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EP0892651A1 - System zur behandlung oder diagnose von herzgewebe - Google Patents

System zur behandlung oder diagnose von herzgewebe

Info

Publication number
EP0892651A1
EP0892651A1 EP96913986A EP96913986A EP0892651A1 EP 0892651 A1 EP0892651 A1 EP 0892651A1 EP 96913986 A EP96913986 A EP 96913986A EP 96913986 A EP96913986 A EP 96913986A EP 0892651 A1 EP0892651 A1 EP 0892651A1
Authority
EP
European Patent Office
Prior art keywords
catheter
delivery catheter
distal end
distal
patient
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP96913986A
Other languages
English (en)
French (fr)
Inventor
Randy J. Kesten
Carl J. Simpson
Michael Aita
Manuel A. Javier, Jr.
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Eclipse Surgical Technologies Inc
Original Assignee
Cardiogenesis Corp
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Cardiogenesis Corp filed Critical Cardiogenesis Corp
Publication of EP0892651A1 publication Critical patent/EP0892651A1/de
Withdrawn legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/06—Body-piercing guide needles or the like
    • A61M25/0662—Guide tubes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
    • A61B18/22—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor
    • A61B18/24—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor with a catheter
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/0021—Catheters; Hollow probes characterised by the form of the tubing
    • A61M25/0041—Catheters; Hollow probes characterised by the form of the tubing pre-formed, e.g. specially adapted to fit with the anatomy of body channels
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/02—Surgical instruments, devices or methods for holding wounds open, e.g. retractors; Tractors
    • A61B17/0218—Surgical instruments, devices or methods for holding wounds open, e.g. retractors; Tractors for minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/32—Surgical cutting instruments
    • A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
    • A61B17/32002—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes with continuously rotating, oscillating or reciprocating cutting instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/32—Surgical cutting instruments
    • A61B17/3203—Fluid jet cutting instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3478—Endoscopic needles, e.g. for infusion
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/00234—Surgical instruments, devices or methods for minimally invasive surgery
    • A61B2017/00238—Type of minimally invasive operation
    • A61B2017/00243—Type of minimally invasive operation cardiac
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/00234—Surgical instruments, devices or methods for minimally invasive surgery
    • A61B2017/00238—Type of minimally invasive operation
    • A61B2017/00243—Type of minimally invasive operation cardiac
    • A61B2017/00247—Making holes in the wall of the heart, e.g. laser Myocardial revascularization
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/00234—Surgical instruments, devices or methods for minimally invasive surgery
    • A61B2017/00292—Surgical instruments, devices or methods for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/003—Steerable
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/22—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22082—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for after introduction of a substance
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2901—Details of shaft
    • A61B2017/2905—Details of shaft flexible
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/32—Surgical cutting instruments
    • A61B2017/320004—Surgical cutting instruments abrasive
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/34—Trocars; Puncturing needles
    • A61B2017/348—Means for supporting the trocar against the body or retaining the trocar inside the body
    • A61B2017/3482—Means for supporting the trocar against the body or retaining the trocar inside the body inside
    • A61B2017/3484—Anchoring means, e.g. spreading-out umbrella-like structure
    • A61B2017/3488—Fixation to inner organ or inner body tissue
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00345—Vascular system
    • A61B2018/00351—Heart
    • A61B2018/00392—Transmyocardial revascularisation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2210/00—Anatomical parts of the body
    • A61M2210/12—Blood circulatory system
    • A61M2210/125—Heart

Definitions

  • This invention is directed to elongated devices for therapeutic or diagnostic procedures in a wall of a patient's heart, particularly to the treatment of myocardial tissue experiencing ischemic conditions by revascularization of such myocardial tissue.
  • Myocardial revascularization typically involves formation of one or more channels in a patient's heart wall defining the heart chamber to allow oxygenated blood to flow from the left ventricle of the patient's heart through the endocardium into a patient's ischemic myocardial tissue.
  • the first trials of the revascularization process was made by Mirhoseini et al. See for example the discussions in Lasers in General Suroerv (Williams & Wilkins; 1 989), pp 21 6-223. Another early disclosure of this procedure is found in U.S. Patent 4,658,817 (Hardy). Both of these references describe revascularization procedures which require the chest wall to be opened and which include formation of the revascularization channels through the epicardium, myocardium and endocardium, i.e. the entire heart wall.
  • What has been needed is a system and method for delivering a channel forming device within the patient's heart chamber which provide for the accurate placement of the operative end of the channel forming device against a desired region of the endocardium at the desired orientation and the maintenance of the position of the device within the patient's heart chamber while the revascularization channel is being formed and the heart is beating.
  • the present invention satisfies these and other needs.
  • the present invention is directed to a system and method for delivering an elongated therapeutic or diagnostic device to the interior of a patient's heart chamber which provides access to a wide region of the patient's endocardium and accurately places and effectively holds the operative distal end of the device at a desired location within the patient's heart chamber.
  • a typical device may be used to form a channel into the wall defining the heart chamber or perform other ablation treatments and diagnosis.
  • the system also allows the position of the operative distal end of the device to be readily changed to facilitate performing therapeutic or diagnostic procedures at a plurality of locations within the heart chamber and at a desired orientation with respect to the patient's endocardium.
  • One presently preferred embodiment of the invention includes a first delivery catheter which has proximal and distal ends, a port in the distal end and an inner lumen extending within the catheter to the port in the distal end.
  • the first delivery catheter is provided with a preshaped distal section, or a distal section which can be deformed or shaped once positioned within the patient's heart chamber.
  • the embodiment also includes a second delivery catheter or sleeve longer than the first delivery catheter which is slidably and preferably rotatably disposed within inner lumen of the first catheter.
  • the second delivery catheter likewise has proximal and distal ends, a port in the distal end an inner lumen extending within the second catheter to the port in the distal end.
  • the distal section of the second delivery catheter may be straight, i.e. in line with the main catheter section but it is preferably provided with a preshaped distal section, or a distal section which can be deformed or shaped once positioned within the patient's heart chamber, so as to facilitate directing an elongated therapeutic or diagnostic device slidably disposed within the inner lumen of the second delivery catheter toward the region of the endocardium where the procedure is to be performed.
  • the orientation is preferably perpendicular or near perpendicular with the endocardial surface of the patient's heart wall.
  • a presently preferred elongated therapeutic or diagnostic device is a laser based optical fiber system for forming channels within the wall of the patient's heart.
  • the optical fiber system which is adapted to emit laser energy from its distal end, is slidably disposed within the inner lumen of the second delivery catheter and is long enough to extend out the distal end of the second delivery catheter to be able to engage tissue of the endocardium while forming the channel or performing other types of procedures.
  • the system is introduced into a peripheral artery, such as the femoral artery, and to be advanced through the patient's arterial system until the distal end of the first catheter is disposed within the patient's left ventricle or slightly down stream from the patient's aortic valve in the ascending aorta.
  • the first delivery catheter may be advanced through a previously introduced guiding catheter which has a distal end within the left ventricle or within the ascending aorta or over a previously positioned guidewire or catheter.
  • the second delivery catheter is rotatably and slidably disposed within the inner lumen of the first delivery catheter to facilitate the desired placement and orientation of the shaped or shapable distal extremity thereof within the left ventricle.
  • Perpendicularity or near perpendicularity of the elongated therapeutic or diagnostic device with respect to the inner endocardial surface of the heart chamber is usually required in order to effectively couple the ablation energy to the tissue.
  • such perpendicularity helps to maintain the position of the distal end of the device, particularly a channel forming device, against the tissue to be ablated or removed to form the channel. Otherwise, the operative tip of the therapeutic or diagnostic device tends to move laterally while the heart is beating resulting in mislocation of the channel, or ablated tissue or medical procedure.
  • Longitudinal and rotational movements of the first and second delivery catheters provides access to a wide region of the patient's endocardial surface and allows for the accurate placement of the operative end of the therapeutic or diagnostic device within the patient's left ventricle in a number of positions.
  • Extension of the second delivery catheter out the distal end of the first delivery catheter to engage the endocardium of the patient's heart can also ensure effective contact by providing more support to the therapeutic or diagnostic device.
  • the location of the distal end of the therapeutic or diagnostic device within the heart chamber and particularly with respect to the endocardial surface can be detected fluoroscopically by providing a radiopaque marker on the distal end of the device.
  • the use of dye injections out the port in the distal end of second delivery catheter or a radiopaque marker on the distal end of the second delivery catheter, or both may be employed to locate the distal end of the first and second delivery catheters.
  • Other means such as a variety of proximity detectors may be employed to detect contact between the distal end of the therapeutic or diagnostic device or the delivery catheters and the endocardium.
  • the distal sections of the first and second delivery catheters may be preformed into a desired shape so that they will provide a desired orientation for the delivery system when it extends into the patient's heart chamber.
  • the catheters may also be provided with control lines or other suitable means (e.g. a shape memory or a superelastic NiTi element) to deflect or otherwise shape the distal sections of the catheters once the distal extremity of the delivery system extends into the heart chamber.
  • suitable means e.g. a shape memory or a superelastic NiTi element
  • the guiding catheter (if used) and first delivery catheter are both preferably relatively stiff catheters so that the position of the therapeutic or diagnostic device will be maintained during the procedure even though the heart is beating.
  • the functions of the first and second delivery catheters can be combined into a single catheter, if the shape of the distal extremity of such a single catheter is controllable after the distal extremity is disposed within the patient's heart chamber.
  • the delivery system has an elongated main section and a distal extremity which extends within the patient's heart chamber which has a double bend.
  • the distal extremity has a proximal portion extending away from the main section at an angle and a distal portion extending away from the proximal portion of the distal extremity at an angle.
  • the proximal portion of the distal extremity extends away from the main catheter section at an angle of about 40° to about 1 20°, preferably about 60° to about 120°.
  • the distal portion of the distal extremity extends away from the proximal portion at an angle of about 40° to about 120°, preferably about 60° to about 120°.
  • the length of the proximal portion of the distal extremity may range from about 0.5 to about 3 cm, preferably about 1 to about 2 cm and the length of the distal portion may range from about 0.5 to about 2.5 cm, preferably about 0.5 to about 1 .5 cm.
  • the delivery system is in the form of a single catheter and a second version of this embodiment the delivery system has first and second delivery catheters as in the previously discussed embodiments.
  • the orientation of the distal portion in the first version may be in one direction for clockwise rotation of the main portion of the delivery system or in another opposite direction for counter clockwise rotation of the main portion.
  • the proximal portion of the delivery system is the distal extremity of the first delivery catheter and the distal portion of the delivery system is the distal section of the second delivery catheter which is slidably disposed within the inner lumen of the first delivery catheter.
  • a positioning sheath may be disposed within the inner most inner lumen of the delivery system which is extended to the surface of the heart wall, to further support the therapeutic or diagnostic device. However, if the delivery system has two changes in direction the advancement of a positioning sheath may become difficult.
  • the anatomy of the left ventricle can vary considerably as to dimensions and to shape from patient to patient.
  • the channel forming member with the first embodiment may not be able to be directed to the entire region in which channels are to be formed.
  • the shape of the guiding catheter or the first delivery catheter and the orientation thereof within the left ventricle can further complicate placement of the channel forming means or other therapeutic or diagnostic device.
  • the rotation of the first and second delivery catheters will ensure that the therapeutic or diagnostic can reach all or at the very least a major part of the region in which the device is to be operated.
  • the passageway formed into the myocardium may be used for other purposes.
  • therapeutic or diagnostic agents may be introduced into the channel for delivery to the patient's endocardium or myocardium.
  • the therapeutic or diagnostic agent may be incorporated into a biocompatible matrix deposited within the channel for delivery or release over an extended period.
  • the channel forming device may be removed and a catheter with an inner lumen extending the length thereof may be advanced through the inner lumen of the second delivery catheter until the distal end of the catheter extends into the channel formed in the wall of the patient's heart.
  • a therapeutic or diagnostic agent may then be delivered through the inner lumen of the catheter and out a port in the distal end into the channel such as described in copending application Serial No. 08.
  • the drug delivery catheter may be generally a simple elongated flexible tube with an inner lumen extending therein to a port or opening in the distal end of the catheter.
  • the outer dimensions are suitable to provide longitudinal movement of the drug delivery catheter within the second delivery catheter.
  • the distal extremity of the drug delivery catheter is preferably configured to readily fit into the channel formed in the endocardium and myocardium so that delivery of the therapeutic or diagnostic agent well into the channel is ensured.
  • the laser device may be replace with a RF energy or an ultrasonic energy delivery system which damages myocardial tissue without forming a channel.
  • injection of small quantities of chemical ablation media such as ethyl alcohol or phenol may likewise be used for similar results.
  • Fig. 1 is an elevational view of an embodiment of the delivery system of the invention disposed within the arterial system of a patient with the distal end of the system disposed within the patient's left ventricle.
  • Fig. 2 is a transverse cross-sectional view of the delivery system shown in Fig. 1 taken along the lines 2-2.
  • Fig. 3 is an elevational view of the system shown in Fig. 1 with the second delivery catheter extending out of the distal end of the first delivery catheter and the distal end thereof pressed against the endocardial layer.
  • Fig. 4 is an elevational view of the system shown in Fig. 1 with a channel forming device, in this case an optical fiber, extending out of the second delivery catheter and into a channel formed by laser energy emitted out the distal end of the optical fiber.
  • a channel forming device in this case an optical fiber
  • Fig. 5 is a schematic representation of the degrees of orientation of the first delivery catheter within the left ventricle of a patient's heart.
  • Fig. 6 is longitudinal cross-sectional view of the distal end of the optical laser shown in Fig. 4.
  • Fig. 7 is a perspective view of an alternative embodiment of the invention.
  • Fig. 8 is a perspective view of an embodiment which is the mirror image of the embodiment shown in Fig. 7.
  • Fig. 9 is an enlarged view of the embodiment shown in Fig. 8 with indications of orientations of the distal portions of the embodiment.
  • Fig. 10 is a elevational view of the distal portion of a channel forming device having an auger on the distal tip.
  • Fig. 1 1 is an elevational view of the distal portion of a channel forming device having an abrading member on the distal tip.
  • Fig. 1 2 is an elevational view of the distal portion of a channel forming device having a circular cutting blade on the distal tip.
  • Fig. 1 3 is an elevational view of the distal portion of a channel forming device having a resistance heated distal tip.
  • Fig. 14 is an elevational view of the distal portion of a channel forming device having a jet forming aperture in the distal tip.
  • Fig. 1 5 is a perspective view of an alternative embodiment of the invention.
  • Fig. 1 6 is an elevational view of an alternative distal section of the outer catheter shown in Fig. 1 5.
  • Fig. 17 is a transverse cross-sectional view of the outer catheter shown in Fig. 1 6 taken along the lines 1 7-17.
  • Fig. 18 is an elevational view of yet another alternative embodiment of the invention.
  • Fig. 19 is a transverse cross-sectional view of the embodiment shown in Fig. 18 taken along the lines 19-19.
  • Fig. 20 illustrates the positioning of the assembly of an embodiment of the invention within the patient's left ventricle with the discharge axis of the first catheter coinciding with the axis of the patient's left ventricle.
  • Fig. 21 illustrates the distal extremity of the delivery catheter system positioned against a patient's intraventricular septal wall.
  • Fig. 22 illustrates the position of the assembly similar to that shown in Fig. 21 except that the distal extremity of the delivery catheter system is disposed more centrally within the left ventrical. The accessible region of the patient's endocardium with the delivery system in this position, is shaded.
  • Fig. 23 depicts the assembly shown in Fig. 15 with the distal extremity of the outer delivery catheter at a large obtuse angle with respect to the main portion of the catheter.
  • Fig. 24 illustrates the assembly shown in Fig. 23 positioned within a patient's left ventricle to access the apical region of the patient's left ventricle which includes the lower interventricular septum region.
  • Fig. 25 illustrates the assembly shown in Fig. 23 with the inner catheter rotated about 180° from that shown in Fig. 23.
  • Fig. 26 illustrates the access gained to the upper portions of the patient's left ventricle by rotating the inner catheter which includes the upper portions of the patient's interventricular septum.
  • Figs. 1 -3 schematically illustrates one presently preferred delivery system 10 of the invention with a distal portion thereof disposed within the left ventricle 1 1 of a patient's heart 12.
  • the delivery system
  • a guiding catheter 13 includes a guiding catheter 13, a first delivery catheter 14 slidably and rotatably disposed within the inner lumen 1 5 of the guiding catheter and a second delivery catheter 1 6 which is slidably disposed within the inner lumen 17 of the first delivery catheter.
  • An optical fiber 18 with a laser focusing lens 20 is slidably disposed within the inner lumen 21 of the second delivery catheter 1 6.
  • the guiding catheter 13 may be of conventional construction which includes a inner lubricous lining 22, a braided fiber reinforcement 23 and an outer jacket 24 which may be formed of suitable polymeric material in a conventional manner, e.g. extruding onto the braided fiber reinforcement.
  • suitable polymers include polyethylene, polyurethane and the like.
  • the strands of the fiber reinforcement 23 may be stainless steel, or other suitable high strength materials including suitable polymeric materials.
  • the lubricous inner liner 22 may be formed of a suitable fluoropolymer such as poly(tetrafluoro)ethylene which is sold under the trademark Teflon ® .
  • the overall length of the guiding catheter 13 is about 70 to about 1 10 cm, the outer diameter is about 0.1 to about 0.1 5 inch (2.5-3.75 mm) and an inner diameter of about 0.07 to about 0.1 inch (1 .8-2.5 mm) .
  • the first delivery catheter 14 is formed in a similar manner as the guiding catheter 1 3 except that the outer diameter of the first delivery catheter is configured so that it can be readily moved longitudinally and readily rotated within the guiding catheter by manipulating the proximal end which extends out of the patient.
  • the overall length of the first delivery catheter 14 is about 10 to about 40 cm longer than the guiding catheter 13 to ensure that the distal end and the proximal end of the first delivery catheter extend out the distal end and the proximal end respectively of the guiding catheter so that movement of the distal end of the first delivery catheter can be effected by manipulation of the proximal end.
  • a pair of radiopaque markers 25 and 26 are provided on the distal end 27 of the first delivery catheter 14 to allow the fluoroscopic observation thereof by the attending physician to determine the location and the orientation of the distal end within the patient's left ventricle 1 1 .
  • the second delivery catheter 16 is an elongated polymeric tubular member which is formed of suitable thermoplastic polymers such as polyethylene, polyamide, polyether amide and polyurethane copolymer such as Pebax.
  • the overall length of the second delivery catheter 1 6 is greater than the overall length of the first delivery catheter 14 to allow movement of the distal end 28 of the second delivery catheter 1 6 by manipulation of its proximal end which extends out the proximal end of the guiding catheter which in turn extends out of the patient.
  • the length of the second delivery catheter 1 6 is typically about 10 to about 30 cm longer than the first delivery catheter 14.
  • the outer diameter of the second delivery catheter 1 6 is about 0.002 to about 0.008 inch (0.05-
  • a radiopaque band 30 may be provided on the distal end 28 of the second delivery catheter 1 6 to allow fluoroscopic detection of the distal end during the procedure.
  • the elongated optical fiber 1 8 is advanced out the port 32 in the distal end 28 of the second delivery catheter 1 6 to contact the surface of the endocardium 31 .
  • Laser energy is then directed through the optical fiber 18 out the lens 20 on the distal end of the optical fiber onto the endocardial tissue as shown in Fig. 4.
  • the axial force applied to the proximal end of the optical fiber 1 8 is preferably sufficient to ensure contact with endocardial and myocardial tissue as the channel 33 is being formed therethrough, but the force should not exceed the level which will cause the optical fiber to mechanically penetrate heart tissue. As shown in more detail in Fig.
  • the lens 20 on the optical fiber 18 has a cylindrical outer surface terminating in a convex distal tip 34.
  • the distal end of the optical fiber 1 8 extends into the interior of the lens 20 and preferably terminates at a location proximal to the internal aspheric or ogival shaped surface 35 so as to be in a light transmitting relationship therewith.
  • the distal end of the optical fiber 1 8 should be secured to the interior of lens 20 by suitable adhesive such as epoxy to prevent dislodgement of the lens when the device is disposed within the patient's body.
  • suitable adhesive such as epoxy
  • the overall length of the optical fiber 18 is longer than the second delivery catheter 1 6 and it is preferably configured to extend out of the second delivery catheter up to about 1 5mm, preferably about 1 to about 10 mm to form the channel 33.
  • the outer diameter of the lens 20 generally will be essentially about the same size as the desired diameter of the channel, e.g. about 0.5 to about 2 mm, preferably about 1 to about 1 .5 mm.
  • the optical fiber 18 should have a diameter of about 0.2 to about 0.4 mm to provide the flexibility required to pass through the passageway of the second delivery catheter 1 6, but it may require support such as described in copending application Serial No.
  • the optical fiber 18 may be a single fiber as describe above or a plurality of optical fibers.
  • the laser energy emitted from the lens 20 on the distal end of the optical fiber 18 may be emitted in a pulsatile manner ranging from about one to about 5 pulses or more during each heart beat.
  • the energy level per pulse typically ranges about 0.5 to about 3 joules, preferably about 0.8 to about 2 joules.
  • a higher laser energy level may be desirable when forming the channel in the endocardium than when forming the channel in myocardial tissue.
  • the universal movement of the distal ends of the first delivery catheter 14, the second delivery catheter 1 6 and the optical fiber 1 8 within the patient's left ventricle is illustrated in Figs. 1 and 5.
  • the guiding catheter 13 is preferably maintained stationary with its distal end either closely adjacent to the side of the aortic valve 36 within the ascending aorta (not shown) or within the interior of the left ventricle 1 1 as shown in phantom in Fig. 1 . If desired, the distal end of the guiding catheter 13 may be first inserted into the left ventricle where the first delivery catheter 14 is extended out the distal end of the guiding catheter and then withdrawn through the aortic valve 36 into the ascending aorta. The first delivery catheter 14 may be moved vertically within the heart chamber 1 1 by extending or withdrawing the catheter along the Z axis and be rotated about the Z axis as shown by angle ⁇ on the circular projection 37.
  • the deflection of the distal extremity of the first delivery catheter 13 from the Z axis, angle ⁇ may be formed or adjusted manually before inserting the first delivery catheter into the patient or it may be adjusted after positioning within the heart chamber, e.g. by providing one or more control lines (not shown) extending through the catheter and secured to the distal end 28 thereof in a manner which is widely practiced with electrophysiological type catheters..
  • the second delivery catheter may then be extended a distance r to contact the surface of the endocardium 31.
  • the guiding catheter 13 and the first delivery catheter 14 are both constructed to be relatively stiff to prevent significant movement thereof when the optical fiber 18 is advanced within the heart chamber 1 1 during channel formation. If needed, mechanical elements (not shown) extending from the guiding catheter 13 or the first delivery catheter 14 may be utilized to engage the endocardium surface on a side opposite the channel forming site to bolster the position of these catheters during the procedure.
  • the guiding catheter 13 may be shaped to ensure that the distal portion of the catheter is more or less centrally located within the ventricle 1 1 to allow complete rotation of the first delivery catheter within the heart chamber.
  • the guide catheter 13 is first introduced into the patient's arterial system, preferably by means of the Seldinger technique, (e.g. the femoral artery) and advanced through the arterial system including the aorta until the distal end of the guide catheter is disposed at a desired location either within the left ventricle 1 1 or in the ascending aorta downstream from the aortic valve.
  • the first delivery catheter 14, the second delivery catheter 16 and the optical fiber 18, or other channel forming device may then be advanced together or sequentially through the guiding catheter into the left ventricle.
  • the first delivery catheter 14 is advanced out of or withdrawn into the guiding catheter 13 (as shown in Fig.
  • the distal extremity of the first delivery catheter 14 is preshaped, the distal extremity forms the desired shape when exiting the guiding catheter 13. If means are provided to deflect the distal tip of the first delivery catheter 14, the deflection means may be employed to shape the distal extremity after it exits the guiding catheter to direct the distal end of the first delivery catheter toward the desired location on the endocardium.
  • the second delivery catheter 1 6 may be extended out the distal end 27 of the first delivery catheter 14 to engage the portion of the endocardium into which the channel 33 is to be formed.
  • the location of the distal end of the second delivery catheter can be detected fluoroscopically by means of the radiopaque marker 30.
  • the elongated channel forming device such as optical fiber 18 may then be advanced through the inner lumen 21 of the second delivery catheter 1 6 and out the port 32 in the distal end 28 thereof into the endocardium tissue to form the channel 33 therein.
  • pressure is applied to the channel forming means so as to maintain contact with the endocardial and myocardial tissue when forming the channel 33 of a desired length.
  • the channel forming device may be withdrawn and repositioned within the left ventricle 1 1 to form a channel at another location within the patient's heart wall.
  • Figs. 7-9 illustrate another presently preferred embodiment which includes a first delivery catheter 40 which has a main section 41 and distal extremity 42.
  • the distal extremity 42 has a proximal portion
  • the distal portion 44 is essentially
  • Optical fiber 1 80° from the distal portion 44 shown in Fig. 8.
  • Optical fiber 1 8 which is slidably disposed within the inner lumen 46, extends out the port 47 in the distal end of the catheter 40.
  • the portion of the optical fiber 45 which extends out of the distal end of the first delivery catheter 40 may be provided with reinforcement (not shown) on the exterior thereof.
  • a rotating auger type channel forming device 50 is shown in Fig. 10 which has a cutting head 51 with a spiral cutting edge 52 secured to the drive shaft 53 rotatably supported within the elongated housing 54.
  • abrasive type channel forming device 60 as shown in Fig. 1 1 which has an enlarged bulbous tip 61 which has abrasive material thereon and which is secured to the drive shaft 62 rotatably supported within the elongated housing 63.
  • Fig. 10 which has a cutting head 51 with a spiral cutting edge 52 secured to the drive shaft 53 rotatably supported within the elongated housing 54.
  • abrasive type channel forming device 60 as shown in Fig. 1 1 which has an enlarged bulbous tip 61 which has abrasive material thereon and which is secured to the drive shaft 62 rotatably supported within the elongated housing 63.
  • Fig. 10 which has a cutting head 51 with a spiral cutting edge 52 secured to the drive shaft 53 rotatably
  • Fig. 12 depicts a channel forming device 80 which has a distal tip 81 which is resistively or inductively heated by conductors 82 and 83.
  • the operating temperature of the distal tip 81 is maintained about 80° to about 1 10° C. which is sufficient to form the channel through the endocardium into the myocardium.
  • a thermocouple or other temperature sensing device 84 may be imbedded into the distal tip 81 to determine the temperature thereof.
  • the signal developed by the sensing device 84 may be used to control the electrical power to the distal tip 81 in a conventional manner.
  • FIG. 14 illustrates yet another type of channel forming device 90 wherein a high velocity fluid jet 91 emitted from a discharge nozzle 92 in the distal end of inner tubular member 93 is employed to form the channel.
  • debris from the channel forming operation is aspirated away from the site through the annular lumen 94 between the inner tubular member 93 and the outer tubular member 95 to avoid passage of such debris into the aorta and ultimately into the arterial system of the patient's brain which can result in a stroke or into the coronary artery system which can result in a myocardial infarct.
  • This embodiment includes an outer catheter 100 having a shaped distal section 101 , a port 102 in the distal end of the catheter and an inner lumen 103 extending within the outer catheter to the port in the distal end.
  • This embodiment also includes an inner catheter 104 slidably and rotatably disposed within the inner lumen 103 of the outer catheter 100 which has a shaped distal section 105, a port 106 in the distal end of the inner catheter and an inner lumen 107 extending therein to the port in the distal end.
  • An optical fiber assembly 108 is slidably disposed within the inner lumen 107 of inner catheter 104. Additional details of the optical fiber assembly 108 can be found in copending application Serial No. 08/584,957, filed January 1 1 , 1 996, entitled CHANNEL FORMING DEVICE WITH PENETRATING LIMITER, assigned to the present assignee which is incorporated herein by reference in its entirety.
  • the distal section 101 of the outer catheter 100 is at an angle with respect to the main shaft section 109 of the outer catheter of about 90° to about 180°, preferably about 135° to about 1 65° .
  • the distal section 105 of the inner catheter 103 is at an angle with respect to the main shaft section 1 10 of the inner catheter of about 45° to about 180° , preferably about 60° to about 130° .
  • the distal section 101 of the outer catheter 100 desirably orients the inner catheter 103 extending out the distal end of the outer catheter in the same direction as the axis of the heart chamber so that rotation of the inner catheter within the outer catheter points the distal section 105 of the inner catheter 104 in a generally perpendicular direction to the endocardium 1 1 1 defining the chamber. Longitudinal and rotational movement of the inner catheter 103 provides access to a large region of the endocardium 1 1 1 .
  • Figs. 17 and 18 illustrate a presently preferred embodiment wherein the outer catheter 100 is provided with a supereleastic metallic shaping member 1 12 to shape and support the distal section 101 of the outer catheter as shown.
  • the pseudoelastic properties of the support member 1 12 allow the distal section 101 to be readily straightened to facilitate entry and advancement through the patient's vasculature, but when the distal section 101 is no longer restrained in the heart chamber, the stress induced martensite phase of the NiTi alloy transforms back to the austenite phase and the remembered shape.
  • the shaped shaping member 1 1 2 causes the distal section 101 to take the shape remembered by the shaping member 1 12.
  • the pseudoelastic properties at body temperature require that the metallic member be predominantly in the austenite phase at or below body temperature.
  • the shaping member 1 12 may be in a martensite phase at body temperature with the curved memory of the austenite phase being activated by heating the shaping member by means of an electrical current or other means to raise the temperature of the metallic member to a temperature which is high enough to convert a predominant amount of the martensite phase to the austenite phase thereby causing the member to transform into the remembered curved shape.
  • the preferred alloy is an equiatomic alloy of nickel and titanium. See for example the alloy compositions and thermomechanical processing described in U.S. Patent No. 5,341 ,818 (Abrams et al. ) which is incorporated herein in its entirety by reference.
  • the nickel-titanium alloys and thermomechanical processing described in this patent would be suitable to manufacture the shaping member 1 10 so as to provide pseudoelastic properties at body temperature.
  • Figs. 1 8-1 9 depict a distal section 101 ' suitable for the outer catheter 100 which is formed of a pseudoelastic alloy such as described above.
  • the distal section 101 ' has a plurality of transverse slots 1 13 in the outer curved portion thereof to facilitate bending without kinking. Longitudinal slots 1 14 may also be provided along the side portion of the distal extremity 101 ' to further facilitate bending without kinking.
  • the distal section 101 ' may be formed of a shape memory alloy and be heated to the transformation temperature to generate the remembered shape.
  • the alloy composition and thermomechanical processing is chosen to ensure that the transformation temperature is less than 100°C, preferably less than 85°C.
  • Fig. 20 illustrates placement of the outer catheter 100 within the patient's left ventricle so that the main shaft section 1 10 of the inner delivery catheter lies along the ventricular axis 1 15.
  • the inner catheter 103 can be moved longitudinally and rotationally to facilitate perpendicular or near perpendicular orientation of the optical fiber with the endocardial surface when the optical fiber engages the endocardium 1 1 1 .
  • FIG. 21 depicts the distal extremity of the outer delivery catheter 100 in position against the interventricular septum 1 1 61.
  • Another advantage of an outer catheter 100 with a large angle bend between the main catheter section 109 and the distal section 101 is shown in Figs. 23 and 24, is the ability to access the apical area 1 1 8 within the left ventricle which has been shaded, including the lower regions of the interventricular septum.
  • the angle between the distal section 105 and the main section 1 10 of the inner delivery catheter 104 shown by double point arrow 1 19 can range from about 30° to about 180°. Withdrawal of the outer delivery catheter 100 and rotation of the inner delivery catheter 104 allows access to the upper portions of the heart chamber as shown in Figs. 25 and 26 including the upper portions of the interventricular septum 1 16.
  • the curvature between the bent and essentially straight portions of the delivery catheters generally must be great enough to allow for the passage of the therapeutic or diagnostic device through the inner lumen thereof. A radius of curvature from about 2 to about 30 mm has been found suitable in most instances.

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EP96913986A 1995-05-10 1996-05-09 System zur behandlung oder diagnose von herzgewebe Withdrawn EP0892651A1 (de)

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US43874395A 1995-05-10 1995-05-10
US438743 1995-05-10
US64685696A 1996-05-08 1996-05-08
PCT/US1996/006700 WO1996035469A1 (en) 1995-05-10 1996-05-09 System for treating or diagnosing heart tissue
US646856 2003-08-22

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Families Citing this family (203)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6179824B1 (en) 1993-05-10 2001-01-30 Arthrocare Corporation System and methods for electrosurgical restenosis of body lumens
US5683366A (en) * 1992-01-07 1997-11-04 Arthrocare Corporation System and method for electrosurgical tissue canalization
US5697882A (en) 1992-01-07 1997-12-16 Arthrocare Corporation System and method for electrosurgical cutting and ablation
US6749604B1 (en) 1993-05-10 2004-06-15 Arthrocare Corporation Electrosurgical instrument with axially-spaced electrodes
US6896674B1 (en) 1993-05-10 2005-05-24 Arthrocare Corporation Electrosurgical apparatus having digestion electrode and methods related thereto
US6915806B2 (en) 1993-05-10 2005-07-12 Arthrocare Corporation Method for harvesting graft vessel
US6690963B2 (en) 1995-01-24 2004-02-10 Biosense, Inc. System for determining the location and orientation of an invasive medical instrument
US6210356B1 (en) 1998-08-05 2001-04-03 Ekos Corporation Ultrasound assembly for use with a catheter
US6176842B1 (en) 1995-03-08 2001-01-23 Ekos Corporation Ultrasound assembly for use with light activated drugs
US6723082B1 (en) 1995-05-10 2004-04-20 Sam G. Payne Delivery catheter system for heart chamber
US6322548B1 (en) 1995-05-10 2001-11-27 Eclipse Surgical Technologies Delivery catheter system for heart chamber
US6251104B1 (en) 1995-05-10 2001-06-26 Eclipse Surgical Technologies, Inc. Guiding catheter system for ablating heart tissue
US6267757B1 (en) 1995-08-09 2001-07-31 Eclipse Surgical Technologies, Inc. Revascularization with RF ablation
US6302875B1 (en) 1996-10-11 2001-10-16 Transvascular, Inc. Catheters and related devices for forming passageways between blood vessels or other anatomical structures
US6283951B1 (en) 1996-10-11 2001-09-04 Transvascular, Inc. Systems and methods for delivering drugs to selected locations within the body
EP1166721A3 (de) 1995-10-13 2003-12-03 Transvascular, Inc. Vorrichtung für transvaskuläre Chirurgie
DE69638011D1 (de) * 1995-10-13 2009-10-08 Medtronic Vascular Inc Ngriff
WO1999013943A1 (en) * 1996-03-05 1999-03-25 Ekos Corporation Ultrasound assembly for use with light activated drugs
US6152918A (en) * 1996-04-05 2000-11-28 Eclipse Surgical Technologies, Inc. Laser device with auto-piercing tip for myocardial revascularization procedures
US6283955B1 (en) 1996-05-13 2001-09-04 Edwards Lifesciences Corp. Laser ablation device
US5980545A (en) * 1996-05-13 1999-11-09 United States Surgical Corporation Coring device and method
US5807383A (en) * 1996-05-13 1998-09-15 United States Surgical Corporation Lasing device
CA2207570A1 (en) * 1996-06-13 1997-12-13 Eclipse Surgical Technologies, Inc. Intraoperative myocardial device and stimulation procedure
US6620155B2 (en) 1996-07-16 2003-09-16 Arthrocare Corp. System and methods for electrosurgical tissue contraction within the spine
US5755682A (en) 1996-08-13 1998-05-26 Heartstent Corporation Method and apparatus for performing coronary artery bypass surgery
US5976164A (en) 1996-09-13 1999-11-02 Eclipse Surgical Technologies, Inc. Method and apparatus for myocardial revascularization and/or biopsy of the heart
US5871495A (en) * 1996-09-13 1999-02-16 Eclipse Surgical Technologies, Inc. Method and apparatus for mechanical transmyocardial revascularization of the heart
US5855577A (en) * 1996-09-17 1999-01-05 Eclipse Surgical Technologies, Inc. Bow shaped catheter
US5931834A (en) 1996-10-15 1999-08-03 Eclipse Surgical Technologies, Inc. Method for non-synchronous laser-assisted myocardial revascularization
US5810746A (en) * 1996-11-21 1998-09-22 Daig Corporation Guiding introducer for endomyocardial biopsy procedures
US6102926A (en) 1996-12-02 2000-08-15 Angiotrax, Inc. Apparatus for percutaneously performing myocardial revascularization having means for sensing tissue parameters and methods of use
US6120520A (en) * 1997-05-27 2000-09-19 Angiotrax, Inc. Apparatus and methods for stimulating revascularization and/or tissue growth
US6051008A (en) 1996-12-02 2000-04-18 Angiotrax, Inc. Apparatus having stabilization members for percutaneously performing surgery and methods of use
US5899915A (en) * 1996-12-02 1999-05-04 Angiotrax, Inc. Apparatus and method for intraoperatively performing surgery
US6165188A (en) * 1996-12-02 2000-12-26 Angiotrax, Inc. Apparatus for percutaneously performing myocardial revascularization having controlled cutting depth and methods of use
US5944716A (en) * 1996-12-09 1999-08-31 Scimed Life Systems, Inc. Radio frequency transmyocardial revascularization corer
US6030380A (en) * 1996-12-09 2000-02-29 Bsc Northwest Technology Center, Inc. Radio frequency transmyocardial revascularization
US5947989A (en) * 1996-12-12 1999-09-07 United States Surgical Corporation Method and apparatus for transmyocardial revascularization
US6067988A (en) 1996-12-26 2000-05-30 Eclipse Surgical Technologies, Inc. Method for creation of drug delivery and/or stimulation pockets in myocardium
US5999678A (en) * 1996-12-27 1999-12-07 Eclipse Surgical Technologies, Inc. Laser delivery means adapted for drug delivery
US5925012A (en) * 1996-12-27 1999-07-20 Eclipse Surgical Technologies, Inc. Laser assisted drug delivery
CA2225521C (en) 1996-12-27 2004-04-06 Eclipse Surgical Technologies, Inc. Laser assisted drug delivery apparatus
US5873865A (en) * 1997-02-07 1999-02-23 Eclipse Surgical Technologies, Inc. Spiral catheter with multiple guide holes
US5730741A (en) * 1997-02-07 1998-03-24 Eclipse Surgical Technologies, Inc. Guided spiral catheter
US5938632A (en) * 1997-03-06 1999-08-17 Scimed Life Systems, Inc. Radiofrequency transmyocardial revascularization apparatus and method
US6045565A (en) * 1997-11-04 2000-04-04 Scimed Life Systems, Inc. Percutaneous myocardial revascularization growth factor mediums and method
US5968059A (en) 1997-03-06 1999-10-19 Scimed Life Systems, Inc. Transmyocardial revascularization catheter and method
US6086534A (en) * 1997-03-07 2000-07-11 Cardiogenesis Corporation Apparatus and method of myocardial revascularization using ultrasonic pulse-echo distance ranging
US5876373A (en) * 1997-04-04 1999-03-02 Eclipse Surgical Technologies, Inc. Steerable catheter
US6582392B1 (en) 1998-05-01 2003-06-24 Ekos Corporation Ultrasound assembly for use with a catheter
US6855143B2 (en) 1997-06-13 2005-02-15 Arthrocare Corporation Electrosurgical systems and methods for recanalization of occluded body lumens
US6004295A (en) * 1997-06-26 1999-12-21 An-Go-Gen Inc. Catheters
US6024739A (en) * 1997-09-05 2000-02-15 Cordis Webster, Inc. Method for detecting and revascularizing ischemic myocardial tissue
US5964757A (en) * 1997-09-05 1999-10-12 Cordis Webster, Inc. Steerable direct myocardial revascularization catheter
US6027473A (en) * 1997-09-05 2000-02-22 Cordis Webster, Inc. Handle for steerable DMR catheter
EP0900547B1 (de) 1997-09-05 2007-05-30 Biosense Webster, Inc. Steuerbarer Katheter zur Erkennung und Revaskularisierung myokardischeen ischämischen Geweben
US6402719B1 (en) 1997-09-05 2002-06-11 Cordis Webster, Inc. Steerable DMR catheter with infusion tube
DE19740824A1 (de) * 1997-09-17 1999-03-18 Laser & Med Tech Gmbh Verfahren und Vorrichtung zur Steigerung der Durchblutung des Herzmuskels
US6554794B1 (en) 1997-09-24 2003-04-29 Richard L. Mueller Non-deforming deflectable multi-lumen catheter
JP2001518345A (ja) * 1997-10-02 2001-10-16 カーディオジェネシス・コーポレイション 高周波エネルギを利用した心筋血管再生術
US6162214A (en) * 1997-10-30 2000-12-19 Eclipse Surgical Technologies, Inc. Corning device for myocardial revascularization
US5935141A (en) * 1997-10-30 1999-08-10 Partisan Management Group Interventional cardiology instrument controlled from an intracoronary reference
US6063082A (en) * 1997-11-04 2000-05-16 Scimed Life Systems, Inc. Percutaneous myocardial revascularization basket delivery system and radiofrequency therapeutic device
US6416490B1 (en) 1997-11-04 2002-07-09 Scimed Life Systems, Inc. PMR device and method
US6056743A (en) * 1997-11-04 2000-05-02 Scimed Life Systems, Inc. Percutaneous myocardial revascularization device and method
US6749617B1 (en) 1997-11-04 2004-06-15 Scimed Life Systems, Inc. Catheter and implants for the delivery of therapeutic agents to tissues
US6156029A (en) 1997-11-25 2000-12-05 Eclipse Surgical Technologies, Inc. Selective treatment of endocardial/myocardial boundary
WO1999044516A1 (en) * 1998-03-05 1999-09-10 Bsc Northwest Technology Center, Inc. Rotating burr pmr device and method
US6093185A (en) * 1998-03-05 2000-07-25 Scimed Life Systems, Inc. Expandable PMR device and method
US5997509A (en) * 1998-03-06 1999-12-07 Cornell Research Foundation, Inc. Minimally invasive gene therapy delivery device and method
US6493575B1 (en) 1998-06-04 2002-12-10 Randy J. Kesten Fluoroscopic tracking enhanced intraventricular catheter system
FR2779934B1 (fr) 1998-06-17 2001-01-05 Saphir Medical Sa Piece a main a commande pneumatique pour applications chirurgicales et medicales
WO1999065408A1 (fr) 1998-06-19 1999-12-23 Saphir Medical Procede de generation d'un train impulsionnel d'un jet liquide sterile pour des applications medicales
FR2780268B1 (fr) 1998-06-24 2000-09-29 Saphir Medical Sa Appareil de distribution a deux voies d'un liquide sterile de travail selon des sequences predeterminees pour des applications chirurgicales ou medicales a l'aide d'au moins une piece a main
US7435247B2 (en) 1998-08-11 2008-10-14 Arthrocare Corporation Systems and methods for electrosurgical tissue treatment
US6254564B1 (en) 1998-09-10 2001-07-03 Percardia, Inc. Left ventricular conduit with blood vessel graft
EP1112043B1 (de) 1998-09-10 2006-04-05 Percardia, Inc. Tmr vorrichtung
US6641610B2 (en) 1998-09-10 2003-11-04 Percardia, Inc. Valve designs for left ventricular conduits
AU6140299A (en) 1998-09-10 2000-04-03 Percardia, Inc. Tmr shunt
US6290728B1 (en) 1998-09-10 2001-09-18 Percardia, Inc. Designs for left ventricular conduit
US6245062B1 (en) 1998-10-23 2001-06-12 Afx, Inc. Directional reflector shield assembly for a microwave ablation instrument
US6176856B1 (en) 1998-12-18 2001-01-23 Eclipse Surgical Technologies, Inc Resistive heating system and apparatus for improving blood flow in the heart
US6123084A (en) * 1998-12-18 2000-09-26 Eclipse Surgical Technologies, Inc. Method for improving blood flow in the heart
US6855123B2 (en) 2002-08-02 2005-02-15 Flow Cardia, Inc. Therapeutic ultrasound system
US6432119B1 (en) * 1999-03-17 2002-08-13 Angiotrax, Inc. Apparatus and methods for performing percutaneous myocardial revascularization and stimulating angiogenesis using autologous materials
DE19912844A1 (de) 1999-03-22 2000-09-28 Saphir Medical Products Gmbh Verwendung eines Schneidegerätes, welches ein Fluid als Schneidemedium einsetzt, zur chirurgischen Behandlung
FR2797581B1 (fr) * 1999-08-20 2001-12-07 Saphir Medical Products Gmbh Procede et appareil chirurgical a jet de liquide sous pression pour la revascularisation transmyocardiale
ES2267507T3 (es) * 1999-03-22 2007-03-16 Eschmann Holdings Limited Aparato quirurgico con chorro de liquido bajo presion para la revascularizacion transmiocardial.
US7226446B1 (en) 1999-05-04 2007-06-05 Dinesh Mody Surgical microwave ablation assembly
US6409697B2 (en) 1999-05-04 2002-06-25 Heartstent Corporation Transmyocardial implant with forward flow bias
US6689103B1 (en) * 1999-05-07 2004-02-10 Scimed Life System, Inc. Injection array apparatus and method
US6277113B1 (en) 1999-05-28 2001-08-21 Afx, Inc. Monopole tip for ablation catheter and methods for using same
US7147633B2 (en) 1999-06-02 2006-12-12 Boston Scientific Scimed, Inc. Method and apparatus for treatment of atrial fibrillation
EP1187652B1 (de) * 1999-06-02 2006-10-11 Boston Scientific Limited Arzneimittelabgabevorrichtungen
CA2310550A1 (en) 1999-06-04 2000-12-04 Eclipse Surgical Technologies, Inc. Enhanced surgical device tracking system
US6425853B1 (en) * 1999-06-23 2002-07-30 Stuart D. Edwards Treating body tissue by applying energy and substances with a retractable catheter and contained cooling element
US6638237B1 (en) 1999-08-04 2003-10-28 Percardia, Inc. Left ventricular conduits and methods for delivery
US7033372B1 (en) 1999-08-04 2006-04-25 Percardia, Inc. Corkscrew reinforced left ventricle to coronary artery channel
US6524324B1 (en) * 1999-11-05 2003-02-25 Scimed Life Systems, Inc. Method and apparatus for demand injury in stimulating angiogenesis
WO2001039682A1 (en) * 1999-12-02 2001-06-07 Baxter International Inc. Methods and apparatus for delivering medicament to tissue
US6673068B1 (en) 2000-04-12 2004-01-06 Afx, Inc. Electrode arrangement for use in a medical instrument
US6854467B2 (en) 2000-05-04 2005-02-15 Percardia, Inc. Methods and devices for delivering a ventricular stent
US6595958B1 (en) 2000-08-08 2003-07-22 Scimed Life Systems, Inc. Tortuous path injection device and method
US6613017B1 (en) 2000-08-08 2003-09-02 Scimed Life Systems, Inc. Controlled depth injection device and method
US6893421B1 (en) 2000-08-08 2005-05-17 Scimed Life Systems, Inc. Catheter shaft assembly
US6582400B1 (en) 2000-10-24 2003-06-24 Scimed Life Systems, Inc. Variable tip catheter
US6530914B1 (en) 2000-10-24 2003-03-11 Scimed Life Systems, Inc. Deflectable tip guide in guide system
US6616626B2 (en) 2000-12-21 2003-09-09 Scimed Life Systems, Inc. Infusion devices and method
US20020087151A1 (en) 2000-12-29 2002-07-04 Afx, Inc. Tissue ablation apparatus with a sliding ablation instrument and method
US6976990B2 (en) 2001-01-25 2005-12-20 Percardia, Inc. Intravascular ventriculocoronary bypass via a septal passageway
US6508783B2 (en) 2001-03-14 2003-01-21 Scimed Life Systems, Inc. Ultrasound method for revascularization and drug delivery
US20030032936A1 (en) 2001-08-10 2003-02-13 Lederman Robert J. Side-exit catheter and method for its use
US7220239B2 (en) 2001-12-03 2007-05-22 Ekos Corporation Catheter with multiple ultrasound radiating members
US7099717B2 (en) 2002-01-03 2006-08-29 Afx Inc. Catheter having improved steering
US6949118B2 (en) 2002-01-16 2005-09-27 Percardia, Inc. Encased implant and methods
US7008397B2 (en) 2002-02-13 2006-03-07 Percardia, Inc. Cardiac implant and methods
US7192427B2 (en) 2002-02-19 2007-03-20 Afx, Inc. Apparatus and method for assessing transmurality of a tissue ablation
US8226629B1 (en) 2002-04-01 2012-07-24 Ekos Corporation Ultrasonic catheter power control
JP2005534361A (ja) 2002-06-27 2005-11-17 リーバイン，ロバート，エイ． 房室弁逆流及び心室リモデリング逆転のためのシステム及び方法
EP1545371B1 (de) * 2002-08-01 2016-04-13 Robert A. Levine Herzvorrichtungen und verfahren für die minimalinvasive reparatur von ischämischer mitralklappen-regurgitation
US9955994B2 (en) 2002-08-02 2018-05-01 Flowcardia, Inc. Ultrasound catheter having protective feature against breakage
DE60318861T2 (de) 2002-08-13 2009-01-08 The General Hospital Corp., Boston Herzvorrichtungen für die perkutane reparatur von atrioventrikulären klappen
US7220233B2 (en) 2003-04-08 2007-05-22 Flowcardia, Inc. Ultrasound catheter devices and methods
US7137963B2 (en) 2002-08-26 2006-11-21 Flowcardia, Inc. Ultrasound catheter for disrupting blood vessel obstructions
US6942677B2 (en) 2003-02-26 2005-09-13 Flowcardia, Inc. Ultrasound catheter apparatus
US7335180B2 (en) 2003-11-24 2008-02-26 Flowcardia, Inc. Steerable ultrasound catheter
US7604608B2 (en) * 2003-01-14 2009-10-20 Flowcardia, Inc. Ultrasound catheter and methods for making and using same
US7326219B2 (en) 2002-09-09 2008-02-05 Wilk Patent Development Device for placing transmyocardial implant
JP4500017B2 (ja) * 2003-07-31 2010-07-14 オリンパス株式会社 内視鏡挿入用補助具
JP4500016B2 (ja) * 2003-07-31 2010-07-14 オリンパス株式会社 内視鏡挿入用補助具
US7758510B2 (en) 2003-09-19 2010-07-20 Flowcardia, Inc. Connector for securing ultrasound catheter to transducer
US8100822B2 (en) 2004-03-16 2012-01-24 Macroplata Systems, Llc Anoscope for treating hemorrhoids without the trauma of cutting or the use of an endoscope
US7540852B2 (en) 2004-08-26 2009-06-02 Flowcardia, Inc. Ultrasound catheter devices and methods
US7749260B2 (en) 2004-12-10 2010-07-06 Da Silva Luiz B Devices and methods for treatment of skin conditions
US7494492B2 (en) 2004-12-10 2009-02-24 Therative, Inc. Skin treatment device
MX2007006806A (es) * 2004-12-10 2007-10-08 Therative Inc Dispositivos y metodos para el tratamineto de condiciones de la piel.
US8221343B2 (en) 2005-01-20 2012-07-17 Flowcardia, Inc. Vibrational catheter devices and methods for making same
DE102005003632A1 (de) 2005-01-20 2006-08-17 Fraunhofer-Gesellschaft zur Förderung der angewandten Forschung e.V. Katheter für die transvaskuläre Implantation von Herzklappenprothesen
US9282984B2 (en) 2006-04-05 2016-03-15 Flowcardia, Inc. Therapeutic ultrasound system
US20080071230A1 (en) 2006-08-30 2008-03-20 Med-El Elektromedizinische Geraete Gmbh System, Apparatus, and Method for Facilitating Interface with Laryngeal Structures
US8246643B2 (en) 2006-11-07 2012-08-21 Flowcardia, Inc. Ultrasound catheter having improved distal end
US10182833B2 (en) 2007-01-08 2019-01-22 Ekos Corporation Power parameters for ultrasonic catheter
US8430837B2 (en) 2007-02-05 2013-04-30 Boston Scientific Scimed, Inc. Thrombectomy apparatus and method
US7896915B2 (en) 2007-04-13 2011-03-01 Jenavalve Technology, Inc. Medical device for treating a heart valve insufficiency
EP2494932B1 (de) 2007-06-22 2020-05-20 Ekos Corporation Vorrichtung zur Behandlung von intrakranialen Blutungen
EP2209517A4 (de) 2007-10-05 2011-03-30 Maquet Cardiovascular Llc Vorrichtungen und verfahren für minimal invasive chirurgische eingriffe
US9044318B2 (en) 2008-02-26 2015-06-02 Jenavalve Technology Gmbh Stent for the positioning and anchoring of a valvular prosthesis
ES2903231T3 (es) 2008-02-26 2022-03-31 Jenavalve Tech Inc Stent para el posicionamiento y anclaje de una prótesis valvular en un sitio de implantación en el corazón de un paciente
US9510854B2 (en) 2008-10-13 2016-12-06 Boston Scientific Scimed, Inc. Thrombectomy catheter with control box having pressure/vacuum valve for synchronous aspiration and fluid irrigation
US8355799B2 (en) 2008-12-12 2013-01-15 Arthrocare Corporation Systems and methods for limiting joint temperature
JP5580540B2 (ja) * 2009-03-02 2014-08-27 オリンパス株式会社 ガイドデバイス
US8226566B2 (en) 2009-06-12 2012-07-24 Flowcardia, Inc. Device and method for vascular re-entry
US20110184402A1 (en) * 2009-11-02 2011-07-28 Cpsi Biotech Flexible Cryogenic Probe Tip
US11344285B2 (en) 2009-12-16 2022-05-31 Boston Scientific Scimed, Inc. Multi-lumen-catheter retractor system for a minimally-invasive, operative gastrointestinal treatment
US10966701B2 (en) 2009-12-16 2021-04-06 Boston Scientific Scimed, Inc. Tissue retractor for minimally invasive surgery
US9565998B2 (en) 2009-12-16 2017-02-14 Boston Scientific Scimed, Inc. Multi-lumen-catheter retractor system for a minimally-invasive, operative gastrointestinal treatment
EP2512577B1 (de) 2009-12-16 2018-03-07 Boston Scientific Scimed, Inc. Anordnungen zur herstellung einer endoluminalen anatomischen struktur
USRE48850E1 (en) 2009-12-16 2021-12-14 Boston Scientific Scimed, Inc. Multi-lumen-catheter retractor system for a minimally-invasive, operative gastrointestinal treatment
US9186131B2 (en) 2009-12-16 2015-11-17 Macroplata, Inc. Multi-lumen-catheter retractor system for a minimally-invasive, operative gastrointestinal treatment
US10758116B2 (en) 2009-12-16 2020-09-01 Boston Scientific Scimed, Inc. System for a minimally-invasive, operative gastrointestinal treatment
US10595711B2 (en) 2009-12-16 2020-03-24 Boston Scientific Scimed, Inc. System for a minimally-invasive, operative gastrointestinal treatment
US8932211B2 (en) 2012-06-22 2015-01-13 Macroplata, Inc. Floating, multi-lumen-catheter retractor system for a minimally-invasive, operative gastrointestinal treatment
US10531869B2 (en) 2009-12-16 2020-01-14 Boston Scientific Scimed, Inc. Tissue retractor for minimally invasive surgery
AU2011257298B2 (en) 2010-05-25 2014-07-31 Jenavalve Technology Inc. Prosthetic heart valve and transcatheter delivered endoprosthesis comprising a prosthetic heart valve and a stent
WO2013109269A1 (en) 2012-01-18 2013-07-25 Bard Peripheral Vascular, Inc. Vascular re-entry device
US10238895B2 (en) 2012-08-02 2019-03-26 Flowcardia, Inc. Ultrasound catheter system
WO2014055981A1 (en) * 2012-10-05 2014-04-10 Board Of Regents, The University Of Texas System System and method for scoring the left ventricular endocardium to increase left ventricular compliance
WO2014113576A1 (en) * 2013-01-16 2014-07-24 Bridges Charles R Needleless injection device and methods of administering one or more needleless injections to an organ of interest
EP3705021A1 (de) * 2013-06-09 2020-09-09 Boston Scientific Scimed, Inc. Retraktorsystem für multilumen-katheter für minimal invasive chirurgische gastrointestinale behandlung
US9409014B2 (en) 2013-06-12 2016-08-09 Med-El Elektromedizinische Geraete Gmbh Method for modifying larynx position by trans-positioning muscle and electrode stimulation
US9108054B2 (en) 2013-06-12 2015-08-18 Med-El Elektromedizinische Geraete Gmbh Method for modifying larynx position by trans-positioning muscle and electrode stimulation
US10433861B2 (en) 2013-08-27 2019-10-08 Board Of Regents Of The University Of Texas System System and method for cutting trabeculae carneae of the left ventricle to increase LV compliance
CN105491978A (zh) 2013-08-30 2016-04-13 耶拿阀门科技股份有限公司 用于假体瓣膜的径向可折叠框架及其制造方法
US9526556B2 (en) 2014-02-28 2016-12-27 Arthrocare Corporation Systems and methods systems related to electrosurgical wands with screen electrodes
US9433427B2 (en) 2014-04-08 2016-09-06 Incuvate, Llc Systems and methods for management of thrombosis
US9248221B2 (en) 2014-04-08 2016-02-02 Incuvate, Llc Aspiration monitoring system and method
US9883877B2 (en) 2014-05-19 2018-02-06 Walk Vascular, Llc Systems and methods for removal of blood and thrombotic material
US9649148B2 (en) 2014-07-24 2017-05-16 Arthrocare Corporation Electrosurgical system and method having enhanced arc prevention
US9597142B2 (en) 2014-07-24 2017-03-21 Arthrocare Corporation Method and system related to electrosurgical procedures
EP4353203A3 (de) 2015-03-20 2024-07-03 JenaValve Technology, Inc. Herzklappenprotheseneinführungssystem
WO2016177562A1 (en) 2015-05-01 2016-11-10 Jenavalve Technology, Inc. Device and method with reduced pacemaker rate in heart valve replacement
CN107708581B (zh) 2015-06-10 2021-11-19 Ekos公司 超声波导管
US10702292B2 (en) 2015-08-28 2020-07-07 Incuvate, Llc Aspiration monitoring system and method
US10561440B2 (en) 2015-09-03 2020-02-18 Vesatek, Llc Systems and methods for manipulating medical devices
US20170100142A1 (en) 2015-10-09 2017-04-13 Incuvate, Llc Systems and methods for management of thrombosis
US10226263B2 (en) 2015-12-23 2019-03-12 Incuvate, Llc Aspiration monitoring system and method
US10492805B2 (en) 2016-04-06 2019-12-03 Walk Vascular, Llc Systems and methods for thrombolysis and delivery of an agent
EP3454795B1 (de) 2016-05-13 2023-01-11 JenaValve Technology, Inc. Herzklappenprotheseneinführungssystem zur einführung einer herzklappenprothese mit einführerhülse und ladesystem
JP6333909B2 (ja) * 2016-09-15 2018-05-30 浜松ホトニクス株式会社 カテーテル
US20180140321A1 (en) 2016-11-23 2018-05-24 C. R. Bard, Inc. Catheter With Retractable Sheath And Methods Thereof
US11596726B2 (en) 2016-12-17 2023-03-07 C.R. Bard, Inc. Ultrasound devices for removing clots from catheters and related methods
US10758256B2 (en) 2016-12-22 2020-09-01 C. R. Bard, Inc. Ultrasonic endovascular catheter
CN110087526B (zh) 2016-12-30 2022-01-14 波士顿科学国际有限公司 用于体腔内部微创治疗的系统
US10582983B2 (en) 2017-02-06 2020-03-10 C. R. Bard, Inc. Ultrasonic endovascular catheter with a controllable sheath
CN110913773B (zh) 2017-03-18 2023-03-28 波士顿科学国际有限公司 用于体腔内的微创治疗的系统
JP6727245B2 (ja) * 2018-04-25 2020-07-22 浜松ホトニクス株式会社 レーザ血栓溶解装置
US11678905B2 (en) 2018-07-19 2023-06-20 Walk Vascular, Llc Systems and methods for removal of blood and thrombotic material
WO2021118958A1 (en) 2019-12-13 2021-06-17 Boston Scientific Scimed, Inc. Devices, systems, and methods for minimally invasive surgery in a body lumen
AU2021373380A1 (en) * 2020-11-08 2023-06-22 Bio Refine Ltd. Heart valve ablation catheter
EP4291261A1 (de) 2021-02-15 2023-12-20 Walk Vascular, LLC Systeme und verfahren zur entfernung von blut und thrombotischem material
US12274458B2 (en) 2021-02-15 2025-04-15 Walk Vascular, Llc Systems and methods for removal of blood and thrombotic material
WO2023204819A1 (en) * 2022-04-22 2023-10-26 Bard Peripheral Vascular, Inc. Endovascular devices with extendible shaver
WO2024102411A1 (en) 2022-11-09 2024-05-16 Jenavalve Technology, Inc. Catheter system for sequential deployment of an expandable implant

Family Cites Families (9)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5135531A (en) * 1984-05-14 1992-08-04 Surgical Systems & Instruments, Inc. Guided atherectomy system
EP0277366A1 (de) * 1987-01-06 1988-08-10 Advanced Cardiovascular Systems, Inc. Führungskatheteranordnung und Verfahren zu ihrer Herstellung
EP0416793A1 (de) * 1989-08-30 1991-03-13 Angeion Corporation Katheter
WO1992012754A1 (en) * 1991-01-23 1992-08-06 Jan Voda Guide catheter construction
NZ272209A (en) * 1991-05-01 2001-02-23 Univ Columbia Myocardial revascularisation of the heart by a laser
WO1994002077A2 (en) * 1992-07-15 1994-02-03 Angelase, Inc. Ablation catheter system
EP1208867B1 (de) * 1993-09-17 2010-03-10 Edwards Lifesciences AG Endovaskulares System zum Erzeugen eines künstlichen Herzstillstandes
US5575766A (en) * 1993-11-03 1996-11-19 Daig Corporation Process for the nonsurgical mapping and treatment of atrial arrhythmia using catheters guided by shaped guiding introducers
DE29501973U1 (de) * 1995-02-08 1995-04-06 Pein, Andreas, 19061 Schwerin Vorrichtung zum Trennen einer biologischen Struktur

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
See references of WO9635469A1 *

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