US20030120259A1 - Deflectable tip guide in guide system - Google Patents
Deflectable tip guide in guide system Download PDFInfo
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- US20030120259A1 US20030120259A1 US10/349,535 US34953503A US2003120259A1 US 20030120259 A1 US20030120259 A1 US 20030120259A1 US 34953503 A US34953503 A US 34953503A US 2003120259 A1 US2003120259 A1 US 2003120259A1
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- tube
- region
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- 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
- A61M25/0105—Steering means as part of the catheter or advancing means; Markers for positioning
- A61M25/0133—Tip steering devices
- A61M25/0147—Tip steering devices with movable mechanical means, e.g. pull wires
-
- 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
- A61M25/0043—Catheters; Hollow probes characterised by structural features
- A61M2025/0063—Catheters; Hollow probes characterised by structural features having means, e.g. stylets, mandrils, rods or wires to reinforce or adjust temporarily the stiffness, column strength or pushability of catheters which are already inserted into the human body
-
- 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
- A61M25/0105—Steering means as part of the catheter or advancing means; Markers for positioning
- A61M25/0133—Tip steering devices
- A61M2025/0161—Tip steering devices wherein the distal tips have two or more deflection regions
-
- 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
Definitions
- the present invention is related generally to medical devices. More specifically, the present invention is related to catheters for performing percutaneous myocardial revascularization (PMR) which is also referred to as transmyocardial revascularization (TMR).
- PMR percutaneous myocardial revascularization
- TMR transmyocardial revascularization
- the present invention includes guide catheters having proximally controllable distally disposed bendable regions.
- a number of techniques are available for treating cardiovascular disease such as cardiovascular by-pass surgery, coronary angioplasty, coronary atherectomy, and stent placement. These techniques are generally applied to by-pass or open lesions in coronary vessels to restore patency and increase blood flow to the heart muscle. In some patients, the number of lesions is so great, or the location so remote in the coronary vasculature, that restoring coronary artery blood flow to the heart is difficult.
- Transmyocardial revascularization also known as percutaneous myocardial revascularization (PMR)
- PMR percutaneous myocardial revascularization
- Heart muscle may be classified as healthy, hibernating, and “dead.”
- Dead tissue is not dead but is scarred, no longer contracting, and no longer capable of contracting even if adequately supplied with blood.
- Hibernating tissue is not contracting muscle tissue but is capable of contracting, provided it is again adequately supplied with blood.
- PMR is performed by wounding the myocardium of the heart, often forming and leaving patent holes, and sometimes injecting angiogenic substances in the process.
- PMR was inspired in part by observations that reptilian hearts are supplied in large part by blood supplied directly from within the heart chambers. In contrast, mammalian hearts are supplied by blood pumped from the heart, through the aorta, and back into the heart muscle through the coronary arteries. Positive results have been observed in some patients receiving PMR treatments. The positive results may be due in part to blood being perfused into the myocardium from the heart chambers through holes into the myocardium which remain open. The positive results are believed to be due in part to a wound healing response of the myocardium which includes formation of new blood vessels in the heart wall, which are believed to connect with the heart chamber interior and/or other coronary blood vessels.
- the PMR procedure can include cutting into the myocardium with therapeutic cutting tips, burning holes with therapeutic tips having laser or radio frequency current burning tips.
- the PMR therapeutic tip can also be used to inject angiogenic substances, such as growth factors or genes selected to cause angiogenesis.
- the PMR procedure generally involves insertion of a therapeutic tip, such as sharp cutting tip, into the heart chamber or chambers selected for treatment.
- the cutting tip and associated inner shaft can be guided into the chamber through a guide catheter, which may have been inserted into the vasculature a long distance from the heart.
- the cutting tip is preferably steered to several positions for forming of several holes in a pattern across the endocardium.
- an outer shaft or tube is sometimes disposed coaxially about the inner shaft and within the guide catheter.
- the outer tube can have structural features at the distal end for bending to various angles to reach various locations in the heart wall.
- the outer tube and inner shaft can be advanced to bring the cutting tip into contact with the heart wall.
- the present invention includes guide catheters which can be used for performing percutaneous myocardial revascularization (PMR).
- Guide catheters incorporating the present invention can provide distal regions that can be bent through varying angles. The distal region bending is preferably controlled at a proximal region or proximal end of the guide catheter.
- One controllably bendable guide catheter has a first lumen for receiving and delivering a therapeutic catheter to the guide catheter distal end and beyond.
- the guide catheter can also have an elongate manipulation member extending from the proximal region of the guide catheter to near the distal end of the guide catheter.
- the member is preferably secured to a location off-center from the central longitudinal axis of the catheter.
- the distal end of the member is bonded to the body of the guide catheter at the distal end of a second, blind lumen near the guide catheter distal end.
- the manipulation member is a pull wire in some embodiments.
- the manipulation member in one embodiment is a flat metallic ribbon.
- the manipulation member is a pull wire which may be formed from metal.
- the member is capable of both pushing on the distal region to straighten the distal region and pulling on the distal region through the off-center attachment point to impart a curve or bend to the distal region.
- the manipulation member is sufficiently strong only in tension, with a straightening bias in the distal region used to straighten the distal region when tension is released.
- the guide catheter distal region is-preferably formed of a more flexible material than the more proximal intermediate guide catheter region.
- a controllably bendable guide catheter can be inserted through a conventional guide catheter in one PMR system.
- the bendable guide catheter is nested within a second controllably bendable guide catheter. This can provide for great flexibility in reaching otherwise hard to reach sites in the endocardium.
- the rotation inhibitor can include internal and external teeth on opposing external and internal opposing surfaces, respectively.
- the teeth can engage each other and resist rotation between the inner and outer tubes.
- elastic deformation of the teeth can allow slippage between the opposed teeth and the two tubes.
- Providing resistance to free rotation between the tubes can lessen the rotation of the two tubes relative to one another in the case where torque has been applied to one tube, but has not been translated to rotational motion at the distal end.
- the applied torque may have been stored in the intermediate portion of the tube and can cause unwanted rotation of either tube at the proximal end.
- a ratcheting mechanism can be provided which urges the tubes to stay in position after the treating physician's hands are removed from the device
- FIG. 1 is a perspective, cutaway view of a heart having a PMR therapeutic catheter disposed within a steerable or controllably bendable guide catheter disposed within a guide catheter;
- FIG. 2 is a fragmentary, perspective, cutaway view of a controllably bendable guide tube having a bendable distal region and an elongate manipulation member;
- FIG. 3 is a fragmentary, perspective view of a steerable inner guide catheter disposed within an outer guide catheter;
- FIG. 4 is a fragmentary, perspective view of a steerable inner guide catheter disposed within an outer steerable guide catheter;
- FIG. 5 is a fragmentary, perspective view of a PMR therapeutic catheter disposed within a steerable guide catheter disposed within a guide catheter;
- FIG. 6 is a fragmentary, perspective view of a PMR therapeutic catheter disposed within a steerable inner guide catheter disposed within an outer steerable guide catheter disposed within a guide catheter;
- FIG. 7 is a longitudinal cross-sectional view of a rotatable, steerable guide catheter disposed within a rotatable guide catheter disposed within a proximal hub;
- FIG. 8 is a transverse cross-sectional view of the catheter of FIG. 7 taken through place 8 - 8 , illustrating external teeth on the rotatable, steerable guide catheter engaged with an internal tooth on the rotatable guide catheter for inhibiting free rotation between the two;
- FIG. 9 is a transverse cross-sectional view somewhat similar to that of FIG. 8, wherein the steerable guide catheter has external teeth engaged with an internal tooth of the rotatable guide catheter;
- FIG. 10 is a detailed view of the inset portion of FIG. 9.
- FIG. 1 illustrates a human heart 20 having a left ventricle 22 , an inner layer to a heart chamber wall or endocardium 24 , a heart chamber wall or myocardium 26 , and an aortic arch 28 .
- a percutaneous myocardial revascularization (PMR) device 30 Disposed through the aortic arch is a percutaneous myocardial revascularization (PMR) device 30 , extending into left ventricle 22 and having an outer guide tube 32 , an inner guide tube 34 , and a therapeutic catheter therapeutic tip 36 near endocardium 24 .
- PMR percutaneous myocardial revascularization
- left ventricle 22 includes upper or superior regions that may require a bend in PMR device 30 in order to reach the superior regions of the myocardium.
- inner guide catheter 34 includes a bent distal region for orienting therapeutic catheter tip 36 toward a target location in the myocardium.
- Guide catheter 40 includes a distal region 42 , an intermediate region 44 disposed proximal of the distal region, and a distal end 46 .
- a longitudinal center axis 48 is illustrated near distal end 46 , as is an off-center axis 50 disposed laterally offset from center axis 48 .
- Guide catheter 40 includes a lumen 52 for receiving a therapeutic catheter, or, in some embodiments, another guide catheter.
- a second lumen 54 is illustrated, having an elongate manipulation member 56 disposed within. Second lumen 54 need not extend through to distal end 46 in most embodiments.
- elongate manipulation member 56 is secured to the body of catheter 40 at an off-center attachment point 58 which is located along off-center axis 50 .
- distal region 42 can be made to bend or deflect.
- manipulation member 56 is sufficiently strong in tension to pull distal region 42 to bend the region, and sufficiently strong in compression to push distal region 42 to straighten the region.
- manipulation member 56 is a flat wire.
- manipulation member 56 is a pull wire strong enough in tension to bend distal region 42 but insufficiently strong in compression to straighten distal region 42 , with distal region 42 being biased to a straight position and resuming that position when the tension of manipulation member 56 is released.
- Guide catheter 40 distal region 42 is preferably formed of a more flexible material than intermediate region 44 .
- distal region 42 is bonded to intermediate region 44 along a plane as illustrated at 60 .
- distal region 42 and intermediate region 44 are formed of materials such as polyether ester elastomer (for example, ARNITEL®, available from DSM Engineering Plastics), a polyester elastomer (for example, HYTREL®, available from DuPont Corporation), a polyether block amide (for example, PEBAX®), or Nylon.
- the two regions can be bonded together using a method well known to those skilled in the art, such as adhesive application or heat bonding.
- intermediate region 44 is formed from the same polymer as distal region 42 , but having a higher durometer value.
- steerable guide catheter 40 having bendable distal region 42 is shown disposed within a second guide catheter 62 having a bent distal region 64 .
- distal bent region 64 is relatively fixed in the degree of bend, and the bend may be used in part to gain entry to the left ventricle.
- the length of guide catheter 40 that extends from second guide catheter 62 can be varied to reach varying locations of the endocardium in the heart chambers such as the left ventricle.
- the distal bend of guide catheter 40 can be used to point a therapeutic catheter to various locations in the heart wall.
- Guide catheter distal region 42 is illustrated in a first bend position “A” and a second, straighter bend position “B”. In the embodiment illustrated, movement between positions A and B is accomplished through the longitudinal movement of elongate manipulation member 56 .
- guide catheter 40 is shown disposed within a steerable second guide catheter 66 having a distal bend region 68 .
- Guide catheter 40 is shown in two positions, “C” and “D”, while second steerable guide catheter 62 is illustrated in two positions, “E” and “F.”
- Second steerable guide catheter 66 controls the bend of distal region 68 through a slidable elongate manipulation member 64 . As shown in FIG. 4, the combination of two independently controlled degrees of bending allows a large degree of control over where in the heart chamber a carried therapeutic catheter tip is to be delivered.
- FIG. 5 illustrates a therapeutic cutting tip catheter 80 disposed within a bent, steerable guide catheter 82 slidably and rotatably disposed within an outer guide catheter 84 .
- FIG. 5 illustrates the range of motion possible through rotation and axial movement, with rotation indicated at 88 and axial movement indicated at 86. These ranges of movement are also possible in addition to the illustrated controlled bending illustrated in FIGS. 3 and 4, but difficult to show on the same figure.
- FIG. 6 illustrates yet another embodiment, illustrating therapeutic cutting tip catheter 80 slidably disposed within a first bendable guide catheter 90 which is slidably and rotatably disposed within a second bendable guide catheter 92 , which is in turn slidably and rotatably disposed within a third, more conventional guide catheter 94 .
- the range of motion of guide catheter 90 is indicated by rotation at 96, axial movement at 104, and bending at 106.
- the range of motion of guide catheter 92 is indicated by rotation at 102, axial movement at 98, and bending at 100.
- guide catheters 90 and 92 are controlled with an elongate manipulation member similar to guide catheters 40 and 66 of FIG. 4.
- FIG. 6 thus illustrates how bendable, steerable guide catheters can be nested within each other to multiple levels to achieve a large range of motion.
- the bendable distal region of the guide catheters can bring a large portion of the left ventricle endocardium into range of the catheter therapeutic tip, giving the ability to treat a large portion of the left ventricle myocardium.
- FIG. 7 another aspect of the present invention is illustrated. Inspection of FIGS. 4 through 6 illustrates guide tubes disposed within guide tubes. As explicitly indicated in FIG. 5 at 88 and in FIG. 6 at 96 and 102, rotation of tubes within tubes is possible.
- the nested guide catheters may be closely matched in size, with little wasted space in between the outside wall of an inner tube and the inside wall of an outer tube.
- the catheters allow for more space in between the tubes, but can have one wall lying more closely to one wall than another, as the nested guide catheters are curved around tortuous vessels turns which can force the inner catheter off-center to lie more closely to one inside surface of the outer catheter.
- the closeness of one or both walls of the inner and outer catheters can thus inhibit rotation of one tube relative to another tube.
- applied rotational force may not be completely translated into rotational movement at the far distal end of the inner catheter. This can result in some applied torque being stored as torsional energy in the inner catheter.
- the treating physician releases the inner catheter proximal end after applied torque to the inner catheter, the proximal end of the inner catheter may spring back. If the outer catheter was being held and then released, the outer tube may spring in the same direction as the applied force to the inner tube.
- FIGS. 7 and 8 illustrate a catheter system 120 having structures for inhibiting the undesirable rotational movement of one catheter when no torque is being applied at the proximal end by the treating physician.
- the structures can prevent the guide catheters from undesirably rotating one within the other.
- Catheter system 120 includes a proximal region 123 , and a proximal hub 122 having a lumen 124 therein for receiving a first guide catheter 126 , which is disposed about a second guide catheter 128 .
- first guide catheter 126 has a distal region 127 having a bend and second catheter 128 also has a distal region 129 having a bend.
- second catheter distal region 129 can be bent, with the bending being controlled from a more proximal region of the catheter.
- Second catheter 128 can be rotated relative to first catheter 126 , and first catheter 126 can be rotated relative to enclosing hub 122 .
- FIG. 8 illustrates an aspect of the invention which can inhibit free rotation of first catheter 126 relative to hub 122 .
- Hub 122 has an internal tooth 130 and first catheter 126 has several outwardly extending teeth 132 in proximal hub region 123 .
- rotational energy may later cause first catheter 126 to rotate.
- tooth 130 engages teeth 132 and inhibits this free rotation.
- the teeth can be forced to move over each other, allowing for rotation. In one embodiment, this movement is possible due to the elastic deformation of at least one of the pairs of opposing teeth.
- the outer tooth is replaced by multiple teeth.
- the inner and outer teeth may be formed of materials such as DELRIN® (an acetal plastic available from DuPont Chemical Company), PEBAX® (polyether block amide), polyesters, polycarbonate, ABS (acrylonitrile butadiene styrene), acrylic, or ULTEM® (a polyetherimide available from General Electric Corporation).
- DELRIN® an acetal plastic available from DuPont Chemical Company
- PEBAX® polyether block amide
- polyesters polycarbonate
- ABS acrylonitrile butadiene styrene
- acrylic or ULTEM® (a polyetherimide available from General Electric Corporation).
- ULTEM® a polyetherimide available from General Electric Corporation
- FIG. 9 illustrates another embodiment having teeth on both an inner and an outer guide catheter.
- An inner guide catheter 140 is disposed within an outer guide catheter 144 , which is in turn disposed within hub 122 .
- inner guide catheter 140 has several outer teeth 142 which engage a single inwardly oriented tooth 146 of outer guide catheter 144 .
- FIG. 10 illustrates outer guide catheter 144 with inwardly disposed tooth 146 in greater detail.
- FIGS. 8, 9, and 10 illustrate embodiments of the invention capable of resisting stored torsional energy from causing free rotation of the guide catheter when the applied torque is removed.
- a guide catheter according to the present invention can be advanced to a target site. In some methods, this is accomplished by first introducing a guide wire through the vasculature and into a heart chamber to be treated, such as the left ventricle.
- a guide wire can be introduced into the femoral artery near the groin, and advanced over the aortic arch and into a chamber of the heart.
- a guide catheter can then be advanced over the guide wire.
- the first guide catheter can be followed by a second guide catheter, either over the first guide catheter or over the guide wire within the first guide catheter.
- the guide wire can be retracted and a therapeutic catheter advanced through the inner most guide catheter. Multiple guide catheters can thus be advanced to position.
- a steerable guide catheter having a controllably bendable distal region is disposed within a conventional guide catheter.
- the conventional guide catheter can terminate distally in either a straight distal region or a curved distal region, depending on the application.
- a first guide catheter having a controllably bendable distal region is disposed within a second guide catheter having a controllably bendable guide catheter. In either case, the guide catheter or catheters can be advanced into the heart chamber with the therapeutic catheter tip disposed within the inner most guide catheter.
- the innermost guide catheter can be extended toward a target site of interest with the longitudinal extension and radial rotation of the catheter proximally controlled by the treating physician.
- the bending of the guide catheter distal region can also be controlled by the treating physician.
- at least a portion of the therapeutic catheter or therapeutic tip is radiopaque to make the tip location visible under fluoroscopy.
- the extension, rotation, and bending can be observed under fluoroscopy, with the extension, rotation, and manipulation of bending controlled in response to the image seen under fluoroscopy.
- one or two of the movements, extension, rotation, or bending may be controlled while the other one or two movements are varied in order to cover a pattern of the heart wall.
- the rotation may be held constant, and the bend may be varied, with the longitudinal extension being varied sufficiently to reach the heart wall.
- the bend may be held constant, and the rotation may be varied, to cover a circular pattern over a portion of the heart wall.
- various therapeutic tips may be delivered to the endocardium, including cutting tips, burning tips, and angiogenic substance injecting tips.
Abstract
Guide catheters which can be used in percutaneous myocardial revascularization (PMR) to deliver therapeutic catheters to difficult to reach heart chamber wall regions. Some guide catheters include distal regions which can be bent under control from the proximal region of the catheter. One steerable guide catheter has a flexible distal region, a more proximal, less flexible intermediate region, a first lumen for receiving a therapeutic catheter, and an elongate manipulation member slidably disposed in a second, blind lumen. The elongate manipulation member can be secured off-center near the distal end of the flexible distal region. The distal region can be bent by retracting the manipulation member and straightened by pushing the manipulation member. Controllably bendable guide catheters according to the present invention can be nested inside other, similar guide catheters. The invention also includes means for resisting free rotation of guide catheters relative to other adjacent catheters or tubes.
Description
- The present invention is related generally to medical devices. More specifically, the present invention is related to catheters for performing percutaneous myocardial revascularization (PMR) which is also referred to as transmyocardial revascularization (TMR). The present invention includes guide catheters having proximally controllable distally disposed bendable regions.
- A number of techniques are available for treating cardiovascular disease such as cardiovascular by-pass surgery, coronary angioplasty, coronary atherectomy, and stent placement. These techniques are generally applied to by-pass or open lesions in coronary vessels to restore patency and increase blood flow to the heart muscle. In some patients, the number of lesions is so great, or the location so remote in the coronary vasculature, that restoring coronary artery blood flow to the heart is difficult. Transmyocardial revascularization (TMR), also known as percutaneous myocardial revascularization (PMR), has been developed as an alternative to these techniques which are directed to bypassing or removing lesions.
- Heart muscle may be classified as healthy, hibernating, and “dead.” Dead tissue is not dead but is scarred, no longer contracting, and no longer capable of contracting even if adequately supplied with blood. Hibernating tissue is not contracting muscle tissue but is capable of contracting, provided it is again adequately supplied with blood. PMR is performed by wounding the myocardium of the heart, often forming and leaving patent holes, and sometimes injecting angiogenic substances in the process.
- PMR was inspired in part by observations that reptilian hearts are supplied in large part by blood supplied directly from within the heart chambers. In contrast, mammalian hearts are supplied by blood pumped from the heart, through the aorta, and back into the heart muscle through the coronary arteries. Positive results have been observed in some patients receiving PMR treatments. The positive results may be due in part to blood being perfused into the myocardium from the heart chambers through holes into the myocardium which remain open. The positive results are believed to be due in part to a wound healing response of the myocardium which includes formation of new blood vessels in the heart wall, which are believed to connect with the heart chamber interior and/or other coronary blood vessels. The PMR procedure can include cutting into the myocardium with therapeutic cutting tips, burning holes with therapeutic tips having laser or radio frequency current burning tips. The PMR therapeutic tip can also be used to inject angiogenic substances, such as growth factors or genes selected to cause angiogenesis.
- The PMR procedure generally involves insertion of a therapeutic tip, such as sharp cutting tip, into the heart chamber or chambers selected for treatment. The cutting tip and associated inner shaft can be guided into the chamber through a guide catheter, which may have been inserted into the vasculature a long distance from the heart. After the inner shaft exits the guide catheter, the cutting tip is preferably steered to several positions for forming of several holes in a pattern across the endocardium. In order to steer the inner shaft and cutting tip, an outer shaft or tube is sometimes disposed coaxially about the inner shaft and within the guide catheter. The outer tube can have structural features at the distal end for bending to various angles to reach various locations in the heart wall. The outer tube and inner shaft can be advanced to bring the cutting tip into contact with the heart wall.
- It may be desirable to revascularize regions of the endocardium that are difficult to reach using conventional guide catheters. For example, it may be important to reach areas of hibernating tissue in superior locations of the left ventricle. Conventional guide catheters may have difficulty bending sufficiently to reach some regions.
- What would be desirable is an improved guide device for steering inner shaft cutting tips into position within the heart myocardium. What would be desirable is a catheter having greater reach and maneuverability in the chambers of the heart.
- The present invention includes guide catheters which can be used for performing percutaneous myocardial revascularization (PMR). Guide catheters incorporating the present invention can provide distal regions that can be bent through varying angles. The distal region bending is preferably controlled at a proximal region or proximal end of the guide catheter. One controllably bendable guide catheter has a first lumen for receiving and delivering a therapeutic catheter to the guide catheter distal end and beyond. The guide catheter can also have an elongate manipulation member extending from the proximal region of the guide catheter to near the distal end of the guide catheter. The member is preferably secured to a location off-center from the central longitudinal axis of the catheter. In one embodiment, the distal end of the member is bonded to the body of the guide catheter at the distal end of a second, blind lumen near the guide catheter distal end.
- The manipulation member is a pull wire in some embodiments. The manipulation member in one embodiment is a flat metallic ribbon. In some embodiments, the manipulation member is a pull wire which may be formed from metal. In one embodiment, the member is capable of both pushing on the distal region to straighten the distal region and pulling on the distal region through the off-center attachment point to impart a curve or bend to the distal region. In another embodiment, the manipulation member is sufficiently strong only in tension, with a straightening bias in the distal region used to straighten the distal region when tension is released. The guide catheter distal region is-preferably formed of a more flexible material than the more proximal intermediate guide catheter region.
- A controllably bendable guide catheter, according to the present invention, can be inserted through a conventional guide catheter in one PMR system. In another PMR system, the bendable guide catheter is nested within a second controllably bendable guide catheter. This can provide for great flexibility in reaching otherwise hard to reach sites in the endocardium.
- Another aspect of the present invention provides for inhibiting free rotation between nested, rotating tubes such as the nested guide catheter tubes. The rotation inhibitor can include internal and external teeth on opposing external and internal opposing surfaces, respectively. The teeth can engage each other and resist rotation between the inner and outer tubes. When the applied rotational force exceeds a threshold, elastic deformation of the teeth can allow slippage between the opposed teeth and the two tubes. Providing resistance to free rotation between the tubes can lessen the rotation of the two tubes relative to one another in the case where torque has been applied to one tube, but has not been translated to rotational motion at the distal end. The applied torque may have been stored in the intermediate portion of the tube and can cause unwanted rotation of either tube at the proximal end. A ratcheting mechanism can be provided which urges the tubes to stay in position after the treating physician's hands are removed from the device
- FIG. 1 is a perspective, cutaway view of a heart having a PMR therapeutic catheter disposed within a steerable or controllably bendable guide catheter disposed within a guide catheter;
- FIG. 2 is a fragmentary, perspective, cutaway view of a controllably bendable guide tube having a bendable distal region and an elongate manipulation member;
- FIG. 3 is a fragmentary, perspective view of a steerable inner guide catheter disposed within an outer guide catheter;
- FIG. 4 is a fragmentary, perspective view of a steerable inner guide catheter disposed within an outer steerable guide catheter;
- FIG. 5 is a fragmentary, perspective view of a PMR therapeutic catheter disposed within a steerable guide catheter disposed within a guide catheter;
- FIG. 6 is a fragmentary, perspective view of a PMR therapeutic catheter disposed within a steerable inner guide catheter disposed within an outer steerable guide catheter disposed within a guide catheter;
- FIG. 7 is a longitudinal cross-sectional view of a rotatable, steerable guide catheter disposed within a rotatable guide catheter disposed within a proximal hub;
- FIG. 8 is a transverse cross-sectional view of the catheter of FIG. 7 taken through place8-8, illustrating external teeth on the rotatable, steerable guide catheter engaged with an internal tooth on the rotatable guide catheter for inhibiting free rotation between the two;
- FIG. 9 is a transverse cross-sectional view somewhat similar to that of FIG. 8, wherein the steerable guide catheter has external teeth engaged with an internal tooth of the rotatable guide catheter; and
- FIG. 10 is a detailed view of the inset portion of FIG. 9.
- FIG. 1 illustrates a
human heart 20 having aleft ventricle 22, an inner layer to a heart chamber wall orendocardium 24, a heart chamber wall ormyocardium 26, and anaortic arch 28. Disposed through the aortic arch is a percutaneous myocardial revascularization (PMR)device 30, extending intoleft ventricle 22 and having anouter guide tube 32, aninner guide tube 34, and a therapeutic cathetertherapeutic tip 36 nearendocardium 24. As can be seen from inspection of FIG. 1,left ventricle 22 includes upper or superior regions that may require a bend inPMR device 30 in order to reach the superior regions of the myocardium. In the embodiment illustrated,inner guide catheter 34 includes a bent distal region for orientingtherapeutic catheter tip 36 toward a target location in the myocardium. - Referring now to FIG. 2, one embodiment of a steerable or
bendable guide catheter 40 is illustrated in more detail.Guide catheter 40 includes adistal region 42, anintermediate region 44 disposed proximal of the distal region, and adistal end 46. Alongitudinal center axis 48 is illustrated neardistal end 46, as is an off-center axis 50 disposed laterally offset fromcenter axis 48.Guide catheter 40 includes alumen 52 for receiving a therapeutic catheter, or, in some embodiments, another guide catheter. Asecond lumen 54 is illustrated, having anelongate manipulation member 56 disposed within.Second lumen 54 need not extend through todistal end 46 in most embodiments. In the embodiment illustrated,elongate manipulation member 56 is secured to the body ofcatheter 40 at an off-center attachment point 58 which is located along off-center axis 50. By pulling onmanipulation member 56 which is attached off-center to guidecatheter 40,distal region 42 can be made to bend or deflect. In one embodiment,manipulation member 56 is sufficiently strong in tension to pulldistal region 42 to bend the region, and sufficiently strong in compression to pushdistal region 42 to straighten the region. In one embodiment,manipulation member 56 is a flat wire. In one embodiment,manipulation member 56 is a pull wire strong enough in tension to benddistal region 42 but insufficiently strong in compression to straightendistal region 42, withdistal region 42 being biased to a straight position and resuming that position when the tension ofmanipulation member 56 is released. -
Guide catheter 40distal region 42 is preferably formed of a more flexible material thanintermediate region 44. In the embodiment illustrated,distal region 42 is bonded tointermediate region 44 along a plane as illustrated at 60. In one embodiment,distal region 42 andintermediate region 44 are formed of materials such as polyether ester elastomer (for example, ARNITEL®, available from DSM Engineering Plastics), a polyester elastomer (for example, HYTREL®, available from DuPont Corporation), a polyether block amide (for example, PEBAX®), or Nylon. The two regions can be bonded together using a method well known to those skilled in the art, such as adhesive application or heat bonding. In one embodiment,intermediate region 44 is formed from the same polymer asdistal region 42, but having a higher durometer value. - Referring now to FIG. 3,
steerable guide catheter 40 having bendabledistal region 42 is shown disposed within asecond guide catheter 62 having a bentdistal region 64. In some embodiments, distalbent region 64 is relatively fixed in the degree of bend, and the bend may be used in part to gain entry to the left ventricle. The length ofguide catheter 40 that extends fromsecond guide catheter 62 can be varied to reach varying locations of the endocardium in the heart chambers such as the left ventricle. The distal bend ofguide catheter 40 can be used to point a therapeutic catheter to various locations in the heart wall. Guide catheterdistal region 42 is illustrated in a first bend position “A” and a second, straighter bend position “B”. In the embodiment illustrated, movement between positions A and B is accomplished through the longitudinal movement ofelongate manipulation member 56. - Referring now to FIG. 4, guide
catheter 40 is shown disposed within a steerablesecond guide catheter 66 having a distal bend region 68.Guide catheter 40 is shown in two positions, “C” and “D”, while secondsteerable guide catheter 62 is illustrated in two positions, “E” and “F.” Second steerable guidecatheter 66 controls the bend of distal region 68 through a slidableelongate manipulation member 64. As shown in FIG. 4, the combination of two independently controlled degrees of bending allows a large degree of control over where in the heart chamber a carried therapeutic catheter tip is to be delivered. - FIG. 5 illustrates a therapeutic
cutting tip catheter 80 disposed within a bent,steerable guide catheter 82 slidably and rotatably disposed within anouter guide catheter 84. FIG. 5 illustrates the range of motion possible through rotation and axial movement, with rotation indicated at 88 and axial movement indicated at 86. These ranges of movement are also possible in addition to the illustrated controlled bending illustrated in FIGS. 3 and 4, but difficult to show on the same figure. - FIG. 6 illustrates yet another embodiment, illustrating therapeutic
cutting tip catheter 80 slidably disposed within a firstbendable guide catheter 90 which is slidably and rotatably disposed within a secondbendable guide catheter 92, which is in turn slidably and rotatably disposed within a third, moreconventional guide catheter 94. The range of motion ofguide catheter 90 is indicated by rotation at 96, axial movement at 104, and bending at 106. Similarly, the range of motion ofguide catheter 92 is indicated by rotation at 102, axial movement at 98, and bending at 100. - In one embodiment, guide
catheters catheters - Referring now to FIG. 7, another aspect of the present invention is illustrated. Inspection of FIGS. 4 through 6 illustrates guide tubes disposed within guide tubes. As explicitly indicated in FIG. 5 at 88 and in FIG. 6 at 96 and 102, rotation of tubes within tubes is possible. In order to provide the largest tubular lumens while providing small outer diameters, the nested guide catheters may be closely matched in size, with little wasted space in between the outside wall of an inner tube and the inside wall of an outer tube. In some embodiments, the catheters allow for more space in between the tubes, but can have one wall lying more closely to one wall than another, as the nested guide catheters are curved around tortuous vessels turns which can force the inner catheter off-center to lie more closely to one inside surface of the outer catheter.
- The closeness of one or both walls of the inner and outer catheters can thus inhibit rotation of one tube relative to another tube. In particular, applied rotational force may not be completely translated into rotational movement at the far distal end of the inner catheter. This can result in some applied torque being stored as torsional energy in the inner catheter. When the treating physician releases the inner catheter proximal end after applied torque to the inner catheter, the proximal end of the inner catheter may spring back. If the outer catheter was being held and then released, the outer tube may spring in the same direction as the applied force to the inner tube. Thus, it is possible for one tube to freely rotate even in the absence of currently applied force to that tube by the treating physician.
- FIGS. 7 and 8 illustrate a
catheter system 120 having structures for inhibiting the undesirable rotational movement of one catheter when no torque is being applied at the proximal end by the treating physician. The structures can prevent the guide catheters from undesirably rotating one within the other.Catheter system 120 includes aproximal region 123, and aproximal hub 122 having alumen 124 therein for receiving afirst guide catheter 126, which is disposed about asecond guide catheter 128. In the embodiment illustrated,first guide catheter 126 has adistal region 127 having a bend andsecond catheter 128 also has adistal region 129 having a bend. In one embodiment, second catheterdistal region 129 can be bent, with the bending being controlled from a more proximal region of the catheter.Second catheter 128 can be rotated relative tofirst catheter 126, andfirst catheter 126 can be rotated relative to enclosinghub 122. - FIG. 8 illustrates an aspect of the invention which can inhibit free rotation of
first catheter 126 relative tohub 122.Hub 122 has aninternal tooth 130 andfirst catheter 126 has several outwardly extendingteeth 132 inproximal hub region 123. Whenfirst catheter 126 is rotated relative tohub 122 and/orsecond catheter 128 is rotated relative tofirst catheter 126, rotational energy may later causefirst catheter 126 to rotate. To inhibit this free rotation,tooth 130 engagesteeth 132 and inhibits this free rotation. When sufficient force is applied, the teeth can be forced to move over each other, allowing for rotation. In one embodiment, this movement is possible due to the elastic deformation of at least one of the pairs of opposing teeth. In one embodiment, the outer tooth is replaced by multiple teeth. The inner and outer teeth may be formed of materials such as DELRIN® (an acetal plastic available from DuPont Chemical Company), PEBAX® (polyether block amide), polyesters, polycarbonate, ABS (acrylonitrile butadiene styrene), acrylic, or ULTEM® (a polyetherimide available from General Electric Corporation). - FIG. 9 illustrates another embodiment having teeth on both an inner and an outer guide catheter. An
inner guide catheter 140 is disposed within anouter guide catheter 144, which is in turn disposed withinhub 122. In the embodiment illustrated,inner guide catheter 140 has severalouter teeth 142 which engage a single inwardly orientedtooth 146 ofouter guide catheter 144. In this embodiment, the free rotation ofinner catheter 140 relative toouter guide catheter 144 is inhibited. FIG. 10 illustratesouter guide catheter 144 with inwardly disposedtooth 146 in greater detail. FIGS. 8, 9, and 10 illustrate embodiments of the invention capable of resisting stored torsional energy from causing free rotation of the guide catheter when the applied torque is removed. - In use, a guide catheter according to the present invention can be advanced to a target site. In some methods, this is accomplished by first introducing a guide wire through the vasculature and into a heart chamber to be treated, such as the left ventricle. For example, a guide wire can be introduced into the femoral artery near the groin, and advanced over the aortic arch and into a chamber of the heart. A guide catheter can then be advanced over the guide wire. The first guide catheter can be followed by a second guide catheter, either over the first guide catheter or over the guide wire within the first guide catheter. The guide wire can be retracted and a therapeutic catheter advanced through the inner most guide catheter. Multiple guide catheters can thus be advanced to position.
- In some applications of the present invention, a steerable guide catheter having a controllably bendable distal region is disposed within a conventional guide catheter. The conventional guide catheter can terminate distally in either a straight distal region or a curved distal region, depending on the application. In other applications, a first guide catheter having a controllably bendable distal region is disposed within a second guide catheter having a controllably bendable guide catheter. In either case, the guide catheter or catheters can be advanced into the heart chamber with the therapeutic catheter tip disposed within the inner most guide catheter.
- The innermost guide catheter can be extended toward a target site of interest with the longitudinal extension and radial rotation of the catheter proximally controlled by the treating physician. The bending of the guide catheter distal region can also be controlled by the treating physician. In preferred embodiments, at least a portion of the therapeutic catheter or therapeutic tip is radiopaque to make the tip location visible under fluoroscopy. The extension, rotation, and bending can be observed under fluoroscopy, with the extension, rotation, and manipulation of bending controlled in response to the image seen under fluoroscopy. In some methods, one or two of the movements, extension, rotation, or bending, may be controlled while the other one or two movements are varied in order to cover a pattern of the heart wall. For example, the rotation may be held constant, and the bend may be varied, with the longitudinal extension being varied sufficiently to reach the heart wall. For example, the bend may be held constant, and the rotation may be varied, to cover a circular pattern over a portion of the heart wall. In use, various therapeutic tips may be delivered to the endocardium, including cutting tips, burning tips, and angiogenic substance injecting tips.
- Numerous advantages of the invention covered by this document have been set forth in the foregoing description. It will be understood, however, that this disclosure is, in many respects, only illustrative. Changes may be made in details, particularly in matters of shape, size, and arrangement of parts without exceeding the scope of the invention. The invention's scope is, of course, defined in the language in which the appended claims are expressed.
Claims (17)
1. A system for performing myocardial revascularization comprising:
a first elongate tube having a distal region, a distal end, a proximal region, a first lumen therethrough, means for bending said distal region, and means for controlling said distal region bending from said proximal region; and
a therapeutic catheter having a distal end slidably disposed within said first tube lumen.
2. A system for performing myocardial revascularization as recited in claim 1 , wherein said therapeutic catheter distal end has a distal tip having a first position extending distally from said first tube distal end, a second position retracted proximally within said first tube distal end, and means for urging said therapeutic catheter distal end between said first and second positions.
3. A system for performing myocardial revascularization as recited in claim 1 , wherein said therapeutic catheter distal end includes means for penetrating said myocardium.
4. A system for performing myocardial revascularization as recited in claim 1 , wherein said first tube has an intermediate region proximal of said distal region and said distal region is more flexible than said intermediate region.
5. A system for performing myocardial revascularization as recited in claim 1, wherein said first tube distal region has a longitudinal center axis and an off-center location disposed off said center axis, and said means for bending includes means for pulling and pushing on said off-center location.
6. A system for performing myocardial revascularization as recited in claim 5 , wherein said means for pushing and pulling includes an elongate manipulation member operably coupled to said off-center location and extending proximally at least to said proximal region.
7. A system for performing myocardial revascularization as recited in claim 6 , wherein said first tube has a second lumen therein and said elongate manipulation member is disposed in said second lumen.
8. A system for performing myocardial revascularization as recited in claim 1 , further comprising a second tube having a distal region, a proximal region, a distal end, and a second lumen therethrough, said second tube having said therapeutic catheter disposed within said second lumen, said second tube being disposed within said first tube first lumen.
9. A system for performing myocardial revascularization as recited in claim 8 , wherein said second tube has means for bending said second tube distal region and means for extending said second tube distal region distally from said first tube distal end.
10. A system for performing myocardial revascularization as recited in claim 9 , wherein said second tube further comprises means for controlling said second tube distal region bending from said second tube proximal region.
11. A system for performing myocardial revascularization as recited in claim 10 , wherein said second tube means for controlling bending includes a second elongate manipulation member disposed within said second tube.
12. A guiding catheter system for performing myocardial revascularization comprising:
a first guide tube having a proximal region and a first lumen therethrough, said first lumen having an inside surface;
a second guide tube having a proximal region and a second lumen therethrough, said second guide tube being disposed at least partially in said first tube first lumen and having an outer surface opposing said first tube inside surface; and
means for resisting free rotation between said first and second tubes.
13. A guiding catheter system for performing myocardial revascularization as recited in claim 12 , wherein said means for resisting free rotation is-disposed on said opposing surfaces.
14. A guiding catheter system for performing myocardial revascularization as recited in claim 13 , wherein said means for resisting free rotation includes a plurality of teeth disposed on at least one of said opposing surfaces and at least one tooth on the other said opposing surfaces for engaging said plurality of teeth.
15. A guiding catheter system for performing myocardial revascularization as recited in claim 14 , wherein said plurality of teeth is disposed on said first tube outer surface and said at least one tooth is disposed on said second tube inner surface.
16. A guide catheter for performing myocardial revascularization comprising:
an elongate tube having a distal region, a distal end, a proximal region, a first lumen therethrough, and a longitudinal center axis;
a second lumen extending from said proximal region to at least said distal region; and
an elongate manipulation member disposed in said second lumen, being accessible from said proximal region, and being operably secured to said tube distal region at a location off-center from said tube longitudinal center axis, such that said-tube distal region can be bent by proximally pulling on said manipulation member.
17. A guide catheter for performing myocardial revascularization as recited in claim 16 , wherein said tube has an intermediate region proximally near said distal region, and said distal region is more flexible than said intermediate region.
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Cited By (21)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20020032478A1 (en) * | 2000-08-07 | 2002-03-14 | Percardia, Inc. | Myocardial stents and related methods of providing direct blood flow from a heart chamber to a coronary vessel |
US20020045928A1 (en) * | 2000-05-04 | 2002-04-18 | Percardia, Inc. | Methods and devices for delivering a ventricular stent |
US20050021124A1 (en) * | 2003-07-22 | 2005-01-27 | Brendan Cunniffe | Stents and stent delivery system |
US20050182455A1 (en) * | 2004-02-12 | 2005-08-18 | Ndi Medical, Llc | Portable percutaneous assemblies, systems and methods for providing highly selective functional or therapeutic neuromuscular stimulation |
US20050182457A1 (en) * | 2004-02-12 | 2005-08-18 | Ndi Medical, Llc | Portable assemblies, systems and methods for providing functional or therapeutic neuromuscular stimulation |
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US20070123952A1 (en) * | 2004-02-12 | 2007-05-31 | Ndi Medical, Llc | Portable assemblies, systems, and methods for providing functional or therapeutic neurostimulation |
US20070156116A1 (en) * | 2005-12-30 | 2007-07-05 | Gonzalez Pablo A | Dual-lever bi-directional handle |
US20070265693A1 (en) * | 2006-05-15 | 2007-11-15 | Paskar Larry D | Coronary sinus catheter system and method |
US20100036445A1 (en) * | 2008-08-01 | 2010-02-11 | Ndi Medical Llc. | Portable assemblies, systems, and methods for providing functional or therapeutic neurostimulation |
US7761167B2 (en) | 2004-06-10 | 2010-07-20 | Medtronic Urinary Solutions, Inc. | Systems and methods for clinician control of stimulation systems |
US7813809B2 (en) | 2004-06-10 | 2010-10-12 | Medtronic, Inc. | Implantable pulse generator for providing functional and/or therapeutic stimulation of muscles and/or nerves and/or central nervous system tissue |
US8165692B2 (en) | 2004-06-10 | 2012-04-24 | Medtronic Urinary Solutions, Inc. | Implantable pulse generator power management |
US8195304B2 (en) | 2004-06-10 | 2012-06-05 | Medtronic Urinary Solutions, Inc. | Implantable systems and methods for acquisition and processing of electrical signals |
US8467875B2 (en) | 2004-02-12 | 2013-06-18 | Medtronic, Inc. | Stimulation of dorsal genital nerves to treat urologic dysfunctions |
US20140088684A1 (en) * | 2006-05-15 | 2014-03-27 | Larry D. Paskar | Catheter system |
US8753312B2 (en) | 2002-01-28 | 2014-06-17 | Cardiac Pacemakers, Inc. | Inner and outer telescoping catheter delivery system |
US9205255B2 (en) | 2004-06-10 | 2015-12-08 | Medtronic Urinary Solutions, Inc. | Implantable pulse generator systems and methods for providing functional and/or therapeutic stimulation of muscles and/or nerves and/or central nervous system tissue |
US9308382B2 (en) | 2004-06-10 | 2016-04-12 | Medtronic Urinary Solutions, Inc. | Implantable pulse generator systems and methods for providing functional and/or therapeutic stimulation of muscles and/or nerves and/or central nervous system tissue |
US9480846B2 (en) | 2006-05-17 | 2016-11-01 | Medtronic Urinary Solutions, Inc. | Systems and methods for patient control of stimulation systems |
WO2024046359A1 (en) * | 2022-08-31 | 2024-03-07 | 杭州诺沁医疗器械有限公司 | Guide assembly, ablation apparatus, and ablation system |
Families Citing this family (41)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US7004936B2 (en) * | 2000-08-09 | 2006-02-28 | Cryocor, Inc. | Refrigeration source for a cryoablation catheter |
US6471694B1 (en) | 2000-08-09 | 2002-10-29 | Cryogen, Inc. | Control system for cryosurgery |
US20070265563A1 (en) * | 2006-05-11 | 2007-11-15 | Heuser Richard R | Device for treating chronic total occlusion |
US6976990B2 (en) * | 2001-01-25 | 2005-12-20 | Percardia, Inc. | Intravascular ventriculocoronary bypass via a septal passageway |
US7674245B2 (en) * | 2001-06-07 | 2010-03-09 | Cardiac Pacemakers, Inc. | Method and apparatus for an adjustable shape guide catheter |
US20030036698A1 (en) * | 2001-08-16 | 2003-02-20 | Robert Kohler | Interventional diagnostic catheter and a method for using a catheter to access artificial cardiac shunts |
US6755812B2 (en) * | 2001-12-11 | 2004-06-29 | Cardiac Pacemakers, Inc. | Deflectable telescoping guide catheter |
US6666826B2 (en) * | 2002-01-04 | 2003-12-23 | Cardiac Pacemakers, Inc. | Method and apparatus for measuring left ventricular pressure |
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 |
US6869414B2 (en) | 2002-03-22 | 2005-03-22 | Cardiac Pacemakers, Inc. | Pre-shaped catheter with proximal articulation and pre-formed distal end |
US7771387B2 (en) * | 2002-05-17 | 2010-08-10 | Boston Scientific Scimed, Inc. | Liquid embolic composition delivery devices and methods |
US20030220661A1 (en) * | 2002-05-21 | 2003-11-27 | Heartstent Corporation | Transmyocardial implant delivery system |
US20040039371A1 (en) * | 2002-08-23 | 2004-02-26 | Bruce Tockman | Coronary vein navigator |
US7326219B2 (en) * | 2002-09-09 | 2008-02-05 | Wilk Patent Development | Device for placing transmyocardial implant |
US20050256452A1 (en) * | 2002-11-15 | 2005-11-17 | Demarchi Thomas | Steerable vascular sheath |
US7166088B2 (en) | 2003-01-27 | 2007-01-23 | Heuser Richard R | Catheter introducer system |
US7824391B2 (en) * | 2003-03-21 | 2010-11-02 | Cardiac Pacemakers, Inc. | Articulating guide catheter |
US7758586B2 (en) * | 2003-05-02 | 2010-07-20 | Atrium Medical Corporation | Method and apparatus for introducing catheters |
WO2004105830A2 (en) * | 2003-05-23 | 2004-12-09 | Belsley Scott J | Adjustable device delivery system |
DE10337580B4 (en) * | 2003-08-16 | 2009-07-02 | Dr. Osypka Gmbh | Catheter with elastically bendable or steerable end |
US7402141B2 (en) * | 2003-08-27 | 2008-07-22 | Heuser Richard R | Catheter guidewire system using concentric wires |
US8491636B2 (en) | 2004-03-23 | 2013-07-23 | Medtronic Cryopath LP | Method and apparatus for inflating and deflating balloon catheters |
US7727228B2 (en) | 2004-03-23 | 2010-06-01 | Medtronic Cryocath Lp | Method and apparatus for inflating and deflating balloon catheters |
US20090012429A1 (en) * | 2004-08-25 | 2009-01-08 | Heuser Richard R | Catheter guidewire system using concentric wires |
US8545418B2 (en) | 2004-08-25 | 2013-10-01 | Richard R. Heuser | Systems and methods for ablation of occlusions within blood vessels |
US8252016B2 (en) | 2005-01-13 | 2012-08-28 | Azam Anwar | System and method for providing embolic protection |
US20060200168A1 (en) * | 2005-03-03 | 2006-09-07 | Azam Anwar | System and method for providing access in divergent directions in a vascular environment |
US8206345B2 (en) | 2005-03-07 | 2012-06-26 | Medtronic Cryocath Lp | Fluid control system for a medical device |
US7780723B2 (en) * | 2005-06-13 | 2010-08-24 | Edwards Lifesciences Corporation | Heart valve delivery system |
US9265949B2 (en) * | 2005-06-28 | 2016-02-23 | Cardiac Pacemakers, Inc. | Method and apparatus for controlling cardiac therapy based on electromechanical timing |
US10842675B2 (en) * | 2006-01-20 | 2020-11-24 | Lensar, Inc. | System and method for treating the structure of the human lens with a laser |
US8062321B2 (en) | 2006-01-25 | 2011-11-22 | Pq Bypass, Inc. | Catheter system for connecting adjacent blood vessels |
US20070185567A1 (en) * | 2006-01-25 | 2007-08-09 | Heuser Richard R | Catheter system with stent device for connecting adjacent blood vessels |
US20080249515A1 (en) * | 2006-01-27 | 2008-10-09 | The Spectranetics Corporation | Interventional Devices and Methods For Laser Ablation |
GB0603010D0 (en) * | 2006-02-15 | 2006-03-29 | Owen Greenings & Mumford Ltd | Bougie |
US8858528B2 (en) * | 2008-04-23 | 2014-10-14 | Ncontact Surgical, Inc. | Articulating cannula access device |
US8267951B2 (en) | 2008-06-12 | 2012-09-18 | Ncontact Surgical, Inc. | Dissecting cannula and methods of use thereof |
US20120053419A1 (en) * | 2010-08-24 | 2012-03-01 | Eliot Bloom | Highly Articulable Catheter |
US20210220131A1 (en) * | 2019-02-27 | 2021-07-22 | Synecor Llc | Transseptal delivery system and methods for therapeutic devices of the aortic valve |
WO2023125569A1 (en) * | 2021-12-30 | 2023-07-06 | 杭州德柯医疗科技有限公司 | Catheter assembly, treatment system and method for transcatheter treatment system |
Citations (13)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4353358A (en) * | 1980-08-28 | 1982-10-12 | Emerson Reynolds L | Sigmoidoscope |
US5163431A (en) * | 1990-04-09 | 1992-11-17 | Cordis Corporation | Angiographic catheter |
US5168864A (en) * | 1991-09-26 | 1992-12-08 | Clarus Medical Systems, Inc. | Deflectable endoscope |
US5330466A (en) * | 1992-12-01 | 1994-07-19 | Cardiac Pathways Corporation | Control mechanism and system and method for steering distal extremity of a flexible elongate member |
US5334145A (en) * | 1992-09-16 | 1994-08-02 | Lundquist Ingemar H | Torquable catheter |
US5484407A (en) * | 1993-06-24 | 1996-01-16 | Osypka; Peter | Catheter with steerable distal end |
US5645520A (en) * | 1994-10-12 | 1997-07-08 | Computer Motion, Inc. | Shape memory alloy actuated rod for endoscopic instruments |
US5676635A (en) * | 1995-08-30 | 1997-10-14 | Levin; Bruce | Instrument for insertion of an endotracheal tube |
US6010449A (en) * | 1997-02-28 | 2000-01-04 | Lumend, Inc. | Intravascular catheter system for treating a vascular occlusion |
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 |
US6126633A (en) * | 1997-07-11 | 2000-10-03 | Olympus Optical Co., Ltd. | Surgical instrument |
US6165188A (en) * | 1996-12-02 | 2000-12-26 | Angiotrax, Inc. | Apparatus for percutaneously performing myocardial revascularization having controlled cutting depth and methods of use |
US6398776B1 (en) * | 1996-06-03 | 2002-06-04 | Terumo Kabushiki Kaisha | Tubular medical device |
Family Cites Families (56)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US5370675A (en) | 1992-08-12 | 1994-12-06 | Vidamed, Inc. | Medical probe device and method |
US4760131A (en) | 1986-04-23 | 1988-07-26 | Collagen Corporation | Wound-healing composition |
US4790311A (en) | 1986-06-03 | 1988-12-13 | Ruiz Oscar F | Radio frequency angioplasty catheter system |
US4896671A (en) | 1988-08-01 | 1990-01-30 | C. R. Bard, Inc. | Catheter with contoured ablation electrode |
US5047026A (en) | 1989-09-29 | 1991-09-10 | Everest Medical Corporation | Electrosurgical implement for tunneling through tissue |
US5364393A (en) | 1990-07-02 | 1994-11-15 | Heart Technology, Inc. | Tissue dissipative recanalization catheter |
US5700259A (en) | 1990-09-24 | 1997-12-23 | Plc Medical Systems, Inc. | Thoracoscopic transmyocardial revascularization handpiece assembly |
US5527292A (en) * | 1990-10-29 | 1996-06-18 | Scimed Life Systems, Inc. | Intravascular device for coronary heart treatment |
US5389096A (en) | 1990-12-18 | 1995-02-14 | Advanced Cardiovascular Systems | System and method for percutaneous myocardial revascularization |
US5093877A (en) | 1990-10-30 | 1992-03-03 | Advanced Cardiovascular Systems | Optical fiber lasing apparatus lens |
US5380316A (en) | 1990-12-18 | 1995-01-10 | Advanced Cardiovascular Systems, Inc. | Method for intra-operative myocardial device revascularization |
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 |
DE69225812T2 (en) | 1992-01-13 | 1998-10-01 | Schneider Usa Inc | CUTTING DEVICE FOR ATHEREECTOMY CATHETER |
US5607405A (en) | 1992-05-19 | 1997-03-04 | Decker; Rand A. | Surgical insertion device and method |
US5620414A (en) | 1992-06-30 | 1997-04-15 | Campbell, Jr.; Robert M. | Apparatus and method for effecting surgical incision through use of a fluid jet |
US5287861A (en) | 1992-10-30 | 1994-02-22 | Wilk Peter J | Coronary artery by-pass method and associated catheter |
US5261889A (en) | 1992-11-24 | 1993-11-16 | Boston Scientific Corporation | Injection therapy catheter |
US5336222A (en) | 1993-03-29 | 1994-08-09 | Boston Scientific Corporation | Integrated catheter for diverse in situ tissue therapy |
US5403311A (en) | 1993-03-29 | 1995-04-04 | Boston Scientific Corporation | Electro-coagulation and ablation and other electrotherapeutic treatments of body tissue |
US5431649A (en) | 1993-08-27 | 1995-07-11 | Medtronic, Inc. | Method and apparatus for R-F ablation |
US5651785A (en) | 1993-09-20 | 1997-07-29 | Abela Laser Systems, Inc. | Optical fiber catheter and method |
WO1995008355A1 (en) | 1993-09-24 | 1995-03-30 | Baxter International Inc. | Methods for enhancing vascularization of implant devices |
US5681308A (en) | 1994-06-24 | 1997-10-28 | Stuart D. Edwards | Ablation apparatus for cardiac chambers |
US5593405A (en) | 1994-07-16 | 1997-01-14 | Osypka; Peter | Fiber optic endoscope |
US5695457A (en) * | 1994-07-28 | 1997-12-09 | Heartport, Inc. | Cardioplegia catheter system |
US5591159A (en) | 1994-11-09 | 1997-01-07 | Taheri; Syde A. | Transcavitary myocardial perfusion apparatus |
US5551427A (en) | 1995-02-13 | 1996-09-03 | Altman; Peter A. | Implantable device for the effective elimination of cardiac arrhythmogenic sites |
WO1996035469A1 (en) | 1995-05-10 | 1996-11-14 | Cardiogenesis Corporation | System for treating or diagnosing heart tissue |
US5672174A (en) | 1995-08-15 | 1997-09-30 | Rita Medical Systems, Inc. | Multiple antenna ablation apparatus and method |
DE19537084A1 (en) | 1995-10-05 | 1997-04-10 | Sievers Hans Hinrich Prof Dr M | Catheter for transmyocardial revasculation with guidable multi=ID main catheter |
US5769843A (en) | 1996-02-20 | 1998-06-23 | Cormedica | Percutaneous endomyocardial revascularization |
US5713894A (en) | 1996-02-27 | 1998-02-03 | Murphy-Chutorian; Douglas | Combined mechanical/optical system for transmyocardial revascularization |
US5810836A (en) | 1996-03-04 | 1998-09-22 | Myocardial Stents, Inc. | Device and method for trans myocardial revascularization (TMR) |
US5725521A (en) | 1996-03-29 | 1998-03-10 | Eclipse Surgical Technologies, Inc. | Depth stop apparatus and method for laser-assisted transmyocardial revascularization and other surgical applications |
US5725523A (en) | 1996-03-29 | 1998-03-10 | Mueller; Richard L. | Lateral-and posterior-aspect method and apparatus for laser-assisted transmyocardial revascularization and other surgical applications |
IL118352A0 (en) | 1996-05-21 | 1996-09-12 | Sudai Amnon | Apparatus and methods for revascularization |
DE29609350U1 (en) | 1996-05-24 | 1996-08-29 | P Osypka Mbh Ges Fuer Medizint | Device for perforating the heart wall |
AU3911097A (en) | 1996-08-08 | 1998-02-25 | Localmed, Inc. | Transmural drug delivery method and apparatus |
US5871495A (en) | 1996-09-13 | 1999-02-16 | Eclipse Surgical Technologies, Inc. | Method and apparatus for mechanical transmyocardial revascularization of the heart |
CA2268977A1 (en) | 1996-10-17 | 1998-04-23 | Ethicon Endo-Surgery, Inc. | Methods and devices for improving blood flow to the heart of a patient |
US6030377A (en) | 1996-10-21 | 2000-02-29 | Plc Medical Systems, Inc. | Percutaneous transmyocardial revascularization marking system |
US6053924A (en) | 1996-11-07 | 2000-04-25 | Hussein; Hany | Device and method for trans myocardial revascularization |
US6042581A (en) | 1996-11-08 | 2000-03-28 | Thomas J. Fogarty | Transvascular TMR device and method |
US6056742A (en) | 1997-02-03 | 2000-05-02 | Eclipse Surgical Technologies, Inc. | Revascularization with laser outputs |
US6045565A (en) | 1997-11-04 | 2000-04-04 | Scimed Life Systems, Inc. | Percutaneous myocardial revascularization growth factor mediums and method |
US5876373A (en) * | 1997-04-04 | 1999-03-02 | Eclipse Surgical Technologies, Inc. | Steerable catheter |
US6015427A (en) * | 1997-07-07 | 2000-01-18 | Eclipse Surgical Technologies, Inc. | Heart stabilizer with controllable stay suture and cutting element |
US6027473A (en) * | 1997-09-05 | 2000-02-22 | Cordis Webster, Inc. | Handle for steerable DMR catheter |
US6179809B1 (en) * | 1997-09-24 | 2001-01-30 | Eclipse Surgical Technologies, Inc. | Drug delivery catheter with tip alignment |
US6056743A (en) | 1997-11-04 | 2000-05-02 | Scimed Life Systems, Inc. | Percutaneous myocardial revascularization device and method |
US6183463B1 (en) * | 1997-12-01 | 2001-02-06 | Cordis Webster, Inc. | Bidirectional steerable cathether with bidirectional control handle |
US6066126A (en) | 1997-12-18 | 2000-05-23 | Medtronic, Inc. | Precurved, dual curve cardiac introducer sheath |
WO2000015146A1 (en) | 1998-09-10 | 2000-03-23 | Percardia, Inc. | Transmyocardial shunt for left ventricular revascularization |
US6312402B1 (en) | 1998-09-24 | 2001-11-06 | Ekos Corporation | Ultrasound catheter for improving blood flow to the heart |
US6126649A (en) * | 1999-06-10 | 2000-10-03 | Transvascular, Inc. | Steerable catheter with external guidewire as catheter tip deflector |
-
2000
- 2000-10-24 US US09/695,525 patent/US6530914B1/en not_active Expired - Lifetime
-
2001
- 2001-10-17 AU AU2002213299A patent/AU2002213299A1/en not_active Abandoned
- 2001-10-17 WO PCT/US2001/032341 patent/WO2002034323A2/en active Application Filing
-
2003
- 2003-01-21 US US10/349,535 patent/US20030120259A1/en not_active Abandoned
Patent Citations (13)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4353358A (en) * | 1980-08-28 | 1982-10-12 | Emerson Reynolds L | Sigmoidoscope |
US5163431A (en) * | 1990-04-09 | 1992-11-17 | Cordis Corporation | Angiographic catheter |
US5168864A (en) * | 1991-09-26 | 1992-12-08 | Clarus Medical Systems, Inc. | Deflectable endoscope |
US5334145A (en) * | 1992-09-16 | 1994-08-02 | Lundquist Ingemar H | Torquable catheter |
US5330466A (en) * | 1992-12-01 | 1994-07-19 | Cardiac Pathways Corporation | Control mechanism and system and method for steering distal extremity of a flexible elongate member |
US5484407A (en) * | 1993-06-24 | 1996-01-16 | Osypka; Peter | Catheter with steerable distal end |
US5645520A (en) * | 1994-10-12 | 1997-07-08 | Computer Motion, Inc. | Shape memory alloy actuated rod for endoscopic instruments |
US5676635A (en) * | 1995-08-30 | 1997-10-14 | Levin; Bruce | Instrument for insertion of an endotracheal tube |
US6398776B1 (en) * | 1996-06-03 | 2002-06-04 | Terumo Kabushiki Kaisha | Tubular medical device |
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 |
US6165188A (en) * | 1996-12-02 | 2000-12-26 | Angiotrax, Inc. | Apparatus for percutaneously performing myocardial revascularization having controlled cutting depth and methods of use |
US6010449A (en) * | 1997-02-28 | 2000-01-04 | Lumend, Inc. | Intravascular catheter system for treating a vascular occlusion |
US6126633A (en) * | 1997-07-11 | 2000-10-03 | Olympus Optical Co., Ltd. | Surgical instrument |
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WO2002034323A2 (en) | 2002-05-02 |
US6530914B1 (en) | 2003-03-11 |
AU2002213299A1 (en) | 2002-05-06 |
WO2002034323A3 (en) | 2003-04-10 |
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