WO1989007422A1 - Expandable pullback atherectomy catheter system - Google Patents

Expandable pullback atherectomy catheter system Download PDF

Info

Publication number
WO1989007422A1
WO1989007422A1 PCT/US1989/000426 US8900426W WO8907422A1 WO 1989007422 A1 WO1989007422 A1 WO 1989007422A1 US 8900426 W US8900426 W US 8900426W WO 8907422 A1 WO8907422 A1 WO 8907422A1
Authority
WO
WIPO (PCT)
Prior art keywords
catheter
tissue
vessel
distal portion
diameter
Prior art date
Application number
PCT/US1989/000426
Other languages
French (fr)
Inventor
Robert E. Fischell
Tim A. Fischell
Original Assignee
Fischell Robert
Fischell Tim A
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 Fischell Robert, Fischell Tim A filed Critical Fischell Robert
Priority to AU31970/89A priority Critical patent/AU618331B2/en
Publication of WO1989007422A1 publication Critical patent/WO1989007422A1/en

Links

Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32Surgical cutting instruments
    • A61B17/3205Excision instruments
    • A61B17/3207Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions
    • A61B17/32075Pullback cutting; combined forward and pullback cutting, e.g. with cutters at both sides of the plaque
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32Surgical cutting instruments
    • A61B17/3205Excision instruments
    • A61B17/3207Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions
    • A61B17/320725Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions with radially expandable cutting or abrading elements
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B17/22004Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for using mechanical vibrations, e.g. ultrasonic shock waves
    • A61B17/22012Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for using mechanical vibrations, e.g. ultrasonic shock waves in direct contact with, or very close to, the obstruction or concrement
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/20Surgical 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
    • A61B18/22Surgical 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
    • A61B18/24Surgical 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
    • A61B18/245Surgical 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 for removing obstructions in blood vessels or calculi

Definitions

  • This invention is in the field of intraoperative and percutaneous transluminal arterial catheters designed for surgical excision of atheromas which typically consist of plaque deposits that cause narrowing (stenosis) of an artery.
  • the cutting out of atheromas has been given the name "ather ⁇ ectomy”.
  • Atherosclerotic arterial disease is the leading cause of morbidity and mortality in the United States and most other developed countries.
  • Atherosclerosis is a chronic disease process characterized by lipid deposits and fibrosis of the intima, irregularly distributed in large and medium sized arteries. The disease is progressive and most often becomes clinically manifested in the middle-aged and elderly.
  • the atherosclerotic plaque causes a reduction of the cross-sectional area of the arterial lumen, with and without thrombosis.
  • Resultant ischemic manifestations include angina pectoris, myocardial infarction, stroke, intermittent claudication, gangrene of the lower extremities and renovascular hypertension.
  • the current management of atherosclerotic disease includes preventative therapy aimed at minimizing known major risk factors such as hypertension, smoking, hyper- cholesterolemia and diabetes mellitus.
  • Coronary artery bypass grafting (CABG), carotid endar- terectomy and bypass grafting (autogenous vein or synthetic graft) of the iliac, femoral and renal arteries are all well established surgical methods of palliative therapy. Although these procedures are often effective in relieving ischemia, each of these represents a major surgical operation with significant associated morbidity, mortality and expense.
  • CABG for example, requires the opening of the chest cavity (thoracotomy) and use of cardiopulmonary bypass, with not uncommon postoperative complications including postperi- cardoto y syndrome, Non-A Non-B hepatitis, stroke and a mortality of approximately one percent (1%).
  • Percutaneous transluminal angioplasty by means of a balloon catheter is a relatively new "nonsurgical" procedure with proven efficacy in relief of atherosclerotic obstruction of the coronary, renal and peripheral circulations.
  • the technique involves the percutaneous passage (under local anesthesia) of a specialized balloon tipped catheter through the site of arterial narrowing, and inflation of the balloon to reduce obstruction. This is always done in conjunction with angiographic visualization of the vessel being treated. When successful, this procedure results in a reduction of the arterial stenosis and a decrease in the transstenotic pressure gradient.
  • the mechanism of action is felt to consist of some combination of plaque compression, intimal splitting and medial/adventitial stretching. Healing of the balloon- damaged plaque may involve fibrosis and retraction of the split intimal elements, with further luminal enlargement in the weeks to months following the procedure.
  • PTA The safety and efficacy of PTA is a function of the vessel being treated, patient selection, and the expertise of the physician performing the procedure.
  • Primary angio ⁇ graphic success defined as a 20% or greater reduction of stenosis, is now achieved in approximately 80-90% of attempts in carefully selected patients at experienced centers.
  • the obvious advantage of PTA, compared to surgical palliative therapy, is that it does not require major surgery or general anesthesia with the associated sequelae.
  • PTA Despite its proven efficacy in the palliation of ob ⁇ structive atherosclerotic disease, PTA, as it is currently performed, has several important technical limitations. These limitations are particularly true in the application of PTA to the coronary circulation.
  • balloon PTA Distal e bolization of atherosclerotic plaque following balloon PTA occurs in approximately 5% of patients undergoing PTA of lower extremity or renal arteries. Although emboli are usually clinically insignificant in these vascular terri ⁇ tories, such embolization could be catastrophic in the cerebral circulation. For this reason, balloon PTA is considered to be contraindicated for the treatment of obstructive lesions in the arteries of the aortic arch, such as the carotid artery.
  • D.S.J. Choy describes a means for using a laser beam to tunnel through an arterial occlusion by vaporization of the obstruction.
  • the difficulty with Choy's technique is that there is insuffi ⁇ cient means to prevent simultaneous destruction of the arterial wall.
  • the Choy invention shows an intense laser beam aimed in the forward direction without significant beam attenuation. If the artery were to curve and the arterial wall were to be exposed to the laser beam, the wall could also be vaporized which could be catastrophic for the patient.
  • the Choy patent describes a means for direct visual ⁇ ization of the obstructed region, it does not describe a centering means or a guidewire following means in order to guarantee that the laser beam does not illuminate part of the arterial wall. Furthermore, the Choy device may completely block a partially obstructed artery thereby cutting off blood flow to distal tissues for a significant time period. The result is ischemia which could cause irreparable damage to heart or brain tissue. Furthermore, if laser oblation was used in the carotid arteries, resulting gas bubble formation could cause some cerebral ischemia and resulting permanent brain damage.
  • Figs. 1, 2 and 3 of the Hoffman patent show an expansible* cutter knife which can be inserted closed, opened within the teat, rotated to allow cutting of teat obstructions and then closed to withdraw the device from the canal.
  • the Hoffman device has no means for preventing the blades from cutting the vessel wall, and hence if used within a human artery, such a rotating or oscillating blade would cut through the arterial wall.
  • the '140 application describes a device for removing stenotic plaque by advancing a tunneling catheter over a guidewire and within a guiding catheter. In this prior invention, the cutting is done by advancing the cutting catheter in a forward (antegrade) direction.
  • the '746 application describes the use of a centering catheter which has expandable spokes to engage the inner arterial wall for centering the catheter. Plaque is removed by ad ⁇ vancing a similar tunnelling catheter described in the '140 application.
  • a potential difficulty in such a procedure is the inability to exert enough forward force to cut through a hard calcified plaque. Furthermore, if the tunneling catheter is advanced too far in the forward direction, it could cut the arterial wall. Even with the use of cutting (as opposed to fracturing the plaque which occurs with balloon dilation) there would still be the possibility of some parti ⁇ culate matter flowing into the bloodstream which could result in some distal ischemia.
  • Serial No. 885,139 filed on July 14, 1986 by Robert E. and Tim A. Fischell and entitled "A Pullback Atherectomy Catheter System” describes the concept of first penetrating the stenotic plaque in a forward direc ⁇ tion with a hollow conically pointed metal tip and then pulling the tip back in a retrograde direction.
  • the tip which includes a cylindrical cutting edge, is designed to shave off a cylindrical layer of the plaque as it is pulled back in the retrograde direction.
  • the PAC utilizes sequentially larger diameter tips which progressively enlarge the lumen of the stenotic plaque.
  • PAC devices would typically be guided to the stenosis by a guidewire that is first passed through the narrowed lumen.
  • Each one of the sequentially larger PAC tips is first advanced within a guiding catheter and over a guidewire until the tip passes through the stenotic plaque.
  • the PAC tip is then pulled back to shave off plaque; then the PAC is withdrawn from the body.
  • Each tip includes a chamber designed to collect the shaved off plaque thus preventing plaque particles from entering the bloodstream.
  • the plaque collection chamber in the tip is both rigid and reasonably long which makes it difficult to use in highly curved arteries
  • the tip diameter is limited to that diameter (approximately 3mm) which could be readily inserted through a percutaneous guiding catheter passing through the femoral artery at the location of the patient's groin
  • the cylindrical hole made in the plaque by the PAC tip moving in a forward (antegrade) direction precludes the removal of plaque when the tip is moved in the retrograde direction because the tip keeps the same diameter when moving in each of these two directions.
  • the Expandable Pullback Atherectomy Catheter (EPAC) described herein operates by first passing the EPAC through a guiding catheter that has been intraoperatively or percu ⁇ taneously inserted within an artery and then penetrating the stenotic opening in a forward direction with the tip diameter small enough to pass through the stenosis.
  • the EPAC tip When inserted into the artery, the EPAC tip is compressed by means of a sheathing catheter that completely encloses its tip. Once past the arterial stenosis, the sheathing catheter, which fits inside the guiding catheter, is pulled back thus allowing the EPAC tip diameter to radially expand to its full size.
  • the expanded EPAC tip is then pulled back through the stenotic plaque with a retrograde motion while spinning which cuts through the plaque and causes the plaque particles to be collected in a flexible plaque collection chamber.
  • the EPAC with the captured plaque is then pulled back through the guiding catheter and completely out of the body. The process is then repeated with sequentially larger expanded diameters of the EPAC tips until the lumen of the artery is sufficiently enlarged to allow adequate blood flow.
  • the cutting action of the EPAC tip is enhanced by rotation, or by applying high energy ultrasonic vibration to the cutting edges or possibly by the application of an electrocautery current applied at the cutting edges. These means for cutting enhancement would be applied only during pullback.
  • an object of the present invention is to safely remove stenotic plaque material by first advancing a small diameter EPAC tip through the stenotic lumen, then allowing that tip to expand its diametric size, and then shaving off stenotic plaque by pulling the rotating cutting edges of the tip back through the stenosis in a retrograde direction.
  • Another object of the present invention is to collect the shaved off plaque into a flexible collection chamber within the tip and then remove the entire EPAC including the collected plaque from the body.
  • Still another object of the present invention is to reduce the thrombogenicity of the plaque collection chamber by heparinizing the walls thereof.
  • a further object of the present invention is to provide a plaque collection chamber which is sufficiently porous to allow blood to flow therethrough while still collecting all shaved plaque which could result in distal embolization.
  • Still another object of the present invention is to reduce the diameter of the EPAC tip after cutting through the stenosis so that the EPAC can be removed through a com ⁇ paratively small diameter guiding catheter.
  • Still another object of the present invention is to utilize ultrasonic vibration of the cutting edges to facilitate the ability of the device to cut through the plaque.
  • Still another object of the present invention is to utilize an electrocautery electric current at the cutting edges of the EPAC tip to enhance the ability of the device to cut through the plaque.
  • Still another object of the present invention is to use sequentially larger diameter tips each sequentially pulled back through the stenotic plaque to progressively enlarge the lumen of the stenosis.
  • Still another object of the present invention is to first use a heated tip catheter or a laser beam to open a fully occluded artery and then to use the EPAC to further enlarge the arterial lumen by excising the remaining plaque.
  • Still another object of the present invention is to use the EPAC system to remove plaque deposited at a branch point of an artery, i.e., to open an ostial stenosis.
  • Still another object of the present invention is to use the EPAC to remove thrombotic tissue from an artery or to simultaneously remove thrombotic tissue and plaque.
  • Still another object of the present invention is to remove any obstructive tissue from artificial vessel grafts or from bypass veins.
  • Still another object of the present invention is to apply a coating to the EPAC that improves lubricity.
  • Still another object of the present invention is to apply the EPAC system for opening of any stenotic or occluded artery including the coronary arteries, the carotid artery, the renal, iliac or hepatic arteries and the arteries of the arms and legs or bypass veins or vessel grafts.
  • Fig. 1 illustrates the Expandable Pullback Atherec ⁇ tomy Catheter (EPAC) attached to a spinning means with the tip in its expanded state.
  • EPAC Expandable Pullback Atherec ⁇ tomy Catheter
  • Fig. 2 is an enlarged, cross-sectional view through line 2-2 of Fig. 1 of the cutting blades of the Expandable Pullback Atherectomy Catheter.
  • Fig. 3 is a cross-sectional view of an artery showing the Expandable Pullback Atherectomy Catheter system with its tip located just distally from a stenotic plaque or atheroma and with the tip in its expanded state.
  • Fig. 4 is a cross-sectional view of the Expandable Pullback Atherectomy Catheter and sheathing catheter with the EPAC tip in its compressed state.
  • Fig. 5 is an enlarged cross-sectional view through line 5-5 in Fig. 4 of the EPAC tip in its compressed state showing the guidewire and sheathing catheter and also showing the plaque collection chamber in its compressed state.
  • Fig. 6 shows the arrangement of the proximal portion of the Expandable Pullback Atherectomy Catheter system as it is configured external to the patient's body.
  • Fig. 1 illustrates the Expandable Pullback Atherec ⁇ tomy Catheter (EPAC) 10.
  • Fig. 2 is an enlarged cross-sectional view of the EPAC 10 at 2-2 of Fig. 1.
  • the other parts of the EPAC system are the guidewire 30, the sheathing catheter 40, and the guiding catheter 50.
  • the principal parts of the EPAC 10 are a distal tip 12, a radially expandable conical cutter 20, a torqueing catheter 14, and a rotating means 28.
  • the distal tip 12 consists of a small diameter distal portion 18 and a radially expandable plaque collection chamber 17 (Fig. 3) defined by the wall 16.
  • the conical cutter 20 consists of a multiplicity of cutter blades 22 that are attached at their distal ends to distal ring 24 and at their proximal ends to the proximal ring 26.
  • the distal ring 24 is radially expandable and is molded into the plaque collection chamber wall 16. Distal ring 24 takes the same cross-sectional shape as the collection chamber 16 when expanded or compressed.
  • the proximal ring 26 (which is not expandable) is molded into the torqueing catheter 14. Attachment holes 25 in the proximal ring 26 assist in main ⁇ taining a strong connection with the wall 16 into which the ring is molded.
  • the proximal ring 26 has attachment holes 27 which enhance the strength of the connection when the ring 26 is molded into the torqueing catheter 14.
  • the shoulder 15 which lies over the distal ring 24 prevents the distal ring 24 and hence the conical cutter 20 from coming in contact with the arterial wall.
  • distal ring 24 and its shoulder 15 act as centering devices to protect the inner arterial walls from being cut by blades 22. Ring 24 also compensates for unequal plaque build-up along the arterial walls by deforming appropriately as the device passes through the stenosis.
  • the torqueing catheter 14 is attached at its proximal end to a spinning means 28 which is typically a drill designed for use in an operating room; such a device could be the System II Drill, Catalogue No. 298-92 of Stryker Surgical Co., Kalamazoo, Michigan.
  • the conical cutter 20 which includes the distal ring 24 and the proximal ring 26 is typically made from a hard spring steel, or from another spring material such as berylium copper.
  • the metal thickness is typically between 2 and 10 mils.
  • the plaque collection chamber wall 16 is typically between 5 and 20 mils thick, and of a flexible plastic such as Mylar, Teflon or Nylon. Ideally the wall 16 would be made porous with pore size between 20 and 50 microns so that blood plasma, red and white cells and platelets could pass through, thus allowing perfusion of distal tissue to minimize risk of damaging heart tissue or brain cells caused by lack of blood. Plaque of this small size could also pass through with no harm to the patient.
  • the distal ring 24 and the plaque collection chamber is typically made in various sizes with diameters (when expanded) from as small as 2 mm to as large as 10 mm with total chamber length from 0.5 to 10 cm.
  • the proximal ring 26 and torqueing catheter 14 is typically made in various sizes with diameters ranging from 1 mm to 4 mm.
  • the torqueing catheter 14 would typically be made from a stiff, strong plastic such as PVC with a wall thickness between 10 and 20 mils.
  • cutter blades 22 are shown as being essentially straight from their smaller diameter at the proximal ring 26 to their larger diameter at the distal ring 24, they could have a variety of shapes, positions, angles and number of blades in order to enhance their cutting action.
  • FIG. 3 is a cross-sectional view of the entire EPAC system which includes the EPAC 10, the guidewire 30, the sheathing catheter 40 and the guiding catheter 50 all shown within an artery having an atheromatous plaque P within the arterial wall AW.
  • the sheathing catheter 40 is shown pulled back so that the distal tip 12 and the conical cutter 20 have expanded radially to their full diameter.
  • the EPAC tip 12 is pulled back while spinning until a cylindrical tunnel has been bored through the plaque. The plaque is collected in the plaque collection chamber 17 and then the rotation is stopped.
  • the EPAC 10 and the sheathing catheter 40 are then pulled back through the guiding catheter 50 until they are totally removed from the patient's body.
  • a packing gland 19 typically of sponge rubber is placed to completely prevent plaque from escaping from the plaque collection chamber 17 while the guidewire 30 remains in place and the EPAC 10 is withdrawn from the patient's artery.
  • a clearance of 20 to 50 microns between the outside diameter of the guidewire 30 and the packing gland 19, would allow acceptably small particulate matter to escape from the plaque collection chamber 17 as well as allowing the flow of some blood which is desirable.
  • the guidewire 30 could be allowed to spin or could remain fixed.
  • the sheathing catheter 40 might be allowed to spin or it might remain non-rotating.
  • the guiding catheter 50 preferably would remain fixed (i.e., non-rotating relative to the arterial wall AW) .
  • the collection chamber 17 is shown in FIG. 3 to be essentially cylindrical in shape, it might also be conical in shape with its large mouth opening proximally. Chamber 17 also could have a much longer, smaller diameter distal portion 18, with only a very short proximal section of a diameter large enough to cover the distal ring 24. Designs have a smaller diameter of the plaque collection chamber 17 as compared to the distal ring 24, would decrease the contact of the wall 16 with the delicate intimal lining of the arterial wall AW. This could minimize damage to the intima during insertion, spinning and removal of the EPAC 10.
  • the spinning mode has been discussed exten ⁇ sively herein, the use of ultrasonic vibration or electro- cautery cutting during pullback with or without rotation would be another practical means for accomplishing atherectomy.
  • the torqueing catheter 14 were fabricated from a thin wall metal tube, such a tube could be used to transmit ultrasonic vibration to the cutting edges 23 and 29 during pullback thus accomplishing the desired atherectomy.
  • an ultrasonic vibration generator would replace the spinning means 28.
  • Yet another technique would be to use a metal tube torqueing catheter 14 that is insulated on all its surfaces except at its proximal end, which is external to the body.
  • the conical cutter 20 would be electrically connected to the torqueing catheter 14 and would also have electrical insulation throughout all its surfaces except at the cutting edges 23 and 29.
  • One terminal of a conventional electrocautery current generator would be connected to the conducting proximal end of the torqueing catheter 14, with the ground connection of the generator being connected to the patient's skin. As the assembly 10 is pulled back, the electrocautery current emanating from the sharp edges
  • Cutting with this technique is analogous to cutting with an electrocautery scalpel as regularly used in surgical procedures.
  • Such an electrocautery atherectomy would have the additional advantage of cauterizing the cut interior surface of the arterial wall thus reducing its tendency to form thrombi.
  • Fig. 4 shows the sheathing catheter 40 extended over and therefore compressing the distal tip 12 of the EPAC 10.
  • the proximal ring 26 retains its precompression size
  • the distal ring 24 follows the plaque collection chamber wall 16 when deformed as shown so as to fit within the sheath ⁇ ing catheter 40.
  • the distal tip 18 and the packing gland 19 of the plaque collection chamber 17 are not compressed by the sheathing catheter 40.
  • the sheathing catheter 40 When the EPAC 10 is pushed through the stenotic lumen, the sheathing catheter 40 might be pushed through first, or alternatively the EPAC 10 could be inserted until the sheathing catheter 40 just stops proximally against the stenosis; then the tip 12 would be pushed through. This latter method minimizes the diameter of that which must be pushed through the stenotic lumen.
  • the smaller diameter distal tip 18 of the plaque collection chamber 17 is designed for and serves to assist in passing the distal tip 12 through a tight stenosis with the sheathing catheter 40 stopping just proximal to that stenosis.
  • the sheathing catheter 40 can be pushed over the distal tip 12 to compress the tip 12.
  • the guiding catheter 50 can be used to compress the tip 12.
  • Using the guiding catheter 50 for this purpose during pullback would allow the greatest volume of the com ⁇ pressed plaque to be held within the collection chamber 17; this would be necessary if a large volume of plaque was collected. If such a large volume of plaque was collected that even the guiding catheter 50 was incapable of containing the plaque filled chamber 17, then the proximal end of the distal ring 24 would be pulled back until it touched the mouth of the guiding catheter 50, and then the entire EPAC system including the guiding catheter 50 would be removed from the patient's body.
  • the walls 16 of the plaque collection chamber 17 in both Figs. 3 and 4 have an exaggerated thickness in order to better show the details of connection to the distal ring 24.
  • the walls 16 are 10 mils thick and would be made from a tough yet flexible (and possibly porous) plastic such as Mylar, Teflon or Nylon.
  • the collection chamber 17 could be many centimeters long and still easily bend around highly curved arteries such as some of the coronary arteries.
  • an appropriately thin wall 16 takes up less volume when the tip 12 is in its compressed state.
  • the collection chamber 17 could be coated with heparin in order to reduce thrombus formation.
  • Fig. 6 illustrates the proximal configuration of the EPAC system external to the patient's body.
  • the guiding catheter 50 is shown penetrating the patient's skin S and entering within the arterial wall AW.
  • a side port 52 on the guiding catheter 50 can be used to inject flushing (saline) solution or angiographic dye, or to apply a suction at the distal end of the guiding catheter 50.
  • Emerging from a packing gland 54 at the proximal end of the guiding catheter 50 is the sheathing catheter 40, and emerging from a packing gland 44 at the proximal end of the sheathing catheter 40 is the torqueing catheter 14 which is attached to a rotating means 28.
  • the guidewire 30 passes through a packing gland at the proximal end of the torqueing catheter 14 and it then passes through a cannula within the spinning means 28.
  • the guidewire 30 would be made long enough so that the entire EPAC system (except for the guiding catheter 50) could be removed from the body while the guidewire 30 remains in place through the stenotic lumen.
  • a conventional electrocautery current generator 60 would have one terminal 61 attached to the non-insulated proximal end of a metal torqueing catheter and its ground terminal 62 attached to a grounding plate 63 in contact with the patient's skin "S".
  • the EPAC 10 can be advantageously used for safely removing many types of ob ⁇ structions from any vessel within a human or animal.
  • blood flow obstructions occurring in arterial blood vessel grafts or bypass veins are particularly well suited for removal by the EPAC.
  • thrombi and plaque could be separately or simultaneously removed from blood vessels thus enlarging such lumens to provide adequate blood flow.
  • the EPAC could be used for opening of other lumen ducts such as urethra, ureter, bile ducts or fallopian tubes.
  • the EPAC provides means for removing obstructive tissue from a vessel in a living body in lieu of balloon angioplasty which merely redistributes such material.
  • the utility of the EPAC to open arteries can also be enhanced by the adjunctive use of conventional balloon angioplasty. For example, a narrow stenosis might first be enlarged from less than 1 mm to 2 mm or greater, and then the EPAC could be used to remove the deformed plaque. Furthermore, the use of a heated tip catheter or a laser beam to first open a small lumen in a fully occluded artery, followed by the use of the EPAC for plaque removal offers a unique and valuable therapy for obtaining long term patency of even fully occluded arteries.
  • the EPAC system can be used with a separate means for plaque removal, such as plaque removal by cutting, grinding or by the user of lasers, performed proximal to the EPAC distal plaque collection chamber 17.
  • the chamber 17 would then be used for the sole purpose of collecting distal emboli released by such a proximally located device, and then would be removed with the EPAC 10 from the body.

Abstract

Disclosed is an expandable pullback atherectomy catheter (EPAC) (10) comprising a distal tip portion (12) capable of assuming two diameters. The distal tip portion (12) includes an expandable cutting means (20) and an expandable tissue collecting means (17). The catheter (10) is guided in an artery (AW) to the stenoisis (P) and the distal tip (12) is urged past the stenosis while being maintained in a compressed state by a sheathing catheter (40). The sheathing catheter is withdrawn allowing the cutting means (20) and collecting means (17) to expand. The stenotic tissue is removed by pulling the distal tip back in a retrograde direction while the cut tissue is captured in the collecting means (17). Additional structural details are provided to prevent injury to the inner wall of an artery and to avoid total obstruction of the artery during the atherectomy procedure.

Description

-l- EXPANDABLE PULLBACK ATHERECTOMY CATHETER SYSTEM
FIELD OF THE INVENTION
This invention is in the field of intraoperative and percutaneous transluminal arterial catheters designed for surgical excision of atheromas which typically consist of plaque deposits that cause narrowing (stenosis) of an artery. The cutting out of atheromas has been given the name "ather¬ ectomy".
BACKGROUND OF THE INVENTION
Atherosclerotic arterial disease is the leading cause of morbidity and mortality in the United States and most other developed countries. Atherosclerosis is a chronic disease process characterized by lipid deposits and fibrosis of the intima, irregularly distributed in large and medium sized arteries. The disease is progressive and most often becomes clinically manifested in the middle-aged and elderly. When severe, the atherosclerotic plaque causes a reduction of the cross-sectional area of the arterial lumen, with and without thrombosis. Resultant ischemic manifestations include angina pectoris, myocardial infarction, stroke, intermittent claudication, gangrene of the lower extremities and renovascular hypertension.
The current management of atherosclerotic disease includes preventative therapy aimed at minimizing known major risk factors such as hypertension, smoking, hyper- cholesterolemia and diabetes mellitus.
Coronary artery bypass grafting (CABG), carotid endar- terectomy and bypass grafting (autogenous vein or synthetic graft) of the iliac, femoral and renal arteries are all well established surgical methods of palliative therapy. Although these procedures are often effective in relieving ischemia, each of these represents a major surgical operation with significant associated morbidity, mortality and expense. CABG, for example, requires the opening of the chest cavity (thoracotomy) and use of cardiopulmonary bypass, with not uncommon postoperative complications including postperi- cardoto y syndrome, Non-A Non-B hepatitis, stroke and a mortality of approximately one percent (1%).
Percutaneous transluminal angioplasty (PTA) by means of a balloon catheter is a relatively new "nonsurgical" procedure with proven efficacy in relief of atherosclerotic obstruction of the coronary, renal and peripheral circulations. The technique involves the percutaneous passage (under local anesthesia) of a specialized balloon tipped catheter through the site of arterial narrowing, and inflation of the balloon to reduce obstruction. This is always done in conjunction with angiographic visualization of the vessel being treated. When successful, this procedure results in a reduction of the arterial stenosis and a decrease in the transstenotic pressure gradient. The mechanism of action is felt to consist of some combination of plaque compression, intimal splitting and medial/adventitial stretching. Healing of the balloon- damaged plaque may involve fibrosis and retraction of the split intimal elements, with further luminal enlargement in the weeks to months following the procedure.
The safety and efficacy of PTA is a function of the vessel being treated, patient selection, and the expertise of the physician performing the procedure. Primary angio¬ graphic success, defined as a 20% or greater reduction of stenosis, is now achieved in approximately 80-90% of attempts in carefully selected patients at experienced centers. The obvious advantage of PTA, compared to surgical palliative therapy, is that it does not require major surgery or general anesthesia with the associated sequelae. Despite its proven efficacy in the palliation of ob¬ structive atherosclerotic disease, PTA, as it is currently performed, has several important technical limitations. These limitations are particularly true in the application of PTA to the coronary circulation.
Even in the most skilled hands, dilation of an arterial obstruction is currently not achievable in approximately 20% of attempts. The most common cause of failed PTA is the inability to pass either the guidewire or dilating catheter through the site of a tight or eccentric stenosis. This problem is even more common in attempts to dilate the difficult to access right and circumflex coronary arteries. Although technical advances, such as steerable catheters, have reduced the frequency of unsuccessful attempts, inability to cross tight, eccentric or fully closed stenosis remains a major limitation of PTA.
Attempts at balloon or guidewire passage in vessels which are tightly stenotic may lead to arterial dissection and/or acute occulusion necessitating emergency vascular surgery. This major complication occurs in 6-8% of attempts at coronary angioplasty.
Inability to dilate an obstruction, even after proper balloon positioning and inflation is a second common mode of PTA failure. This problem is most frequently encountered in older plaques which are densely fibrotic and/or calcified.
Restenosis of the obstructed arterial segment follow¬ ing successful PTA is major problem with the current techni¬ que. This problem is more common following PTA of a coronary obstruction (30-35% at one year) than in the peripheral circulation (10-15% at two years). Pharmacologic attempts to reduce the incidence of restenosis have been largely unsuccessful.
Distal e bolization of atherosclerotic plaque following balloon PTA occurs in approximately 5% of patients undergoing PTA of lower extremity or renal arteries. Although emboli are usually clinically insignificant in these vascular terri¬ tories, such embolization could be catastrophic in the cerebral circulation. For this reason, balloon PTA is considered to be contraindicated for the treatment of obstructive lesions in the arteries of the aortic arch, such as the carotid artery.
DESCRIPTION OF THE PRIOR ART '
In U.S. Patent 4,207,874 (dated June 17, 1980) D.S.J. Choy describes a means for using a laser beam to tunnel through an arterial occlusion by vaporization of the obstruction. The difficulty with Choy's technique is that there is insuffi¬ cient means to prevent simultaneous destruction of the arterial wall. For example, the Choy invention shows an intense laser beam aimed in the forward direction without significant beam attenuation. If the artery were to curve and the arterial wall were to be exposed to the laser beam, the wall could also be vaporized which could be catastrophic for the patient. Although the Choy patent describes a means for direct visual¬ ization of the obstructed region, it does not describe a centering means or a guidewire following means in order to guarantee that the laser beam does not illuminate part of the arterial wall. Furthermore, the Choy device may completely block a partially obstructed artery thereby cutting off blood flow to distal tissues for a significant time period. The result is ischemia which could cause irreparable damage to heart or brain tissue. Furthermore, if laser oblation was used in the carotid arteries, resulting gas bubble formation could cause some cerebral ischemia and resulting permanent brain damage.
In U.S. Patent 4,273,128 (dated June 16, 1981) B.G. Lary describes a coronary cutting and dilating instrument used for opening a coronary stenosis that is restricting blood flow. The device described by Lary could not be used in a completely or nearly completely occluded artery because of its "blunt ovoid tip" nor could it pass through a very narrow stenosis. Furthermore, the Lary concept does not have any means to prevent its cutting blade from cutting through the arterial wall. Furthermore, there is no means taught in the Lary patent for centering the cutting blade within the arterial walls. Thus, if the probe wire 13 (Fig. 10) of the Lary patent guides the knife through a highly eccentric lumen within the stenotic plaque, its knife blade could cut through the arterial wall resulting in serious adverse effects for the patient.
Similar to the Lary device (although actually in a different field of use, namely removing growths from the teats of cows) is the device disclosed in U.S. Patent 2,730,101 (dated January 10, 1956) by R.D. Hoffman and entitled "Teat Bistoury with Expandable Cutter Knives." Figs. 1, 2 and 3 of the Hoffman patent show an expansible* cutter knife which can be inserted closed, opened within the teat, rotated to allow cutting of teat obstructions and then closed to withdraw the device from the canal. The Hoffman device has no means for preventing the blades from cutting the vessel wall, and hence if used within a human artery, such a rotating or oscillating blade would cut through the arterial wall. Because the flow of milk is out of the cow's body, particulate matter released during cutting with the Hoffman device would not harm the animal; however, in the entirely different field of use in the artery of a human, the absence of a definitive plaque collection means in the Hoffman device would result in the release of particulate matter into the flowing blood. Such particulate matter could then flow distally causing ischemia, stroke or even death. Thus the Hoffman device is entirely unsuitable for use in human (or animal) arteries. Further advances are described in prior patent appli¬ cations Serial No. 874,140 filed on June 13, 1986, and Serial No. 694,746 filed on January 25, 1985, both by Robert E. and Tim A. Fischell entitled "A Guide Wire Following Tunneling Catheter System for Transluminal Arterial Angioplasty", and "A Tunneling Catheter System for Transluminal Arterial Angioplasty", respectively. The '140 application describes a device for removing stenotic plaque by advancing a tunneling catheter over a guidewire and within a guiding catheter. In this prior invention, the cutting is done by advancing the cutting catheter in a forward (antegrade) direction. The '746 application describes the use of a centering catheter which has expandable spokes to engage the inner arterial wall for centering the catheter. Plaque is removed by ad¬ vancing a similar tunnelling catheter described in the '140 application. A potential difficulty in such a procedure is the inability to exert enough forward force to cut through a hard calcified plaque. Furthermore, if the tunneling catheter is advanced too far in the forward direction, it could cut the arterial wall. Even with the use of cutting (as opposed to fracturing the plaque which occurs with balloon dilation) there would still be the possibility of some parti¬ culate matter flowing into the bloodstream which could result in some distal ischemia.
Another application. Serial No. 885,139 filed on July 14, 1986 by Robert E. and Tim A. Fischell and entitled "A Pullback Atherectomy Catheter System," describes the concept of first penetrating the stenotic plaque in a forward direc¬ tion with a hollow conically pointed metal tip and then pulling the tip back in a retrograde direction. The tip, which includes a cylindrical cutting edge, is designed to shave off a cylindrical layer of the plaque as it is pulled back in the retrograde direction. Thus, the force required to perform the cutting is exerted by pulling back on the catheter (a retrograde motion) as opposed to cutting with a forward (antegrade) motion. The PAC utilizes sequentially larger diameter tips which progressively enlarge the lumen of the stenotic plaque.
PAC devices would typically be guided to the stenosis by a guidewire that is first passed through the narrowed lumen. Each one of the sequentially larger PAC tips is first advanced within a guiding catheter and over a guidewire until the tip passes through the stenotic plaque. The PAC tip is then pulled back to shave off plaque; then the PAC is withdrawn from the body. Each tip includes a chamber designed to collect the shaved off plaque thus preventing plaque particles from entering the bloodstream. Although PAC offers considerable advantage over prior atherectomy systems, it has three distinct disadvantages. Specifically, (1) the plaque collection chamber in the tip is both rigid and reasonably long which makes it difficult to use in highly curved arteries, (2) the tip diameter is limited to that diameter (approximately 3mm) which could be readily inserted through a percutaneous guiding catheter passing through the femoral artery at the location of the patient's groin, and (3) to the extent that the plaque is not elastic, the cylindrical hole made in the plaque by the PAC tip moving in a forward (antegrade) direction precludes the removal of plaque when the tip is moved in the retrograde direction because the tip keeps the same diameter when moving in each of these two directions.
SUMMARY OF THE INVENTION
It is the goal of the present invention to eliminate the numerous shortcomings of the prior art in order to provide an extremely flexible and expandable device which can safely tunnel a clean hole through virtually any arterial stenosis without cutting the arterial wall or creating gas bubbles, or causing the release of particulate matter into the blood¬ stream.
The Expandable Pullback Atherectomy Catheter (EPAC) described herein operates by first passing the EPAC through a guiding catheter that has been intraoperatively or percu¬ taneously inserted within an artery and then penetrating the stenotic opening in a forward direction with the tip diameter small enough to pass through the stenosis. When inserted into the artery, the EPAC tip is compressed by means of a sheathing catheter that completely encloses its tip. Once past the arterial stenosis, the sheathing catheter, which fits inside the guiding catheter, is pulled back thus allowing the EPAC tip diameter to radially expand to its full size. The expanded EPAC tip is then pulled back through the stenotic plaque with a retrograde motion while spinning which cuts through the plaque and causes the plaque particles to be collected in a flexible plaque collection chamber. The EPAC with the captured plaque is then pulled back through the guiding catheter and completely out of the body. The process is then repeated with sequentially larger expanded diameters of the EPAC tips until the lumen of the artery is sufficiently enlarged to allow adequate blood flow.
As described in prior application Serial No. 874,140 noted above, the cutting action of the EPAC tip is enhanced by rotation, or by applying high energy ultrasonic vibration to the cutting edges or possibly by the application of an electrocautery current applied at the cutting edges. These means for cutting enhancement would be applied only during pullback.
Thus an object of the present invention is to safely remove stenotic plaque material by first advancing a small diameter EPAC tip through the stenotic lumen, then allowing that tip to expand its diametric size, and then shaving off stenotic plaque by pulling the rotating cutting edges of the tip back through the stenosis in a retrograde direction.
Another object of the present invention is to collect the shaved off plaque into a flexible collection chamber within the tip and then remove the entire EPAC including the collected plaque from the body.
Still another object of the present invention is to reduce the thrombogenicity of the plaque collection chamber by heparinizing the walls thereof.
A further object of the present invention is to provide a plaque collection chamber which is sufficiently porous to allow blood to flow therethrough while still collecting all shaved plaque which could result in distal embolization.
Still another object of the present invention is to reduce the diameter of the EPAC tip after cutting through the stenosis so that the EPAC can be removed through a com¬ paratively small diameter guiding catheter.
Still another object of the present invention is to utilize ultrasonic vibration of the cutting edges to facilitate the ability of the device to cut through the plaque.
Still another object of the present invention is to utilize an electrocautery electric current at the cutting edges of the EPAC tip to enhance the ability of the device to cut through the plaque.
Still another object of the present invention is to use sequentially larger diameter tips each sequentially pulled back through the stenotic plaque to progressively enlarge the lumen of the stenosis.
Still another object of the present invention is to first use the EPAC to bore a tunnel into the plaque and then use balloon angioplasty to further enlarge the lumen of the stenotic plaque. Still another object of the present invention is to first use balloon angioplasty to enlarge a very narrow stenotic lumen and then to use the EPAC to further enlarge the arterial lumen by excising the plaque.
Still another object of the present invention is to first use a heated tip catheter or a laser beam to open a fully occluded artery and then to use the EPAC to further enlarge the arterial lumen by excising the remaining plaque.
Still another object of the present invention is to use the EPAC system to remove plaque deposited at a branch point of an artery, i.e., to open an ostial stenosis.
Still another object of the present invention is to use the EPAC to remove thrombotic tissue from an artery or to simultaneously remove thrombotic tissue and plaque.
Still another object of the present invention is to remove any obstructive tissue from artificial vessel grafts or from bypass veins.
Still another object of the present invention is to apply a coating to the EPAC that improves lubricity.
Still another object of the present invention is to apply the EPAC system for opening of any stenotic or occluded artery including the coronary arteries, the carotid artery, the renal, iliac or hepatic arteries and the arteries of the arms and legs or bypass veins or vessel grafts.
BRIEF DESCRIPTION OF THE DRAWINGS
Fig. 1 illustrates the Expandable Pullback Atherec¬ tomy Catheter (EPAC) attached to a spinning means with the tip in its expanded state.
Fig. 2 is an enlarged, cross-sectional view through line 2-2 of Fig. 1 of the cutting blades of the Expandable Pullback Atherectomy Catheter. Fig. 3 is a cross-sectional view of an artery showing the Expandable Pullback Atherectomy Catheter system with its tip located just distally from a stenotic plaque or atheroma and with the tip in its expanded state.
Fig. 4 is a cross-sectional view of the Expandable Pullback Atherectomy Catheter and sheathing catheter with the EPAC tip in its compressed state.
Fig. 5 is an enlarged cross-sectional view through line 5-5 in Fig. 4 of the EPAC tip in its compressed state showing the guidewire and sheathing catheter and also showing the plaque collection chamber in its compressed state.
Fig. 6 shows the arrangement of the proximal portion of the Expandable Pullback Atherectomy Catheter system as it is configured external to the patient's body.
DETAILED DESCRIPTION OF THE INVENTION
Fig. 1 illustrates the Expandable Pullback Atherec¬ tomy Catheter (EPAC) 10. Fig. 2 is an enlarged cross-sectional view of the EPAC 10 at 2-2 of Fig. 1. The other parts of the EPAC system (all shown in Fig. 3) are the guidewire 30, the sheathing catheter 40, and the guiding catheter 50.
Referring first to Fig. 1, the principal parts of the EPAC 10 are a distal tip 12, a radially expandable conical cutter 20, a torqueing catheter 14, and a rotating means 28. The distal tip 12 consists of a small diameter distal portion 18 and a radially expandable plaque collection chamber 17 (Fig. 3) defined by the wall 16. The conical cutter 20 consists of a multiplicity of cutter blades 22 that are attached at their distal ends to distal ring 24 and at their proximal ends to the proximal ring 26. The distal ring 24 is radially expandable and is molded into the plaque collection chamber wall 16. Distal ring 24 takes the same cross-sectional shape as the collection chamber 16 when expanded or compressed. The proximal ring 26 (which is not expandable) is molded into the torqueing catheter 14. Attachment holes 25 in the proximal ring 26 assist in main¬ taining a strong connection with the wall 16 into which the ring is molded. The proximal ring 26 has attachment holes 27 which enhance the strength of the connection when the ring 26 is molded into the torqueing catheter 14.
The shoulder 15 which lies over the distal ring 24 prevents the distal ring 24 and hence the conical cutter 20 from coming in contact with the arterial wall. Thus, distal ring 24 and its shoulder 15 act as centering devices to protect the inner arterial walls from being cut by blades 22. Ring 24 also compensates for unequal plaque build-up along the arterial walls by deforming appropriately as the device passes through the stenosis. The torqueing catheter 14 is attached at its proximal end to a spinning means 28 which is typically a drill designed for use in an operating room; such a device could be the System II Drill, Catalogue No. 298-92 of Stryker Surgical Co., Kalamazoo, Michigan.
When the EPAC 10 is pulled back through stenotic plaque while the cutter 20 is simultaneously rotated by the spinning means 28 in a counterclockwise direction (as seen from the proximal direction) then, as seen in Figs. 1 and 2, the longitudinal sharpened edges 29 of the blades 22 cut through the plaque and force the plaque into the collection chamber 17. The direction arrow R of Fig. 2 indicates the rotational direction of the EPAC tip. A curved sharpened edge 23 of each blade 22 enhances the cutting action by providing a slicing motion through the plaque as the EPAC is rotated while being pulled back in a retrograde direction. The conical cutter 20 which includes the distal ring 24 and the proximal ring 26 is typically made from a hard spring steel, or from another spring material such as berylium copper. The metal thickness is typically between 2 and 10 mils. The plaque collection chamber wall 16 is typically between 5 and 20 mils thick, and of a flexible plastic such as Mylar, Teflon or Nylon. Ideally the wall 16 would be made porous with pore size between 20 and 50 microns so that blood plasma, red and white cells and platelets could pass through, thus allowing perfusion of distal tissue to minimize risk of damaging heart tissue or brain cells caused by lack of blood. Plaque of this small size could also pass through with no harm to the patient. The distal ring 24 and the plaque collection chamber is typically made in various sizes with diameters (when expanded) from as small as 2 mm to as large as 10 mm with total chamber length from 0.5 to 10 cm. The proximal ring 26 and torqueing catheter 14 is typically made in various sizes with diameters ranging from 1 mm to 4 mm. The torqueing catheter 14 would typically be made from a stiff, strong plastic such as PVC with a wall thickness between 10 and 20 mils.
Although the cutter blades 22 are shown as being essentially straight from their smaller diameter at the proximal ring 26 to their larger diameter at the distal ring 24, they could have a variety of shapes, positions, angles and number of blades in order to enhance their cutting action.
Figure 3 is a cross-sectional view of the entire EPAC system which includes the EPAC 10, the guidewire 30, the sheathing catheter 40 and the guiding catheter 50 all shown within an artery having an atheromatous plaque P within the arterial wall AW. In Fig. 3 the sheathing catheter 40 is shown pulled back so that the distal tip 12 and the conical cutter 20 have expanded radially to their full diameter. With the aid of angiography, after the tip 12 has been advanced beyond the stenosis, the EPAC tip 12 is pulled back while spinning until a cylindrical tunnel has been bored through the plaque. The plaque is collected in the plaque collection chamber 17 and then the rotation is stopped. The EPAC 10 and the sheathing catheter 40 are then pulled back through the guiding catheter 50 until they are totally removed from the patient's body. A packing gland 19 typically of sponge rubber is placed to completely prevent plaque from escaping from the plaque collection chamber 17 while the guidewire 30 remains in place and the EPAC 10 is withdrawn from the patient's artery. However, a clearance of 20 to 50 microns between the outside diameter of the guidewire 30 and the packing gland 19, would allow acceptably small particulate matter to escape from the plaque collection chamber 17 as well as allowing the flow of some blood which is desirable.
The procedure described above could be repeated if necessary with an EPAC tip 12 that has a larger expanded diameter. This procedure can be repeated with successively larger diameter tips 12 until the stenotic lumen is suffi¬ ciently enlarged to allow adequate blood flow.
When the EPAC tip 12 is rotated by means of apply¬ ing torque to the torqueing catheter 14 by means of the spinning means 28 (all shown in Fig. 1), the guidewire 30 could be allowed to spin or could remain fixed. Furthermore, the sheathing catheter 40 might be allowed to spin or it might remain non-rotating. However, the guiding catheter 50 preferably would remain fixed (i.e., non-rotating relative to the arterial wall AW) . Further, it may be advantageous to spin the conical cutter 20 while slidably connecting the plaque collection chamber 17 so that the chamber 17 does not spin. The risk of cutting the arterial wall is highest when the conical cutter is expanded. As shown in Fig. 3, the thickness (typically 2 to 20 mils) of the plastic material of the shoulder 15 of the plaque collection chamber 17, prevents even the largest diameter portion of the conical cutter 20 from cutting into the arterial wall.
Although the collection chamber 17 is shown in FIG. 3 to be essentially cylindrical in shape, it might also be conical in shape with its large mouth opening proximally. Chamber 17 also could have a much longer, smaller diameter distal portion 18, with only a very short proximal section of a diameter large enough to cover the distal ring 24. Designs have a smaller diameter of the plaque collection chamber 17 as compared to the distal ring 24, would decrease the contact of the wall 16 with the delicate intimal lining of the arterial wall AW. This could minimize damage to the intima during insertion, spinning and removal of the EPAC 10.
Although the spinning mode has been discussed exten¬ sively herein, the use of ultrasonic vibration or electro- cautery cutting during pullback with or without rotation would be another practical means for accomplishing atherectomy. For example, if the torqueing catheter 14 were fabricated from a thin wall metal tube, such a tube could be used to transmit ultrasonic vibration to the cutting edges 23 and 29 during pullback thus accomplishing the desired atherectomy. In this case, an ultrasonic vibration generator would replace the spinning means 28.
Yet another technique would be to use a metal tube torqueing catheter 14 that is insulated on all its surfaces except at its proximal end, which is external to the body. In this technique the conical cutter 20 would be electrically connected to the torqueing catheter 14 and would also have electrical insulation throughout all its surfaces except at the cutting edges 23 and 29. One terminal of a conventional electrocautery current generator would be connected to the conducting proximal end of the torqueing catheter 14, with the ground connection of the generator being connected to the patient's skin. As the assembly 10 is pulled back, the electrocautery current emanating from the sharp edges
23 and 29 would assist in performing the desired atherectomy.
Cutting with this technique is analogous to cutting with an electrocautery scalpel as regularly used in surgical procedures. Such an electrocautery atherectomy would have the additional advantage of cauterizing the cut interior surface of the arterial wall thus reducing its tendency to form thrombi.
Fig. 4 shows the sheathing catheter 40 extended over and therefore compressing the distal tip 12 of the EPAC 10. Although the proximal ring 26 retains its precompression size, the distal ring 24 follows the plaque collection chamber wall 16 when deformed as shown so as to fit within the sheath¬ ing catheter 40. The distal tip 18 and the packing gland 19 of the plaque collection chamber 17 are not compressed by the sheathing catheter 40.
When the EPAC 10 is pushed through the stenotic lumen, the sheathing catheter 40 might be pushed through first, or alternatively the EPAC 10 could be inserted until the sheathing catheter 40 just stops proximally against the stenosis; then the tip 12 would be pushed through. This latter method minimizes the diameter of that which must be pushed through the stenotic lumen. The smaller diameter distal tip 18 of the plaque collection chamber 17 is designed for and serves to assist in passing the distal tip 12 through a tight stenosis with the sheathing catheter 40 stopping just proximal to that stenosis. When the distal tip 12 is pulled back through the stenotic plaque P (Fig. 3), the sheathing catheter 40 can be pushed over the distal tip 12 to compress the tip 12. Alternatively, the guiding catheter 50 can be used to compress the tip 12. Using the guiding catheter 50 for this purpose during pullback would allow the greatest volume of the com¬ pressed plaque to be held within the collection chamber 17; this would be necessary if a large volume of plaque was collected. If such a large volume of plaque was collected that even the guiding catheter 50 was incapable of containing the plaque filled chamber 17, then the proximal end of the distal ring 24 would be pulled back until it touched the mouth of the guiding catheter 50, and then the entire EPAC system including the guiding catheter 50 would be removed from the patient's body.
The walls 16 of the plaque collection chamber 17 in both Figs. 3 and 4 have an exaggerated thickness in order to better show the details of connection to the distal ring 24. In the preferred embodiment, the walls 16 are 10 mils thick and would be made from a tough yet flexible (and possibly porous) plastic such as Mylar, Teflon or Nylon. Thus the collection chamber 17 could be many centimeters long and still easily bend around highly curved arteries such as some of the coronary arteries. Furthermore, as shown in Fig. 5, an appropriately thin wall 16 takes up less volume when the tip 12 is in its compressed state. Additionally, the collection chamber 17 could be coated with heparin in order to reduce thrombus formation.
Fig. 6 illustrates the proximal configuration of the EPAC system external to the patient's body. The guiding catheter 50 is shown penetrating the patient's skin S and entering within the arterial wall AW. A side port 52 on the guiding catheter 50 can be used to inject flushing (saline) solution or angiographic dye, or to apply a suction at the distal end of the guiding catheter 50. Emerging from a packing gland 54 at the proximal end of the guiding catheter 50 is the sheathing catheter 40, and emerging from a packing gland 44 at the proximal end of the sheathing catheter 40 is the torqueing catheter 14 which is attached to a rotating means 28. The guidewire 30 passes through a packing gland at the proximal end of the torqueing catheter 14 and it then passes through a cannula within the spinning means 28. The guidewire 30 would be made long enough so that the entire EPAC system (except for the guiding catheter 50) could be removed from the body while the guidewire 30 remains in place through the stenotic lumen.
If ultrasonic vibration is used, the spinning means 28 of Fig. 6 would be replaced with a conventional generator of ultrasonic (or even sonic) vibrations. If electrocautery is used, the connections would be as shown by dotted lines in Fig. 6; that is, a conventional electrocautery current generator 60 would have one terminal 61 attached to the non-insulated proximal end of a metal torqueing catheter and its ground terminal 62 attached to a grounding plate 63 in contact with the patient's skin "S".
Although the removal of plaque from a human artery has been described in detail herein, the EPAC 10 can be advantageously used for safely removing many types of ob¬ structions from any vessel within a human or animal. For example, blood flow obstructions occurring in arterial blood vessel grafts or bypass veins are particularly well suited for removal by the EPAC. Furthermore, thrombi and plaque could be separately or simultaneously removed from blood vessels thus enlarging such lumens to provide adequate blood flow. Finally, the EPAC could be used for opening of other lumen ducts such as urethra, ureter, bile ducts or fallopian tubes. In all cases, the EPAC provides means for removing obstructive tissue from a vessel in a living body in lieu of balloon angioplasty which merely redistributes such material.
The utility of the EPAC to open arteries can also be enhanced by the adjunctive use of conventional balloon angioplasty. For example, a narrow stenosis might first be enlarged from less than 1 mm to 2 mm or greater, and then the EPAC could be used to remove the deformed plaque. Furthermore, the use of a heated tip catheter or a laser beam to first open a small lumen in a fully occluded artery, followed by the use of the EPAC for plaque removal offers a unique and valuable therapy for obtaining long term patency of even fully occluded arteries.
Furthermore, the EPAC system can be used with a separate means for plaque removal, such as plaque removal by cutting, grinding or by the user of lasers, performed proximal to the EPAC distal plaque collection chamber 17. The chamber 17 would then be used for the sole purpose of collecting distal emboli released by such a proximally located device, and then would be removed with the EPAC 10 from the body.
Various other modifications, adaptations, and alter¬ native designs are of course, possible in light of the above teachings. Therefore, it should be understood that within the scope of the appended claims, the invention may be prac¬ ticed otherwise than as specifically described herein.

Claims

WHAT IS CLAIMED IS:
1. An apparatus for deployment within a vessel of a living body for removing obstructing tissue on the inner wall of said vessel, the apparatus comprising: catheter means having a distal portion with first and second regions, and being capable of assuming a first and a second diameter, said second diameter being larger than said first diameter; cutting means located at said first region of said distal portion of the catheter means for cutting said obstructing tissue as the catheter means is pulled back in a retrograde direction through said obstructing tissue; tissue collecting means having a proximal and a distal end located at said second region of said distal portion of the catheter means for collecting the obstructing tissue as it is cut from the vessel wall; deployment means for selectively causing said distal portion to assume said first or second diameter; and centering means on said distal portion of the catheter means for engaging the inner wall of the vessel when said distal portion assumes said second diameter and for preventing the cutting means from contacting and cutting the inner wall of said vessel.
2. The apparatus of Claim 1 wherein said collection means is a collection chamber formed of a flexible, deform- able plastic.
3. The apparatus of Claim 2 wherein said collection chamber is porous for allowing small particulate matter and blood plasma and cells to flow therethrough.
4. The apparatus of Claim 1 wherein said collection chamber is treated with heparin.
5. The apparatus of Claim 1 wherein said collection means is slidably connected to said cutting means so that rotation of said cutting means does not cause rotation of said collection means.
6. The apparatus of Claim 1 wherein said cutting means comprises a radially expandable conical cutter having a multiplicity of radial cutting spokes.
7. The apparatus of Claim 6 wherein said radial cutting spokes are curved.
8. The apparatus of Claim 1 wherein said deploy¬ ment means comprises a sheathing catheter having a diameter slightly larger than said first diameter of said distal portion of the catheter means so that when the sheathing catheter surrounds said distal portion, said distal portion assumes said first diameter, and when the sheathing cathe¬ ter does not surround said distal portion, said distal portion assumes said second diameter.
9. The apparatus of Claim 1 wherein said tissue collecting means is positioned at the distal end of said distal portion of the catheter means and said cutting means is positioned at the proximal end of said distal portion of the catheter means.
10. The apparatus of Claim 1 wherein the distal end of said tissue collecting means has a diameter smaller than the proximal end of said tissue collecting means.
11. The apparatus of Claim 1 wherein said tissue collecting means is conical in shape.
12. The apparatus of Claim 1 wherein said deploy¬ ment means surrounds and compresses said distal portion of the catheter means for causing said distal portion to assume said first diameter.
13. The apparatus of Claim 12 wherein said deploy¬ ment means is a sheathing catheter.
14. The apparatus of Claim 12 wherein said deploy¬ ment means is a guiding catheter.
15. The apparatus of Claim 1 wherein said center¬ ing means comprises a shoulder having a diameter larger than the diameter of said cutting means and forming the outside of the proximal end of said tissue collecting means so that when said distal portion of the catheter means assumes said second diameter, the shoulder causes the walls of the tissue collecting means to engage the inner wall of the vessel to.prevent said cutting means from cutting the wall of the vessel.
16. The apparatus of Claim 15 wherein said shoulder is deformable to follow the deformation of the tissue collecting means when the distal portion of said catheter means assumes said first and second diameters.
17. The apparatus of Claim 1 wherein said catheter means is coated with a lubricant for facilitating inser¬ tion into a vessel.
18. The apparatus of Claim 1 and further comprising means for rotating said cutting means while said catheter means is pulled back through said obstructing tissue.
19. The apparatus of Claim 1 wherein said cutting means is mechanically vibrated while said catheter means is pulled back through said obstructing tissue.
20. The apparatus of Claim 1 wherein said cutting means is connected to an electrical circuit to perform electrocautery while said catheter means is pulled back through said obstructing tissue.
21. A method for removing obstructing tissue from a vessel within a living body using a catheter system having a distal portion comprising a cutting means and a tissue collection means, said distal portion being capable of assuming a first and second diameter, said first diameter being smaller than said second diameter, said method comprising the steps of: advancing said catheter system with said distal portion in said first diameter position, through said vessel until the distal portion is just beyond the ob¬ structing tissue; causing said distal portion of the catheter means to assume said second diameter; pulling said catheter system back in a retro¬ grade direction through said obstructing tissue to place said cutting means in contact with the obstructing tissue and to cut said obstructing tissue away from the wall of the vessel while the cut tissue is collected in the collection means; and withdrawing said catheter system from the vessel along with the cut and collected obstructing tissue.
22. The method of Claim 21 wherein said catheter system is advanced through the vessel over a guidewire.
23. The method of Claim 21 wherein said catheter system is advanced through the vessel within a guiding catheter.
24. The method of Claim 21 wherein said distal portion of the catheter system is caused to assume said first diameter before it is withdrawn from the vessel.
25. The method of Claim 21 wherein said vessel is an artery.
26. The method of Claim 21 wherein said vessel is a bypass vein.
27. The method of Claim 21 wherein said vessel is an artificial graft.
28. The method of Claim 21 wherein said obstruct¬ ing tissue is plaque.
29. The method of Claim 21 wherein said obstruct¬ ing tissue is thrombus.
30. The method of Claim 21 wherein said obstruct¬ ing tissue is both plaque and thrombus.
31. The method of Claim 21 wherein said vessel is a ureter.
32. The method of Claim 21 wherein said vessel is a urethra.
33. The method of Claim 21 wherein said vessel is a tube in the reproductive system.
34. The method of Claim 21 wherein said vessel is a tube in the digestive tract.
35. An apparatus for deployment within a vessel of a living body for removing obstructing tissue from said vessel, the apparatus comprising: catheter means having a distal portion capable of assuming a first and second diameter, said second diameter being larger than said first diameter; tissue collecting means having a proximal and a distal end located at said distal portion of the catheter means for collecting obstructing tissue after it has been cut from the vessel wall; deployment means for selectively causing said distal portion to assume said first or said second dia¬ meter.
36. The apparatus of Claim 35 and further com¬ prising cutting means located proximally of said tissue collecting means for cutting said obstructing tissue.
37. The apparatus of Claim 36 wherein said cutting means is mounted on a separate second catheter in such a manner as to be concentric with said catheter means.
38. A method for removing obstructing tissue from a vessel within a living body using a catheter system having a distal portion comprising a tissue collection means, said distal portion being capable of assuming a first and a second diameter, said first diameter being smaller than said second diameter, said method comprising the steps of: advancing said catheter system with said distal portion in said first diameter position, through said vessel until the distal portion is just beyond the ob¬ structing tissue; causing said distal portion of the catheter system to assume said second diameter; placing a cutting means in contact with the obstructing tissue and cutting said obstructing tissue away from the wall of the vessel; collecting the cut tissue in the collection means; and withdrawing said catheter system from the vessel along with the cut and collected obstructing tissue.
39. The method of Claim 38 wherein said cutting means is mounted on a separate second catheter.
PCT/US1989/000426 1988-02-09 1989-02-07 Expandable pullback atherectomy catheter system WO1989007422A1 (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
AU31970/89A AU618331B2 (en) 1988-02-09 1989-02-07 Expandable pullback atherectomy catheter system

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US153,912 1988-02-09
US07/153,912 US4886061A (en) 1988-02-09 1988-02-09 Expandable pullback atherectomy catheter system

Publications (1)

Publication Number Publication Date
WO1989007422A1 true WO1989007422A1 (en) 1989-08-24

Family

ID=22549237

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US1989/000426 WO1989007422A1 (en) 1988-02-09 1989-02-07 Expandable pullback atherectomy catheter system

Country Status (4)

Country Link
US (1) US4886061A (en)
EP (1) EP0356507A4 (en)
JP (1) JPH02503161A (en)
WO (1) WO1989007422A1 (en)

Cited By (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0511323A1 (en) * 1990-11-16 1992-11-04 Berkshire Res & Dev Inc Adjustable intra-luminal valvulotome.
US6336934B1 (en) 1997-11-07 2002-01-08 Salviac Limited Embolic protection device
US6565591B2 (en) 2000-06-23 2003-05-20 Salviac Limited Medical device
US6887256B2 (en) 1997-11-07 2005-05-03 Salviac Limited Embolic protection system
US9687267B2 (en) 2009-12-02 2017-06-27 Covidien Lp Device for cutting tissue
US11304753B2 (en) 2019-09-13 2022-04-19 Alleviant Medical, Inc. Systems, devices, and methods for forming an anastomosis

Families Citing this family (208)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5088991A (en) * 1988-07-14 1992-02-18 Novoste Corporation Fuseless soft tip angiographic catheter
DE3830704A1 (en) * 1988-09-09 1990-03-22 Falah Redha MEDICAL INSTRUMENT
US5011488A (en) * 1988-12-07 1991-04-30 Robert Ginsburg Thrombus extraction system
US5904679A (en) * 1989-01-18 1999-05-18 Applied Medical Resources Corporation Catheter with electrosurgical cutter
US5628746A (en) * 1989-01-18 1997-05-13 Applied Medical Resources Corporation Dilatation catheter assembly with cutting element and method of using the same
US5211651A (en) * 1989-08-18 1993-05-18 Evi Corporation Catheter atherotome
US5156610A (en) * 1989-08-18 1992-10-20 Evi Corporation Catheter atherotome
US5071424A (en) * 1989-08-18 1991-12-10 Evi Corporation Catheter atherotome
US5571169A (en) * 1993-06-07 1996-11-05 Endovascular Instruments, Inc. Anti-stenotic method and product for occluded and partially occluded arteries
DE69023652T2 (en) * 1989-08-18 1996-10-31 Evi Corp ATHEROTOMY CATHETER.
US5009659A (en) * 1989-10-30 1991-04-23 Schneider (Usa) Inc. Fiber tip atherectomy catheter
US5074871A (en) * 1989-12-07 1991-12-24 Evi Corporation Catheter atherotome
US5011490A (en) * 1989-12-07 1991-04-30 Medical Innovative Technologies R&D Limited Partnership Endoluminal tissue excision catheter system and method
US5158564A (en) * 1990-02-14 1992-10-27 Angiomed Ag Atherectomy apparatus
US5154724A (en) * 1990-05-14 1992-10-13 Andrews Winston A Atherectomy catheter
US5395311A (en) * 1990-05-14 1995-03-07 Andrews; Winston A. Atherectomy catheter
US5100424A (en) * 1990-05-21 1992-03-31 Cardiovascular Imaging Systems, Inc. Intravascular catheter having combined imaging abrasion head
US5196024A (en) * 1990-07-03 1993-03-23 Cedars-Sinai Medical Center Balloon catheter with cutting edge
US5320634A (en) * 1990-07-03 1994-06-14 Interventional Technologies, Inc. Balloon catheter with seated cutting edges
US5722945A (en) * 1990-07-17 1998-03-03 Aziz Yehia Anis Removal of tissue
US5492528A (en) * 1990-07-17 1996-02-20 Anis; Azis Y. Removal of tissue
US5222959A (en) * 1990-07-17 1993-06-29 Anis Aziz Y Removal of tissue
US5160342A (en) * 1990-08-16 1992-11-03 Evi Corp. Endovascular filter and method for use thereof
US5108419A (en) * 1990-08-16 1992-04-28 Evi Corporation Endovascular filter and method for use thereof
US5127902A (en) * 1990-09-05 1992-07-07 Medical Innovative Technologies R&D Limited Partnership Apparatus and method for precisely controlling the excision of obstructive tissue in a human blood vessel
US5112345A (en) * 1990-12-17 1992-05-12 Interventional Technologies Atherectomy cutter with arcuate blades
US5957882A (en) * 1991-01-11 1999-09-28 Advanced Cardiovascular Systems, Inc. Ultrasound devices for ablating and removing obstructive matter from anatomical passageways and blood vessels
FR2685190B1 (en) * 1991-12-23 1998-08-07 Jean Marie Lefebvre ROTARY ATHERECTOMY OR THROMBECTOMY DEVICE WITH CENTRIFUGAL TRANSVERSE DEVELOPMENT.
US5742019A (en) * 1992-01-13 1998-04-21 Interventional Technologies Inc. Method for manufacturing an atherectomy cutter having a positive angle of attack
US5224945A (en) * 1992-01-13 1993-07-06 Interventional Technologies, Inc. Compressible/expandable atherectomy cutter
WO1993019679A1 (en) 1992-04-07 1993-10-14 The Johns Hopkins University A percutaneous mechanical fragmentation catheter system
US5176693A (en) * 1992-05-11 1993-01-05 Interventional Technologies, Inc. Balloon expandable atherectomy cutter
US5571122A (en) * 1992-11-09 1996-11-05 Endovascular Instruments, Inc. Unitary removal of plaque
US5643297A (en) * 1992-11-09 1997-07-01 Endovascular Instruments, Inc. Intra-artery obstruction clearing apparatus and methods
US5490859A (en) * 1992-11-13 1996-02-13 Scimed Life Systems, Inc. Expandable intravascular occlusion material removal devices and methods of use
US5836868A (en) * 1992-11-13 1998-11-17 Scimed Life Systems, Inc. Expandable intravascular occlusion material removal devices and methods of use
US5792157A (en) * 1992-11-13 1998-08-11 Scimed Life Systems, Inc. Expandable intravascular occlusion material removal devices and methods of use
US5501694A (en) * 1992-11-13 1996-03-26 Scimed Life Systems, Inc. Expandable intravascular occlusion material removal devices and methods of use
DE4307642C1 (en) * 1993-03-11 1994-06-09 Redha Falah Medical instrument for dispersal of deposits in arteries and/or veins - has partly hollow body with basic body to which cutters are attached having cutting edges pointing in draw direction
CH685738A5 (en) * 1993-03-25 1995-09-29 Ferromec Sa Medical instrument for removing deposits formed on the inner walls of the arteries or veins.
US5897567A (en) * 1993-04-29 1999-04-27 Scimed Life Systems, Inc. Expandable intravascular occlusion material removal devices and methods of use
AU682338B2 (en) * 1993-05-06 1997-10-02 Linvatec Corporation Rotatable endoscopic shaver with polymeric blades
US5417703A (en) * 1993-07-13 1995-05-23 Scimed Life Systems, Inc. Thrombectomy devices and methods of using same
US5419774A (en) * 1993-07-13 1995-05-30 Scimed Life Systems, Inc. Thrombus extraction device
US5429617A (en) * 1993-12-13 1995-07-04 The Spectranetics Corporation Radiopaque tip marker for alignment of a catheter within a body
US5902313A (en) * 1994-03-09 1999-05-11 Redha; Falah Medical instrument for atherectomy
US5601582A (en) * 1994-11-16 1997-02-11 Wilson-Cook Medical Inc. Cutting catheter
DE19507560A1 (en) * 1995-03-03 1996-09-05 Heiss Josef Medizintech Medical instrument for intravenous use
US5624433A (en) * 1995-04-24 1997-04-29 Interventional Technologies Inc. Angioplasty balloon with light incisor
US5885258A (en) * 1996-02-23 1999-03-23 Memory Medical Systems, Inc. Medical instrument with slotted memory metal tube
US5855601A (en) * 1996-06-21 1999-01-05 The Trustees Of Columbia University In The City Of New York Artificial heart valve and method and device for implanting the same
US5954713A (en) 1996-07-12 1999-09-21 Newman; Fredric A. Endarterectomy surgical instruments and procedure
US5713913A (en) * 1996-11-12 1998-02-03 Interventional Technologies Inc. Device and method for transecting a coronary artery
US8353948B2 (en) * 1997-01-24 2013-01-15 Celonova Stent, Inc. Fracture-resistant helical stent incorporating bistable cells and methods of use
US5882329A (en) * 1997-02-12 1999-03-16 Prolifix Medical, Inc. Apparatus and method for removing stenotic material from stents
AU6657098A (en) 1997-02-12 1998-08-26 Prolifix Medical, Inc. Apparatus for removal of material from stents
US5893869A (en) * 1997-02-19 1999-04-13 University Of Iowa Research Foundation Retrievable inferior vena cava filter system and method for use thereof
US6974469B2 (en) 1997-03-06 2005-12-13 Scimed Life Systems, Inc. Distal protection device and method
US6251086B1 (en) * 1999-07-27 2001-06-26 Scimed Life Systems, Inc. Guide wire with hydrophilically coated tip
US6183487B1 (en) 1997-03-06 2001-02-06 Scimed Life Systems, Inc. Ablation device for reducing damage to vessels and/or in-vivo stents
US6066149A (en) 1997-09-30 2000-05-23 Target Therapeutics, Inc. Mechanical clot treatment device with distal filter
US6096054A (en) 1998-03-05 2000-08-01 Scimed Life Systems, Inc. Expandable atherectomy burr and method of ablating an occlusion from a patient's blood vessel
US6561998B1 (en) 1998-04-07 2003-05-13 Transvascular, Inc. Transluminal devices, systems and methods for enlarging interstitial penetration tracts
US6238401B1 (en) 1998-07-31 2001-05-29 Zuli Holdings Ltd. Apparatus and method for selectively positioning a device and manipulating it
US20030150821A1 (en) 1999-07-16 2003-08-14 Bates Mark C. Emboli filtration system and methods of use
US7306618B2 (en) * 1999-07-30 2007-12-11 Incept Llc Vascular device for emboli and thrombi removal and methods of use
US6142987A (en) * 1999-08-03 2000-11-07 Scimed Life Systems, Inc. Guided filter with support wire and methods of use
US6235044B1 (en) * 1999-08-04 2001-05-22 Scimed Life Systems, Inc. Percutaneous catheter and guidewire for filtering during ablation of mycardial or vascular tissue
US7887556B2 (en) * 2000-12-20 2011-02-15 Fox Hollow Technologies, Inc. Debulking catheters and methods
US7713279B2 (en) 2000-12-20 2010-05-11 Fox Hollow Technologies, Inc. Method and devices for cutting tissue
US6299622B1 (en) 1999-08-19 2001-10-09 Fox Hollow Technologies, Inc. Atherectomy catheter with aligned imager
US7708749B2 (en) 2000-12-20 2010-05-04 Fox Hollow Technologies, Inc. Debulking catheters and methods
US8328829B2 (en) 1999-08-19 2012-12-11 Covidien Lp High capacity debulking catheter with razor edge cutting window
US6371971B1 (en) 1999-11-15 2002-04-16 Scimed Life Systems, Inc. Guidewire filter and methods of use
DE60034146T2 (en) * 1999-12-22 2007-12-13 Boston Scientific Ltd., St. Michael ENDOLUMINAL OCCLUSION SPÜLKATHETER
US6695813B1 (en) 1999-12-30 2004-02-24 Advanced Cardiovascular Systems, Inc. Embolic protection devices
US6540722B1 (en) 1999-12-30 2003-04-01 Advanced Cardiovascular Systems, Inc. Embolic protection devices
US20010031981A1 (en) 2000-03-31 2001-10-18 Evans Michael A. Method and device for locating guidewire and treating chronic total occlusions
US6565588B1 (en) 2000-04-05 2003-05-20 Pathway Medical Technologies, Inc. Intralumenal material removal using an expandable cutting device
AU2001253173B2 (en) 2000-04-05 2005-05-12 Boston Scientific Limited Intralumenal material removal systems and methods
AUPQ831500A0 (en) * 2000-06-22 2000-07-13 White, Geoffrey H. Method and apparatus for performing percutaneous thromboembolectomies
US6773443B2 (en) 2000-07-31 2004-08-10 Regents Of The University Of Minnesota Method and apparatus for taking a biopsy
US6616681B2 (en) * 2000-10-05 2003-09-09 Scimed Life Systems, Inc. Filter delivery and retrieval device
US6451037B1 (en) * 2000-11-22 2002-09-17 Scimed Life Systems, Inc. Expandable atherectomy burr with metal reinforcement
AU2002231074A1 (en) 2000-12-20 2002-07-01 Fox Hollow Technologies, Inc. Debulking catheter
US7169165B2 (en) * 2001-01-16 2007-01-30 Boston Scientific Scimed, Inc. Rapid exchange sheath for deployment of medical devices and methods of use
US6974468B2 (en) * 2001-02-28 2005-12-13 Scimed Life Systems, Inc. Filter retrieval catheter
US7226464B2 (en) * 2001-03-01 2007-06-05 Scimed Life Systems, Inc. Intravascular filter retrieval device having an actuatable dilator tip
US6800083B2 (en) 2001-04-09 2004-10-05 Scimed Life Systems, Inc. Compressible atherectomy burr
US6616676B2 (en) * 2001-04-10 2003-09-09 Scimed Life Systems, Inc. Devices and methods for removing occlusions in vessels
US6997939B2 (en) 2001-07-02 2006-02-14 Rubicon Medical, Inc. Methods, systems, and devices for deploying an embolic protection filter
US6951570B2 (en) 2001-07-02 2005-10-04 Rubicon Medical, Inc. Methods, systems, and devices for deploying a filter from a filter device
US6962598B2 (en) 2001-07-02 2005-11-08 Rubicon Medical, Inc. Methods, systems, and devices for providing embolic protection
US20030023263A1 (en) 2001-07-24 2003-01-30 Incept Llc Apparatus and methods for aspirating emboli
US6632231B2 (en) * 2001-08-23 2003-10-14 Scimed Life Systems, Inc. Segmented balloon catheter blade
US20030078614A1 (en) 2001-10-18 2003-04-24 Amr Salahieh Vascular embolic filter devices and methods of use therefor
US6887257B2 (en) 2001-10-19 2005-05-03 Incept Llc Vascular embolic filter exchange devices and methods of use thereof
US20030083692A1 (en) * 2001-10-29 2003-05-01 Scimed Life Systems, Inc. Distal protection device and method of use thereof
US7594926B2 (en) 2001-11-09 2009-09-29 Boston Scientific Scimed, Inc. Methods, systems and devices for delivering stents
AU2002352628B2 (en) 2001-11-09 2006-06-29 Rubicon Medical, Inc. Stent delivery device with embolic protection
US7153320B2 (en) * 2001-12-13 2006-12-26 Scimed Life Systems, Inc. Hydraulic controlled retractable tip filter retrieval catheter
US6793666B2 (en) * 2001-12-18 2004-09-21 Scimed Life Systems, Inc. Distal protection mechanically attached filter cartridge
US6932830B2 (en) * 2002-01-10 2005-08-23 Scimed Life Systems, Inc. Disc shaped filter
US7247162B1 (en) 2002-01-14 2007-07-24 Edwards Lifesciences Corporation Direct access atherectomy devices
US20030135162A1 (en) 2002-01-17 2003-07-17 Scimed Life Systems, Inc. Delivery and retrieval manifold for a distal protection filter
US7118539B2 (en) * 2002-02-26 2006-10-10 Scimed Life Systems, Inc. Articulating guide wire for embolic protection and methods of use
US7060082B2 (en) * 2002-05-06 2006-06-13 Scimed Life Systems, Inc. Perfusion guidewire in combination with a distal filter
US7179269B2 (en) 2002-05-20 2007-02-20 Scimed Life Systems, Inc. Apparatus and system for removing an obstruction from a lumen
US7001406B2 (en) * 2002-05-23 2006-02-21 Scimed Life Systems Inc. Cartridge embolic protection filter and methods of use
US7115138B2 (en) * 2002-09-04 2006-10-03 Boston Scientific Scimed, Inc. Sheath tip
US20040093011A1 (en) * 2002-10-01 2004-05-13 Scimed Life Systems, Inc. Embolic protection device with lesion length assessment markers
US7998163B2 (en) 2002-10-03 2011-08-16 Boston Scientific Scimed, Inc. Expandable retrieval device
US8468678B2 (en) 2002-10-02 2013-06-25 Boston Scientific Scimed, Inc. Expandable retrieval device
EP1578479A4 (en) * 2002-10-29 2006-08-23 James C Peacock Iii Embolic filter device and related systems and methods
US20040102789A1 (en) 2002-11-22 2004-05-27 Scimed Life Systems, Inc. Selectively locking device
US20040102806A1 (en) * 2002-11-27 2004-05-27 Scimed Life Systems, Inc. Intravascular filter monitoring
US20040116831A1 (en) * 2002-12-13 2004-06-17 Scimed Life Systems, Inc. Distal protection guidewire with nitinol core
US6746463B1 (en) 2003-01-27 2004-06-08 Scimed Life Systems, Inc Device for percutaneous cutting and dilating a stenosis of the aortic valve
US20040147955A1 (en) * 2003-01-28 2004-07-29 Scimed Life Systems, Inc. Embolic protection filter having an improved filter frame
US20040167566A1 (en) * 2003-02-24 2004-08-26 Scimed Life Systems, Inc. Apparatus for anchoring an intravascular device along a guidewire
US7137991B2 (en) * 2003-02-24 2006-11-21 Scimed Life Systems, Inc. Multi-wire embolic protection filtering device
JP2004297166A (en) * 2003-03-25 2004-10-21 Murata Mfg Co Ltd Temperature-compensated piezoelectric oscillator and electronic equipment using the same
US7163550B2 (en) 2003-03-26 2007-01-16 Scimed Life Systems, Inc. Method for manufacturing medical devices from linear elastic materials while maintaining linear elastic properties
US20040193208A1 (en) * 2003-03-27 2004-09-30 Scimed Life Systems, Inc. Radiopaque embolic protection filter membrane
US8246640B2 (en) 2003-04-22 2012-08-21 Tyco Healthcare Group Lp Methods and devices for cutting tissue at a vascular location
US7279002B2 (en) * 2003-04-25 2007-10-09 Boston Scientific Scimed, Inc. Cutting stent and balloon
US7632288B2 (en) 2003-05-12 2009-12-15 Boston Scientific Scimed, Inc. Cutting balloon catheter with improved pushability
US7758604B2 (en) 2003-05-29 2010-07-20 Boston Scientific Scimed, Inc. Cutting balloon catheter with improved balloon configuration
US7780626B2 (en) 2003-08-08 2010-08-24 Boston Scientific Scimed, Inc. Catheter shaft for regulation of inflation and deflation
US7887557B2 (en) 2003-08-14 2011-02-15 Boston Scientific Scimed, Inc. Catheter having a cutting balloon including multiple cavities or multiple channels
US7699865B2 (en) 2003-09-12 2010-04-20 Rubicon Medical, Inc. Actuating constraining mechanism
US8535344B2 (en) 2003-09-12 2013-09-17 Rubicon Medical, Inc. Methods, systems, and devices for providing embolic protection and removing embolic material
US8048093B2 (en) * 2003-12-19 2011-11-01 Boston Scientific Scimed, Inc. Textured balloons
US7473265B2 (en) 2004-03-15 2009-01-06 Boston Scientific Scimed, Inc. Filter media and methods of manufacture
US7754047B2 (en) * 2004-04-08 2010-07-13 Boston Scientific Scimed, Inc. Cutting balloon catheter and method for blade mounting
US7566319B2 (en) 2004-04-21 2009-07-28 Boston Scientific Scimed, Inc. Traction balloon
US7976557B2 (en) 2004-06-23 2011-07-12 Boston Scientific Scimed, Inc. Cutting balloon and process
US7621904B2 (en) * 2004-10-21 2009-11-24 Boston Scientific Scimed, Inc. Catheter with a pre-shaped distal tip
US8038691B2 (en) 2004-11-12 2011-10-18 Boston Scientific Scimed, Inc. Cutting balloon catheter having flexible atherotomes
US7291158B2 (en) 2004-11-12 2007-11-06 Boston Scientific Scimed, Inc. Cutting balloon catheter having a segmented blade
US8066726B2 (en) * 2004-11-23 2011-11-29 Boston Scientific Scimed, Inc. Serpentine cutting blade for cutting balloon
US8038696B2 (en) 2004-12-06 2011-10-18 Boston Scientific Scimed, Inc. Sheath for use with an embolic protection filter
ATE413204T1 (en) * 2004-12-30 2008-11-15 Cook Inc CATHETER ARRANGEMENT WITH PLAQUE CUTTING BALLOON
US20060178685A1 (en) * 2004-12-30 2006-08-10 Cook Incorporated Balloon expandable plaque cutting device
WO2006074256A1 (en) * 2005-01-05 2006-07-13 Cook Incorporated Angioplasty cutting device and apparatus for treating a stenotic lesion in a body vessel
US7478465B1 (en) 2005-01-10 2009-01-20 Boston Scientific Scimed, Inc. Method of securing a restraining member on a medical device
US7204464B2 (en) 2005-01-21 2007-04-17 Boston Scientific Scimed, Inc. Medical wire holder
US8480629B2 (en) 2005-01-28 2013-07-09 Boston Scientific Scimed, Inc. Universal utility board for use with medical devices and methods of use
US20060184191A1 (en) 2005-02-11 2006-08-17 Boston Scientific Scimed, Inc. Cutting balloon catheter having increased flexibility regions
US20060229658A1 (en) * 2005-04-07 2006-10-12 Stivland Timothy M Embolic protection filter with reduced landing zone
US20060247674A1 (en) * 2005-04-29 2006-11-02 Roman Ricardo D String cutting balloon
US20060282115A1 (en) * 2005-06-09 2006-12-14 Abrams Robert M Thin film vessel occlusion device
US20070005097A1 (en) * 2005-06-20 2007-01-04 Renati Richard J Intravascular filter
US7708753B2 (en) 2005-09-27 2010-05-04 Cook Incorporated Balloon catheter with extendable dilation wire
WO2007053728A1 (en) * 2005-11-01 2007-05-10 Cook Incorporated Angioplasty cutting device and method
US20070185525A1 (en) * 2006-02-07 2007-08-09 White Bradley R Floating on the wire filter wire
US20070239198A1 (en) * 2006-04-03 2007-10-11 Boston Scientific Scimed, Inc. Filter and wire with distal isolation
US20070265655A1 (en) * 2006-05-09 2007-11-15 Boston Scientific Scimed, Inc. Embolic protection filter with enhanced stability within a vessel
EP2026707A2 (en) * 2006-05-15 2009-02-25 Applied Medical Resources Corporation Dilatation catheter assembly with bipolar cutting element
US20070276419A1 (en) 2006-05-26 2007-11-29 Fox Hollow Technologies, Inc. Methods and devices for rotating an active element and an energy emitter on a catheter
US20080228139A1 (en) 2007-02-06 2008-09-18 Cook Incorporated Angioplasty Balloon With Concealed Wires
US8323307B2 (en) 2007-02-13 2012-12-04 Cook Medical Technologies Llc Balloon catheter with dilating elements
US8216209B2 (en) 2007-05-31 2012-07-10 Abbott Cardiovascular Systems Inc. Method and apparatus for delivering an agent to a kidney
US20080300610A1 (en) * 2007-05-31 2008-12-04 Cook Incorporated Device for treating hardened lesions and method of use thereof
US8551129B2 (en) * 2007-11-14 2013-10-08 Todd P. Lary Treatment of coronary stenosis
US11589880B2 (en) 2007-12-20 2023-02-28 Angiodynamics, Inc. System and methods for removing undesirable material within a circulatory system utilizing during a surgical procedure
US10517617B2 (en) 2007-12-20 2019-12-31 Angiodynamics, Inc. Systems and methods for removing undesirable material within a circulatory system utilizing a balloon catheter
US8784440B2 (en) 2008-02-25 2014-07-22 Covidien Lp Methods and devices for cutting tissue
JP5778427B2 (en) 2008-03-13 2015-09-16 クック・メディカル・テクノロジーズ・リミテッド・ライアビリティ・カンパニーCook Medical Technologies Llc Incision balloon with connector and expansion element
US8192451B2 (en) * 2008-06-05 2012-06-05 Cardiovascular Systems, Inc. Cutting and coring atherectomy device and method
US20100010521A1 (en) * 2008-07-10 2010-01-14 Cook Incorporated Cutting balloon with movable member
CA2739665C (en) 2008-10-13 2018-01-02 Tyco Healthcare Group Lp Devices and methods for manipulating a catheter shaft
US8444669B2 (en) 2008-12-15 2013-05-21 Boston Scientific Scimed, Inc. Embolic filter delivery system and method
RU2509537C2 (en) 2009-04-29 2014-03-20 ТАЙКО ХЕЛСКЕА ГРУП эЛПи Methods and devices for tissue cutting and cleansing
US8192452B2 (en) * 2009-05-14 2012-06-05 Tyco Healthcare Group Lp Easily cleaned atherectomy catheters and methods of use
EP2509519B1 (en) * 2009-12-11 2019-08-07 Covidien LP Material removal device having improved material capture efficiency
US8348987B2 (en) * 2009-12-22 2013-01-08 Cook Medical Technologies Llc Balloon with scoring member
CA2800920C (en) 2010-06-14 2015-04-14 Covidien Lp Material removal device
US10039900B2 (en) * 2010-09-07 2018-08-07 Angiodynamics, Inc. Fluid delivery and treatment device and method of use
AU2011319797B2 (en) 2010-10-28 2015-04-09 Covidien Lp Material removal device and method of use
CA2817213C (en) 2010-11-11 2016-06-14 Covidien Lp Flexible debulking catheters with imaging and methods of use and manufacture
US9055964B2 (en) 2011-03-15 2015-06-16 Angio Dynamics, Inc. Device and method for removing material from a hollow anatomical structure
EP2750862B1 (en) 2011-09-01 2016-07-06 Covidien LP Catheter with helical drive shaft and methods of manufacture
US10342699B2 (en) 2012-08-03 2019-07-09 J.D. Franco & Co., Llc Systems and methods for treating eye diseases
US9579157B2 (en) 2012-09-13 2017-02-28 Covidien Lp Cleaning device for medical instrument and method of use
US9943329B2 (en) 2012-11-08 2018-04-17 Covidien Lp Tissue-removing catheter with rotatable cutter
US10286190B2 (en) 2013-12-11 2019-05-14 Cook Medical Technologies Llc Balloon catheter with dynamic vessel engaging member
CN104906682A (en) 2014-01-24 2015-09-16 史蒂文·沙勒布瓦 Articulating balloon catheter and method for using the same
WO2015200702A1 (en) 2014-06-27 2015-12-30 Covidien Lp Cleaning device for catheter and catheter including the same
US10314667B2 (en) 2015-03-25 2019-06-11 Covidien Lp Cleaning device for cleaning medical instrument
US10292721B2 (en) 2015-07-20 2019-05-21 Covidien Lp Tissue-removing catheter including movable distal tip
US10314664B2 (en) 2015-10-07 2019-06-11 Covidien Lp Tissue-removing catheter and tissue-removing element with depth stop
WO2018140371A1 (en) 2017-01-25 2018-08-02 Rmvidlund Llc Blood vessel access and closure devices and related methods of use
CN110573099B (en) 2017-05-03 2023-01-03 美敦力瓦斯科尔勒公司 Tissue removal catheter
US11690645B2 (en) 2017-05-03 2023-07-04 Medtronic Vascular, Inc. Tissue-removing catheter
WO2019240676A2 (en) * 2017-08-31 2019-12-19 T.C. İstanbul Aydin Uni̇versi̇tesi̇ Coronary plaque liquefaction/cleaning catheter
US10779929B2 (en) 2017-10-06 2020-09-22 J.D. Franco & Co., Llc Treating eye diseases by deploying a stent
US10758254B2 (en) 2017-12-15 2020-09-01 J.D. Franco & Co., Llc Medical systems, devices, and related methods
RU2701412C1 (en) * 2018-05-24 2019-09-26 Антон Сергеевич Кузнецов Method of removing atherosclerotic plaques and device for its implementation
US11172946B2 (en) 2018-10-26 2021-11-16 Progressive NEURO, Inc. Apparatus, system, and method for vasculature obstruction removal
US11197685B2 (en) 2018-11-15 2021-12-14 Progressive NEURO, Inc. Apparatus, system, and method for vasculature obstruction removal
US11253279B2 (en) 2018-11-15 2022-02-22 Progressive NEURO, Inc. Apparatus, system, and method for vasculature obstruction removal
US11357534B2 (en) 2018-11-16 2022-06-14 Medtronic Vascular, Inc. Catheter
US10668258B1 (en) 2018-12-31 2020-06-02 J.D. Franco & Co., Llc Intravascular devices, systems, and methods to address eye disorders
US11284913B2 (en) 2019-01-08 2022-03-29 Progressive NEURO, Inc. Apparatus, system, and method for vasculature obstruction removal
US11819236B2 (en) 2019-05-17 2023-11-21 Medtronic Vascular, Inc. Tissue-removing catheter
US11648020B2 (en) 2020-02-07 2023-05-16 Angiodynamics, Inc. Device and method for manual aspiration and removal of an undesirable material
WO2023110128A1 (en) * 2021-12-17 2023-06-22 Clearstream Technologies Limited Catheter device for extracting an occlusion from a blood vessel

Citations (9)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US1167014A (en) * 1915-06-25 1916-01-04 William R O'brien Veterinary surgical instrument.
US2505358A (en) * 1949-04-20 1950-04-25 Sklar Mfg Co Inc J Double-cutting biopsy bistoury
US2541691A (en) * 1949-06-24 1951-02-13 Clarence D Eicher Embalmer's drainage instrument
US2730101A (en) * 1954-02-23 1956-01-10 Roy D Hoffman Teat bistoury with expansible cutter knives
US3472230A (en) * 1966-12-19 1969-10-14 Fogarty T J Umbrella catheter
SU764684A1 (en) * 1978-01-31 1980-09-25 Челябинский государственный медицинский институт Trap filter
US4273128A (en) * 1980-01-14 1981-06-16 Lary Banning G Coronary cutting and dilating instrument
US4696667A (en) * 1986-03-20 1987-09-29 Helmut Masch Intravascular catheter and method
US4765332A (en) * 1986-07-14 1988-08-23 Medinnovations, Inc. Pullback atherectomy catheter system

Family Cites Families (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4207874A (en) * 1978-03-27 1980-06-17 Choy Daniel S J Laser tunnelling device

Patent Citations (9)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US1167014A (en) * 1915-06-25 1916-01-04 William R O'brien Veterinary surgical instrument.
US2505358A (en) * 1949-04-20 1950-04-25 Sklar Mfg Co Inc J Double-cutting biopsy bistoury
US2541691A (en) * 1949-06-24 1951-02-13 Clarence D Eicher Embalmer's drainage instrument
US2730101A (en) * 1954-02-23 1956-01-10 Roy D Hoffman Teat bistoury with expansible cutter knives
US3472230A (en) * 1966-12-19 1969-10-14 Fogarty T J Umbrella catheter
SU764684A1 (en) * 1978-01-31 1980-09-25 Челябинский государственный медицинский институт Trap filter
US4273128A (en) * 1980-01-14 1981-06-16 Lary Banning G Coronary cutting and dilating instrument
US4696667A (en) * 1986-03-20 1987-09-29 Helmut Masch Intravascular catheter and method
US4765332A (en) * 1986-07-14 1988-08-23 Medinnovations, Inc. Pullback atherectomy catheter system

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
See also references of EP0356507A4 *

Cited By (12)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0511323A1 (en) * 1990-11-16 1992-11-04 Berkshire Res & Dev Inc Adjustable intra-luminal valvulotome.
EP0511323A4 (en) * 1990-11-16 1994-01-12 Berkshire Research & Development, Inc.
US6336934B1 (en) 1997-11-07 2002-01-08 Salviac Limited Embolic protection device
US6432122B1 (en) 1997-11-07 2002-08-13 Salviac Limited Embolic protection device
US6887256B2 (en) 1997-11-07 2005-05-03 Salviac Limited Embolic protection system
US8852226B2 (en) 1997-11-07 2014-10-07 Salviac Limited Vascular device for use during an interventional procedure
US6565591B2 (en) 2000-06-23 2003-05-20 Salviac Limited Medical device
US9687267B2 (en) 2009-12-02 2017-06-27 Covidien Lp Device for cutting tissue
US10499947B2 (en) 2009-12-02 2019-12-10 Covidien Lp Device for cutting tissue
US11304753B2 (en) 2019-09-13 2022-04-19 Alleviant Medical, Inc. Systems, devices, and methods for forming an anastomosis
US11612432B2 (en) 2019-09-13 2023-03-28 Alleviant Medical, Inc. Systems, devices, and methods for forming an anastomosis
US11871987B2 (en) 2019-09-13 2024-01-16 Alleviant Medical, Inc. Systems, devices, and methods for forming an anastomosis

Also Published As

Publication number Publication date
US4886061A (en) 1989-12-12
EP0356507A1 (en) 1990-03-07
JPH02503161A (en) 1990-10-04
EP0356507A4 (en) 1990-09-12

Similar Documents

Publication Publication Date Title
US4886061A (en) Expandable pullback atherectomy catheter system
US4765332A (en) Pullback atherectomy catheter system
US4898575A (en) Guide wire following tunneling catheter system and method for transluminal arterial atherectomy
US7951161B2 (en) Atherectomy system having a variably exposed cutter
EP0316796B1 (en) Intravascular ultrasonic catheter probe for treating intravascular blockage
JP3321165B2 (en) Improved venous valve cutter
US6306151B1 (en) Balloon with reciprocating stent incisor
EP0635242B1 (en) Thrombectomy apparatus
US6632230B2 (en) Ablation system with catheter clearing abrasive
EP0189329A2 (en) A tunneling catheter system for transluminal arterial angioplasty
US6258109B1 (en) Guidewire bearing to prevent darting
US5934284A (en) Method for increasing blood flow in vessels
US5728123A (en) Balloon actuated catheter
JP2549823B2 (en) Cutter for atherectomy catheter
US4962755A (en) Method for performing endarterectomy
US5842479A (en) Method of restoring reduced or absent blood flow capacity
JPH05501074A (en) Improved distal atherectomy catheter
JPH07409A (en) Device and method for incising arteriostenosis part
JPH10502567A (en) Automatic centering barbarotome
WO2000009195A1 (en) Percutaneous in-situ coronary bypass method and apparatus
JPH02206452A (en) Method and intrument for removing affected tissue from body blood
JPH0576537A (en) Atherectomy instrument
JP2004506454A (en) Percutaneous and remote endarterectomy method and apparatus
AU618331B2 (en) Expandable pullback atherectomy catheter system
CN218484622U (en) Thrombectomy device

Legal Events

Date Code Title Description
AK Designated states

Kind code of ref document: A1

Designated state(s): AU DK FI JP KR NO

AL Designated countries for regional patents

Kind code of ref document: A1

Designated state(s): AT BE CH DE FR GB IT LU NL SE

WWE Wipo information: entry into national phase

Ref document number: 1989902987

Country of ref document: EP

WWP Wipo information: published in national office

Ref document number: 1989902987

Country of ref document: EP

WWR Wipo information: refused in national office

Ref document number: 1989902987

Country of ref document: EP

WWW Wipo information: withdrawn in national office

Ref document number: 1989902987

Country of ref document: EP