device 70 may be, for example, constant current or constant voltage. In electrical activation embodiments using a modulated signal, wherein the output signal comprises, for example, a series of pulses, several pulse characteristics may be changed individually or in combination to change the power or energy level of the output signal. Such pulse characteristics include, but are not limited to: pulse amplitude (PA), pulse frequency (PF), pulse width or duration (PW), pulse waveform (square, triangular, sinusoidal, etc.), pulse polarity (for bipolar electrodes) and pulse phase (monophasic, biphasic). [0085] In electrical activation wherein the output signal comprises a pulse train, several other signal characteristics may be changed in addition to the pulse characteristics described above, as described in copending application Ser. No. 09/964,079, the full disclosure of which is incorporated herein by reference. [0086] FIGS. 4A and 4B show schematic illustrations of a baroreceptor activation device 300 in the form of an extravascular electrically conductive structure or electrode 302. The electrode structure 302 may comprise a coil, braid or other structure capable of surrounding the vascular wall. Alternatively, the electrode structure 302 may comprise one or more electrode patches distributed around the outside surface of the vascular wall. Because the electrode structure 302 is disposed on the outside surface of the vascular wall, intravascular delivery techniques may not be practical, but minimally invasive surgical techniques will suffice. The extravascular electrode structure 302 may receive electrical signals directly from the driver 66 of the control system 60 by way of electrical lead 304, or indirectly by utilizing an inductor (not shown) as described in copending commonly assigned application Ser. No. 10/402,393 (Attorney Docket No. 21433-000420US), filed on Mar. 27, 2003, the full disclosure of which is incorporated herein by reference. [0087] Refer now to FIGS. 5A-5F which show schematic illustrations of various possible arrangements of electrodes around the carotid sinus 20 for extravascular electrical activation embodiments, such as baroreceptor activation device 300 described with reference to FIGS. 4A and 4B. The electrode designs illustrated and described hereinafter may be particularly suitable for connection to the carotid arteries at or near the carotid sinus, and may be designed to minimize extraneous tissue stimulation. [0088] In FIGS. 5A-5F, the carotid arteries are shown, including the common 14, the external 18 and the internal 19 carotid arteries. The location of the carotid sinus 20 may be identified by a landmark bulge 21, which is typically located on the internal carotid artery 19 just distal of the bifurcation, or extends across the bifurcation from the common carotid artery 14 to the internal carotid artery 19. [0089] The carotid sinus 20, and in particular the bulge 21 of the carotid sinus, may contain a relatively high density of baroreceptors 30 (not shown) in the vascular wall. For this reason, it may be desirable to position the electrodes 302 of the activation device 300 on and/or around the sinus bulge 21 to maximize baroreceptor responsiveness and to minimize extraneous tissue stimulation. [0090] It should be understood that the device 300 and electrodes 302 are merely schematic, and only a portion of which may be shown, for purposes of illustrating various positions of the electrodes 302 on and/or around the carotid sinus 20 and the sinus bulge 21. In each of the embodiments described herein, the electrodes 302 may be monopolar, bipolar, or tripolar (anode-cathode-anode or cathode-anode-cathode sets). Specific extravascular electrode designs are described in more detail hereinafter. [0091] In FIG. 5A, the electrodes 302 of the extravascular electrical activation device 300 extend around a portion or the entire circumference of the sinus 20 in a circular fashion. Often, it would be desirable to reverse the illustrated electrode configuration in actual use. In FIG. SB, the electrodes 302 of the extravascular electrical activation device 300 extend around a portion or the entire circumference of the sinus 20 in a helical fashion. In the helical arrangement shown in FIG. 5B, the electrodes 302 may wrap around the sinus 20 any number of times to establish the desired electrode 302 contact and coverage. In the circular arrangement shown in FIG. 5A, a single pair of electrodes 302 may wrap around the sinus 20, or a plurality of electrode pairs 302 may be wrapped around the sinus 20 as shown in FIG. 5C to establish more electrode 302 contact and coverage. [0092] The plurality of electrode pairs 302 may extend from a point proximal of the sinus 20 or bulge 21, to a point distal of the sinus 20 or bulge 21 to ensure activation of baroreceptors 30 throughout the sinus 20 region. The electrodes 302 may be connected to a single channel or multiple channels as discussed in more detail hereinafter. The plurality of electrode pairs 302 may be selectively activated for purposes of targeting a specific area of the sinus 20 to increase baroreceptor responsiveness, or for purposes of reducing the exposure of tissue areas to activation to maintain baroreceptor responsiveness long term. [0093] In FIG. 5D, the electrodes 302 extend around the entire circumference of the sinus 20 in a criss cross fashion. The criss cross arrangement of the electrodes 302 establishes contact with both the internal 19 and external 18 carotid arteries around the carotid sinus 20. Similarly, in FIG. 5E, the electrodes 302 extend around all or a portion of the circumference of the sinus 20, including the internal 19 and external 18 carotid arteries at the bifurcation, and in some instances the common carotid artery 14. In FIG. 5F, the electrodes 302 extend around all or a portion of the circumference of the sinus 20, including the internal 19 and external 18 carotid arteries distal of the bifurcation. In FIGS. 5E and 5F, the extravascular electrical activation devices 300 are shown to include a substrate or base structure 306 which may encapsulate and insulate the electrodes 302 and may provide a means for attachment to the sinus 20 as described in more detail hereinafter. [0094] From the foregoing discussion with reference to FIGS. 5A-5F, it should be apparent that there are a number of suitable arrangements for the electrodes 302 of the activation device 300, relative to the carotid sinus 20 and associated anatomy. In each of the examples given above, the electrodes 302 are wrapped around a portion of the carotid structure, which may require deformation of the electrodes 302 from their relaxed geometry (e.g., straight). To reduce or eliminate such deformation, the electrodes 302 and/or the base structure 306 may have a relaxed geometry that substantially conforms to the shape of the carotid anatomy at the point of attachment. In other words, the electrodes 302 and the base structure or backing 306 may be pre shaped to conform to the carotid anatomy in a substantially relaxed state. [0095] Alternatively, the electrodes 302 may have a geometry and/or orientation that reduces the amount of electrode 302 strain. Optionally, as described in more detail below, the backing or base structure 306 may be elastic or stretchable to facilitate wrapping of and conforming to the carotid sinus or other vascular structure. [0096] For example, in FIG. 6, the electrodes 302 are shown to have a serpentine or wavy shape. The serpentine shape of the electrodes 302 reduces the amount of strain seen by the electrode material when wrapped around a carotid structure. In addition, the serpentine shape of the electrodes increases the contact surface area of the electrode 302 with the carotid tissue. As an alternative, the electrodes 302 may be arranged to be substantially orthogonal to the wrap direction (i.e., substantially parallel to the axis of the carotid arteries) as shown in FIG. 7. In this alternative, the electrodes 302 each have a length and a width or diameter, wherein the length is substantially greater than the width or diameter. The electrodes 302 each have a longitudinal axis parallel to the length thereof, wherein the longitudinal axis is orthogonal to the wrap direction and substantially parallel to the longitudinal axis of the carotid artery about which the device 300 is wrapped. As with the multiple electrode embodiments described previously, the electrodes 302 may be connected to a single channel or multiple channels as discussed in more detail hereinafter. [0097] Refer now to FIGS. 8-11 which schematically illustrate various multi-channel electrodes for the extravascular electrical activation device 300. FIG. 8 illustrates a six (6) channel electrode assembly including six (6) separate elongate electrodes 302 extending adjacent to and parallel with each other. The electrodes 302 are each connected to multi-channel cable 304. Some of the electrodes 302 may be common, thereby reducing the number of conductors necessary in the cable 304. [0098] Base structure or substrate 306 may comprise a flexible and electrically insulating material suitable for implantation, such as silicone, perhaps reinforced with a flexible material such as polyester fabric. The base 306 may have a length suitable to wrap around all (360.degree.) or a portion (i.e., less than 360.degree.) of the circumference of one or more of the carotid arteries adjacent the carotid sinus 20. The electrodes 302 may extend around a portion (i.e., less than 360.degree. such as 270.degree., 180.degree. or 90.degree.) of the circumference of one or more of the carotid arteries adjacent the carotid sinus 20. To this end, the electrodes 302 may have a length that is less than (e.g., 75%, 50% or 25%) the length of the base 206. The electrodes 302 may be parallel, orthogonal or oblique to the length of the base 306, which is generally orthogonal to the axis of the carotid artery to which it is disposed about. Preferably, the base structure or backing will be elastic (i.e., stretchable), typically being composed of at least in part of silicone, latex, or other elastomer. If such elastic structures are reinforced, the reinforcement should be arranged so that it does not interfere with the ability of the base to stretch and conform to the vascular surface. [0099] The electrodes 302 may comprise round wire, rectangular ribbon or foil formed of an electrically conductive and radiopaque material such as platinum. The base structure 306 substantially encapsulates the electrodes 302, leaving only an exposed area for electrical connection to extravascular carotid sinus tissue. For example, each electrode 302 may be partially recessed in the base 206 and may have one side exposed along all or a portion of its length for electrical connection to carotid tissue. Electrical paths through the carotid tissues may be defined by one or more pairs of the elongate electrodes 302. [0100] In all embodiments described with reference to FIGS. 8-11, the multi-channel electrodes 302 may be selectively activated for purposes of mapping and targeting a specific area of the carotid sinus 20 to determine the best combination of electrodes 302 (e.g., individual pair, or groups of pairs) to activate for maximum baroreceptor responsiveness, as described elsewhere herein. In addition, the multi-channel electrodes 302 may be selectively activated for purposes of reducing the exposure of tissue areas to activation to maintain long term efficacy as described, as described elsewhere herein. For these purposes, it may be useful to utilize more than two (2) electrode channels. Alternatively, the electrodes 302 may be connected to a single channel whereby baroreceptors are uniformly activated throughout the sinus 20 region. [0101] An alternative multi-channel electrode design is illustrated in FIG. 9. In this embodiment, the device 300 includes sixteen (16) individual electrode pads 302 connected to 16 channel cable 304 via 4 channel connectors 303. In this embodiment, the circular electrode pads 302 are partially encapsulated by the base structure 306 to leave one face of each button electrode 302 exposed for electrical connection to carotid tissues. With this arrangement, electrical paths through the carotid tissues may be defined by one or more pairs (bipolar) or groups (tripolar) of electrode pads 302. [0102] A variation of the multi-channel pad type electrode design is illustrated in FIG. 10. In this embodiment, the device 300 includes sixteen (16) individual circular pad electrodes 302 surrounded by sixteen (16) rings 305, which collectively may be referred to as concentric electrode pads 302/305. Pad electrodes 302 are connected to 17 channel cable 304 via 4 channel connectors 303, and rings 305 are commonly connected to 17 channel cable 304 via a single channel connector 307. In this embodiment, the circular shaped electrodes 302 and the rings 305 are partially encapsulated by the base structure 306 to leave one face of each pad electrode 302 and one side of each ring 305 exposed for electrical connection to carotid tissues. As an alternative, two rings 305 may surround each electrode 302, with the rings 305 being commonly connected. With these arrangements, electrical paths through the carotid tissues may be defined between one or more pad electrode 302/ring 305 sets to create localized electrical paths. [0103] Another variation of the multi-channel pad electrode design is illustrated in FIG. 11. In this embodiment, the device 300 includes a control IC chip 310 connected to 3 channel cable 304. The control chip 310 is also connected to sixteen (16) individual pad electrodes 302 via 4 channel connectors 303. The control chip 310 permits the number of channels in cable 304 to be reduced by utilizing a coding system. The control system 60 sends a coded control signal which is received by chip 310. The chip 310 converts the code and enables or disables selected electrode 302 pairs in accordance with the code. [0104] For example, the control signal may comprise a pulse wave form, wherein each pulse includes a different code. The code for each pulse causes the chip 310 to enable one or more pairs of electrodes, and to disable the remaining electrodes. Thus, the pulse is only transmitted to the enabled electrode pair(s) corresponding to the code sent with that pulse. Each subsequent pulse would have a different code than the preceding pulse, such that the chip 310 enables and disables a different set of electrodes 302 corresponding to the different code. Thus, virtually any number of electrode pairs may be selectively activated using control chip 310, without the need for a separate channel in cable 304 for each electrode 302. By reducing the number of channels in cable 304, the size and cost thereof may be reduced. [0105] Optionally, the IC chip 310 may be connected to feedback sensor 80, taking advantage of the same functions as described with reference to FIG. 3. In addition, one or more of the electrodes 302 may be used as feedback sensors when not enabled for activation. For example, such a feedback sensor electrode may be used to measure or monitor electrical conduction in the vascular wall to provide data analogous to an ECG. Alternatively, such a feedback sensor electrode may be used to sense a change in impedance due to changes in blood volume during a pulse pressure to provide data indicative of heart rate, blood pressure, or other physiologic parameter. [0106] Refer now to FIG. 12 which schematically illustrates an extravascular electrical activation device 300 including a support collar or anchor 312. In this embodiment, the activation device 300 is wrapped around the internal carotid artery 19 at the carotid sinus 20, and the support collar 312 is wrapped around the common carotid artery 14. The activation device 300 is connected to the support collar 312 by cables 304, which act as a loose tether. With this arrangement, the collar 312 isolates the activation device from movements and forces transmitted by the cables 304 proximal of the support collar, such as may be encountered by movement of the control system 60 and/or driver 66. As an alternative to support collar 312, a strain relief (not shown) may be connected to the base structure 306 of the activation device 300 at the juncture between the cables 304 and the base 306. With either approach, the position of the device 300 relative to the carotid anatomy may be better maintained despite movements of other parts of the system. [0107] In this embodiment, the base structure 306 of the activation device 300 may comprise molded tube, a tubular extrusion, or a sheet of material wrapped into a tube shape utilizing a suture flap 308 with sutures 309 as shown. The base structure 306 may be formed of a flexible and biocompatible material such as silicone, which may be reinforced with a flexible material such as polyester fabric available under the trade name DACRON.RTM. to form a composite structure. The inside diameter of the base structure 306 may correspond to the outside diameter of the carotid artery at the location of implantation, for example 6 to 8 mm. The wall thickness of the base structure 306 may be very thin to maintain flexibility and a low profile, for example less than 1 mm. If the device 300 is to be disposed about a sinus bulge 21, a correspondingly shaped bulge may be formed into the base structure for added support and assistance in positioning. [0108] The electrodes 302 (shown in phantom) may comprise round wire, rectangular ribbon or foil, formed of an electrically conductive and radiopaque material such as platinum or platinum iridium. The electrodes may be molded into the base structure 306 or adhesively connected to the inside diameter thereof, leaving a portion of the electrode exposed for electrical connection to carotid tissues. The electrodes 302 may encompass less than the entire inside circumference (e.g., 300.degree.) of the base structure 306 to avoid shorting. The electrodes 302 may have any of the shapes and arrangements described previously. For example, as shown in FIG. 12, two rectangular ribbon electrodes 302 may be used, each having a width of 1 mm spaced 1.5 mm apart. [0109] The support collar 312 may be formed similarly to base structure 306. For example, the support collar may comprise molded tube, a tubular extrusion, or a sheet of material wrapped into a tube shape utilizing a suture flap 315 with sutures 313 as shown. The support collar 312 may be formed of a flexible and biocompatible material such as silicone, which may be reinforced to form a composite structure. The cables 304 are secured to the support collar 312, leaving slack in the cables 304 between the support collar 312 and the activation device 300. [0110] In all embodiments described herein, it may be desirable to secure the activation device to the vascular wall using sutures or other fixation means. For example, sutures 311 may be used to maintain the position of the electrical activation device 300 relative to the carotid anatomy (or other vascular site containing baroreceptors). Such sutures 311 may be connected to base structure 306, and pass through all or a portion of the vascular wall. For example, the sutures 311 may be threaded through the base structure 306, through the adventitia of the vascular wall, and tied. If the base structure 306 comprises a patch or otherwise partially surrounds the carotid anatomy, the corners and/or ends of the base structure may be sutured, with additional sutures evenly distributed therebetween. In order to minimize the propagation of a hole or a tear through the base structure 306, a reinforcement material such as polyester fabric may be embedded in the silicone material. In addition to sutures, other fixation means may be employed such as staples or a biocompatible adhesive, for example. [0111] Refer now to FIG. 13 which schematically illustrates an alternative extravascular electrical activation device 300 including one or more electrode ribs 316 interconnected by spine 317. Optionally, a support collar 312 having one or more (non electrode) ribs 316 may be used to isolate the activation device 300 from movements and forces transmitted by the cables 304 proximal of the support collar 312. [0112] The ribs 316 of the activation device 300 are sized to fit about the carotid anatomy, such as the internal carotid artery 19 adjacent the carotid sinus 20. Similarly, the ribs 316 of the support collar 312 may be sized to fit about the carotid anatomy, such as the common carotid artery 14 proximal of the carotid sinus 20. The ribs 316 may be separated, placed on a carotid artery, and closed thereabout to secure the device 300 to the carotid anatomy. [0113] Each of the ribs 316 of the device 300 includes an electrode 302 on the inside surface thereof for electrical connection to carotid tissues. The ribs 316 provide insulating material around the electrodes 302, leaving only an inside portion exposed to the vascular wall. The electrodes 302 are coupled to the multi-channel cable 304 through spine 317. Spine 317 also acts as a tether to ribs 316 of the support collar 312, which do not include electrodes since their function is to provide support. The multi-channel electrode 302 functions discussed with reference to FIGS. 8-11 are equally applicable to this embodiment. [0114] The ends of the ribs 316 may be connected (e.g., sutured) after being disposed about a carotid artery, or may remain open as shown. If the ends remain open, the ribs 316 may be formed of a relatively stiff material to ensure a mechanical lock around the carotid artery. For example, the ribs 316 may be formed of polyethylene, polypropylene, PTFE, or other similar insulating and biocompatible material. Alternatively, the ribs 316 may be formed of a metal such as stainless steel or a nickel titanium alloy, as long as the metallic material was electrically isolated from the electrodes 302. As a further alternative, the ribs 316 may comprise an insulating and biocompatible polymeric material with the structural integrity provided by metallic (e.g., stainless steel, nickel titanium alloy, etc.) reinforcement. In this latter alternative, the electrodes 302 may comprise the metallic reinforcement. [0115] Refer now to FIG. 14 which schematically illustrates a specific example of an electrode assembly for an extravascular electrical activation device 300. In this specific example, the base structure 306 comprises a silicone sheet having a length of 5.0 inches, a thickness of 0.007 inches, and a width of 0.312 inches. The electrodes 302 comprise platinum ribbon having a length of 0.47 inches, a thickness of 0.0005 inches, and a width of 0.040 inches. The electrodes 302 are adhesively connected to one side of the silicone sheet 306. [0116] The electrodes 302 are connected to a modified bipolar endocardial pacing lead, available under the trade name CONIFIX from Innomedica (now BIOMEC Cardiovascular, Inc.), model number 501112. The proximal end of the cable 304 is connected to the control system 60 or driver 66 as described previously. The pacing lead is modified by removing the pacing electrode to form the cable body 304. The MP35 wires are extracted from the distal end thereof to form two coils 318 positioned side by side having a diameter of about 0.020 inches. The coils 318 are then attached to the electrodes utilizing 316 type stainless steel crimp terminals laser welded to one end of the platinum electrodes 302. The distal end of the cable 304 and the connection between the coils 318 and the ends of the electrodes 302 are encapsulated by silicone. [0117] The cable 304 illustrated in FIG. 14 comprises a coaxial type cable including two coaxially disposed coil leads separated into two separate coils 318 for attachment to the electrodes 302. An alternative cable 304 construction is illustrated in FIG. 15. FIG. 15 illustrates an alternative cable body 304 which may be formed in a curvilinear shape such as a sinusoidal configuration, prior to implantation. The curvilinear configuration readily accommodates a change in distance between the device 300 and the control system 60 or the driver 66. Such a change in distance may be encountered during flexion and/or extension of the neck of the patient after implantation. [0118] In this alternative embodiment, the cable body 304 may comprise two or more conductive wires 304 a arranged coaxially or collinearly as shown. Each conductive wire 304 a may comprise a multifilament structure of suitable conductive material such as stainless steel or MP35N. An insulating material may surround the wire conductors 304 a individually and/or collectively. For purposes of illustration only, a pair of electrically conductive wires 304 a having an insulating material surrounding each wire 304 a individually is shown. The insulated wires 304 a may be connected by a spacer 304 b comprising, for example, an insulating material. An additional jacket of suitable insulating material may surround each of the conductors 304 a. The insulating jacket may be formed to have the same curvilinear shape of the insulated wires 304 a to help maintain the shape of the cable body 304 during implantation. [0119] If a sinusoidal configuration is chosen for the curvilinear shape, the amplitude (A) may range from 1 mm to 10 mm, and preferably ranges from 2 mm to 3 mm. The wavelength (WL) of the sinusoid may range from 2 mm to 20 mm, and preferably ranges from 4 mm to 10 mm. The curvilinear or sinusoidal shape may be formed by a heat setting procedure utilizing a fixture which holds the cable 304 in the desired shape while the cable is exposed to heat. Sufficient heat is used to heat set the conductive wires 304 a and/or the surrounding insulating material. After cooling, the cable 304 may be removed from the fixture, and the cable 304 retains the desired shape. [0120] Refer now to FIGS. 16-18 which illustrate various transducers that may be mounted to the wall of a vessel such as a carotid artery 14 to monitor wall expansion or contraction using strain, force and/or pressure gauges. An example of an implantable blood pressure measurement device that may be disposed about a blood vessel is disclosed in U.S. Pat. No. 6,106,477 to Miesel et al., the entire disclosure of which is incorporated herein by reference. The output from such gauges may be correlated to blood pressure and/or heart rate, for example, and may be used to provide feedback to the control system 60 as described previously herein. In FIG. 16, an implantable pressure measuring assembly comprises a foil strain gauge or force sensing resistor device 740 disposed about an artery such as common carotid artery 14. A transducer portion 742 may be mounted to a silicone base or backing 744 which is wrapped around and sutured or otherwise attached to the artery 14. [0121] Alternatively, the transducer 750 may be adhesively connected to the wall of the artery 14 using a biologically compatible adhesive such as cyanoacrylate as shown in FIG. 17. In this embodiment, the transducer 750 comprises a micro machined sensor (MEMS) that measures force or pressure. The MEMS transducer 750 includes a micro arm 752 (shown in section in FIG. 18) coupled to a silicon force sensor contained over an elastic base 754. A cap 756 covers the arm 752 a top portion of the base 754. The base 754 include an interior opening creating access from the vessel wall 14 to the arm 752. An incompressible gel 756 fills the space between the arm 752 and the vessel wall 14 such that force is transmitted to the arm upon expansion and contraction of the vessel wall. In both cases, changes in blood pressure within the artery cause changes in vessel wall stress which are detected by the transducer and which may be correlated with the blood pressure. [0122] Refer now to FIGS. 19-21 which illustrate an alternative extravascular electrical activation device 700, which, may also be referred to as an electrode cuff device or more generally as an “electrode assembly.” Except as described herein and shown in the drawings, device 700 may be the same in design and function as extravascular electrical activation device 300 described previously. [0123] As seen in FIGS. 19 and 20, electrode assembly or cuff device 700 includes coiled electrode conductors 702/704 embedded in a flexible support 706. In the embodiment shown, an outer electrode coil 702 and an inner electrode coil 704 are used to provide a pseudo tripolar arrangement, but other polar arrangements are applicable as well as described previously. The coiled electrodes 702/704 may be formed of fine round, flat or ellipsoidal wire such as 0.002 inch diameter round PtIr alloy wire wound into a coil form having a nominal diameter of 0.015 inches with a pitch of 0.004 inches, for example. The flexible support or base 706 may be formed of a biocompatible and flexible (preferably elastic) material such as silicone or other suitable thin walled elastomeric material having a wall thickness of 0.005 inches and a length (e.g., 2.95 inches) sufficient to surround the carotid sinus, for example. [0124] Each turn of the coil in the contact area of the electrodes 702/704 is exposed from the flexible support 706 and any adhesive to form a conductive path to the artery wall. The exposed electrodes 702/704 may have a length (e.g., 0.236 inches) sufficient to extend around at least a portion of the carotid sinus, for example. The electrode cuff 700 is assembled flat with the contact surfaces of the coil electrodes 702/704 tangent to the inside plane of the flexible support 706. When the electrode cuff 700 is wrapped around the artery, the inside contact surfaces of the coiled electrodes 702/704 are naturally forced to extend slightly above the adjacent surface of the flexible support, thereby improving contact to the artery wall. [0125] The ratio of the diameter of the coiled electrodes 702/704 to the wire diameter is preferably large enough to allow the coil to bend and elongate without significant bending stress or torsional stress in the wire. Flexibility is a significant advantage of this design which allows the electrode cuff 700 to conform to the shape of the carotid artery and sinus, and permits expansion and contraction of the artery or sinus without encountering significant stress or fatigue. In particular, the flexible electrode cuff 700 may be wrapped around and stretched to conform to the shape of the carotid sinus and artery during implantation. This may be achieved without collapsing or distorting the shape of the artery and carotid sinus due to the compliance of the electrode cuff 700. The flexible support 706 is able to flex and stretch with the conductor coils 702/704 because of the absence of fabric reinforcement in the electrode contact portion of the cuff 700. By conforming to the artery shape, and by the edge of the flexible support 706 sealing against the artery wall, the amount of stray electrical field and extraneous stimulation will likely be reduced. [0126] The pitch of the coil electrodes 702/704 may be greater than the wire diameter in order to provide a space between each turn of the wire to thereby permit bending without necessarily requiring axial elongation thereof. For example, the pitch of the contact coils 702/704 may be 0.004 inches per turn with a 0.002 inch diameter wire, which allows for a 0.002 inch space between the wires in each turn. The inside of the coil may be filled with a flexible adhesive material such as silicone adhesive which may fill the spaces between adjacent wire turns. By filling the small spaces between the adjacent coil turns, the chance of pinching tissue between coil turns is minimized thereby avoiding abrasion to the artery wall. Thus, the embedded coil electrodes 702/704 are mechanically captured and chemically bonded into the flexible support 706. In the unlikely event that a coil electrode 702/704 comes loose from the support 706, the diameter of the coil is large enough to be atraumatic to the artery wall. Preferably, the centerline of the coil electrodes 702/704 lie near the neutral axis of electrode cuff structure 700 and the flexible support 706 comprises a material with isotropic elasticity such as silicone in order to minimize the shear forces on the adhesive bonds between the coil electrodes 702/704 and the support 706. [0127] The electrode coils 702/704 are connected to corresponding conductive coils 712/714, respectively, in an elongate lead 710 which is connected to the control system 60. Anchoring wings 718 may be provided on the lead 710 to tether the lead 710 to adjacent tissue and minimize the effects or relative movement between the lead 710 and the electrode cuff 700. As seen in FIG. 21, the conductive coils 712/714 may be formed of 0.003 MP35N bifilar wires wound into 0.018 inch diameter coils which are electrically connected to electrode coils 702/704 by splice wires 716. The conductive coils 712/714 may be individually covered by an insulating covering 718 such as silicone tubing and collectively covered by insulating covering 720. [0128] The conductive material of the electrodes 702/704 may be a metal as described above or a conductive polymer such as a silicone material filled with metallic particles such as Pt particles. In this latter embodiment, the polymeric electrodes may be integrally formed with the flexible support 706 with the electrode contacts comprising raised areas on the inside surface of the flexible support 706 electrically coupled to the lead 710 by wires or wire coils. The use of polymeric electrodes may be applied to other electrode design embodiments described elsewhere herein. [0129] Reinforcement patches 708 such as DACRON.RTM. fabric may be selectively incorporated into the flexible support 706. For example, reinforcement patches 708 may be incorporated into the ends or other areas of the flexible support 706 to accommodate suture anchors. The reinforcement patches 708 provide points where the electrode cuff 700 may be sutured to the vessel wall and may also provide tissue in growth to further anchor the device 700 to the exterior of the vessel wall. For example, the fabric reinforcement patches 708 may extend beyond the edge of the flexible support 706 so that tissue in growth may help anchor the electrode assembly or cuff 700 to the vessel wall and may reduce reliance on the sutures to retain the electrode assembly 700 in place. As a substitute for or in addition to the sutures and tissue in growth, bioadhesives such as cyanoacrylate may be employed to secure the device 700 to the vessel wall. In addition, an adhesive incorporating conductive particles such as Pt coated micro spheres may be applied to the exposed inside surfaces of the electrodes 702/704 to enhance electrical conduction to the tissue and possibly limit conduction along one axis to limit extraneous tissue stimulation. [0130] The reinforcement patches 708 may also be incorporated into the flexible support 706 for strain relief purposes and to help retain the coils 702/704 to the support 706 where the leads 710 attach to the electrode assembly 700 as well as where the outer coil 702 loops back around the inner coil 704. Preferably, the patches 708 are selectively incorporated into the flexible support 706 to permit expansion and contraction of the device 700, particularly in the area of the electrodes 702/704. In particular, the flexible support 706 is only fabric reinforced in selected areas thereby maintaining the ability of the electrode cuff 700 to stretch. [0131] Referring now to FIGS. 22-26, the electrode assembly of FIGS. 19-21 can be modified to have “flattened” coil electrodes in the region of the assembly where the electrodes contact the extravascular tissue. As shown in FIG. 22, an electrode-carrying surface 801 of the electrode assembly, is located generally between parallel reinforcement strips or tabs 808. The flattened coil section 810 will generally be exposed on a lower surface 803 of the base 806 (FIG. 23) and will be covered or encapsulated by a parylene or other polymeric structure or material 802 over an upper surface 805 thereof. The coil is formed with a generally circular periphery 809, as best seen in FIGS. 24 and 26, and may be mechanically flattened, typically over a silicone or other supporting insert 815, as best seen in FIG. 25. The use of the flattened coil structure is particularly beneficial since it retains flexibility, allowing the electrodes to bend, stretch, and flex together with the elastomeric base 806, while also increasing the flat electrode area available to contact the extravascular surface. [0132] Referring now to FIGS. 27-30, an additional electrode assembly 900 constructed in accordance with the principles of the present invention will be described. Electrode assembly 900 comprises an electrode base, typically an elastic base 902, typically formed from silicone or other elastomeric material, having an electrode-carrying surface 904 and a plurality of attachment tabs 906 (906 a, 906 b, 906 c, and 906 d) extending from the electrode-carrying surface. The attachment tabs 906 are preferably formed from the same material as the electrode-carrying surface 904 of the base 902, but could be formed from other elastomeric materials as well. In the latter case, the base will be molded, stretched or otherwise assembled from the various pieces. In the illustrated embodiment, the attachment tabs 906 are formed integrally with the remainder of the base 902, i.e., typically being cut from a single sheet of the elastomeric material. [0133] The geometry of the electrode assembly 900, and in particular the geometry of the base 902, is selected to permit a number of different attachment modes to the blood vessel. In particular, the geometry of the assembly 902 of FIG. 27 is intended to permit attachment to various locations on the carotid arteries at or near the carotid sinus and carotid bifurcation. [0134] A number of reinforcement regions 910 (910 a, 910 b, 910 c, 910 d, and 910 e) are attached to different locations on the base 902 to permit suturing, clipping, stapling, or other fastening of the attachment tabs 906 to each other and/or the electrode-carrying surface 904 of the base 902. In the preferred embodiment intended for attachment at or around the carotid sinus, a first reinforcement strip 910 a is provided over an end of the base 902 opposite to the end which carries the attachment tabs. Pairs of reinforcement strips 910 b and 910 c are provided on each of the axially aligned attachment tabs 906 a and 906 b, while similar pairs of reinforcement strips 910 d and 910 e are provided on each of the transversely angled attachment tabs 906 c and 906 d. In the illustrated embodiment, all attachment tabs will be provided on one side of the base, preferably emanating from adjacent corners of the rectangular electrode-carrying surface 904. [0135] The structure of electrode assembly 900 permits the surgeon to implant the electrode assembly so that the electrodes 920 (which are preferably stretchable, flat-coil electrodes as described in detail above), are located at a preferred location relative to the target baroreceptors. The preferred location may be determined, for example, as described in copending application Ser. No. 09/963,991, filed on Sep. 26, 2001, the full disclosure of which incorporated herein by reference. [0136] Once the preferred location for the electrodes 920 of the electrode assembly 900 is determined, the surgeon may position the base 902 so that the electrodes 920 are located appropriately relative to the underlying baroreceptors. Thus, the electrodes 920 may be positioned over the common carotid artery CC as shown in FIG. 28, or over the internal carotid artery IC, as shown in FIGS. 29 and 30. In FIG. 28, the assembly 900 may be attached by stretching the base 902 and attachment tabs 906 a and 906 b over the exterior of the common carotid artery. The reinforcement tabs 906 a or 906 b may then be secured to the reinforcement strip 910 a, either by suturing, stapling, fastening, gluing, welding, or other well-known means. Usually, the reinforcement tabs 906 c and 906 d will be cut off at their bases, as shown at 922 and 924, respectively. [0137] In other cases, the bulge of the carotid sinus and the baroreceptors may be located differently with respect to the carotid bifurcation. For example, as shown in FIG. 29, the receptors may be located further up the internal carotid artery IC so that the placement of electrode assembly 900 as shown in FIG. 28 will not work. The assembly 900, however, may still be successfully attached by utilizing the transversely angled attachment tabs 906 c and 906 d rather than the central or axial tabs 906 a and 906 b. As shown in FIG. 29, the lower tab 906 d is wrapped around the common carotid artery CC, while the upper attachment tab 906 c is wrapped around the internal carotid artery IC. The axial attachment tabs 906 a and 906 b will usually be cut off (at locations 926), although neither of them could in some instances also be wrapped around the internal carotid artery IC. Again, the tabs which are used may be stretched and attached to reinforcement strip 910 a, as generally described above. [0138] Referring to FIG. 30, in instances where the carotid bifurcation has less of an angle, the assembly 900 may be attached using the upper axial attachment tab 906 a and be lower transversely angled attachment tab 906 d. Attachment tabs 906 b and 906 c may be cut off, as shown at locations 928 and 930, respectively. In all instances, the elastic nature of the base 902 and the stretchable nature of the electrodes 920 permit the desired conformance and secure mounting of the electrode assembly over the carotid sinus. It would be appreciated that these or similar structures would also be useful for mounting electrode structures at other locations in the vascular system. [0139] In most activation device embodiments described herein, it may be desirable to incorporate anti-inflammatory agents (e.g., steroid eluting electrodes) such as described in U.S. Pat. No. 4,711,251 to Stokes, U.S. Pat. No. 5,522,874 to Gates and U.S. Pat. No. 4,972,848 to Di Domenico et al., the entire disclosures of which are incorporated herein by reference. Such agents reduce tissue inflammation at the chronic interface between the device (e.g., electrodes) and the vascular wall tissue, to thereby increase the efficiency of stimulus transfer, reduce power consumption, and maintain activation efficiency, for example. [0140] Those skilled in the art will recognize that the present invention may be manifested in a variety of forms other than the specific embodiments described and contemplated herein. Accordingly, departures in form and detail may be made without departing from the scope and spirit of the present invention as described in the appended claims. Patent CitationsCited PatentFiling datePublication dateApplicantTitleUS3645267 *Oct 29, 1969Feb 29, 1972Medtronic IncMedical-electronic stimulator, particularly a carotid sinus nerve stimulator with controlled turn-on amplitude rateUS3645287 *Sep 17, 1970Feb 29, 1972Ver Flugtechnische WerkeTwo-way valveUS3650277 *Feb 17, 1970Mar 21, 1972Lkb Medical AbApparatus for influencing the systemic blood pressure in a patient by carotid sinus nerve stimulationUS3870051 *Apr 26, 1973Mar 11, 1975Nat Res DevUrinary controlUS3943936 *Oct 9, 1973Mar 16, 1976Rasor Associates, Inc.Self powered pacers and stimulatorsUS4014318 *May 22, 1975Mar 29, 1977Dockum James MCirculatory assist device and systemUS4256094 *Jun 18, 1979Mar 17, 1981Kapp John PArterial pressure control systemUS4323073 *Aug 21, 1979Apr 6, 1982Cos Electronics CorporationApparatus and method for controlling the application of therapeutic direct current to living tissueUS4331157 *Jul 9, 1980May 25, 1982Stimtech, Inc.Mutually noninterfering transcutaneous nerve stimulation and patient monitoringUS4525074 *Aug 14, 1984Jun 25, 1985Citizen Watch Co., Ltd.Apparatus for measuring the quantity of physical exerciseUS4573481 *Jun 25, 1984Mar 4, 1986Huntington Institute Of Applied ResearchImplantable electrode arrayUS4586501 *Oct 19, 1983May 6, 1986Michel ClaracqDevice for partly occluding a vessel in particular the inferior vena cava and inherent component of this deviceUS4590946 *Jun 14, 1984May 27, 1986Biomed Concepts, Inc.Surgically implantable electrode for nerve bundlesUS4640286 *Nov 2, 1984Feb 3, 1987Staodynamics, Inc.Optimized nerve fiber stimulationUS4641664 *Apr 15, 1985Feb 10, 1987Siemens AktiengesellschaftEndocardial electrode arrangementUS4664120 *Jan 22, 1986May 12, 1987Cordis CorporationAdjustable isodiametric atrial-ventricular pervenous leadUS4719921 *Aug 28, 1985Jan 19, 1988Raul ChirifeCardiac pacemaker adaptive to physiological requirementsUS4739762 *Nov 3, 1986Apr 26, 1988Expandable Grafts PartnershipExpandable intraluminal graft, and method and apparatus for implanting an expandable intraluminal graftUS4800882 *Mar 13, 1987Jan 31, 1989Cook IncorporatedEndovascular stent and delivery systemUS4803988 *Feb 2, 1987Feb 14, 1989Staodynamics, Inc.Nerve fiber stimulation using plural equally active electrodesUS4813418 *Feb 2, 1987Mar 21, 1989Staodynamics, Inc.Nerve fiber stimulation using symmetrical biphasic waveform applied through plural equally active electrodesUS4825871 *May 18, 1987May 2, 1989Societe Anonyme Dite: AtesysDefibrillating or cardioverting electric shock system including electrodesUS4828544 *Sep 5, 1985May 9, 1989Quotidian No. 100 Pty LimitedControl of blood flowUS4830003 *Jun 17, 1988May 16, 1989Wolff Rodney GCompressive stent and delivery systemUS4917092 *Jul 13, 1988Apr 17, 1990Medical Designs, Inc.Transcutaneous nerve stimulator for treatment of sympathetic nerve dysfunctionUS4987897 *Sep 18, 1989Jan 29, 1991Medtronic, Inc.Body bus medical device communication systemUS5025807 *Jan 25, 1989Jun 25, 1991Jacob ZabaraNeurocybernetic prosthesisUS5078736 *May 4, 1990Jan 7, 1992Interventional Thermodynamics, Inc.Method and apparatus for maintaining patency in the body passagesUS5086787 *Feb 28, 1991Feb 11, 1992Medtronic, Inc.Steroid eluting intramuscular leadUS5088787 *Jan 30, 1991Feb 18, 1992Creative Extruded Products, Inc.Auto window moldingUS5092332 *Feb 22, 1990Mar 3, 1992Medtronic, Inc.Steroid eluting cuff electrode for peripheral nerve stimulationUS5113859 *Jun 25, 1990May 19, 1992Medtronic, Inc.Acoustic body bus medical device communication systemUS5113869 *Aug 21, 1990May 19, 1992Telectronics Pacing Systems, Inc.Implantable ambulatory electrocardiogram monitorUS5117826 *May 2, 1991Jun 2, 1992Staodyn, Inc.Combined nerve fiber and body tissue stimulation apparatus and methodUS5181911 *Apr 22, 1991Jan 26, 1993Shturman Technologies, Inc.Helical balloon perfusion angioplasty catheterUS5199428 *Mar 22, 1991Apr 6, 1993Medtronic, Inc.Implantable electrical nerve stimulator/pacemaker with ischemia for decreasing cardiac workloadUS5203326 *Dec 18, 1991Apr 20, 1993Telectronics Pacing Systems, Inc.Antiarrhythmia pacer using antiarrhythmia pacing and autonomic nerve stimulation therapyUS5215089 *Oct 21, 1991Jun 1, 1993Cyberonics, Inc.Electrode assembly for nerve stimulationUS5222971 *Oct 9, 1990Jun 29, 1993Scimed Life Systems, Inc.Temporary stent and methods for use and manufactureUS5282468 *Jan 8, 1992Feb 1, 1994Medtronic, Inc.Implantable neural electrodeUS5282488 *Nov 18, 1991Feb 1, 1994Eastman Kodak CompanyInterchangeable fluid path moduleUS5295959 *Mar 13, 1992Mar 22, 1994Medtronic, Inc.Autoperfusion dilatation catheter having a bonded channelUS5299569 *May 3, 1991Apr 5, 1994Cyberonics, Inc.Treatment of neuropsychiatric disorders by nerve stimulationUS5304206 *Nov 18, 1991Apr 19, 1994Cyberonics, Inc.Activation techniques for implantable medical deviceUS5314453 *Dec 6, 1991May 24, 1994Spinal Cord SocietyPosition sensitive power transfer antennaUS5318592 *Sep 14, 1992Jun 7, 1994BIOTRONIK, Mess- und Therapiegerate GmbH & Co., Ingenieurburo BerlinCardiac therapy systemUS5324310 *Jul 1, 1992Jun 28, 1994Medtronic, Inc.Cardiac pacemaker with auto-capture functionUS5324325 *Mar 29, 1993Jun 28, 1994Siemens Pacesetter, Inc.Myocardial steroid releasing leadUS5408744 *Apr 30, 1993Apr 25, 1995Medtronic, Inc.Substrate for a sintered electrodeUS5411540 *Jun 3, 1993May 2, 1995Massachusetts Institute Of TechnologyMethod and apparatus for preferential neuron stimulationUS5509888 *Jul 26, 1994Apr 23, 1996Conceptek CorporationController valve device and methodUS5522854 *May 19, 1994Jun 4, 1996Duke UniversityMethod and apparatus for the prevention of arrhythmia by nerve stimulationUS5522874 *Jul 28, 1994Jun 4, 1996Gates; James T.Medical lead having segmented electrodeUS5529067 *Aug 19, 1994Jun 25, 1996Novoste CorporationMethods for procedures related to the electrophysiology of the heartUS5634878 *Sep 19, 1994Jun 3, 1997Eska Medical Gmbh & Co.Implantable device for selectively opening and closing a tubular organ of the bodyUS5707400 *Sep 19, 1995Jan 13, 1998Cyberonics, Inc.Treating refractory hypertension by nerve stimulationUS5715837 *Aug 29, 1996Feb 10, 1998Light Sciences Limited PartnershipTranscutaneous electromagnetic energy transferUS5725471 *Nov 28, 1994Mar 10, 1998Neotonus, Inc.Magnetic nerve stimulator for exciting peripheral nervesUS5725563 *Apr 20, 1994Mar 10, 1998Klotz; AntoineElectronic device and method for adrenergically stimulating the sympathetic system with respect to the venous mediaUS5727558 *Feb 14, 1996Mar 17, 1998Hakki; A-HamidNoninvasive blood pressure monitor and control deviceUS5741316 *Dec 2, 1996Apr 21, 1998Light Sciences Limited PartnershipElectromagnetic coil configurations for power transmission through tissueUS5766236 *Apr 19, 1996Jun 16, 1998Detty; Gerald D.Electrical stimulation support bracesUS5766527 *Apr 10, 1996Jun 16, 1998Medtronic, Inc.Method of manufacturing medical electrical leadUS5861015 *May 5, 1997Jan 19, 1999Benja-Athon; AnuthepModulation of the nervous system for treatment of pain and related disordersUS5876422 *Jul 7, 1998Mar 2, 1999Vitatron Medical B.V.Pacemaker system with peltier cooling of A-V node for treating atrial fibrillationUS5891181 *Sep 15, 1997Apr 6, 1999Zhu; QiangBlood pressure depressorUS5904708 *Mar 19, 1998May 18, 1999Medtronic, Inc.System and method for deriving relative physiologic signalsUS5913876 *Sep 22, 1997Jun 22, 1999Cardiothoracic Systems, Inc.Method and apparatus for using vagus nerve stimulation in surgeryUS5916239 *Nov 24, 1997Jun 29, 1999Purdue Research FoundationMethod and apparatus using vagal stimulation for control of ventricular rate during atrial fibrillationUS6016449 *Oct 27, 1997Jan 18, 2000Neuropace, Inc.System for treatment of neurological disordersUS6023642 *May 8, 1997Feb 8, 2000Biogenics Ii, LlcCompact transcutaneous electrical nerve stimulatorUS6050952 *Jan 14, 1998Apr 18, 2000Hakki; A-HamidMethod for noninvasive monitoring and control of blood pressureUS6052623 *Nov 30, 1998Apr 18, 2000Medtronic, Inc.Feedthrough assembly for implantable medical devices and methods for providing sameUS6058331 *Apr 27, 1998May 2, 2000Medtronic, Inc.Apparatus and method for treating peripheral vascular disease and organ ischemia by electrical stimulation with closed loop feedback controlUS6061596 *Nov 20, 1996May 9, 2000Advanced Bionics CorporationMethod for conditioning pelvic musculature using an implanted microstimulatorUS6073048 *Nov 17, 1995Jun 6, 2000Medtronic, Inc.Baroreflex modulation with carotid sinus nerve stimulation for the treatment of heart failureUS6077227 *Dec 28, 1998Jun 20, 2000Medtronic, Inc.Method for manufacture and implant of an implantable blood vessel cuffUS6077298 *Feb 20, 1999Jun 20, 2000Tu; Lily ChenExpandable/retractable stent and methods thereofUS6178349 *Apr 15, 1999Jan 23, 2001Medtronic, Inc.Drug delivery neural stimulation device for treatment of cardiovascular disordersUS6208894 *Mar 25, 1998Mar 27, 2001Alfred E. Mann Foundation For Scientific Research And Advanced BionicsSystem of implantable devices for monitoring and/or affecting body parametersUS6231516 *Feb 23, 1998May 15, 2001Vacusense, Inc.Endoluminal implant with therapeutic and diagnostic capabilityUS6253110 *Apr 27, 1999Jun 26, 2001Medtronic IncMethod for tissue stimulation and fabrication of low polarization implantable stimulation electrodeUS6522926 *Sep 27, 2000Feb 18, 2003Cvrx, Inc.Devices and methods for cardiovascular reflex controlUS6564101 *Feb 2, 1999May 13, 2003The Trustees Of Columbia University In The City Of New YorkElectrical system for weight loss and laparoscopic implanation thereofUS6701186 *Sep 13, 2001Mar 2, 2004Cardiac Pacemakers, Inc.Atrial pacing and sensing in cardiac resynchronization therapyUS6704598 *May 23, 2001Mar 9, 2004Cardiac Pacemakers, Inc.Cardiac rhythm management system selecting between multiple same-chamber electrodes for delivering cardiac therapyUS6850801 *Sep 26, 2001Feb 1, 2005Cvrx, Inc.Mapping methods for cardiovascular reflex control devicesUS6985774 *Sep 26, 2001Jan 10, 2006Cvrx, Inc.Stimulus regimens for cardiovascular reflex controlUS7194313 *Jun 8, 2004Mar 20, 2007Cardiac Pacemakers, Inc.Baroreflex therapy for disordered breathingUS20020005982 *Jan 11, 2001Jan 17, 2002Rolf BorlinghausArrangement for spectrally sensitive reflected-light and transmitted-light microscopyUS20030040785 *Aug 21, 2001Feb 27, 2003Maschino Steve E.Circumneural electrode assemblyUS20030060848 *Sep 26, 2001Mar 27, 2003Kieval Robert S.Mapping methods for cardiovascular reflex control devicesUS20030060857 *Sep 26, 2001Mar 27, 2003Perrson Bruce J.Electrode designs and methods of use for cardiovascular reflex control devicesUS20030060858 *Sep 26, 2001Mar 27, 2003Kieval Robert S.Stimulus regimens for cardiovascular reflex controlUS20040010303 *Mar 27, 2003Jan 15, 2004Cvrx, Inc.Electrode structures and methods for their use in cardiovascular reflex controlUS20040019364 *Mar 27, 2003Jan 29, 2004Cvrx, Inc.Devices and methods for cardiovascular reflex control via coupled electrodesUS20040062852 *Sep 30, 2002Apr 1, 2004Medtronic, Inc.Method for applying a drug coating to a medical deviceUS20040102818 *Nov 26, 2002May 27, 2004Hakky Said I.Method and system for controlling blood pressureUS20050021092 *Jun 18, 2004Jan 27, 2005Yun Anthony JoonkyooTreatment of conditions through modulation of the autonomic nervous system* Cited by examinerReferenced byCiting PatentFiling datePublication dateApplicantTitleUS7647114Jan 12, 2010Cardiac Pacemakers, Inc.Baroreflex modulation based on monitored cardiovascular parameterUS7657312Nov 3, 2003Feb 2, 2010Cardiac Pacemakers, Inc.Multi-site ventricular pacing therapy with parasympathetic stimulationUS7706884Dec 24, 2003Apr 27, 2010Cardiac Pacemakers, Inc.Baroreflex stimulation synchronized to circadian rhythmUS7783353Nov 9, 2006Aug 24, 2010Cardiac Pacemakers, Inc.Automatic neural stimulation modulation based on activity and circadian rhythmUS7813812Oct 12, 2010Cvrx, Inc.Baroreflex stimulator with integrated pressure sensorUS7840271Jul 20, 2005Nov 23, 2010Cvrx, Inc.Stimulus regimens for cardiovascular reflex controlUS7869881Dec 24, 2003Jan 11, 2011Cardiac Pacemakers, Inc.Baroreflex stimulator with integrated pressure sensorUS7949400May 24, 2011Cvrx, Inc.Devices and methods for cardiovascular reflex control via coupled electrodesUS8000793May 23, 2008Aug 16, 2011Cardiac Pacemakers, Inc.Automatic baroreflex modulation based on cardiac activityUS8024050Sep 20, 2011Cardiac Pacemakers, Inc.Lead for stimulating the baroreceptors in the pulmonary arteryUS8060206Nov 15, 2011Cvrx, Inc.Baroreflex modulation to gradually decrease blood pressureUS8086314Dec 27, 2011Cvrx, Inc.Devices and methods for cardiovascular reflex controlUS8116841Sep 12, 2008Feb 14, 2012Corventis, Inc.Adherent device with multiple physiological sensorsUS8121693Oct 23, 2008Feb 21, 2012Cardiac Pacemakers, Inc.Baroreflex stimulation to treat acute myocardial infarctionUS8126560Dec 24, 2003Feb 28, 2012Cardiac Pacemakers, Inc.Stimulation lead for stimulating the baroreceptors in the pulmonary arteryUS8131362Aug 19, 2009Mar 6, 2012Cardiac Pacemakers, Inc.Combined neural stimulation and cardiac resynchronization therapyUS8131373Mar 30, 2010Mar 6, 2012Cardiac Pacemakers, Inc.Baroreflex stimulation synchronized to circadian rhythmUS8195289Jun 5, 2012Cardiac Pacemakers, Inc.Baroreflex stimulation system to reduce hypertensionUS8249686Sep 12, 2008Aug 21, 2012Corventis, Inc.Adherent device for sleep disordered breathingUS8285356Oct 9, 2012Corventis, Inc.Adherent device with multiple physiological sensorsUS8285389Oct 9, 2012Cardiac Pacemakers, Inc.Automatic neural stimulation modulation based on motion and physiological activityUS8290595Oct 16, 2012Cvrx, Inc.Method and apparatus for stimulation of baroreceptors in pulmonary arteryUS8321023Jan 27, 2009Nov 27, 2012Cardiac Pacemakers, Inc.Baroreflex modulation to gradually decrease blood pressureUS8374688Feb 12, 2013Corventis, Inc.System and methods for wireless body fluid monitoringUS8406868Mar 26, 2013Medtronic, Inc.Therapy using perturbation and effect of physiological systemsUS8412317Apr 2, 2013Corventis, Inc.Method and apparatus to measure bioelectric impedance of patient tissueUS8423134Apr 26, 2011Apr 16, 2013Medtronic, Inc.Therapy using perturbation and effect of physiological systemsUS8442640Jan 4, 2010May 14, 2013Cardiac Pacemakers, Inc.Neural stimulation modulation based on monitored cardiovascular parameterUS8457746Aug 4, 2011Jun 4, 2013Cardiac Pacemakers, Inc.Implantable systems and devices for providing cardiac defibrillation and apnea therapyUS8460189Sep 12, 2008Jun 11, 2013Corventis, Inc.Adherent cardiac monitor with advanced sensing capabilitiesUS8473076Sep 6, 2011Jun 25, 2013Cardiac Pacemakers, Inc.Lead for stimulating the baroreceptors in the pulmonary arteryUS8538535Aug 5, 2010Sep 17, 2013Rainbow Medical Ltd.Enhancing perfusion by contractionUS8571655Jan 26, 2010Oct 29, 2013Cardiac Pacemakers, Inc.Multi-site ventricular pacing therapy with parasympathetic stimulationUS8583236Mar 8, 2010Nov 12, 2013Cvrx, Inc.Devices and methods for cardiovascular reflex controlUS8591430Sep 12, 2008Nov 26, 2013Corventis, Inc.Adherent device for respiratory monitoringUS8606359Apr 13, 2007Dec 10, 2013Cvrx, Inc.System and method for sustained baroreflex stimulationUS8620425Jul 30, 2010Dec 31, 2013Medtronic, Inc.Nerve signal differentiation in cardiac therapyUS8626282Nov 15, 2012Jan 7, 2014Cardiac Pacemakers, Inc.Baroreflex modulation to gradually change a physiological parameterUS8626290Aug 16, 2011Jan 7, 2014Enopace Biomedical Ltd.Acute myocardial infarction treatment by electrical stimulation of the thoracic aortaUS8626299Dec 1, 2010Jan 7, 2014Enopace Biomedical Ltd.Thoracic aorta and vagus nerve stimulationUS8626301Jun 3, 2013Jan 7, 2014Cardiac Pacemakers, Inc.Automatic baroreflex modulation based on cardiac activityUS8639322May 30, 2012Jan 28, 2014Cardiac Pacemakers, Inc.System and method for delivering myocardial and autonomic neural stimulationUS8639327Jul 30, 2010Jan 28, 2014Medtronic, Inc.Nerve signal differentiation in cardiac therapyUS8649863Dec 20, 2010Feb 11, 2014Rainbow Medical Ltd.Pacemaker with no productionUS8684925Sep 12, 2008Apr 1, 2014Corventis, Inc.Injectable device for physiological monitoringUS8706223Jan 19, 2012Apr 22, 2014Medtronic, Inc.Preventative vagal stimulationUS8712531May 24, 2012Apr 29, 2014Cvrx, Inc.Automatic baroreflex modulation responsive to adverse eventUS8718752Mar 11, 2009May 6, 2014Corventis, Inc.Heart failure decompensation prediction based on cardiac rhythmUS8718763Jan 19, 2012May 6, 2014Medtronic, Inc.Vagal stimulationUS8718789Apr 19, 2010May 6, 2014Cvrx, Inc.Electrode structures and methods for their use in cardiovascular reflex controlUS8725259Jan 19, 2012May 13, 2014Medtronic, Inc.Vagal stimulationUS8781582Jan 19, 2012Jul 15, 2014Medtronic, Inc.Vagal stimulationUS8781583Jan 19, 2012Jul 15, 2014Medtronic, Inc.Vagal stimulationUS8790257Sep 12, 2008Jul 29, 2014Corventis, Inc.Multi-sensor patient monitor to detect impending cardiac decompensationUS8790259Oct 22, 2010Jul 29, 2014Corventis, Inc.Method and apparatus for remote detection and monitoring of functional chronotropic incompetenceUS8805501Jan 25, 2012Aug 12, 2014Cardiac Pacemakers, Inc.Baroreflex stimulation to treat acute myocardial infarctionUS8805513Apr 23, 2013Aug 12, 2014Cardiac Pacemakers, Inc.Neural stimulation modulation based on monitored cardiovascular parameterUS8818513Mar 1, 2012Aug 26, 2014Cardiac Pacemakers, Inc.Baroreflex stimulation synchronized to circadian rhythmUS8838239 *Jul 8, 2013Sep 16, 2014Cardiac Pacemakers, Inc.Combined remodeling control therapy and anti-remodeling therapy by implantable cardiac deviceUS8838246Sep 27, 2006Sep 16, 2014Cvrx, Inc.Devices and methods for cardiovascular reflex treatmentsUS8855783Nov 10, 2011Oct 7, 2014Enopace Biomedical Ltd.Detector-based arterial stimulationUS8862243Jul 25, 2006Oct 14, 2014Rainbow Medical Ltd.Electrical stimulation of blood vesselsUS8874211Dec 15, 2010Oct 28, 2014Cardiac Pacemakers, Inc.Hypertension therapy based on activity and circadian rhythmUS8880190Nov 30, 2012Nov 4, 2014Cvrx, Inc.Electrode structures and methods for their use in cardiovascular reflex controlUS8888699Apr 26, 2011Nov 18, 2014Medtronic, Inc.Therapy using perturbation and effect of physiological systemsUS8897868Sep 12, 2008Nov 25, 2014Medtronic, Inc.Medical device automatic start-up upon contact to patient tissueUS8923972Jul 25, 2007Dec 30, 2014Vascular Dynamics, Inc.Elliptical element for blood pressure reductionUS8965498Mar 28, 2011Feb 24, 2015Corventis, Inc.Method and apparatus for personalized physiologic parametersUS9020595May 19, 2010Apr 28, 2015Cardiac Pacemakers, Inc.Baroreflex activation therapy with conditional shut offUS9044609Nov 18, 2011Jun 2, 2015Cvrx, Inc.Electrode structures and methods for their use in cardiovascular reflex controlUS9125567Sep 29, 2009Sep 8, 2015Vascular Dynamics, Inc.Devices and methods for control of blood pressureUS9125732Feb 18, 2011Sep 8, 2015Vascular Dynamics, Inc.Devices and methods for control of blood pressureUS9155893Apr 22, 2014Oct 13, 2015Medtronic, Inc.Use of preventative vagal stimulation in treatment of acute myocardial infarction or ischemiaUS9173615Sep 23, 2014Nov 3, 2015Medtronic Monitoring, Inc.Method and apparatus for personalized physiologic parametersUS9186089Sep 12, 2008Nov 17, 2015Medtronic Monitoring, Inc.Injectable physiological monitoring systemUS9211413Jul 14, 2014Dec 15, 2015Medtronic, Inc.Preventing use of vagal stimulation parametersUS9265948Oct 14, 2014Feb 23, 2016Cardiac Pacemakers, Inc.Automatic neural stimulation modulation based on activityUS9314635Feb 10, 2009Apr 19, 2016Cardiac Pacemakers, Inc.Automatic baroreflex modulation responsive to adverse eventUS20050143779 *Sep 13, 2004Jun 30, 2005Cardiac Pacemakers, Inc.Baroreflex modulation based on monitored cardiovascular parameterUS20050149128 *Dec 24, 2003Jul 7, 2005Heil Ronald W.Jr.Barorflex stimulation system to reduce hypertensionUS20050149130 *Dec 24, 2003Jul 7, 2005Imad LibbusBaroreflex stimulation synchronized to circadian rhythmUS20050149131 *Dec 24, 2003Jul 7, 2005Imad LibbusBaroreflex modulation to gradually decrease blood pressureUS20050149132 *Dec 24, 2003Jul 7, 2005Imad LibbusAutomatic baroreflex modulation based on cardiac activityUS20050149143 *Dec 24, 2003Jul 7, 2005Imad LibbusBaroreflex stimulator with integrated pressure sensorUS20050251212 *Jul 20, 2005Nov 10, 2005Cvrx, Inc.Stimulus regimens for cardiovascular reflex controlUS20070021792 *Jun 30, 2006Jan 25, 2007Cvrx, Inc.Baroreflex Modulation Based On Monitored Cardiovascular ParameterUS20070021794 *Jun 30, 2006Jan 25, 2007Cvrx, Inc.Baroreflex Therapy for Disordered BreathingUS20070060972 *Sep 27, 2006Mar 15, 2007Cvrx, Inc.Devices and methods for cardiovascular reflex treatmentsUS20070142864 *Nov 9, 2006Jun 21, 2007Imad LibbusAutomatic neural stimulation modulation based on activityUS20070185543 *Apr 13, 2007Aug 9, 2007Cvrx, Inc.System and method for sustained baroreflex stimulationUS20080015659 *Sep 25, 2007Jan 17, 2008Yi ZhangNeurostimulation systems and methods for cardiac conditionsUS20080021507 *Jan 9, 2007Jan 24, 2008Cardiac Pacemakers, Inc.Sensing with compensation for neural stimulatorUS20080033501 *Jul 25, 2007Feb 7, 2008Yossi GrossElliptical element for blood pressure reductionUS20080097540 *Dec 14, 2007Apr 24, 2008Cvrx, Inc.Ecg input to implantable pulse generator using carotid sinus leadsUS20080171923 *Oct 31, 2007Jul 17, 2008Cvrx, Inc.Assessing autonomic activity using baroreflex analysisUS20080172101 *Oct 31, 2007Jul 17, 2008Cvrx, Inc.Non-linear electrode arrayUS20080177350 *Oct 31, 2007Jul 24, 2008Cvrx, Inc.Expandable Stimulation Electrode with Integrated Pressure Sensor and Methods Related TheretoUS20080215111 *Oct 31, 2007Sep 4, 2008Cvrx, Inc.Devices and Methods for Cardiovascular Reflex ControlUS20080215117 *Jul 25, 2006Sep 4, 2008Yossi GrossElectrical Stimulation of Blood VesselsUS20080228238 *May 23, 2008Sep 18, 2008Cardiac Pacemakers, Inc.Automatic baroreflex modulation based on cardiac activityUS20080289920 *May 21, 2008Nov 27, 2008Hoerbiger-Origa Holding AgPneumatic cylinder with a self-adjusting end position damping arrangement, and method for self-adjusting end position dampingUS20090048641 *Oct 23, 2008Feb 19, 2009Cardiac Pacemakers, Inc.Baroreflex stimulation to treat acute myocardial infarctionUS20090073991 *Sep 12, 2008Mar 19, 2009Corventis, Inc.Dynamic Pairing of Patients to Data Collection GatewaysUS20090076336 *Sep 12, 2008Mar 19, 2009Corventis, Inc.Medical Device Automatic Start-up Upon Contact to Patient TissueUS20090076340 *Sep 12, 2008Mar 19, 2009Corventis, Inc.Adherent Cardiac Monitor with Advanced Sensing CapabilitiesUS20090076341 *Sep 12, 2008Mar 19, 2009Corventis, Inc.Adherent Athletic MonitorUS20090076342 *Sep 12, 2008Mar 19, 2009Corventis, Inc.Adherent Multi-Sensor Device with Empathic MonitoringUS20090076343 *Sep 12, 2008Mar 19, 2009Corventis, Inc.Energy Management for Adherent Patient MonitorUS20090076344 *Sep 12, 2008Mar 19, 2009Corventis, Inc.Multi-Sensor Patient Monitor to Detect Impending Cardiac DecompensationUS20090076345 *Sep 12, 2008Mar 19, 2009Corventis, Inc.Adherent Device with Multiple Physiological SensorsUS20090076346 *Sep 12, 2008Mar 19, 2009Corventis, Inc.Tracking and Security for Adherent Patient MonitorUS20090076348 *Sep 12, 2008Mar 19, 2009Corventis, Inc.Injectable Device for Physiological MonitoringUS20090076349 *Sep 12, 2008Mar 19, 2009Corventis, Inc.Adherent Multi-Sensor Device with Implantable Device Communication CapabilitiesUS20090076350 *Sep 12, 2008Mar 19, 2009Corventis, Inc.Data Collection in a Multi-Sensor Patient MonitorUS20090076363 *Sep 12, 2008Mar 19, 2009Corventis, Inc.Adherent Device with Multiple Physiological SensorsUS20090076364 *Sep 12, 2008Mar 19, 2009Corventis, Inc.Adherent Device for Sleep Disordered BreathingUS20090076397 *Sep 12, 2008Mar 19, 2009Corventis, Inc.Adherent Emergency Patient MonitorUS20090076401 *Sep 12, 2008Mar 19, 2009Corventis, Inc.Injectable Physiological Monitoring SystemUS20090076405 *Sep 12, 2008Mar 19, 2009Corventis, Inc.Adherent Device for Respiratory MonitoringUS20090076410 *Sep 12, 2008Mar 19, 2009Corventis, Inc.System and Methods for Wireless Body Fluid MonitoringUS20090076559 *Sep 12, 2008Mar 19, 2009Corventis, Inc.Adherent Device for Cardiac Rhythm ManagementUS20090143838 *Jan 27, 2009Jun 4, 2009Imad LibbusBaroreflex modulation to gradually decrease blood pressureUS20090234410 *Mar 11, 2009Sep 17, 2009Corventis, Inc.Heart Failure Decompensation Prediction Based on Cardiac RhythmUS20090234418 *Apr 9, 2009Sep 17, 2009Kieval Robert SDevices and methods for cardiovascular reflex control via coupled electrodesUS20090264792 *Apr 20, 2009Oct 22, 2009Corventis, Inc.Method and Apparatus to Measure Bioelectric Impedance of Patient TissueUS20090306734 *Dec 10, 2009Julia MoffittCombined neural stimulation and cardiac resynchronization therapyUS20100125307 *Jan 26, 2010May 20, 2010Pastore Joseph MMulti-site ventricular pacing therapy with parasympathetic stimulationUS20100174347 *Nov 10, 2009Jul 8, 2010Kieval Robert SDevices and methods for cardiovascular reflex control via coupled electrodesUS20100179614 *Mar 8, 2010Jul 15, 2010Kieval Robert SDevices and methods for cardiovascular reflex controlUS20100185255 *Mar 30, 2010Jul 22, 2010Imad LibbusBaroreflex stimulation synchronized to circadian rhythmUS20100191303 *Mar 24, 2010Jul 29, 2010Cvrx, Inc.Automatic baroreflex modulation responsive to adverse eventUS20100191310 *Jul 27, 2009Jul 29, 2010Corventis, Inc.Communication-Anchor Loop For Injectable DeviceUS20100249874 *Sep 30, 2010Bolea Stephen LBaroreflex therapy for disordered breathingUS20100274321 *Oct 28, 2010Imad LibbusBaroreflex activation therapy with conditional shut offUS20110009692 *Dec 28, 2008Jan 13, 2011Yossi GrossNitric oxide generation to treat female sexual dysfunctionUS20110077729 *May 5, 2010Mar 31, 2011Vascular Dynamics Inc.Devices and methods for control of blood pressureUS20110082514 *Apr 7, 2011Imad LibbusHypertension therapy based on activity and circadian rhythmUS20110106216 *May 5, 2011Imad LibbusBaroreflex stimulator with integrated pressure sensorUS20110137370 *Dec 1, 2010Jun 9, 2011Enopace Biomedical Ltd.Thoracic aorta and vagus nerve stimulationUS20110144470 *Dec 2, 2010Jun 16, 2011Corventis, Inc.Body adherent patch with electronics for physiologic monitoringUS20110178416 *Jul 21, 2011Vascular Dynamics Inc.Devices and methods for control of blood pressureUS20110213408 *Sep 29, 2009Sep 1, 2011Vascular Dynamics Inc.Devices and methods for control of blood pressureWO2010035271A1 *Sep 29, 2009Apr 1, 2010Vascular Dynamics Inc.Devices and methods for control of blood pressureWO2013169995A1 *May 9, 2013Nov 14, 2013Vascular Dynamics, Inc.Methods and apparatus for stimulating stretch receptors in the vasculature* Cited by examinerClassifications U.S. Classification607/44International ClassificationA61N1/36, A61N1/05, A61N1/00Cooperative ClassificationA61N1/36125, A61N1/36114, A61N1/36053, A61N1/0551, A61B5/02028, A61N1/36185, A61N1/08, A61N1/05, A61N1/056, A61N1/3702, A61N1/36117, A61N1/3611, A61N1/36135European ClassificationA61N1/36Z3J, A61B5/02F, A61N1/05, A61N1/08, A61N1/368R, A61N1/36Z5P3A, A61N1/37B, A61N1/05NLegal EventsDateCodeEventDescriptionNov 30, 2006ASAssignmentOwner name: CVRX, INC., MINNESOTAFree format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:KIEVAL, ROBERT S.;BURNS, MATTHEW M.;SERDAR, DAVID J.;REEL/FRAME:018566/0327;SIGNING DATES FROM 20061004 TO 20061005Owner name: CVRX, INC., MINNESOTAFree format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:KIEVAL, ROBERT S.;BURNS, MATTHEW M.;SERDAR, DAVID J.;SIGNING DATES FROM 20061004 TO 20061005;REEL/FRAME:018566/0327May 15, 2015FPAYFee paymentYear of fee payment: 4RotateOriginal ImageGoogle Home - Sitemap - USPTO Bulk Downloads - Privacy Policy - Terms of Service - About Google Patents - Send FeedbackData provided by IFI CLAIMS Patent Services