WO2006078884A2 - Devices, systems and methods for treating disorders of the ear, nose and throat - Google Patents
Devices, systems and methods for treating disorders of the ear, nose and throat Download PDFInfo
- Publication number
- WO2006078884A2 WO2006078884A2 PCT/US2006/002004 US2006002004W WO2006078884A2 WO 2006078884 A2 WO2006078884 A2 WO 2006078884A2 US 2006002004 W US2006002004 W US 2006002004W WO 2006078884 A2 WO2006078884 A2 WO 2006078884A2
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- balloon
- catheter
- ostium
- guidewire
- shaft
- Prior art date
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B17/12027—Type of occlusion
- A61B17/1204—Type of occlusion temporary occlusion
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F11/00—Methods or devices for treatment of the ears or hearing sense; Non-electric hearing aids; Methods or devices for enabling ear patients to achieve auditory perception through physiological senses other than hearing sense; Protective devices for the ears, carried on the body or in the hand
- A61F11/20—Ear surgery
- A61F11/202—Surgical middle-ear ventilation or drainage, e.g. permanent; Implants therefor
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B17/12027—Type of occlusion
- A61B17/1204—Type of occlusion temporary occlusion
- A61B17/12045—Type of occlusion temporary occlusion double occlusion, e.g. during anastomosis
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B17/12099—Occluding by internal devices, e.g. balloons or releasable wires characterised by the location of the occluder
- A61B17/12104—Occluding by internal devices, e.g. balloons or releasable wires characterised by the location of the occluder in an air passage
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B17/12131—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device
- A61B17/12136—Balloons
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/1604—Chisels; Rongeurs; Punches; Stamps
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/1604—Chisels; Rongeurs; Punches; Stamps
- A61B17/1606—Chisels; Rongeurs; Punches; Stamps of forceps type, i.e. having two jaw elements moving relative to each other
- A61B17/1608—Chisels; Rongeurs; Punches; Stamps of forceps type, i.e. having two jaw elements moving relative to each other the two jaw elements being linked to two elongated shaft elements moving longitudinally relative to each other
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/1662—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
- A61B17/1679—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the ear
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/1662—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
- A61B17/1688—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the sinus or nose
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/24—Surgical instruments, devices or methods, e.g. tourniquets for use in the oral cavity, larynx, bronchial passages or nose; Tongue scrapers
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
- A61B17/32002—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes with continuously rotating, oscillating or reciprocating cutting instruments
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/3205—Excision instruments
- A61B17/3207—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions
- A61B17/32075—Pullback cutting; combined forward and pullback cutting, e.g. with cutters at both sides of the plaque
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/06—Devices, other than using radiation, for detecting or locating foreign bodies ; determining position of probes within or on the body of the patient
- A61B5/065—Determining position of the probe employing exclusively positioning means located on or in the probe, e.g. using position sensors arranged on the probe
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B50/00—Containers, covers, furniture or holders specially adapted for surgical or diagnostic appliances or instruments, e.g. sterile covers
- A61B50/10—Furniture specially adapted for surgical or diagnostic appliances or instruments
- A61B50/13—Trolleys, e.g. carts
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B50/00—Containers, covers, furniture or holders specially adapted for surgical or diagnostic appliances or instruments, e.g. sterile covers
- A61B50/10—Furniture specially adapted for surgical or diagnostic appliances or instruments
- A61B50/15—Mayo stands; Tables
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B50/00—Containers, covers, furniture or holders specially adapted for surgical or diagnostic appliances or instruments, e.g. sterile covers
- A61B50/20—Holders specially adapted for surgical or diagnostic appliances or instruments
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/10—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges for stereotaxic surgery, e.g. frame-based stereotaxis
- A61B90/14—Fixators for body parts, e.g. skull clamps; Constructional details of fixators, e.g. pins
- A61B90/16—Bite blocks
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/10—Balloon catheters
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B10/00—Other methods or instruments for diagnosis, e.g. instruments for taking a cell sample, for biopsy, for vaccination diagnosis; Sex determination; Ovulation-period determination; Throat striking implements
- A61B10/02—Instruments for taking cell samples or for biopsy
- A61B10/06—Biopsy forceps, e.g. with cup-shaped jaws
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3478—Endoscopic needles, e.g. for infusion
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00238—Type of minimally invasive operation
- A61B2017/00243—Type of minimally invasive operation cardiac
- A61B2017/00247—Making holes in the wall of the heart, e.g. laser Myocardial revascularization
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
- A61B2017/003—Steerable
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B2017/320004—Surgical cutting instruments abrasive
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B2017/348—Means for supporting the trocar against the body or retaining the trocar inside the body
- A61B2017/3482—Means for supporting the trocar against the body or retaining the trocar inside the body inside
- A61B2017/3484—Anchoring means, e.g. spreading-out umbrella-like structure
- A61B2017/3486—Balloon
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B2017/348—Means for supporting the trocar against the body or retaining the trocar inside the body
- A61B2017/3482—Means for supporting the trocar against the body or retaining the trocar inside the body inside
- A61B2017/3484—Anchoring means, e.g. spreading-out umbrella-like structure
- A61B2017/3488—Fixation to inner organ or inner body tissue
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
- A61B2018/00345—Vascular system
- A61B2018/00351—Heart
- A61B2018/00392—Transmyocardial revascularisation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
- A61B2034/2046—Tracking techniques
- A61B2034/2051—Electromagnetic tracking systems
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/36—Image-producing devices or illumination devices not otherwise provided for
- A61B90/361—Image-producing devices, e.g. surgical cameras
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/95—Instruments specially adapted for placement or removal of stents or stent-grafts
- A61F2/958—Inflatable balloons for placing stents or stent-grafts
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2250/0058—Additional features; Implant or prostheses properties not otherwise provided for
- A61F2250/0067—Means for introducing or releasing pharmaceutical products into the body
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/10—Balloon catheters
- A61M2025/1043—Balloon catheters with special features or adapted for special applications
- A61M2025/105—Balloon catheters with special features or adapted for special applications having a balloon suitable for drug delivery, e.g. by using holes for delivery, drug coating or membranes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/10—Balloon catheters
- A61M2025/1043—Balloon catheters with special features or adapted for special applications
- A61M2025/1052—Balloon catheters with special features or adapted for special applications for temporarily occluding a vessel for isolating a sector
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/0067—Catheters; Hollow probes characterised by the distal end, e.g. tips
- A61M25/0068—Static characteristics of the catheter tip, e.g. shape, atraumatic tip, curved tip or tip structure
- A61M25/007—Side holes, e.g. their profiles or arrangements; Provisions to keep side holes unblocked
Definitions
- the present invention relates generally to medical devices, systems and methods and more particularly to minimally invasive devices, systems and methods for treating sinusitis and other ear, nose & throat disorders.
- Surgical treatments for sinusitis and other disorders of the ear, nose and throat have evolved slowly over the years.
- functional endoscopic sinus surgery FESS
- FESS functional endoscopic sinus surgery
- an endoscope is inserted into the nose and, under visualization through the endoscope, the surgeon may remove diseased or hypertrophic tissue or bone and may enlarge the ostia of the sinuses to restore normal drainage of the sinuses.
- FESS procedures can be effective in the treatment of sinusitis and for the removal of tumors, polyps and other aberrant growths from the nose.
- Data from a preoperative CT scan or other anatomical mapping procedure is downloaded into a computer and special sensors known as localizers are attached to the surgical instruments.
- localizers are attached to the surgical instruments.
- the surgeon can ascertain, in three dimensions, the precise position of each localizer-equipped surgical instrument at any given point in time.
- This information coupled with the visual observations made through the standard endoscope, can help the surgeon to carefully position the surgical instruments to avoid creating CSF leaks and to avoid causing damage to nerves or other critical structures.
- FESS continues to be the gold standard therapy for severe sinuses, it has several shortfalls. Often patients complain of the post-operative pain and bleeding associated with the procedure, and a significant subset of patients remain symptomatic even after multiple surgeries. Since FESS is considered an option only for the most severe cases (those showing abnormalities under CT scan), a large population of patients exist that can neither tolerate the prescribed medications nor be considered candidates for surgery. Further, because the methodologies to assess sinus disease are primarily static measurements (CT, MRI), patients whose symptoms are episodic are often simply offered drug therapy when in fact underlying mechanical factors may play a significant role. To date, there is no mechanical therapy offered for these patients, and even though they may fail pharmaceutical therapies, no other course of action is indicated. This leaves a large population of patients in need of relief, unwilling or afraid to take steroids, but not sick enough to qualify for surgery.
- United States patent publication number 2004/0064150 A1 discloses balloon catheters formed of a stiff hypotube to be pushed into a sinus.
- the balloon catheters have a stiff hypotube with a fixed pre-set angle that enables them to be pushed into the sinus.
- the prior art has not provided catheters, devices, systems and methods that are optimal for minimally invasive treatment of sinusitis, mucocysts, tumors, infections, hearing disorders, fractures, choanal atresia or other conditions of the paranasal sinuses, Eustachian tubes, Lachrymal ducts and other ear, nose, throat or mouth structures.
- the present invention provides methods, devices and systems for diagnosing and/or treating sinusitis, mucocysts, tumors, infections, hearing disorders, fractures, choanal atresia or other conditions of the paranasal sinuses, Eustachian tubes, llachrymal ducts, ducts of salivary glands and other ear, nose, throat or mouth structures.
- one or more flexible catheters or other flexible elongate devices as described herein are inserted in to the nose, nasopharynx, paranasal sinus, Eustachian tubes, middle ear, lachrymal ducts, ducts of salvary glands or other anatomical passageways of the ear, nose, throat or mouth to perform an interventional or surgical procedure.
- Examples of procedures that may be performed using these flexible catheters or other flexible elongate devices include but are not limited to: delivering contrast medium; performing an imaging study, delivering a therapeutically effective amount of a therapeutic substance; implanting a stent or a tissue remodeling device, substance delivery implant or other therapeutic apparatus; cutting, ablating, debulking, cauterizing, heating, dilating or otherwise modifying tissue such as nasal polyps, abberant or enlarged tissue, abnormal tissue, etc.; grafting or implanting cells or tissue; reducing, setting, affixing or otherwise treating a fracture; delivering a gene or gene therapy preparation; cutting, ablating, debulking, cauterizing, heating, freezing, lasing, forming an osteotomy or trephination in or otherwise modifying bony or cartilaginous tissue within paranasal sinus, nasopharynx, Eustachian tube, middle ear, Lachrymal duct or elsewhere within the ear, nose, throat or mouth; remodeling or changing the shape, size
- novel access, stabilizing and occluding devices may be used to facilitate insertion of working devices such as endoscopes, guidewires, catheters (e.g. balloon catheters), tissue cutting or remodeling devices, sizing devices, biopsy devices, image-guided devices containing sensors or transmitters, electrosurgical devices, energy emitting devices, devices for injecting diagnostic or therapeutic agents, devices for implanting devices such as stents, substance eluting devices, substance delivery implants, etc. into the paranasal sinuses and other structures in the ear, nose, throat or mouth for performing some or all of the procedures described herein.
- working devices such as endoscopes, guidewires, catheters (e.g. balloon catheters), tissue cutting or remodeling devices, sizing devices, biopsy devices, image-guided devices containing sensors or transmitters, electrosurgical devices, energy emitting devices, devices for injecting diagnostic or therapeutic agents, devices for implanting devices such as stents, substance eluting devices, substance delivery implants, etc. into the paranasal sinuses
- imaging and navigation technologies may also be referenced by computer directly or indirectly to pre-existing or simultaneously created 3-D or 2-D data sets which help the doctor place the devices within the appropriate region of the anatomy.
- elongate guide e.g., a wire, rod, probe, guidewire, flexible member, malleable member, tube, cannula, catheter, stylets, etc.
- a dilator e.g., a dilation catheter, balloon catheter, expandable member, etc.
- the dilation of the natural ostium may, in at least some cases, result in breaking or rearrangement of bone that underlies the mucosa of the ostium.
- a method for treating a mucocyst or other or other flowable-substance-containing structure located within a paranasal sinus comprising the steps of A) providing a penetrator that is useable to form an opening in the mucocyst or other flowable-substance-containing structure; B) providing a compressor useable to compress the mucocyst or other flowable-substance-containing structure after an opening has been formed therein by the penetrator such that its contents will be forced out of the opening formed by the penetrator; C) advancing the penetrator into the paranasal sinus and using the penetrator to form an opening in the mucocyst or other flowable-substance-containing structure; and D) positioning the compressor in the paranasal sinus and using the compressor to compress the mucocyst or other flowable-substance- containing structure such that its contents will be forced out of the opening formed by the penetrator.
- a method for dilating a Eustachian tube in a human or animal subject said method domprising the steps of: A) providing a a guide member (e.g., a guidewire) that is insertable through the nose and is advanceable into the Eustachian tube through the pharyngeal ostium of the Eustachian tube and a dilator that is advanceable over the guidewire and useable to dilate the Eustachian tube; B) inserting the guidewire into the Eustachian tube; C) advancing the dilator over the guide member and into the Eustachian tube; and D) using the dilator to dilate the Eustachian tube.
- a guide member e.g., a guidewire
- the guide member e.g., guidewire
- an anchor e.g., a balloon
- marker(s) such as radiopaque markers may be provided on the guide memner and/or may be inserted into the adjacent ear canal next to the tympanic membrane to allow the operator to clearly view the location at which the Eustachian tube enters the middle ear, thereby further guarding against inadvertent advancement of the device(s) into the middle ear.
- a method for modifying a bony structure within the nose or paranasal sinus human or animal subject comprising the steps of: A) providing a direct viewing apparatus (e.g., a scope, rigid scope, flexible scope, camera, video camera, intranasal camera similar to an intraoral camera but sized for insertion into the nares or nasal cavity); B) inserting the direct viewing apparatus into the nose; C) advancing a guide device to a first location within the nasal cavity or paranasal sinus under direct viewing using the direct viewing apparatus; D) providing an indirect viewing apparatus (e.g., an imaging device, fluoroscope, fluoroscope with C-arm, magnetic resonance imaging device, tomographic device, CT scanner, electromagnetic navigational and/or guidance system, PET scanner, combination CT/PET scanner and optical coherence tomography device, etc.); E) advancing a working device (e.g., an endoscope, wire, probe, needle, catheter, balloon catheter, di
- a method for determining the position of a device within the body of a human or animal subject comprising the steps of A) providing a device having an electromagnetic element (e.g., a sensor or electromagnetic coil) thereon; B) providing a plurality of fiducial markers which emit electromagnetic energy and an attachment substance or apparatus for removably attaching the fiducial markers to teeth, bones or other anatomical structures; C) using the attachment substance or apparatus to removably attach the fiducial markers to teeth, bones or other anatomical structures of the subject's body; D)performing an imaging procedure to obtain an image of a portion of the subject's body including the fiducial markers; and, thereafter, E) advancing the device into the subject's body and detecting the electromagnetic element on the device as well as the electromagnetic energy emitted by the fiducial markers; and F) using the image obtained in Step D and the information dectected in Step E to determine the current position of the device within the subject's body.
- an electromagnetic element e.g., a sensor or electromagnetic coil
- Figure 1 shows a schematic diagram of the general working environment of an example of a system for catheter-based minimally invasive sinus surgery being used to perform a sinus surgery on a human patient.
- Figure 1A shows a magnified view of region 1A of Figure 1 showing a system for catheter-based minimally invasive sinus surgery of a human patient.
- Figure 1 B shows a perspective view of a treatment tray for catheter- based minimally invasive sinus surgery of a human patient.
- Figure 2A shows a portion of a stabilizing device comprising a stabilizing member.
- Figures 2B-2D show various alternate embodiments of stabilizing member of Figure 2A.
- Figure 2E-2G show perspective views of various embodiments of inflatable occluding devices.
- Figures 3A-3D' show embodiments of stabilizing members comprising an adhesive element.
- Figures 4A and 4B show perspective views of an occluding device in deflated and inflated states respectively.
- Figure 5 shows a perspective view of a guide catheter comprising a plastically deformable (malleable) region.
- Figure 6 shows a perspective view of a guide catheter comprising a lubricious layer.
- Figure 6A shows a crossectional view of the guide catheter of Figure 6 through the plane 6A-6A.
- Figure 7 shows perspective view of an embodiment of a guide catheter comprising a straight hypotube.
- Figure 7A shows a crossection of the guide catheter of Figure 7 through plane 7A-7A.
- Figure 8 shows perspective view of a second embodiment of a guide catheter comprising a straight hypotube.
- Figure 8A shows a crossection of the guide catheter of Figure 8 through plane 8A-8A.
- Figure 8B shows a crossection of the guide catheter of Figure 8 through plane 8B-8B.
- Figure 8C shows a perspective view of an embodiment of a guide catheter comprising a curved or bent hypotube to facilitate access to the frontal sinuses.
- Figure 8D shows a perspective view of a second embodiment of a guide catheter comprising a curved or bent hypotube to facilitate access to the sphenoid sinuses.
- Figure 8E shows a perspective view of an embodiment of a guide catheter comprising two bent or angled or curved regions to facilitate access to the maxillary sinuses.
- Figure 8F shows a perspective view of a second embodiment of a guide catheter comprising two bent or angled or curved regions and a hypotube to facilitate access to the maxillary sinuses.
- Figure 8G shows a coronal section of the paranasal anatomy showing a method of accessing a maxillary sinus ostium using the guide catheter of Figure 8F.
- Figure 8H shows a sagittal section of the paranasal anatomy showing the method of Figure 8G to access a maxillary sinus ostium using the guide catheter of Figure 8F.
- Figure 81 shows a perspective view of an example of a guide catheter comprising a common proximal portion and a plurality of detachable distal tips.
- Figure 9 shows a perspective view of a set of devices to dilate or modify ostia or other openings in the ear, nose, throat or mouth structures.
- Figure 10 shows a perspective view of a probing device.
- Figures 10A - 10C show various steps of a method of using the probing device shown in Figure 10 to access an anatomical region.
- Figure 11 A shows a perspective view of a first embodiment of a dual balloon catheter that can be used to perform a diagnostic or therapeutic procedure.
- Figure 11 B shows a perspective view of a second embodiment of a dual balloon catheter that can be used to perform a diagnostic or therapeutic procedure.
- Figures 11C - 11E show perspective views of third, fourth and fifth embodiments respectively of dual balloon catheters for dilating an anatomical region.
- Figures 11 F - 11J show the various steps of a method of dilating an anatomical region using the catheter of Figure 11D.
- Figures 12A - 12C show the various steps of a method of deploying a stent in the ear, nose, throat or mouth using a working catheter comprising a locating mechanism.
- Figures 12D - 12H show the various steps of a method of dilating an anatomical opening in the ear, nose, throat or mouth using a combination of a dilating device and an anchoring device.
- Figure 13 shows a perspective view of a dilating device comprising an electrode element to reduce restenosis.
- Figure 14 shows a perspective view of an embodiment of a balloon catheter comprising a sizing balloon and a dilating balloon.
- Figure 14A shows a crossectional view through the plane 14A-14A of
- Figures 14B - 14D show the various steps of dilating an anatomical opening using the balloon catheter in Figure 14.
- Figure 15 shows a perspective view of a balloon catheter comprising a sleeve for delivering diagnostic or therapeutic agents.
- Figure 15A shows a crossectional view through plane 15A-15A of Figure 15.
- Figure 16 shows a perspective view of a balloon catheter comprising one or more agent delivery reservoirs.
- Figure 16A shows a crossectional view through plane 16A-16A of Figure
- Figure 17 shows a perspective view of a balloon catheter comprising a balloon comprising one or more micropores.
- Figure 17A shows a crossectional view through the plane 17A-17A of Figure 17.
- Figure 18 shows a balloon catheter comprising a balloon having an outer coating of diagnostic or therapeutic agents.
- Figures 18A - 18C show the steps of a method of using the balloon catheter of Figure 18 to dilate an anatomical region.
- Figure 19A shows a perspective view of a lavage catheter.
- Figure 19B shows a crossectional view through the plane 19B - 19B of Figure 19A.
- Figure 19C shows the method of operation of lavage catheter of Figure 19A to lavage an anatomical region.
- Figure 2OA shows a perspective view of the distal end of a second embodiment of a lavage catheter.
- Figure 2OB shows a perspective view of the distal end of the lavage catheter of Figure 2OA introduced in an anatomical region.
- Figure 2OC shows an embodiment of the lavage cattheter of Figure 2OA being used to lavage an anatomical region.
- Figure 2OD shows a sagittal section of a human head showing the general working environment of the lavage devices of Figures 2OA - 2OC.
- Figure 21 shows a perspective view of a cutting device comprising cutting jaws.
- Figure 21A shows a perspective view of the distal region of the cutting device of Figure 21 wherein the cutting jaws are closed as seen from the distal end of the cutting device.
- Figure 21 B shows a perspective view of one embodiment of the cutting jaws of the cutting device of Figure 21.
- Figure 21C shows a crossectional view of the cutting device in Figure 21 through cutting plane 21C-21C.
- Figure 22A shows a perspective view of an alternate embodiment of a device comprising cutting or gripping jaws.
- Figure 22B shows a perspective view of the device of Figure 22A wherein the cutting or gripping jaws of the cutting device are in a closed configuration.
- Figures 23A - 23C show the various steps of a method of puncturing an anatomical region using a flexible, rotating drill shaft.
- Figure 23D shows a sectional view of an embodiment of a drilling device.
- Figures 24A - 24C show a sagittal section of an Ethmoid sinus showing various methods of treating Ethmoid sinus diseases by a minimally invasive approach.
- Figures 24A' - 24A"" show a method of creating drainage channels for sinus secretions in Ethmoid sinus.
- Figure 25A shows a perspective view of an embodiment of an ostium enlarger and/or microshaver.
- Figure 25B shows one embodiment of the device of F Figure 25A being used to remove tissue or matter.
- Figure 25C shown another embodiment of the device of Figure 25A being used to shave tissue or matter.
- Figure 25D is an exploded view of the device of Figure 25C.
- Figures 26A - 26C show various steps of a method of treating a mucocyst by a puncturing needle and a balloon catheter.
- Figures 27A - 27B show various steps of a method of treating a mucocyst by a balloon catheter comprising a deployable puncturing needle.
- Figures 28A - 28C show various embodiments of catheters comprising agent delivery needles.
- Figure 29A illustrates an embodiment of a displacement catheter to displace and remove secretions in an anatomical region.
- Figure 29B shows a sectional view of an anatomical region showing a method of displacing secretions by the displacement catheter of Figure 29A.
- Figure 30 shows a perspective view of an embodiment of an ultrasonic drilling device.
- Figures 3OA - 3OB show a sectional view of an anatomical region showing a method of expanding an anatomical opening using the drilling device of Figure 30.
- Figure 31 shows a sectional view of an embodiment of a catheter for providing an internal cast for fractured bony cavities.
- Figure 31 A shows a crossection through the outer balloon in the catheter of Figure 31 through plane 31 A - 31 A.
- Figures 31 B - 31 D show various steps of a method of providing an internal cast for a fractured bony cavity using the catheter shown in Figure 31
- Figure 32 shows an embodiment of a surgical navigation system comprising electromagnetic sensors.
- Figure 32A shows an enlarged view of region 32A in Figure 32.
- Figure 33 shows a section of the anatomical region around a Eustachian tube (ET) showing a diagnostic or therapeutic procedure being performed by devices inserted through the pharyngeal ostium of the Eustachian tube.
- ET Eustachian tube
- Figure 33A shows an enlarged view of region 33A in Figure 33.
- Figure 33B shows a front view of a human head with a portion of the face removed to show an embodiment of a method of introducing a guidewire into a Eustachian tube.
- Figures 34A - 34D illustrate various examples of working elements that could be located on the diagnostic or therapeutic device in Figure 33.
- Figure 35 shows a perspective view of an embodiment of a guidewire comprising a sensor used for surgical navigation.
- Figure 35A shows an enlarged view of an embodiment of a low profile proximal region of the guidewire in Figure 35.
- Figure 35B shows a perspective view of a method of advancing a diagnostic or therapeutic device over the guidewire in Figure 35.
- Figure 35C shows a perspective view of an embodiment of a guidewire comprising a sensor having a diagnostic or therapeutic device preloaded on the guidewire.
- Figure 35D shows a perspective view of a second embodiment of a guidewire comprising a sensor having a diagnostic or therapeutic device preloaded on the guidewire.
- Figure 1 shows a schematic diagram of the general working environment of an example of a system for catheter-based minimally invasive sinus surgery being used to perform a sinus surgery on a human patient.
- the human patient is treated by a working device 10.
- Working device 10 may be connected to one or more auxiliary devices located on a treatment tray 12.
- a C-arm fluoroscope 14 provides fluoroscopic visualization of anatomical regions during the procedure.
- An instrument console 16 comprising one or more functional modules 18 may also be present. Examples of functional modules that can be used with the invention are: 1. Suction pump for delivering a controlled amount of negative pressure or vacuum to a suction device,
- Power module to supply power to drills or other electrical devices
- Storage modules for storing instruments, medications etc.
- Energy delivery module to provide radiofrequency, laser, ultrasound or other therapeutic energy to a surgical device
- Fluoroscope, MRI, CT, Video, Endoscope or Camera or other imaging modules to connect or interact with devices used during various diagnostic or therapeutic procedures
- Display module e.g. a LCD, CRT or Holographic screen to display data from various modules such as an endoscope, fluoroscope or other data or imaging module,
- Remote control module to enable an operator to control one or more parameters of one or more functional modules 18,
- Stabilization device for holding various apparatuses during the procedure which may include a stabilization arm, table, dip, intranasal or extranasal inflatable support or robotically controlled apparatus,
- Rotary drive module for rotating rotatable device such as a drill or auger (e.g., a motor having a rotation drive shaft or drive cable attached thereto.
- Instrument console module 16 can be controlled by console control means 20, e.g. a foot pedal controller, a remote controller etc. Instrument console 16 may be fitted with wheels to enable an operator to change the position of the instrument console 16 in an operating area. In one embodiment, instrument console module 16 and C-arm fluoroscope 14 are integrated in a single unit.
- Figure 1A shows a magnified view of region 1A of F Figure 1 showing a system for catheter-based minimally invasive sinus surgery of a human patient.
- a balloon catheter is used as an example of working device 10.
- Working device 10 has attachments for a variety of auxiliary devices such as a balloon inflation syringe 22, a guidewire 24 and a suction or irrigation tube 26.
- Working device 10 and the auxiliary devices may be detachably attached to treatment tray 12.
- Treatment tray 12 may comprise one or more treatment tray controllers 28 to control one or more treatment parameters.
- Treatment tray 12 may comprise one or more storage modules to store devices used during a surgery e.g. irrigation bottles, swabs etc.
- Figure 1B shows a perspective view of a treatment tray for catheter- based minimally invasive sinus surgery of a human patient.
- Treatment tray 12 comprises one or more device holders 30 to detachably hold devices during the surgery.
- device holders 30 are detachably attached to device holder slots 32 on treatment tray 12.
- the position of device holders 30 on treatment tray 12 can be changed by removing a device holder 30 from a device holder slot 32 and transferring to a new device holder slot 32.
- FIG 2A shows a portion of a stabilizing device 100 comprising a stabilizing member 102.
- Stabilizing member 102 comprises a lumen through which working device 10 can be introduced.
- stabilizing member 102 is located in a nostril.
- stabilizing member 102 may be located in other suitable regions of the head e.g. the nasal passages.
- Stabilizing member 102 may be oriented to stabilizing device 100 in a variety of orientations. Also, the stabilizing member can be used to stabilize more than one working device.
- Figures 2B-2D show various alternate embodiments of stabilizing member 102 of Figure 2A.
- Figure 2B shows an embodiment of a radially symmetrical stabilizing member 104, wherein the axis 106 of stabilizing member 104 is substantially parallel to the axis 110 of stabilizing device 100.
- Figure 2C shows an embodiment of a radially symmetrical stabilizing member 112.
- the axis 114 of stabilizing member 112 is substantially non-parallel to the axis 116 of stabilizing device 100.
- FIG. 2D shows an embodiment of a stabilizing member 118, wherein stabilizing member 118 comprises two lumens enclosing a first stabilizing device 120 and a second stabilizing device 122.
- Suitable materials that can be used for constructing the stabilizing members are:
- Foam materials such as polyurethane foam, polyvinyl chloride foam, Thermal-Reactive FoamTM etc.
- Inflatable members such as compliant or non-compliant balloons
- Moldable materials such as silicone rubber or wax
- Metals such as stainless steel or super-elastic or shape memory metals such as Nitinol
- Thermoplastic elastomers such as block copolymers e.g. styrene- butadiene-styrene (SBS) rubber or ionomers etc.
- SBS styrene- butadiene-styrene
- the stabilizing members may be pre-molded to a predefined shape.
- Figures 2E-2G show perspective views of various embodiments of inflatable occluding devices.
- Figure 2E shows a partial view of an occluding device 124 comprising an inflatable occluding member 126.
- Inflatable occluding member 126 may be made of compliant materials e.g. silicone rubber, or non- compliant materials e.g. polyethylene terephthalate (PET).
- Inflatable occluding member 126 can be inflated through an inflation port 127 located on the occluding device 124.
- Occluding device 124 can have one or more device insertion ports.
- the device insertion ports can be used to insert a variety of diagnostic or therapeutic devices such as endoscopes, guidewires, catheters etc.
- occluding device 124 has a first device insertion port 128 and a second device insertion port 130.
- the device insertion ports may comprise one or more flush ports.
- occluding device 124 comprises a first flush port 132 located on first device insertion port 128 and a second flush port 134 located on second device insertion port 130.
- Such an occluding device may be used for occluding one or two nostrils to provide a gas- tight or liquid-tight seal against the nostril or to stabilize devices that are passed through the device insertion ports on the occluding device.
- the inflatable occluding member may be made of variety of shapes.
- Figure 2F shows an occluding device 136 comprising an inflatable occluding member 138 of an elongated shape wherein the diameter of the inflatable occluding member 138 tapers along the length of occluding device 136.
- Inflatable occluding member 138 may also be spherical, disk shaped, cylindrical, conical etc.
- the inflatable occluding member may comprise a variety of surface features.
- Figure 2G shows an occluding device 140 comprising an inflatable occluding member 142. Inflatable occluding member comprises a series or parallel circular ribs on its surface.
- coatings e.g. friction increasing coatings, abrasion resisting coatings, puncture resisting coatings, conductive coatings, radiopaque coatings, echogenic coatings, thrombogenicity reducing coatings and drug releasing coatings etc.
- braids, grooves etc. may also be present on inflatable occluding member 142.
- Figures 3A - 3D 1 show embodiments of stabilizing members comprising an adhesive element.
- Figure 3A shows front view of an embodiment of a stabilizing member 200 comprising a pair of upper wings 202 and a pair of lower wings 204. In this embodiment, upper wings 202 are larger than lower wings 204.
- Stabilizing member 200 further comprises one or more orifices 206 through which one or more working devices can be introduced.
- Stabilizing member 200 is made of a light weight, flexible material that conforms to the contours of the patient's body. Examples of such materials are woven and non-woven fabrics, plastic films (e.g. polyvinylchloride films, polypropylene films etc.), cellulose, paper etc.
- Stabilizing member 200 may have a porous structure for increased transmission of water vapor produced in perspiration from the skin under stabilizing member 200.
- One surface of stabilizing member 200 is coated with an adhesive to enable stabilizing member 200 to adhere to a surface on a patient's body.
- a non-allergenic adhesive is used to minimize skin irritation. Examples of such adhesives are non-allergenic pressure-sensitive adhesives such as silicone pressure sensitive adhesives, rubber pressure sensitive adhesives and acrylic or hydrogel pressure sensitive adhesives.
- Stabilization member 200 may also be lubricated with a silicone or other biocompatible lubricant at the orifice to allow easier introduction and removal of devices.
- Stabilizing member 200 may be used to stabilize one or more working devices.
- Figure 3B shows a front view of stabilizing member 200 of Figure 3A with two working devices: a first working device 208 and a second working device 210.
- Figure 3C shows a front view of the stabilizing member 200 of Figure 3A with a single working device 212.
- Figure 3D shows a side view of stabilizing member 200 of Figure 3A attached to a patient's body.
- Upper wings 202 are attached on the nose of the patient.
- Lower wings 204 are attached above the upper lip of the patient.
- a working device 10 is introduced through the orifice 206 into the patient's nose.
- Figure 3D' shows a front view of stabilizing member 200 of Figure 3A attached to a patient's body.
- FIGS 4A and 4B show perspective views of an occluding device in deflated and inflated states respectively.
- Occluding device 300 comprises a shaft 302 and an inflatable balloon 304 located on distal region of shaft 302.
- Shaft 302 has a diameter D.sub.1 and inflatable balloon 304 has a diameter D.sub.2 in the deflated state, wherein D.sub.2 is greater then D.sub.1.
- Inflatable balloon 304 can be made of compliant materials e.g. polyurethane, silicone etc. or non-compliant materials e.g. polyethylene terephthalate etc.
- Inflatable balloon 304 can be inflated through balloon inflation port 306 located on proximal region of occluding device 300.
- Occluding device 300 further comprises a series of aspiration ports 308 located proximal to inflatable balloon 304. Aspiration ports 308 are connected to an aspiration lumen 310 to aspirate contents proximal to inflatable balloon 304.
- FIG. 5 shows a perspective view of a guide catheter comprising a plastically deformable (malleable) region.
- Guide catheter 400 comprises a shaft 402 comprising a malleable region 404 located on distal region of shaft 402.
- Shaft 402 may comprise stiffening elements e.g. a braid, hypotube etc.
- Malleable region 404 may comprise malleable metallic tubes, rods (e.g. rods embedded in shaft 402 etc.), wires etc. Examples of metals that can be used for constructing malleable region 404 are malleable stainless steel, fully annealed stainless steel, copper, aluminum etc.
- Guide catheter 400 further comprises a threaded luer 406 located on proximal end of shaft 402.
- malleable region 404 is located on distal end of guide catheter 400.
- Malleable region 404 can also be located on proximal region or any other intermediate region on shaft 402.
- Shaft 402 may also comprise more than one malleable regions.
- Such a design comprising one or more malleable regions can be used for any of the devices mentioned herein such as catheters with working elements, guide catheters, guide catheters with a pre-set shape, steerable guide catheters, steerable catheters, guidewires, guidewires with a pre-set shape, steerable guidewires, ports, introducers, sheaths or other diagnostic or therapeutic devices.
- Figure 6 shows a perspective view of a guide catheter comprising a lubricious layer.
- Guide catheter 500 comprises a shaft 502 comprising a threaded luer 504 located on the proximal end of the shaft 502.
- Figure 6A shows a crossectional view of the guide catheter of Figure 6 through the plane 6A-6A.
- Shaft 502 comprises a braid 506 embedded in the shaft.
- Shaft 502 further comprises a lubricious layer 508 located on the inner surface of shaft 502.
- Lubricious layer 508 may be made of suitable materials such as Teflon liners, Teflon coatings or Teflon sheaths.
- Such a design comprising one or more lubricious layers can be used for any of the devices mentioned herein such as catheters with working elements, guide catheters, guide catheters with a pre-set shape, steerable guide catheters, steerable catheters, guidewires, guidewires with a pre-set shape, steerable guidewires, ports, introducers, sheaths or other diagnostic or therapeutic devices.
- Figure 7 shows perspective view of an embodiment of a guide catheter comprising a straight hypotube.
- Guide catheter 600 comprises a tubular element 602 and a hypotube 604 attached to the external surface of tubular element 602. Suitable materials for constructing hypotube 604 are Stainless Steel 304, Nitinol etc.
- hypotube 604 is annealed to the external surface of tubular element 602.
- Tubular element 602 can be made from a variety of materials including Pebax, HDPE etc.
- Tubular element 602 may comprise a braid or a jacket.
- tubular element 602 comprises a lubricious coating 605 on its inner surface.
- the lubricious coating 605 can be made of suitable lubricious materials such as Teflon.
- tubular element 602 comprises a bent or angled region near the distal end of tubular element 602.
- the bent or angled region may enclose an angle from 0 degrees to 180 degrees. Further this bent or angled region may be further bent out of plane to present a compound three-dimension end shape.
- Hypotube 604 can be malleable or substantially stiff.
- a malleable hypotube can be used in situations where the guide catheter 600 has to be bent or distorted to optimize its shape to conform to a patient's anatomy. Examples of materials that can be used to make a malleable hypotube are malleable stainless steel, fully annealed stainless steel, copper, aluminum etc.
- a substantially stiff hypotube can be used in situations where extra support is needed for introduction or removal or devices through guide catheter 600.
- Hypotube 604 may be bent to a two-dimensional or three-dimensional shape.
- Distal tip of tubular element 602 may comprise a radio-opaque marker 606 e.g. a standard radio-opaque marker band.
- the proximal region of tubular element 602 comprises a threaded luer.
- Figure 7A shows a crossectional view of guide catheter 600 of Figure 7 through plane 7A-7A.
- the crossection of guide catheter 600 shows an outer hypotube 604 enclosing a tubular member 602 which in turn comprises a lubricious coating 605 located on the inner surface of tubular member 602.
- Figure 8 shows a perspective view of a second embodiment of a guide catheter comprising a straight hypotube.
- Guide catheter 700 comprises a hypotube 702.
- Proximal end of hypotube 702 may comprise a threaded luer 704.
- Hypotube 702 encloses a tubular liner 706 that protrudes from the distal end of hypotube 702.
- Suitable materials for constructing tubular liner 706 are PTFE, Nylon, PEEK etc.
- Distal region of tubular liner 706 is covered with a tubular element 708.
- Tubular element 708 may be constructed of suitable materials such as Pebax, HDPE, Nylon etc. and may comprise a braid.
- Proximal end of tubular element 708 may be bonded to distal end of hypotube 702 or may overlap distal region of hypotube 702.
- distal region of tubular element 708 comprises a bent or angled region.
- stiffness of tubular element 708 varies along the length of tubular element 708.
- Tubular element 708 may comprise a radio-opaque marker band 710 near distal end of tubular element 708.
- Figure 8A shows a crossectional view of guide catheter 700 of Figure 8 through plane 8A-8A showing hypotube 702 and tubular liner 706.
- Figure 8B shows a crossectional view of guide catheter 700 of Figure 8 through plane 8B-8B showing tubular element 708 and tubular liner 706.
- the hypotubes disclosed above may be malleable or non-malleable. They may also comprise one or more bent or angled regions.
- Figure 8C shows a perspective view of an embodiment of a guide catheter comprising a curved or bent hypotube to facilitate access to the frontal sinuses.
- Guide catheter 712 comprises a hypotube 714 comprising a threaded luer 716 at the proximal end of hypotube 714.
- Hypotube 714 may comprise one or more bent or angled regions. In this embodiment, the bent or angled region encloses an angle ranging from 60 degrees to 180 degrees.
- Hypotube 714 may be malleable or non-malleable. In this example, hypotube 714encloses a tubular element 718.
- Tubular element 718 may be constructed of suitable materials such as Pebax, HDPE etc.
- the distal region of tubular element 718 comprises a bent or angled region.
- the bent or angled region encloses an angle ranging from 60 degrees to 170 degrees to facilitate access to the frontal sinuses using guide catheter 712.
- Distal region of tubular element 718 may comprise a radio-opaque marker 720.
- Figure 8D shows a perspective view of a second embodiment of a guide catheter comprising a curved or bent hypotube to facilitate access to the sphenoid sinuses.
- the catheter construction is similar to the catheter in F Figure 8C except the bent or angled region of hypotube 714 encloses an angle ranging from 90 degrees to 180 degrees and the bent or angled region of tubular element 718 encloses an angle ranging from 120 degrees to 180 degrees.
- Figure 8E shows a perspective view of an embodiment of a guide catheter comprising two bent or angled or curved regions to facilitate access to the maxillary sinuses.
- Guide catheter 740 comprises a tubular element 742 comprising a threaded luer 744 at the proximal end of tubular element 742.
- Tubular element 742 further comprises a proximal bent, curved or angled region 746 enclosing an angle ranging from 90 degrees to 180 degrees and a distal bent, curved or angled region 748 enclosing an angle ranging from 90 degrees to 180 degrees.
- Tubular element 742 can be constructed from a variety of biocompatible materials such as Pebax, HDPE, Nylon, PEEK etc. and may comprise a braid.
- the inner surface of tubular element 742 may comprise a lubricious layer e.g. a Teflon layer.
- a curved region 750 is attached to the distal end of tubular element 742. Curved region 750 may enclose an angle ranging from 75 degrees to 180 degrees. The stiffness of curved region 750 is more than the stiffness of tubular element 742 so that there is no significant change to the shape of curved region 750 during the operation of guide catheter 740.
- the distal end of curved region 750 comprises a soft, atraumatic tip 752.
- the distal end of curved region 750 may also comprise a radioopaque marker.
- Guide catheter 740 may be further bent out of plane to present a compound three- dimension end shape.
- Figure 8F shows a perspective view of a second embodiment of a guide catheter comprising two bent or angled or curved regions and a hypotube to facilitate access to the maxillary sinuses.
- the construction of guide catheter 754 is similar to guide catheter 740 in Figure 8E except that guide catheter 754 further comprises a hypotube 756 on the outer surface of the proximal region of guide catheter 754.
- Figure 8G shows a coronal section of the paranasal anatomy showing a method of accessing a maxillary sinus ostium using guide catheter 754 of Figure 8F.
- Guide catheter 754 is introduced through a nostril and advanced in the paranasal anatomy such that atraumatic tip 752 is located inside or adjacent to a maxillary sinus ostium MSO.
- Proximal bent, curved or angled region 746 allows guide catheter 754 to be positioned around the inferior turbinate IT.
- distal bent, curved or angled region 748 allows guide catheter 754 to be positioned around the middle turbinate MT.
- a guidewire or a suitable diagnostic or therapeutic device may then be introduced through the lumen of guide catheter 754 into the maxillary sinus MS.
- Figure 8H shows a sagittal section of the paranasal anatomy showing the method of Figure 8G to access a maxillary sinus ostium using guide catheter 754 of Figure 8F.
- Figure 81 shows a perspective view of an example of a guide catheter comprising a common proximal portion and a plurality of detachable distal tips. Distal end of common proximal portion 760 attaches to proximal end of a first detachable tip 762 by an attachment mechanism.
- First detachable tip 762 comprises an angled, curved or bent region enclosing an angle of 80 - 110 degrees suitable for access to the frontal and ethmoid sinuses.
- first detachable tip 762 and second detachable tip 764 may comprise a radioopaque marker such as a radioopaque band.
- a radioopaque marker such as a radioopaque band.
- FIG. 9 shows a perspective view of a set of devices to dilate or modify ostia or other openings in the ear, nose, throat or mouth structures.
- Guide catheter 800 comprises a shaft 802 comprising a threaded luer 804 at proximal end of shaft 802.
- Distal end of shaft 802 comprises a radio-opaque marker band MB to enable the physician to identify the tip of shaft 802 in a fluoroscopic image.
- the distal end of shaft 802 may be substantially straight or may comprise one or more bent or angled regions.
- One or more distance markings DM may also be located on the shaft 802.
- An optional subselective catheter 806 may also be present in the set of devices.
- Subselective catheter 806 comprises a shaft 808 comprising a threaded luer 810 at the proximal end of shaft 808.
- Inner diameter of shaft 808 is smaller than inner diameter of shaft 802.
- Distal end of the shaft 808 comprises a radio-opaque marker band MB to enable the physician to identify the tip of shaft 808 in a fluoroscopic image.
- Distal end of shaft 808 may be substantially straight or may comprise one or more bent or angled regions.
- One or more distance markings DM may also be located on the shaft 808.
- Working device 812 comprises a shaft 814 comprising a working element 816 located on distal region of shaft 814 and a threaded luer 818 located on proximal end of shaft 814.
- the working element 816 is a dilating balloon.
- Other examples of working elements include dilating stents, suction or irrigation devices, needles, polypectomy tools, brushes, brushes, energy emitting devices such as ablation devices, laser devices, image-guided devices containing sensors or transmitters, endoscopes, tissue modifying devices such as cutters, biopsy devices, devices for injecting diagnostic or therapeutic agents, drug delivery devices such as substance eluting devices, substance delivery implants etc.
- the distal end of shaft 814 may be substantially straight or may comprise a bent or angled region.
- One or more distance markings DM may also be located on shaft 814.
- the set of devices further comprises a guidewire 820.
- Guidewire 820 may be substantially straight or may comprise a bent or angled region.
- One or more distance markings DM may also be located on guidewire 820.
- guide catheter 800 is introduced into a patient's body so that distal end of guide catheter 800 is in the vicinity of an anatomical opening (e.g. an ostium) of an anatomical region (e.g. a paranasal sinus). Thereafter, guidewire 820 is introduced through guide catheter 800 into the anatomical region e.g. the paranasal sinus.
- guide catheter 800 may be removed and the smaller subselective catheter 806 may be introduced over guide wire 820 into the paranasal sinus. Thereafter, working device 812 is introduced over guidewire 820 into the paranasal sinus and a diagnostic or therapeutic procedure is performed by working device 812.
- subselective catheter 806 is introduced into a patient's body so that distal end of subselective catheter 806 is in the vicinity of an anatomical opening (e.g. an ostium) of an anatomical region (e.g. a paranasal sinus). Thereafter, guidewire 820 is introduced through subselective catheter 806 into the anatomical region e.g.
- FIG 10 shows a perspective view of a probing device.
- the probing device 900 comprises a probing element 902 and a detachable handle 904.
- Probing element 902 comprises an atraumatic tip 906 located on the distal end of probing element 902.
- atraumatic tip 906 is spherical.
- Probing element 902 can be made from a variety of biocompatible materials such as metals (e.g. stainless steel, titanium, Nitinol etc.) or polymers (e.g. Pebax, polyethylene etc.).
- Probing element 902 may be rigid or flexible or malleable. In the embodiment shown in Figure 10, the distal region of the probing element 902 is malleable.
- Probing element 902 may comprise one or more curved or angled regions. Length of probing element 902 can range from 10 centimeters to 30 centimeters. Detachable handle can be attached to the probing element 902 by a variety of attachment mechanisms including screw arrangement, clipping mechanism etc.
- the tip of the probing element may further be modified to include a marker, sensor or transmitter capable of being tracked using one or more imaging modalities, such as x-ray, electromagnetic, radio-frequency, ultrasound, radiation, optics, and/or similar modalities.
- Figures 10A - 10C show various steps of a method of using the probing device shown in Figure 10 to access an anatomical region.
- probing device 900 is advanced in to a patient's frontal sinus ostium through the nasal cavity.
- Atraumatic tip 906 prevents the probing device 900 from perforating and damaging healthy tissues.
- detachable handle 904 is detached from probing element 902.
- a working device 908 e.g. a catheter is advanced over the probing element 902 into the patient's frontal sinus ostium.
- Working device 908 can then be used to perform a diagnostic or therapeutic procedure or introduce other devices.
- probing device 900 was used to access the patient's frontal sinus ostium.
- Other anatomical locations in the patient's body e.g. ostia of other paranasal sinuses, ostia of lachrymal ducts, regions in the Eustachian tube, ducts of salvary glands, etc. may be accessed by similar methods.
- working device 908 may be preloaded over probing element 902 and maintained in a retracted position relative to the probing element until distal portion of the probing element 902 is introduced into a desired location. Further, multiple working devices may be inserted within working device 908 or over working device 908 once it is properly positioned.
- Figure 11 A shows a perspective view of a first embodiment of a dual balloon catheter that can be used to perform a diagnostic or therapeutic procedure.
- Catheter 1000 comprises a catheter shaft 1002 and a proximal balloon 1004 and a distal balloon 1006 located on catheter shaft 1002.
- a variety of diagnostic or therapeutic modules may be located in the inter-balloon region 1008 located between proximal balloon 1004 and distal balloon 1006.
- diagnostic or therapeutic modules are dilating or occluding balloons, dilating stents, suction or irrigation devices, needles, polypectomy tools, energy emitting devices like ablation devices, laser devices, image-guided devices containing sensors or transmitters, imaging devices, endoscopes, tissue modifying devices like cutters, biopsy devices, devices for injecting diagnostic or therapeutic agents, lavage devices, drug delivery devices such as substance eluting devices, substance delivery implants etc. etc.
- a catheter hub 1010 is located on the proximal end of catheter shaft 1002.
- Catheter hub 1010 comprises a balloon inflation port 1012 that can be used to inflate both proximal balloon 1004 and distal balloon 1006.
- Figure 11 B shows a perspective view of a second embodiment of a dual balloon catheter that can be used to perform a diagnostic or therapeutic procedure.
- the catheter 1014 shown in this embodiment further comprises a second balloon inflation port 1016.
- Balloon inflation port 1012 is used to inflate proximal balloon 1004 and second balloon inflation port 1016 is used to inflate distal balloon 1006.
- distal balloon 1006 is inflated before proximal balloon 1004.
- FIGS 11C - 11 E show perspective views of third, fourth and fifth embodiments respectively of dual balloon catheters for dilating an anatomical region.
- catheter 1020 comprises a catheter shaft 1022 comprising a catheter hub 1024 at the proximal end of catheter shaft 1022.
- the distal region of catheter shaft 1022 comprises a proximal balloon 1026 and a distal balloon 1028.
- Proximal balloon 1026 and distal balloon 1028 can be made from compliant or non-compliant materials.
- Catheter shaft 1022 further comprises a dilating balloon 1030 located between proximal balloon 1026 and distal balloon 1028. Dilating balloon 1030 is constructed from suitable non- compliant materials such as Polyethylene terephthalate etc.
- FIG. 11 D shows a perspective view of catheter 1020 in Figure 11C further comprising a stent 1038 disposed on dilating balloon 1030.
- stent designs can be used to construct stent 1038 such as metallic tube designs, polymeric tube designs, chain-linked designs, spiral designs, rolled sheet designs, single wire designs etc. These designs may have an open celled or closed celled structure.
- a variety of fabrication methods can be used for fabricating stent 1038 including but not limited to laser cutting a metal or polymer element, welding metal elements etc.
- a variety of materials can be used for fabricating stent 1038 including but not limited to metals, polymers, foam type materials, plastically deformable materials, super elastic materials etc.
- Some non-limiting examples of materials that can be used to construct stent 1038 are Nitinol, stainless steel, titanium, polyurethane, gelfilm, polyethylene and silicones e.g. silastic.
- a variety of features can be added to stent 1038 including but not limited to radiopaque coatings, drug elution mechanisms etc.
- Figure 11E shows a perspective view of catheter 1020 in Figure 11C wherein proximal balloon 1026 and distal balloon 1028 are conical. Dual balloon catheters may also be used to deploy self- expanding stents at a target anatomical region.
- Figures 11F - 11J show the various steps of a method of dilating an anatomical region using the catheter of Figure 11 D.
- catheter 1020 is introduced into an anatomical region to be dilated.
- catheter 1020 is introduced over a guidewire 1040.
- distal balloon 1028 is inflated through second balloon inflation port 1034.
- catheter 1020 is pulled in the proximal direction till distal balloon 1028 gets lodged in the anatomical region to be dilated.
- proximal balloon 1026 is inflated through first balloon inflation port 1032. This enables catheter 1020 to be securely lodged in the anatomical region to be dilated.
- dilating balloon 1030 is inflated through third balloon inflation port 1036. Inflated dilation balloon 1030 exerts an outward force on the anatomical region and causes it to dilate. This step also deploys stent 1038.
- proximal balloon 1026, distal balloon 1028 and dilating balloon 1030 are deflated and catheter 1020 is removed by pulling catheter 1020 in the proximal direction.
- Figures 12A - 12C show the various steps of a method of deploying a stent in the ear, nose, throat or mouth using a working catheter comprising a locating mechanism.
- the locating mechanism is a locator balloon.
- a working device 1100 is provided that comprises a locator balloon 1104 and a stent 1106 located on a stent deploying balloon 1108 located on a catheter shaft 1110. Locator balloon 1104 is located on the distal region of the catheter shaft 1110 and stent 1106 is located proximal to the locator balloon 1104.
- the working device 1100 is inserted into an anatomical region through an anatomical opening 1111 such that the locator balloon 1104 is located distal to anatomical opening 1111.
- Examples of the anatomical region are paranasal sinuses, Eustachian tubes, lachrymal ducts and other structures in the ear, nose, throat or mouth etc.
- Examples of anatomical opening 1111 are ostia of paranasal sinuses, ostia of lachrymal ducts etc.
- locator balloon 1104 is inflated. The inflated diameter of the locater balloon is greater than the diameter of the anatomical opening.
- Working device 1100 is then pulled in the proximal direction such that locator balloon 1104 presses against the anatomical opening 1111. This enables stent 1106 to be positioned accurately in a desired location relative to anatomical opening 1111.
- stent deploying balloon 1108 is inflated to deploy stent 1106. Thereafter, stent deploying balloon 1108 and locator balloon 1104 are deflated and the working device 1100 is removed by pulling it out in the proximal direction. Similar working catheters comprising locating mechanisms can also be used to deploy self-expanding stents.
- the locating mechanism was a locator balloon.
- Other examples of locating device are deployable elements such as wire meshes, radially projecting wires, deployable devices located on guidewires (e.g. balloons, wire meshes etc.), devices deployed on pull-elements (e.g. radially expandable elements etc.) etc.
- Figures 12D - 12H show the various steps of a method of dilating an anatomical opening in the ear, nose, throat or mouth using a combination of a dilating device and an anchoring device.
- the dilating device is a dilating balloon catheter and the anchoring device is an anchoring balloon catheter.
- an anchoring balloon catheter 1120 comprising a catheter shaft 1122 and an anchoring balloon 1124 is inserted over a guidewire GW into an anatomical opening.
- shaft 1122 of anchoring balloon catheter 1120 is coated with a lubricious coating such as Teflon.
- the anatomical opening is the sphenoid sinus ostium SSO of a sphenoid sinus SS.
- anchoring balloon 1124 is inflated. The inflated diameter of anchoring balloon 1124 is greater than the diameter of the anatomical opening. Thereafter, anchoring balloon catheter 1120 is pulled in the proximal direction so that anchoring balloon 1124 is anchored in the anatomical opening.
- a dilating balloon catheter 1126 comprising a shaft 1128 and a dilating balloon 1130 is advanced in the proximal direction over shaft 1122 of anchoring balloon catheter 1120. Dilating balloon catheter 1126 is advanced till the distal portion of dilating balloon catheter 1126 touches anchoring balloon 1124.
- This design accurately positions dilating balloon 1130 in a target location in the anatomical opening.
- dilating balloon 1130 is inflated to dilate the anatomical opening.
- the dilating balloon 1130 and anchoring balloon 1124 are deflated and dilating balloon catheter 1126 and anchoring balloon catheter 1120 are withdrawn from the anatomical opening by pulling them in the proximal direction.
- Dilating balloon 1130 can be made of suitable non-compliant materials e.g. polyethylene terephthalate etc.
- Anchoring balloon 1124 can be made of suitable compliant materials e.g. polyurethane, silicone etc. or non-compliant materials e.g. polyethylene terephthalate etc.
- Examples of anchoring devices are catheters comprising balloons, deployable elements such as wire meshes, radially projecting wires; deployable devices located on guidewires (e.g. balloons, wire meshes etc.); devices deployed on pull-elements (e.g. radially expandable elements etc.) etc.
- Such a combination of an anchoring device and a working device inserted along the anchoring device can be used for a variety of other methods and devices disclosed herein for treating anatomical openings such as ostia of paranasal sinuses, ostia of lachrymal ducts, ducts of salvary glands, Eustachian tubes and other ear, nose, throat or mouth structures etc.
- FIG. 13 shows a perspective view of a dilating device comprising an electrode element to reduce restenosis.
- Dilating device 1200 comprises a shaft 1202 and a dilating element 1204 located on the distal region of shaft 1202. Examples of dilating elements are non-compliant dilating balloons, mechanically expandable elements etc.
- Dilating device 1200 further comprises an electrode element 1206 located on dilating element 1204. Electrode element 1206 in combination with one or more surface electrodes attached to a surface of a patient's body delivers electrical energy to an anatomical region to be dilated. The electrical energy causes a controlled destruction of the adjacent anatomical region thereby reducing the risk to restenosis of the dilated region.
- Electrode element 1206 may have a variety of configurations including meshes, wires wound in a spiral configuration, wires wound in a sinusoidal configuration etc. Electrode element 1206 can be constructed from a variety of biocompatible metallic materials such as platinum-iridium alloys (e.g. 90% platinum/10% iridium) etc. Dilating device 1200 may further comprise an insulating layer between electrode element 1206 and dilating element 1204. In one embodiment, electrode element 1206 is located on a sheath that can be advanced over dilating device 1200 such that electrode element 1206 is located above dilating element 1204.
- FIG 14 shows a perspective view of an embodiment of a balloon catheter comprising a sizing balloon and a dilating balloon. A portion of the sizing balloon has been removed to show the dilating balloon underneath the sizing balloon.
- Balloon catheter 1300 comprises a shaft 1302 and a dilating balloon 1304 located on distal region of shaft 1302. Dilating balloon 1304 can be made of suitable non-compliant materials e.g. polyethylene terephthalate, Nylon etc. Dilating balloon 1304 is inflated through a first balloon inflation opening 1305. Balloon catheter 1300 further comprises a sizing balloon 1306 located around dilating balloon 1304.
- Sizing balloon 1306 is made from a compliant or semi-compliant material such as crosslinked polyethylene or other polyolefins, polyurethane, flexible polyvinylchloride, Nylon etc. Sizing balloon 1306 is inflated through a second balloon inflation opening 1307. Dilating balloon 1304 and sizing balloon 1306 enclose an inter-balloon volume 1308.
- Figure 14A shows a crossection of the balloon catheter in Figure 14 through plane 14A - 14A.
- Shaft 1302 comprises a guidewire lumen 1310, a first inflation lumen 1312 that terminates distally in first balloon inflation opening 1305 of Figure 14, and a second inflation lumen 1314 that terminates distally in second balloon inflation opening 1307 of Figure 14.
- Figures 14B - 14D show the various steps of dilating an anatomical opening using the balloon catheter in Figure 14.
- balloon catheter 1300 is introduced over a guidewire GW into an anatomical opening 1316 to be dilated.
- Examples of the types of anatomical openings 1316 that may be dilated by this invention include ostia of paranasal sinuses, Eustachian tubes, ostia of lachrymal ducts, etc.
- sizing balloon 1306 is inflated using an imageable inflating medium.
- suitable imageable inflating media are saline with a radioopaque contrast agent, carbon dioxide gas etc.
- Distal region of balloon catheter 1300 is subsequently imaged using a suitable imaging modality such as fluoroscopy or X-rays. This enables an operator to accurately estimate the size of anatomical opening 1316.
- a balloon catheter is also suited for estimating the diameter of the narrowest region in a tubular anatomical region e.g. a Eustachian tube prior to performing a diagnostic or therapeutic procedure such as balloon dilation.
- balloon catheter 1300 may be repositioned and step 14C repeated if necessary.
- step 14D sizing balloon 1306 is deflated.
- dilating balloon 1304 is inflated to dilate a target region in anatomical opening 1316.
- dilating balloon 1304 is deflated and balloon catheter 1300 is withdrawn from anatomical opening 1316.
- sizing balloon 1306 may be reinflated after a balloon dilation procedure to obtain feedback about the performance of the balloon dilation procedure.
- FIG 15 shows a perspective view of a balloon catheter 1400 for delivering diagnostic or therapeutic agents.
- This balloon catheter 1400 comprises a catheter shaft 1402 which may be flexible, malleable or rigid, and a dilating balloon 1404 located on the distal region of shaft 1402.
- Dilating balloon 1404 can be made of any suitable compliant or non-compliant materials (e.g. polyethylene terephthalate etc.).
- An outer balloon or sheath 1406 covers the dilating balloon 1404, as shown in the cut-away view of Figure 15.
- Sheath 1406 can be made of suitable non-compliant materials e.g. polyethylene terephthalate etc.
- Sheath 1406 comprises one or more pores 1408 through which diagnostic or therapeutic agents can be delivered to the surrounding anatomy. Pores 1408 may have a pore size ranging from sub-micron to a few microns.
- Dilating balloon 1404 is inflated by a balloon inflation lumen 1410.
- the diagnostic or therapeutic agents can be delivered to the region between sheath 1406 and dilating balloon 1404 by an agent delivery lumen 1412.
- sheath 1406 is attached to shaft 1402.
- Figure 15A shows a crossection through the plane 15A-15A of Figure 15 showing shaft 1402 comprising balloon inflation lumen 1410, agent delivery lumen 1412 and a guidewire lumen 1414.
- FIG 16 shows a perspective view of a balloon catheter comprising one or more agent delivery reservoirs.
- Balloon catheter 1500 comprises a shaft 1502 and a balloon 1504 located on the distal region of shaft 1502.
- Balloon 1504 may be made from suitable compliant or semi-compliant material such as crosslinked polyethylene or other polyolefins, polyurethane, flexible polyvinylchloride, Nylon, etc., or from non-compliant materials such as polyurethane, etc.
- Balloon catheter 1500 further comprises one or more agent delivery reservoirs 1506 located on balloon 1504.
- Agent delivery reservoirs 1506 contain one or more diagnostic or therapeutic agents absorbed in a matrix.
- diagnostic or therapeutic agents are contrast agents, pharmaceutically acceptable salt or dosage form of an antimicrobial agent (e.g., antibiotic, antiviral, anti-parasitic, antifungal, etc.), a corticosteroid or other anti-inflammatory (e.g., an NSAID), a decongestant (e.g., vasoconstrictor), a mucous thinning agent (e.g., an expectorant or mucolytic), an anesthetic agent with or without vasoconstrictor (e.g., Xylocaine with or without epinephrine, Tetracaine with or without epinephrine), an analgesic agent, an agent that prevents of modifies an allergic response (e.g., an antihistamine, cytokine inhibitor, leucotriene inhibitor, IgE inhibitor, immunomodulator), an allergen or another substance that causes secretion of mucous by tissues, antiproliferative agents, hemostatic agents to stop bleeding, cytotoxic agents
- agent delivery reservoirs 1506 comprise diagnostic or therapeutic agents absorbed in a porous matrix formed of a porous material such as a flexible or rigid polymer foam, cotton wadding, gauze, etc.
- nonbiodegradable polymers that may be foamed or otherwise rendered porous include polyurethane, polycarbonate, silicone elastomers etc.
- Figure 16A shows a crossection view through plane 16A-16A of Figure 16 showing shaft 1502 comprising a balloon inflation lumen 1508 and a guidewire lumen 1510.
- FIG 17 shows a perspective view of a balloon catheter comprising a balloon comprising one or more micropores or openings.
- Balloon catheter 1600 comprises a shaft 1602 comprising a dilating balloon 1604 located on the distal region of shaft 1602.
- Dilating balloon 1604 can be made of suitable non- compliant materials e.g. polyethylene terephthalate etc.
- Dilating balloon 1604 comprises one or more micropores 1606 of a pore size ranging from submicron (e.g. 0.5 micron) to a few microns.
- Micropores 1606 can be formed on material of dilating balloon 1604 by various processes including mechanical punching, mechanical drilling, irradiation e.g.
- Dilating balloon 1604 is inflated using an inflating medium comprising one or more diagnostic or therapeutic agents to be delivered to a target anatomical region such as ostia of paranasal sinuses, ostia of lachrymal ducts, ducts of salvary glands, Eustachian tubes etc.
- diagnostic or therapeutic agents are contrast agents, pharmaceutically acceptable salt or dosage form of an antimicrobial agent (e.g., antibiotic, antiviral, anti-parasitic, antifungal, etc.), an anesthetic agent, an analgesic agent, a corticosteroid or other anti-inflammatory (e.g., an NSAID), a decongestant (e.g., vasoconstrictor), a mucous thinning agent (e.g., an expectorant or mucolytic), an agent that prevents of modifies an allergic response (e.g., an antihistamine, cytokine inhibitor, leucotriene inhibitor, IgE inhibitor, immunomodulator), an allergen or another substance that causes secretion of mucous by tissues, anti-proliferative agents, hemostatic agents to stop bleeding, cytotoxic agents e.g.
- an antimicrobial agent e.g., antibiotic, antiviral, anti-parasitic, antifungal, etc.
- an anesthetic agent
- FIG. 17A shows a crossectional view through the plane 17A-17A of Figure 17 showing shaft 1602 comprising a guidewire lumen 1608 and a balloon inflation lumen 1610.
- FIG 18 shows a balloon catheter comprising a balloon having an outer coating of diagnostic or therapeutic agents.
- Balloon catheter 1700 comprises a shaft 1702 and a dilating balloon 1704 located on the distal region of shaft 1702.
- Dilating balloon 1704 can be made of suitable non-compliant materials e.g. polyethylene terephthalate etc.
- Dilating balloon 1704 comprises a coating 1706 of one or more diagnostic or therapeutic agents on the outer surface of dilating balloon 1704.
- Coating 1706 may comprise diagnostic or therapeutic agents located in a suitable carrier medium.
- the carrier medium is a hydrogel.
- the carrier medium is a solid having the consistency of wax e.g. sterile bone wax.
- the carrier containing the agents can be deposited on the outer surface of dilating balloon 1704 just before balloon catheter 1700 is used for performing a diagnostic or therapeutic procedure.
- Coating 1706 may be present on the surface of dilating balloon 1704 in a variety of configurations.
- coating 1706 is in the form of parallel strips of a carrier medium comprising one or more diagnostic or therapeutic agents.
- the coating may also be in the form of an annular layer, a plurality of discrete spots etc.
- coating 1706 comes into contact with the adjacent anatomical region.
- a portion of coating 1706 is deposited on the adjacent anatomical region which delivers the diagnostic or therapeutic agents to the adjacent anatomical region.
- coating 1706 comprises a hemostatic material with a consistency of bone-wax.
- Figures 18A - 18C show the steps of a method of using the balloon catheter of Figure 18 to dilate an anatomical region.
- balloon catheter 1700 is introduced in an anatomical region 1708.
- Balloon catheter 1700 is positioned such dilating balloon 1704 is located in the target region to be dilated.
- dilating balloon 1704 is inflated. This dilates anatomical region 1708 and deposits a portion of coating 1706 on the dilated region.
- dilating balloon 1704 is deflated and balloon catheter 1700 is withdrawn from anatomical region 1708 leaving behind a deposited layer 1710 of coating 1706 on the dilated anatomical region 1708.
- FIG 19A shows a perspective view of a lavage catheter.
- Lavage catheter 1800 comprises a shaft 1802 and an occluding balloon 1804 located on the distal region of shaft 1802.
- Occluding balloon 1804 can be made of suitable compliant materials e.g. polyurethane, silicone etc. or non-compliant materials e.g. polyethylene terephthalate etc.
- Lavage catheter 1800 further comprises a flushing tip 1806 and an aspiration tip 1808 located on the distal end of shaft 1802.
- lavage catheter 1800 is introduced over a guidewire GW into an anatomical region e.g. a sphenoid sinus SS through an anatomical opening e.g. a sphenoid sinus ostium SSO.
- FIG 19B shows a crossectional view through the plane 19B - 19B of Figure 19A.
- Shaft 1802 comprises an aspiration lumen 1810, a flushing lumen 1812 and a guidewire lumen 1814.
- Distal end of aspiration lumen 1810 opens at the distal end of aspiration tip 1808 and distal end of flushing lumen 1812 opens at the distal end of flushing tip 1806.
- FIG 19C shows the method of operation of lavage catheter 1800 of Figure 19A to lavage an anatomical region.
- occluding balloon 1804 is inflated and lavage catheter 1800 is pulled in the proximal direction till occluding balloon occludes the anatomical opening e.g. sphenoid sinus ostium SSO.
- a flushing medium introduced in the anatomical region through flushing tip 1806.
- the flushing medium may be introduced in lavage catheter 1800 from a flushing medium container 1816 e.g. a saline bag connected to the proximal region of lavage catheter 1800.
- the flushing medium is aspirated from the anatomical region through aspiration tip 1808.
- the proximal end of lavage catheter 1800 may be connected to a collection vessel 1818 to collect the aspirated flushing medium.
- collection vessel 1818 is further connected to wall suction.
- FIG. 2OA shows a perspective view of the distal end of a second embodiment of a lavage catheter.
- Lavage catheter 1900 comprises a tubular member 1902 comprising a one or more openings 1904 located on the distal region of tubular member 1902.
- Tubular member 1902 may be made from a variety of materials such as silicone elastomers, Pebax, HDPE etc.
- Distal region of tubular member 1902 may comprise a curved or bent region.
- Tubular member 1902 comprises a first lumen connected to openings 1904. Suitable diagnostic or therapeutic fluids can be introduced or removed through openings 1904.
- Examples of such fluids are saline, pharmaceutically acceptable salt or dosage form of an antimicrobial agent (e.g., antibiotic, antiviral, anti-parasitic, antifungal, etc.), a corticosteroid or other anti-inflammatory (e.g., an NSAID), a decongestant (e.g., vasoconstrictor), a mucous thinning agent (e.g., an expectorant or mucolytic), an agent that prevents of modifies an allergic response (e.g., an antihistamine, cytokine inhibitor, leucotriene inhibitor, IgE inhibitor, immunomodulator), an allergen or another substance that causes secretion of mucous by tissues, a contrast agent, an anesthetic agent with or without vasoconstrictor (e.g., Xylocaine with or without epinephrine, Tetracaine with or without epinephrine), an analgesic agent, hemostatic agents to stop bleeding, antiproliferative
- Figure 2OB shows a perspective view of the distal end of the lavage catheter of Figure 2OA introduced in an anatomical region.
- the anatomical region is a maxillary sinus MS comprising a maxillary sinus ostium MSO.
- Lavage catheter 1900 may be introduced into the anatomical region by an over-the-wire method, through a cannula, or by a variety of methods disclosed in this patent application and in the patents documents incorporated herein by reference.
- Other examples of anatomical regions that can be treated using lavage catheter 1900 are other paranasal sinuses, lachrymal ducts, Eustachian tubes, and other hollow organs in the ear, nose, throat or mouth.
- FIG. 2OC shows an embodiment of the lavage catheter of Figure 2OA being used to lavage an anatomical region.
- lavage catheter 1900 further comprises an outer sheath 1910 comprising an occluding balloon 1912 located on the distal region of outer sheath 1910.
- Occluding balloon 1912 may be made from suitable compliant or semi-compliant material such as crosslinked polyethylene or other polyolefins, polyurethane, flexible polyvinylchloride, Nylon etc. or from non-compliant materials such as polyurethane etc.
- Outer sheath 1910 covers tubular member 1902 such that outer sheath and tubular member 1902 enclose a suction lumen 1914 between them.
- Tubular member 1902 is used to introduce a lavage fluid 1916 into the anatomical region through openings 1904.
- Suction lumen 1914 is used to remove lavage fluid 1916 from the anatomical region.
- Figure 2OD shows a sagittal section of a human head showing the general working environment of the lavage devices of Figures 2OA - 2OC.
- Distal end of lavage catheter 1900 is introduced into an anatomical region such as Ethmoid air cell EAC.
- Lavage catheter 1900 may be introduced into the EAC by an over-the-wire method, through a cannula, or by a variety of methods disclosed in this patent application and in the patents documents incorporated herein by reference.
- Proximal end of lavage catheter 1900 is detachabiy connected to a irrigation and suction apparatus 1918.
- Irrigation and suction apparatus 1918 provides lavage fluid 1916 to lavage catheter 1900 and also provides suction to remove lavage fluid 1916 from the EAC.
- Lavage catheter 1900 may similarly be used to diagnose or treat other paranasal sinuses, lachrymal ducts, ducts of salvary glands, Eustachian tubes, and other hollow organs in the ear, nose, throat or mouth.
- FIG 21 shows a perspective view of a cutting device comprising cutting jaws.
- Cutting device 2000 comprises a shaft 2002 comprising an upper jaw 2004 and a lower jaw 2006 located on the distal end of shaft 2002.
- Proximal region of shaft 2002 comprises a scissor-like device with handles or other suitable control apparatus 2008 that is useable to control the movement of upper jaw 2004 and/or lower jaw 2006.
- Upper jaw 2004 and lower jaw 2006 are hinged together so that they can be opened or closed by scissor handles 2008 to bite, grip or cut tissue.
- the edges of upper jaw 2004 and lower jaw 2006 are provided with a series of cutting teeth. Alternately, the edges of upper jaw 2004 and lower jaw 2006 may be provided with sharp edges, blunt gripping teeth etc.
- Shaft 2002 comprises a lumen 2010. This enables cutting device 2000 to be advanced over an access device such as a guidewire to access a target anatomical region. Examples of materials that can be used to construct cutting device 2000 are stainless steel 304, stainless steel 316, titanium, titanium alloys etc.
- Figure 21A shows a perspective view of the distal region of the cutting device of Figure 21 wherein the cutting jaws are closed.
- Figure 21 B shows a perspective view of one embodiment of the jaws of the cutting device of Figure 21.
- Upper jaw 2004 comprises an upper jaw notch 2012.
- upper jaw notch 2012 is semicircular in shape.
- lower jaw 2006 comprises a lower jaw notch 2014.
- lower jaw notch 2014 is semicircular in shape. This design enables a guidewire to pass through a gap in the distal end of the cutting device 2000 even when upper jaw 2004 and lower jaw 2006 are closed.
- a guidewire passes through an opening located on either upper jaw 2004 or lower jaw 2006.
- Upper jaw 2004 and lower jaw 2006 can also be square, ovoid, trapezoidal or circular in shape.
- Figure 21 C shows a crossectional view of the cutting device in Figure 21 through plane 21C-21C.
- Shaft 2002 of cutting device 2000 comprises a lumen 2010 for an access device such as a guidewire.
- Shaft 2002 further comprises one or more pull wires 2016 that connect upper jaw 2004 and lower jaw 2006 to control apparatus 2008. When the control apparatus 2008 is moved, pull wires 2016 transmit the movement to upper jaw 2004 and lower jaw 2006 causing them to open or close.
- FIG 22A shows a perspective view of an alternate embodiment of a device comprising cutting or gripping jaws.
- Cutting device 2100 comprises a shaft 2102.
- Distal end of cutting device 2100 comprises an upper jaw 2104 and a lower jaw 2106 that are hinged together at a first hinge 2108.
- Proximal end of upper jaw 2104 comprises a first elongate member 2110
- proximal end of second jaw 2106 comprises a second elongate member 2112.
- the proximal end of first elongate member 2110 is connected to a second hinge 2114 which in turn is connected to a third elongate member 2116.
- Proximal end of second elongate member 2112 is connected to a third hinge 2118 which in turn is connected to a fourth elongate member 2120.
- FIG. 22A shows cutting device 2100 wherein the upper jaw 2104 and lower jaw 2106 are in an open configuration.
- fourth hinge 2122 is pulled inside shaft 2102. This causes the distal ends of third elongate member 2116 and fourth elongate member 2120 to come closer to each other.
- cutting device 2100 comprises a spring mechanism located between pull wire 2124 and shaft 2102 that biases upper jaw 2104 and lower jaw 2106 in an open or closed configuration.
- Figure 22B shows a perspective view of the device of Figure 22A wherein the jaws of the cutting device are in a closed configuration.
- Figures 23A - 23C show the various steps of a method of puncturing an anatomical region using a flexible, rotating drill shaft.
- an access catheter 2200 is introduced through a nostril to a location adjacent to an anatomical region 2202 to be punctured.
- anatomical region 2202 is a maxillary sinus having a maxillary sinus ostium 2204.
- Other examples of the types of anatomical regions 2202 are other paranasal sinuses, lachrymal ducts, bony structures in the ear, nose, throat or mouth etc.
- Access catheter 2200 can be made of suitable biocompatible materials having a sufficient stiffness such as malleable stainless steel tubes; titanium tubes; fully annealed stainless steel tubes; copper tubes; aluminum tubes; tubular elements made of Pebax, HDPE etc. comprising a hypotube; etc.
- One or more regions of access catheter 2200 may be shapeable or malleable to allow a user to adjust the shape of access catheter 2200 to a patient's unique anatomy.
- a substantially stiff access catheter 2200 can be used in situations where extra support is needed for introduction or removal or devices through access catheter 2200.
- a lubricious coating e.g. a Teflon coating is present on the inner surface of access catheter 2200.
- a flexible drill shaft 2206 is introduced through access catheter 2200. Access catheter 2200 helps to align flexible drill shaft 2206 in the anatomical region 2202 in a desired orientation. Flexible drill shaft 2206 can be designed for efficient transfer of unidirectional or bidirectional torque. Flexible drill shaft 2206 can be made from a suitable material having a high torsional stiffness such as heat treated spring steel. Proximal end of flexible drill shaft 2206 is connected to a reversible drive motor that is used to rotate flexible drill shaft 2206 at a desired angular velocity. Flexible drill shaft 2206 comprises a drill bit 2208 located on the distal end of flexible drill shaft 2206.
- Drill bit 2208 can range from 0.5 mm - 5 mm in diameter. Drill bit 2208 may be made from suitable materials such as tungsten carbide, carbon steel, diamond powder coated metal etc. Drill bit 2208 can have a drill bit design such as twist drill bit, masonry drill bit, spur point bit, step drill bit etc.
- Flexible drill shaft 2206 is introduced through access catheter 2202 till drill bit 2208 ntouches a target location on anatomical region 2202 to be punctured. In Figure 23C, flexible drill shaft 2206 is rotated so that drill bit 2208 punctures anatomical region 2202. Such a method and device can be used for a minimally invasive puncturing of suitable anatomical regions for drainage, aeration, introduction of diagnostic or therapeutic devices etc.
- Such a device and method can also be used for enlarging or clearing natural or artificial openings in anatomical regions.
- access catheter 2200 and flexible drill shaft 2206 are withdrawn from the anatomy.
- flexible drill shaft 2206 is a non-rotating shaft having high column strength and comprising a puncturing tip at the distal end of flexible drill shaft 2206.
- flexible drill shaft 2206 acts as an ultrasonic drill by connecting the proximal end of flexible drill shaft to an ultrasonic generator.
- access catheter 2200 comprises one or more bearings that reduce friction between access catheter 2200 and flexible drill shaft 2206.
- FIG 23D shows a sectional view of an embodiment of a drilling device.
- Drilling device 2220 comprises a shaft 2222 comprising a proximal rigid portion 2224 and a distal rigid portion 2226.
- Shaft 2222 may comprise a deformable (e.g., corrugated, plastically deformable, malleable, etc.) portion 2228 between proximal rigid portion 2224 and distal rigid portion 2226.
- Plastically deformable region 2228 allows the shape of drilling device 2220 to be adjusted to facilitate advancement of the device through tortous anatomy, to access to a target anatomical location and/or to achieve a desired positioning or attitude of the bit 2230 within the subject's body.
- Proximal rigid portion 2224, distal rigid portion 2226 and plastically deformable or malleable region 2228 can be made of suitable biocompatible materials such as stainless steel e.g. fully annealed stainless steel, copper, aluminum etc.
- Drilling device 2220 further comprises a rotating drill bit 2230 located at distal end of a rotatable drive member of shaft 2222.
- Rotating drill bit 2230 can be made from suitable materials such as tungsten carbide, carbon steel, diamond powder coated metal etc.
- Rotating drill bit 2230 can be an abrasive coated spherical ball or a twist (e.g., helical) drill bit, masonry drill bit, spur point bit, step drill bit etc.
- Proximal region of rotating drill bit 2230 is in contact with distal end of shaft 2222.
- the contact surfaces between rotating drill bit 2230 and shaft 2222 comprise a lubricious coating e.g. a Teflon coating.
- Proximal region of rotating drill bit 2230 is also attached to a flexible drive shaft 2232 that supplies torque to the rotating drill bit 2230.
- flexible drive shaft 2232 comprises a coil assembly with high torsional stiffness and column strength.
- flexible drive shaft 2232 comprises a heat treated spring steel cable. Proximal end of flexible drive shaft 2232 is connected to a reversible drive motor.
- rotating drill bit 2230 and flexible drive shaft 2232 comprise a coaxial lumen to enable drilling device 2220 to be introduced over a guidewire into a target anatomy.
- a device can be used for a minimally invasive puncturing of suitable anatomical regions for drainage, aeration, introduction of diagnostic or therapeutic devices etc.
- Such a device can also be used for enlarging or clearing natural or artificial openings in anatomical regions.
- this device 2220 is referred to herein as a "drilling device” it may be used for numerous purposes other than “drilling.”
- this device 2220 may be used to cut, grind, polish or create grooves or depressions in bone, cartilage or other tissue and/or may be used as a screw driver.
- this drilling device 2220 may alternatively be aptly referred to as a cutter, grinder, rotating rasp, rotating brush, dremmel, polisher, burnisher, boring tool, grooving tool, etc.
- the bit may comprise a drive bit that is useable to drive a permanent or resorbable bone screw or other type of screw or anchor.
- Figures 24A - 24C show a sagittal section of an Ethmoid sinus showing various methods of treating Ethmoid sinus diseases by a minimally invasive approach.
- Figure 24A shows a sagittal section of an Ethmoid sinus comprising an anterior Ethmoid air cell 2300, a posterior Ethmoid air cell 2302 and an intermediate Ethmoid air cell 2304 located between anterior Ethmoid air cell 2300 and posterior Ethmoid air cell 2302.
- a guide catheter 2306 is introduced to a region inferior to the basal lamella of a middle turbinate.
- Guide catheter 2306 may comprise a design selected from the various guide catheter designs disclosed herein and in the patent documents incorporated herein by reference.
- an introducer needle 2308 is introduced through guide catheter 2306.
- Introducer needle 2308 comprises a lumen through which devices such as guidewires can be introduced.
- Introducer needle 2308 can be made of suitable biocompatible materials such as Stainless steel, Nitinol, polymers, polymer-metal composites etc.
- Introducer needle 2308 is advanced through guide catheter 2306 such that the distal tip of introducer needle 2308 punctures a wall of an Ethmoid air cell e.g.
- a guidewire 2310 is introduced through introducer needle 2308 into the Ethmoid air cell e.g. anterior Ethmoid air cell 2300.
- introducer needle 2308 is removed from the anatomy.
- a working device is introduced over guidewire 2310 into the Ethmoid air cell.
- An example of a working device is a balloon catheter 2312 comprising a dilating balloon 2314. Thereafter, the working device is used to perform a diagnostic or therapeutic procedure e.g. balloon dilation of the introducer needle puncture site to create a drainage channel for sinus secretions.
- FIG. 24A - 24B may also be used to create an opening of a suitable diameter to facilitate insertion of other working devices into the Ethmoid air cells.
- Figure 24C shows a method of treating Ethmoid sinus diseases by a rongeur.
- rongeur 2316 having a distal cutting tip 2318 is introduced through guide catheter 2306 into an Ethmoid air cell via the introducer needle puncture site. Thereafter, rongeur 2316 is used to remove tissue from the Ethmoid air cell.
- Figures 24A' - 24A"" show a method of creating drainage channels for sinus secretions in Ethmoid sinus.
- guide catheter 2306 is introduced to a region inferior to the basal lamella of a middle turbinate.
- introducer needle 2308 is advanced through guide catheter 2306 such that the distal tip of introducer needle 2308 punctures a wall of an Ethmoid air cell e.g. an intermediate Ethmoid air cell 2304 and enters the Ethmoid air cell.
- introducer needle is used to create internal channels in the Ethmoid sinus by puncturing walls of adjacent Ethmoid air cells e.g. anterior Ethmoid air cell 2300, posterior Ethmoid air cell 2302 etc.
- introducer needle 2308 and guide catheter 2306 are removed leaving behind internal channels that allow drainage of sinus secretions through the introducer needle puncture site in the intermediate Ethmoid air cell 2304.
- Sinus secretions from anterior Ethmoid air cell 2300 or posterior Ethmoid air cell 2302 flow into intermediate Ethmoid air cell 2304 from which they flow out of the Ethmoid sinus.
- the internal channels as well as the introducer needle puncture site in the intermediate Ethmoid air cell 2304 may be dilated using a balloon catheter as shown in Figures 24A - 24B.
- introducer needle 2308 was introduced into the Ethmoid sinus through intermediate Ethmoid air cell 2304. Similar procedures may be performed by introducing introducer needle 2304 into the Ethmoid sinus through anterior Ethmoid air cell 2300 or posterior Ethmoid air cell 2302.
- anterior Ethmoid air cell 2300, posterior Ethmoid air cell 2302 and intermediate Ethmoid air cell 2304 are punctured separately through the basal lamella of a middle turbinate to create separate drainage channels for each Ethmoid air cell as shown in Figure 24A"".
- Figure 25A shows a perspective view of an embodiment of a microshaver or ostium enlarger device 2400.
- Device 2400 comprises a proximal portion 2402 and a distal portion 2403.
- Proximal portion 2402 is hollow and comprises a proximal cutting surface 2404 e.g. sharp cutting teeth etc. located on the distal end of proximal portion 2402.
- Distal portion 2403 comprises a distal cutting surface 2406 e.g.
- Distal portion 2403 is further connected to a pull shaft 2408 that encloses a guidewire lumen 2410.
- Guidewire lumen 2410 allows microshaver 2400 to be introduced over a guidewire GW into a target anatomy.
- the region between pull shaft 2408 and proximal portion 2402 encloses a suction lumen 2412.
- Suction lumen 2412 can be used to remove solid debris or liquids from the target anatomy by suction.
- Proximal portion 2402, distal portion 2403 and pull shaft 2408 can be made of suitable biocompatible materials such as stainless steel.
- Figure 25B shows a crossection of a paranasal sinus showing one way in which the device 2400 of F Figure 25A may be used to remove tissue or matter.
- the device 2400 is introduced over a guidewire GW into paranasal sinus 2414.
- the device 2400 is then positioned such that the tissue or matter is located between proximal cutting surface 2404 and distal cutting surface 2406.
- pull shaft 2408 is pulled in the proximal direction. This causes movement of distal region 2403 in the proximal direction with respect to proximal portion 2402.
- cylindrical distal cutter 2406 cylindrical proximal cutter 2404 may be rotated relative to the other to further cut or shave tissue.
- suction lumen 2412 can be used to remove any solid debris or liquids generated during the procedure.
- Figure 25C and 25D show an example of another way in which the device 2400 may be used — i.e., to shave tissue or matter.
- Examples of anatomical structures / that may be shaved by this device 2400 include bone, cartilage and soft tissues of Eustachian tubes, turbinates, lachrymal ducts, anatomical openings such as ostia of paranasal sinuses, ostia of lachrymal ducts, etc. and other regions in the ear, nose, throat or mouth.
- the cutting surfaces are positioned adjacent to the tissue or matter to be shaved and the cylindrical distal cutter 2406 and/or cylindrical proximal cutter 2404 is/are rotated to shave the tissue or matter. Suction may be applied through lumen 2412 to draw the tissue or matter into slots 2409 such that it will be shaved by the rotating proximal cutter 2404.
- Figures 26A - 26C show a device and method for treating a mucocyst of other flowable substance-containing structure (e.g., cyst, hematoma, pustule, etc.) located within a paranasal sinus, ear, nose or throat.
- the device comprises an elongate shaft 2500, a penetrator such as a needle 2502 that is advanceable from and retractable into the shaft 2500 to form an opening in the mucocyst or other structure, and a compressor such as a balloon 2506 that is useable to compress the mucocyst or other structure to force its contents to flow out of the opening created by the needle 2502 or other penetrator.
- a penetrator such as a needle 2502 that is advanceable from and retractable into the shaft 2500 to form an opening in the mucocyst or other structure
- a compressor such as a balloon 2506 that is useable to compress the mucocyst or other structure to force its contents to flow out
- a guide catheter 2500 is introduced into an anatomical region through an anatomical opening.
- the outer diameter of guide catheter 2500 is less than the inner diameter of the anatomical opening.
- frontal sinus FS is used as an example of an anatomical region.
- Other examples of anatomical regions are other paranasal sinuses, lachrymal passages, Eustachian tubes and other structures in the ear, nose, throat or mouth etc.
- Guide catheter 2500 may comprise a design selected from the various guide catheter designs disclosed herein and in the patent documents incorporated herein by reference.
- a puncturing needle 2502 is then introduced through guide catheter 2500 into the frontal sinus FS.
- Puncturing needle 2502 has a sharp distal tip and can be made from a variety of materials such as hardened tool steel, stainless steel etc. Puncturing needle 2502 is navigated through the frontal sinus FS such that the distal tip of puncturing needle 2502 punctures a mucocyst 2503 in the frontal sinus FS. Thereafter, puncturing needle 2502 is withdrawn. In Figure 26B, a guidewire GW is introduced into the frontal sinus FS. Thereafter, a balloon catheter 2504 comprising a balloon 2506 is introduced over guidewire GW into the frontal sinus FS.
- Balloon 2506 can be made of suitable compliant or semi-compliant materials such as crosslinked polyethylene or other polyolefins, polyurethane, flexible polyvinylchloride, Nylon, etc. Balloon 2506 is then inflated. Inflated balloon 2506 compresses the punctured mucocyst 2503. This causes drainage of mucocyst secretions into the frontal sinus FS. In Figure 26C, balloon 2506 is inflated further so that it occupies a volume in the frontal sinus FS and displaces the mucocyst secretions from the frontal sinus FS out through the frontal sinus ostium FSO.
- suitable compliant or semi-compliant materials such as crosslinked polyethylene or other polyolefins, polyurethane, flexible polyvinylchloride, Nylon, etc. Balloon 2506 is then inflated. Inflated balloon 2506 compresses the punctured mucocyst 2503. This causes drainage of mucocyst secretions into the
- Figures 27A - 27B show various steps of a method of treating a mucocyst by a balloon catheter comprising a deployable puncturing needle.
- a guide catheter 2600 is introduced into an anatomical region through an anatomical opening.
- the outer diameter of guide catheter 2600 is less than the inner diameter of the anatomical opening.
- frontal sinus FS is used as an example of an anatomical region.
- Other examples of anatomical regions are other paranasal sinuses, lachrymal passages, Eustachian tubes, other ear, nose, throat and mouth structures etc.
- Guide catheter 2600 may comprise a design selected from the various guide catheter designs disclosed herein and in the patent documents incorporated herein by reference.
- a balloon catheter 2602 comprising a balloon 2604 and a deployable puncturing needle 2606 is then introduced through guide catheter 2600 into the frontal sinus FS.
- Balloon 2604 can be made of suitable compliant or semi- compliant materials such as crosslinked polyethylene or other polyolefins, polyurethane, flexible polyvinylchloride, Nylon, etc.
- Deployable puncturing needle 2606 can be made from a variety of materials such as hardened tool steel, stainless steel etc.
- Balloon catheter 2604 is oriented in a desired orientation and deployable puncturing needle 2606 is advanced such that the distal tip of deployable puncturing needle 2606 punctures the mucocyst MC. Thereafter, deployable puncturing needle 2606 is withdrawn into balloon catheter 2602.
- balloon 2604 is inflated. Inflated balloon 2604 compresses the punctured mucocyst MC. This causes drainage of mucocyst secretions into the frontal sinus FS. Balloon 2604 is then inflated further so that it occupies a volume in the frontal sinus FS and displaces the mucocyst secretions from the frontal sinus FS out through the frontal sinus ostium FSO.
- deployable puncturing needle 2606 is located in a needle lumen. Deployable puncturing needle 2606 may be advanced or withdrawn by advancing or withdrawing deployable puncturing needle 2606 through the needle lumen.
- FIGS 28A-28C show various embodiments of catheters comprising agent delivery needles.
- catheter 2700 comprises a shaft 2702 having a guidewire lumen.
- Catheter 2700 further comprises a deployable injecting needle 2704 made from suitable biocompatible materials such as stainless steel.
- Deployable injecting needle 2704 comprises a lumen for injecting one or more diagnostic or therapeutic agents 2706 into the adjacent anatomy.
- Deployable injecting needle 2704 is deployed at any suitable angle to the longitudinal axis of shaft 2702, for example such angle may range from 0 degrees to 135 degrees.
- deployable injecting needle 2704 is located in a needle lumen.
- Deployable injecting needle 2704 is deployed or withdrawn by relative motion of deployable injecting needle 2704 with respect to shaft 2702.
- deployable injecting needle 2704 can be deployed or withdrawn by inflating or deflating a deploying balloon.
- the deploying balloon can be made from suitable materials such as polyimide, parylene (e.g. C 1 D 1 N), silicone, polyurethane, polyethylene terephthalate etc.
- Catheter 2700 is introduced into a target anatomy and deployable injecting needle 2704 is deployed. Deployable injecting needle 2704 penetrates into the adjacent anatomy.
- One or more diagnostic or therapeutic agents 2706 are then injected into the adjacent anatomy.
- catheter 2700 may be introduced in an anatomical region through a guide catheter 2708.
- Figure 28B shows a perspective view of catheter 2700 of Figure 28A wherein catheter 2700 further comprises a second deployable injecting needle 2710.
- Second deployable injecting needle 2710 comprises a lumen for injecting one or more diagnostic or therapeutic agents 2712 into the adjacent anatomy.
- diagnostic or therapeutic agents 2712 are the same as diagnostic or therapeutic agents 2706.
- Figure 28C shows a perspective view of catheter 2700 of Figure 28A wherein catheter 2700 further comprises a balloon 2714.
- balloon 2714 is a dilating balloon made of suitable non- compliant materials e.g. polyethylene terephthalate etc. This embodiment can be used for both balloon dilation and agent delivery.
- balloon 2714 is an anchoring balloon made of suitable non-compliant materials e.g.
- the anchoring balloon can be used to stabilize the position and orientation of catheter 2700 before agent delivery.
- diagnostic or therapeutic agents that can be delivered by the catheters in Figures 28A - 28C are pharmaceutically acceptable salt or dosage form of an antimicrobial agent (e.g., antibiotic, antiviral, anti-parasitic, antifungal, etc.), an anesthetic agent with or without a vasoconstriction agents (e.g., antibiotic, antiviral, anti-parasitic, antifungal, etc.), an anesthetic agent with or without a vasoconstriction agents (e.g.
- an antimicrobial agent e.g., antibiotic, antiviral, anti-parasitic, antifungal, etc.
- an anesthetic agent with or without a vasoconstriction agents
- Xylocaine with or without Epinephrine, Tetracaine with or without epinephrine, etc. an analgesic agent, a corticosteroid or other anti-inflammatory (e.g., an NSAID), a decongestant (e.g., vasoconstrictor), a mucous thinning agent (e.g., an expectorant or mucolytic), an agent that prevents of modifies an allergic response (e.g., an antihistamine, cytokine inhibitor, leucotriene inhibitor, IgE inhibitor, immunomodulator), an allergen or another substance that causes secretion of mucous by tissues, hemostatic agents to stop bleeding, anti- proliferative agents, cytotoxic agents e.g.
- an analgesic agent e.g., a corticosteroid or other anti-inflammatory (e.g., an NSAID), a decongestant (e.g., vasoconstrictor), a mucous thinning
- Catheters in Figures 28A - 28C can be used to diagnose or treat anatomical regions such as paranasal sinuses, regions in the Eustachian tubes, lachrymal ducts, ducts of salvary glands, anatomical openings such as ostia of paranasal sinuses, ostia of lachrymal ducts, other regions in the ear, nose, throat or mouth etc.
- anatomical regions such as paranasal sinuses, regions in the Eustachian tubes, lachrymal ducts, ducts of salvary glands, anatomical openings such as ostia of paranasal sinuses, ostia of lachrymal ducts, other regions in the ear, nose, throat or mouth etc.
- FIG 29A illustrates an embodiment of a displacement catheter to displace and remove secretions in an anatomical region.
- Displacement catheter 2800 comprises an outer sheath 2802 that encloses a balloon catheter 2804.
- Outer sheath 2802 may be flexible or substantially rigid.
- Outer sheath 2802 may be made of suitable materials such as Pebax, HDPE etc.
- Outer sheath 2802 may comprise a hypotube made of suitable biocompatible materials such as stainless steel, Nitinol etc.
- Balloon catheter 2804 comprises a catheter shaft 2806 and a balloon 2808 located on the distal region of catheter shaft 2806.
- Catheter shaft 2806 may be made of suitable materials such as Pebax, HDPE etc.
- Balloon 2808 may be made from suitable compliant or semi-compliant material such as crosslinked polyethylene or other polyolefins, polyurethane, flexible polyvinylchloride, Nylon etc.
- Figure 29B shows a sectional view of an anatomical region showing a method of displacing secretions by the displacement catheter of Figure 29A.
- Displacement catheter 2800 is introduced in an anatomical region.
- a Maxillary sinus MS is used as an example of an anatomical region.
- Other examples of anatomical regions that can be treated using displacement catheter 2800 are other paranasal sinuses, lachrymal passages, Eustachian tubes etc.
- Displacement catheter 2800 can be advanced into an anatomical region through natural openings e.g.
- displacement catheter 2800 is advanced into the Maxillary sinus through a natural opening such as a maxillary sinus ostium MSO such that the distal end of displacement catheter is near the distal region of Maxillary sinus MS.
- Outer diameter of outer sheath 2802 is less than inner diameter of Maxillary sinus ostium MSO.
- outer sheath 2802 is withdrawn gradually by pulling outer sheath 2802 in the proximal direction over balloon catheter 2804.
- balloon 2808 is inflated by a suitable inflating medium such as saline mixed with radiographic contrast. This causes distal region of balloon 2804 to inflate before the proximal region of balloon 2804.
- Balloon 2804 gradually begins to occupy available volume in the Maxillary sinus MS and thus displaces secretions 2810 out of the Maxillary sinus MS through the Maxillary sinus ostium MSO.
- distal region of balloon 2804 has a higher compliance than proximal regions of balloon 2804.
- balloon 2804 comprises multiple compartments such that each compartment can be inflated independently of other compartments.
- Balloon 2804 may be detachably connected to catheter shaft 2806 to enable permanent occlusion of the anatomical region.
- Balloon 2804 may also comprise a variety of drug delivery mechanisms including drug eluting coatings, drug eluting pores for eluting a drug dissolved in the inflating medium etc.
- Drilling device 2900 comprises a rigid or flexible drilling shaft 2902.
- Drilling shaft 2902 can be made of suitable materials such as tungsten carbide flexible wire.
- the proximal end of drilling shaft 2902 is connected to a piezoelectric crystal 2904 such as a quartz (SiO2) or barium titanate (BaTiO3) crystal.
- Piezoelectric crystal 2904 may have a layer of backing material 2906 on the proximal surface of piezoelectric crystal 2904.
- Piezoelectric crystal 2904 is connected by electrodes 2908 to an electric power source 2910.
- Electric power source 2910 delivers a suitable current via electrodes 2908 to piezoelectric crystal 2904 to cause piezoelectric crystal 2904 to vibrate at an ultrasonic frequency.
- the vibration of piezoelectric crystal 2904 is transmitted to drilling shaft 2902.
- drilling shaft 2902 is connected to piezoelectric crystal 2904 by a coupler 2912.
- Figures 3OA - 3OB show a sectional view of an anatomical region showing a method of enlarging a natural or artificially created anatomical opening using the drilling device of Figure 30.
- the drilling device may also be used to create new openings in an anatomical region.
- Distal part of drilling device 2900 comprising drilling shaft 2902 of diameter D.sub.2 is positioned such that the distal end of drilling shaft 2902 touches an anatomical opening e.g. a sphenoid sinus ostium SSO to be dilated.
- the anatomical opening has an initial diameter D.sub.1.
- current from electric power source 2910 is switched on, which in turn causes drilling shaft 2902 to vibrate in the axial direction.
- drilling shaft 2902 causes distal tip of drilling shaft 2902 to impact the anatomical opening.
- the impact of drilling shaft 2902 causes dilation of the anatomical opening from an initial diameter D.sub.1 to a diameter D.sub.2.
- drilling devices may be used to puncture, remodel or change the shape, size or configuration of anatomical structures such as paranasal sinuses, Eustachian tubes, middle ear, nasopharynx, Lachrymal ducts or other anatomical regions in the ear, nose, throat or mouth.
- Such drilling devices may comprise for example elements for ablation or delivery of energy such as laser, RF, thermal shock waves etc.
- FIG 31 shows a sectional view of an embodiment of a catheter for providing an internal cast for fractured bony cavities.
- Catheter 3000 comprises a shaft 3002 comprising a plurality of inflating elements e.g. inflating balloon in the distal region of shaft 3002.
- catheter 3000 comprises a proximal interior balloon 3004, a distal interior balloon 3006 and an intermediate interior balloon 3008 located between proximal interior balloon 3004 and distal interior balloon 3006.
- Catheter 3000 further comprises an intermediate balloon 3010 covering proximal interior balloon 3004 and intermediate interior balloon 3008 as shown in Figure 31.
- Catheter 3000 further comprises an outer balloon 3012 that covers intermediate balloon 3010 and a portion of distal interior balloon 3006 as shown in Figure 31.
- the balloons on catheter 3000 can be inflated independently of each other.
- proximal interior balloon 3004 can be inflated by a proximal interior balloon lumen 3014
- distal interior balloon 3006 can be inflated by a distal interior balloon inflation lumen 3016
- intermediate interior balloon 3008 can be inflated by an intermediate balloon inflation lumen 3018.
- the balloons on catheter 3000 may be made from suitable compliant or semi-compliant material such as crosslinked polyethylene or other polyolefins, polyurethane, flexible polyvinylchloride, Nylon etc. or from suitable non-compliant materials e.g. polyethylene terephthalate etc.
- FIG. 31A shows a crossection through the outer balloon 3012 in the catheter 3000 of Figure 31 through plane 31A - 31A.
- Outer balloon 3012 comprises a balloon material 3020 made from suitable compliant or semi-compliant material such as crosslinked polyethylene or other polyolefins, polyurethane, flexible polyvinylchloride, Nylon etc. or from suitable non-compliant materials e.g. polyethylene terephthalate etc.
- a coating 3022 is located on the outer surface of balloon material 3020.
- contrast agents examples include contrast agents, pharmaceutically acceptable salt or dosage form of an antimicrobial agent (e.g., antibiotic, antiviral, anti-parasitic, antifungal, etc.), an anesthetic agent with or without a vasoconstriction agents (e.g., an antimicrobial agent, antibiotic, antiviral, anti-parasitic, antifungal, etc.), an anesthetic agent with or without a vasoconstriction agents (e.g.
- an antimicrobial agent e.g., antibiotic, antiviral, anti-parasitic, antifungal, etc.
- an anesthetic agent with or without a vasoconstriction agents
- Xylocaine with or without Epinephrine, Tetracaine with or without epinephrine, etc. an analgesic agent, a corticosteroid or other anti-inflammatory (e.g., an NSAID), a decongestant (e.g., vasoconstrictor), a mucous thinning agent (e.g., an expectorant or mucolytic), an agent that prevents of modifies an allergic response (e.g., an antihistamine, cytokine inhibitor, leucotriene inhibitor, IgE inhibitor, immunomodulator), an allergen or another substance that causes secretion of mucous by tissues, hemostatic agents to stop bleeding, anti- proliferative agents, cytotoxic agents e.g. alcohol, biological agents such as protein molecules, stem cells, genes or gene therapy preparations etc.
- an analgesic agent e.g., a corticosteroid or other anti-inflammatory (e.g., an NSAID), a decongestant (
- Figures 31 B - 31 D shows various steps of a method of providing an internal cast for a fractured bony cavity using the catheter shown in Figure 31.
- Maxillary sinus MS is used as an example of bony cavity that can be treated using catheter 3000.
- Figure 31 B shows a patient with a fractured bony cavity e.g. a fractured Maxillary sinus MS having one or more fractured bones 3024.
- catheter 3000 is introduced into the Maxillary sinus MS through a natural opening e.g. an ostium or an artificially created opening.
- one or more balloons on catheter 3000 are sequentially inflated to push fractured bones 3024 into their original un-fractured configuration.
- Catheter 3000 may then be left in place for a desired period ranging from a few minutes to several days during which fractured bones 3024 begin to heal in their original un-fractured configuration. After catheter 3000 has been left in place for the desired period, catheter 3000 is removed by deflating the balloons and withdrawing catheter 3000 from the anatomy. Thus, catheter 3000 provides an internal cast for a fractured bony cavity. Various embodiments of catheter 3000 may be used for crating internal casts for fractured paranasal sinuses, lachrymal passages, Eustachian tubes, other structures in the ear, nose, throat, mouth etc.
- Figures 32 and 32A show an embodiment of a surgical navigation system comprising electromagnetic sensors.
- electromagnetic sensors that can be used with the present invention are electromagnetic sensors of an electromagnetic surgical navigation system such as GE InstaTrakTM 3500 plus system etc.
- Figure 32 shows a perspective view of a patient's head showing the location of external ear canal electromagnetic sensors 3100 and teeth electromagnetic sensors 3102.
- External ear canal electromagnetic sensors 3100 are introduced through an ear canal into a region adjacent to a tympanum.
- Teeth electromagnetic sensors 3102 are attached to one or more teeth of the patient. In one embodiment, teeth electromagnetic sensors 3102 are attached to teeth using an adhesive.
- teeth electromagnetic sensors 3102 are attached to braces or caps which in turn are attached to teeth.
- the braces or caps can be made of suitable materials that cause minimal artifacts on CT or MRI images.
- An example of such a material is aluminum alloy 2017-T4 which causes minimal artifacts on a CT scan image.
- Other locations of electromagnetic sensors include skin (e.g. a skin patch comprising an electromagnetic sensor), a head frame etc. The patient's head is imaged using an imaging modality such as CT or MRI.
- External ear canal electromagnetic sensors 3100 and teeth electromagnetic sensors 3102 are passively imaged by the imaging modality and thus act as fiducial markers.
- Figures 32 and 32A illustrate a surgical navigation system comprising fiducial markers that have electromagnetic sensors.
- fiducial markers such as passively imaged fiducial markers or active sensors or transmitters may be used in conjunction with the various methods and devices disclosed herein.
- the fiducial markers may be located on relevant anatomical regions such as teeth, ear canals, skull bones, frames fixed to rigid bones etc.
- the fiducial markers may be used with a variety of modalities including but not limited to electromagnetic, infrared, ultrasonic, radio-frequency, MRI, CT, Fluoroscopic or other 2D or 3D image guided systems for the head, neck or other anatomical regions manufactured by companies such as Biosense, Stryker, Brainlab, Xomed, GE/VTI etc.
- FIG 32A shows an enlarged view of region 32A in Figure 32.
- Teeth electromagnetic sensors 3102 are connected to the electromagnetic surgical navigation system by removable leads 3104.
- external ear canal electromagnetic sensors 3100 or teeth electromagnetic sensors 3102 are connected to the electromagnetic surgical navigation system by telemetry.
- suitable electromagnetic surgical navigation systems such as GE InstaTrakTM 3500 plus system etc.
- data from imaging modality such as CT or MRI and the electromagnetic surgical navigation system is merged to obtain a three dimensional map of the anatomy showing the electromagnetic sensors.
- the three dimensional map can then be used for image guided procedures such as diagnostic or therapeutic procedures of paranasal sinuses, Eustachian tubes, lachrymal ducts, other ear, nose, throat or mouth structures etc.
- image guided surgery systems such as infrared sensor based systems e.g. Stryker Leibinger® Navigation System can also be used in conjunction with one or more methods or devices disclosed herein.
- Figure 33 shows a section of the anatomical region around a Eustachian tube (ET) showing a diagnostic or therapeutic procedure being performed by devices inserted through the pharyngeal ostium of the Eustachian tube.
- Figure 33 shows a guidewire GW inserted into a desired region in the ET through the Nasopharynx and a diagnostic or therapeutic being performed by a device introduced into the Eustachian tube over guidewire GW.
- ET Eustachian tube
- Figure 33A shows an enlarged view of region 33A in Figure 33 showing the anatomical region around a Eustachian tube (ET) showing a diagnostic or therapeutic procedure being performed by devices inserted through the pharyngeal ostium of the Eustachian tube.
- guidewire GW comprises an anchoring balloon 3200 located on the distal region of guidewire GW. Anchoring balloon 3200 is inflated after positioning guidewire GW at a target location. Anchoring balloon 3200 anchors guidewire GW to the adjacent anatomy and prevents accidental repositioning of guidewire GW during a diagnostic or therapeutic procedure.
- Anchoring balloon 3200 may be made from suitable compliant or semi-compliant material such as crosslinked polyethylene or other polyolefins, polyurethane, flexible polyvinylchloride, Nylon etc.
- Guidewire GW may comprise anchoring elements other than anchoring balloon 3200 such as a notch on guidewire GW, a bent region on guidewire GW, a self expanding element, a hook, a coiled element etc.
- guidewire GW comprises a sensor 3202 located on the distal region of guidewire GW. Sensor 3202 enables guidewire GW to be used in conjunction with a suitable surgical navigation system.
- sensor 3202 is an electromagnetic sensor used in conjunction with an electromagnetic surgical navigation system such as GE InstaTrakTM 3500 plus system etc.
- One or more sensor 3202 or other types of surgical navigation sensors or transmitters may also be located on other diagnostic or therapeutic devices disclosed herein.
- Sensor 3202 may be used in conjunction with a stationary sensor 3204 located in the external ear.
- the combination of sensor 3202 and stationary sensor 3204 enables guidewire GW to be accurately positioned in a target region.
- a radioopaque plug 3206 is inserted from the external ear to a region adjacent to an eardrum. Radioopaque plug 3206 serves as a fiducial marker during preoperative scanning of the patient and thus enables a physician to accurately position a diagnostic or therapeutic device close to the eardrum.
- Other image guidance methods and devices can also be used in conjunction with diagnostic or therapeutic procedures disclosed herein.
- Figure 33A also shows a diagnostic or therapeutic device 3208 comprising a shaft 3210 and a working element 3212 e.g. a dilating balloon being introduced over guidewire GW.
- Diagnostic or therapeutic device 3208 may comprise a radiopaque marker 3214.
- Figure 33B shows a front view of a human head with a portion of the face removed to show an embodiment of a method of introducing a guidewire into a Eustachian tube.
- a guide catheter 3250 is introduced through a nostril into the Nasopharynx.
- Distal portion of guide catheter 3250 may comprise a bent or angled region.
- Guide catheter 3250 can be constructed using one of the various designs disclosed herein and in the patent documents incorporated herein by reference.
- Guide catheter 3250 is positioned in the Nasopharynx such that the distal tip of guide catheter 3250 is located near a nasopharyngeal opening of a Eustachian tube.
- a guidewire GW is introduced through guide catheter 3250 into the Eustachian tube.
- Guidewire GW can then be used to advance one or more diagnostic or therapeutic devices into the Eustachian tube to perform one or more diagnostic or therapeutic procedures.
- Figures 34A - 34D illustrate various examples of working elements that can be located on the diagnostic or therapeutic device in Figure 33.
- Figure 34A shows an example of a working element comprising a dilating balloon.
- Dilating balloon 3312 can be made from a suitable non-compliant materials e.g. polyethylene terephthalate, Nylon etc.
- devices shown in Figures 14, 15, 16, 17 and 18 may also be used to treat a Eustachian tube as shown in Figure 33.
- Figure 34B shows an example of a working element comprising a dilating balloon loaded with a balloon-expandable stent.
- Dilating balloon 3314 can be made from a suitable non-compliant materials e.g. polyethylene terephthalate, Nylon etc.
- stent designs can be used to construct stent 3316 such as metallic tube designs, polymeric tube designs, chain-linked designs, spiral designs, rolled sheet designs, single wire designs etc. These designs may have an open celled or closed celled structure.
- a variety of fabrication methods can be used for fabricating stent 3316 including but not limited to laser cutting a metal or polymer element, welding metal elements etc.
- a variety of materials can be used for fabricating stent 3316 including but not limited to metals, polymers, foam type materials, plastically deformable materials, super elastic materials etc.
- a variety of features can be added to stent 3316 including but not limited to radiopaque coatings, drug elution mechanisms to elute antiinflammatory agents, antibiotics etc.
- stent 3316 is bioabsorbable.
- Working elements may also comprise a self-expanding stent instead of a pressure-expandable stent.
- FIG 34C shows an example of a working element comprising a lavage element.
- Lavage element 3318 comprises a plurality of lavage openings 3320.
- Lavage openings are connected to a lavage lumen in shaft 3210 through which suitable lavage media such as solutions containing contrast agents, pharmaceutically acceptable salt or dosage form of an antimicrobial agent (e.g., antibiotic, antiviral, anti-parasitic, antifungal, etc.), an anesthetic agent with or without a vasoconstriction agents (e.g.
- an antimicrobial agent e.g., antibiotic, antiviral, anti-parasitic, antifungal, etc.
- an anesthetic agent with or without a vasoconstriction agents
- Xylocaine with or without Epinephrine, Tetracaine with or without epinephrine, etc. an analgesic agent, a corticosteroid or other anti-inflammatory (e.g., an NSAID), a decongestant (e.g., vasoconstrictor), a mucous thinning agent (e.g., an expectorant or mucolytic), an agent that prevents of modifies an allergic response (e.g., an antihistamine, cytokine inhibitor, leucotriene inhibitor, IgE inhibitor, immunomodulator), an allergen or another substance that causes secretion of mucous by tissues, hemostatic agents to stop bleeding, antiproliferative agents, cytotoxic agents e.g.
- an analgesic agent e.g., a corticosteroid or other anti-inflammatory (e.g., an NSAID), a decongestant (e.g., vasoconstrictor), a mucous thinning agent
- FIG. 34D shows an example of a working element comprising a substance delivery reservoir.
- Substance delivery reservoir 3322 may be fully or partially biodegradable or non-biodegradable.
- substance delivery reservoir 3322 is made of a suitable biocompatible material such as hydrogel (e.g. collage hydrogel).
- substance delivery reservoir 3322 comprises a porous matrix formed of a porous material such as a flexible or rigid polymer foam, cotton wadding, gauze, etc.
- non-biodegradable polymers that may be foamed or otherwise rendered porous include polyurethane, polycarbonate, silicone elastomers etc.
- Substance delivery reservoir 3322 may also include one or more embodiments disclosed in United States Patent Application Serial No.
- the substance delivery reservoir 3322 or any substance delivery devices described in this application may be used to deliver various types of therapeutic or diagnostic agents.
- diagnostic or therapeutic substance as used herein is to be broadly construed to include any feasible drugs, prodrugs, proteins, gene therapy preparations, cells, diagnostic agents, contrast or imaging agents, biologicals, etc. Such substances may be in bound or free form, liquid or solid, colloid or other suspension, solution or may be in the form of a gas or other fluid or nan-fluid.
- the substance delivered may comprise pharmaceutically acceptable salt or dosage form of an antimicrobial agent (e.g., antibiotic, antiviral, antiparacytic, antifungal, etc.), a corticosteroid or other anti-inflammatory (e.g., an NSAID), a decongestant (e.g., vasoconstrictor), a mucous thinning agent (e.g., an expectorant or mucolytic), an agent that prevents of modifies an allergic response (e.g., an antihistamine, cytokine inhibitor, leucotriene inhibitor, IgE inhibitor, immunomodulator), etc.
- an antimicrobial agent e.g., antibiotic, antiviral, antiparacytic, antifungal, etc.
- a corticosteroid or other anti-inflammatory e.g., an NSAID
- a decongestant e.g., vasoconstrictor
- a mucous thinning agent e.g., an expectorant or mucolytic
- antimicrobial agents include acyclovir, amantadine, aminoglycosides (e.g., amikacin, gentamicin and tobramycin), amoxicillin, amoxicillin/clavulanate, amphotericin B, ampicillin, ampicillin/sulbactam, atovaquone, azithromycin, cefazolin, cefepime, cefotaxime, cefotetan, cefpodoxime, ceftazidime, ceftizoxime, ceftriaxone, cefuroxime, cefuroxime axetil, cephalexin, chloramphenicol, clotrimazole, ciprofloxacin, clarithromycin, clindamycin, dapsone, dicloxacillin, doxycycline, erythromycin, fluconazole, foscamet, ganciclovir, atifloxacin, imipenem/cil
- the substances delivered in this invention may include various steroids or other anti-inflammatory agents (e.g., nonsteroidal anti-inflammatory agents or NSAIDS), analgesic agents or antipyretic agents.
- corticosteroids that have previously administered by intranasal administration may be used, such as beclomethasone (Vancenase® or Beconase®), flunisolide (Nasalide®), fluticasone proprionate (Flonase®), triamcinolone acetonide (Nasacort®), budesonide (Rhinocort Aqua®), loterednol etabonate (Locort) and mometasone (Nasonex®).
- beclomethasone Vancenase® or Beconase®
- flunisolide Nasalide®
- fluticasone proprionate Flonase®
- Triamcinolone acetonide Nasacort®
- COX inhibitors e.g., salicylic acid derivatives, aspirin, sodium salicylate, choline magnesium trisalicylate, salsalate, diflunisal, sulfasalazine and olsalazine; para-aminophenol derivatives such as acetaminophen; indole and indene acetic acids such as indomethacin and sulindac; heteroaryl acetic acids such as tolmetin, dicofenac and ketorolac; arylpropionic acids such as ibuprofen, naproxen, flurbiprofen, ketoprofen, fenoprofen and oxaprozin; anthranilic acids (fenamates) such as mefenamic acid and meloxicam; enolic acids such as the oxicams (piroxicam, meloxicam) and
- the substances delivered in this invention may include a) various cytokine inhibitors such as humanized anti-cytokine antibodies, anti-cytokine receptor antibodies, recombinant (new cell resulting from genetic recombination) antagonists, or soluble receptors; b) various leucotriene modifiers such as zafirlukast, montelukast and zileuton; c) immunoglobulin E (IgE) inhibitors such as Omalizumab (an anti-lgE monoclonal antibody formerly called rhu Mab-E25) and secretory leukocyte protease inhibitor) and d) SYK Kinase inhibitoers such as an agent designated as "R-112" manufactured by Rigel Pharmaceuticals, Inc, or South San Francisco, California.
- various cytokine inhibitors such as humanized anti-cytokine antibodies, anti-cytokine receptor antibodies, recombinant (new cell resulting from genetic recombination) antagonists, or soluble receptors
- the substances delivered in this invention may include various vasoconstrictors for decongestant and or hemostatic purposes including but not limited to pseudoephedrine, xylometazoline, oxymetazoline, phenylephrine, epinephrine, etc.
- the substances delivered in this invention may include various mucolytics or other agents that modify the viscosity or consistency of mucous or mucoid secretions, including but not limited to acetylcysteine (MucomystTM, MucosilTM) and guaifenesin.
- various mucolytics or other agents that modify the viscosity or consistency of mucous or mucoid secretions including but not limited to acetylcysteine (MucomystTM, MucosilTM) and guaifenesin.
- the substance delivered by this invention comprises a combination of an anti-inflammatory agent (e.g. a steroid or an NSAID) and a mucolytic agent.
- an anti-inflammatory agent e.g. a steroid or an NSAID
- a mucolytic agent e.g. a steroid or an NSAID
- the substances delivered in this invention may include various mast cell stabilizers or drugs which prevent the release of histamine such as cromolyn (e.g., Nasal Chrom®) and nedocromil.
- cromolyn e.g., Nasal Chrom®
- nedocromil e.g., nedocromil
- the substances delivered in this invention may include various antihistamines such as azelastine (e.g., Astylin ® ), diphenhydramine, loratidine, etc. Additionally or alternatively, in some embodiments such as those where it is desired to dissolve, degrade, cut, break or remodel bone or cartilage, the substances delivered in this invention may include substances that weaken or modify bone and/or cartilage to facilitate other procedures of this invention wherein bone or cartilage is remodeled, reshaped, broken or removed.
- azelastine e.g., Astylin ®
- diphenhydramine e.g., diphenhydramine, loratidine, etc.
- the substances delivered in this invention may include substances that weaken or modify bone and/or cartilage to facilitate other procedures of this invention wherein bone or cartilage is remodeled, reshaped, broken or removed.
- Such an agent would be a calcium chelator such as EDTA that could be injected or delivered in a substance delivery implant next to a region of bone that is to be remodeled or modified.
- EDTA calcium chelator
- Another example would be a preparation consisting of or containing bone degrading cells such as osteoclasts.
- Other examples would include various enzymes of material that may soften or break down components of bone or cartilage such as collagenase (CGN), trypsin, trypsin/EDTA, hyaluronidase, and tosyllysylchloromethane (TLCM).
- CGN collagenase
- trypsin trypsin
- trypsin/EDTA trypsin/EDTA
- hyaluronidase hyaluronidase
- TLCM tosyllysylchloromethane
- the substances delivered in this invention may include other classes of substances that are used to treat rhinitis, nasal polyps, nasal inflammation, and other disorders of the ear, nose and throat including but not limited to anti-cholinergic agents that tend to dry up nasal secretions such as ipratropium (Atrovent Nasal®), as well as other agents not listed here.
- anti-cholinergic agents that tend to dry up nasal secretions such as ipratropium (Atrovent Nasal®), as well as other agents not listed here.
- the substances delivered in this invention may include locally or topically acting diuretics such as furosemide and/or hyperosmolar agents such as sodium chloride gel or other salt preparations that draw water from tissue or substances that directly or indirectly change the osmolar content of the mucous to cause more water to exit the tissue to shrink the polyps directly at their site.
- diuretics such as furosemide
- hyperosmolar agents such as sodium chloride gel or other salt preparations that draw water from tissue or substances that directly or indirectly change the osmolar content of the mucous to cause more water to exit the tissue to shrink the polyps directly at their site.
- the substances delivered in this invention may include antitumor agents (e.g., cancer chemotherapeutic agents, biological response modifiers, vascularization inhibitors, hormone receptor blockers, cryotherapeutic agents or other agents that destroy or inhibit neoplasia or tumorigenesis) such as; alkylating agents or other agents which directly kill cancer cells by attacking their DNA (e.g., cyclophosphamide, isophosphamide), nitrosoureas or other agents which kill cancer cells by inhibiting changes necessary for cellular DNA repair (e.g., carmustine (BCNU) and lomustine (CCNU)), antimetabolites and other agents that block cancer cell growth by interfering with certain cell functions, usually DNA synthesis (e.g., 6 mercaptopurine and 5-fluorouracil (5FU), antitumor antibiotics and other compounds that act by binding or intercalating DNA and preventing RNA synthesis
- antitumor agents e.g., cancer chemotherapeutic agents, biological response modifiers,
- biological response modifiers e.g., interferon, bacillus calmette-guerin (BCG), monoclonal antibodies, interluken 2, granulocyte colony stimulating factor (GCSF), etc.
- BCG Bacillus calmette-guerin
- GCSF granulocyte colony stimulating factor
- PGDF receptor antagonists herceptin, asparaginase, busulphan, carboplatin, cisplatin, carmustine, cchlorambucil, cytarabine, dacarbazine, etoposide, flucarbazine, flurouracil, gemcitabine, hydroxyurea, ifosphamide, irinotecan, lomustine, melphalan, mercaptopurine, methotrexate, thioguanine, thiotepa, tomudex, topotecan, treosulfan, vinblastine, vincristine, mitoazitrone, oxaliplatin,
- the substances delivered in this invention may include cells (mucosal cells, fibroblasts, stem cells or genetically engineered cells) as well as genes and gene delivery vehicles like plasmids, adenoviral vectors or naked DNA, mRNA, etc. injected with genes that code for anti-inflammatory substances, etc., and, as mentioned above, osteoclasts that modify or soften bone when so desired, cells that participate in or effect mucogenesis or ciliagenesis, etc.
- the device may be ideal to position the device in a specific location upstream in the mucous flow path (i.e. frontal sinus or ethmoid cells). This could allow the deposition of fewer drug releasing devices, and permit the "bathing" of all the downstream tissues with the desired drug.
- This utilization of mucous as a carrier for the drug may be ideal, especially since the concentrations for the drug may be highest in regions where the mucous is retained; whereas non-diseased regions with good mucous flow will be less affected by the drug. This could be particularly useful in chronic sinusitis, or tumors where bringing the concentration of drug higher at those specific sites may have greater therapeutic benefit.
- a solute such as a salt or other mucous soluble material may be positioned at a location whereby mucous will contact the substance and a quantity of the substance will become dissolved in the mucous thereby changing some property (e.g., pH, osmolarity, etc) of the mucous.
- this technique may be used to render the mucous hyperosmolar so that the flowing mucous will draw water and/or other fluid from polyps, edematous mucosal tissue, etc., thereby providing a drying or desiccating therapeutic effect.
- the nasal cavities provide unique access to the olfactory system and thus the brain. Any of the devices and methods described herein may also be used to deliver substances to the brain or alter the functioning of the olfactory system.
- Such examples include, the delivery of energy or the deposition of devices and/or substances and/or substance delivering implant(s) to occlude or alter olfactory perception, to suppress appetite or otherwise treat obesity, epilepsy (e.g., barbiturates such as phenobarbital or mephoobarbital; iminostilbenes such as carbamazepine and oxcarbazepine; succinimides such as ethylsuximide; valproic acid; benzodiazepines such as clonazepam, clorazepate, diazepam and lorazepam, gabapentin, lamotrigine, acetazolamide, felbamate, levetiraceam, tiagabine, topiramate, zonisamide, etc.), personality or mental disorders (e.g., antidepressants, antianxiety agents, antipsychotics, etc.) , chronic pain, Parkinson's disease (e.g., dopamine receptor
- the working element need not necessarily be a substance delivery reservoir 3322.
- another type of working element useable in this invention is a laser device.
- the laser device may comprise an optical fiber that delivers laser energy through the distal region of the optical fiber.
- Typical examples of lasers that can be used in the present invention are Nd:YAG lasers, Ho: NAG lasers, short pulsed laser systems such as excimer lasers (wavelength: 308 nm, pulse length full width at half maximum height : 60 ns), dye lasers (wavelength: 504 nm, pulse length full width at half maximum height: 1200 ns), tunable die lasers, KTP lasers, argon lasers, Alexandrite lasers (wavelength: 755 nm, pulse length full width at half maximum height : 300-500 ns) etc.
- excimer lasers wavelength: 308 nm, pulse length full width at half maximum height : 60 ns
- dye lasers wavelength: 504 nm, pulse length full width at half maximum height: 1200 ns
- tunable die lasers KTP lasers
- argon lasers argon lasers
- Alexandrite lasers wavelength: 755 nm, pulse length full width at half maximum height :
- Such a laser device may also be used in conjunction with or as a part of any method, system or device disclosed in this patent application for laser-assisted ablation or cutting, laser-assisted cauterization or other laser- assisted methods of treating sinusitis, mucocysts, tumors, polyps, occlusions, obstructions, edema or other conditions of the paranasal sinuses, Eustachian tubes, Lachrymal ducts, salivary glands and other hard or soft ear, nose, throat or mouth structures.
- Such devices, systems and methods may also be used for performing other diagnostic or therapeutic procedures of Eustachian tubes, tympanums and middle ear structures.
- Examples of such procedures are biopsies, microendoscopy of the Eustachian tube and the middle ear structures, diagnosis and/or treatment of roundwindow ruptures, auditory-ossicle dislocations after tympanoplasty, prothesis dislocation after stapeclotomy, neuroradiologically undetectable liquorrhea caused by otobasal fractures, progressive disorders of the sound-conducting apparatus, Dysplasia of the ear, chronic otitis media mesotympanalis, cholesteatoma, presurgical evaluation of pathologic findings of both the mucosal lining and the ossicular chain, epitympanic retraction pockets of the ear drum, all chronic and recurrent ventilation or drainage disorders of Eustachian tubes etc.
- Figure 35 shows a perspective view of an embodiment of a guidewire comprising a sensor used for surgical navigation.
- Guidewire 3400 comprises a sensor 3402 located on the distal region of guidewire 3400. Sensor 3402 enables guidewire 3400 to be used in conjunction with a suitable surgical navigation system.
- sensor 3402 is an electromagnetic sensor used in conjunction with an electromagnetic surgical navigation system such as GE InstaTrakTM 3500 plus system.
- guidewire 3400 comprises an anchoring balloon 3404 located on the distal region of guidewire 3400. Anchoring balloon 3404 is inflated after positioning guidewire 3400 at a target location. Anchoring balloon 3404 anchors guidewire 3400 to adjacent anatomy and prevents accidental repositioning of guidewire 3400 during a diagnostic or therapeutic procedure.
- Anchoring balloon 3404 may be made from suitable compliant or semi-compliant material such as crosslinked polyethylene or other polyolefins, polyurethane, flexible polyvinylchloride, Nylon etc.
- guidewire 3400 comprises a soft distal tip.
- guidewire 3400 comprises a curved distal end e.g. a "J" shaped distal end.
- Sensors similar to sensor 3402 may be present on other diagnostic or therapeutic devices disclosed herein such as balloon catheters etc.
- the devices disclosed herein may comprise other types of sensors or transmitters such as electromagnetic, RF, piezoelectric, magnetic etc.
- the sensors or transmitters may be in the form of a variety of configurations including but not limited to single coils, multiple coils, antennae etc.
- the sensors or transmitters may be oriented in a variety of configurations including but not limited to nested, paired, orthogonal to each other, etc.
- Figure 35A shows an enlarged view of an embodiment of a low profile proximal region of the guidewire in Figure 35.
- the proximal region of guidewire 3400 comprises a distal electrical contact 3406 and a proximal electrical contact 3408.
- Distal electrical contact 3406 and proximal electrical contact 3408 are connected to sensor 3402 by conducting wires that run along guidewire 3400 to provide electrical energy to sensor 3402.
- Distal electrical contact 3406 and proximal electrical contact 3408 are connected to an external electrical supply by detachable electrodes.
- Distal electrical contact 3406 and proximal electrical contact 3408 can be made of suitable conducting materials such as stainless steel, silver-palladium alloys, silver-platinum alloys etc.
- guidewire 3400 further comprises a second insulating element 3412 located on the proximal end of guidewire 3400.
- a low profile proximal region allows for the introduction of diagnostic or therapeutic devices over guidewire 3400.
- Figure 35B shows a perspective view of a method of advancing a diagnostic or therapeutic device over the guidewire in Figure 35.
- the diagnostic or therapeutic device is a balloon catheter 3414 comprising a shaft 3416 having a balloon 3418 at the distal region of shaft 3416 and a hub 3420 at the proximal end of shaft 3416.
- Balloon catheter is advanced into a target anatomical region over the guidewire 3400.
- guidewire 3400 comprises a low profile proximal end so that devices can be introduced in an over-the-wire manner into a target anatomy.
- Figure 35C shows a perspective view of an embodiment of a combination of a guidewire comprising a sensor having a diagnostic or therapeutic device preloaded on the guidewire.
- the diagnostic or therapeutic device is balloon catheter 3414.
- the proximal end of guidewire 3400 is connected to an external electrical supply 3422 by conducting wires 3424.
- guidewire 3400 does not have a low profile proximal end so that devices cannot be introduced in an over-the-wire manner into a target anatomy.
- balloon catheter 3414 is preloaded on guidewire 3400 by inserting proximal end of balloon catheter 3414 over distal end of guidewire 3400.
- Figure 35D shows a perspective view of a second embodiment of a combination of a guidewire comprising a sensor having a diagnostic or therapeutic device preloaded on the guidewire.
- the diagnostic or therapeutic device is balloon catheter 3414.
- the proximal end of guidewire 3400 is connected by conducting wires 3426 to plug 3428.
- Plug 3428 detachably fits into an external power supply 3430.
- guidewire 3400 does not have a low profile proximal end so that devices cannot be introduced in an over-the-wire manner into a target anatomy.
- balloon catheter 3414 is preloaded on guidewire 3400 by inserting proximal end of balloon catheter 3414 over distal end of guidewire 3400.
- One or more flexible regions especially flexible distal regions on the diagnostic or therapeutic devices disclosed herein may comprise bending or deflecting elements.
- bending or deflecting elements are one or more pull wires etc. made of suitable materials such as stainless steel flat wire etc.
- the abovementioned devices and methods may also be used for diagnosing or treating other conditions caused by narrowing or blockage of structures in the ear, nose, throat or mouth such as choanal atresia.
- catheters may comprise one or more lumens such as end-to-end lumens, zipper lumens, rapid exchange lumens, parallel lumen surrounded by a jacket etc.
- lumens such as end-to-end lumens, zipper lumens, rapid exchange lumens, parallel lumen surrounded by a jacket etc.
Abstract
Sinusitis, mucocysts, tumors, infections, hearing disorders, choanal atresia, fractures and other disorders of the paranasal sinuses, Eustachian tubes, Lachrymal ducts and other ear, nose, throat and mouth structures are diagnosed and/or treated using minimally invasive approaches and, in many cases, flexible catheters as opposed to instruments having rigid shafts. Various diagnostic procedures and devices are used to perform imaging studies, mucus flow studies, air/gas flow studies, anatomic dimension studies and endoscopic studies. Access and occluding devices may be used to facilitate insertion of working devices such asendoscopes, wires, probes, needles, catheters, balloon catheters, dilation catheters, dilators, balloons, tissue cutting or remodeling devices, suction or irrigation devices, imaging devices, sizing devices, biopsy devices, image-guided devices containing sensors or transmitters, electrosurgical devices, energy emitting devices, devices for injecting diagnostic or therapeutic agents, devices for implanting devices such as stents, substance eluting or delivering devices and implants, etc.
Description
DEVICES, SYSTEMS AND METHODS FOR TREATING DISORDERS OF THE EAR, NOSE AND THROAT
RELATED APPLICATION
This application is a continuation-in-part of 1) United States Patent Application Serial No. 10/829,917 entitled "Devices, Systems and Methods for Diagnosing and Treating Sinusitis and Other Disorders of the Ears, Nose and/or Throat" filed on April 21 , 2004, 2) United States Patent Application Serial No. 10/912,578 entitled "Implantable Device and Methods for Delivering Drugs and Other Substances to Treat Sinusitis and Other Disorders" filed on August 4, 2004 and 3) United States Patent Application Serial No. 10/944,270 entitled "Apparatus and Methods for Dilating and Modifying Ostia of Paranasal Sinuses and Other Intranasal or Paranasal Structures" filed on September 17, 2004, the entireties of each such parent application being expressly incorporated herein by reference.
FIELD OF THE INVENTION
The present invention relates generally to medical devices, systems and methods and more particularly to minimally invasive devices, systems and methods for treating sinusitis and other ear, nose & throat disorders.
BACKGROUND OF THE INVENTION
Surgical treatments for sinusitis and other disorders of the ear, nose and throat have evolved slowly over the years. In current clinical practice, functional endoscopic sinus surgery (FESS) is often used to treat sinusitis or other disorders where drainage of mucous is impaired and/or chronic infections are present. In FESS, an endoscope is inserted into the nose and, under visualization through the endoscope, the surgeon may remove diseased or hypertrophic tissue or bone and may enlarge the ostia of the sinuses to restore normal drainage of the sinuses. FESS procedures can be effective in the treatment of sinusitis and for the removal of tumors, polyps and other aberrant growths from the nose. Other endoscopic intranasal procedures have been
used to remove pituitary tumors, to treat Graves disease (i.e., a complication of hyperthyroidism which results in protrusion of the eyes) and surgical repair of rare conditions wherein cerebrospinal fluid leaks into the nose (i.e., cerebrospinal fluid rhinorrhea). In some instances, sinus and ENT surgery has been performed with the assistance of electronic navigation devices (i.e., "image-guided FESS"). In such image guided surgical procedures, integrated anatomical information is supplied through CT-scan images or other anatomical mapping data taken before the operation. Data from a preoperative CT scan or other anatomical mapping procedure is downloaded into a computer and special sensors known as localizers are attached to the surgical instruments. Thus, using the computer, the surgeon can ascertain, in three dimensions, the precise position of each localizer-equipped surgical instrument at any given point in time. This information, coupled with the visual observations made through the standard endoscope, can help the surgeon to carefully position the surgical instruments to avoid creating CSF leaks and to avoid causing damage to nerves or other critical structures.
Although FESS continues to be the gold standard therapy for severe sinuses, it has several shortfalls. Often patients complain of the post-operative pain and bleeding associated with the procedure, and a significant subset of patients remain symptomatic even after multiple surgeries. Since FESS is considered an option only for the most severe cases (those showing abnormalities under CT scan), a large population of patients exist that can neither tolerate the prescribed medications nor be considered candidates for surgery. Further, because the methodologies to assess sinus disease are primarily static measurements (CT, MRI), patients whose symptoms are episodic are often simply offered drug therapy when in fact underlying mechanical factors may play a significant role. To date, there is no mechanical therapy offered for these patients, and even though they may fail pharmaceutical therapies, no other course of action is indicated. This leaves a large population of patients in need of relief, unwilling or afraid to take steroids, but not sick enough to qualify for surgery.
Some experimental or investigational procedures have also been performed in an effort to treat sinusitis by methods that are less invasive and/or
less damaging to ancillary tissues than FESS. For example, European physicians have reported the use of a hydrophilic guidewire and standard PTCA balloon catheter to treat restenosis of surgically created openings in diseased frontal sinuses and stenotic nasal conae. Gόttmann, D., Strohm, M., Strecker, E. P., Karlsruhe, D. E., Balloon dilatation of Recurrent Ostial Oclusion of the Frontal Sinus, Abstract No. B-0453, European Congress of Radiology (2001); Strohm, M., Gδttmann, D., Treatment of Stenoses of Upper Air Routes by Balloon Dilation, Proceeding of the 83rd Annual Convention of the Association of West German ENT Physicians (1999). The interventions described in this abstract were conducted only on frontal sinuses that had previously been surgically modified and nasal conae. These techniques were not reported to be ueable for the treatment of sinus ostia that has not previously been surcically altered or ostia of sinuses other than the easily accessible frontal sinuses. Also, in these these reported cases, standard vascular guidewires and angioplasty balloon catheters were used. The techniques described in these publications have not been widely adopted by ENT surgeons, possibly due to the fact that they lacked important novel improvements and modifications as described in this patent application and prior United States Patent Application Serial Nos. 10/829,917, 10/912,578 and 10/944,270, of which this application is a continuation-in-part.
Other methods and devices for sinus intervention using dilating balloons have been disclosed in United States Patent No. 2,525,183 (Robison) and United States Patent Publication No. 2004/0064150 A1 (Becker). For example, United States Patent No.2, 525, 183 (Robison) discloses an inflatable pressure device which can be inserted following sinus surgery and inflated within the sinus. The patent does not disclose device designs and methods for flexibly navigating through the complex nasal anatomy to access the natural ostia of the sinuses. The discussion of balloon materials is also fairly limited to thin flexible materials like rubber which are most likely to be inadequate for dilating the bony ostia of the sinus.
United States patent publication number 2004/0064150 A1 (Becker) discloses balloon catheters formed of a stiff hypotube to be pushed into a sinus. The balloon catheters have a stiff hypotube with a fixed pre-set angle that enables them to be pushed into the sinus. In at least some procedures wherein
it is desired to position the balloon catheter in the ostium of a paranasal sinus, it is necessary to advance the balloon catheter through complicated or tortuous anatomy in order to properly position the balloon catheter within the desired sinus ostium. Also, there is a degree of individual variation in the intranasal and paranasal anatomy of human beings, thus making it difficult to design a stiff-shaft balloon catheter that is optimally shaped for use in all individuals. Indeed, rigid catheters formed of hypotubes that have pre-set angles cannot be easily adjusted by the physician to different shapes to account for individual variations in the anatomy. In view of this, the Becker patent application describes the necessity of having available a set of balloon catheters, each having a particular fixed angle so that the physician can select the appropriate catheter for the patient's anatomy. The requirement to test multiple disposable catheters for fit is likely to be very expensive and impractical. Moreover, if such catheter are disposable items (e.g., not sterilizable and reusable) the need to test and discard a number of catheters before finding one that has the ideal bend angle could be rather expensive.
The prior art has not provided catheters, devices, systems and methods that are optimal for minimally invasive treatment of sinusitis, mucocysts, tumors, infections, hearing disorders, fractures, choanal atresia or other conditions of the paranasal sinuses, Eustachian tubes, Lachrymal ducts and other ear, nose, throat or mouth structures.
SUMMARY OF THE INVENTION
In general, the present invention provides methods, devices and systems for diagnosing and/or treating sinusitis, mucocysts, tumors, infections, hearing disorders, fractures, choanal atresia or other conditions of the paranasal sinuses, Eustachian tubes, llachrymal ducts, ducts of salivary glands and other ear, nose, throat or mouth structures.
In accordance with the present invention, there are provided methods wherein one or more flexible catheters or other flexible elongate devices as described herein are inserted in to the nose, nasopharynx, paranasal sinus, Eustachian tubes, middle ear, lachrymal ducts, ducts of salvary glands or other anatomical passageways of the ear, nose, throat or mouth to perform an interventional or surgical procedure. Examples of procedures that may be
performed using these flexible catheters or other flexible elongate devices include but are not limited to: delivering contrast medium; performing an imaging study, delivering a therapeutically effective amount of a therapeutic substance; implanting a stent or a tissue remodeling device, substance delivery implant or other therapeutic apparatus; cutting, ablating, debulking, cauterizing, heating, dilating or otherwise modifying tissue such as nasal polyps, abberant or enlarged tissue, abnormal tissue, etc.; grafting or implanting cells or tissue; reducing, setting, affixing or otherwise treating a fracture; delivering a gene or gene therapy preparation; cutting, ablating, debulking, cauterizing, heating, freezing, lasing, forming an osteotomy or trephination in or otherwise modifying bony or cartilaginous tissue within paranasal sinus, nasopharynx, Eustachian tube, middle ear, Lachrymal duct or elsewhere within the ear, nose, throat or mouth; remodeling or changing the shape, size or configuration of a sinus ostium or other anatomical structure that affects drainage from one or more paranasal sinuses; removing puss or aberrant matter from the paranasal sinus or elsewhere within the nose; scraping or otherwise removing cells that line the interior of a paranasal sinus; removing all or a portion of a tumor; removing a polyp; delivering histamine, an allergen or another substance that causes secretion of mucous by tissues within a paranasal sinus to permit assessment of drainage from the sinus etc.
Still further in accordance with the invention, there are provided novel access, stabilizing and occluding devices. They may be used to facilitate insertion of working devices such as endoscopes, guidewires, catheters (e.g. balloon catheters), tissue cutting or remodeling devices, sizing devices, biopsy devices, image-guided devices containing sensors or transmitters, electrosurgical devices, energy emitting devices, devices for injecting diagnostic or therapeutic agents, devices for implanting devices such as stents, substance eluting devices, substance delivery implants, etc. into the paranasal sinuses and other structures in the ear, nose, throat or mouth for performing some or all of the procedures described herein.
Still further in accordance with the invention, there are presented several modalities for navigation and imaging of the interventional devices within the nose, nasopharynx, paranasal sinuses, Eustachian tubes, middle ear, lachrymal ducts, ducts of salvary glands or other anatomical passageways of the ear,
nose, throat or mouth using endoscopic, fluoroscopic, radiofrequency localization, electromagnetic and other radiative energy based imaging and navigation modalities. These imaging and navigation technologies may also be referenced by computer directly or indirectly to pre-existing or simultaneously created 3-D or 2-D data sets which help the doctor place the devices within the appropriate region of the anatomy.
Still further in accordance with the invention, there are provided methods for improving drainage from a paranasal sinus that has a natural ostium that has not previously been surgically altered, said method comprising the steps of: A) providing an elongate guide (e.g., a wire, rod, probe, guidewire, flexible member, malleable member, tube, cannula, catheter, stylets, etc.) and a dilator (e.g., a dilation catheter, balloon catheter, expandable member, etc.); B) advancing the elongate guide to a position within or near the ostium; C) using the elongate guide to advance the dilatior to a position where the dilator is within the ostium; and D) using the dilator to dilate the natural ostium. The dilation of the natural ostium may, in at least some cases, result in breaking or rearrangement of bone that underlies the mucosa of the ostium.
Still further in accordance with the invention, there is provided a method for treating a mucocyst or other or other flowable-substance-containing structure located within a paranasal sinus, said method comprising the steps of A) providing a penetrator that is useable to form an opening in the mucocyst or other flowable-substance-containing structure; B) providing a compressor useable to compress the mucocyst or other flowable-substance-containing structure after an opening has been formed therein by the penetrator such that its contents will be forced out of the opening formed by the penetrator; C) advancing the penetrator into the paranasal sinus and using the penetrator to form an opening in the mucocyst or other flowable-substance-containing structure; and D) positioning the compressor in the paranasal sinus and using the compressor to compress the mucocyst or other flowable-substance- containing structure such that its contents will be forced out of the opening formed by the penetrator.
Still further in accordance with the invention, there is provided a method for dilating a Eustachian tube in a human or animal subject, said method domprising the steps of: A) providing a a guide member (e.g., a guidewire) that
is insertable through the nose and is advanceable into the Eustachian tube through the pharyngeal ostium of the Eustachian tube and a dilator that is advanceable over the guidewire and useable to dilate the Eustachian tube; B) inserting the guidewire into the Eustachian tube; C) advancing the dilator over the guide member and into the Eustachian tube; and D) using the dilator to dilate the Eustachian tube. In some embodiments of this method, the guide member (e.g., guidewire) may have an anchor (e.g., a balloon) for holding the guide member in a substantially fixed position within the Eustachian tube, thereby guarding against inadvertent advancement of the guide member or dilation catheter into the middle ear as may injure the bones of the middle ear. In some embodiments, marker(s) such as radiopaque markers may be provided on the guide memner and/or may be inserted into the adjacent ear canal next to the tympanic membrane to allow the operator to clearly view the location at which the Eustachian tube enters the middle ear, thereby further guarding against inadvertent advancement of the device(s) into the middle ear.
Still further in accordance with the invention, there is provided a method for modifying a bony structure within the nose or paranasal sinus human or animal subject, said method comprising the steps of: A) providing a direct viewing apparatus (e.g., a scope, rigid scope, flexible scope, camera, video camera, intranasal camera similar to an intraoral camera but sized for insertion into the nares or nasal cavity); B) inserting the direct viewing apparatus into the nose; C) advancing a guide device to a first location within the nasal cavity or paranasal sinus under direct viewing using the direct viewing apparatus; D) providing an indirect viewing apparatus (e.g., an imaging device, fluoroscope, fluoroscope with C-arm, magnetic resonance imaging device, tomographic device, CT scanner, electromagnetic navigational and/or guidance system, PET scanner, combination CT/PET scanner and optical coherence tomography device, etc.); E) advancing a working device ( e.g., an endoscope, wire, probe, needle, catheter, balloon catheter, dilation catheter, dilator, balloon, tissue cutting or remodeling device, suction or irrigation device, imaging device, sizing device, biopsy device, image-guided device containing sensor or transmitter, electrosurgical device, energy emitting device such as laser, rf, etc., device for injecting diagnostic or therapeutic agent, device for implanting other articles such as stents, substance eluting or delivering device, implant, etc.) over the
guide device to a second location location within the nasal cavity or paranasal sinus, under indirect viewing using the direct viewing apparatus; and F) using the working device to perform a therapeutic or diagnostic procedure.
Still further in accordance with the invention, there is provided a method for determining the position of a device within the body of a human or animal subject, said method comprising the steps of A) providing a device having an electromagnetic element (e.g., a sensor or electromagnetic coil) thereon; B) providing a plurality of fiducial markers which emit electromagnetic energy and an attachment substance or apparatus for removably attaching the fiducial markers to teeth, bones or other anatomical structures; C) using the attachment substance or apparatus to removably attach the fiducial markers to teeth, bones or other anatomical structures of the subject's body; D)performing an imaging procedure to obtain an image of a portion of the subject's body including the fiducial markers; and, thereafter, E) advancing the device into the subject's body and detecting the electromagnetic element on the device as well as the electromagnetic energy emitted by the fiducial markers; and F) using the image obtained in Step D and the information dectected in Step E to determine the current position of the device within the subject's body.
Further aspects, details and embodiments of the present invention will be understood by those of skill in the art upon reading the following detailed description of the invention and the accompanying drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
Figure 1 shows a schematic diagram of the general working environment of an example of a system for catheter-based minimally invasive sinus surgery being used to perform a sinus surgery on a human patient.
Figure 1A shows a magnified view of region 1A of Figure 1 showing a system for catheter-based minimally invasive sinus surgery of a human patient.
Figure 1 B shows a perspective view of a treatment tray for catheter- based minimally invasive sinus surgery of a human patient.
Figure 2A shows a portion of a stabilizing device comprising a stabilizing member.
Figures 2B-2D show various alternate embodiments of stabilizing member of Figure 2A.
Figure 2E-2G show perspective views of various embodiments of inflatable occluding devices. Figures 3A-3D' show embodiments of stabilizing members comprising an adhesive element.
Figures 4A and 4B show perspective views of an occluding device in deflated and inflated states respectively.
Figure 5 shows a perspective view of a guide catheter comprising a plastically deformable (malleable) region.
Figure 6 shows a perspective view of a guide catheter comprising a lubricious layer.
Figure 6A shows a crossectional view of the guide catheter of Figure 6 through the plane 6A-6A. Figure 7 shows perspective view of an embodiment of a guide catheter comprising a straight hypotube.
Figure 7A shows a crossection of the guide catheter of Figure 7 through plane 7A-7A.
Figure 8 shows perspective view of a second embodiment of a guide catheter comprising a straight hypotube.
Figure 8A shows a crossection of the guide catheter of Figure 8 through plane 8A-8A.
Figure 8B shows a crossection of the guide catheter of Figure 8 through plane 8B-8B. Figure 8C shows a perspective view of an embodiment of a guide catheter comprising a curved or bent hypotube to facilitate access to the frontal sinuses.
Figure 8D shows a perspective view of a second embodiment of a guide catheter comprising a curved or bent hypotube to facilitate access to the sphenoid sinuses.
Figure 8E shows a perspective view of an embodiment of a guide catheter comprising two bent or angled or curved regions to facilitate access to the maxillary sinuses.
Figure 8F shows a perspective view of a second embodiment of a guide catheter comprising two bent or angled or curved regions and a hypotube to facilitate access to the maxillary sinuses.
Figure 8G shows a coronal section of the paranasal anatomy showing a method of accessing a maxillary sinus ostium using the guide catheter of Figure 8F.
Figure 8H shows a sagittal section of the paranasal anatomy showing the method of Figure 8G to access a maxillary sinus ostium using the guide catheter of Figure 8F. Figure 81 shows a perspective view of an example of a guide catheter comprising a common proximal portion and a plurality of detachable distal tips.
Figure 9 shows a perspective view of a set of devices to dilate or modify ostia or other openings in the ear, nose, throat or mouth structures.
Figure 10 shows a perspective view of a probing device. Figures 10A - 10C show various steps of a method of using the probing device shown in Figure 10 to access an anatomical region.
Figure 11 A shows a perspective view of a first embodiment of a dual balloon catheter that can be used to perform a diagnostic or therapeutic procedure. Figure 11 B shows a perspective view of a second embodiment of a dual balloon catheter that can be used to perform a diagnostic or therapeutic procedure.
Figures 11C - 11E show perspective views of third, fourth and fifth embodiments respectively of dual balloon catheters for dilating an anatomical region.
Figures 11 F - 11J show the various steps of a method of dilating an anatomical region using the catheter of Figure 11D.
Figures 12A - 12C show the various steps of a method of deploying a stent in the ear, nose, throat or mouth using a working catheter comprising a locating mechanism.
Figures 12D - 12H show the various steps of a method of dilating an anatomical opening in the ear, nose, throat or mouth using a combination of a dilating device and an anchoring device.
Figure 13 shows a perspective view of a dilating device comprising an electrode element to reduce restenosis.
Figure 14 shows a perspective view of an embodiment of a balloon catheter comprising a sizing balloon and a dilating balloon. Figure 14A shows a crossectional view through the plane 14A-14A of
Figure 14.
Figures 14B - 14D show the various steps of dilating an anatomical opening using the balloon catheter in Figure 14.
Figure 15 shows a perspective view of a balloon catheter comprising a sleeve for delivering diagnostic or therapeutic agents.
Figure 15A shows a crossectional view through plane 15A-15A of Figure 15.
Figure 16 shows a perspective view of a balloon catheter comprising one or more agent delivery reservoirs. Figure 16A shows a crossectional view through plane 16A-16A of Figure
16.
Figure 17 shows a perspective view of a balloon catheter comprising a balloon comprising one or more micropores.
Figure 17A shows a crossectional view through the plane 17A-17A of Figure 17.
Figure 18 shows a balloon catheter comprising a balloon having an outer coating of diagnostic or therapeutic agents.
Figures 18A - 18C show the steps of a method of using the balloon catheter of Figure 18 to dilate an anatomical region. Figure 19A shows a perspective view of a lavage catheter.
Figure 19B shows a crossectional view through the plane 19B - 19B of Figure 19A.
Figure 19C shows the method of operation of lavage catheter of Figure 19A to lavage an anatomical region. Figure 2OA shows a perspective view of the distal end of a second embodiment of a lavage catheter.
Figure 2OB shows a perspective view of the distal end of the lavage catheter of Figure 2OA introduced in an anatomical region.
Figure 2OC shows an embodiment of the lavage cattheter of Figure 2OA being used to lavage an anatomical region.
Figure 2OD shows a sagittal section of a human head showing the general working environment of the lavage devices of Figures 2OA - 2OC. Figure 21 shows a perspective view of a cutting device comprising cutting jaws.
Figure 21A shows a perspective view of the distal region of the cutting device of Figure 21 wherein the cutting jaws are closed as seen from the distal end of the cutting device. Figure 21 B shows a perspective view of one embodiment of the cutting jaws of the cutting device of Figure 21.
Figure 21C shows a crossectional view of the cutting device in Figure 21 through cutting plane 21C-21C.
Figure 22A shows a perspective view of an alternate embodiment of a device comprising cutting or gripping jaws.
Figure 22B shows a perspective view of the device of Figure 22A wherein the cutting or gripping jaws of the cutting device are in a closed configuration.
Figures 23A - 23C show the various steps of a method of puncturing an anatomical region using a flexible, rotating drill shaft. Figure 23D shows a sectional view of an embodiment of a drilling device.
Figures 24A - 24C show a sagittal section of an Ethmoid sinus showing various methods of treating Ethmoid sinus diseases by a minimally invasive approach.
Figures 24A' - 24A"" show a method of creating drainage channels for sinus secretions in Ethmoid sinus.
Figure 25A shows a perspective view of an embodiment of an ostium enlarger and/or microshaver.
Figure 25B shows one embodiment of the device of FFigure 25A being used to remove tissue or matter. Figure 25C shown another embodiment of the device of Figure 25A being used to shave tissue or matter.
Figure 25D is an exploded view of the device of Figure 25C.
Figures 26A - 26C show various steps of a method of treating a mucocyst by a puncturing needle and a balloon catheter.
Figures 27A - 27B show various steps of a method of treating a mucocyst by a balloon catheter comprising a deployable puncturing needle.
Figures 28A - 28C show various embodiments of catheters comprising agent delivery needles. Figure 29A illustrates an embodiment of a displacement catheter to displace and remove secretions in an anatomical region.
Figure 29B shows a sectional view of an anatomical region showing a method of displacing secretions by the displacement catheter of Figure 29A.
Figure 30 shows a perspective view of an embodiment of an ultrasonic drilling device.
Figures 3OA - 3OB show a sectional view of an anatomical region showing a method of expanding an anatomical opening using the drilling device of Figure 30.
Figure 31 shows a sectional view of an embodiment of a catheter for providing an internal cast for fractured bony cavities.
Figure 31 A shows a crossection through the outer balloon in the catheter of Figure 31 through plane 31 A - 31 A.
Figures 31 B - 31 D show various steps of a method of providing an internal cast for a fractured bony cavity using the catheter shown in Figure 31 Figure 32 shows an embodiment of a surgical navigation system comprising electromagnetic sensors.
Figure 32A shows an enlarged view of region 32A in Figure 32.
Figure 33 shows a section of the anatomical region around a Eustachian tube (ET) showing a diagnostic or therapeutic procedure being performed by devices inserted through the pharyngeal ostium of the Eustachian tube.
Figure 33A shows an enlarged view of region 33A in Figure 33.
Figure 33B shows a front view of a human head with a portion of the face removed to show an embodiment of a method of introducing a guidewire into a Eustachian tube. Figures 34A - 34D illustrate various examples of working elements that could be located on the diagnostic or therapeutic device in Figure 33.
Figure 35 shows a perspective view of an embodiment of a guidewire comprising a sensor used for surgical navigation.
Figure 35A shows an enlarged view of an embodiment of a low profile proximal region of the guidewire in Figure 35.
Figure 35B shows a perspective view of a method of advancing a diagnostic or therapeutic device over the guidewire in Figure 35. Figure 35C shows a perspective view of an embodiment of a guidewire comprising a sensor having a diagnostic or therapeutic device preloaded on the guidewire.
Figure 35D shows a perspective view of a second embodiment of a guidewire comprising a sensor having a diagnostic or therapeutic device preloaded on the guidewire.
DETAILED DESCRIPTION
The following detailed description, the accompanying drawings and the above-set-forth Brief Description of the Drawings are intended to describe some, but not necessarily all, examples or embodiments of the invention. The contents of this detailed description, the accompanying drawings and the above-set-forth Brief Description of the Drawings do not limit the scope of the invention in any way. A number of the drawings in this patent application show anatomical structures of the ear, nose and throat. In general, these anatomical structures are labeled with the following reference letters:
Nasal Cavity NC
Nasopharynx NP
Frontal Sinus FS
Frontal Sinus Ostium FSO
Ethmoid Sinus ES
Ethmoid Air Cells EAC
Sphenoid Sinus SS
Sphenoid Sinus Ostium SSO
Maxillary Sinus MS
Maxillary sinus ostium MSO
Mucocyst MC
Eustachian tube ET
Cochlea C
Tympanic cavity TC
Middle turbinate MT
Inferior turbinate IT Uncinate UN
Figure 1 shows a schematic diagram of the general working environment of an example of a system for catheter-based minimally invasive sinus surgery being used to perform a sinus surgery on a human patient. The human patient is treated by a working device 10. Working device 10 may be connected to one or more auxiliary devices located on a treatment tray 12. A C-arm fluoroscope 14 provides fluoroscopic visualization of anatomical regions during the procedure. An instrument console 16 comprising one or more functional modules 18 may also be present. Examples of functional modules that can be used with the invention are: 1. Suction pump for delivering a controlled amount of negative pressure or vacuum to a suction device,
2. Irrigation pump to deliver saline, antibiotic solution or other suitable irrigation medium,
3. Power module to supply power to drills or other electrical devices, 4. Storage modules for storing instruments, medications etc.,
5. Energy delivery module to provide radiofrequency, laser, ultrasound or other therapeutic energy to a surgical device,
6. Fluoroscope, MRI, CT, Video, Endoscope or Camera or other imaging modules to connect or interact with devices used during various diagnostic or therapeutic procedures,
7. Display module e.g. a LCD, CRT or Holographic screen to display data from various modules such as an endoscope, fluoroscope or other data or imaging module,
8. Remote control module to enable an operator to control one or more parameters of one or more functional modules 18,
9. Programmable Microprocessor that can store one or more operation settings for one or more functional modules 18 etc., and
10. Stabilization device for holding various apparatuses during the procedure which may include a stabilization arm, table, dip, intranasal or extranasal inflatable support or robotically controlled apparatus,
11. Rotary drive module for rotating rotatable device such as a drill or auger (e.g., a motor having a rotation drive shaft or drive cable attached thereto.
One or more functional modules 18 may be connected to the working device 10. Instrument console module 16 can be controlled by console control means 20, e.g. a foot pedal controller, a remote controller etc. Instrument console 16 may be fitted with wheels to enable an operator to change the position of the instrument console 16 in an operating area. In one embodiment, instrument console module 16 and C-arm fluoroscope 14 are integrated in a single unit.
Figure 1A shows a magnified view of region 1A of FFigure 1 showing a system for catheter-based minimally invasive sinus surgery of a human patient. In FFigure 1A, a balloon catheter is used as an example of working device 10. Working device 10 has attachments for a variety of auxiliary devices such as a balloon inflation syringe 22, a guidewire 24 and a suction or irrigation tube 26. Working device 10 and the auxiliary devices may be detachably attached to treatment tray 12. Treatment tray 12 may comprise one or more treatment tray controllers 28 to control one or more treatment parameters. Treatment tray 12 may comprise one or more storage modules to store devices used during a surgery e.g. irrigation bottles, swabs etc.
Figure 1B shows a perspective view of a treatment tray for catheter- based minimally invasive sinus surgery of a human patient. Treatment tray 12 comprises one or more device holders 30 to detachably hold devices during the surgery. In one embodiment, device holders 30 are detachably attached to device holder slots 32 on treatment tray 12. Thus the position of device holders 30 on treatment tray 12 can be changed by removing a device holder 30 from a device holder slot 32 and transferring to a new device holder slot 32.
Figure 2A shows a portion of a stabilizing device 100 comprising a stabilizing member 102. Stabilizing member 102 comprises a lumen through which working device 10 can be introduced. In this example, stabilizing member
102 is located in a nostril. Alternatively, stabilizing member 102 may be located in other suitable regions of the head e.g. the nasal passages.
Stabilizing member 102 may be oriented to stabilizing device 100 in a variety of orientations. Also, the stabilizing member can be used to stabilize more than one working device. Figures 2B-2D show various alternate embodiments of stabilizing member 102 of Figure 2A. Figure 2B shows an embodiment of a radially symmetrical stabilizing member 104, wherein the axis 106 of stabilizing member 104 is substantially parallel to the axis 110 of stabilizing device 100. Figure 2C shows an embodiment of a radially symmetrical stabilizing member 112. The axis 114 of stabilizing member 112 is substantially non-parallel to the axis 116 of stabilizing device 100. Figure 2D shows an embodiment of a stabilizing member 118, wherein stabilizing member 118 comprises two lumens enclosing a first stabilizing device 120 and a second stabilizing device 122. Suitable materials that can be used for constructing the stabilizing members are:
• Foam materials such as polyurethane foam, polyvinyl chloride foam, Thermal-Reactive Foam™ etc.,
• Inflatable members such as compliant or non-compliant balloons,
• Moldable materials such as silicone rubber or wax, • Metals such as stainless steel or super-elastic or shape memory metals such as Nitinol
• Thermoplastic elastomers such as block copolymers e.g. styrene- butadiene-styrene (SBS) rubber or ionomers etc.
The stabilizing members may be pre-molded to a predefined shape. Figures 2E-2G show perspective views of various embodiments of inflatable occluding devices. Figure 2E shows a partial view of an occluding device 124 comprising an inflatable occluding member 126. Inflatable occluding member 126 may be made of compliant materials e.g. silicone rubber, or non- compliant materials e.g. polyethylene terephthalate (PET). Inflatable occluding member 126 can be inflated through an inflation port 127 located on the occluding device 124. Occluding device 124 can have one or more device insertion ports. The device insertion ports can be used to insert a variety of diagnostic or therapeutic devices such as endoscopes, guidewires, catheters
etc. In this example, occluding device 124 has a first device insertion port 128 and a second device insertion port 130. The device insertion ports may comprise one or more flush ports. In this example, occluding device 124 comprises a first flush port 132 located on first device insertion port 128 and a second flush port 134 located on second device insertion port 130. Such an occluding device may be used for occluding one or two nostrils to provide a gas- tight or liquid-tight seal against the nostril or to stabilize devices that are passed through the device insertion ports on the occluding device.
The inflatable occluding member may be made of variety of shapes. Figure 2F shows an occluding device 136 comprising an inflatable occluding member 138 of an elongated shape wherein the diameter of the inflatable occluding member 138 tapers along the length of occluding device 136. Inflatable occluding member 138 may also be spherical, disk shaped, cylindrical, conical etc. The inflatable occluding member may comprise a variety of surface features. For example, Figure 2G shows an occluding device 140 comprising an inflatable occluding member 142. Inflatable occluding member comprises a series or parallel circular ribs on its surface. Other surface features such as coatings (e.g. friction increasing coatings, abrasion resisting coatings, puncture resisting coatings, conductive coatings, radiopaque coatings, echogenic coatings, thrombogenicity reducing coatings and drug releasing coatings etc.), braids, grooves etc. may also be present on inflatable occluding member 142.
Figures 3A - 3D1 show embodiments of stabilizing members comprising an adhesive element. Figure 3A shows front view of an embodiment of a stabilizing member 200 comprising a pair of upper wings 202 and a pair of lower wings 204. In this embodiment, upper wings 202 are larger than lower wings 204. Stabilizing member 200 further comprises one or more orifices 206 through which one or more working devices can be introduced. Stabilizing member 200 is made of a light weight, flexible material that conforms to the contours of the patient's body. Examples of such materials are woven and non-woven fabrics, plastic films (e.g. polyvinylchloride films, polypropylene films etc.), cellulose, paper etc. Stabilizing member 200 may have a porous structure for increased transmission of water vapor produced in perspiration from the skin under stabilizing member 200. One surface of stabilizing member 200 is coated with
an adhesive to enable stabilizing member 200 to adhere to a surface on a patient's body. A non-allergenic adhesive is used to minimize skin irritation. Examples of such adhesives are non-allergenic pressure-sensitive adhesives such as silicone pressure sensitive adhesives, rubber pressure sensitive adhesives and acrylic or hydrogel pressure sensitive adhesives. Stabilization member 200 may also be lubricated with a silicone or other biocompatible lubricant at the orifice to allow easier introduction and removal of devices.
Stabilizing member 200 may be used to stabilize one or more working devices. Figure 3B shows a front view of stabilizing member 200 of Figure 3A with two working devices: a first working device 208 and a second working device 210. Figure 3C shows a front view of the stabilizing member 200 of Figure 3A with a single working device 212.
Figure 3D shows a side view of stabilizing member 200 of Figure 3A attached to a patient's body. Upper wings 202 are attached on the nose of the patient. Lower wings 204 are attached above the upper lip of the patient. A working device 10 is introduced through the orifice 206 into the patient's nose. Figure 3D' shows a front view of stabilizing member 200 of Figure 3A attached to a patient's body.
Figures 4A and 4B show perspective views of an occluding device in deflated and inflated states respectively. Occluding device 300 comprises a shaft 302 and an inflatable balloon 304 located on distal region of shaft 302. Shaft 302 has a diameter D.sub.1 and inflatable balloon 304 has a diameter D.sub.2 in the deflated state, wherein D.sub.2 is greater then D.sub.1. Inflatable balloon 304 can be made of compliant materials e.g. polyurethane, silicone etc. or non-compliant materials e.g. polyethylene terephthalate etc. Inflatable balloon 304 can be inflated through balloon inflation port 306 located on proximal region of occluding device 300. The inflated diameter D.sub.3 of the inflatable balloon is greater than D.sub.2 and is particularly suitable for occluding the Nasopharynx. Occluding device 300 further comprises a series of aspiration ports 308 located proximal to inflatable balloon 304. Aspiration ports 308 are connected to an aspiration lumen 310 to aspirate contents proximal to inflatable balloon 304.
Any diagnostic or therapeutic device disclosed herein may comprise one or more malleable regions. For example, Figure 5 shows a perspective view of a
guide catheter comprising a plastically deformable (malleable) region. Guide catheter 400 comprises a shaft 402 comprising a malleable region 404 located on distal region of shaft 402. Shaft 402 may comprise stiffening elements e.g. a braid, hypotube etc. Malleable region 404 may comprise malleable metallic tubes, rods (e.g. rods embedded in shaft 402 etc.), wires etc. Examples of metals that can be used for constructing malleable region 404 are malleable stainless steel, fully annealed stainless steel, copper, aluminum etc. Guide catheter 400 further comprises a threaded luer 406 located on proximal end of shaft 402. In this example, malleable region 404 is located on distal end of guide catheter 400. Malleable region 404 can also be located on proximal region or any other intermediate region on shaft 402. Shaft 402 may also comprise more than one malleable regions. Such a design comprising one or more malleable regions can be used for any of the devices mentioned herein such as catheters with working elements, guide catheters, guide catheters with a pre-set shape, steerable guide catheters, steerable catheters, guidewires, guidewires with a pre-set shape, steerable guidewires, ports, introducers, sheaths or other diagnostic or therapeutic devices.
Figure 6 shows a perspective view of a guide catheter comprising a lubricious layer. Guide catheter 500 comprises a shaft 502 comprising a threaded luer 504 located on the proximal end of the shaft 502. Figure 6A shows a crossectional view of the guide catheter of Figure 6 through the plane 6A-6A. Shaft 502 comprises a braid 506 embedded in the shaft. Shaft 502 further comprises a lubricious layer 508 located on the inner surface of shaft 502. Lubricious layer 508 may be made of suitable materials such as Teflon liners, Teflon coatings or Teflon sheaths. Such a design comprising one or more lubricious layers can be used for any of the devices mentioned herein such as catheters with working elements, guide catheters, guide catheters with a pre-set shape, steerable guide catheters, steerable catheters, guidewires, guidewires with a pre-set shape, steerable guidewires, ports, introducers, sheaths or other diagnostic or therapeutic devices.
Figure 7 shows perspective view of an embodiment of a guide catheter comprising a straight hypotube. Guide catheter 600 comprises a tubular element 602 and a hypotube 604 attached to the external surface of tubular element 602. Suitable materials for constructing hypotube 604 are Stainless Steel 304,
Nitinol etc. In one embodiment, hypotube 604 is annealed to the external surface of tubular element 602. Tubular element 602 can be made from a variety of materials including Pebax, HDPE etc. Tubular element 602 may comprise a braid or a jacket. In an embodiment, tubular element 602 comprises a lubricious coating 605 on its inner surface. The lubricious coating 605 can be made of suitable lubricious materials such as Teflon. In an embodiment, tubular element 602 comprises a bent or angled region near the distal end of tubular element 602. The bent or angled region may enclose an angle from 0 degrees to 180 degrees. Further this bent or angled region may be further bent out of plane to present a compound three-dimension end shape. Hypotube 604 can be malleable or substantially stiff. A malleable hypotube can be used in situations where the guide catheter 600 has to be bent or distorted to optimize its shape to conform to a patient's anatomy. Examples of materials that can be used to make a malleable hypotube are malleable stainless steel, fully annealed stainless steel, copper, aluminum etc. A substantially stiff hypotube can be used in situations where extra support is needed for introduction or removal or devices through guide catheter 600. Examples of materials that can be used to make a substantially stiff hypotube are Stainless Steel 304, Nitinol etc. Hypotube 604 may be bent to a two-dimensional or three-dimensional shape. Distal tip of tubular element 602 may comprise a radio-opaque marker 606 e.g. a standard radio-opaque marker band. The proximal region of tubular element 602 comprises a threaded luer.
Figure 7A shows a crossectional view of guide catheter 600 of Figure 7 through plane 7A-7A. The crossection of guide catheter 600 shows an outer hypotube 604 enclosing a tubular member 602 which in turn comprises a lubricious coating 605 located on the inner surface of tubular member 602.
Figure 8 shows a perspective view of a second embodiment of a guide catheter comprising a straight hypotube. Guide catheter 700 comprises a hypotube 702. Proximal end of hypotube 702 may comprise a threaded luer 704. Hypotube 702 encloses a tubular liner 706 that protrudes from the distal end of hypotube 702. Suitable materials for constructing tubular liner 706 are PTFE, Nylon, PEEK etc. Distal region of tubular liner 706 is covered with a tubular element 708. Tubular element 708 may be constructed of suitable materials such as Pebax, HDPE, Nylon etc. and may comprise a braid. Proximal
end of tubular element 708 may be bonded to distal end of hypotube 702 or may overlap distal region of hypotube 702. In one embodiment, distal region of tubular element 708 comprises a bent or angled region. In another embodiment, stiffness of tubular element 708 varies along the length of tubular element 708. Tubular element 708 may comprise a radio-opaque marker band 710 near distal end of tubular element 708. Figure 8A shows a crossectional view of guide catheter 700 of Figure 8 through plane 8A-8A showing hypotube 702 and tubular liner 706. Figure 8B shows a crossectional view of guide catheter 700 of Figure 8 through plane 8B-8B showing tubular element 708 and tubular liner 706.
The hypotubes disclosed above may be malleable or non-malleable. They may also comprise one or more bent or angled regions. For example, Figure 8C shows a perspective view of an embodiment of a guide catheter comprising a curved or bent hypotube to facilitate access to the frontal sinuses. Guide catheter 712 comprises a hypotube 714 comprising a threaded luer 716 at the proximal end of hypotube 714. Hypotube 714 may comprise one or more bent or angled regions. In this embodiment, the bent or angled region encloses an angle ranging from 60 degrees to 180 degrees. Hypotube 714 may be malleable or non-malleable. In this example, hypotube 714encloses a tubular element 718. Tubular element 718 may be constructed of suitable materials such as Pebax, HDPE etc. The distal region of tubular element 718 comprises a bent or angled region. In this embodiment, the bent or angled region encloses an angle ranging from 60 degrees to 170 degrees to facilitate access to the frontal sinuses using guide catheter 712. Distal region of tubular element 718 may comprise a radio-opaque marker 720. Figure 8D shows a perspective view of a second embodiment of a guide catheter comprising a curved or bent hypotube to facilitate access to the sphenoid sinuses. The catheter construction is similar to the catheter in FFigure 8C except the bent or angled region of hypotube 714 encloses an angle ranging from 90 degrees to 180 degrees and the bent or angled region of tubular element 718 encloses an angle ranging from 120 degrees to 180 degrees.
Figure 8E shows a perspective view of an embodiment of a guide catheter comprising two bent or angled or curved regions to facilitate access to the maxillary sinuses. Guide catheter 740 comprises a tubular element 742
comprising a threaded luer 744 at the proximal end of tubular element 742. Tubular element 742 further comprises a proximal bent, curved or angled region 746 enclosing an angle ranging from 90 degrees to 180 degrees and a distal bent, curved or angled region 748 enclosing an angle ranging from 90 degrees to 180 degrees. Tubular element 742 can be constructed from a variety of biocompatible materials such as Pebax, HDPE, Nylon, PEEK etc. and may comprise a braid. The inner surface of tubular element 742 may comprise a lubricious layer e.g. a Teflon layer. A curved region 750 is attached to the distal end of tubular element 742. Curved region 750 may enclose an angle ranging from 75 degrees to 180 degrees. The stiffness of curved region 750 is more than the stiffness of tubular element 742 so that there is no significant change to the shape of curved region 750 during the operation of guide catheter 740. The distal end of curved region 750 comprises a soft, atraumatic tip 752. The distal end of curved region 750 may also comprise a radioopaque marker. Guide catheter 740 may be further bent out of plane to present a compound three- dimension end shape. Figure 8F shows a perspective view of a second embodiment of a guide catheter comprising two bent or angled or curved regions and a hypotube to facilitate access to the maxillary sinuses. The construction of guide catheter 754 is similar to guide catheter 740 in Figure 8E except that guide catheter 754 further comprises a hypotube 756 on the outer surface of the proximal region of guide catheter 754.
Figure 8G shows a coronal section of the paranasal anatomy showing a method of accessing a maxillary sinus ostium using guide catheter 754 of Figure 8F. Guide catheter 754 is introduced through a nostril and advanced in the paranasal anatomy such that atraumatic tip 752 is located inside or adjacent to a maxillary sinus ostium MSO. Proximal bent, curved or angled region 746 allows guide catheter 754 to be positioned around the inferior turbinate IT. Similarly, distal bent, curved or angled region 748 allows guide catheter 754 to be positioned around the middle turbinate MT. A guidewire or a suitable diagnostic or therapeutic device may then be introduced through the lumen of guide catheter 754 into the maxillary sinus MS. Figure 8H shows a sagittal section of the paranasal anatomy showing the method of Figure 8G to access a maxillary sinus ostium using guide catheter 754 of Figure 8F.
Figure 81 shows a perspective view of an example of a guide catheter comprising a common proximal portion and a plurality of detachable distal tips. Distal end of common proximal portion 760 attaches to proximal end of a first detachable tip 762 by an attachment mechanism. First detachable tip 762 comprises an angled, curved or bent region enclosing an angle of 80 - 110 degrees suitable for access to the frontal and ethmoid sinuses. Similarly, distal end of common proximal portion 760 attaches to proximal end of a second detachable tip 764 by an attachment mechanism. Second detachable tip comprises two angled, curved or bent regions enclosing angles of 80 - 110 degrees and 80 - 110 degrees respectively. Such a design is suitable for access to the maxillary sinuses. Examples of attachment mechanisms are screw mechanisms, snap fitting mechanisms, slide fit mechanisms etc. Distal end of first detachable tip 762 and second detachable tip 764 may comprise a radioopaque marker such as a radioopaque band. Such a design comprising detachable distal regions can be used in a variety of diagnostic or therapeutic devices discloses herein. It can be used for easy access to one or more anatomical regions in the ear, nose, throat or mouth by using multiple detachable distal tips, wherein each detachable tip is optimized for access to a particular anatomical region. Figure 9 shows a perspective view of a set of devices to dilate or modify ostia or other openings in the ear, nose, throat or mouth structures. Guide catheter 800 comprises a shaft 802 comprising a threaded luer 804 at proximal end of shaft 802. Distal end of shaft 802 comprises a radio-opaque marker band MB to enable the physician to identify the tip of shaft 802 in a fluoroscopic image. The distal end of shaft 802 may be substantially straight or may comprise one or more bent or angled regions. One or more distance markings DM may also be located on the shaft 802. An optional subselective catheter 806 may also be present in the set of devices. Subselective catheter 806 comprises a shaft 808 comprising a threaded luer 810 at the proximal end of shaft 808. Inner diameter of shaft 808 is smaller than inner diameter of shaft 802. Distal end of the shaft 808 comprises a radio-opaque marker band MB to enable the physician to identify the tip of shaft 808 in a fluoroscopic image. Distal end of shaft 808 may be substantially straight or may comprise one or more bent or angled regions. One or more distance markings DM may also be located on the
shaft 808. Working device 812 comprises a shaft 814 comprising a working element 816 located on distal region of shaft 814 and a threaded luer 818 located on proximal end of shaft 814. In this example, the working element 816 is a dilating balloon. Other examples of working elements include dilating stents, suction or irrigation devices, needles, polypectomy tools, brushes, brushes, energy emitting devices such as ablation devices, laser devices, image-guided devices containing sensors or transmitters, endoscopes, tissue modifying devices such as cutters, biopsy devices, devices for injecting diagnostic or therapeutic agents, drug delivery devices such as substance eluting devices, substance delivery implants etc. The distal end of shaft 814 may be substantially straight or may comprise a bent or angled region. One or more distance markings DM may also be located on shaft 814. The set of devices further comprises a guidewire 820. Guidewire 820 may be substantially straight or may comprise a bent or angled region. One or more distance markings DM may also be located on guidewire 820. In one embodiment of a method using the abovementioned set of devices, guide catheter 800 is introduced into a patient's body so that distal end of guide catheter 800 is in the vicinity of an anatomical opening (e.g. an ostium) of an anatomical region (e.g. a paranasal sinus). Thereafter, guidewire 820 is introduced through guide catheter 800 into the anatomical region e.g. the paranasal sinus. If necessary, guide catheter 800 may be removed and the smaller subselective catheter 806 may be introduced over guide wire 820 into the paranasal sinus. Thereafter, working device 812 is introduced over guidewire 820 into the paranasal sinus and a diagnostic or therapeutic procedure is performed by working device 812. In another embodiment of a method using the abovementioned set of devices, subselective catheter 806 is introduced into a patient's body so that distal end of subselective catheter 806 is in the vicinity of an anatomical opening (e.g. an ostium) of an anatomical region (e.g. a paranasal sinus). Thereafter, guidewire 820 is introduced through subselective catheter 806 into the anatomical region e.g. the paranasal sinus. Thereafter, subselective catheter 806 is removed. Larger guide catheter 800 is then introduced over guide wire 820. Working device 812 is then introduced over guidewire 820 into the paranasal sinus and a diagnostic or therapeutic procedure is performed by working device 812. This
method embodiment enables a user to introduce larger working device 812 in the anatomical region.
Figure 10 shows a perspective view of a probing device. The probing device 900 comprises a probing element 902 and a detachable handle 904. Probing element 902 comprises an atraumatic tip 906 located on the distal end of probing element 902. In one embodiment, atraumatic tip 906 is spherical. Probing element 902 can be made from a variety of biocompatible materials such as metals (e.g. stainless steel, titanium, Nitinol etc.) or polymers (e.g. Pebax, polyethylene etc.). Probing element 902 may be rigid or flexible or malleable. In the embodiment shown in Figure 10, the distal region of the probing element 902 is malleable. This enables a physician to adjust probing device 900 for a patient's unique anatomy. Probing element 902 may comprise one or more curved or angled regions. Length of probing element 902 can range from 10 centimeters to 30 centimeters. Detachable handle can be attached to the probing element 902 by a variety of attachment mechanisms including screw arrangement, clipping mechanism etc. The tip of the probing element may further be modified to include a marker, sensor or transmitter capable of being tracked using one or more imaging modalities, such as x-ray, electromagnetic, radio-frequency, ultrasound, radiation, optics, and/or similar modalities.
Figures 10A - 10C show various steps of a method of using the probing device shown in Figure 10 to access an anatomical region. In Figure 10A, probing device 900 is advanced in to a patient's frontal sinus ostium through the nasal cavity. Atraumatic tip 906 prevents the probing device 900 from perforating and damaging healthy tissues. Thereafter, in Figure 10B, detachable handle 904 is detached from probing element 902. Thereafter, in Figure 10C, a working device 908 e.g. a catheter is advanced over the probing element 902 into the patient's frontal sinus ostium. Working device 908 can then be used to perform a diagnostic or therapeutic procedure or introduce other devices. In this example, probing device 900 was used to access the patient's frontal sinus ostium. Other anatomical locations in the patient's body e.g. ostia of other paranasal sinuses, ostia of lachrymal ducts, regions in the Eustachian tube, ducts of salvary glands, etc. may be accessed by similar methods. It is also possible that working device 908 may be preloaded over probing element 902
and maintained in a retracted position relative to the probing element until distal portion of the probing element 902 is introduced into a desired location. Further, multiple working devices may be inserted within working device 908 or over working device 908 once it is properly positioned. Figure 11 A shows a perspective view of a first embodiment of a dual balloon catheter that can be used to perform a diagnostic or therapeutic procedure. Catheter 1000 comprises a catheter shaft 1002 and a proximal balloon 1004 and a distal balloon 1006 located on catheter shaft 1002. A variety of diagnostic or therapeutic modules may be located in the inter-balloon region 1008 located between proximal balloon 1004 and distal balloon 1006. Examples of such diagnostic or therapeutic modules are dilating or occluding balloons, dilating stents, suction or irrigation devices, needles, polypectomy tools, energy emitting devices like ablation devices, laser devices, image-guided devices containing sensors or transmitters, imaging devices, endoscopes, tissue modifying devices like cutters, biopsy devices, devices for injecting diagnostic or therapeutic agents, lavage devices, drug delivery devices such as substance eluting devices, substance delivery implants etc. etc. A catheter hub 1010 is located on the proximal end of catheter shaft 1002. Catheter hub 1010 comprises a balloon inflation port 1012 that can be used to inflate both proximal balloon 1004 and distal balloon 1006.
Figure 11 B shows a perspective view of a second embodiment of a dual balloon catheter that can be used to perform a diagnostic or therapeutic procedure. The catheter 1014 shown in this embodiment further comprises a second balloon inflation port 1016. Balloon inflation port 1012 is used to inflate proximal balloon 1004 and second balloon inflation port 1016 is used to inflate distal balloon 1006. In one embodiment of a method using catheter 1014, distal balloon 1006 is inflated before proximal balloon 1004.
Figures 11C - 11 E show perspective views of third, fourth and fifth embodiments respectively of dual balloon catheters for dilating an anatomical region. In Figure 11 C, catheter 1020 comprises a catheter shaft 1022 comprising a catheter hub 1024 at the proximal end of catheter shaft 1022. The distal region of catheter shaft 1022 comprises a proximal balloon 1026 and a distal balloon 1028. Proximal balloon 1026 and distal balloon 1028 can be made from compliant or non-compliant materials. Catheter shaft 1022 further
comprises a dilating balloon 1030 located between proximal balloon 1026 and distal balloon 1028. Dilating balloon 1030 is constructed from suitable non- compliant materials such as Polyethylene terephthalate etc. The balloons are inflated through three balloon inflation ports located on catheter hub 1024. A first balloon inflation port 1032 is used to inflate proximal balloon 1026, a second balloon inflation port 1034 is used to inflate distal balloon 1028 and a third balloon inflation port 1036 is used to inflate dilating balloon 1030. Figure 11 D shows a perspective view of catheter 1020 in Figure 11C further comprising a stent 1038 disposed on dilating balloon 1030. Several types of stent designs can be used to construct stent 1038 such as metallic tube designs, polymeric tube designs, chain-linked designs, spiral designs, rolled sheet designs, single wire designs etc. These designs may have an open celled or closed celled structure. A variety of fabrication methods can be used for fabricating stent 1038 including but not limited to laser cutting a metal or polymer element, welding metal elements etc. A variety of materials can be used for fabricating stent 1038 including but not limited to metals, polymers, foam type materials, plastically deformable materials, super elastic materials etc. Some non-limiting examples of materials that can be used to construct stent 1038 are Nitinol, stainless steel, titanium, polyurethane, gelfilm, polyethylene and silicones e.g. silastic. A variety of features can be added to stent 1038 including but not limited to radiopaque coatings, drug elution mechanisms etc. Figure 11E shows a perspective view of catheter 1020 in Figure 11C wherein proximal balloon 1026 and distal balloon 1028 are conical. Dual balloon catheters may also be used to deploy self- expanding stents at a target anatomical region. Figures 11F - 11J show the various steps of a method of dilating an anatomical region using the catheter of Figure 11 D. In Figure 11 F, catheter 1020 is introduced into an anatomical region to be dilated. In one embodiment, catheter 1020 is introduced over a guidewire 1040. In Figure 11 G, distal balloon 1028 is inflated through second balloon inflation port 1034. Thereafter, catheter 1020 is pulled in the proximal direction till distal balloon 1028 gets lodged in the anatomical region to be dilated. Thereafter in Figure 11 H, proximal balloon 1026 is inflated through first balloon inflation port 1032. This enables catheter 1020 to be securely lodged in the anatomical region to be dilated. Thereafter in Figure 111, dilating balloon 1030 is inflated through third balloon inflation port 1036.
Inflated dilation balloon 1030 exerts an outward force on the anatomical region and causes it to dilate. This step also deploys stent 1038. Thereafter in Figure 11J, proximal balloon 1026, distal balloon 1028 and dilating balloon 1030 are deflated and catheter 1020 is removed by pulling catheter 1020 in the proximal direction.
Figures 12A - 12C show the various steps of a method of deploying a stent in the ear, nose, throat or mouth using a working catheter comprising a locating mechanism. In this example, the locating mechanism is a locator balloon. A working device 1100 is provided that comprises a locator balloon 1104 and a stent 1106 located on a stent deploying balloon 1108 located on a catheter shaft 1110. Locator balloon 1104 is located on the distal region of the catheter shaft 1110 and stent 1106 is located proximal to the locator balloon 1104. In Figure 12A, the working device 1100 is inserted into an anatomical region through an anatomical opening 1111 such that the locator balloon 1104 is located distal to anatomical opening 1111. Examples of the anatomical region are paranasal sinuses, Eustachian tubes, lachrymal ducts and other structures in the ear, nose, throat or mouth etc. Examples of anatomical opening 1111 are ostia of paranasal sinuses, ostia of lachrymal ducts etc. In Figure 12B, locator balloon 1104 is inflated. The inflated diameter of the locater balloon is greater than the diameter of the anatomical opening. Working device 1100 is then pulled in the proximal direction such that locator balloon 1104 presses against the anatomical opening 1111. This enables stent 1106 to be positioned accurately in a desired location relative to anatomical opening 1111. In Figure 12C, stent deploying balloon 1108 is inflated to deploy stent 1106. Thereafter, stent deploying balloon 1108 and locator balloon 1104 are deflated and the working device 1100 is removed by pulling it out in the proximal direction. Similar working catheters comprising locating mechanisms can also be used to deploy self-expanding stents.
In this example, the locating mechanism was a locator balloon. Other examples of locating device are deployable elements such as wire meshes, radially projecting wires, deployable devices located on guidewires (e.g. balloons, wire meshes etc.), devices deployed on pull-elements (e.g. radially expandable elements etc.) etc.
Figures 12D - 12H show the various steps of a method of dilating an anatomical opening in the ear, nose, throat or mouth using a combination of a dilating device and an anchoring device. In this example, the dilating device is a dilating balloon catheter and the anchoring device is an anchoring balloon catheter. In Figure 12D1 an anchoring balloon catheter 1120 comprising a catheter shaft 1122 and an anchoring balloon 1124 is inserted over a guidewire GW into an anatomical opening. In one embodiment, shaft 1122 of anchoring balloon catheter 1120 is coated with a lubricious coating such as Teflon. In this example the anatomical opening is the sphenoid sinus ostium SSO of a sphenoid sinus SS. In Figure 12E, anchoring balloon 1124 is inflated. The inflated diameter of anchoring balloon 1124 is greater than the diameter of the anatomical opening. Thereafter, anchoring balloon catheter 1120 is pulled in the proximal direction so that anchoring balloon 1124 is anchored in the anatomical opening. In Figure 12F, a dilating balloon catheter 1126 comprising a shaft 1128 and a dilating balloon 1130 is advanced in the proximal direction over shaft 1122 of anchoring balloon catheter 1120. Dilating balloon catheter 1126 is advanced till the distal portion of dilating balloon catheter 1126 touches anchoring balloon 1124. This design accurately positions dilating balloon 1130 in a target location in the anatomical opening. Thereafter, in Figure 12G, dilating balloon 1130 is inflated to dilate the anatomical opening. Thereafter, in Figure 12H, the dilating balloon 1130 and anchoring balloon 1124 are deflated and dilating balloon catheter 1126 and anchoring balloon catheter 1120 are withdrawn from the anatomical opening by pulling them in the proximal direction. Dilating balloon 1130 can be made of suitable non-compliant materials e.g. polyethylene terephthalate etc. Anchoring balloon 1124 can be made of suitable compliant materials e.g. polyurethane, silicone etc. or non-compliant materials e.g. polyethylene terephthalate etc. Examples of anchoring devices are catheters comprising balloons, deployable elements such as wire meshes, radially projecting wires; deployable devices located on guidewires (e.g. balloons, wire meshes etc.); devices deployed on pull-elements (e.g. radially expandable elements etc.) etc.
Such a combination of an anchoring device and a working device inserted along the anchoring device can be used for a variety of other methods and devices disclosed herein for treating anatomical openings such as ostia of
paranasal sinuses, ostia of lachrymal ducts, ducts of salvary glands, Eustachian tubes and other ear, nose, throat or mouth structures etc.
Figure 13 shows a perspective view of a dilating device comprising an electrode element to reduce restenosis. Dilating device 1200 comprises a shaft 1202 and a dilating element 1204 located on the distal region of shaft 1202. Examples of dilating elements are non-compliant dilating balloons, mechanically expandable elements etc. Dilating device 1200 further comprises an electrode element 1206 located on dilating element 1204. Electrode element 1206 in combination with one or more surface electrodes attached to a surface of a patient's body delivers electrical energy to an anatomical region to be dilated. The electrical energy causes a controlled destruction of the adjacent anatomical region thereby reducing the risk to restenosis of the dilated region. Electrode element 1206 may have a variety of configurations including meshes, wires wound in a spiral configuration, wires wound in a sinusoidal configuration etc. Electrode element 1206 can be constructed from a variety of biocompatible metallic materials such as platinum-iridium alloys (e.g. 90% platinum/10% iridium) etc. Dilating device 1200 may further comprise an insulating layer between electrode element 1206 and dilating element 1204. In one embodiment, electrode element 1206 is located on a sheath that can be advanced over dilating device 1200 such that electrode element 1206 is located above dilating element 1204.
Figure 14 shows a perspective view of an embodiment of a balloon catheter comprising a sizing balloon and a dilating balloon. A portion of the sizing balloon has been removed to show the dilating balloon underneath the sizing balloon. Balloon catheter 1300 comprises a shaft 1302 and a dilating balloon 1304 located on distal region of shaft 1302. Dilating balloon 1304 can be made of suitable non-compliant materials e.g. polyethylene terephthalate, Nylon etc. Dilating balloon 1304 is inflated through a first balloon inflation opening 1305. Balloon catheter 1300 further comprises a sizing balloon 1306 located around dilating balloon 1304. Sizing balloon 1306 is made from a compliant or semi-compliant material such as crosslinked polyethylene or other polyolefins, polyurethane, flexible polyvinylchloride, Nylon etc. Sizing balloon 1306 is inflated through a second balloon inflation opening 1307. Dilating balloon 1304 and sizing balloon 1306 enclose an inter-balloon volume 1308.
Figure 14A shows a crossection of the balloon catheter in Figure 14 through plane 14A - 14A. Shaft 1302 comprises a guidewire lumen 1310, a first inflation lumen 1312 that terminates distally in first balloon inflation opening 1305 of Figure 14, and a second inflation lumen 1314 that terminates distally in second balloon inflation opening 1307 of Figure 14.
Figures 14B - 14D show the various steps of dilating an anatomical opening using the balloon catheter in Figure 14. In Figure 14B, balloon catheter 1300 is introduced over a guidewire GW into an anatomical opening 1316 to be dilated. Examples of the types of anatomical openings 1316 that may be dilated by this invention include ostia of paranasal sinuses, Eustachian tubes, ostia of lachrymal ducts, etc. Thereafter, in Figure 14C, sizing balloon 1306 is inflated using an imageable inflating medium. Examples of suitable imageable inflating media are saline with a radioopaque contrast agent, carbon dioxide gas etc. Distal region of balloon catheter 1300 is subsequently imaged using a suitable imaging modality such as fluoroscopy or X-rays. This enables an operator to accurately estimate the size of anatomical opening 1316. Such a balloon catheter is also suited for estimating the diameter of the narrowest region in a tubular anatomical region e.g. a Eustachian tube prior to performing a diagnostic or therapeutic procedure such as balloon dilation. On the basis of information obtained during step 14C, balloon catheter 1300 may be repositioned and step 14C repeated if necessary. Thereafter, in step 14D, sizing balloon 1306 is deflated. Also in step 14D, dilating balloon 1304 is inflated to dilate a target region in anatomical opening 1316. Thereafter, dilating balloon 1304 is deflated and balloon catheter 1300 is withdrawn from anatomical opening 1316. In one embodiment, sizing balloon 1306 may be reinflated after a balloon dilation procedure to obtain feedback about the performance of the balloon dilation procedure.
Figure 15 shows a perspective view of a balloon catheter 1400 for delivering diagnostic or therapeutic agents. This balloon catheter 1400 comprises a catheter shaft 1402 which may be flexible, malleable or rigid, and a dilating balloon 1404 located on the distal region of shaft 1402. Dilating balloon 1404 can be made of any suitable compliant or non-compliant materials (e.g. polyethylene terephthalate etc.). An outer balloon or sheath 1406 covers the dilating balloon 1404, as shown in the cut-away view of Figure 15. Sheath 1406
can be made of suitable non-compliant materials e.g. polyethylene terephthalate etc. or compliant or semi-compliant materials such as crosslinked polyethylene or other polyolefins, polyurethane, flexible polyvinylchloride, Nylon etc. Sheath 1406 comprises one or more pores 1408 through which diagnostic or therapeutic agents can be delivered to the surrounding anatomy. Pores 1408 may have a pore size ranging from sub-micron to a few microns. Dilating balloon 1404 is inflated by a balloon inflation lumen 1410. The diagnostic or therapeutic agents can be delivered to the region between sheath 1406 and dilating balloon 1404 by an agent delivery lumen 1412. In this particular embodiment, sheath 1406 is attached to shaft 1402. Figure 15A shows a crossection through the plane 15A-15A of Figure 15 showing shaft 1402 comprising balloon inflation lumen 1410, agent delivery lumen 1412 and a guidewire lumen 1414.
Figure 16 shows a perspective view of a balloon catheter comprising one or more agent delivery reservoirs. Balloon catheter 1500 comprises a shaft 1502 and a balloon 1504 located on the distal region of shaft 1502. Balloon 1504 may be made from suitable compliant or semi-compliant material such as crosslinked polyethylene or other polyolefins, polyurethane, flexible polyvinylchloride, Nylon, etc., or from non-compliant materials such as polyurethane, etc. Balloon catheter 1500 further comprises one or more agent delivery reservoirs 1506 located on balloon 1504. Agent delivery reservoirs 1506 contain one or more diagnostic or therapeutic agents absorbed in a matrix. Examples of diagnostic or therapeutic agents are contrast agents, pharmaceutically acceptable salt or dosage form of an antimicrobial agent (e.g., antibiotic, antiviral, anti-parasitic, antifungal, etc.), a corticosteroid or other anti-inflammatory (e.g., an NSAID), a decongestant (e.g., vasoconstrictor), a mucous thinning agent (e.g., an expectorant or mucolytic), an anesthetic agent with or without vasoconstrictor (e.g., Xylocaine with or without epinephrine, Tetracaine with or without epinephrine), an analgesic agent, an agent that prevents of modifies an allergic response (e.g., an antihistamine, cytokine inhibitor, leucotriene inhibitor, IgE inhibitor, immunomodulator), an allergen or another substance that causes secretion of mucous by tissues, antiproliferative agents, hemostatic agents to stop bleeding, cytotoxic agents e.g. alcohol, biological agents such as protein molecules, stem cells, genes or gene therapy preparations etc. When balloon
1504 is inflated to dilate an anatomical region, it exerts pressure on agent delivery reservoirs 1506. This pressure squeezes out the one or more diagnostic or therapeutic agents absorbed in the matrix and causes them to be released into the anatomical region. In one embodiment, agent delivery reservoirs 1506 comprise diagnostic or therapeutic agents absorbed in a porous matrix formed of a porous material such as a flexible or rigid polymer foam, cotton wadding, gauze, etc. Examples of biodegradable polymers that may be foamed or otherwise rendered porous include polyglycolide, poly-L-lactide, poly- D-lactide, poly(amino acids), polydioxanone, polycaprolactone, polygluconate, polylactic acid-polyethylene oxide copolymers, modified cellulose, collagen, polyorthoesters, polyhydroxybutyrate, polyanhydride, polyphosphoester, poly(alpha-hydroxy acid) and combinations thereof. Examples of nonbiodegradable polymers that may be foamed or otherwise rendered porous include polyurethane, polycarbonate, silicone elastomers etc. Figure 16A shows a crossection view through plane 16A-16A of Figure 16 showing shaft 1502 comprising a balloon inflation lumen 1508 and a guidewire lumen 1510.
Figure 17 shows a perspective view of a balloon catheter comprising a balloon comprising one or more micropores or openings. Balloon catheter 1600 comprises a shaft 1602 comprising a dilating balloon 1604 located on the distal region of shaft 1602. Dilating balloon 1604 can be made of suitable non- compliant materials e.g. polyethylene terephthalate etc. Dilating balloon 1604 comprises one or more micropores 1606 of a pore size ranging from submicron (e.g. 0.5 micron) to a few microns. Micropores 1606 can be formed on material of dilating balloon 1604 by various processes including mechanical punching, mechanical drilling, irradiation e.g. directing a laser beam or an ion or electron beam at the balloon material etc. Dilating balloon 1604 is inflated using an inflating medium comprising one or more diagnostic or therapeutic agents to be delivered to a target anatomical region such as ostia of paranasal sinuses, ostia of lachrymal ducts, ducts of salvary glands, Eustachian tubes etc. Examples of diagnostic or therapeutic agents are contrast agents, pharmaceutically acceptable salt or dosage form of an antimicrobial agent (e.g., antibiotic, antiviral, anti-parasitic, antifungal, etc.), an anesthetic agent, an analgesic agent, a corticosteroid or other anti-inflammatory (e.g., an NSAID), a decongestant (e.g., vasoconstrictor), a mucous thinning agent (e.g., an
expectorant or mucolytic), an agent that prevents of modifies an allergic response (e.g., an antihistamine, cytokine inhibitor, leucotriene inhibitor, IgE inhibitor, immunomodulator), an allergen or another substance that causes secretion of mucous by tissues, anti-proliferative agents, hemostatic agents to stop bleeding, cytotoxic agents e.g. alcohol, biological agents such as protein molecules, stem cells, genes or gene therapy preparations etc. When dilating balloon 1604 is inflated, a portion of the inflating medium seeps out of dilating balloon 1604 through micropores 1606 and thus is delivered to the adjacent anatomical regions. Thus dilation and agent delivery can be achieved in a single step. Figure 17A shows a crossectional view through the plane 17A-17A of Figure 17 showing shaft 1602 comprising a guidewire lumen 1608 and a balloon inflation lumen 1610.
Figure 18 shows a balloon catheter comprising a balloon having an outer coating of diagnostic or therapeutic agents. Balloon catheter 1700 comprises a shaft 1702 and a dilating balloon 1704 located on the distal region of shaft 1702. Dilating balloon 1704 can be made of suitable non-compliant materials e.g. polyethylene terephthalate etc. Dilating balloon 1704 comprises a coating 1706 of one or more diagnostic or therapeutic agents on the outer surface of dilating balloon 1704. Coating 1706 may comprise diagnostic or therapeutic agents located in a suitable carrier medium. In one embodiment, the carrier medium is a hydrogel. In another embodiment, the carrier medium is a solid having the consistency of wax e.g. sterile bone wax. In another embodiment, the carrier containing the agents can be deposited on the outer surface of dilating balloon 1704 just before balloon catheter 1700 is used for performing a diagnostic or therapeutic procedure. Coating 1706 may be present on the surface of dilating balloon 1704 in a variety of configurations. In one embodiment, coating 1706 is in the form of parallel strips of a carrier medium comprising one or more diagnostic or therapeutic agents. The coating may also be in the form of an annular layer, a plurality of discrete spots etc. When dilating balloon 1704 is inflated to dilate an anatomical region, coating 1706 comes into contact with the adjacent anatomical region. A portion of coating 1706 is deposited on the adjacent anatomical region which delivers the diagnostic or therapeutic agents to the adjacent anatomical region. Thus dilation and agent delivery can be
achieved in a single step. In one embodiment, coating 1706 comprises a hemostatic material with a consistency of bone-wax.
Figures 18A - 18C show the steps of a method of using the balloon catheter of Figure 18 to dilate an anatomical region. In Figure 18A1 balloon catheter 1700 is introduced in an anatomical region 1708. Balloon catheter 1700 is positioned such dilating balloon 1704 is located in the target region to be dilated. Thereafter, in Figure 18B, dilating balloon 1704 is inflated. This dilates anatomical region 1708 and deposits a portion of coating 1706 on the dilated region. Thereafter, in Figure 18C, dilating balloon 1704 is deflated and balloon catheter 1700 is withdrawn from anatomical region 1708 leaving behind a deposited layer 1710 of coating 1706 on the dilated anatomical region 1708.
Figure 19A shows a perspective view of a lavage catheter. Lavage catheter 1800 comprises a shaft 1802 and an occluding balloon 1804 located on the distal region of shaft 1802. Occluding balloon 1804 can be made of suitable compliant materials e.g. polyurethane, silicone etc. or non-compliant materials e.g. polyethylene terephthalate etc. Lavage catheter 1800 further comprises a flushing tip 1806 and an aspiration tip 1808 located on the distal end of shaft 1802. In Figure 19A, lavage catheter 1800 is introduced over a guidewire GW into an anatomical region e.g. a sphenoid sinus SS through an anatomical opening e.g. a sphenoid sinus ostium SSO. Figure 19B shows a crossectional view through the plane 19B - 19B of Figure 19A. Shaft 1802 comprises an aspiration lumen 1810, a flushing lumen 1812 and a guidewire lumen 1814. Distal end of aspiration lumen 1810 opens at the distal end of aspiration tip 1808 and distal end of flushing lumen 1812 opens at the distal end of flushing tip 1806.
Figure 19C shows the method of operation of lavage catheter 1800 of Figure 19A to lavage an anatomical region. In Figure 19C, occluding balloon 1804 is inflated and lavage catheter 1800 is pulled in the proximal direction till occluding balloon occludes the anatomical opening e.g. sphenoid sinus ostium SSO. Thereafter, a flushing medium introduced in the anatomical region through flushing tip 1806. The flushing medium may be introduced in lavage catheter 1800 from a flushing medium container 1816 e.g. a saline bag connected to the proximal region of lavage catheter 1800. The flushing medium is aspirated from the anatomical region through aspiration tip 1808. The proximal end of lavage
catheter 1800 may be connected to a collection vessel 1818 to collect the aspirated flushing medium. In one embodiment, collection vessel 1818 is further connected to wall suction.
Figure 2OA shows a perspective view of the distal end of a second embodiment of a lavage catheter. Lavage catheter 1900 comprises a tubular member 1902 comprising a one or more openings 1904 located on the distal region of tubular member 1902. Tubular member 1902 may be made from a variety of materials such as silicone elastomers, Pebax, HDPE etc. Distal region of tubular member 1902 may comprise a curved or bent region. Tubular member 1902 comprises a first lumen connected to openings 1904. Suitable diagnostic or therapeutic fluids can be introduced or removed through openings 1904. Examples of such fluids are saline, pharmaceutically acceptable salt or dosage form of an antimicrobial agent (e.g., antibiotic, antiviral, anti-parasitic, antifungal, etc.), a corticosteroid or other anti-inflammatory (e.g., an NSAID), a decongestant (e.g., vasoconstrictor), a mucous thinning agent (e.g., an expectorant or mucolytic), an agent that prevents of modifies an allergic response (e.g., an antihistamine, cytokine inhibitor, leucotriene inhibitor, IgE inhibitor, immunomodulator), an allergen or another substance that causes secretion of mucous by tissues, a contrast agent, an anesthetic agent with or without vasoconstrictor (e.g., Xylocaine with or without epinephrine, Tetracaine with or without epinephrine), an analgesic agent, hemostatic agents to stop bleeding, antiproliferative agents, cytotoxic agents e.g. alcohol, biological agents such as protein molecules, stem cells, genes or gene therapy preparations etc. In one embodiment, tubular member 1902 comprises a second lumen that acts as a guidewire lumen.
Figure 2OB shows a perspective view of the distal end of the lavage catheter of Figure 2OA introduced in an anatomical region. In this example, the anatomical region is a maxillary sinus MS comprising a maxillary sinus ostium MSO. Lavage catheter 1900 may be introduced into the anatomical region by an over-the-wire method, through a cannula, or by a variety of methods disclosed in this patent application and in the patents documents incorporated herein by reference. Other examples of anatomical regions that can be treated using lavage catheter 1900 are other paranasal sinuses, lachrymal ducts, Eustachian tubes, and other hollow organs in the ear, nose, throat or mouth.
Figure 2OC shows an embodiment of the lavage catheter of Figure 2OA being used to lavage an anatomical region. In this embodiment, lavage catheter 1900 further comprises an outer sheath 1910 comprising an occluding balloon 1912 located on the distal region of outer sheath 1910. Occluding balloon 1912 may be made from suitable compliant or semi-compliant material such as crosslinked polyethylene or other polyolefins, polyurethane, flexible polyvinylchloride, Nylon etc. or from non-compliant materials such as polyurethane etc. Outer sheath 1910 covers tubular member 1902 such that outer sheath and tubular member 1902 enclose a suction lumen 1914 between them. Tubular member 1902 is used to introduce a lavage fluid 1916 into the anatomical region through openings 1904. Suction lumen 1914 is used to remove lavage fluid 1916 from the anatomical region.
Figure 2OD shows a sagittal section of a human head showing the general working environment of the lavage devices of Figures 2OA - 2OC. Distal end of lavage catheter 1900 is introduced into an anatomical region such as Ethmoid air cell EAC. Lavage catheter 1900 may be introduced into the EAC by an over-the-wire method, through a cannula, or by a variety of methods disclosed in this patent application and in the patents documents incorporated herein by reference. Proximal end of lavage catheter 1900 is detachabiy connected to a irrigation and suction apparatus 1918. Irrigation and suction apparatus 1918 provides lavage fluid 1916 to lavage catheter 1900 and also provides suction to remove lavage fluid 1916 from the EAC. Lavage catheter 1900 may similarly be used to diagnose or treat other paranasal sinuses, lachrymal ducts, ducts of salvary glands, Eustachian tubes, and other hollow organs in the ear, nose, throat or mouth.
Figure 21 shows a perspective view of a cutting device comprising cutting jaws. Cutting device 2000 comprises a shaft 2002 comprising an upper jaw 2004 and a lower jaw 2006 located on the distal end of shaft 2002. Proximal region of shaft 2002 comprises a scissor-like device with handles or other suitable control apparatus 2008 that is useable to control the movement of upper jaw 2004 and/or lower jaw 2006. Upper jaw 2004 and lower jaw 2006 are hinged together so that they can be opened or closed by scissor handles 2008 to bite, grip or cut tissue. In one embodiment, the edges of upper jaw 2004 and lower jaw 2006 are provided with a series of cutting teeth. Alternately, the edges
of upper jaw 2004 and lower jaw 2006 may be provided with sharp edges, blunt gripping teeth etc. Shaft 2002 comprises a lumen 2010. This enables cutting device 2000 to be advanced over an access device such as a guidewire to access a target anatomical region. Examples of materials that can be used to construct cutting device 2000 are stainless steel 304, stainless steel 316, titanium, titanium alloys etc.
Figure 21A shows a perspective view of the distal region of the cutting device of Figure 21 wherein the cutting jaws are closed.
Figure 21 B shows a perspective view of one embodiment of the jaws of the cutting device of Figure 21. Upper jaw 2004 comprises an upper jaw notch 2012. In one embodiment, upper jaw notch 2012 is semicircular in shape. Similarly, lower jaw 2006 comprises a lower jaw notch 2014. In one embodiment, lower jaw notch 2014 is semicircular in shape. This design enables a guidewire to pass through a gap in the distal end of the cutting device 2000 even when upper jaw 2004 and lower jaw 2006 are closed. In another embodiment, a guidewire passes through an opening located on either upper jaw 2004 or lower jaw 2006. Upper jaw 2004 and lower jaw 2006 can also be square, ovoid, trapezoidal or circular in shape.
Figure 21 C shows a crossectional view of the cutting device in Figure 21 through plane 21C-21C. Shaft 2002 of cutting device 2000 comprises a lumen 2010 for an access device such as a guidewire. Shaft 2002 further comprises one or more pull wires 2016 that connect upper jaw 2004 and lower jaw 2006 to control apparatus 2008. When the control apparatus 2008 is moved, pull wires 2016 transmit the movement to upper jaw 2004 and lower jaw 2006 causing them to open or close.
Figure 22A shows a perspective view of an alternate embodiment of a device comprising cutting or gripping jaws. Cutting device 2100 comprises a shaft 2102. Distal end of cutting device 2100 comprises an upper jaw 2104 and a lower jaw 2106 that are hinged together at a first hinge 2108. Proximal end of upper jaw 2104 comprises a first elongate member 2110 and proximal end of second jaw 2106 comprises a second elongate member 2112. The proximal end of first elongate member 2110 is connected to a second hinge 2114 which in turn is connected to a third elongate member 2116. Proximal end of second elongate member 2112 is connected to a third hinge 2118 which in turn is
connected to a fourth elongate member 2120. The proximal ends of third elongate member 2116 and fourth elongate member 2120 are connected by a fourth hinge 2122 to pull wire 2124 that passes through shaft 2102. Figure 22A shows cutting device 2100 wherein the upper jaw 2104 and lower jaw 2106 are in an open configuration. When pull wire 2124 is pulled in the proximal direction, fourth hinge 2122 is pulled inside shaft 2102. This causes the distal ends of third elongate member 2116 and fourth elongate member 2120 to come closer to each other. This in turn causes the proximal ends of first elongate member 2110 and second elongate member 2112 to come closer to each other. This in turn causes upper jaw 2104 and lower jaw 2106 close. Similarly, pushing pull wire 2124 in the distal direction causes upper jaw 2104 and lower jaw 2106 to open. In one embodiment, cutting device 2100 comprises a spring mechanism located between pull wire 2124 and shaft 2102 that biases upper jaw 2104 and lower jaw 2106 in an open or closed configuration. Figure 22B shows a perspective view of the device of Figure 22A wherein the jaws of the cutting device are in a closed configuration.
Figures 23A - 23C show the various steps of a method of puncturing an anatomical region using a flexible, rotating drill shaft. In Figure 23A, an access catheter 2200 is introduced through a nostril to a location adjacent to an anatomical region 2202 to be punctured. In this example, anatomical region 2202 is a maxillary sinus having a maxillary sinus ostium 2204. Other examples of the types of anatomical regions 2202 are other paranasal sinuses, lachrymal ducts, bony structures in the ear, nose, throat or mouth etc. Access catheter 2200 can be made of suitable biocompatible materials having a sufficient stiffness such as malleable stainless steel tubes; titanium tubes; fully annealed stainless steel tubes; copper tubes; aluminum tubes; tubular elements made of Pebax, HDPE etc. comprising a hypotube; etc. One or more regions of access catheter 2200 may be shapeable or malleable to allow a user to adjust the shape of access catheter 2200 to a patient's unique anatomy. A substantially stiff access catheter 2200 can be used in situations where extra support is needed for introduction or removal or devices through access catheter 2200. In an embodiment, a lubricious coating e.g. a Teflon coating is present on the inner surface of access catheter 2200. The lubricious coating can be made of suitable lubricious materials such as Teflon. In Figure 23B, a flexible drill shaft
2206 is introduced through access catheter 2200. Access catheter 2200 helps to align flexible drill shaft 2206 in the anatomical region 2202 in a desired orientation. Flexible drill shaft 2206 can be designed for efficient transfer of unidirectional or bidirectional torque. Flexible drill shaft 2206 can be made from a suitable material having a high torsional stiffness such as heat treated spring steel. Proximal end of flexible drill shaft 2206 is connected to a reversible drive motor that is used to rotate flexible drill shaft 2206 at a desired angular velocity. Flexible drill shaft 2206 comprises a drill bit 2208 located on the distal end of flexible drill shaft 2206. Drill bit 2208 can range from 0.5 mm - 5 mm in diameter. Drill bit 2208 may be made from suitable materials such as tungsten carbide, carbon steel, diamond powder coated metal etc. Drill bit 2208 can have a drill bit design such as twist drill bit, masonry drill bit, spur point bit, step drill bit etc. Flexible drill shaft 2206 is introduced through access catheter 2202 till drill bit 2208 ntouches a target location on anatomical region 2202 to be punctured. In Figure 23C, flexible drill shaft 2206 is rotated so that drill bit 2208 punctures anatomical region 2202. Such a method and device can be used for a minimally invasive puncturing of suitable anatomical regions for drainage, aeration, introduction of diagnostic or therapeutic devices etc. Such a device and method can also be used for enlarging or clearing natural or artificial openings in anatomical regions. After a desired opening is created or enlarged, access catheter 2200 and flexible drill shaft 2206 are withdrawn from the anatomy. In one embodiment, flexible drill shaft 2206 is a non-rotating shaft having high column strength and comprising a puncturing tip at the distal end of flexible drill shaft 2206. In another embodiment, flexible drill shaft 2206 acts as an ultrasonic drill by connecting the proximal end of flexible drill shaft to an ultrasonic generator. In another embodiment, access catheter 2200 comprises one or more bearings that reduce friction between access catheter 2200 and flexible drill shaft 2206.
Figure 23D shows a sectional view of an embodiment of a drilling device. Drilling device 2220 comprises a shaft 2222 comprising a proximal rigid portion 2224 and a distal rigid portion 2226. Shaft 2222 may comprise a deformable (e.g., corrugated, plastically deformable, malleable, etc.) portion 2228 between proximal rigid portion 2224 and distal rigid portion 2226. Plastically deformable region 2228 allows the shape of drilling device 2220 to be adjusted to facilitate
advancement of the device through tortous anatomy, to access to a target anatomical location and/or to achieve a desired positioning or attitude of the bit 2230 within the subject's body. Proximal rigid portion 2224, distal rigid portion 2226 and plastically deformable or malleable region 2228 can be made of suitable biocompatible materials such as stainless steel e.g. fully annealed stainless steel, copper, aluminum etc. Drilling device 2220 further comprises a rotating drill bit 2230 located at distal end of a rotatable drive member of shaft 2222. Rotating drill bit 2230 can be made from suitable materials such as tungsten carbide, carbon steel, diamond powder coated metal etc. Rotating drill bit 2230 can be an abrasive coated spherical ball or a twist (e.g., helical) drill bit, masonry drill bit, spur point bit, step drill bit etc. Proximal region of rotating drill bit 2230 is in contact with distal end of shaft 2222. In order to reduce friction between rotating drill bit 2230 and shaft 2222, the contact surfaces between rotating drill bit 2230 and shaft 2222 comprise a lubricious coating e.g. a Teflon coating. Proximal region of rotating drill bit 2230 is also attached to a flexible drive shaft 2232 that supplies torque to the rotating drill bit 2230. In one embodiment, flexible drive shaft 2232 comprises a coil assembly with high torsional stiffness and column strength. In another embodiment, flexible drive shaft 2232 comprises a heat treated spring steel cable. Proximal end of flexible drive shaft 2232 is connected to a reversible drive motor. In one embodiment, rotating drill bit 2230 and flexible drive shaft 2232 comprise a coaxial lumen to enable drilling device 2220 to be introduced over a guidewire into a target anatomy. Such a device can be used for a minimally invasive puncturing of suitable anatomical regions for drainage, aeration, introduction of diagnostic or therapeutic devices etc. Such a device can also be used for enlarging or clearing natural or artificial openings in anatomical regions. It will be appreciated by those of skill in the art that, although this device 2220 is referred to herein as a "drilling device" it may be used for numerous purposes other than "drilling." For example, this device 2220 may be used to cut, grind, polish or create grooves or depressions in bone, cartilage or other tissue and/or may be used as a screw driver. Thus, in some applications, this drilling device 2220 may alternatively be aptly referred to as a cutter, grinder, rotating rasp, rotating brush, dremmel, polisher, burnisher, boring tool, grooving tool, etc. Also, in some embodiments, the bit may comprise a drive bit that is useable to drive a
permanent or resorbable bone screw or other type of screw or anchor. Also, the bit 2230 may be interchangeable and a variety of different bits 2220 may be provided to accomplish various different applications (e.g., grinding, polishing, burnishing, grooving, boring, rasping, debulking, forming indentations or depressions, driving screws, etc.). Figures 24A - 24C show a sagittal section of an Ethmoid sinus showing various methods of treating Ethmoid sinus diseases by a minimally invasive approach. Figure 24A shows a sagittal section of an Ethmoid sinus comprising an anterior Ethmoid air cell 2300, a posterior Ethmoid air cell 2302 and an intermediate Ethmoid air cell 2304 located between anterior Ethmoid air cell 2300 and posterior Ethmoid air cell 2302. A guide catheter 2306 is introduced to a region inferior to the basal lamella of a middle turbinate. Guide catheter 2306 may comprise a design selected from the various guide catheter designs disclosed herein and in the patent documents incorporated herein by reference. Thereafter, an introducer needle 2308 is introduced through guide catheter 2306. Introducer needle 2308 comprises a lumen through which devices such as guidewires can be introduced. Introducer needle 2308 can be made of suitable biocompatible materials such as Stainless steel, Nitinol, polymers, polymer-metal composites etc. Introducer needle 2308 is advanced through guide catheter 2306 such that the distal tip of introducer needle 2308 punctures a wall of an Ethmoid air cell e.g. anterior Ethmoid air cell 2300 and enters the Ethmoid air cell. Thereafter, a guidewire 2310 is introduced through introducer needle 2308 into the Ethmoid air cell e.g. anterior Ethmoid air cell 2300. Thereafter, introducer needle 2308 is removed from the anatomy. In Figure 24B, a working device is introduced over guidewire 2310 into the Ethmoid air cell. An example of a working device is a balloon catheter 2312 comprising a dilating balloon 2314. Thereafter, the working device is used to perform a diagnostic or therapeutic procedure e.g. balloon dilation of the introducer needle puncture site to create a drainage channel for sinus secretions. Similarly, other working devices such as dilating or occluding balloons, dilating stents, suction or irrigation devices, needles, polypectomy tools, brushes, energy emitting devices such as ablation devices, laser devices, image-guided devices containing sensors or transmitters, imaging devices, endoscopes, tissue modifying devices such as cutters, biopsy devices, devices for injecting diagnostic or therapeutic agents, lavage devices, drug delivery
devices such as substance eluting devices, substance delivery implants etc. may be used to perform diagnostic or therapeutic procedures. The method shown in Figures 24A - 24B may also be used to create an opening of a suitable diameter to facilitate insertion of other working devices into the Ethmoid air cells. For example, Figure 24C shows a method of treating Ethmoid sinus diseases by a rongeur. In this method, rongeur 2316 having a distal cutting tip 2318 is introduced through guide catheter 2306 into an Ethmoid air cell via the introducer needle puncture site. Thereafter, rongeur 2316 is used to remove tissue from the Ethmoid air cell. Figures 24A' - 24A"" show a method of creating drainage channels for sinus secretions in Ethmoid sinus. In Figure 24A', guide catheter 2306 is introduced to a region inferior to the basal lamella of a middle turbinate. Thereafter, introducer needle 2308 is advanced through guide catheter 2306 such that the distal tip of introducer needle 2308 punctures a wall of an Ethmoid air cell e.g. an intermediate Ethmoid air cell 2304 and enters the Ethmoid air cell. In Figure 24A", introducer needle is used to create internal channels in the Ethmoid sinus by puncturing walls of adjacent Ethmoid air cells e.g. anterior Ethmoid air cell 2300, posterior Ethmoid air cell 2302 etc. In Figure 24A", introducer needle 2308 and guide catheter 2306 are removed leaving behind internal channels that allow drainage of sinus secretions through the introducer needle puncture site in the intermediate Ethmoid air cell 2304. Sinus secretions from anterior Ethmoid air cell 2300 or posterior Ethmoid air cell 2302 flow into intermediate Ethmoid air cell 2304 from which they flow out of the Ethmoid sinus. The internal channels as well as the introducer needle puncture site in the intermediate Ethmoid air cell 2304 may be dilated using a balloon catheter as shown in Figures 24A - 24B. In Figures 24A' - 24A'", introducer needle 2308 was introduced into the Ethmoid sinus through intermediate Ethmoid air cell 2304. Similar procedures may be performed by introducing introducer needle 2304 into the Ethmoid sinus through anterior Ethmoid air cell 2300 or posterior Ethmoid air cell 2302. In one embodiment, anterior Ethmoid air cell 2300, posterior Ethmoid air cell 2302 and intermediate Ethmoid air cell 2304 are punctured separately through the basal lamella of a middle turbinate to create separate drainage channels for each Ethmoid air cell as shown in Figure 24A"".
Figure 25A shows a perspective view of an embodiment of a microshaver or ostium enlarger device 2400. Device 2400 comprises a proximal portion 2402 and a distal portion 2403. Proximal portion 2402 is hollow and comprises a proximal cutting surface 2404 e.g. sharp cutting teeth etc. located on the distal end of proximal portion 2402. Distal portion 2403 comprises a distal cutting surface 2406 e.g. sharp cutting teeth etc. located on the proximal end of distal portion 2403. Distal portion 2403 is further connected to a pull shaft 2408 that encloses a guidewire lumen 2410. Guidewire lumen 2410 allows microshaver 2400 to be introduced over a guidewire GW into a target anatomy. The region between pull shaft 2408 and proximal portion 2402 encloses a suction lumen 2412. Suction lumen 2412 can be used to remove solid debris or liquids from the target anatomy by suction. Proximal portion 2402, distal portion 2403 and pull shaft 2408 can be made of suitable biocompatible materials such as stainless steel. Figure 25B shows a crossection of a paranasal sinus showing one way in which the device 2400 of FFigure 25A may be used to remove tissue or matter. The device 2400 is introduced over a guidewire GW into paranasal sinus 2414. The device 2400 is then positioned such that the tissue or matter is located between proximal cutting surface 2404 and distal cutting surface 2406. Thereafter, in this embodiment, pull shaft 2408 is pulled in the proximal direction. This causes movement of distal region 2403 in the proximal direction with respect to proximal portion 2402. This in turn forces cylindrical distal cutter 2406 to be retracted into the interior of thecylindrical proximal cutter 2404, thereby cutting off or breaking tissue or matter that is captured therebetween. Optionally, in this embodiment, the cylindrical distal cutter 2406 cylindrical proximal cutter 2404 may be rotated relative to the other to further cut or shave tissue. Also, optionally in this embodiment, suction lumen 2412 can be used to remove any solid debris or liquids generated during the procedure.
Figure 25C and 25D show an example of another way in which the device 2400 may be used — i.e., to shave tissue or matter. Examples of anatomical structures/ that may be shaved by this device 2400 include bone, cartilage and soft tissues of Eustachian tubes, turbinates, lachrymal ducts, anatomical openings such as ostia of paranasal sinuses, ostia of lachrymal ducts, etc. and other regions in the ear, nose, throat or mouth. As shown in
Figure 25C, in this embodiment, there need not be a proximally moveable pull shaft 2408, but rather the distal cutting surface 2406 may remain positioned within the cylindrical proximal cutting surface 2404. The cutting surfaces are positioned adjacent to the tissue or matter to be shaved and the cylindrical distal cutter 2406 and/or cylindrical proximal cutter 2404 is/are rotated to shave the tissue or matter. Suction may be applied through lumen 2412 to draw the tissue or matter into slots 2409 such that it will be shaved by the rotating proximal cutter 2404.
Figures 26A - 26C show a device and method for treating a mucocyst of other flowable substance-containing structure (e.g., cyst, hematoma, pustule, etc.) located within a paranasal sinus, ear, nose or throat. In general, the device comprises an elongate shaft 2500, a penetrator such as a needle 2502 that is advanceable from and retractable into the shaft 2500 to form an opening in the mucocyst or other structure, and a compressor such as a balloon 2506 that is useable to compress the mucocyst or other structure to force its contents to flow out of the opening created by the needle 2502 or other penetrator. Specifically, as shown in the example of Figure 26A, a guide catheter 2500 is introduced into an anatomical region through an anatomical opening. The outer diameter of guide catheter 2500 is less than the inner diameter of the anatomical opening. In Figures 26A - 26C, frontal sinus FS is used as an example of an anatomical region. Other examples of anatomical regions are other paranasal sinuses, lachrymal passages, Eustachian tubes and other structures in the ear, nose, throat or mouth etc. Guide catheter 2500 may comprise a design selected from the various guide catheter designs disclosed herein and in the patent documents incorporated herein by reference. A puncturing needle 2502 is then introduced through guide catheter 2500 into the frontal sinus FS. Puncturing needle 2502 has a sharp distal tip and can be made from a variety of materials such as hardened tool steel, stainless steel etc. Puncturing needle 2502 is navigated through the frontal sinus FS such that the distal tip of puncturing needle 2502 punctures a mucocyst 2503 in the frontal sinus FS. Thereafter, puncturing needle 2502 is withdrawn. In Figure 26B, a guidewire GW is introduced into the frontal sinus FS. Thereafter, a balloon catheter 2504 comprising a balloon 2506 is introduced over guidewire GW into the frontal sinus FS. Balloon 2506 can be made of suitable compliant or semi-compliant
materials such as crosslinked polyethylene or other polyolefins, polyurethane, flexible polyvinylchloride, Nylon, etc. Balloon 2506 is then inflated. Inflated balloon 2506 compresses the punctured mucocyst 2503. This causes drainage of mucocyst secretions into the frontal sinus FS. In Figure 26C, balloon 2506 is inflated further so that it occupies a volume in the frontal sinus FS and displaces the mucocyst secretions from the frontal sinus FS out through the frontal sinus ostium FSO.
Figures 27A - 27B show various steps of a method of treating a mucocyst by a balloon catheter comprising a deployable puncturing needle. In Figure 27A, a guide catheter 2600 is introduced into an anatomical region through an anatomical opening. The outer diameter of guide catheter 2600 is less than the inner diameter of the anatomical opening. In Figures 27A - 27B, frontal sinus FS is used as an example of an anatomical region. Other examples of anatomical regions are other paranasal sinuses, lachrymal passages, Eustachian tubes, other ear, nose, throat and mouth structures etc. Guide catheter 2600 may comprise a design selected from the various guide catheter designs disclosed herein and in the patent documents incorporated herein by reference. A balloon catheter 2602 comprising a balloon 2604 and a deployable puncturing needle 2606 is then introduced through guide catheter 2600 into the frontal sinus FS. Balloon 2604 can be made of suitable compliant or semi- compliant materials such as crosslinked polyethylene or other polyolefins, polyurethane, flexible polyvinylchloride, Nylon, etc. Deployable puncturing needle 2606 can be made from a variety of materials such as hardened tool steel, stainless steel etc. Balloon catheter 2604 is oriented in a desired orientation and deployable puncturing needle 2606 is advanced such that the distal tip of deployable puncturing needle 2606 punctures the mucocyst MC. Thereafter, deployable puncturing needle 2606 is withdrawn into balloon catheter 2602. In Figure 27B, balloon 2604 is inflated. Inflated balloon 2604 compresses the punctured mucocyst MC. This causes drainage of mucocyst secretions into the frontal sinus FS. Balloon 2604 is then inflated further so that it occupies a volume in the frontal sinus FS and displaces the mucocyst secretions from the frontal sinus FS out through the frontal sinus ostium FSO. In one embodiment, deployable puncturing needle 2606 is located in a needle lumen. Deployable puncturing needle 2606 may be advanced or withdrawn by
advancing or withdrawing deployable puncturing needle 2606 through the needle lumen.
Figures 28A-28C show various embodiments of catheters comprising agent delivery needles. In Figure 28A, catheter 2700 comprises a shaft 2702 having a guidewire lumen. Catheter 2700 further comprises a deployable injecting needle 2704 made from suitable biocompatible materials such as stainless steel. Deployable injecting needle 2704 comprises a lumen for injecting one or more diagnostic or therapeutic agents 2706 into the adjacent anatomy. Deployable injecting needle 2704 is deployed at any suitable angle to the longitudinal axis of shaft 2702, for example such angle may range from 0 degrees to 135 degrees. In one embodiment, deployable injecting needle 2704 is located in a needle lumen. Deployable injecting needle 2704 is deployed or withdrawn by relative motion of deployable injecting needle 2704 with respect to shaft 2702. In another embodiment, deployable injecting needle 2704 can be deployed or withdrawn by inflating or deflating a deploying balloon. The deploying balloon can be made from suitable materials such as polyimide, parylene (e.g. C1D1N), silicone, polyurethane, polyethylene terephthalate etc. Catheter 2700 is introduced into a target anatomy and deployable injecting needle 2704 is deployed. Deployable injecting needle 2704 penetrates into the adjacent anatomy. One or more diagnostic or therapeutic agents 2706 are then injected into the adjacent anatomy. In one embodiment, catheter 2700 may be introduced in an anatomical region through a guide catheter 2708. Figure 28B shows a perspective view of catheter 2700 of Figure 28A wherein catheter 2700 further comprises a second deployable injecting needle 2710. Second deployable injecting needle 2710 comprises a lumen for injecting one or more diagnostic or therapeutic agents 2712 into the adjacent anatomy. In one embodiment, diagnostic or therapeutic agents 2712 are the same as diagnostic or therapeutic agents 2706. Figure 28C shows a perspective view of catheter 2700 of Figure 28A wherein catheter 2700 further comprises a balloon 2714. In one embodiment, balloon 2714 is a dilating balloon made of suitable non- compliant materials e.g. polyethylene terephthalate etc. This embodiment can be used for both balloon dilation and agent delivery. In another embodiment, balloon 2714 is an anchoring balloon made of suitable non-compliant materials e.g. polyethylene terephthalate etc. or suitable compliant or semi-compliant
materials such as crosslinked polyethylene or other polyolefins, polyurethane, flexible polyvinylchloride, Nylon etc. The anchoring balloon can be used to stabilize the position and orientation of catheter 2700 before agent delivery.
Examples of diagnostic or therapeutic agents that can be delivered by the catheters in Figures 28A - 28C are pharmaceutically acceptable salt or dosage form of an antimicrobial agent (e.g., antibiotic, antiviral, anti-parasitic, antifungal, etc.), an anesthetic agent with or without a vasoconstriction agents (e.g. Xylocaine with or without Epinephrine, Tetracaine with or without epinephrine, etc.), an analgesic agent, a corticosteroid or other anti-inflammatory (e.g., an NSAID), a decongestant (e.g., vasoconstrictor), a mucous thinning agent (e.g., an expectorant or mucolytic), an agent that prevents of modifies an allergic response (e.g., an antihistamine, cytokine inhibitor, leucotriene inhibitor, IgE inhibitor, immunomodulator), an allergen or another substance that causes secretion of mucous by tissues, hemostatic agents to stop bleeding, anti- proliferative agents, cytotoxic agents e.g. alcohol, biological agents such as protein molecules, stem cells, genes or gene therapy preparations, viral vectors carrying DNA, proteins or mRNA coding for important therapeutic functions or substances etc. Catheters in Figures 28A - 28C can be used to diagnose or treat anatomical regions such as paranasal sinuses, regions in the Eustachian tubes, lachrymal ducts, ducts of salvary glands, anatomical openings such as ostia of paranasal sinuses, ostia of lachrymal ducts, other regions in the ear, nose, throat or mouth etc.
Figure 29A illustrates an embodiment of a displacement catheter to displace and remove secretions in an anatomical region. Displacement catheter 2800 comprises an outer sheath 2802 that encloses a balloon catheter 2804. Outer sheath 2802 may be flexible or substantially rigid. Outer sheath 2802 may be made of suitable materials such as Pebax, HDPE etc. Outer sheath 2802 may comprise a hypotube made of suitable biocompatible materials such as stainless steel, Nitinol etc. Balloon catheter 2804 comprises a catheter shaft 2806 and a balloon 2808 located on the distal region of catheter shaft 2806. Catheter shaft 2806 may be made of suitable materials such as Pebax, HDPE etc. Balloon 2808 may be made from suitable compliant or semi-compliant material such as crosslinked polyethylene or other polyolefins, polyurethane, flexible polyvinylchloride, Nylon etc.
Figure 29B shows a sectional view of an anatomical region showing a method of displacing secretions by the displacement catheter of Figure 29A. Displacement catheter 2800 is introduced in an anatomical region. In Figure 29B1 a Maxillary sinus MS is used as an example of an anatomical region. Other examples of anatomical regions that can be treated using displacement catheter 2800 are other paranasal sinuses, lachrymal passages, Eustachian tubes etc. Displacement catheter 2800 can be advanced into an anatomical region through natural openings e.g. ostia of sinuses or artificially created openings. In this example, displacement catheter 2800 is advanced into the Maxillary sinus through a natural opening such as a maxillary sinus ostium MSO such that the distal end of displacement catheter is near the distal region of Maxillary sinus MS. Outer diameter of outer sheath 2802 is less than inner diameter of Maxillary sinus ostium MSO. Thereafter, outer sheath 2802 is withdrawn gradually by pulling outer sheath 2802 in the proximal direction over balloon catheter 2804. Simultaneously, balloon 2808 is inflated by a suitable inflating medium such as saline mixed with radiographic contrast. This causes distal region of balloon 2804 to inflate before the proximal region of balloon 2804. Balloon 2804 gradually begins to occupy available volume in the Maxillary sinus MS and thus displaces secretions 2810 out of the Maxillary sinus MS through the Maxillary sinus ostium MSO. In one embodiment of balloon 2804, distal region of balloon 2804 has a higher compliance than proximal regions of balloon 2804. In another embodiment, balloon 2804 comprises multiple compartments such that each compartment can be inflated independently of other compartments. Balloon 2804 may be detachably connected to catheter shaft 2806 to enable permanent occlusion of the anatomical region. Balloon 2804 may also comprise a variety of drug delivery mechanisms including drug eluting coatings, drug eluting pores for eluting a drug dissolved in the inflating medium etc.
Figure 30 shows a perspective view of an embodiment of an ultrasonic drilling device. Drilling device 2900 comprises a rigid or flexible drilling shaft 2902. Drilling shaft 2902 can be made of suitable materials such as tungsten carbide flexible wire. The proximal end of drilling shaft 2902 is connected to a piezoelectric crystal 2904 such as a quartz (SiO2) or barium titanate (BaTiO3) crystal. Piezoelectric crystal 2904 may have a layer of backing material 2906 on the proximal surface of piezoelectric crystal 2904. Piezoelectric crystal 2904 is
connected by electrodes 2908 to an electric power source 2910. Electric power source 2910 delivers a suitable current via electrodes 2908 to piezoelectric crystal 2904 to cause piezoelectric crystal 2904 to vibrate at an ultrasonic frequency. The vibration of piezoelectric crystal 2904 is transmitted to drilling shaft 2902. In one embodiment, drilling shaft 2902 is connected to piezoelectric crystal 2904 by a coupler 2912.
Figures 3OA - 3OB show a sectional view of an anatomical region showing a method of enlarging a natural or artificially created anatomical opening using the drilling device of Figure 30. The drilling device may also be used to create new openings in an anatomical region. Distal part of drilling device 2900 comprising drilling shaft 2902 of diameter D.sub.2 is positioned such that the distal end of drilling shaft 2902 touches an anatomical opening e.g. a sphenoid sinus ostium SSO to be dilated. The anatomical opening has an initial diameter D.sub.1. Thereafter, current from electric power source 2910 is switched on, which in turn causes drilling shaft 2902 to vibrate in the axial direction. The vibration of drilling shaft 2902 causes distal tip of drilling shaft 2902 to impact the anatomical opening. In Figure 3OB, the impact of drilling shaft 2902 causes dilation of the anatomical opening from an initial diameter D.sub.1 to a diameter D.sub.2. Similarly, other embodiments of drilling devices may be used to puncture, remodel or change the shape, size or configuration of anatomical structures such as paranasal sinuses, Eustachian tubes, middle ear, nasopharynx, Lachrymal ducts or other anatomical regions in the ear, nose, throat or mouth. Such drilling devices may comprise for example elements for ablation or delivery of energy such as laser, RF, thermal shock waves etc.
Figure 31 shows a sectional view of an embodiment of a catheter for providing an internal cast for fractured bony cavities. Catheter 3000 comprises a shaft 3002 comprising a plurality of inflating elements e.g. inflating balloon in the distal region of shaft 3002. In the example shown in Figure 31 , catheter 3000 comprises a proximal interior balloon 3004, a distal interior balloon 3006 and an intermediate interior balloon 3008 located between proximal interior balloon 3004 and distal interior balloon 3006. Catheter 3000 further comprises an intermediate balloon 3010 covering proximal interior balloon 3004 and intermediate interior balloon 3008 as shown in Figure 31. Catheter 3000 further
comprises an outer balloon 3012 that covers intermediate balloon 3010 and a portion of distal interior balloon 3006 as shown in Figure 31. The balloons on catheter 3000 can be inflated independently of each other. For example proximal interior balloon 3004 can be inflated by a proximal interior balloon lumen 3014, distal interior balloon 3006 can be inflated by a distal interior balloon inflation lumen 3016 and intermediate interior balloon 3008 can be inflated by an intermediate balloon inflation lumen 3018. The balloons on catheter 3000 may be made from suitable compliant or semi-compliant material such as crosslinked polyethylene or other polyolefins, polyurethane, flexible polyvinylchloride, Nylon etc. or from suitable non-compliant materials e.g. polyethylene terephthalate etc. The balloons on catheter 3000 may be coated with a variety of coatings including lubricious coatings, drug eluting coatings etc. Figure 31A shows a crossection through the outer balloon 3012 in the catheter 3000 of Figure 31 through plane 31A - 31A. Outer balloon 3012 comprises a balloon material 3020 made from suitable compliant or semi-compliant material such as crosslinked polyethylene or other polyolefins, polyurethane, flexible polyvinylchloride, Nylon etc. or from suitable non-compliant materials e.g. polyethylene terephthalate etc. A coating 3022 is located on the outer surface of balloon material 3020. Examples of materials that can be used in coating 3022 are contrast agents, pharmaceutically acceptable salt or dosage form of an antimicrobial agent (e.g., antibiotic, antiviral, anti-parasitic, antifungal, etc.), an anesthetic agent with or without a vasoconstriction agents (e.g. Xylocaine with or without Epinephrine, Tetracaine with or without epinephrine, etc.), an analgesic agent, a corticosteroid or other anti-inflammatory (e.g., an NSAID), a decongestant (e.g., vasoconstrictor), a mucous thinning agent (e.g., an expectorant or mucolytic), an agent that prevents of modifies an allergic response (e.g., an antihistamine, cytokine inhibitor, leucotriene inhibitor, IgE inhibitor, immunomodulator), an allergen or another substance that causes secretion of mucous by tissues, hemostatic agents to stop bleeding, anti- proliferative agents, cytotoxic agents e.g. alcohol, biological agents such as protein molecules, stem cells, genes or gene therapy preparations etc.
Figures 31 B - 31 D shows various steps of a method of providing an internal cast for a fractured bony cavity using the catheter shown in Figure 31. In Figures 31B - 31 D, Maxillary sinus MS is used as an example of bony cavity
that can be treated using catheter 3000. Figure 31 B shows a patient with a fractured bony cavity e.g. a fractured Maxillary sinus MS having one or more fractured bones 3024. In Figure 31 C, catheter 3000 is introduced into the Maxillary sinus MS through a natural opening e.g. an ostium or an artificially created opening. In Figure 31 D, one or more balloons on catheter 3000 are sequentially inflated to push fractured bones 3024 into their original un-fractured configuration. Catheter 3000 may then be left in place for a desired period ranging from a few minutes to several days during which fractured bones 3024 begin to heal in their original un-fractured configuration. After catheter 3000 has been left in place for the desired period, catheter 3000 is removed by deflating the balloons and withdrawing catheter 3000 from the anatomy. Thus, catheter 3000 provides an internal cast for a fractured bony cavity. Various embodiments of catheter 3000 may be used for crating internal casts for fractured paranasal sinuses, lachrymal passages, Eustachian tubes, other structures in the ear, nose, throat, mouth etc.
The various devices and methods disclosed herein may be used in conjunction with various surgical navigations systems. Figures 32 and 32A show an embodiment of a surgical navigation system comprising electromagnetic sensors. Examples of electromagnetic sensors that can be used with the present invention are electromagnetic sensors of an electromagnetic surgical navigation system such as GE InstaTrak™ 3500 plus system etc. Figure 32 shows a perspective view of a patient's head showing the location of external ear canal electromagnetic sensors 3100 and teeth electromagnetic sensors 3102. External ear canal electromagnetic sensors 3100 are introduced through an ear canal into a region adjacent to a tympanum. Teeth electromagnetic sensors 3102 are attached to one or more teeth of the patient. In one embodiment, teeth electromagnetic sensors 3102 are attached to teeth using an adhesive. In an alternate embodiment, teeth electromagnetic sensors 3102 are attached to braces or caps which in turn are attached to teeth. The braces or caps can be made of suitable materials that cause minimal artifacts on CT or MRI images. An example of such a material is aluminum alloy 2017-T4 which causes minimal artifacts on a CT scan image. Other locations of electromagnetic sensors include skin (e.g. a skin patch comprising an electromagnetic sensor), a head frame etc. The patient's head is imaged using
an imaging modality such as CT or MRI. External ear canal electromagnetic sensors 3100 and teeth electromagnetic sensors 3102 are passively imaged by the imaging modality and thus act as fiducial markers.
Figures 32 and 32A illustrate a surgical navigation system comprising fiducial markers that have electromagnetic sensors. Various other embodiments of fiducial markers such as passively imaged fiducial markers or active sensors or transmitters may be used in conjunction with the various methods and devices disclosed herein. The fiducial markers may be located on relevant anatomical regions such as teeth, ear canals, skull bones, frames fixed to rigid bones etc. The fiducial markers may be used with a variety of modalities including but not limited to electromagnetic, infrared, ultrasonic, radio-frequency, MRI, CT, Fluoroscopic or other 2D or 3D image guided systems for the head, neck or other anatomical regions manufactured by companies such as Biosense, Stryker, Brainlab, Xomed, GE/VTI etc. Figure 32A shows an enlarged view of region 32A in Figure 32. Teeth electromagnetic sensors 3102 are connected to the electromagnetic surgical navigation system by removable leads 3104. In another embodiment, external ear canal electromagnetic sensors 3100 or teeth electromagnetic sensors 3102 are connected to the electromagnetic surgical navigation system by telemetry. During a procedure, external ear canal electromagnetic sensors 3100 and/or teeth electromagnetic sensors 3102 are actively imaged by suitable electromagnetic surgical navigation systems such as GE InstaTrak™ 3500 plus system etc. Thereafter, data from imaging modality such as CT or MRI and the electromagnetic surgical navigation system is merged to obtain a three dimensional map of the anatomy showing the electromagnetic sensors. The three dimensional map can then be used for image guided procedures such as diagnostic or therapeutic procedures of paranasal sinuses, Eustachian tubes, lachrymal ducts, other ear, nose, throat or mouth structures etc.
Other image guided surgery systems such as infrared sensor based systems e.g. Stryker Leibinger® Navigation System can also be used in conjunction with one or more methods or devices disclosed herein.
Figure 33 shows a section of the anatomical region around a Eustachian tube (ET) showing a diagnostic or therapeutic procedure being performed by devices inserted through the pharyngeal ostium of the Eustachian tube. Figure
33 shows a guidewire GW inserted into a desired region in the ET through the Nasopharynx and a diagnostic or therapeutic being performed by a device introduced into the Eustachian tube over guidewire GW.
Figure 33A shows an enlarged view of region 33A in Figure 33 showing the anatomical region around a Eustachian tube (ET) showing a diagnostic or therapeutic procedure being performed by devices inserted through the pharyngeal ostium of the Eustachian tube. In one embodiment, guidewire GW comprises an anchoring balloon 3200 located on the distal region of guidewire GW. Anchoring balloon 3200 is inflated after positioning guidewire GW at a target location. Anchoring balloon 3200 anchors guidewire GW to the adjacent anatomy and prevents accidental repositioning of guidewire GW during a diagnostic or therapeutic procedure. Anchoring balloon 3200 may be made from suitable compliant or semi-compliant material such as crosslinked polyethylene or other polyolefins, polyurethane, flexible polyvinylchloride, Nylon etc. Guidewire GW may comprise anchoring elements other than anchoring balloon 3200 such as a notch on guidewire GW, a bent region on guidewire GW, a self expanding element, a hook, a coiled element etc. In another embodiment, guidewire GW comprises a sensor 3202 located on the distal region of guidewire GW. Sensor 3202 enables guidewire GW to be used in conjunction with a suitable surgical navigation system. In one embodiment, sensor 3202 is an electromagnetic sensor used in conjunction with an electromagnetic surgical navigation system such as GE InstaTrak™ 3500 plus system etc. One or more sensor 3202 or other types of surgical navigation sensors or transmitters may also be located on other diagnostic or therapeutic devices disclosed herein. Sensor 3202 may be used in conjunction with a stationary sensor 3204 located in the external ear. The combination of sensor 3202 and stationary sensor 3204 enables guidewire GW to be accurately positioned in a target region. In an embodiment, a radioopaque plug 3206 is inserted from the external ear to a region adjacent to an eardrum. Radioopaque plug 3206 serves as a fiducial marker during preoperative scanning of the patient and thus enables a physician to accurately position a diagnostic or therapeutic device close to the eardrum. Other image guidance methods and devices can also be used in conjunction with diagnostic or therapeutic procedures disclosed herein. Figure 33A also shows a diagnostic or therapeutic device 3208 comprising a shaft
3210 and a working element 3212 e.g. a dilating balloon being introduced over guidewire GW. Diagnostic or therapeutic device 3208 may comprise a radiopaque marker 3214.
Figure 33B shows a front view of a human head with a portion of the face removed to show an embodiment of a method of introducing a guidewire into a Eustachian tube. In Figure 33B, a guide catheter 3250 is introduced through a nostril into the Nasopharynx. Distal portion of guide catheter 3250 may comprise a bent or angled region. For example, such bent or angled region may form e an internal angle ranging from 45 degrees to 150 degrees. Guide catheter 3250 can be constructed using one of the various designs disclosed herein and in the patent documents incorporated herein by reference. Guide catheter 3250 is positioned in the Nasopharynx such that the distal tip of guide catheter 3250 is located near a nasopharyngeal opening of a Eustachian tube. Thereafter, a guidewire GW is introduced through guide catheter 3250 into the Eustachian tube. Guidewire GW can then be used to advance one or more diagnostic or therapeutic devices into the Eustachian tube to perform one or more diagnostic or therapeutic procedures.
Figures 34A - 34D illustrate various examples of working elements that can be located on the diagnostic or therapeutic device in Figure 33. Figure 34A shows an example of a working element comprising a dilating balloon. Dilating balloon 3312 can be made from a suitable non-compliant materials e.g. polyethylene terephthalate, Nylon etc. Similarly, devices shown in Figures 14, 15, 16, 17 and 18 may also be used to treat a Eustachian tube as shown in Figure 33. Figure 34B shows an example of a working element comprising a dilating balloon loaded with a balloon-expandable stent. Dilating balloon 3314 can be made from a suitable non-compliant materials e.g. polyethylene terephthalate, Nylon etc. Several types of stent designs can be used to construct stent 3316 such as metallic tube designs, polymeric tube designs, chain-linked designs, spiral designs, rolled sheet designs, single wire designs etc. These designs may have an open celled or closed celled structure. A variety of fabrication methods can be used for fabricating stent 3316 including but not limited to laser cutting a metal or polymer element, welding metal elements etc. A variety of materials can be used for fabricating stent 3316 including but not limited to metals,
polymers, foam type materials, plastically deformable materials, super elastic materials etc. A variety of features can be added to stent 3316 including but not limited to radiopaque coatings, drug elution mechanisms to elute antiinflammatory agents, antibiotics etc. In one embodiment, stent 3316 is bioabsorbable. Working elements may also comprise a self-expanding stent instead of a pressure-expandable stent.
Figure 34C shows an example of a working element comprising a lavage element. Lavage element 3318 comprises a plurality of lavage openings 3320. Lavage openings are connected to a lavage lumen in shaft 3210 through which suitable lavage media such as solutions containing contrast agents, pharmaceutically acceptable salt or dosage form of an antimicrobial agent (e.g., antibiotic, antiviral, anti-parasitic, antifungal, etc.), an anesthetic agent with or without a vasoconstriction agents (e.g. Xylocaine with or without Epinephrine, Tetracaine with or without epinephrine, etc.), an analgesic agent, a corticosteroid or other anti-inflammatory (e.g., an NSAID), a decongestant (e.g., vasoconstrictor), a mucous thinning agent (e.g., an expectorant or mucolytic), an agent that prevents of modifies an allergic response (e.g., an antihistamine, cytokine inhibitor, leucotriene inhibitor, IgE inhibitor, immunomodulator), an allergen or another substance that causes secretion of mucous by tissues, hemostatic agents to stop bleeding, antiproliferative agents, cytotoxic agents e.g. alcohol, biological agents such as protein molecules, stem cells, genes or gene therapy preparations etc. can be delivered. In one embodiment, a fraction of lavage openings 3320 are connected to an aspiration lumen to aspirate the lavage media out of the Eustachian tube. Figure 34D shows an example of a working element comprising a substance delivery reservoir. Substance delivery reservoir 3322 may be fully or partially biodegradable or non-biodegradable. In one embodiment, substance delivery reservoir 3322 is made of a suitable biocompatible material such as hydrogel (e.g. collage hydrogel). In another embodiment, substance delivery reservoir 3322 comprises a porous matrix formed of a porous material such as a flexible or rigid polymer foam, cotton wadding, gauze, etc. Examples of biodegradable polymers that may be foamed or otherwise rendered porous include polyglycolide, poly-L-lactide, poly-D-lactide, poly(amino acids), polydioxanone, polycaprolactone, polygluconate, polylactic acid-polyethylene
oxide copolymers, modified cellulose, collagen, polyorthoesters, polyhydroxybutyrate, polyanhydride, polyphosphoester, poly(alpha-hydroxy acid) and combinations thereof. Examples of non-biodegradable polymers that may be foamed or otherwise rendered porous include polyurethane, polycarbonate, silicone elastomers etc. Substance delivery reservoir 3322 may also include one or more embodiments disclosed in United States Patent Application Serial No. 10/912,578 entitled "Implantable Device and Methods for Delivering Drugs and Other Substances to Treat Sinusitis and Other Disorders" filed on August 4, 2004, the entire disclosure of which is expressly incorporated herein by reference. The substance delivery reservoir 3322 or any substance delivery devices described in this application may be used to deliver various types of therapeutic or diagnostic agents. The term "diagnostic or therapeutic substance" as used herein is to be broadly construed to include any feasible drugs, prodrugs, proteins, gene therapy preparations, cells, diagnostic agents, contrast or imaging agents, biologicals, etc. Such substances may be in bound or free form, liquid or solid, colloid or other suspension, solution or may be in the form of a gas or other fluid or nan-fluid. For example, in some applications where it is desired to treat or prevent a microbial infection, the substance delivered may comprise pharmaceutically acceptable salt or dosage form of an antimicrobial agent (e.g., antibiotic, antiviral, antiparacytic, antifungal, etc.), a corticosteroid or other anti-inflammatory (e.g., an NSAID), a decongestant (e.g., vasoconstrictor), a mucous thinning agent (e.g., an expectorant or mucolytic), an agent that prevents of modifies an allergic response (e.g., an antihistamine, cytokine inhibitor, leucotriene inhibitor, IgE inhibitor, immunomodulator), etc. Some nonlimiting examples of antimicrobial agents that may be used in this invention include acyclovir, amantadine, aminoglycosides (e.g., amikacin, gentamicin and tobramycin), amoxicillin, amoxicillin/clavulanate, amphotericin B, ampicillin, ampicillin/sulbactam, atovaquone, azithromycin, cefazolin, cefepime, cefotaxime, cefotetan, cefpodoxime, ceftazidime, ceftizoxime, ceftriaxone, cefuroxime, cefuroxime axetil, cephalexin, chloramphenicol, clotrimazole, ciprofloxacin, clarithromycin, clindamycin, dapsone, dicloxacillin, doxycycline, erythromycin, fluconazole, foscamet, ganciclovir, atifloxacin, imipenem/cilastatin, isoniazid, itraconazole, ketoconazole, metronidazole, nafcillin, nafcillin, nystatin, penicillin, penicillin G, pentamidine,
piperacillin/tazobactam, rifampin, quinupristin-dalfopristin, ticarcillin/clavulanate, trimethoprim/sulfamethoxazole, valacyclovir, vancomycin, mafenide, silver sulfadiazine, mupirocin (e.g., Bactroban Nasal®, Glaxo SmithKline, Research Triangle Park, North Carolina), nystatin, triamcinolone/nystatin, clotrimazole/betamethasone, clotrimazole, ketoconazole, butoconazole, miconazole, fluconazole, detergent-like chemicals that disrupt or disable microbes (e.g., nonoxynol-9, octoxynol-9, benzalkonium chloride, menfegol, and N-docasanol); chemicals that block microbial attachment to target cells and/or inhibits entry of infectious pathogens (e.g., sulphated and sulponated polymers such as PC-515 (carrageenan), Pro-2000, and Dextrin 2 Sulphate); antiretroviral agents (e.g., PMPA gel) that prevent retroviruses from replicating in the cells; genetically engineered or naturally occurring antibodies that combat pathogens such as anti-viral antibodies genetically engineered from plants known as "plantibodies;" agents which change the condition of the tissue to make it hostile to the pathogen (such as substances which alter mucosal pH (e.g., Buffer Gel and Acidform); non-pathogenic or "friendly" microbes that cause the production of hydrogen peroxide or other substances that kill or inhibit the growth of pathogenic microbes (e.g., lactobacillus); antimicrobial proteins or peptides such as those described in United States Patent No. 6,716,813 (Lin et al,.) which is expressly incorporated herein by reference or antimicrobial metals (e.g., colloidal silver).
Additionally or alternatively, in some applications where it is desired to treat or prevent inflammation the substances delivered in this invention may include various steroids or other anti-inflammatory agents (e.g., nonsteroidal anti-inflammatory agents or NSAIDS), analgesic agents or antipyretic agents. For example, corticosteroids that have previously administered by intranasal administration may be used, such as beclomethasone (Vancenase® or Beconase®), flunisolide (Nasalide®), fluticasone proprionate (Flonase®), triamcinolone acetonide (Nasacort®), budesonide (Rhinocort Aqua®), loterednol etabonate (Locort) and mometasone (Nasonex®). Other salt forms of the aforementioned corticosteroids may also be used. Also, other non-limiting examples of steroids that may be useable in the present invention include but are not limited to aclometasone, desonide, hydrocortisone, betamethasone, clocortolone, desoximetasone, fluocinolone, flurandrenolide, mometasone,
prednicarbate; amcinonide, desoximetasone, diflorasone, fluocinolone, fluocinonide, halcinonide, clobetasol, augmented betamethasone, diflorasone, halobetasol, prednisone, dexamethasone and methylprednisolone. Other antiinflammatory, analgesic or antipyretic agents that may be used include the nonselective COX inhibitors (e.g., salicylic acid derivatives, aspirin, sodium salicylate, choline magnesium trisalicylate, salsalate, diflunisal, sulfasalazine and olsalazine; para-aminophenol derivatives such as acetaminophen; indole and indene acetic acids such as indomethacin and sulindac; heteroaryl acetic acids such as tolmetin, dicofenac and ketorolac; arylpropionic acids such as ibuprofen, naproxen, flurbiprofen, ketoprofen, fenoprofen and oxaprozin; anthranilic acids (fenamates) such as mefenamic acid and meloxicam; enolic acids such as the oxicams (piroxicam, meloxicam) and alkanones such as nabumetone) and Selective COX-2 Inhibitors (e.g., diaryl-substituted furanones such as rofecoxib; diaryl-substituted pyrazoles such as celecoxib; indole acetic acids such as etodolac and sulfonamides such as nimesulide)
Additionally or alternatively, in some applications, such as those where it is desired to treat or prevent an allergic or immune response and/or cellular proliferation, the substances delivered in this invention may include a) various cytokine inhibitors such as humanized anti-cytokine antibodies, anti-cytokine receptor antibodies, recombinant (new cell resulting from genetic recombination) antagonists, or soluble receptors; b) various leucotriene modifiers such as zafirlukast, montelukast and zileuton; c) immunoglobulin E (IgE) inhibitors such as Omalizumab (an anti-lgE monoclonal antibody formerly called rhu Mab-E25) and secretory leukocyte protease inhibitor) and d) SYK Kinase inhibitoers such as an agent designated as "R-112" manufactured by Rigel Pharmaceuticals, Inc, or South San Francisco, California.
Additionally or alternatively, in some applications, such as those where it is desired to shrink mucosal tissue, cause decongestion or effect hemostasis, the substances delivered in this invention may include various vasoconstrictors for decongestant and or hemostatic purposes including but not limited to pseudoephedrine, xylometazoline, oxymetazoline, phenylephrine, epinephrine, etc.
Additionally or alternatively, in some applications, such as those where it is desired to facilitate the flow of mucous, the substances delivered in this
invention may include various mucolytics or other agents that modify the viscosity or consistency of mucous or mucoid secretions, including but not limited to acetylcysteine (Mucomyst™, Mucosil™) and guaifenesin.
In one particular embodiment, the substance delivered by this invention comprises a combination of an anti-inflammatory agent (e.g. a steroid or an NSAID) and a mucolytic agent.
Additionally or alternatively, in some applications such as those where it is desired to prevent or deter histamine release, the substances delivered in this invention may include various mast cell stabilizers or drugs which prevent the release of histamine such as cromolyn (e.g., Nasal Chrom®) and nedocromil.
Additionally or alternatively, in some applications such as those where it is desired to prevent or inhibit the effect of histamine, the substances delivered in this invention may include various antihistamines such as azelastine (e.g., Astylin®), diphenhydramine, loratidine, etc. Additionally or alternatively, in some embodiments such as those where it is desired to dissolve, degrade, cut, break or remodel bone or cartilage, the substances delivered in this invention may include substances that weaken or modify bone and/or cartilage to facilitate other procedures of this invention wherein bone or cartilage is remodeled, reshaped, broken or removed. One example of such an agent would be a calcium chelator such as EDTA that could be injected or delivered in a substance delivery implant next to a region of bone that is to be remodeled or modified. Another example would be a preparation consisting of or containing bone degrading cells such as osteoclasts. Other examples would include various enzymes of material that may soften or break down components of bone or cartilage such as collagenase (CGN), trypsin, trypsin/EDTA, hyaluronidase, and tosyllysylchloromethane (TLCM).
Additionally or alternatively, in some applications, the substances delivered in this invention may include other classes of substances that are used to treat rhinitis, nasal polyps, nasal inflammation, and other disorders of the ear, nose and throat including but not limited to anti-cholinergic agents that tend to dry up nasal secretions such as ipratropium (Atrovent Nasal®), as well as other agents not listed here.
Additionally or alternatively, in some applications such as those where it is desired to draw fluid from polyps or edematous tissue, the substances
delivered in this invention may include locally or topically acting diuretics such as furosemide and/or hyperosmolar agents such as sodium chloride gel or other salt preparations that draw water from tissue or substances that directly or indirectly change the osmolar content of the mucous to cause more water to exit the tissue to shrink the polyps directly at their site.
Additionally or alternatively, in some applications such as those wherein it is desired to treat a tumor or cancerous lesion, the substances delivered in this invention may include antitumor agents (e.g., cancer chemotherapeutic agents, biological response modifiers, vascularization inhibitors, hormone receptor blockers, cryotherapeutic agents or other agents that destroy or inhibit neoplasia or tumorigenesis) such as; alkylating agents or other agents which directly kill cancer cells by attacking their DNA (e.g., cyclophosphamide, isophosphamide), nitrosoureas or other agents which kill cancer cells by inhibiting changes necessary for cellular DNA repair (e.g., carmustine (BCNU) and lomustine (CCNU)), antimetabolites and other agents that block cancer cell growth by interfering with certain cell functions, usually DNA synthesis (e.g., 6 mercaptopurine and 5-fluorouracil (5FU), antitumor antibiotics and other compounds that act by binding or intercalating DNA and preventing RNA synthesis (e.g., doxorubicin, daunorubicin, epirubicin, idarubicin, mitomycin-C and bleomycin) plant (vinca) alkaloids and other anti-tumor agents derived from plants (e.g., vincristine and vinblastine), steroid hormones, hormone inhibitors, hormone receptor antagonists and other agents which affect the growth of hormone-responsive cancers (e.g., tamoxifen, herceptin, aromatase ingibitors such as aminoglutethamide and formestane, trriazole inhibitors such as letrozole and anastrazole, steroidal inhibitors such as exemestane), antiangiogenic proteins, small molecules, gene therapies and/or other agents that inhibit angiogenesis or vascularization of tumors (e.g., meth-1, meth-2, thalidomide), bevacizumab (Avastin), squalamine, endostatin, angiostatin, Angiozyme, AE-941 (Neovastat), CC-5013 (Revimid), medi-522 (Vitaxin), 2- methoxyestradiol (2ME2, Panzem), carboxyamidotriazole (CAI), combretastatin A4 prodrug (CA4P), SU6668, SU11248, BMS-275291 , COL-3, EMD 121974, IMC-1C11 , IM862, TNP-470, celecoxib (Celebrex), rofecoxib (Vioxx), interferon alpha, interleukin-12 (IL-12) or any of the compounds identified in Science Vol. 289, Pages 1197-1201 (August 17, 2000) which is expressly incorporated
herein by reference, biological response modifiers (e.g., interferon, bacillus calmette-guerin (BCG), monoclonal antibodies, interluken 2, granulocyte colony stimulating factor (GCSF), etc.), PGDF receptor antagonists, herceptin, asparaginase, busulphan, carboplatin, cisplatin, carmustine, cchlorambucil, cytarabine, dacarbazine, etoposide, flucarbazine, flurouracil, gemcitabine, hydroxyurea, ifosphamide, irinotecan, lomustine, melphalan, mercaptopurine, methotrexate, thioguanine, thiotepa, tomudex, topotecan, treosulfan, vinblastine, vincristine, mitoazitrone, oxaliplatin, procarbazine, streptocin, taxol, taxotere, analogs/congeners and derivatives of such compounds as well as other antitumor agents not listed here.
Additionally or alternatively, in some applications such as those where it is desired to grow new cells or to modify existing cells, the substances delivered in this invention may include cells (mucosal cells, fibroblasts, stem cells or genetically engineered cells) as well as genes and gene delivery vehicles like plasmids, adenoviral vectors or naked DNA, mRNA, etc. injected with genes that code for anti-inflammatory substances, etc., and, as mentioned above, osteoclasts that modify or soften bone when so desired, cells that participate in or effect mucogenesis or ciliagenesis, etc.
Additionally or alternatively to being combined with a device and/or a substance releasing modality, it may be ideal to position the device in a specific location upstream in the mucous flow path (i.e. frontal sinus or ethmoid cells). This could allow the deposition of fewer drug releasing devices, and permit the "bathing" of all the downstream tissues with the desired drug. This utilization of mucous as a carrier for the drug may be ideal, especially since the concentrations for the drug may be highest in regions where the mucous is retained; whereas non-diseased regions with good mucous flow will be less affected by the drug. This could be particularly useful in chronic sinusitis, or tumors where bringing the concentration of drug higher at those specific sites may have greater therapeutic benefit. In all such cases, local delivery will permit these drugs to have much less systemic impact. Further, it may be ideal to configure the composition of the drug or delivery system such that it maintains a loose affinity to the mucous permitting it to distribute evenly in the flow. Also, in some applications, rather than a drug, a solute such as a salt or other mucous soluble material may be positioned at a location whereby mucous
will contact the substance and a quantity of the substance will become dissolved in the mucous thereby changing some property (e.g., pH, osmolarity, etc) of the mucous. In some cases, this technique may be used to render the mucous hyperosmolar so that the flowing mucous will draw water and/or other fluid from polyps, edematous mucosal tissue, etc., thereby providing a drying or desiccating therapeutic effect.
Additionally or alternatively to substances directed towards local delivery to affect changes within the sinus cavity, the nasal cavities provide unique access to the olfactory system and thus the brain. Any of the devices and methods described herein may also be used to deliver substances to the brain or alter the functioning of the olfactory system. Such examples include, the delivery of energy or the deposition of devices and/or substances and/or substance delivering implant(s) to occlude or alter olfactory perception, to suppress appetite or otherwise treat obesity, epilepsy (e.g., barbiturates such as phenobarbital or mephoobarbital; iminostilbenes such as carbamazepine and oxcarbazepine; succinimides such as ethylsuximide; valproic acid; benzodiazepines such as clonazepam, clorazepate, diazepam and lorazepam, gabapentin, lamotrigine, acetazolamide, felbamate, levetiraceam, tiagabine, topiramate, zonisamide, etc.), personality or mental disorders (e.g., antidepressants, antianxiety agents, antipsychotics, etc.) , chronic pain, Parkinson's disease (e.g., dopamine receptor agonists such as bromocriptine, pergolide, ropinitrol and pramipexole; dopamine precursors such as levodopa; COMT inhibitors such as tolcapone and entacapone; selegiline; muscarinic receptor antagonists such as trihexyphenidyl, benztropine and diphenhydramine) and Alzheimer's disease, Huntington's disease or other dementias, disorders of cognition or chronic degenerative diseases (e.g. tacrine, donepezil, rivastigmine, galantamine, fluoxetine, carbamazepine, clozapine, clonazepam and proteins or genetic therapies that inhibit the formation of beta- amyloid plaques), etc. The working element need not necessarily be a substance delivery reservoir 3322. For example, another type of working element useable in this invention is a laser device. In one embodiment, the laser device may comprise an optical fiber that delivers laser energy through the distal region of the optical fiber. Typical examples of lasers that can be used in the present invention are
Nd:YAG lasers, Ho: NAG lasers, short pulsed laser systems such as excimer lasers (wavelength: 308 nm, pulse length full width at half maximum height : 60 ns), dye lasers (wavelength: 504 nm, pulse length full width at half maximum height: 1200 ns), tunable die lasers, KTP lasers, argon lasers, Alexandrite lasers (wavelength: 755 nm, pulse length full width at half maximum height : 300-500 ns) etc. Such a laser device may also be used in conjunction with or as a part of any method, system or device disclosed in this patent application for laser-assisted ablation or cutting, laser-assisted cauterization or other laser- assisted methods of treating sinusitis, mucocysts, tumors, polyps, occlusions, obstructions, edema or other conditions of the paranasal sinuses, Eustachian tubes, Lachrymal ducts, salivary glands and other hard or soft ear, nose, throat or mouth structures.
Such devices, systems and methods may also be used for performing other diagnostic or therapeutic procedures of Eustachian tubes, tympanums and middle ear structures. Examples of such procedures are biopsies, microendoscopy of the Eustachian tube and the middle ear structures, diagnosis and/or treatment of roundwindow ruptures, auditory-ossicle dislocations after tympanoplasty, prothesis dislocation after stapeclotomy, neuroradiologically undetectable liquorrhea caused by otobasal fractures, progressive disorders of the sound-conducting apparatus, Dysplasia of the ear, chronic otitis media mesotympanalis, cholesteatoma, presurgical evaluation of pathologic findings of both the mucosal lining and the ossicular chain, epitympanic retraction pockets of the ear drum, all chronic and recurrent ventilation or drainage disorders of Eustachian tubes etc.
Figure 35 shows a perspective view of an embodiment of a guidewire comprising a sensor used for surgical navigation. Guidewire 3400 comprises a sensor 3402 located on the distal region of guidewire 3400. Sensor 3402 enables guidewire 3400 to be used in conjunction with a suitable surgical navigation system. In one embodiment, sensor 3402 is an electromagnetic sensor used in conjunction with an electromagnetic surgical navigation system such as GE InstaTrak™ 3500 plus system. In one embodiment, guidewire 3400 comprises an anchoring balloon 3404 located on the distal region of guidewire 3400. Anchoring balloon 3404 is inflated after positioning guidewire 3400 at a
target location. Anchoring balloon 3404 anchors guidewire 3400 to adjacent anatomy and prevents accidental repositioning of guidewire 3400 during a diagnostic or therapeutic procedure. Anchoring balloon 3404 may be made from suitable compliant or semi-compliant material such as crosslinked polyethylene or other polyolefins, polyurethane, flexible polyvinylchloride, Nylon etc. In one embodiment, guidewire 3400 comprises a soft distal tip. In another embodiment, guidewire 3400 comprises a curved distal end e.g. a "J" shaped distal end. Sensors similar to sensor 3402 may be present on other diagnostic or therapeutic devices disclosed herein such as balloon catheters etc. Similarly, the devices disclosed herein may comprise other types of sensors or transmitters such as electromagnetic, RF, piezoelectric, magnetic etc. The sensors or transmitters may be in the form of a variety of configurations including but not limited to single coils, multiple coils, antennae etc. The sensors or transmitters may be oriented in a variety of configurations including but not limited to nested, paired, orthogonal to each other, etc.
Figure 35A shows an enlarged view of an embodiment of a low profile proximal region of the guidewire in Figure 35. The proximal region of guidewire 3400 comprises a distal electrical contact 3406 and a proximal electrical contact 3408. Distal electrical contact 3406 and proximal electrical contact 3408 are connected to sensor 3402 by conducting wires that run along guidewire 3400 to provide electrical energy to sensor 3402. Distal electrical contact 3406 and proximal electrical contact 3408 are connected to an external electrical supply by detachable electrodes. Distal electrical contact 3406 and proximal electrical contact 3408 can be made of suitable conducting materials such as stainless steel, silver-palladium alloys, silver-platinum alloys etc. Distal electrical contact 3406 and proximal electrical contact 3408 are separated from each other by a first insulating element 3410. In one embodiment, guidewire 3400 further comprises a second insulating element 3412 located on the proximal end of guidewire 3400. A low profile proximal region allows for the introduction of diagnostic or therapeutic devices over guidewire 3400.
Figure 35B shows a perspective view of a method of advancing a diagnostic or therapeutic device over the guidewire in Figure 35. In this example, the diagnostic or therapeutic device is a balloon catheter 3414 comprising a shaft 3416 having a balloon 3418 at the distal region of shaft 3416
and a hub 3420 at the proximal end of shaft 3416. Balloon catheter is advanced into a target anatomical region over the guidewire 3400. In this example, guidewire 3400 comprises a low profile proximal end so that devices can be introduced in an over-the-wire manner into a target anatomy. Figure 35C shows a perspective view of an embodiment of a combination of a guidewire comprising a sensor having a diagnostic or therapeutic device preloaded on the guidewire. In this example, the diagnostic or therapeutic device is balloon catheter 3414. The proximal end of guidewire 3400 is connected to an external electrical supply 3422 by conducting wires 3424. In this example, guidewire 3400 does not have a low profile proximal end so that devices cannot be introduced in an over-the-wire manner into a target anatomy. Thus, balloon catheter 3414 is preloaded on guidewire 3400 by inserting proximal end of balloon catheter 3414 over distal end of guidewire 3400.
Figure 35D shows a perspective view of a second embodiment of a combination of a guidewire comprising a sensor having a diagnostic or therapeutic device preloaded on the guidewire. In this example, the diagnostic or therapeutic device is balloon catheter 3414. The proximal end of guidewire 3400 is connected by conducting wires 3426 to plug 3428. Plug 3428 detachably fits into an external power supply 3430. In this example, guidewire 3400 does not have a low profile proximal end so that devices cannot be introduced in an over-the-wire manner into a target anatomy. Thus, balloon catheter 3414 is preloaded on guidewire 3400 by inserting proximal end of balloon catheter 3414 over distal end of guidewire 3400.
One or more flexible regions especially flexible distal regions on the diagnostic or therapeutic devices disclosed herein may comprise bending or deflecting elements. Examples of such bending or deflecting elements are one or more pull wires etc. made of suitable materials such as stainless steel flat wire etc.
The abovementioned devices and methods may also be used for diagnosing or treating other conditions caused by narrowing or blockage of structures in the ear, nose, throat or mouth such as choanal atresia.
Various devices described herein such as catheters may comprise one or more lumens such as end-to-end lumens, zipper lumens, rapid exchange lumens, parallel lumen surrounded by a jacket etc.
It is to be appreciated that the invention has been described hereabove with reference to certain examples or embodiments of the invention but that various additions, deletions, alterations and modifications may be made to those examples and embodiments without departing from the intended spirit and scope of the invention. For example, any element or attribute of one embodiment or example may be incorporated into or used with another embodiment or example, unless to do so would render the embodiment or example unsuitable for its intended use. All reasonable additions, deletions, modifications and alterations are to be considered equivalents of the described examples and embodiments and are to be included within the scope of the following claims.
Claims
1. An apparatus for stabilizing or holding at least one working device, such as a catheter, scope, guidewire or tube, wherein a distal portion of the working device has been inserted through the nose, mouth or other facial opening or facial incision in a human or animal subject and a proximal portion of the working device remains outside of the subject's body, and wherein the subject's body is positioned on a body support surface, said apparatus comprising: a tray that is mounted in fixed position relative to said body support surface; and at least one working device holder attached or connected to the tray, said working device holder being conFigured to stabilize or hold a portion of the working device that remains outside of the subject's body.
2. An apparatus according to claim 1 wherein the working device holder is releasably connectable or attachable to the tray.
3. An apparatus according to claim 1 wherein a plurality of said working device holders are connectable or attachable to the tray at a plurality of selectable connection or attachment locations.
4. An apparatus according to claim 1 wherein the working device holder comprises a stabilizing member for stabilizing the working device.
5. An apparatus according to claim 1 wherein the tray comprises a plurality of holes into which the working device holder is insertable.
6. An apparatus according to claim 1 wherein the tray comprises a penetrable material into which the working device holder is insertable.
7. An apparatus according to claim 1 wherein the body support surface is located on a table upon which the subject may lie generally in a dorsally recumbent position.
8. An apparatus according to claim 1 wherein the support surface is located on a reclined or reclinable chair upon which the subject may recline generally in a dorsally recumbent position.
9. A system for use in the performance of a medical or surgical procedure within the ear, nose or throat of a human or animal subject, wherein at least one elongate working device is inserted through the nose, mouth or other facial opening or facial incision and used to perform at least a portion of the medical or surgical procedure within the ear, nose or throat of a human or animal subject, said system comprising."
a monitor useable to display an image;
an imaging apparatus that causes the monitor to display an image indicating the position of the working device within the ear, nose, throat, paranasal sinus, nasopharynx, Eustachian tube or naso-lacrimal duct of the subject;
a console conFigured to receive and provide power to one or additional apparatus selected from the group consisting of: aspiration pump for applying suction; irrigation pump for delivering irrigation fluid; rotational drive apparatus for driving a drill, auger, rotating rasp or other rotational working device; storage apparatus for storing items; radiofrequency apparatus for delivering pulsed or continuous radiofrequency energy; ultrasound apparatus for delivering pulsed or continuous ultrasound; light source apparatus for delivering pulsed or continuous light to a lamp, endoscope, or other lighted device; camera; laser for delivering pulsed or continuous laser light; image processing apparatus for receiving and processing an image obtained from an endoscope, intracorporeal camera or other image receiving device; electrocardiograph; pulse oximeter; pneumotachometer; recording apparatus for recording images; recording apparatus for recording variables measured by other apparatus attached to the console; and
a controller comprising a computing device or microprocessor that sends control signals to one or more apparatus selected from the group consisting of; a) the other apparatus connected to the console, b) the at least one working device, c) the monitor and d) the imaging device.
10. A system according to claim 9 further comprising a manually operable control apparatus for energizing and de-energizing one or more apparatus selected from; a) the other apparatus connected to the console, b) the at least one working device, c) the monitor and d) the imaging device.
11. A system according to claim 10 wherein the manually operable control apparatus comprises a foot pedal.
12. A system according to claim 9 wherein a controller is connected to the console, said controller being programmable by the operator.
13. A system according to claim 12 wherein the controller is adapted to receive settings of one or more variables selected from the group consisting of: irrigation flow rate, irrigation fluid pressure, aspiration flow rate, suction pressure, frequency of radiofrequency energy delivered by a radiofrequency module; pulse width of radiofrequency energy delivered by a radiofrequency module; duty cycle of radiofrequency energy delivered by a radiofrequency module; frequency of untrasound delivered by an ultrasound module; pulse width of ultrasound delivered by an ultrasound module; duty cycle of ultrasound delivered by an ultrasound module; the frequency of laser light delivered by a laser module; pulse width of laser light delivered by a laser module and duty cycle of laser light delivered by a laser module.
14. A system according to claim 9 wherein a laser module is connected to the console, said laser module being selected from the group consisting of: a carbon dioxide laser; a neodymium YAG laser; a tunable dye laser; a KTP laser and an argon laser.
15. A system according to claim 9 wherein the imaging apparatus comprises a fluoroscope.
16. A system according to claim 15 wherein the imaging apparatus comprises a fluoroscope with a C arm.
17. A device for occluding a nostril of a human or animal subject while permitting a catheter, guidewire or other working device to be inserted through that nostril, said device comprising: an occluder member that conforms to the shape of the nostril in which it is inserted; and a passageway that extends through said occluder member to permit the catheter, guidewire or other working device to be inserted through the occluder member when the occluder member is positioned within the nostril.
18. A device according to claim 17 wherein the occluder member comprises a resilient material that may be compressed, inserted into the nostril while in a compressed state and subsequently allows to re-expand to a non-compressed state wherein it conforms to the shape of the nostril in which it is positioned.
19. A device according to claim 17 wherein the occluder member comprises a balloon that is sufficiently compliant to conform to the shape of the nostril in which it is positioned.
20. A device for occluding a nostril of a human or animal subject while permitting a catheter, guidewire or other working device to be inserted through that nostril, said device comprising: an occluder balloon that occludes the nostril, said balloon being conFigured to resist pulling of the device out of the nostril; and a passageway that extends through said occluder balloon to permit the catheter, guidewire or other working device to be inserted through the occluder balloon when the occluder balloon is positioned within the nostril.
21. A device according to claim 17 wherein the occluder balloon has one or more ribs formed on its outer surface to frictionally engage the adjacent anatomical wall of the nostril in which it is positioned to resist pulling of the device out of the nostril.
22. An adhesive device useable to resist pulling of a device out of a nostril of a human or animal subject, said device comprising: a flexible article having an inner adhesive surface and an outer non- adhesive surface, said flexible article being shaped such that a portion of the device may be positioned over the nares to deter pulling of the device from the nostril and at least a portion of the inner adhesive surface is adhered to skin to hold the device in place.
23. A device according to claim 22 wherein the article has upper wings that adhere to the skin in the sides of the nose and/or cheeks adjacent to the nose.
24. A device according to claim 22 wherein the article has lower wings that adhere to the skin of the upper lip and/or face adjacent to the upper lip.
25. A device according to claim 22 wherein an opening is formed in the portion of the device that is positioned over the nares to permit insertion of a catheter, guidewire or other working device through said opening and through the nostril.
26. A device for occluding the nasal cavity or nasopharynx of a human or animal subject, posterior to the intranasal septum, said device comprising: a tube having a proximal portion of a first diameter and a distal portion of a second diameter that is larger than said first diameter; a balloon mounted on the distal portion of the tube; said tube being insertable through a nostril to a position where the distal portion of the tube is posterior to the intranasal septum, said balloon being thereafter inflatable to substantially block the nasal cavity or nasopharynx posterior to the nasal septum.
27. A device according to claim 26 further comprising at least one aperture formed in the tube proximal to the balloon to facilitate suctioning of matter from the nasal cavity proximal to the balloon.
28. A device according to claim 26 further comprising an anterior occluder on the proximal portion of the tube for occluding the nostril through which the tube is inserted.
29. A guide catheter for insertion into the nose, paranasal sinus, Eustachian tube, naso-lacrimal duct or nasopharynx of a human or animal subject, said guide catheter comprising: a tube having a proximal portion and a distal portion, once of said proximal and distal portions being rigid or flexible and substantially non- malleable and the other of said proximal and distal portions being substantially malleable.
30. A guide catheter according to claim 29 wherein the distal portion is substantially malleable.
31. A guide catheter according to claim 29 wherein the proximal portion is substantially malleable.
32. A guide catheter according to claim 29 wherein the guide catheter has a lumen extending therethrough and wherein a tubular liner is disposed within said lumen.
33. A guide catheter according to claim 32 wherein the tubular liner comprises polytetrafluoroethylene.
34. A guide catheter according to claim 29 further comprising a substantially atraumatic distal tip.
35. A guide catheter for insertion into the nose, paranasal sinus, Eustachian tube, naso-lacrimal duct or nasopharynx of a human or animal subject, said guide catheter comprising: a polymer tube having a lumen, a wall and a braid disposed within the wall; and a tubular liner is disposed within said lumen.
36. A guide catheter according to claim 35 wherein the tubular liner comprises polytetrafluoroethylene.
37. A guide catheter according to claim 35 further comprising a substantially atraumatic distal tip.
38. A device for insertion into a paranasal sinus, Eustachian tube, naso- lacrimal duct or other anatomical structure of the ear, nose or throat and for guiding a second device to that paranasal sinus, Eustachian tube, naso-lacrimal duct or other anatomical structure, said device comprising:
an elongate shaft having a proximal end and a distal end, at least a portion of said shaft being formed of plastically deformable material such that it may be bent into a desired shape;
a bulbous tip member on the distal end of the shaft; and a handle removably attachable to the proximal end of the shaft.
39. A system comprising a) device according to claim 38 in combination with b) a second device that is advanceable over said shaft when the handle is detached from the proximal end of the shaft.
40. A system according to claim 39 wherein the second device comprises a catheter.
41. A system according to claim 40 wherein the catheter comprises a balloon catheter.
42. A catheter device for treating a disease or disorder of a paranasal sinus having an ostium which opens into said paranasal sinus, said device comprising:
a catheter shaft having a distal end, said catheter shaft being advancable, distal end first, through the ostium and into the paranasal sinus;
a distal balloon that is positionable inside the paranasal sinus adjacent to the ostium;
a proximal balloon that is positionable outside the paranasal sinus adjacent to the ostium; and
at least one balloon inflation lumen extending through the catheter shaft for inflation of said distal and proximal balloons.
43. A device according to claim 42 comprising a single inflation lumen that is useable to simultaneously inflate the proximal and distal balloons.
44. A device according to claim 42 comprising a proximal balloon inflation lumen useable to inflate the proximal balloon and a distal balloon inflation lumen useable to inflate the distal balloon.
45. A device according to claim 43 further comprising a lumen that extends through the catheter shaft and opens distal to the distal balloon.
46. A device according to claim 42 further comprising a dilator positioned between the proximal and distal balloons, said dilator being useable to dilate the ostium.
47. A device according to claim 46 wherein the dilator comprises a balloon.
48. A device according to claim 42 comprising a lumen that is sized to receive a guidewire such that the device may be advanced over a guidewire.
49. A device according to claim 42 further comprising a stent mounted between the proximal and distal balloons for stenting the ostium.
50. A catheter device for treating a disease or disorder of a paranasal sinus having an ostium which opens into said paranasal sinus, said device comprising:
a catheter shaft having a distal end, said catheter shaft being advancable, distal end first, through the ostium and into the paranasal sinus;
an intrasinus balloon on a portion of the catheter shaft that becomes inserted within the paranasal sinus, said intrasinus balloon having a proximal end, the proximal end of the intrasinus balloon having an indented central portion surrounded by a peripheral portion, the peripheral portion being placeable in contact with the inner surface of the paranasal sinus adjacent to the ostium; and a dilator located proximal to the intrasinus balloon, said dilator being useable to dilate the ostium.
51. A device according to claim 50 wherein the dilator extends at least partially into the indented central portion of the proximal end of the intrasinus balloon.
52. A device according to claim 51 wherein the dilator comprises a dilation balloon.
53. A device according to claim 50 further comprising a stent mounted proximal to the intrasinus balloon for stenting the ostium.
54. A balloon catheter device useable to dilate the ostium of a paranasal sinus, said balloon catheter device comprising:
a catheter shaft;
a non-compliant inner balloon attached to said catheter shaft; and
a compliant outer balloon attached to said catheter shaft and surrounding said inner balloon;
the compliant outer balloon being initially inflatable and positionable within the ostium such that the ostium creates an indentation in the compliant outer balloon and, thereafter, the non-compliant inner balloon being inflatable to dilate the ostium.
55. A balloon catheter device according to claim 54 wherein the outer balloon is radiopaque to facilitate radiographic visualization of the indentation in the compliant balloon created by the ostium.
56. A balloon catheter device according to claim 54 wherein the outer balloon is inflated with a radiopaque fluid to facilitate radiographic visualization of the indentation in the compliant balloon created by the ostium.
57. A balloon catheter device according to claim 54 wherein inflation fluid passes out of the outer balloon as the inner balloon is inflated.
58. A balloon catheter device for delivering a substance to a location within the body of a human or animal subject, said device comprising: a catheter shaft;
an inner balloon attached to the catheter shaft; and
an outer sheath attached to the catheter shaft and surrounding the inner balloon, the substance being transmissible through at least a portion of the outer sheath;
the inner balloon being inflatable to compress the porous outer sheath against tissue within the subject's body and the substance being present or introduceable between the inner balloon and the outer sheath such that a therapeutically effective amount of the substance will pass through the outer sheath and into contact with the tissue.
59. A balloon catheter device according to claim 58 wherein the outer sheath comprises a porous membrane through which the substance may pass.
60. A balloon catheter device for delivering a substance to a location within the body of a human or animal subject, said device comprising:
a catheter shaft;
a balloon attached to the catheter shaft, said balloon having an outer surface; and at least one substance reservoir on the outer surface of the balloon, said substance reservoir comprising a porous matrix in which said substance is disposed;
said balloon being inflatable to compress the at least one substance reservoir against tissue within the subject's body such that a therapeutically effective amount of the substance will contact the tissue.
61. A balloon catheter device according to claim 60 wherein a plurality of substance reservoirs are disposed circumferentially about the outer surface of the balloon.
62. A balloon catheter device according to claim 60 wherein the at least one substance reservoir comprises a coating on the outer surface of the balloon.
63. A balloon catheter device according to claim 60 wherein the balloon is sized and constructed such that it may be inflated within the ostium of a paranasal sinus to cause dilation of the ostium.
64. A device useable to lavage a paranasal sinus having an ostium, said device comprising:
a catheter having a proximal end, a distal end, an infusion lumen, an aspiration lumen, an infusion outlet aperture and an aspiration inlet aperture; a balloon located on the catheter proximal to the infusion fluid outlet aperture and aspiration inlet aperture, said balloon being sized and conFigured to occlude the ostium such that lavage fluid may be infused through the infusion lumen, out of the of the infusion outlet aperture and into the paranasal sinus and such lavage fluid may then be aspirated from the paranasal sinus through the aspiration inlet aperture and through the aspiration lumen.
65. A device according to claim 64 wherein the infusion outlet aperture and an aspiration inlet aperture are spaced apart from each other to facilitate circulation of lavage fluid about the interior of the paranasal sinus.
66. A system useable to deliver fluid into a paranasal sinus having an ostium, said system comprising:
a balloon catheter having a balloon that is sized and conFigured to occlude the ostium of the paranasal sinus;
a fluid delivery catheter that is advanceable through the balloon catheter and into the paranasal sinus, said fluid delivery catheter having a lumen and a curled distal portion wherein a plurality of side apertures are formed, the curled distal portion being positionable in the paranasal sinus such that fluid may be infused through the infusion lumen, out of the side apertures and into contact with the walls of the paranasal sinus.
67. A system according to claim 66 further comprising an aspiration lumen in the balloon catheter through which fluid may be aspirated from the paranasal sinus.
68. An over-the-wire biopsy device comprising:
an elongate shaft having a lumen and a distal end;
specimen capturing jaws on the distal end of the shaft, said jaws being moveable between an open position and a closed position, said jaws, when is said closed position, having an opening formed therein, said opening being sized to permit passage of a guidewire therethrough and positioned in alignment with said lumen such that the device may be advanced over a guidewire while the jaws are in the closed position.
69. An over the wire biopsy device according to claim 68 wherein the elongate shaft is selected from the group consisting of: a flexible shaft, a rigid shaft, a shaft that is partially flexible and partially rigid, a shaft that is plastically deformable and a shaft that has a region that is plastically deformable.
70. A drilling device useable for drilling, cutting, grinding, notching, brushing, grooving or driving screws into or through bone, cartilage or tissue, said device comprising:
an elongate shaft having a lumen, a distal end and a plastically deformable region;
a bit member rotatably mounted on the distal end of the tubular shaft; and
a flexible drive member that extends through the lumen of the elongate shaft, said flexible drive member being connected to the bit member to rotationally drive the bit member.
71. A drilling device according to claim 70 wherein substantially coaxial lumens extend through the bit member and the flexible drive member, said substantially coaxial lumens are useable for advancing the device over a guidewire.
72. A drilling device according to claim 70 wherein the bit member is selected from the group consisting of: cutter, grinder, rasp, brush, dremmel, polisher, burnisher, boring tool, grooving tool and screw driver.
73. A device for treating a mucocyst or other flowable-substance-containing structure located within a paranasal sinus, said device comprising:
an elongate shaft;
a penetrator that is advancebale from and retractable into the shaft, said penetrator being useable to form an opening in the mucocyst or other flowable- substance-containing structure; and
a compressor useable to compress the mucocyst or other flowable- substance-containing structure such that its contents will be forced out of the opening formed by the penetrator.
74. A device according to claim 73 wherein the penetrator is a needle.
75. A device according to claim 73 wherein the compressor comprises a balloon.
76. A fiducial marker system for use in an electronic navigation system for navigating surgical or interventional devices within the body of a human or animal subject, said fiducial marker comprising:
an electromagnetically active element; and
an attachment substance or apparatus for removably attaching the electromagnetically active element to a tooth, bone or anatomical structure.
77. A fiducial marker system according to claim 76 wherein the attachment substance or apparatus comprises a temporary cement for temporarily attaching the electromagnetically active element to the surface of a tooth.
78. A fiducial marker device for use in an electronic navigation system for navigating surgical or interventional devices within the body of a human or animal subject, said fiducial marker comprising:
an intra-ear member conFigured to fit snugly in one of the subject's ear canals; and
an electromagnetically active element on or in the intra-ear member.
79. A fiducial marker device according to claim 78 wherein the intra-ear member comprises a plug that is conFigured to be advanced into the ear canal and to fit snuggly immediately adjacent to the tympanic membrane.
80. A system for dilating a Eustachian tube, said system comprising:
a guidewire that is insertable through the nose and is advanceable into the Eustachian tube through the pharyngeal ostium of the Eustachian tube;
a guidewire anchor for holding the guidewire in a substantially fixed position within the Eustachian tube;
a dilator that is advanceable over the guidewire and useable to dilate the Eustachian tube.
81. A system according to claim 80 wherein the guidewire anchor comprises a balloon on the guidewire.
82. A system according to claim 80 wherein the dilator comprises a balloon catheter.
83. A system according to claim 80 further comprising an imageable marker for marking the location at which the Eustachian tube passes into the middle ear, said marker being useable by the operator to prevent advancement of the guidewire into the middle ear.
84. A system according to claim 83 wherein the imageable marker comprises a radiopaque marker that inserts into the ear canal adjacent to the Eustachian tube to permit the operator to visualize the location of the inferior floor of the ear canal.
85. A system according to claim 83 wherein the guidewire further comprises a marker on the distal tip of the guidewire to enhance the operator's ability to track the location of the distal tip of the guidewire relative to anatomical structures of the middle ear.
86, A device for treating a depressed facia! fracture adjacent to a paranasal sinus, said device comprising: •
an elongate shaft; and an expander that comprises a plurality of individually inflatable bladders;
the device being advanceable into the paranasal sinus and each bladder being individually inflatable within the paranasal sinus to push the depressed facial fracture outwardly to a desired shape.
87. A device according to claim 86 wherein the expander comprises a multi- lobed balloon.
88. A method for improving drainage from a paranasal sinus that has a natural ostium that has not previously been surgically altered, said method comprising the steps of:
A) providing an elongate guide and a dilator, said dilatorbeing advancabSe over or through the guide;
B) advancing the elongate guide to a position within or near the ostium;
C) using the elongate guide to advance the dilator to a position where the dilator is within the ostium; and
D) using the dilator to dilate the natural ostium.
89. A method according to claim 88 wherein the elongate guide provided in Step A comprises a guide catheter having a lumen and wherein Step C comprises advancing the dilation catheter over or through the elongate guide to a position where the dilator is positioned within the ostium.
90. A method according to claim 89 wherein at least a portion of the guide catheter is malleable and wherein the method further comprises the step of:
shaping a malleable portion of the guide catheter.
91. A method according to claim 88 wherein the elongate guide provided in Step A comprises a guidewire and wherein Step C comprises advancing the balloon catheter over the guidewire to a position where the balloon is positioned within the ostium.
92. A method according to claim 89 wherein at least a portion of the guidewire is malleable and wherein the method further comprises the step of:
shaping a malleable portion of the guidewire.
93. A method according to claim 88 wherein the elongate guide provided in Step A comprises an elongate member having a proximal end, a distal end and a handle that is removeably attachable to the proximal end, and, wherein;
Step B comprises advancing the elongate member with the handle attached to its proximal end to a position where its distal end has passed through the ostium and into the paranasal sinus or where its distal end is located in or near the ostium; and
Step C comprises i) removing the handle from the proximal end of the guide member and ii) advancing the balloon catheter over the guide member to a position where the balloon is positioned within the ostium.
94. A method according to claim 93 wherein the elongate member has a bulbous distal tip member on its distal end.
95. A method according to claim 93 wherein at least a portion of the elongate member is malleable and wherein the method further comprises the step of; shaping a malleable portion of the elongate member.
96. A method according to claim 89 wherein the guide catheter comprises a flexible catheter and a malleable outer tube through which the flexible catheter extends.
97. A method according to claim 96 wherein the method further comprises the step of:
shaping the malleable outer tube.
98. A method according to claim 88 wherein the elongate guide provided in Step A comprises a guide system that' includes i) a guidewire and iii) a guide catheter, and, wherein:
Step B comprises inserting the guide catheter to a first position and advancing the guidewire through the guide catheter such that the guidewire extends into or through the ostium.
99. A method according to claim 98 further comprising the steps of:
providing a tubular sheath that is advanceable over the guidewire; and
advancing said tubular sheath over the guidewire.
100. A method according to claim 99 further comprising the step of:
Removing the guidewire leaving the tubular sheath in place.
101. A method according to claim 100 further comprising the step of infusing or aspirating matter through said tubular'sheath. 1 102. A method according to claim 100 further comprising the step of inserting
2 a different guidewire through the tubular sheath,
1 103. A method according to claim 88 wherein the elongate guide provided in
2 Step A comprises a guide system that includes i) a guidewire, ii) a tubular
3 sheath having a curved region and a lumen through which the guidewire may be
4 advanced and iii) a guide catheter, and, wherein: 5
6 Step B comprises inserting the guide catheter to a first position,
7 advanceing the tubular sheath through the guide catheter to a position where a
8 curved portion of the tubular sheath extends out of the distal end of the guide
9 catheter and and advancing the guidewire through the lumen of the curved 10 tubular sheath such that the guidewire extends into or through the ostium.
1 104. A method according to claim 88 wherein the dilator comprises a balloon
2 that is positionable in the ostium and expandable therein to dilate the ostium.
1 105. A method according to claim 88 wherein the dilator comprises i) a
2 catheter shaft having a distal end, said catheter shaft being advancable, distal
3 end first, through the ostium and into the paranasal sinus, ii) an intrasinus
4 balloon on a portion of the catheter shaft that becomes inserted within the
5 paranasal sinus, said intrasinus balloon having a proximal end, the proximal end . 6 of the intrasinus balloon having an indented central portion surrounded by a
7 peripheral portion and iii) a dilator located proximal to the intrasinus balloon,
8 said dilator being useable to dilate the ostium, and, wherein: - 9
10 Step C comprises advancing the dilation catheter to a position where the
11 intrasinus balloon is within the paranasal sinus; and •12
13 Step D comprises inflating the intrasinus balloon, thereafter pulling the
14 dilation catheter in the proximal direction until the peripheral portion of the
15 proximal surface of the intrasinus balloon is in contact with the inner surface of
16 the paranasal sinus adjacent to the ostium and thereafter using the dilator to
17 dilate the ostium.
106. A method according to claim 88 wherein the dilator comprises: i) a catheter shaft, ii) a balloon attached' to the catheter shaft, said balloon having an outer surface and iii) at least one substance reservoir on the outer surface of the balloon, said substance reservoir comprising a porous matrix in which a therapeutic or diagnostic substance is disposed, and, wherein:
Step D comprises inflating the balloon to dilate the ostium and compress the at least one substance reservoir against osteal tissue such that a therapeutically or diagnostically effective amount of the substance contacts the tissue.
107. A method according to claim 106 wherein a plurality of substance reservoirs are disposed circumferentiaily about the outer surface of the balloon.
108, A method according to claim 106 wherein the at least one substance reservoir comprises a coating on the outer surface of the balloon.
109. A method according to claim 88 wherein, the dilator comprises i) a catheter shaft, ii) a non-compliant inner balloon attached to said catheter shaft and iii) a compliant outer balloon attached to said catheter shaft and surrounding said inner balloon, and, wherein: ' , Step C comprises inflating the compliant outer balloon and moving the dilation catheter as necessary to position the inflated compliant outer balloon in the ostium such that the ostium creates an indentation in the compliant outer balloon; and, thereafter
Step D comprises inflating the noncompϋant inner balloon to dilate the ostium.
110. A method according to claim 109 wherein the outer balloon is radiopaque and Step C further comprises using radiographic imaging to observe the indentation in the compliant balloon created by the ostium.
111. A method according to claim 109 wherein Step C comprises inflating the compliant- outer baϋloon with a radiopaque fluid to facilitate radiographic visualization of the indentation in the compliant balloon created by the ostium.
112. A method according to claim 109 wherein Step D further comprises releasing inflation fluid from the outer balloon as the inner balloon is inflated.
113. A method according to claim 88 wherein the dilator has an outer surface which contains a diagnostic or therapeutic agent and wherein Step D comprises expanding the dilator to dilate the natural ostium and to transfer a diagnostic or therapeutic amount of the diagnostic or therapeutic agent to the ostium.
114. A method according to claim 113 wherein the outer surface of the dilator contains a hemostatic agent and in Step D a hemostatically effective amount of the hemostatic agent is transferred from the dilator to the ostium.
115. A method according to claim 88 wherein Step B is carried out with fluoroscopic visualization of the ostium.
116. A method according to claim 115 wherein a C-arm fluoroscope is used and wherein step B further comprises positioning the C-arm.
117. A method for treating a mucocyst or other or other flowable-substance- containing structure located within a paranasal sinus, said method comprising the steps of:
A) providing a penetrator that is useable to form an opening in the mucocyst or other flowable-substance-containing structure; .
B) providing a compressor useable to compress the mucocyst or other flowable-substance-containing structure after an opening has been formed therein by the penetrator such that its contents will be forced out of the opening formed by the penetrator; C) advancing the penetrator into the paranasal sinus and using the penetrator to form an opening in the mucocyst or other flowable-substance- containing structure; and
D) positioning the compressor in the paranasal sinus and using the compressor to compress the mucocyst or other flowable-substance-containing structure such that its contents will be forced out of the opening formed by the penetrator.
118, A method for determining the position of a device within the body of a human or animal subject, said method comprising the steps of:
A) providing a device having an electromagnetic element thereon;
B) providing a plurality of fiducial markers which emit electromagnetic energy and an attachment substance or apparatus for removably attaching the fiducial markers to teeth, bones or other anatomical structures;
C) using the attachment substance or apparatus to removably attach the fiducial markers to teeth, bones or other anatomical structures of the subject's body;
D) performing an imaging procedure to obtain an image of a portion of the subject's body including the fiducial markers; and, thereafter,
E) advancing the device into the subject's body and detecting the electromagnetic element on the device as well as the electromagnetic energy emitted by the fiducial markers; and
F) using the image obtained in Step D and the information dectected in Step E . to determine the current position of the device within the subject's body.
119. A method according to claim 118 wherein the attachment substance or apparatus comprises a temporary cement for temporarily attaching the eiectromagneticaily active element to the surface of a tooth and wherein Step C comprises using said cement to removably attach fiducial markers to teeth.
120. A method for dilating a Eustachian tube in a human or animal subject, said method domprising the steps of:
A) providing a a guidewire that is insertable through the nose and is advanceable into the Eustachian tube through the pharyngeal ostium of the Eustachian tube and a dilator that is advanceable over the guidewire and useable to dilate the Eustachian tube;
B) inserting the guidewire into the Eustachian tube;
C) advancing the dilator over the guidewire and into the Eustachian tube; and
D) using the dilator to dilate the Eustachian tube,
121. A method according to claim 120 wherein the guidewire has an anchor for holding the guidewire in a substantially fixed position within the Eustachian tube and wherein Step B further comprises anchoring the guidewire within the Eustachian tube.
122. A method according to claim 120 further comprising the steps of providing an imageable marker for marking the location at which the Eustachian tube passes into the middle ear, said marker being useable by the operator to prevent advancement of the guidewire into the middle ear; and imaging said marker and using the image thereby provided to avoid advancing the gυidewire or dilator into the middle ear in a manner that would cause substantial damage to anatomical structures of the middle ear.
123. A method according to claim 122 wherein the imageable marker is inserted into the ear canal adjacent to the Eustachian tube being treated.
124. A method for modifying a bony structure within the nose or paranasal sinus human or animal subject, said method comprising the steps of:
A) providing a direct viewing apparatus;
B) inserting the optical viewing apparatus into the nose;
C) advancing a guide device to a first location within the nasal cavity or paranasal sinus under direct viewing using the direct viewing apparatus;
D) providing an direct viewing apparatus;
E) advancing a working device over the guide device to a second location location within the nasal cavity or paranasal sinus, under indirect viewing using the direct viewing apparatus; and
F) using the working device to perform a therapeutic or diagnostic procedure. .
125. A method according to claim 124 wherein the direct viewing apparatus is comprises a scope.
126. A method according to claim 124 wherein the direct viewing apparatus comprises a video camera sized for insertion into the nares or nasal cavity. •
127. A method according to claim .124 wherein the indirect viewing apparatus comprises an imaging apparatus.
128. A method according to cjatm 124 wherein the indirect viewing apparatus comprises at least one apparatus selected from the group consisting of a fluoroscope, a fluoroscope with C-arm, a magnetic resonance imaging device, a tomographic device, a CT scanner, an electromagnetic navigational and/or guidance system, a PET scanner, a combination CT/PET scanner and an optical coherence tomography device.
129. A method according to claim 124 wherein the guide device comprises a device selected from the group consisting of; wires, rods, probes, guidewires, flexible members, malleable members, tubes, cannulae, catheters and stylets.
130. A method according to claim 124 wherein the working device comprises a device selected from the group consisting of; endoscopes, wires, probes, needles, catheters, balloon catheters, dilation catheters, dilators, balloons, tissue cutting or remodeling devices, suction or irrigation devices, imaging devices, sizing devices, biopsy devices, image-guided devices containing sensors or transmitters, electrosurgical devices, energy emitting devices, devices for injecting diagnostic or therapeutic agents, devices for implanting devices such as stents, substance eluting or delivering devices and implants.
Priority Applications (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
EP06718986.0A EP1838381B1 (en) | 2005-01-18 | 2006-01-18 | Systems for treating disorders of the ear, nose and throat |
ES06718986T ES2728374T3 (en) | 2005-01-18 | 2006-01-18 | Systems to treat disorders of the ear, nose and throat |
Applications Claiming Priority (5)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US10/829,917 US7654997B2 (en) | 2004-04-21 | 2004-04-21 | Devices, systems and methods for diagnosing and treating sinusitus and other disorders of the ears, nose and/or throat |
US10/912,578 US7361168B2 (en) | 2004-04-21 | 2004-08-04 | Implantable device and methods for delivering drugs and other substances to treat sinusitis and other disorders |
US10/944,270 US20060004323A1 (en) | 2004-04-21 | 2004-09-17 | Apparatus and methods for dilating and modifying ostia of paranasal sinuses and other intranasal or paranasal structures |
US11/037,548 US7462175B2 (en) | 2004-04-21 | 2005-01-18 | Devices, systems and methods for treating disorders of the ear, nose and throat |
US11/037,548 | 2005-01-18 |
Publications (2)
Publication Number | Publication Date |
---|---|
WO2006078884A2 true WO2006078884A2 (en) | 2006-07-27 |
WO2006078884A3 WO2006078884A3 (en) | 2007-11-01 |
Family
ID=36263060
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/US2006/002004 WO2006078884A2 (en) | 2004-04-21 | 2006-01-18 | Devices, systems and methods for treating disorders of the ear, nose and throat |
Country Status (2)
Country | Link |
---|---|
US (12) | US7462175B2 (en) |
WO (1) | WO2006078884A2 (en) |
Cited By (32)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
WO2011082139A1 (en) * | 2009-12-29 | 2011-07-07 | Acclarent, Inc. | System for treating target ti s sue within the eustachian tube |
RU2506056C2 (en) * | 2008-09-18 | 2014-02-10 | Аккларент, Инк. | Methods and apparatus for treating ear, nose and throat diseases |
US9039657B2 (en) | 2004-08-04 | 2015-05-26 | Acclarent, Inc. | Implantable devices and methods for delivering drugs and other substances to treat sinusitis and other disorders |
US9050440B2 (en) | 2005-09-23 | 2015-06-09 | Acclarent, Inc. | Multi-conduit balloon catheter |
US9055965B2 (en) | 2004-04-21 | 2015-06-16 | Acclarent, Inc. | Devices, systems and methods useable for treating sinusitis |
US9072626B2 (en) | 2009-03-31 | 2015-07-07 | Acclarent, Inc. | System and method for treatment of non-ventilating middle ear by providing a gas pathway through the nasopharynx |
US9089258B2 (en) | 2004-04-21 | 2015-07-28 | Acclarent, Inc. | Endoscopic methods and devices for transnasal procedures |
RU2572745C2 (en) * | 2009-12-28 | 2016-01-20 | Аккларент, Инк. | Removing tissue from paranasal sinus and nasal cavity |
US9603506B2 (en) | 2006-09-15 | 2017-03-28 | Acclarent, Inc. | Methods and devices for facilitating visualization in a surgical environment |
US9610428B2 (en) | 2004-04-21 | 2017-04-04 | Acclarent, Inc. | Devices, systems and methods useable for treating frontal sinusitis |
US9615775B2 (en) | 2007-04-30 | 2017-04-11 | Acclarent, Inc. | Methods and devices for ostium measurements |
US9629684B2 (en) | 2013-03-15 | 2017-04-25 | Acclarent, Inc. | Apparatus and method for treatment of ethmoid sinusitis |
US9629656B2 (en) | 2006-05-17 | 2017-04-25 | Acclarent, Inc. | Adapter for attaching electromagnetic image guidance components to a medical device |
US9636258B2 (en) | 2009-03-31 | 2017-05-02 | Acclarent, Inc. | System and method for treatment of non-ventilating middle ear by providing a gas pathway through the nasopharynx |
US9649477B2 (en) | 2004-04-21 | 2017-05-16 | Acclarent, Inc. | Frontal sinus spacer |
US9750401B2 (en) | 2008-07-30 | 2017-09-05 | Acclarent, Inc. | Paranasal ostium finder devices and methods |
US9820688B2 (en) | 2006-09-15 | 2017-11-21 | Acclarent, Inc. | Sinus illumination lightwire device |
US9861793B2 (en) | 2008-03-10 | 2018-01-09 | Acclarent, Inc. | Corewire design and construction for medical devices |
US10098652B2 (en) | 2004-04-21 | 2018-10-16 | Acclarent, Inc. | Systems and methods for transnasal dilation of passageways in the ear, nose or throat |
US10124154B2 (en) | 2005-06-10 | 2018-11-13 | Acclarent, Inc. | Catheters with non-removable guide members useable for treatment of sinusitis |
US10188413B1 (en) | 2004-04-21 | 2019-01-29 | Acclarent, Inc. | Deflectable guide catheters and related methods |
US10206821B2 (en) | 2007-12-20 | 2019-02-19 | Acclarent, Inc. | Eustachian tube dilation balloon with ventilation path |
US10492810B2 (en) | 2004-04-21 | 2019-12-03 | Acclarent, Inc. | Devices, systems and methods for diagnosing and treating sinusitis and other disorders of the ears, nose and/or throat |
US10524814B2 (en) | 2009-03-20 | 2020-01-07 | Acclarent, Inc. | Guide system with suction |
US10631756B2 (en) | 2004-04-21 | 2020-04-28 | Acclarent, Inc. | Guidewires for performing image guided procedures |
US10806891B2 (en) | 2009-09-21 | 2020-10-20 | Cook Regentec Llc | Method for infusing stem cells |
US10856727B2 (en) | 2004-04-21 | 2020-12-08 | Acclarent, Inc. | Endoscopic methods and devices for transnasal procedures |
US10874838B2 (en) | 2004-04-21 | 2020-12-29 | Acclarent, Inc. | Systems and methods for transnasal dilation of passageways in the ear, nose or throat |
US11019989B2 (en) | 2004-04-21 | 2021-06-01 | Acclarent, Inc. | Methods and apparatus for treating disorders of the ear nose and throat |
US11065061B2 (en) | 2004-04-21 | 2021-07-20 | Acclarent, Inc. | Systems and methods for performing image guided procedures within the ear, nose, throat and paranasal sinuses |
US11202644B2 (en) | 2004-04-21 | 2021-12-21 | Acclarent, Inc. | Shapeable guide catheters and related methods |
US11529502B2 (en) | 2004-04-21 | 2022-12-20 | Acclarent, Inc. | Apparatus and methods for dilating and modifying ostia of paranasal sinuses and other intranasal or paranasal structures |
Families Citing this family (433)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
DE10105592A1 (en) | 2001-02-06 | 2002-08-08 | Achim Goepferich | Placeholder for drug release in the frontal sinus |
US8317816B2 (en) | 2002-09-30 | 2012-11-27 | Acclarent, Inc. | Balloon catheters and methods for treating paranasal sinuses |
JP2006520786A (en) * | 2003-03-14 | 2006-09-14 | シネクサス, インコーポレイテッド | Sinus delivery of sustained-release therapeutic agents |
ES2700851T3 (en) | 2003-10-09 | 2019-02-19 | Sentreheart Inc | Apparatus for tissue binding |
US9351750B2 (en) * | 2004-04-21 | 2016-05-31 | Acclarent, Inc. | Devices and methods for treating maxillary sinus disease |
US9554691B2 (en) | 2004-04-21 | 2017-01-31 | Acclarent, Inc. | Endoscopic methods and devices for transnasal procedures |
US8864787B2 (en) | 2004-04-21 | 2014-10-21 | Acclarent, Inc. | Ethmoidotomy system and implantable spacer devices having therapeutic substance delivery capability for treatment of paranasal sinusitis |
US7419497B2 (en) | 2004-04-21 | 2008-09-02 | Acclarent, Inc. | Methods for treating ethmoid disease |
US7410480B2 (en) | 2004-04-21 | 2008-08-12 | Acclarent, Inc. | Devices and methods for delivering therapeutic substances for the treatment of sinusitis and other disorders |
US20060004323A1 (en) * | 2004-04-21 | 2006-01-05 | Exploramed Nc1, Inc. | Apparatus and methods for dilating and modifying ostia of paranasal sinuses and other intranasal or paranasal structures |
US7462175B2 (en) | 2004-04-21 | 2008-12-09 | Acclarent, Inc. | Devices, systems and methods for treating disorders of the ear, nose and throat |
US7720521B2 (en) | 2004-04-21 | 2010-05-18 | Acclarent, Inc. | Methods and devices for performing procedures within the ear, nose, throat and paranasal sinuses |
US9101384B2 (en) | 2004-04-21 | 2015-08-11 | Acclarent, Inc. | Devices, systems and methods for diagnosing and treating sinusitis and other disorders of the ears, Nose and/or throat |
US8146400B2 (en) | 2004-04-21 | 2012-04-03 | Acclarent, Inc. | Endoscopic methods and devices for transnasal procedures |
US8109981B2 (en) | 2005-01-25 | 2012-02-07 | Valam Corporation | Optical therapies and devices |
KR100675379B1 (en) * | 2005-01-25 | 2007-01-29 | 삼성전자주식회사 | Printing system and printing method |
US8096303B2 (en) | 2005-02-08 | 2012-01-17 | Koninklijke Philips Electronics N.V | Airway implants and methods and devices for insertion and retrieval |
US8371307B2 (en) | 2005-02-08 | 2013-02-12 | Koninklijke Philips Electronics N.V. | Methods and devices for the treatment of airway obstruction, sleep apnea and snoring |
KR20080005939A (en) | 2005-04-04 | 2008-01-15 | 시네수스 인코포레이티드 | Device and methods for treating paranasal sinus conditions |
US20060224034A1 (en) * | 2005-04-05 | 2006-10-05 | Kenneth Reever | Radiation shield |
US7276905B2 (en) * | 2005-07-11 | 2007-10-02 | General Electric Company | Method and system of tracking an intracorporeal device with MR imaging |
US7816975B2 (en) * | 2005-09-20 | 2010-10-19 | Hewlett-Packard Development Company, L.P. | Circuit and method for bias voltage generation |
US7465268B2 (en) | 2005-11-18 | 2008-12-16 | Senorx, Inc. | Methods for asymmetrical irradiation of a body cavity |
US8172792B2 (en) * | 2005-12-27 | 2012-05-08 | Tyco Healthcare Group Lp | Embolic protection systems for bifurcated conduits |
US20070179518A1 (en) * | 2006-02-02 | 2007-08-02 | Becker Bruce B | Balloon Catheters and Methods for Treating Paranasal Sinuses |
JP2007215577A (en) * | 2006-02-14 | 2007-08-30 | Fujifilm Corp | Endoscopic instrument and diagnostic system |
US20070244529A1 (en) * | 2006-04-18 | 2007-10-18 | Zoom Therapeutics, Inc. | Apparatus and methods for treatment of nasal tissue |
US8657846B2 (en) | 2006-04-21 | 2014-02-25 | Entellus Medical, Inc. | Guide catheter and method of use |
US7520876B2 (en) * | 2006-04-21 | 2009-04-21 | Entellus Medical, Inc. | Device and method for treatment of sinusitis |
US20090318875A1 (en) * | 2006-05-15 | 2009-12-24 | Mayo Foundation For Medical Education And Research | Devices and methods to treat nasal passages |
US20070286941A1 (en) * | 2006-06-13 | 2007-12-13 | Bin Huang | Surface treatment of a polymeric stent |
US8535707B2 (en) | 2006-07-10 | 2013-09-17 | Intersect Ent, Inc. | Devices and methods for delivering active agents to the osteomeatal complex |
US20080027520A1 (en) * | 2006-07-25 | 2008-01-31 | Zoom Therapeutics, Inc. | Laser treatment of tissue |
US20080027423A1 (en) * | 2006-07-25 | 2008-01-31 | Zoom Therapeutics, Inc. | Systems for treatment of nasal tissue |
US7547323B2 (en) * | 2006-08-29 | 2009-06-16 | Sinexus, Inc. | Stent for irrigation and delivery of medication |
US20080086051A1 (en) * | 2006-09-20 | 2008-04-10 | Ethicon Endo-Surgery, Inc. | System, storage medium for a computer program, and method for displaying medical images |
JP5153776B2 (en) * | 2006-10-03 | 2013-02-27 | バーチャル ポーツ リミテッド | Clip instrument for assisting surgery |
WO2008055301A1 (en) | 2006-11-07 | 2008-05-15 | Univ Sydney | Devices and methods for the treatment of heart failure |
US20110257723A1 (en) | 2006-11-07 | 2011-10-20 | Dc Devices, Inc. | Devices and methods for coronary sinus pressure relief |
US10413284B2 (en) | 2006-11-07 | 2019-09-17 | Corvia Medical, Inc. | Atrial pressure regulation with control, sensing, monitoring and therapy delivery |
US9232997B2 (en) | 2006-11-07 | 2016-01-12 | Corvia Medical, Inc. | Devices and methods for retrievable intra-atrial implants |
IL187667A (en) * | 2006-11-27 | 2011-12-29 | Mediguide Ltd | System and method for navigating a surgical needle toward an organ of the body of a patient |
US8439687B1 (en) | 2006-12-29 | 2013-05-14 | Acclarent, Inc. | Apparatus and method for simulated insertion and positioning of guidewares and other interventional devices |
US8206349B2 (en) | 2007-03-01 | 2012-06-26 | Medtronic Xomed, Inc. | Systems and methods for biofilm removal, including a biofilm removal endoscope for use therewith |
US20080167527A1 (en) * | 2007-01-09 | 2008-07-10 | Slenker Dale E | Surgical systems and methods for biofilm removal, including a sheath for use therewith |
US9326665B2 (en) * | 2007-01-09 | 2016-05-03 | Medtronic Xomed, Inc. | Surgical instrument, system, and method for biofilm removal |
US20080172033A1 (en) * | 2007-01-16 | 2008-07-17 | Entellus Medical, Inc. | Apparatus and method for treatment of sinusitis |
US7850382B2 (en) * | 2007-01-18 | 2010-12-14 | Sanford, L.P. | Valve made from two materials and writing utensil with retractable tip incorporating same |
US20080183128A1 (en) * | 2007-01-24 | 2008-07-31 | John Morriss | Methods, devices and systems for treatment and/or diagnosis of disorders of the ear, nose and throat |
US20100089404A1 (en) * | 2007-01-25 | 2010-04-15 | C.R. Bard,Inc. | Endotracheal and Tracheostomy Devices |
US7488130B2 (en) | 2007-02-01 | 2009-02-10 | Sanford, L.P. | Seal assembly for retractable instrument |
ES2714583T3 (en) | 2007-02-09 | 2019-05-29 | B & D Medical Dev Llc | Pelvic balloon tamponade |
US8457718B2 (en) * | 2007-03-21 | 2013-06-04 | Ethicon Endo-Surgery, Inc. | Recognizing a real world fiducial in a patient image data |
US20080319307A1 (en) * | 2007-06-19 | 2008-12-25 | Ethicon Endo-Surgery, Inc. | Method for medical imaging using fluorescent nanoparticles |
US8155728B2 (en) * | 2007-08-22 | 2012-04-10 | Ethicon Endo-Surgery, Inc. | Medical system, method, and storage medium concerning a natural orifice transluminal medical procedure |
US20080221434A1 (en) * | 2007-03-09 | 2008-09-11 | Voegele James W | Displaying an internal image of a body lumen of a patient |
US8081810B2 (en) * | 2007-03-22 | 2011-12-20 | Ethicon Endo-Surgery, Inc. | Recognizing a real world fiducial in image data of a patient |
EP2136869B1 (en) * | 2007-03-27 | 2021-07-21 | Intratech Medical Ltd. | Spiral balloon catheter |
EP2929842B1 (en) | 2007-03-30 | 2019-06-12 | Sentreheart, Inc. | Devices and sytems for closing the left atrial appendage |
US8241266B2 (en) | 2007-04-05 | 2012-08-14 | Entellus Medical, Inc. | Apparatus and method for treatment of ethmoids |
EP2136746B1 (en) | 2007-04-20 | 2012-12-19 | Doheny Eye Institute | Independent surgical center |
US8568391B2 (en) | 2007-04-20 | 2013-10-29 | Doheny Eye Institute | Sterile surgical tray |
US20100174415A1 (en) * | 2007-04-20 | 2010-07-08 | Mark Humayun | Sterile surgical tray |
US20080281301A1 (en) * | 2007-04-20 | 2008-11-13 | Deboer Charles | Personal Surgical Center |
US8323271B2 (en) * | 2007-04-20 | 2012-12-04 | Doheny Eye Institute | Sterile surgical tray |
US8485199B2 (en) | 2007-05-08 | 2013-07-16 | Acclarent, Inc. | Methods and devices for protecting nasal turbinate during surgery |
US9370642B2 (en) | 2007-06-29 | 2016-06-21 | J.W. Medical Systems Ltd. | Adjustable-length drug delivery balloon |
US20090030409A1 (en) * | 2007-07-27 | 2009-01-29 | Eric Goldfarb | Methods and devices for facilitating visualization in a surgical environment |
US8303640B2 (en) * | 2007-07-30 | 2012-11-06 | Audubon Technologies, Llc | Device for maintaining patent paranasal sinus ostia |
US20090076446A1 (en) * | 2007-09-14 | 2009-03-19 | Quest Medical, Inc. | Adjustable catheter for dilation in the ear, nose or throat |
EP2190520A4 (en) * | 2007-09-20 | 2011-01-26 | Estimme Ltd | Electrical stimulation in the middle ear for treatment of hearing related disorders |
WO2009042268A1 (en) * | 2007-09-28 | 2009-04-02 | Choi George Y | Device and methods for treatment of tissue |
US20090099573A1 (en) * | 2007-10-10 | 2009-04-16 | Donald Gonzales | Apparatus and Method for Treating Eustachian Tube Dysfunction |
US7998524B2 (en) | 2007-12-10 | 2011-08-16 | Abbott Cardiovascular Systems Inc. | Methods to improve adhesion of polymer coatings over stents |
US8585731B2 (en) * | 2007-12-18 | 2013-11-19 | Intersect Ent, Inc. | Self-expanding devices and methods therefor |
US7815687B2 (en) * | 2007-12-18 | 2010-10-19 | Med Institute, Inc. | Method of promoting cell proliferation and ingrowth by injury to the native tissue |
US20090163890A1 (en) * | 2007-12-20 | 2009-06-25 | Acclarent, Inc. | Method and System for Accessing, Diagnosing and Treating Target Tissue Regions Within the Middle Ear and the Eustachian Tube |
US20100274188A1 (en) * | 2007-12-20 | 2010-10-28 | Acclarent, Inc. | Method and System for Treating Target Tissue Within the Eustachian Tube |
US8226312B2 (en) | 2008-03-28 | 2012-07-24 | Sanford, L.P. | Valve door having a force directing component and retractable instruments comprising same |
US8974486B2 (en) * | 2008-04-01 | 2015-03-10 | Robert Kotler | Device and method for maintaining unobstructed nasal passageways after nasal surgery |
US9827367B2 (en) | 2008-04-29 | 2017-11-28 | Medtronic Xomed, Inc. | Surgical instrument, system, and method for frontal sinus irrigation |
US8187261B2 (en) | 2008-05-29 | 2012-05-29 | Boston Scientific Scimed, Inc. | Regulating internal pressure of a cryotherapy balloon catheter |
WO2009147669A1 (en) * | 2008-06-03 | 2009-12-10 | Virtual Ports Ltd. | A multi-components device, system and method for assisting minimally invasive procedures |
US8932207B2 (en) | 2008-07-10 | 2015-01-13 | Covidien Lp | Integrated multi-functional endoscopic tool |
US20130006055A1 (en) | 2008-07-30 | 2013-01-03 | Acclarent, Inc. | Swing prism endoscope |
US20100030031A1 (en) | 2008-07-30 | 2010-02-04 | Acclarent, Inc. | Swing prism endoscope |
EP2320832A4 (en) | 2008-08-01 | 2015-07-29 | Intersect Ent Inc | Methods and devices for crimping self-expanding devices |
US20110202037A1 (en) * | 2008-08-18 | 2011-08-18 | Bolger William E | Fluid delivery catheter apparatus |
US8945142B2 (en) | 2008-08-27 | 2015-02-03 | Cook Medical Technologies Llc | Delivery system for implanting nasal ventilation tube |
EP2334361A4 (en) * | 2008-08-27 | 2011-10-26 | Patrick C Melder | Nasal ventilation system and method of using same |
US8465481B2 (en) * | 2008-10-20 | 2013-06-18 | Boston Scientific Scimed, Inc. | Providing cryotherapy with a balloon catheter having a non-uniform thermal profile |
RU2493796C2 (en) * | 2008-10-22 | 2013-09-27 | Дохени Ай Инститьют | Sterile surgical tray |
US8221012B2 (en) | 2008-11-07 | 2012-07-17 | Sanford, L.P. | Retractable instruments comprising a one-piece valve door actuating assembly |
US8226601B2 (en) | 2008-11-12 | 2012-07-24 | Sanovas, Inc. | Resector balloon system |
US8540667B2 (en) * | 2008-11-12 | 2013-09-24 | Sanovas, Inc. | Multi-balloon catheter for extravasated drug delivery |
US9216031B2 (en) * | 2008-12-16 | 2015-12-22 | Nico Corporation | Tissue removal device with adjustable fluid supply sleeve for neurosurgical and spinal surgery applications |
EP2373234A1 (en) | 2008-12-16 | 2011-10-12 | Aardvark Medical, Inc. | Methods and systems for delivery of fluids, aerosols and acoustic energy to tissue surfaces, cavities and obstructed passages such as intranasal ostia |
US8702738B2 (en) * | 2008-12-16 | 2014-04-22 | Nico Corporation | Tissue removal device for neurosurgical and spinal surgery applications |
US10080578B2 (en) | 2008-12-16 | 2018-09-25 | Nico Corporation | Tissue removal device with adjustable delivery sleeve for neurosurgical and spinal surgery applications |
US9931105B2 (en) | 2008-12-16 | 2018-04-03 | Nico Corporation | System and method of taking and collecting tissue cores for treatment |
US10368890B2 (en) | 2008-12-16 | 2019-08-06 | Nico Corporation | Multi-functional surgical device for neurosurgical and spinal surgery applications |
US9655639B2 (en) * | 2008-12-16 | 2017-05-23 | Nico Corporation | Tissue removal device for use with imaging devices in neurosurgical and spinal surgery applications |
US9820480B2 (en) | 2008-12-16 | 2017-11-21 | Nico Corporation | System for collecting and preserving tissue cores |
US8460327B2 (en) * | 2008-12-16 | 2013-06-11 | Nico Corporation | Tissue removal device for neurosurgical and spinal surgery applications |
US9279751B2 (en) | 2008-12-16 | 2016-03-08 | Nico Corporation | System and method of taking and collecting tissue cores for treatment |
US8430825B2 (en) | 2008-12-16 | 2013-04-30 | Nico Corporation | Tissue removal device for neurosurgical and spinal surgery applications |
US8496599B2 (en) * | 2008-12-16 | 2013-07-30 | Nico Corporation | Tissue removal device for neurosurgical and spinal surgery applications |
US9504247B2 (en) | 2008-12-16 | 2016-11-29 | Nico Corporation | System for collecting and preserving tissue cores |
US8657841B2 (en) * | 2008-12-16 | 2014-02-25 | Nico Corporation | Tissue removal device for neurosurgical and spinal surgery applications |
US8611985B2 (en) | 2009-01-29 | 2013-12-17 | Imactis | Method and device for navigation of a surgical tool |
US8393814B2 (en) | 2009-01-30 | 2013-03-12 | Sanford, L.P. | Retractable instrument having a two stage protraction/retraction sequence |
EP2393513B1 (en) * | 2009-02-06 | 2016-10-19 | The General Hospital Corporation | Methods of treating vascular lesions |
US9226689B2 (en) | 2009-03-10 | 2016-01-05 | Medtronic Xomed, Inc. | Flexible circuit sheet |
US9226688B2 (en) | 2009-03-10 | 2016-01-05 | Medtronic Xomed, Inc. | Flexible circuit assemblies |
US8504139B2 (en) | 2009-03-10 | 2013-08-06 | Medtronic Xomed, Inc. | Navigating a surgical instrument |
US9339221B1 (en) | 2009-03-24 | 2016-05-17 | Vioptix, Inc. | Diagnosing intestinal ischemia based on oxygen saturation measurements |
AU2010232589B2 (en) | 2009-04-01 | 2014-11-27 | Atricure, Inc. | Tissue ligation devices and controls therefor |
US10207126B2 (en) | 2009-05-11 | 2019-02-19 | Cytyc Corporation | Lumen visualization and identification system for multi-lumen balloon catheter |
CA3001814C (en) | 2009-05-15 | 2020-12-22 | Intersect Ent, Inc. | Expandable devices and methods therefor |
US8282667B2 (en) | 2009-06-05 | 2012-10-09 | Entellus Medical, Inc. | Sinus dilation catheter |
AU2010256450B2 (en) * | 2009-06-05 | 2014-09-18 | Arthrocare Corporation | Systems and devices for providing therapy of an anatomical structure |
US8834513B2 (en) * | 2009-06-05 | 2014-09-16 | Entellus Medical, Inc. | Method and articles for treating the sinus system |
US9445766B1 (en) | 2009-07-08 | 2016-09-20 | Vioptix, Inc. | Methods for locating a blood vessel |
US20120010644A1 (en) * | 2009-07-09 | 2012-01-12 | Sideris Eleftherios B | Method and apparatus for occluding a physiological opening |
US20110015612A1 (en) * | 2009-07-15 | 2011-01-20 | Regents Of The University Of Minnesota | Implantable devices for treatment of sinusitis |
US8435261B2 (en) * | 2009-07-15 | 2013-05-07 | Regents Of The University Of Minnesota | Treatment and placement device for sinusitis applications |
EP2456499A4 (en) * | 2009-07-21 | 2015-07-08 | Leonard V Covello | Devices and methods for minimally invasive access to sinuses and treatment of sinusitis |
US20110028831A1 (en) * | 2009-07-30 | 2011-02-03 | Kent James P | Permanently visible implantable fiduciary tissue marker |
US8968190B2 (en) * | 2009-08-25 | 2015-03-03 | Covidien Lp | Single incision surgical portal apparatus including inner member |
US9757107B2 (en) | 2009-09-04 | 2017-09-12 | Corvia Medical, Inc. | Methods and devices for intra-atrial shunts having adjustable sizes |
EP2477617B1 (en) | 2009-09-18 | 2018-01-31 | Bioinspire Technologies Inc. | Free-standing biodegradable patch |
US9271925B2 (en) | 2013-03-11 | 2016-03-01 | Bioinspire Technologies, Inc. | Multi-layer biodegradable device having adjustable drug release profile |
US8888686B2 (en) * | 2009-09-23 | 2014-11-18 | Entellus Medical, Inc. | Endoscope system for treatment of sinusitis |
US20120203069A1 (en) * | 2009-11-14 | 2012-08-09 | Blake Hannaford | Surgical shield for soft tissue protection |
US20110118551A1 (en) * | 2009-11-14 | 2011-05-19 | SPI Surgical, Inc. | Collateral soft tissue protection surgical device |
US9011326B2 (en) | 2009-11-14 | 2015-04-21 | Spiway Llc | Soft tissue shield for trans-orbital surgery |
US8986201B2 (en) | 2009-11-14 | 2015-03-24 | Spiway Llc | Surgical tissue protection sheath |
US9451981B2 (en) * | 2009-11-14 | 2016-09-27 | Spiway Llc | Surgical tissue protection sheath |
WO2011064775A1 (en) | 2009-11-25 | 2011-06-03 | Hanoch Kislev | Probing system for measuring the direction and speed of mucus flow in vivo |
JP6062247B2 (en) * | 2010-01-20 | 2017-01-18 | ケーシーアイ ライセンシング インク | Connection pad for fluid perfusion and negative pressure therapy |
DE102010006035A1 (en) * | 2010-01-27 | 2011-07-28 | Paterok, Peter, Dr., 41061 | Applicator for use in photodynamic therapy |
US9277995B2 (en) | 2010-01-29 | 2016-03-08 | Corvia Medical, Inc. | Devices and methods for reducing venous pressure |
CN102905626A (en) | 2010-01-29 | 2013-01-30 | Dc设备公司 | Devices and systems for treating heart failure |
US8825129B2 (en) * | 2010-03-05 | 2014-09-02 | Sri International | Indwelling nerve block catheters |
US20110230829A1 (en) * | 2010-03-19 | 2011-09-22 | Fitzgerald Patrick J | Arterial Tamponade Device and Method |
US20110230907A1 (en) * | 2010-03-19 | 2011-09-22 | Sinocclusive Llc | Arterial tamponade device and method |
EP2558007A4 (en) | 2010-04-13 | 2017-11-29 | Sentreheart, Inc. | Methods and devices for accessing and delivering devices to a heart |
WO2011130639A1 (en) | 2010-04-15 | 2011-10-20 | Entellus Medical, Inc. | Method and apparatus for treating dilating the ethmoid infundibulum |
WO2011137301A2 (en) | 2010-04-30 | 2011-11-03 | Medtronic Xomed, Inc. | Navigated malleable surgical instrument |
WO2011140535A1 (en) | 2010-05-07 | 2011-11-10 | Entellus Medical, Inc. | Sinus balloon dilation catheters and sinus surgury tools |
FR2961703B1 (en) * | 2010-06-23 | 2012-07-13 | Medical Innovation Dev | OROGASTRIC PROBE OF LONGITUDINAL GASTRECTOMY |
US8672837B2 (en) | 2010-06-24 | 2014-03-18 | Hansen Medical, Inc. | Methods and devices for controlling a shapeable medical device |
US10751206B2 (en) | 2010-06-26 | 2020-08-25 | Scott M. Epstein | Catheter or stent delivery system |
US20110319902A1 (en) * | 2010-06-26 | 2011-12-29 | Scott Epstein | Catheter delivery system |
US20110315146A1 (en) * | 2010-06-28 | 2011-12-29 | Beevers Timothy R | Infant nasal cpap canula seal defining a vent |
CA2807656A1 (en) | 2010-08-30 | 2012-03-08 | SinuSys Corporation | Devices and methods for dilating a paranasal sinus opening and for treating sinusitis |
MX2013003290A (en) | 2010-09-22 | 2013-05-30 | Acclarent Inc | Apparatus for treating disorders of the sinuses. |
EP2618886B1 (en) | 2010-09-22 | 2015-10-14 | Acclarent, Inc. | Medical device for treatment of a sinus opening |
AU2011305256A1 (en) | 2010-09-24 | 2013-04-11 | Entrigue Surgical, Inc. | Systems, devices, and methods for providing therapy to an anatomical structure using high frequency pressure waves and/or cryogenic temperatures |
US9155492B2 (en) | 2010-09-24 | 2015-10-13 | Acclarent, Inc. | Sinus illumination lightwire device |
US9125800B2 (en) * | 2010-09-27 | 2015-09-08 | Avent, Inc. | Stoma length indicator assembly and positioning system |
US9352172B2 (en) | 2010-09-30 | 2016-05-31 | Hologic, Inc. | Using a guide member to facilitate brachytherapy device swap |
US9022967B2 (en) | 2010-10-08 | 2015-05-05 | Sinopsys Surgical, Inc. | Implant device, tool, and methods relating to treatment of paranasal sinuses |
US8833373B2 (en) * | 2010-11-12 | 2014-09-16 | The Johns Hopkins University | Nasally inserted airway opening device for obstructive sleep apnea treatment |
US8971993B2 (en) | 2010-11-19 | 2015-03-03 | Mediguide Ltd. | Systems and methods for navigating a surgical device |
US8668642B2 (en) | 2010-11-23 | 2014-03-11 | Covidien Lp | Port device including retractable endoscope cleaner |
AU2011332014B2 (en) | 2010-11-27 | 2016-12-22 | Securus Medical Group, Inc. | Ablation and temperature measurement devices |
WO2012096816A1 (en) * | 2011-01-10 | 2012-07-19 | Spotlight Technology Partners Llc | Apparatus and methods for accessing and treating a body cavity, lumen, or ostium |
WO2012097287A1 (en) * | 2011-01-13 | 2012-07-19 | Innovia Llc | Endoluminal drug applicator and method of treating diseased vessels of the body |
US10492868B2 (en) | 2011-01-28 | 2019-12-03 | Medtronic Navigation, Inc. | Method and apparatus for image-based navigation |
US10617374B2 (en) | 2011-01-28 | 2020-04-14 | Medtronic Navigation, Inc. | Method and apparatus for image-based navigation |
US9974501B2 (en) | 2011-01-28 | 2018-05-22 | Medtronic Navigation, Inc. | Method and apparatus for image-based navigation |
CN107334512B (en) | 2011-02-10 | 2021-04-13 | 可维亚媒体公司 | Device for creating and maintaining an intra-atrial pressure relief opening |
US8348925B2 (en) * | 2011-02-23 | 2013-01-08 | Fischell Innovations, Llc | Introducer sheath with thin-walled shaft and improved means for attachment to the skin |
US8591495B2 (en) | 2011-02-23 | 2013-11-26 | Fischell Innovations, Llc | Introducer sheath with thin-walled shaft |
WO2012114334A1 (en) | 2011-02-24 | 2012-08-30 | Ilan Ben Oren | Hybrid catheter for endoluminal intervention |
US20160074581A1 (en) | 2014-09-17 | 2016-03-17 | Lawrence J. Gerrans | Modulated Drug Delivery |
US10898693B2 (en) | 2011-03-01 | 2021-01-26 | Sanovas Intellectual Property, Llc | Nasal delivery of agents with nested balloon catheter |
US8348890B2 (en) | 2011-03-01 | 2013-01-08 | Sanovas, Inc. | Nested balloon catheter for localized drug delivery |
US8597239B2 (en) | 2011-03-01 | 2013-12-03 | Sanovas, Inc. | Abrading balloon catheter for extravasated drug delivery |
KR101749236B1 (en) * | 2011-04-01 | 2017-07-04 | 한국전자통신연구원 | Canal Type Mini-Apparatus Inserting in Ears for Diagnosis and Curing of Disease |
US9180281B2 (en) | 2011-04-08 | 2015-11-10 | Sanovas, Inc. | Adjustable balloon catheter for extravasated drug delivery |
US20120259401A1 (en) * | 2011-04-08 | 2012-10-11 | Gerrans Lawrence J | Balloon catheter for launching drug delivery device |
US9238126B2 (en) | 2011-04-08 | 2016-01-19 | Sanovas Inc. | Biofeedback controlled deformation of sinus ostia |
US8535294B2 (en) | 2011-06-01 | 2013-09-17 | Fischell Innovations Llc | Carotid sheath with flexible distal section |
WO2012173616A1 (en) * | 2011-06-15 | 2012-12-20 | Empire Technology Development Llc | Punch tool |
US9486614B2 (en) | 2011-06-29 | 2016-11-08 | Entellus Medical, Inc. | Sinus dilation catheter |
EP2731654B1 (en) * | 2011-07-13 | 2018-12-26 | The Foundry, LLC | Delivery devices for nasopharyngeal mucosa targets |
WO2013016275A1 (en) | 2011-07-22 | 2013-01-31 | Cook Medical Technologies Llc | Irrigation devices adapted to be used with a light source for the identification and treatment of bodily passages |
JP6352180B2 (en) * | 2011-07-25 | 2018-07-04 | アクラレント インコーポレイテッド | Device and method for nasal dilatation and irrigation of sinuses |
US20130184574A1 (en) * | 2011-07-25 | 2013-07-18 | Richard R. Newhauser, JR. | Devices and methods for transnasal irrigation or suctioning of the sinuses |
BR112014002055A2 (en) * | 2011-07-28 | 2017-02-21 | Acclarent Inc | improved device and method for dilating an airway stenosis |
US9457173B2 (en) | 2011-09-10 | 2016-10-04 | Cook Medical Technologies Llc | Methods of providing access to a salivary duct |
US9204918B2 (en) | 2011-09-28 | 2015-12-08 | RELIGN Corporation | Medical ablation system and method of use |
US9004071B2 (en) | 2011-10-18 | 2015-04-14 | Ian Joseph Alexander | Nasal guide and method of use thereof |
US9861800B2 (en) | 2011-10-18 | 2018-01-09 | Treble Innovations | Systems and methods for controlling balloon catheters |
US9750486B2 (en) | 2011-10-25 | 2017-09-05 | Medtronic Navigation, Inc. | Trackable biopsy needle |
US9283360B2 (en) | 2011-11-10 | 2016-03-15 | Entellus Medical, Inc. | Methods and devices for treating sinusitis |
US9114202B1 (en) * | 2011-11-15 | 2015-08-25 | Bionix Development Corporation | Lighted suction device |
US9375138B2 (en) | 2011-11-25 | 2016-06-28 | Cook Medical Technologies Llc | Steerable guide member and catheter |
US9205236B2 (en) | 2011-12-22 | 2015-12-08 | Corvia Medical, Inc. | Methods, systems, and devices for resizable intra-atrial shunts |
US8747428B2 (en) | 2012-01-12 | 2014-06-10 | Fischell Innovations, Llc | Carotid sheath with entry and tracking rapid exchange dilators and method of use |
US9956042B2 (en) | 2012-01-13 | 2018-05-01 | Vanderbilt University | Systems and methods for robot-assisted transurethral exploration and intervention |
US10143358B2 (en) | 2012-02-07 | 2018-12-04 | Treble Innovations, Llc | System and method for a magnetic endoscope |
GB2499456A (en) * | 2012-02-20 | 2013-08-21 | George Vassos | Nasal irrigation device |
US20140031852A1 (en) * | 2012-02-29 | 2014-01-30 | SinuSys Corporation | Devices and methods for Dilating a Eustachian Tube |
CA2862297A1 (en) | 2012-02-29 | 2013-09-06 | SinuSys Corporation | Devices and methods for dilating a paranasal sinus opening and for treating sinusitis |
AU2013235386B2 (en) | 2012-03-19 | 2016-12-08 | Cook Medical Technologies Llc | Medical devices, methods and kits for delivering medication to a bodily passage |
EP2836170B1 (en) | 2012-04-11 | 2018-02-14 | Sinopsys Surgical, Inc. | Implantation tools, tool assemblies and kits |
US20130274600A1 (en) | 2012-04-13 | 2013-10-17 | Acclarent, Inc. | Devices and Method for Maxillary Sinus Lavage |
US9579448B2 (en) | 2012-04-13 | 2017-02-28 | Acclarent, Inc. | Balloon dilation catheter system for treatment and irrigation of the sinuses |
US20130281778A1 (en) * | 2012-04-19 | 2013-10-24 | Terumo Kabushiki Kaisha | Treatment instrument for medical use and method |
US9295455B2 (en) * | 2012-04-20 | 2016-03-29 | Terumo Kabushiki Kaisha | Biopsy system and biopsy method |
US9539726B2 (en) * | 2012-04-20 | 2017-01-10 | Vanderbilt University | Systems and methods for safe compliant insertion and hybrid force/motion telemanipulation of continuum robots |
US9549720B2 (en) | 2012-04-20 | 2017-01-24 | Vanderbilt University | Robotic device for establishing access channel |
US9687303B2 (en) | 2012-04-20 | 2017-06-27 | Vanderbilt University | Dexterous wrists for surgical intervention |
US10278676B2 (en) * | 2012-06-27 | 2019-05-07 | Michael J. Vaillancourt | Safety shield for a needle assembly |
US8886333B2 (en) * | 2012-07-19 | 2014-11-11 | Boston Scientific Neuromodulation Corporation | Self-affixing external charging system for an implantable medical device |
US9332998B2 (en) | 2012-08-13 | 2016-05-10 | Covidien Lp | Apparatus and methods for clot disruption and evacuation |
US9332999B2 (en) | 2012-08-13 | 2016-05-10 | Covidien Lp | Apparatus and methods for clot disruption and evacuation |
AU2013308707A1 (en) * | 2012-08-29 | 2015-03-12 | Arthrocare Corporation | Systems, devices and methods for providing therapy with image guidance |
US20140066966A1 (en) * | 2012-08-30 | 2014-03-06 | Children's National Medical Center | Endopyloric tool and method to treat hypertropic pyloric stenosis |
CN103785099B (en) * | 2012-10-31 | 2016-06-29 | 易成刚 | A kind of tissue expander of external valve |
US10279155B1 (en) | 2012-11-02 | 2019-05-07 | Michael B. Siegel | Methods and systems for bathing nose and sinus passages |
EP2916748B1 (en) | 2012-11-07 | 2020-07-15 | 3NT Medical Ltd. | Paranasal sinus access system |
US9433462B2 (en) | 2012-12-21 | 2016-09-06 | Cook Medical Technologies Llc | Tissue fusion system, apparatus and method |
US9492644B2 (en) | 2012-12-21 | 2016-11-15 | Avent, Inc. | Dilation device for placing catheter tubes |
US9463307B2 (en) | 2012-12-21 | 2016-10-11 | Medtronic Xomed, Inc. | Sinus dilation system and method |
WO2014107341A1 (en) * | 2013-01-07 | 2014-07-10 | Securus Medical Group, Inc. | Temperature measurement systems, method and devices |
CN104968306B (en) | 2013-01-25 | 2018-09-25 | 西诺普西斯外科股份有限公司 | Nasal sinus enters implanted device and related tool, method and external member |
US20200397976A1 (en) * | 2013-02-04 | 2020-12-24 | Michael Rontal | Balloon irrigation and cleaning system for interior walls of sinus cavities |
US10758667B2 (en) * | 2013-02-04 | 2020-09-01 | Michael Rontal | Balloon irrigation and cleaning system for interior walls of body cavities |
US10166146B2 (en) * | 2013-03-08 | 2019-01-01 | Mark Mitchnick | Ear medication dispenser with sensor |
US11039735B2 (en) | 2013-03-13 | 2021-06-22 | Spiway Llc | Surgical tissue protection sheath |
US10986984B2 (en) | 2013-03-13 | 2021-04-27 | Spiway Llc | Surgical tissue protection sheath |
US9057600B2 (en) | 2013-03-13 | 2015-06-16 | Hansen Medical, Inc. | Reducing incremental measurement sensor error |
US11153696B2 (en) | 2017-02-14 | 2021-10-19 | Virtual 3-D Technologies Corp. | Ear canal modeling using pattern projection |
US9456752B2 (en) * | 2013-03-14 | 2016-10-04 | Aperture Diagnostics Ltd. | Full-field three-dimensional surface measurement |
EP2968877B1 (en) | 2013-03-14 | 2020-01-01 | Intersect ENT, Inc. | Systems and devices for treating a sinus condition |
US9014851B2 (en) | 2013-03-15 | 2015-04-21 | Hansen Medical, Inc. | Systems and methods for tracking robotically controlled medical instruments |
US9433437B2 (en) * | 2013-03-15 | 2016-09-06 | Acclarent, Inc. | Apparatus and method for treatment of ethmoid sinusitis |
US9956383B2 (en) | 2013-03-15 | 2018-05-01 | Cook Medical Technologies Llc | Medical devices and methods for providing access to a bodily passage during dilation |
US9629595B2 (en) * | 2013-03-15 | 2017-04-25 | Hansen Medical, Inc. | Systems and methods for localizing, tracking and/or controlling medical instruments |
US9364107B2 (en) | 2013-03-15 | 2016-06-14 | Berry Plastics Corporation | Drink cup lid |
US20140277039A1 (en) * | 2013-03-15 | 2014-09-18 | Acclarent, Inc. | Apparatus and method for treatment of ethmoid sinusitis |
US9271663B2 (en) | 2013-03-15 | 2016-03-01 | Hansen Medical, Inc. | Flexible instrument localization from both remote and elongation sensors |
US10537719B2 (en) * | 2013-03-26 | 2020-01-21 | George Naoum | Device and method of controlled provision of therapeutic liquid in the nose |
US10278729B2 (en) * | 2013-04-26 | 2019-05-07 | Medtronic Xomed, Inc. | Medical device and its construction |
US9351783B2 (en) | 2013-05-01 | 2016-05-31 | Medtronic Cryocath Lp | Diagnostic guidewire for cryoablation sensing and pressure monitoring |
CA2911226C (en) | 2013-05-23 | 2024-02-20 | S.T.S. Medical Ltd. | Shape change structure |
US9687263B2 (en) | 2013-05-30 | 2017-06-27 | SinuSys Corporation | Devices and methods for inserting a sinus dilator |
US11020016B2 (en) | 2013-05-30 | 2021-06-01 | Auris Health, Inc. | System and method for displaying anatomy and devices on a movable display |
US9457141B2 (en) * | 2013-06-03 | 2016-10-04 | Bigfoot Biomedical, Inc. | Infusion pump system and method |
US9446187B2 (en) * | 2013-06-03 | 2016-09-20 | Bigfoot Biomedical, Inc. | Infusion pump system and method |
US11260208B2 (en) * | 2018-06-08 | 2022-03-01 | Acclarent, Inc. | Dilation catheter with removable bulb tip |
AU2014311441A1 (en) | 2013-08-26 | 2016-03-10 | Merit Medical Systems, Inc. | Sheathless guide, rapid exchange dilator and associated methods |
WO2015035048A2 (en) * | 2013-09-04 | 2015-03-12 | Simplicity, Llc | Nasal dilator |
US11246666B2 (en) | 2013-09-06 | 2022-02-15 | The Brigham And Women's Hospital, Inc. | System and method for a tissue resection margin measurement device |
US10207091B2 (en) | 2013-09-13 | 2019-02-19 | David G. Dillard | Force-directional nasal surgery dilatation device |
US9700459B2 (en) | 2013-10-16 | 2017-07-11 | Sinopsys Surgical, Inc. | Apparatuses, tools and kits relating to fluid manipulation treatments of paranasal sinuses |
US10258408B2 (en) | 2013-10-31 | 2019-04-16 | Sentreheart, Inc. | Devices and methods for left atrial appendage closure |
WO2015073397A1 (en) * | 2013-11-13 | 2015-05-21 | Thixos Llc | Devices, kits and methods relating to treatment of facet joints |
CN112515609A (en) * | 2013-11-14 | 2021-03-19 | Clph有限责任公司 | Devices, systems, and methods for epicardial imaging and injection |
US9504454B2 (en) * | 2013-11-19 | 2016-11-29 | King Abdulaziz University | Transoral repair of choanal atresia |
WO2015081262A1 (en) | 2013-11-28 | 2015-06-04 | Xcelerator Labs, Llc | Ophtalmic surgical systems, methods, and devices |
US9962226B2 (en) | 2013-11-28 | 2018-05-08 | Alcon Pharmaceuticals Ltd. | Ophthalmic surgical systems, methods, and devices |
US10286190B2 (en) | 2013-12-11 | 2019-05-14 | Cook Medical Technologies Llc | Balloon catheter with dynamic vessel engaging member |
US9694163B2 (en) | 2013-12-17 | 2017-07-04 | Biovision Technologies, Llc | Surgical device for performing a sphenopalatine ganglion block procedure |
US9516995B2 (en) | 2013-12-17 | 2016-12-13 | Biovision Technologies, Llc | Surgical device for performing a sphenopalatine ganglion block procedure |
US9510743B2 (en) | 2013-12-17 | 2016-12-06 | Biovision Technologies, Llc | Stabilized surgical device for performing a sphenopalatine ganglion block procedure |
US10016580B2 (en) | 2013-12-17 | 2018-07-10 | Biovision Technologies, Llc | Methods for treating sinus diseases |
CA2936453A1 (en) | 2014-01-09 | 2015-07-16 | Axiosonic, Llc | Systems and methods using ultrasound for treatment |
US9956384B2 (en) | 2014-01-24 | 2018-05-01 | Cook Medical Technologies Llc | Articulating balloon catheter and method for using the same |
KR20150091983A (en) * | 2014-02-04 | 2015-08-12 | (주)네오팜 | Composition for preventing hair loss or promoting hair growth |
US9937323B2 (en) | 2014-02-28 | 2018-04-10 | Cook Medical Technologies Llc | Deflectable catheters, systems, and methods for the visualization and treatment of bodily passages |
US10675450B2 (en) | 2014-03-12 | 2020-06-09 | Corvia Medical, Inc. | Devices and methods for treating heart failure |
GB201405244D0 (en) * | 2014-03-24 | 2014-05-07 | T & T Devices Ltd | A nasal bridle insertion device |
US9510976B2 (en) | 2014-04-29 | 2016-12-06 | Abbott Cardiovascular Systems Inc. | Devices and methods for treatment of the Eustachian tube and sinus cavity |
CN104161567A (en) * | 2014-05-09 | 2014-11-26 | 殷敏 | Adenoid excising forceps |
USD834188S1 (en) | 2014-06-02 | 2018-11-20 | Simplicity, Llc | Nasal dilator |
USD802127S1 (en) | 2014-06-02 | 2017-11-07 | Simplicity, Llc | Nasal dilator |
US9579154B2 (en) * | 2014-07-09 | 2017-02-28 | Roberto Neri | Support device for percutaneous intervention |
US10772489B2 (en) | 2014-07-09 | 2020-09-15 | Acclarent, Inc. | Guidewire navigation for sinuplasty |
US10463242B2 (en) | 2014-07-09 | 2019-11-05 | Acclarent, Inc. | Guidewire navigation for sinuplasty |
USD772408S1 (en) | 2014-07-09 | 2016-11-22 | Simplicity | Nasal dilator |
JP6799526B2 (en) | 2014-07-23 | 2020-12-16 | コルヴィア メディカル インコーポレイテッド | Equipment and methods for the treatment of heart failure |
WO2016014996A1 (en) | 2014-07-24 | 2016-01-28 | Sinopsys Surgical, Inc. | Apparatuses, tools, kits and methods relating to paranasal sinus access |
JP6082169B2 (en) | 2014-09-05 | 2017-02-15 | オリンパス株式会社 | Endoscopic treatment tool, treatment tool unit, and treatment system |
US10661061B2 (en) | 2014-09-08 | 2020-05-26 | Sanovas Intellectual Property, Llc | Clearance of sinus ostia blockage |
EP3197370B1 (en) * | 2014-09-24 | 2021-11-17 | Devicor Medical Products, Inc. | Mri biopsy system |
WO2016084087A2 (en) | 2014-11-26 | 2016-06-02 | S.T.S. Medical Ltd. | Shape change structure for treatment of nasal conditions including sinusitis |
USD772406S1 (en) | 2014-12-16 | 2016-11-22 | Biovision Technologies, Llc | Surgical device |
EP3242612B1 (en) | 2015-01-08 | 2020-08-26 | Sinusafe Medical Ltd | Paranasal sinus medical device |
US10322269B1 (en) | 2015-01-19 | 2019-06-18 | Dalent, LLC | Dilator device |
CN113679931A (en) | 2015-01-22 | 2021-11-23 | 因特尔赛克特耳鼻喉公司 | Drug coated balloon |
AU2016238332B2 (en) * | 2015-03-24 | 2020-05-07 | Atricure, Inc. | Devices and methods for left atrial appendage closure |
WO2016154488A2 (en) | 2015-03-24 | 2016-09-29 | Sentreheart, Inc. | Tissue ligation devices and methods therefor |
US10335319B2 (en) * | 2015-03-30 | 2019-07-02 | Acclarent, Inc. | Method and apparatus for cleaning isthmus of eustachian tube |
CN104814819A (en) * | 2015-04-08 | 2015-08-05 | 朱宏伟 | Biological naso-lacrymal duct support device |
US10362965B2 (en) | 2015-04-22 | 2019-07-30 | Acclarent, Inc. | System and method to map structures of nasal cavity |
US20160324689A1 (en) * | 2015-05-07 | 2016-11-10 | 3D Global Biotech Inc. | Duct For Tear Flow |
CN104873313A (en) * | 2015-05-19 | 2015-09-02 | 马美英 | Sense-organ disease nursing device |
CA3209217A1 (en) | 2015-06-29 | 2017-01-05 | Lyra Therapeutics, Inc. | Scaffold loading and delivery systems |
CN113633434A (en) | 2015-06-29 | 2021-11-12 | 莱拉医药公司 | Implantable stent for treating sinusitis |
US10232082B2 (en) | 2015-06-29 | 2019-03-19 | 480 Biomedical, Inc. | Implantable scaffolds for treatment of sinusitis |
US10561305B2 (en) | 2015-06-30 | 2020-02-18 | Sanovas Intellectual Property, Llc | Body cavity dilation system |
CN104905957A (en) * | 2015-06-30 | 2015-09-16 | 福州创方医药科技有限公司 | Paranasal sinus expansion washing device and application method thereof |
US10682503B2 (en) | 2015-06-30 | 2020-06-16 | Sanovas Intellectual Property, Llc | Sinus ostia dilation system |
US10940299B2 (en) | 2015-08-10 | 2021-03-09 | Gyms Acmi, Inc. | Center marker for dilatation balloon |
US10512763B2 (en) | 2015-08-25 | 2019-12-24 | Acclarent, Inc. | Dilation catheter with expandable stop element |
US10354558B2 (en) * | 2015-08-27 | 2019-07-16 | Tusker Medical, Inc. | System and method for training use of pressure equalization tube delivery instrument |
EP3349649B1 (en) | 2015-09-18 | 2022-03-09 | Auris Health, Inc. | Navigation of tubular networks |
CN106612369A (en) * | 2015-10-27 | 2017-05-03 | 华为终端(东莞)有限公司 | Positioning information processing method and device |
US10779891B2 (en) | 2015-10-30 | 2020-09-22 | Acclarent, Inc. | System and method for navigation of surgical instruments |
US11266776B2 (en) * | 2015-10-30 | 2022-03-08 | Medtronic Xomed, Inc. | Method and apparatus for irrigation |
US10143526B2 (en) | 2015-11-30 | 2018-12-04 | Auris Health, Inc. | Robot-assisted driving systems and methods |
KR200482235Y1 (en) * | 2015-12-28 | 2017-01-02 | 이성완 | Paranasal sinuses expanding remedy device |
US10973664B2 (en) | 2015-12-30 | 2021-04-13 | Lyra Therapeutics, Inc. | Scaffold loading and delivery systems |
US11684420B2 (en) | 2016-05-05 | 2023-06-27 | Eximo Medical Ltd. | Apparatus and methods for resecting and/or ablating an undesired tissue |
US10820923B2 (en) * | 2016-05-16 | 2020-11-03 | Biosense Webster (Israel) Ltd. | Insertion tube with deflectable tip |
WO2018008020A1 (en) | 2016-07-03 | 2018-01-11 | Sinusafe Medical Ltd. | Medical device for treatment of a sinus and/or an ear and methods of use thereof |
US20190261861A1 (en) * | 2016-07-22 | 2019-08-29 | Caresfream Dental Technology Topco Limited | Method and apparatus for ear impression and ent imaging |
US10321913B2 (en) * | 2016-08-04 | 2019-06-18 | Biosense Webster (Israel) Ltd. | Balloon positioning in a sinuplasty procedure |
CN106344153B (en) * | 2016-08-23 | 2019-04-02 | 深圳先进技术研究院 | A kind of flexible puncture needle needle point autotracker and method |
CN106437692B (en) * | 2016-08-23 | 2023-03-21 | 中国电建集团贵阳勘测设计研究院有限公司 | Deep karst leakage channel detection structure and method based on water level of inner pipe of drill rod |
WO2018050165A1 (en) * | 2016-09-16 | 2018-03-22 | David Spiggle | Catheter for applying a medium into the middle ear |
US10799092B2 (en) * | 2016-09-19 | 2020-10-13 | Covidien Lp | System and method for cleansing segments of a luminal network |
EP3515321A2 (en) | 2016-09-21 | 2019-07-31 | 3NT Medical Ltd. | Seeker with dilator |
US20180085174A1 (en) | 2016-09-23 | 2018-03-29 | Acclarent, Inc. | Suction device for use in image-guided sinus medical procedure |
US20180103963A1 (en) * | 2016-10-13 | 2018-04-19 | Arthrex, Inc. | Medical device handpiece with interchangeable rotary head and drill bit |
WO2018071065A1 (en) | 2016-10-14 | 2018-04-19 | Noar Mark D | Balloon structure with anchoring portions for anchoring in a bodily passage |
US10485609B2 (en) | 2016-10-18 | 2019-11-26 | Acclarent, Inc. | Dilation balloon with RF energy delivery feature |
US10507310B2 (en) | 2016-10-27 | 2019-12-17 | Acclarent, Inc. | Dilation apparatus with malleable feature and apparatus to bend malleable feature |
US20180140176A1 (en) * | 2016-11-23 | 2018-05-24 | Pradeep K. Sinha | Sinuplasty device |
EP3576596A4 (en) | 2016-12-02 | 2021-01-06 | Vanderbilt University | Steerable endoscope with continuum manipulator |
IT201600128780A1 (en) * | 2016-12-20 | 2018-06-20 | Techpol S R L | HYGIENIC STICARD FOR PERSONAL CARE, IN PARTICULAR FOR EARS OF THE EAR |
RU2662644C2 (en) * | 2016-12-27 | 2018-07-26 | Дмитрий Александрович Щербаков | Method of intraoperative navigation in surgical treatment of neck organs |
US10244926B2 (en) | 2016-12-28 | 2019-04-02 | Auris Health, Inc. | Detecting endolumenal buckling of flexible instruments |
US10610308B2 (en) | 2017-02-01 | 2020-04-07 | Acclarent, Inc. | Navigation guidewire with interlocked coils |
US20180214217A1 (en) | 2017-02-01 | 2018-08-02 | Jephrey S. Rodriguez | Surgical instrument with navigation wire interface features |
WO2018148544A1 (en) * | 2017-02-09 | 2018-08-16 | Intuitive Surgical Operations, Inc. | Systems and methods of accessing encapsulated targets |
US10820951B2 (en) * | 2017-03-14 | 2020-11-03 | Verb Surgical Inc. | Techniques for damping vibration in a robotic surgical system |
US20180264237A1 (en) | 2017-03-20 | 2018-09-20 | Acclarent, Inc. | Navigation guidewire with shielded sensor coil |
US20180280046A1 (en) | 2017-03-30 | 2018-10-04 | Acclarent, Inc. | Guidewire with optics tube containing core wire |
CN108990412B (en) | 2017-03-31 | 2022-03-22 | 奥瑞斯健康公司 | Robot system for cavity network navigation compensating physiological noise |
US10577159B2 (en) * | 2017-04-07 | 2020-03-03 | Berry Plastics Corporation | Drink cup lid |
US10561370B2 (en) | 2017-04-26 | 2020-02-18 | Accalrent, Inc. | Apparatus to secure field generating device to chair |
EP3615122A4 (en) | 2017-04-28 | 2021-02-17 | Merit Medical Systems, Inc. | Introducer with partially annealed reinforcement element and related systems and methods |
IT201700046337A1 (en) * | 2017-04-28 | 2018-10-28 | Francesco Antoniomaria Garbagnati | INSTRUMENT FOR VISUAL ACCESS TO CABLES |
US10201639B2 (en) | 2017-05-01 | 2019-02-12 | 480 Biomedical, Inc. | Drug-eluting medical implants |
US11253677B2 (en) | 2017-05-31 | 2022-02-22 | Acclarent, Inc. | Navigable suction instrument with coaxial annular sensor |
US10022192B1 (en) | 2017-06-23 | 2018-07-17 | Auris Health, Inc. | Automatically-initialized robotic systems for navigation of luminal networks |
US10874839B2 (en) | 2017-07-13 | 2020-12-29 | Acclarent, Inc. | Adjustable instrument for dilation of anatomical passageway |
WO2019017721A1 (en) * | 2017-07-21 | 2019-01-24 | 심민보 | Tip for intra-tympanic injection |
EP4241969A3 (en) | 2017-08-07 | 2023-11-01 | Berry Global, Inc. | Method and apparatus for thermoforming an article |
US20190060618A1 (en) | 2017-08-25 | 2019-02-28 | Acclarent, Inc. | Core wire assembly for guidewire |
CN108014408A (en) * | 2017-09-04 | 2018-05-11 | 首都医科大学附属北京胸科医院 | A kind of coronary vein guidance system |
US10835327B2 (en) | 2017-09-05 | 2020-11-17 | Acclarent, Inc. | Sensor guided instrument with penetrating feature |
US10973603B2 (en) | 2017-09-08 | 2021-04-13 | Acclarent, Inc. | Dilation system with illuminating orientation indicator features |
US11583249B2 (en) * | 2017-09-08 | 2023-02-21 | Biosense Webster (Israel) Ltd. | Method and apparatus for performing non-fluoroscopic transseptal procedure |
US11278706B2 (en) | 2017-09-08 | 2022-03-22 | Acclarent, Inc. | Guidewire assembly with intertwined core wire |
US10967504B2 (en) | 2017-09-13 | 2021-04-06 | Vanderbilt University | Continuum robots with multi-scale motion through equilibrium modulation |
EP3675780A4 (en) | 2017-09-20 | 2021-10-06 | Sinopsys Surgical, Inc. | Paranasal sinus fluid access implantation tools, assemblies, kits and methods |
US11058493B2 (en) | 2017-10-13 | 2021-07-13 | Auris Health, Inc. | Robotic system configured for navigation path tracing |
US10555778B2 (en) | 2017-10-13 | 2020-02-11 | Auris Health, Inc. | Image-based branch detection and mapping for navigation |
US11723518B2 (en) * | 2017-10-25 | 2023-08-15 | Boston Scientific Scimed, Inc. | Direct visualization catheter and system |
US10736647B2 (en) | 2017-10-30 | 2020-08-11 | Acclarent, Inc. | Dilation catheter with navigation sensor and vent passageway in tip |
CN111315310B (en) * | 2017-11-08 | 2024-02-13 | 泰利福医疗公司 | Wireless medical equipment navigation system and method |
US11116509B2 (en) | 2017-11-10 | 2021-09-14 | Avantec Vascular Corporation | System and method for delivering an embolic device |
US10806476B2 (en) * | 2017-11-12 | 2020-10-20 | David Awrey Randall | Anterior—posterior inflatable nosebleed packing |
NL2019909B1 (en) * | 2017-11-14 | 2019-05-20 | Academisch Ziekenhuis Leiden | SYSTEM, METHOD AND CATHETER FOR PITUITARY AND BRAIN IMPLANTATION |
US10857333B2 (en) | 2017-11-27 | 2020-12-08 | Acclarent, Inc. | Guidewire with integral expandable dilator |
US10864046B2 (en) | 2017-12-04 | 2020-12-15 | Acclarent, Inc. | Dilation instrument with navigation and distally located force sensor |
US20190167151A1 (en) * | 2017-12-05 | 2019-06-06 | Acclarent, Inc. | System and method for tracking patient movement during guided medical procedure |
US10959785B2 (en) | 2017-12-12 | 2021-03-30 | Acclarent, Inc. | Tissue shaving instrument with navigation sensor |
US10888382B2 (en) | 2017-12-14 | 2021-01-12 | Acclarent, Inc. | Mounted patient tracking component for surgical navigation system |
AU2018384820A1 (en) | 2017-12-14 | 2020-05-21 | Auris Health, Inc. | System and method for estimating instrument location |
US20190184142A1 (en) | 2017-12-14 | 2019-06-20 | Acclarent, Inc. | Guidewire assembly with offset core wires |
EP3684283A4 (en) | 2017-12-18 | 2021-07-14 | Auris Health, Inc. | Methods and systems for instrument tracking and navigation within luminal networks |
US11103266B2 (en) * | 2017-12-28 | 2021-08-31 | Acclarent, Inc. | Medical instrument with integral navigation control features |
US11185693B2 (en) | 2018-02-07 | 2021-11-30 | Medtronic Xomed, Inc. | Cochlear implant localization system |
US10751132B2 (en) | 2018-02-07 | 2020-08-25 | Medtronic Xomed, Inc. | Cochlear implant localization system |
US10773082B2 (en) | 2018-02-07 | 2020-09-15 | Medtronic Xomed, Inc. | Cochlear implant localization system |
US10974022B2 (en) * | 2018-02-28 | 2021-04-13 | Gyrus Acmi, Inc. | Nasal implant assembly |
JP2021119800A (en) * | 2018-03-19 | 2021-08-19 | オリンパス株式会社 | Insertion aid for endoscope and endoscope system |
US10827913B2 (en) | 2018-03-28 | 2020-11-10 | Auris Health, Inc. | Systems and methods for displaying estimated location of instrument |
MX2020010112A (en) | 2018-03-28 | 2020-11-06 | Auris Health Inc | Systems and methods for registration of location sensors. |
US11229447B2 (en) * | 2018-04-25 | 2022-01-25 | excelENT LLC | Systems, instruments and methods for treating sinuses |
US11103256B2 (en) | 2018-05-21 | 2021-08-31 | Acclarent, Inc. | Shaver with blood vessel and nerve monitoring features |
US10905499B2 (en) | 2018-05-30 | 2021-02-02 | Auris Health, Inc. | Systems and methods for location sensor-based branch prediction |
US10898275B2 (en) | 2018-05-31 | 2021-01-26 | Auris Health, Inc. | Image-based airway analysis and mapping |
JP7214757B2 (en) | 2018-05-31 | 2023-01-30 | オーリス ヘルス インコーポレイテッド | Robotic system and method for navigation of luminal networks that detect physiological noise |
EP3801189A4 (en) | 2018-05-31 | 2022-02-23 | Auris Health, Inc. | Path-based navigation of tubular networks |
US11147629B2 (en) | 2018-06-08 | 2021-10-19 | Acclarent, Inc. | Surgical navigation system with automatically driven endoscope |
US11622805B2 (en) | 2018-06-08 | 2023-04-11 | Acclarent, Inc. | Apparatus and method for performing vidian neurectomy procedure |
US10688289B2 (en) * | 2018-06-12 | 2020-06-23 | Intersect Ent, Inc. | Systems and methods for sinus access |
US20190388117A1 (en) | 2018-06-20 | 2019-12-26 | Acclarent, Inc. | Surgical shaver with feature to detect window state |
US10525240B1 (en) | 2018-06-28 | 2020-01-07 | Sandler Scientific LLC | Sino-nasal rinse delivery device with agitation, flow-control and integrated medication management system |
USD907997S1 (en) | 2018-08-10 | 2021-01-19 | Berry Global, Inc. | Drink cup lid |
US11065021B2 (en) | 2018-10-03 | 2021-07-20 | Daniel Ezra Walzman | Osteotomy device |
US20200107902A1 (en) * | 2018-10-03 | 2020-04-09 | Daniel Ezra Walzman | Osteotomy Device |
US20200170659A1 (en) | 2018-12-04 | 2020-06-04 | Acclarent, Inc. | Bi-directional articulating surgical shaver |
US11583313B1 (en) | 2018-12-06 | 2023-02-21 | Spiway Llc | Surgical access sheath and methods of use |
CN109646060A (en) * | 2019-01-15 | 2019-04-19 | 西安交通大学 | A kind of minimal invasion tumor of spine aspiration biopsy device |
US11672959B2 (en) | 2019-01-18 | 2023-06-13 | Intersect Ent, Inc. | Expandable member systems and methods for drug delivery |
WO2020163461A1 (en) | 2019-02-06 | 2020-08-13 | Berry Global, Inc. | Polypropylene sheets and articles |
EP3921154A4 (en) | 2019-02-06 | 2023-01-25 | Berry Global, Inc. | Process of forming polymeric material |
USD911168S1 (en) | 2019-03-05 | 2021-02-23 | Berry Global, Inc. | Drink cup lid |
USD877325S1 (en) | 2019-06-06 | 2020-03-03 | Dalent, LLC | Inflatable therapeutic treatment balloon device |
US11752020B2 (en) * | 2019-06-19 | 2023-09-12 | Michael J. Spearman | Tool for placement of degradable ostial stent |
WO2021007348A1 (en) * | 2019-07-09 | 2021-01-14 | Arrinex, Inc. | Devices and methods for treating ear, nose, and throat afflictions |
US11833013B2 (en) | 2019-08-14 | 2023-12-05 | Acclarent, Inc. | Method for treating patulous eustachian tube |
KR20220058918A (en) | 2019-08-30 | 2022-05-10 | 아우리스 헬스, 인코포레이티드 | Instrument image reliability system and method |
CN114340542B (en) | 2019-08-30 | 2023-07-21 | 奥瑞斯健康公司 | Systems and methods for weight-based registration of position sensors |
CN110801312A (en) * | 2019-10-21 | 2020-02-18 | 复旦大学附属中山医院 | Intervene valve release stop device |
US20210169549A1 (en) * | 2019-12-04 | 2021-06-10 | Acclarent, Inc. | Photodynamic therapy ablation device |
US11382634B2 (en) | 2019-12-18 | 2022-07-12 | Avantec Vascular Corporation | Embolic device suited for ease of delivery and placement |
EP4084721A4 (en) | 2019-12-31 | 2024-01-03 | Auris Health Inc | Anatomical feature identification and targeting |
EP4084722A4 (en) | 2019-12-31 | 2024-01-10 | Auris Health Inc | Alignment interfaces for percutaneous access |
CN114901192A (en) | 2019-12-31 | 2022-08-12 | 奥瑞斯健康公司 | Alignment technique for percutaneous access |
US20230218301A1 (en) * | 2020-06-11 | 2023-07-13 | Icahn School Of Medicine At Mount Sinai | Pharynx aspiration device for minimizing infectious particle exposure during endonasal surgeries |
US20210401479A1 (en) * | 2020-06-24 | 2021-12-30 | Acclarent, Inc. | Apparatus and method for ablating eustachian tube |
CN112315812B (en) * | 2020-11-06 | 2021-12-24 | 浙江大学 | Nutrition feeding pump |
EP4011418A1 (en) * | 2020-12-09 | 2022-06-15 | George NAOUM | Device for controlled administration of a liquid solution to nasal cavities and paranasal sinuses |
CN113230144B (en) * | 2021-04-29 | 2022-09-16 | 河南科技大学第一附属医院 | Larynx mucous cyst nursing rehabilitation device |
RU2766988C1 (en) * | 2021-07-14 | 2022-03-16 | Федеральное государственное бюджетное учреждение "Российский научно-клинический центр аудиологии и слухопротезирования Федерального медико-биологического агентства" (ФГБУ РНКЦ АиС ФМБА России) | Method for performing balloon dilatation of the auditory tube |
US11733266B2 (en) * | 2021-07-21 | 2023-08-22 | Rohde & Schwarz Gmbh & Co. Kg | Probe cable assembly and method |
US20230043660A1 (en) * | 2021-08-04 | 2023-02-09 | Boston Scientific Scimed, Inc. | Ostial stent delivery device, system, and method |
US20230270507A1 (en) * | 2022-02-28 | 2023-08-31 | DePuy Synthes Products, Inc. | Surgical Imaging And Display System, And Related Methods |
WO2023194970A1 (en) | 2022-04-08 | 2023-10-12 | Acclarent, Inc. | Intranasal balloon compression for treatment of chronic rhinitis |
US20230364746A1 (en) | 2022-05-13 | 2023-11-16 | Joseph M. Grubb | Multitool with locking multipurpose driver |
DE102022117911A1 (en) | 2022-07-18 | 2024-01-18 | Standard Instruments GmbH Gesellschaft für Medizintechnik, Mess- und Regeltechnik, Steuerungstechnik | Connection cable and detachment device |
KR200497072Y1 (en) * | 2023-01-10 | 2023-07-18 | 이성완 | Expansion therapy device for nasal and paranasal sinuses |
Citations (3)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
EP1042998A2 (en) | 1999-04-07 | 2000-10-11 | Medtronic Ave, Inc. | Endolumenal prosthesis delivery assembly and method of use |
US6328564B1 (en) | 1999-04-06 | 2001-12-11 | Raymond C. Thurow | Deep ear canal locating and head orienting device |
US6332089B1 (en) | 1996-02-15 | 2001-12-18 | Biosense, Inc. | Medical procedures and apparatus using intrabody probes |
Family Cites Families (909)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US513667A (en) * | 1894-01-30 | Sliding staple for hasps | ||
US446173A (en) * | 1891-02-10 | Hasp and staple | ||
US512055A (en) * | 1894-01-02 | Cartridge-shell battery | ||
US504424A (en) | 1893-09-05 | Oscar de pezzer | ||
US2899227A (en) | 1959-08-11 | Charles-louis gschwend | ||
US644061A (en) * | 1899-10-14 | 1900-02-27 | George W Coffield | Friction-clutch. |
US693961A (en) * | 1901-03-16 | 1902-02-25 | Richard J Flinn | Stream-trap. |
US705346A (en) * | 1901-11-02 | 1902-07-22 | Jonathan R Hamilton | Dilator. |
US816792A (en) | 1904-09-06 | 1906-04-03 | Oliver H P Green | Lock. |
US798775A (en) | 1905-04-13 | 1905-09-05 | Valorus A Bradbury | Dispensing-bottle. |
US1080934A (en) | 1912-08-19 | 1913-12-09 | Walter L Shackleford | Rectal tube. |
US1200267A (en) | 1915-02-04 | 1916-10-03 | Motors Lock Company Of America | Lock for automobile-hoods. |
US1650959A (en) | 1926-04-08 | 1927-11-29 | Louis K Pitman | Surgical instrument |
US1735519A (en) | 1926-07-17 | 1929-11-12 | Arlyn T Vance | Physician's dilator |
US1878671A (en) | 1929-07-02 | 1932-09-20 | John Murray | Dilator |
US1828986A (en) | 1929-09-26 | 1931-10-27 | Golder E Stevens | Dilating irrigator |
US2201749A (en) | 1939-02-15 | 1940-05-21 | Vandegrift Middleton | Expanding vein tube |
US2525183A (en) * | 1947-03-20 | 1950-10-10 | Jehu M Robison | Antral pressure device |
US2493326A (en) * | 1949-03-01 | 1950-01-03 | John H Trinder | Tampon for control of intractable nasal hemorrhages |
US2847997A (en) | 1956-01-13 | 1958-08-19 | James J Tibone | Catheter |
US2906179A (en) | 1957-01-28 | 1959-09-29 | North American Aviation Inc | Vector gage |
US3037286A (en) | 1957-01-28 | 1962-06-05 | North American Aviation Inc | Vector gage |
US3009265A (en) | 1960-05-09 | 1961-11-21 | Superior Plastics Inc | Anatomical device |
US2995832A (en) | 1960-08-01 | 1961-08-15 | Alderson Res Lab Inc | Training aid for intravenous therapy |
US3173418A (en) | 1961-01-10 | 1965-03-16 | Ostap E Baran | Double-wall endotracheal cuff |
US3435826A (en) | 1964-05-27 | 1969-04-01 | Edwards Lab Inc | Embolectomy catheter |
US3347061A (en) | 1965-01-11 | 1967-10-17 | Eaton Yale & Towne | Flexible drive mechanism |
US3393073A (en) | 1965-04-16 | 1968-07-16 | Eastman Kodak Co | High contrast photographic emulsions |
US3376659A (en) | 1965-06-09 | 1968-04-09 | Bard Inc C R | Demonstration device |
US3447061A (en) * | 1965-07-12 | 1969-05-27 | Basic Inc | Multi-phase rectifier with inherent phase balance |
US3384970A (en) | 1965-09-22 | 1968-05-28 | Boice Gages Inc | Precision coordinates measurement apparatus for gaging and layout operations |
US3486539A (en) | 1965-09-28 | 1969-12-30 | Jacuzzi Bros Inc | Liquid dispensing and metering assembly |
US3469578A (en) | 1965-10-12 | 1969-09-30 | Howard R Bierman | Infusion device for ambulatory patients with flow control means |
US3509638A (en) | 1966-08-04 | 1970-05-05 | Midland Ross Corp | Treating apparatus |
US3506005A (en) | 1967-02-23 | 1970-04-14 | Arthur S Gilio | Pressure infusion device for medical use |
US3552384A (en) * | 1967-07-03 | 1971-01-05 | American Hospital Supply Corp | Controllable tip guide body and catheter |
US3515888A (en) | 1967-10-27 | 1970-06-02 | California Computer Products | Manual optical digitizer |
US3481043A (en) | 1967-12-12 | 1969-12-02 | Bendix Corp | Gaging machine |
US3531868A (en) | 1968-04-18 | 1970-10-06 | Ford Motor Co | Surface scanner for measuring the coordinates of points on a three-dimensional surface |
US3527220A (en) | 1968-06-28 | 1970-09-08 | Fairchild Hiller Corp | Implantable drug administrator |
US3993073A (en) | 1969-04-01 | 1976-11-23 | Alza Corporation | Novel drug delivery device |
US3948262A (en) | 1969-04-01 | 1976-04-06 | Alza Corporation | Novel drug delivery device |
US3967618A (en) | 1969-04-01 | 1976-07-06 | Alza Corporation | Drug delivery device |
US3624661A (en) | 1969-05-14 | 1971-11-30 | Honeywell Inc | Electrographic printing system with plural staggered electrode rows |
US3834394A (en) | 1969-11-21 | 1974-09-10 | R Sessions | Occlusion device and method and apparatus for inserting the same |
US3903893A (en) | 1970-05-04 | 1975-09-09 | Alexander L Scheer | Nasal hemostatic device |
US4069307A (en) * | 1970-10-01 | 1978-01-17 | Alza Corporation | Drug-delivery device comprising certain polymeric materials for controlled release of drug |
GB1340788A (en) * | 1971-02-04 | 1974-01-30 | Matburn Holdings Ltd | Nasal tampons |
US3731963A (en) | 1971-04-20 | 1973-05-08 | R Pond | Electrically actuated lock mechanism |
US3804081A (en) | 1971-07-29 | 1974-04-16 | Olympus Optical Co | Endoscope |
US3802096A (en) | 1971-08-09 | 1974-04-09 | H Matern | Composite model for medical study |
US3948254A (en) | 1971-11-08 | 1976-04-06 | Alza Corporation | Novel drug delivery device |
US3850176A (en) | 1972-02-07 | 1974-11-26 | G Gottschalk | Nasal tampon |
US3910617A (en) | 1972-02-20 | 1975-10-07 | Square D Co | Solenoid operated electric strike |
JPS4920979A (en) | 1972-06-19 | 1974-02-23 | ||
JPS4932484U (en) | 1972-06-19 | 1974-03-20 | ||
US3800788A (en) * | 1972-07-12 | 1974-04-02 | N White | Antral catheter for reduction of fractures |
CH557178A (en) | 1972-08-10 | 1974-12-31 | Siemens Ag | DEVICE FOR DISPENSING DRUGS. |
US4016251A (en) | 1972-08-17 | 1977-04-05 | Alza Corporation | Vaginal drug dispensing device |
US3792391A (en) * | 1972-12-18 | 1974-02-12 | L Ewing | Electrically operated two position electromechanical mechanism |
US3921636A (en) | 1973-01-15 | 1975-11-25 | Alza Corp | Novel drug delivery device |
US3993069A (en) | 1973-03-26 | 1976-11-23 | Alza Corporation | Liquid delivery device bladder |
US3847145A (en) * | 1973-04-13 | 1974-11-12 | M Grossan | Nasal irrigation system |
US4450150A (en) | 1973-05-17 | 1984-05-22 | Arthur D. Little, Inc. | Biodegradable, implantable drug delivery depots, and method for preparing and using the same |
US3859993A (en) * | 1973-08-27 | 1975-01-14 | Daniel G Bitner | Operating table accessory |
US3993072A (en) | 1974-08-28 | 1976-11-23 | Alza Corporation | Microporous drug delivery device |
US3935859A (en) * | 1974-09-16 | 1976-02-03 | Doyle Donald E | Surgical nasal splint |
US4052505A (en) | 1975-05-30 | 1977-10-04 | Alza Corporation | Ocular therapeutic system manufactured from copolymer |
DE2541084C3 (en) | 1975-09-15 | 1978-12-07 | Siemens Ag, 1000 Berlin Und 8000 Muenchen | Method for producing a self-supporting coil in the winding area |
US4102342A (en) * | 1975-12-29 | 1978-07-25 | Taichiro Akiyama | Valved device |
US4138151A (en) * | 1976-07-30 | 1979-02-06 | Olympus Optical Company Limited | Detent device for locking the lid of a cassette receiving compartment of a tape recorder |
US4471779A (en) | 1976-08-25 | 1984-09-18 | Becton, Dickinson And Company | Miniature balloon catheter |
JPS5618817Y2 (en) | 1976-10-18 | 1981-05-02 | ||
US4207890A (en) | 1977-01-04 | 1980-06-17 | Mcneilab, Inc. | Drug-dispensing device and method |
JPS567971Y2 (en) | 1977-07-23 | 1981-02-21 | ||
US4184497A (en) * | 1977-08-26 | 1980-01-22 | University Of Utah | Peritoneal dialysis catheter |
US4198766A (en) | 1978-06-21 | 1980-04-22 | Baxter Travenol Laboratories, Inc. | Intravenous training/demonstration aid |
USRE31351E (en) | 1978-08-04 | 1983-08-16 | Bell Telephone Laboratories, Incorporated | Feedback nonlinear equalization of modulated data signals |
US4213095A (en) | 1978-08-04 | 1980-07-15 | Bell Telephone Laboratories, Incorporated | Feedforward nonlinear equalization of modulated data signals |
US4217898A (en) | 1978-10-23 | 1980-08-19 | Alza Corporation | System with microporous reservoir having surface for diffusional delivery of agent |
US4268115A (en) | 1979-06-01 | 1981-05-19 | Tetra-Tech, Inc. | Quick-release fiber-optic connector |
US4299226A (en) | 1979-08-08 | 1981-11-10 | Banka Vidya S | Coronary dilation method |
JPS5628334A (en) | 1979-08-14 | 1981-03-19 | Nissan Motor Co Ltd | Automatic change gear |
US4299227A (en) | 1979-10-19 | 1981-11-10 | Lincoff Harvey A | Ophthalmological appliance |
US4312353A (en) | 1980-05-09 | 1982-01-26 | Mayfield Education And Research Fund | Method of creating and enlarging an opening in the brain |
US4338941A (en) | 1980-09-10 | 1982-07-13 | Payton Hugh W | Apparatus for arresting posterior nosebleeds |
DE3041873C2 (en) | 1980-11-06 | 1982-12-23 | Danfoss A/S, 6430 Nordborg | Device for generating a speed-dependent control pressure |
USD269204S (en) | 1981-02-05 | 1983-05-31 | Trepp Charles A | Dental hygiene device |
US4437856A (en) * | 1981-02-09 | 1984-03-20 | Alberto Valli | Peritoneal catheter device for dialysis |
FR2502499B1 (en) | 1981-03-27 | 1987-01-23 | Farcot Jean Christian | APPARATUS FOR BLOOD RETROPERFUSION, IN PARTICULAR FOR THE TREATMENT OF INFARCTUS BY INJECTION OF ARTERIAL BLOOD INTO THE CORONARY SINUS |
US4592357A (en) * | 1981-05-21 | 1986-06-03 | Ersek Robert A | Septal splint |
CH653400A5 (en) | 1981-06-17 | 1985-12-31 | Bauer Kaba Ag | LOCK CYLINDER. |
US4435716A (en) | 1981-09-14 | 1984-03-06 | Adrian Zandbergen | Method of making a conical spiral antenna |
DE3202878C2 (en) | 1982-01-29 | 1985-10-31 | Geze Gmbh, 7250 Leonberg | Electromagnetically operated lock for sliding leaves of doors or the like. |
US4571239A (en) * | 1982-03-01 | 1986-02-18 | Heyman Arnold M | Catheter-stylet assembly for slipover urethral instruments |
US4450975A (en) | 1982-03-02 | 1984-05-29 | Mark Designs International, Inc. | Wall-mounted ash tray |
US5370675A (en) | 1992-08-12 | 1994-12-06 | Vidamed, Inc. | Medical probe device and method |
GB2125874B (en) | 1982-08-17 | 1985-08-14 | Michael David Dunn | Solenoid operated locks |
US4464175A (en) | 1982-08-25 | 1984-08-07 | Altman Alan R | Multipurpose tamponade and thrombosclerotherapy tube |
US4499899A (en) | 1983-01-21 | 1985-02-19 | Brimfield Precision, Inc. | Fiber-optic illuminated microsurgical scissors |
US4581017B1 (en) | 1983-03-07 | 1994-05-17 | Bard Inc C R | Catheter systems |
US4639244A (en) * | 1983-05-03 | 1987-01-27 | Nabil I. Rizk | Implantable electrophoretic pump for ionic drugs and associated methods |
US4564364A (en) * | 1983-05-26 | 1986-01-14 | Alza Corporation | Active agent dispenser |
USD283921S (en) | 1983-06-27 | 1986-05-20 | Difco Laboratories Incorporated | Blood collector |
EP0129634B1 (en) | 1983-06-27 | 1988-05-04 | Börje Drettner | An instrument for the treatment of sinusitis |
US4554929A (en) | 1983-07-13 | 1985-11-26 | Advanced Cardiovascular Systems, Inc. | Catheter guide wire with short spring tip and method of using the same |
NL8302648A (en) | 1983-07-26 | 1985-02-18 | Fundatech Sa | APPARATUS FOR SUPPLY AND EXTRACTION OF A LIQUID SUBSTANCE TO RESP. FROM THE JAWS. |
US4675613A (en) | 1983-08-11 | 1987-06-23 | Hewlett-Packard Company | Noise compensated synchronous detector system |
US4571240A (en) * | 1983-08-12 | 1986-02-18 | Advanced Cardiovascular Systems, Inc. | Catheter having encapsulated tip marker |
CA1232814A (en) | 1983-09-16 | 1988-02-16 | Hidetoshi Sakamoto | Guide wire for catheter |
US4585000A (en) | 1983-09-28 | 1986-04-29 | Cordis Corporation | Expandable device for treating intravascular stenosis |
USD284892S (en) | 1983-09-29 | 1986-07-29 | Glassman Jacob A | Biliary exploratory balloon catheter with replaceable lead-tip |
SE442164B (en) | 1984-01-11 | 1985-12-09 | Olle Berg | DEVICE FOR NAVIGATION WALL OPERATIONS |
US4589868A (en) | 1984-03-12 | 1986-05-20 | Dretler Stephen P | Expandable dilator-catheter |
JPS60253428A (en) | 1984-05-30 | 1985-12-14 | 住友電気工業株式会社 | Fiberscope with bending mechanism |
US4851228A (en) | 1984-06-20 | 1989-07-25 | Merck & Co., Inc. | Multiparticulate controlled porosity osmotic |
US4596528A (en) | 1984-07-02 | 1986-06-24 | Lewis Leonard A | Simulated skin and method |
US4705801A (en) * | 1984-10-16 | 1987-11-10 | Ciba-Geigy Corporation | Production for producing 3-cyano-4-phenyl indoles and intermediates |
US5019075A (en) | 1984-10-24 | 1991-05-28 | The Beth Israel Hospital | Method and apparatus for angioplasty |
US4637389A (en) * | 1985-04-08 | 1987-01-20 | Heyden Eugene L | Tubular device for intubation |
US4607622A (en) | 1985-04-11 | 1986-08-26 | Charles D. Fritch | Fiber optic ocular endoscope |
US4619274A (en) | 1985-04-18 | 1986-10-28 | Advanced Cardiovascular Systems, Inc. | Torsional guide wire with attenuated diameter |
US4645495A (en) * | 1985-06-26 | 1987-02-24 | Vaillancourt Vincent L | Vascular access implant needle patch |
US4641654A (en) | 1985-07-30 | 1987-02-10 | Advanced Cardiovascular Systems, Inc. | Steerable balloon dilatation catheter assembly having dye injection and pressure measurement capabilities |
IT1182613B (en) * | 1985-10-15 | 1987-10-05 | Olivetti & Co Spa | KEY WITH SELECTIVELY ACTIVATED DISPLAY AND KEYBOARD USING SUCH KEY |
US4696544A (en) | 1985-11-18 | 1987-09-29 | Olympus Corporation | Fiberscopic device for inspection of internal sections of construction, and method for using same |
US4748986A (en) | 1985-11-26 | 1988-06-07 | Advanced Cardiovascular Systems, Inc. | Floppy guide wire with opaque tip |
US4691948A (en) | 1985-11-27 | 1987-09-08 | A-Dec, Inc. | Fail-secure lock system |
DE3704247A1 (en) | 1986-02-14 | 1987-08-20 | Olympus Optical Co | ENDOSCOPE INSERTION DEVICE |
US4669469A (en) | 1986-02-28 | 1987-06-02 | Devices For Vascular Intervention | Single lumen atherectomy catheter device |
US4834709A (en) | 1986-03-26 | 1989-05-30 | Sherwood Medical Company | Preformable catheter |
US5350395A (en) | 1986-04-15 | 1994-09-27 | Yock Paul G | Angioplasty apparatus facilitating rapid exchanges |
US4708834A (en) | 1986-05-01 | 1987-11-24 | Pharmacaps, Inc. | Preparation of gelatin-encapsulated controlled release composition |
US4672961A (en) | 1986-05-19 | 1987-06-16 | Davies David H | Retrolasing catheter and method |
US4795439A (en) * | 1986-06-06 | 1989-01-03 | Edward Weck Incorporated | Spiral multi-lumen catheter |
CH668188A5 (en) | 1986-06-09 | 1988-12-15 | Franz Rappai | Corticosteroid ointment compsns. - comprise e.g. dexamethasone in poly:alkylene glycol base, and are used esp. for treating rhinitis |
US5019372A (en) | 1986-06-27 | 1991-05-28 | The Children's Medical Center Corporation | Magnetically modulated polymeric drug release system |
US4854330A (en) | 1986-07-10 | 1989-08-08 | Medrad, Inc. | Formed core catheter guide wire assembly |
US4920967A (en) | 1986-07-18 | 1990-05-01 | Pfizer Hospital Products Group, Inc. | Doppler tip wire guide |
US4847258A (en) | 1986-08-26 | 1989-07-11 | Ciba-Geigy Corporation | Substituted benzoylphenylureas compounds useful as pesticides |
US4803076A (en) * | 1986-09-04 | 1989-02-07 | Pfizer Inc. | Controlled release device for an active substance |
US4726772A (en) * | 1986-12-01 | 1988-02-23 | Kurt Amplatz | Medical simulator |
US5527336A (en) * | 1986-12-09 | 1996-06-18 | Boston Scientific Corporation | Flow obstruction treatment method |
US5312430A (en) * | 1986-12-09 | 1994-05-17 | Rosenbluth Robert F | Balloon dilation catheter |
US5030227A (en) | 1988-06-02 | 1991-07-09 | Advanced Surgical Intervention, Inc. | Balloon dilation catheter |
US4771776A (en) | 1987-01-06 | 1988-09-20 | Advanced Cardiovascular Systems, Inc. | Dilatation catheter with angled balloon and method |
US4819619A (en) * | 1987-01-16 | 1989-04-11 | Augustine Scott D | Device for inserting a nasal tube |
US4815478A (en) | 1987-02-17 | 1989-03-28 | Medtronic Versaflex, Inc. | Steerable guidewire with deflectable tip |
US4736970A (en) | 1987-03-09 | 1988-04-12 | Mcgourty Thomas K | Electrically controlled door lock |
US4811743A (en) * | 1987-04-21 | 1989-03-14 | Cordis Corporation | Catheter guidewire |
US4793359A (en) | 1987-04-24 | 1988-12-27 | Gv Medical, Inc. | Centering balloon structure for transluminal angioplasty catheter |
US4748969A (en) | 1987-05-07 | 1988-06-07 | Circon Corporation | Multi-lumen core deflecting endoscope |
US4867138A (en) | 1987-05-13 | 1989-09-19 | Olympus Optical Co., Ltd. | Rigid electronic endoscope |
US4755171A (en) | 1987-05-29 | 1988-07-05 | Tennant Jerald L | Tubular surgical device |
US4796629A (en) * | 1987-06-03 | 1989-01-10 | Joseph Grayzel | Stiffened dilation balloon catheter device |
DE3719250A1 (en) | 1987-06-10 | 1988-12-22 | Kellner Hans Joerg Dr Med | ENDOSCOPE |
SE8704767L (en) | 1987-11-30 | 1989-05-31 | Sigmund Johannes Loefstedt | NEW METHOD FOR ADMINISTRATION OF MEDICINAL PRODUCTS |
US5041089A (en) | 1987-12-11 | 1991-08-20 | Devices For Vascular Intervention, Inc. | Vascular dilation catheter construction |
US4846186A (en) | 1988-01-12 | 1989-07-11 | Cordis Corporation | Flexible guidewire |
US4917667A (en) | 1988-02-11 | 1990-04-17 | Retroperfusion Systems, Inc. | Retroperfusion balloon catheter and method |
US5372138A (en) | 1988-03-21 | 1994-12-13 | Boston Scientific Corporation | Acousting imaging catheters and the like |
US4883465A (en) | 1988-05-24 | 1989-11-28 | Brennan H George | Nasal tampon and method for using |
US4940062A (en) | 1988-05-26 | 1990-07-10 | Advanced Cardiovascular Systems, Inc. | Guiding member with deflectable tip |
US4998917A (en) | 1988-05-26 | 1991-03-12 | Advanced Cardiovascular Systems, Inc. | High torque steerable dilatation catheter |
DE58906894D1 (en) | 1988-06-13 | 1994-03-17 | Yaroslavskij Mezotraslevoj Nt | DEVICE FOR DIAGNOSTICS AND TREATMENT OF NOSE DISEASES. |
EP0349053B1 (en) * | 1988-06-29 | 1992-06-17 | Jaico C.V. Cooperatieve Vennootschap | Pressure capsule for spray can, and spray can which utilizes such a capsule |
US5267965A (en) | 1988-07-06 | 1993-12-07 | Ethicon, Inc. | Safety trocar |
EP0355996A3 (en) | 1988-07-21 | 1990-05-02 | Advanced Interventional Systems, Inc. | Guidance and delivery system for high-energy pulsed laser light and endoscope |
DE8810044U1 (en) | 1988-08-03 | 1988-11-17 | Effner Gmbh | Optical adjustment device |
US5067489A (en) | 1988-08-16 | 1991-11-26 | Flexmedics Corporation | Flexible guide with safety tip |
US4917419A (en) | 1988-08-22 | 1990-04-17 | Mora Jr Saturnino F | Electromechanical door lock system |
US4898577A (en) * | 1988-09-28 | 1990-02-06 | Advanced Cardiovascular Systems, Inc. | Guiding cathether with controllable distal tip |
JPH0296072A (en) | 1988-09-30 | 1990-04-06 | Aisin Seiki Co Ltd | Lid lock device |
US4943275A (en) | 1988-10-14 | 1990-07-24 | Abiomed Limited Partnership | Insertable balloon with curved support |
US4984581A (en) * | 1988-10-12 | 1991-01-15 | Flexmedics Corporation | Flexible guide having two-way shape memory alloy |
JPH066342B2 (en) | 1988-10-14 | 1994-01-26 | 三菱重工業株式会社 | Shape memory film and its use |
US5090910A (en) * | 1988-10-14 | 1992-02-25 | Narlo Jeanie R | Multiple three dimensional facial display system |
US4961433A (en) | 1988-11-02 | 1990-10-09 | Cardiometrics, Inc. | Guide wire assembly with electrical functions and male and female connectors for use therewith |
US5001825A (en) | 1988-11-03 | 1991-03-26 | Cordis Corporation | Catheter guidewire fabrication method |
US5189110A (en) * | 1988-12-23 | 1993-02-23 | Asahi Kasei Kogyo Kabushiki Kaisha | Shape memory polymer resin, composition and the shape memorizing molded product thereof |
US5087246A (en) * | 1988-12-29 | 1992-02-11 | C. R. Bard, Inc. | Dilation catheter with fluted balloon |
US4998916A (en) | 1989-01-09 | 1991-03-12 | Hammerslag Julius G | Steerable medical device |
US5221260A (en) | 1989-01-13 | 1993-06-22 | Scimed Life Systems, Inc. | Innerless dilatation balloon catheter |
US5087244A (en) * | 1989-01-31 | 1992-02-11 | C. R. Bard, Inc. | Catheter and method for locally applying medication to the wall of a blood vessel or other body lumen |
US5662674A (en) | 1989-02-03 | 1997-09-02 | Debbas; Elie | Apparatus for locating a breast mass |
US4966163A (en) | 1989-02-14 | 1990-10-30 | Advanced Cardiovascular Systems, Inc. | Extendable guidewire for vascular procedures |
US5024650A (en) | 1989-02-15 | 1991-06-18 | Matsushita Electric Works, Ltd. | Stress dissolving refreshment system |
SU1662571A1 (en) | 1989-03-01 | 1991-07-15 | Курский Государственный Медицинский Институт | Process for preparing x-ray contrast agent for investigating sinuses |
US4946466A (en) | 1989-03-03 | 1990-08-07 | Cordis Corporation | Transluminal angioplasty apparatus |
RU1768142C (en) | 1989-03-29 | 1992-10-15 | Ярославский Межотраслевой Научно-Технический Центр | Device for therapy of sinuitis |
US4919112B1 (en) | 1989-04-07 | 1993-12-28 | Low-cost semi-disposable endoscope | |
EP0395098B1 (en) | 1989-04-28 | 1994-04-06 | Tokin Corporation | Readily operable catheter guide wire using shape memory alloy with pseudo elasticity |
DE68916960T2 (en) | 1989-05-24 | 1994-11-03 | Tsukada Medical Research Co | A BALLOON INSTRUMENT FOR CONTINUOUSLY INJECTING A MEDICAL LIQUID. |
US5009655A (en) * | 1989-05-24 | 1991-04-23 | C. R. Bard, Inc. | Hot tip device with optical diagnostic capability |
US4994033A (en) * | 1989-05-25 | 1991-02-19 | Schneider (Usa) Inc. | Intravascular drug delivery dilatation catheter |
AU5721990A (en) | 1989-06-07 | 1991-01-07 | Ultra-Klean Ltd. | Exercise and toning apparatus |
US5207695A (en) * | 1989-06-19 | 1993-05-04 | Trout Iii Hugh H | Aortic graft, implantation device, and method for repairing aortic aneurysm |
AU640675B2 (en) | 1989-06-28 | 1993-09-02 | Zkz Science Corp. | Balloon tamponade devices and methods for their placement |
DE3923851C1 (en) | 1989-07-19 | 1990-08-16 | Richard Wolf Gmbh, 7134 Knittlingen, De | |
DE3927001A1 (en) | 1989-08-16 | 1991-02-21 | Lucien C Dr Med Olivier | CATHETER SYSTEM |
US5484409A (en) | 1989-08-25 | 1996-01-16 | Scimed Life Systems, Inc. | Intravascular catheter and method for use thereof |
US5180368A (en) * | 1989-09-08 | 1993-01-19 | Advanced Cardiovascular Systems, Inc. | Rapidly exchangeable and expandable cage catheter for repairing damaged blood vessels |
US5021043A (en) * | 1989-09-11 | 1991-06-04 | C. R. Bard, Inc. | Method and catheter for dilatation of the lacrimal system |
US5169386A (en) * | 1989-09-11 | 1992-12-08 | Bruce B. Becker | Method and catheter for dilatation of the lacrimal system |
ES2043289T3 (en) | 1989-09-25 | 1993-12-16 | Schneider Usa Inc | THE EXTRUSION OF MULTIPLE LAYERS AS A PROCEDURE FOR MAKING ANGIOPLASTY BALLS. |
US5256144A (en) | 1989-11-02 | 1993-10-26 | Danforth Biomedical, Inc. | Low profile, high performance interventional catheters |
US5335671A (en) * | 1989-11-06 | 1994-08-09 | Mectra Labs, Inc. | Tissue removal assembly with provision for an electro-cautery device |
US5026384A (en) | 1989-11-07 | 1991-06-25 | Interventional Technologies, Inc. | Atherectomy systems and methods |
US5112228A (en) | 1989-11-13 | 1992-05-12 | Advanced Cardiovascular Systems, Inc. | Vascular model |
US5215105A (en) | 1989-11-14 | 1993-06-01 | Custom Medical Concepts, Inc. | Method of treating epidural lesions |
US5137517A (en) | 1989-11-28 | 1992-08-11 | Scimed Life Systems, Inc. | Device and method for gripping medical shaft |
US5053007A (en) | 1989-12-14 | 1991-10-01 | Scimed Life Systems, Inc. | Compression balloon protector for a balloon dilatation catheter and method of use thereof |
US5843089A (en) | 1990-12-28 | 1998-12-01 | Boston Scientific Corporation | Stent lining |
US5439446A (en) | 1994-06-30 | 1995-08-08 | Boston Scientific Corporation | Stent and therapeutic delivery system |
US5209730A (en) | 1989-12-19 | 1993-05-11 | Scimed Life Systems, Inc. | Method for placement of a balloon dilatation catheter across a stenosis and apparatus therefor |
US5156595A (en) | 1989-12-28 | 1992-10-20 | Scimed Life Systems, Inc. | Dilatation balloon catheter and method of manufacturing |
USD329496S (en) | 1990-02-20 | 1992-09-15 | Celia Clarke | Needle depth gauge |
US5060660A (en) | 1990-02-28 | 1991-10-29 | C. R. Bard, Inc. | Steerable extendable guidewire with adjustable tip |
US5125915A (en) | 1990-03-02 | 1992-06-30 | Cardiopulmonics, Inc. | Locking y-connector for selective attachment to exterior of medical tubing |
AU113882S (en) | 1990-03-07 | 1992-05-08 | Terumo Corp | Catheter |
US5478565A (en) | 1990-03-27 | 1995-12-26 | Warner-Lambert Company | Treatment of sinus headache |
US5147315A (en) | 1990-04-06 | 1992-09-15 | C. R. Bard, Inc. | Access catheter and system for use in the female reproductive system |
US5238004A (en) * | 1990-04-10 | 1993-08-24 | Boston Scientific Corporation | High elongation linear elastic guidewire |
US5171233A (en) | 1990-04-25 | 1992-12-15 | Microvena Corporation | Snare-type probe |
CA2082805A1 (en) | 1990-05-11 | 1991-11-12 | Mark A. Saab | High-strength, thin-walled single piece catheters |
FR2662083A1 (en) | 1990-05-21 | 1991-11-22 | Perouse Sa Laboratoires | Dilator apparatus, in particular for a blood vessel |
SE502055C2 (en) | 1990-05-23 | 1995-07-31 | Atos Medical Ab | Device for applying a drainage duct |
AU8074591A (en) * | 1990-06-15 | 1992-01-07 | Cortrak Medical, Inc. | Drug delivery apparatus and method |
US5044678A (en) | 1990-07-25 | 1991-09-03 | Lectron Products, Inc. | Solenoid operated latch device with movable pole piece |
US5055051A (en) | 1990-08-03 | 1991-10-08 | Dornier Medical Systems, Inc. | Semi-anthropomorphic biliary/renal training phantom for medical imaging and lithotripsy training |
US5167220A (en) | 1990-08-09 | 1992-12-01 | Brown Cathy K | Systems and methods for maintaining a clear visual field during endoscopic procedures |
US5163989A (en) | 1990-08-27 | 1992-11-17 | Advanced Cardiovascular Systems, Inc. | Method for forming a balloon mold and the use of such mold |
US5345945A (en) | 1990-08-29 | 1994-09-13 | Baxter International Inc. | Dual coil guidewire with radiopaque distal tip |
US5197457A (en) | 1990-09-12 | 1993-03-30 | Adair Edwin Lloyd | Deformable and removable sheath for optical catheter |
DE4032096C2 (en) | 1990-10-10 | 1995-03-30 | Boehringer Ingelheim Kg | Use of emulsifier-free emulsion polymers in pharmaceutical preparations with delayed release of the active ingredient |
JP2699641B2 (en) | 1990-10-11 | 1998-01-19 | 日本電気株式会社 | Phase jitter suppression circuit |
JPH0683726B2 (en) | 1990-10-12 | 1994-10-26 | 日本精線株式会社 | Guide wire for catheter |
US5169043A (en) | 1990-12-12 | 1992-12-08 | Catania Claude L | Versatile carrying bag |
EP0491349B1 (en) | 1990-12-18 | 1998-03-18 | Advanced Cardiovascular Systems, Inc. | Method of manufacturing a Superelastic guiding member |
US5341818A (en) | 1992-12-22 | 1994-08-30 | Advanced Cardiovascular Systems, Inc. | Guidewire with superelastic distal portion |
US5102402A (en) * | 1991-01-04 | 1992-04-07 | Medtronic, Inc. | Releasable coatings on balloon catheters |
US5368558A (en) | 1991-01-11 | 1994-11-29 | Baxter International Inc. | Ultrasonic ablation catheter device having endoscopic component and method of using same |
US6006126A (en) | 1991-01-28 | 1999-12-21 | Cosman; Eric R. | System and method for stereotactic registration of image scan data |
US5465717A (en) | 1991-02-15 | 1995-11-14 | Cardiac Pathways Corporation | Apparatus and Method for ventricular mapping and ablation |
US5139510A (en) | 1991-02-22 | 1992-08-18 | Xomed-Treace Inc. | Nasal packing device |
WO1992015286A1 (en) | 1991-02-27 | 1992-09-17 | Nova Pharmaceutical Corporation | Anti-infective and anti-inflammatory releasing systems for medical devices |
US5183470A (en) * | 1991-03-04 | 1993-02-02 | International Medical, Inc. | Laparoscopic cholangiogram catheter and method of using same |
US5195168A (en) | 1991-03-15 | 1993-03-16 | Codex Corporation | Speech coder and method having spectral interpolation and fast codebook search |
US6733473B1 (en) | 1991-04-05 | 2004-05-11 | Boston Scientific Corporation | Adjustably stiffenable convertible catheter assembly |
US5211952A (en) | 1991-04-12 | 1993-05-18 | University Of Southern California | Contraceptive methods and formulations for use therein |
US5226302A (en) | 1991-04-15 | 1993-07-13 | Loctec Corporation | Six-way self-adjusting lock for use on truck storage boxes and the like |
CA2069052A1 (en) | 1991-05-21 | 1992-11-22 | L. Venkata Raman | Superelastic formable guidewire |
US5127393A (en) | 1991-05-28 | 1992-07-07 | Medilase, Inc. | Flexible endoscope with rigid introducer |
US5386817A (en) * | 1991-06-10 | 1995-02-07 | Endomedical Technologies, Inc. | Endoscope sheath and valve system |
US5213576A (en) | 1991-06-11 | 1993-05-25 | Cordis Corporation | Therapeutic porous balloon catheter |
US5429582A (en) | 1991-06-14 | 1995-07-04 | Williams; Jeffery A. | Tumor treatment |
CA2068584C (en) | 1991-06-18 | 1997-04-22 | Paul H. Burmeister | Intravascular guide wire and method for manufacture thereof |
US5264260A (en) | 1991-06-20 | 1993-11-23 | Saab Mark A | Dilatation balloon fabricated from low molecular weight polymers |
US5236422A (en) | 1991-06-24 | 1993-08-17 | Eplett Jr James D | Antiseptic urinary catheter cuff |
US5766151A (en) | 1991-07-16 | 1998-06-16 | Heartport, Inc. | Endovascular system for arresting the heart |
US5269752A (en) * | 1991-09-12 | 1993-12-14 | Bennett Laurence M | Method of extracorporeal treatment using a kink resistant catheter |
US5252183A (en) | 1991-09-13 | 1993-10-12 | Abb Lummus Crest Inc. | Process of pulping and bleaching fibrous plant material with tert-butyl alcohol and tert-butyl peroxide |
US5168864A (en) | 1991-09-26 | 1992-12-08 | Clarus Medical Systems, Inc. | Deflectable endoscope |
US5304123A (en) | 1991-10-24 | 1994-04-19 | Children's Medical Center Corporation | Detachable balloon catheter for endoscopic treatment of vesicoureteral reflux |
US5290310A (en) | 1991-10-30 | 1994-03-01 | Howmedica, Inc. | Hemostatic implant introducer |
US5333620A (en) | 1991-10-30 | 1994-08-02 | C. R. Bard, Inc. | High performance plastic coated medical guidewire |
US5246016A (en) | 1991-11-08 | 1993-09-21 | Baxter International Inc. | Transport catheter and multiple probe analysis method |
US5251092A (en) | 1991-11-27 | 1993-10-05 | Protek Devices, Lp | Receptacle assembly with both insulation displacement connector bussing and friction connector coupling of power conductors to surge suppressor circuit |
US5243996A (en) | 1992-01-03 | 1993-09-14 | Cook, Incorporated | Small-diameter superelastic wire guide |
US6053172A (en) * | 1995-06-07 | 2000-04-25 | Arthrocare Corporation | Systems and methods for electrosurgical sinus surgery |
US6063079A (en) * | 1995-06-07 | 2000-05-16 | Arthrocare Corporation | Methods for electrosurgical treatment of turbinates |
US6190381B1 (en) | 1995-06-07 | 2001-02-20 | Arthrocare Corporation | Methods for tissue resection, ablation and aspiration |
US6109268A (en) | 1995-06-07 | 2000-08-29 | Arthrocare Corporation | Systems and methods for electrosurgical endoscopic sinus surgery |
US6086585A (en) | 1995-06-07 | 2000-07-11 | Arthrocare Corporation | System and methods for electrosurgical treatment of sleep obstructive disorders |
US5273052A (en) | 1992-01-08 | 1993-12-28 | Danforth Biomedical, Incorporated | Guidewire with reversible contact seal for releasable securement to catheter |
ATE200432T1 (en) | 1992-01-09 | 2001-04-15 | Advanced Cardiovascular System | DEVICE FOR REPLACING A GUIDE WIRE |
US5250059A (en) | 1992-01-22 | 1993-10-05 | Devices For Vascular Intervention, Inc. | Atherectomy catheter having flexible nose cone |
US5699796A (en) | 1993-01-29 | 1997-12-23 | Cardima, Inc. | High resolution intravascular signal detection |
US5341240A (en) | 1992-02-06 | 1994-08-23 | Linvatec Corporation | Disposable endoscope |
JPH05211985A (en) | 1992-02-07 | 1993-08-24 | Olympus Optical Co Ltd | Endoscope guide apparatus for cerebral ventricle |
US5263926A (en) | 1992-02-18 | 1993-11-23 | Wilk Peter J | Device and related method for reducing swelling of hemorrhoidal tissues |
US5409444A (en) | 1992-03-04 | 1995-04-25 | Kensey Nash Corporation | Method and apparatus to reduce injury to the vascular system |
DE69326631T2 (en) | 1992-03-19 | 2000-06-08 | Medtronic Inc | Intraluminal expansion device |
US5346075A (en) * | 1992-04-17 | 1994-09-13 | Johnson & Johnson Medical, Inc. | Apparatus and method for holding a medical instrument |
USD355031S (en) * | 1992-04-20 | 1995-01-31 | Terumo Kabushiki Kaisha | Catheter |
US5368566A (en) | 1992-04-29 | 1994-11-29 | Cardiovascular Dynamics, Inc. | Delivery and temporary stent catheter having a reinforced perfusion lumen |
US5275593A (en) * | 1992-04-30 | 1994-01-04 | Surgical Technologies, Inc. | Ophthalmic surgery probe assembly |
US5817102A (en) | 1992-05-08 | 1998-10-06 | Schneider (Usa) Inc. | Apparatus for delivering and deploying a stent |
US5584827A (en) | 1992-05-18 | 1996-12-17 | Ultracell Medical Technologies, Inc | Nasal-packing article |
US5713848A (en) | 1993-05-19 | 1998-02-03 | Dubrul; Will R. | Vibrating catheter |
US5772680A (en) | 1992-06-02 | 1998-06-30 | General Surgical Innovations, Inc. | Apparatus and method for developing an anatomic space for laparoscopic procedures with laparoscopic visualization |
US5255679A (en) | 1992-06-02 | 1993-10-26 | Cardiac Pathways Corporation | Endocardial catheter for mapping and/or ablation with an expandable basket structure having means for providing selective reinforcement and pressure sensing mechanism for use therewith, and method |
US5324284A (en) | 1992-06-05 | 1994-06-28 | Cardiac Pathways, Inc. | Endocardial mapping and ablation system utilizing a separately controlled ablation catheter and method |
US5348537A (en) | 1992-07-15 | 1994-09-20 | Advanced Cardiovascular Systems, Inc. | Catheter with intraluminal sealing element |
US5313967A (en) | 1992-07-24 | 1994-05-24 | Medtronic, Inc. | Helical guidewire |
US5707376A (en) * | 1992-08-06 | 1998-01-13 | William Cook Europe A/S | Stent introducer and method of use |
US5720719A (en) | 1992-08-12 | 1998-02-24 | Vidamed, Inc. | Ablative catheter with conformable body |
US5514131A (en) | 1992-08-12 | 1996-05-07 | Stuart D. Edwards | Method for the ablation treatment of the uvula |
EP0597195B1 (en) | 1992-08-18 | 1999-07-21 | The Spectranetics Corporation | Fiber optic guide wire |
IT1258142B (en) * | 1992-09-04 | 1996-02-20 | NASAL AND / OR RHINOPARINGEOUS SWAB | |
US5647361A (en) | 1992-09-28 | 1997-07-15 | Fonar Corporation | Magnetic resonance imaging method and apparatus for guiding invasive therapy |
JP3371482B2 (en) * | 1992-09-30 | 2003-01-27 | 住友電気工業株式会社 | Wheel speed detecting gear and manufacturing method thereof |
EP0649316B2 (en) | 1992-10-15 | 2013-08-28 | The General Hospital Corporation | An infusion pump with an electronically loadable drug library |
US5356418A (en) | 1992-10-28 | 1994-10-18 | Shturman Cardiology Systems, Inc. | Apparatus and method for rotational atherectomy |
US5295694A (en) | 1992-10-27 | 1994-03-22 | Levin John M | Laparoscopic surgery simulating game |
US5336178A (en) | 1992-11-02 | 1994-08-09 | Localmed, Inc. | Intravascular catheter with infusion array |
US5306272A (en) | 1992-11-02 | 1994-04-26 | Neuro Navigational Corporation | Advancer for surgical instrument |
US5314408A (en) * | 1992-11-13 | 1994-05-24 | Cardiovascular Imaging Systems, Inc. | Expandable member for a catheter system |
US5549542A (en) | 1992-11-17 | 1996-08-27 | Life Medical Technologies, Inc. | Deflectable endoscope |
ATE151615T1 (en) | 1992-11-18 | 1997-05-15 | Spectrascience Inc | DIAGNOSTIC IMAGE DEVICE |
US5391147A (en) * | 1992-12-01 | 1995-02-21 | Cardiac Pathways Corporation | Steerable catheter with adjustable bend location and/or radius and method |
US5314417A (en) | 1992-12-22 | 1994-05-24 | Ethicon, Inc. | Safety trocar |
US5368564A (en) | 1992-12-23 | 1994-11-29 | Angeion Corporation | Steerable catheter |
US5336163A (en) | 1993-01-06 | 1994-08-09 | Smith & Nephew Richards, Inc. | Expandable nasal stent |
CN2151720Y (en) | 1993-01-08 | 1994-01-05 | 陈吉峰 | Hemostat for nasal cavity and nasopharynx cavity |
AU5822094A (en) | 1993-01-18 | 1994-08-15 | John Crowe | Endoscope forceps |
JP3345147B2 (en) | 1993-01-26 | 2002-11-18 | テルモ株式会社 | Vasodilators and catheters |
US5407433A (en) | 1993-02-10 | 1995-04-18 | Origin Medsystems, Inc. | Gas-tight seal accommodating surgical instruments with a wide range of diameters |
US5329927A (en) | 1993-02-25 | 1994-07-19 | Echo Cath, Inc. | Apparatus and method for locating an interventional medical device with a ultrasound color imaging system |
WO1994021320A1 (en) | 1993-03-15 | 1994-09-29 | Advanced Cardiovascular Systems, Inc. | Fluid delivery catheter |
US5318528A (en) * | 1993-04-13 | 1994-06-07 | Advanced Surgical Inc. | Steerable surgical devices |
EP0702535B1 (en) | 1993-04-13 | 2003-01-08 | Boston Scientific Corporation | Prosthesis delivery system with dilating tip |
US5985307A (en) | 1993-04-14 | 1999-11-16 | Emory University | Device and method for non-occlusive localized drug delivery |
US5350396A (en) | 1993-04-15 | 1994-09-27 | Hood Laboratories | Nasal splint |
US5464650A (en) | 1993-04-26 | 1995-11-07 | Medtronic, Inc. | Intravascular stent and method |
US5824048A (en) | 1993-04-26 | 1998-10-20 | Medtronic, Inc. | Method for delivering a therapeutic substance to a body lumen |
ATE161819T1 (en) | 1993-04-27 | 1998-01-15 | Solvay Fluor & Derivate | METHOD FOR PRODUCING CARBOXYLIC ACID ESTERS FROM CARBOXYLIC ACID HALIDES AND ALCOHOLS |
US5450853A (en) | 1993-10-22 | 1995-09-19 | Scimed Life Systems, Inc. | Pressure sensor |
US5617870A (en) | 1993-04-29 | 1997-04-08 | Scimed Life Systems, Inc. | Intravascular flow measurement system |
US5346508A (en) | 1993-04-29 | 1994-09-13 | Scimed Life Systems, Inc. | Apparatus and method for performing diagnostics and intravascular therapies |
US5873835A (en) * | 1993-04-29 | 1999-02-23 | Scimed Life Systems, Inc. | Intravascular pressure and flow sensor |
US6832996B2 (en) | 1995-06-07 | 2004-12-21 | Arthrocare Corporation | Electrosurgical systems and methods for treating tissue |
DE4315821A1 (en) | 1993-05-12 | 1994-11-17 | Christian Dr Med Milewski | Device for tamponade and for keeping open bone-restricted body cavities and passages after surgical manipulation |
US5334187A (en) * | 1993-05-21 | 1994-08-02 | Cathco, Inc. | Balloon catheter system with slit opening handle |
US5372584A (en) | 1993-06-24 | 1994-12-13 | Ovamed Corporation | Hysterosalpingography and selective salpingography |
US5402799A (en) | 1993-06-29 | 1995-04-04 | Cordis Corporation | Guidewire having flexible floppy tip |
JP3337272B2 (en) | 1993-06-29 | 2002-10-21 | 株式会社町田製作所 | Medical equipment |
US5370640A (en) | 1993-07-01 | 1994-12-06 | Kolff; Jack | Intracorporeal catheter placement apparatus and method |
AU692786B2 (en) * | 1993-07-02 | 1998-06-18 | Materials Evolution And Development Usa, Inc. | Implantable system for cell growth control |
WO1995002430A1 (en) | 1993-07-15 | 1995-01-26 | Advanced Cardiovascular Systems, Inc. | Rapid exchange type intraluminal catheter with guiding element |
US5391199A (en) * | 1993-07-20 | 1995-02-21 | Biosense, Inc. | Apparatus and method for treating cardiac arrhythmias |
US5472449A (en) | 1993-07-26 | 1995-12-05 | Chou; Kuei C. | Permanent pigment applicator having a detachable needle coupler |
US5415633A (en) | 1993-07-28 | 1995-05-16 | Active Control Experts, Inc. | Remotely steered catheterization device |
US5441494A (en) | 1993-07-29 | 1995-08-15 | Ethicon, Inc. | Manipulable hand for laparoscopy |
US5719702A (en) * | 1993-08-03 | 1998-02-17 | The United States Of America As Represented By The United States Department Of Energy | Polarization-balanced beamsplitter |
US6277107B1 (en) | 1993-08-13 | 2001-08-21 | Daig Corporation | Guiding introducer for introducing medical devices into the coronary sinus and process for using same |
US5562619A (en) | 1993-08-19 | 1996-10-08 | Boston Scientific Corporation | Deflectable catheter |
US5578048A (en) * | 1993-09-15 | 1996-11-26 | United States Surgical Corporation | Manipulator apparatus |
DE69431206T2 (en) | 1993-09-20 | 2003-04-17 | Boston Scient Corp | DEVICE FOR REPEATING SAMPLING |
US5607386A (en) | 1993-09-21 | 1997-03-04 | Flam; Gary H. | Malleable fiberoptic intubating stylet and method |
US5558091A (en) | 1993-10-06 | 1996-09-24 | Biosense, Inc. | Magnetic determination of position and orientation |
US5400783A (en) | 1993-10-12 | 1995-03-28 | Cardiac Pathways Corporation | Endocardial mapping apparatus with rotatable arm and method |
US5465733A (en) | 1993-10-14 | 1995-11-14 | Hinohara; Tomoaki | Guide wire for catheters and method for its use |
US5445646A (en) * | 1993-10-22 | 1995-08-29 | Scimed Lifesystems, Inc. | Single layer hydraulic sheath stent delivery apparatus and method |
US5437282A (en) | 1993-10-29 | 1995-08-01 | Boston Scientific Corporation | Drive shaft for acoustic imaging catheters and flexible catheters |
US5720300A (en) * | 1993-11-10 | 1998-02-24 | C. R. Bard, Inc. | High performance wires for use in medical devices and alloys therefor |
US5507301A (en) | 1993-11-19 | 1996-04-16 | Advanced Cardiovascular Systems, Inc. | Catheter and guidewire system with flexible distal portions |
US5334167A (en) | 1993-11-19 | 1994-08-02 | Cocanower David A | Modified nasogastric tube for use in enteral feeding |
US5459700A (en) * | 1993-11-22 | 1995-10-17 | Advanced Cardiovascular Systems, Inc. | Manual timer control for inflation device |
US6673025B1 (en) * | 1993-12-01 | 2004-01-06 | Advanced Cardiovascular Systems, Inc. | Polymer coated guidewire |
US5451221A (en) | 1993-12-27 | 1995-09-19 | Cynosure, Inc. | Endoscopic light delivery system |
US6716216B1 (en) | 1998-08-14 | 2004-04-06 | Kyphon Inc. | Systems and methods for treating vertebral bodies |
US5538510A (en) | 1994-01-31 | 1996-07-23 | Cordis Corporation | Catheter having coextruded tubing |
SE9400364D0 (en) | 1994-02-02 | 1994-02-02 | Sven Eric Stangerup | Nasal catheter and procedure for the treatment of nasal bleeding |
US5904701A (en) | 1994-02-14 | 1999-05-18 | Daneshvar; Yousef | Device for aiding procedural and therapeutic interventions of the gastrointestinal tract |
US5591194A (en) * | 1994-02-18 | 1997-01-07 | C. R. Bard, Inc. | Telescoping balloon catheter and method of use |
US5411016A (en) * | 1994-02-22 | 1995-05-02 | Scimed Life Systems, Inc. | Intravascular balloon catheter for use in combination with an angioscope |
DE4405720C1 (en) * | 1994-02-23 | 1995-10-19 | Wolf Gmbh Richard | Instrument for endoscopic therapy of carpal tunnel syndrome |
AUPM409094A0 (en) | 1994-02-25 | 1994-03-24 | Trimec Securities Pty. Limited | Improvements in electromagnetic locks |
US5582167A (en) | 1994-03-02 | 1996-12-10 | Thomas Jefferson University | Methods and apparatus for reducing tracheal infection using subglottic irrigation, drainage and servoregulation of endotracheal tube cuff pressure |
US5425370A (en) | 1994-03-23 | 1995-06-20 | Echocath, Inc. | Method and apparatus for locating vibrating devices |
US5887467A (en) | 1994-03-30 | 1999-03-30 | U-Code, Inc. | Pawl & solenoid locking mechanism |
US5454817A (en) | 1994-04-11 | 1995-10-03 | Katz; David L. | Oto-nasal foreign body extractor |
US5533985A (en) | 1994-04-20 | 1996-07-09 | Wang; James C. | Tubing |
US5507795A (en) * | 1994-04-29 | 1996-04-16 | Devices For Vascular Intervention, Inc. | Catheter with perfusion system |
US5599304A (en) * | 1994-05-10 | 1997-02-04 | Mount Sinai School Of Medicine Of The City University Of New York | Sinonasal suction apparatus |
US6139510A (en) | 1994-05-11 | 2000-10-31 | Target Therapeutics Inc. | Super elastic alloy guidewire |
US5824044A (en) | 1994-05-12 | 1998-10-20 | Endovascular Technologies, Inc. | Bifurcated multicapsule intraluminal grafting system |
US5551946A (en) | 1994-05-17 | 1996-09-03 | Bullard; James R. | Multifunctional intubating guide stylet and laryngoscope |
US5497783A (en) | 1994-05-18 | 1996-03-12 | Scimed Life Systems, Inc. | Guidewire having radioscopic tip |
US5569183A (en) | 1994-06-01 | 1996-10-29 | Archimedes Surgical, Inc. | Method for performing surgery around a viewing space in the interior of the body |
JPH07327916A (en) | 1994-06-02 | 1995-12-19 | Olympus Optical Co Ltd | Visual field direction varying type endoscope |
JP3119486B2 (en) | 1994-06-17 | 2000-12-18 | 久光製薬株式会社 | Electrode for iontophoresis and device using the same |
US5633000A (en) | 1994-06-23 | 1997-05-27 | Axxia Technologies | Subcutaneous implant |
US5857998A (en) | 1994-06-30 | 1999-01-12 | Boston Scientific Corporation | Stent and therapeutic delivery system |
US5458572A (en) | 1994-07-01 | 1995-10-17 | Boston Scientific Corp. | Catheter with balloon folding into predetermined configurations and method of manufacture |
US5441497A (en) | 1994-07-14 | 1995-08-15 | Pdt Cardiovascular, Inc. | Light diffusing guidewire |
US5486181A (en) * | 1994-08-04 | 1996-01-23 | Implex Corporation | Acetabular cup, method and tool and installing the same |
US6579285B2 (en) | 1994-09-09 | 2003-06-17 | Cardiofocus, Inc. | Photoablation with infrared radiation |
US5803089A (en) | 1994-09-15 | 1998-09-08 | Visualization Technology, Inc. | Position tracking and imaging system for use in medical applications |
US5673707A (en) | 1994-09-23 | 1997-10-07 | Boston Scientific Corporation | Enhanced performance guidewire |
US5558652A (en) | 1994-10-06 | 1996-09-24 | B. Braun Medical, Inc. | Introducer with radiopaque marked tip and method of manufacture therefor |
US5722401A (en) | 1994-10-19 | 1998-03-03 | Cardiac Pathways Corporation | Endocardial mapping and/or ablation catheter probe |
US6503185B1 (en) * | 1994-10-27 | 2003-01-07 | Novoste Corporation | Method and apparatus for treating a desired area in the vascular system of a patient |
US5814029A (en) | 1994-11-03 | 1998-09-29 | Daig Corporation | Guiding introducer system for use in ablation and mapping procedures in the left ventricle |
DK0788351T3 (en) | 1994-11-10 | 2003-05-26 | Univ Kentucky Res Found | Implantable, refillable device for speed-controlled drug delivery directly to an internal part of the body |
US6059752A (en) | 1994-12-09 | 2000-05-09 | Segal; Jerome | Mechanical apparatus and method for dilating and irradiating a site of treatment |
US5637113A (en) | 1994-12-13 | 1997-06-10 | Advanced Cardiovascular Systems, Inc. | Polymer film for wrapping a stent structure |
US5664580A (en) | 1995-01-31 | 1997-09-09 | Microvena Corporation | Guidewire having bimetallic coil |
US5599576A (en) | 1995-02-06 | 1997-02-04 | Surface Solutions Laboratories, Inc. | Medical apparatus with scratch-resistant coating and method of making same |
US5599284A (en) * | 1995-02-08 | 1997-02-04 | Shea; John P. | Pre-operative nasal splint for endoscopic sinus surgery and method |
US6830785B1 (en) | 1995-03-20 | 2004-12-14 | Toto Ltd. | Method for photocatalytically rendering a surface of a substrate superhydrophilic, a substrate with a superhydrophilic photocatalytic surface, and method of making thereof |
WO1996029071A1 (en) | 1995-03-21 | 1996-09-26 | Ramot University Authority For Applied Research & Industrial Development Ltd. | Uses of antibacterial compounds |
EP0820258B1 (en) | 1995-03-23 | 2002-10-09 | Advanced Animal Technology Limited | Substance delivery device |
DE69626105T2 (en) | 1995-03-30 | 2003-10-23 | Heartport Inc | ENDOVASCULAR CATHETER FOR LEADING FROM THE HEART |
KR960032597U (en) | 1995-03-31 | 1996-10-24 | Tape recorder reservation recording switch | |
US5685838A (en) | 1995-04-17 | 1997-11-11 | Xomed-Treace, Inc. | Sinus debrider apparatus |
US5837313A (en) | 1995-04-19 | 1998-11-17 | Schneider (Usa) Inc | Drug release stent coating process |
US6638291B1 (en) | 1995-04-20 | 2003-10-28 | Micrus Corporation | Three dimensional, low friction vasoocclusive coil, and method of manufacture |
US5752522A (en) * | 1995-05-04 | 1998-05-19 | Cardiovascular Concepts, Inc. | Lesion diameter measurement catheter and method |
US6122541A (en) | 1995-05-04 | 2000-09-19 | Radionics, Inc. | Head band for frameless stereotactic registration |
US5735817A (en) | 1995-05-19 | 1998-04-07 | Shantha; T. R. | Apparatus for transsphenoidal stimulation of the pituitary gland and adjoining brain structures |
US5749357A (en) | 1995-05-19 | 1998-05-12 | Linder; Gerald S. | Malleable introducer |
US5656030A (en) | 1995-05-22 | 1997-08-12 | Boston Scientific Corporation | Bidirectional steerable catheter with deflectable distal tip |
JPH08317989A (en) | 1995-05-24 | 1996-12-03 | Piolax Inc | Guide wire for medical care |
DE69638035D1 (en) | 1995-05-26 | 2009-11-05 | Ishihara Sangyo Kaisha | Process for the preparation of substituted 1,1,1-trifluoro-3-buten-2-ones |
US5833650A (en) | 1995-06-05 | 1998-11-10 | Percusurge, Inc. | Catheter apparatus and method for treating occluded vessels |
EP0836499A1 (en) | 1995-06-07 | 1998-04-22 | Cardima, Inc. | Guiding catheter for coronary sinus |
US5752513A (en) | 1995-06-07 | 1998-05-19 | Biosense, Inc. | Method and apparatus for determining position of object |
US5729129A (en) | 1995-06-07 | 1998-03-17 | Biosense, Inc. | Magnetic location system with feedback adjustment of magnetic field generator |
US6238391B1 (en) | 1995-06-07 | 2001-05-29 | Arthrocare Corporation | Systems for tissue resection, ablation and aspiration |
US5707389A (en) * | 1995-06-07 | 1998-01-13 | Baxter International Inc. | Side branch occlusion catheter device having integrated endoscope for performing endoscopically visualized occlusion of the side branches of an anatomical passageway |
US5782795A (en) * | 1995-06-30 | 1998-07-21 | Xomed Surgical Products, Inc. | Surgical suction cutting instrument with internal irrigation |
US6258046B1 (en) * | 1995-07-06 | 2001-07-10 | Institute Of Critical Care Medicine | Method and device for assessing perfusion failure in a patient by measurement of blood flow |
US5645789A (en) | 1995-07-20 | 1997-07-08 | Navius Corporation | Distensible pet balloon and method of manufacture |
US5638819A (en) | 1995-08-29 | 1997-06-17 | Manwaring; Kim H. | Method and apparatus for guiding an instrument to a target |
US5669388A (en) | 1995-09-06 | 1997-09-23 | Echocath, Inc. | Apparatus and method for automatic placement of transducer |
US5601594A (en) * | 1995-09-14 | 1997-02-11 | Best; Barry D. | Nasal stent |
GB2305174A (en) | 1995-09-15 | 1997-04-02 | Zeneca Ltd | Chemical process |
US6027461A (en) | 1995-10-11 | 2000-02-22 | Micro Therapeutics, Inc. | Infusion guidewire having fixed core wire and flexible radiopaque marker |
US6283951B1 (en) * | 1996-10-11 | 2001-09-04 | Transvascular, Inc. | Systems and methods for delivering drugs to selected locations within the body |
WO1997013463A1 (en) | 1995-10-13 | 1997-04-17 | Transvascular, Inc. | Methods and apparatus for bypassing arterial obstructions and/or performing other transvascular procedures |
US6302875B1 (en) | 1996-10-11 | 2001-10-16 | Transvascular, Inc. | Catheters and related devices for forming passageways between blood vessels or other anatomical structures |
US6375615B1 (en) | 1995-10-13 | 2002-04-23 | Transvascular, Inc. | Tissue penetrating catheters having integral imaging transducers and their methods of use |
US5916149A (en) | 1995-10-25 | 1999-06-29 | Ryan, Jr.; Edwin H. | Shielded illumination device for ophthalmic surgery and the like |
US6113567A (en) | 1995-10-25 | 2000-09-05 | Becker; Bruce B. | Lacrimal silicone tube with reduced friction |
US6287315B1 (en) | 1995-10-30 | 2001-09-11 | World Medical Manufacturing Corporation | Apparatus for delivering an endoluminal prosthesis |
US6019736A (en) * | 1995-11-06 | 2000-02-01 | Francisco J. Avellanet | Guidewire for catheter |
US5843050A (en) | 1995-11-13 | 1998-12-01 | Micro Therapeutics, Inc. | Microcatheter |
US5749848A (en) * | 1995-11-13 | 1998-05-12 | Cardiovascular Imaging Systems, Inc. | Catheter system having imaging, balloon angioplasty, and stent deployment capabilities, and method of use for guided stent deployment |
US5827224A (en) | 1995-11-22 | 1998-10-27 | Shippert; Ronald D. | Pressure applying fluid transfer medical device |
FI100318B (en) | 1995-11-23 | 1997-11-14 | Fiskars Consumer Oy Ab | Articulated hand tools |
US5733248A (en) | 1995-11-29 | 1998-03-31 | Scimed Life Systems, Inc. | Universal guide catheter |
DE69728257T2 (en) * | 1996-01-08 | 2005-03-10 | Biosense Inc. | DEVICE FOR MYOCARDIAL VASCULATION |
US5722984A (en) | 1996-01-16 | 1998-03-03 | Iso Stent, Inc. | Antithrombogenic radioactive coating for an intravascular stent |
US6039699A (en) | 1996-01-22 | 2000-03-21 | Cordis Corporation | Stiff catheter guidewire with flexible distal portion |
US5711315A (en) * | 1996-02-15 | 1998-01-27 | Jerusalmy; Israel | Sinus lift method |
US6860264B2 (en) | 1996-02-26 | 2005-03-01 | Evergreen Medical Incorporated | Method and apparatus for endotracheal intubation using a light wand and curved guide |
US5817013A (en) | 1996-03-19 | 1998-10-06 | Enable Medical Corporation | Method and apparatus for the minimally invasive harvesting of a saphenous vein and the like |
US6679833B2 (en) | 1996-03-22 | 2004-01-20 | Sdgi Holdings, Inc. | Devices and methods for percutaneous surgery |
US5682199A (en) | 1996-03-28 | 1997-10-28 | Jedmed Instrument Company | Video endoscope with interchangeable endoscope heads |
US5779699A (en) | 1996-03-29 | 1998-07-14 | Medtronic, Inc. | Slip resistant field focusing ablation catheter electrode |
US5980503A (en) | 1996-04-08 | 1999-11-09 | Guidant Corporation | Endoscopic cardioplegia infusion cannula and method of use |
WO1997037612A1 (en) | 1996-04-10 | 1997-10-16 | Curaden Ag | Method of determining the approximal passability of an interdental space |
US6171298B1 (en) * | 1996-05-03 | 2001-01-09 | Situs Corporation | Intravesical infuser |
US7022105B1 (en) | 1996-05-06 | 2006-04-04 | Novasys Medical Inc. | Treatment of tissue in sphincters, sinuses and orifices |
US6503087B1 (en) * | 1996-05-08 | 2003-01-07 | Gaumard Scientific, Inc. | Interactive education system for teaching patient care |
US6270477B1 (en) * | 1996-05-20 | 2001-08-07 | Percusurge, Inc. | Catheter for emboli containment |
US6050972A (en) | 1996-05-20 | 2000-04-18 | Percusurge, Inc. | Guidewire inflation system |
US6652480B1 (en) | 1997-03-06 | 2003-11-25 | Medtronic Ave., Inc. | Methods for reducing distal embolization |
US5693065A (en) | 1996-06-25 | 1997-12-02 | Rains, Iii; B. Manrin | Frontal sinus stent |
US6167296A (en) | 1996-06-28 | 2000-12-26 | The Board Of Trustees Of The Leland Stanford Junior University | Method for volumetric image navigation |
US5789391A (en) | 1996-07-03 | 1998-08-04 | Inspire Pharmaceuticals, Inc. | Method of treating sinusitis with uridine triphosphates and related compounds |
US5865767A (en) * | 1996-07-10 | 1999-02-02 | Cordis Corporation | Guidewire having compound taper |
JPH1024098A (en) | 1996-07-10 | 1998-01-27 | Terumo Corp | Balloon and balloon catheter |
US5882346A (en) | 1996-07-15 | 1999-03-16 | Cardiac Pathways Corporation | Shapable catheter using exchangeable core and method of use |
US5664567A (en) | 1996-07-16 | 1997-09-09 | Linder; Gerald S. | Fenestrated nasopharyngeal airway for drainage |
US6569147B1 (en) | 1996-07-26 | 2003-05-27 | Kensey Nash Corporation | Systems and methods of use for delivering beneficial agents for revascularizing stenotic bypass grafts and other occluded blood vessels and for other purposes |
US6126682A (en) | 1996-08-13 | 2000-10-03 | Oratec Interventions, Inc. | Method for treating annular fissures in intervertebral discs |
US5797878A (en) | 1996-08-15 | 1998-08-25 | Guidant Corporation | Catheter having optimized balloon taper angle |
US5833682A (en) | 1996-08-26 | 1998-11-10 | Illumenex Corporation | Light delivery system with blood flushing capability |
US6322498B1 (en) | 1996-10-04 | 2001-11-27 | University Of Florida | Imaging scope |
US5843113A (en) | 1996-10-08 | 1998-12-01 | High; Kenneth | Endocystotomy tool |
US5971975A (en) | 1996-10-09 | 1999-10-26 | Target Therapeutics, Inc. | Guide catheter with enhanced guidewire tracking |
US6379319B1 (en) | 1996-10-11 | 2002-04-30 | Transvascular, Inc. | Systems and methods for directing and snaring guidewires |
US5820568A (en) | 1996-10-15 | 1998-10-13 | Cardiac Pathways Corporation | Apparatus and method for aiding in the positioning of a catheter |
US6016439A (en) * | 1996-10-15 | 2000-01-18 | Biosense, Inc. | Method and apparatus for synthetic viewpoint imaging |
US5779669A (en) | 1996-10-28 | 1998-07-14 | C. R. Bard, Inc. | Steerable catheter with fixed curve |
US6913763B2 (en) | 1996-11-19 | 2005-07-05 | Intrabrain International Nv | Method and device for enhanced delivery of a biologically active agent through the spinal spaces into the central nervous system of a mammal |
US5872879A (en) * | 1996-11-25 | 1999-02-16 | Boston Scientific Corporation | Rotatable connecting optical fibers |
US5836638A (en) | 1996-12-09 | 1998-11-17 | Illinois Tool Works Inc. | Fuel door assembly |
US5830188A (en) | 1996-12-11 | 1998-11-03 | Board Of Regents, The University Of Texas System | Curved cannula for continuous spinal anesthesia |
US5766194A (en) | 1996-12-23 | 1998-06-16 | Georgia Skin And Cancer Clinic, Pc | Surgical apparatus for tissue removal |
JP3949729B2 (en) | 1997-01-03 | 2007-07-25 | バイオセンス・インコーポレイテッド | Shape adaptive catheter |
US5935061A (en) | 1997-01-03 | 1999-08-10 | Biosense, Inc. | Obstetrical instrument system and method |
US6007516A (en) | 1997-01-21 | 1999-12-28 | Vasca, Inc. | Valve port and method for vascular access |
US5980551A (en) | 1997-02-07 | 1999-11-09 | Endovasc Ltd., Inc. | Composition and method for making a biodegradable drug delivery stent |
US6669689B2 (en) | 1997-02-27 | 2003-12-30 | Cryocath Technologies Inc. | Cryosurgical catheter |
US6190332B1 (en) | 1998-02-19 | 2001-02-20 | Percusurge, Inc. | Core wire with shapeable tip |
CA2322876A1 (en) * | 1997-03-06 | 1998-09-11 | Percusurge, Inc. | Intravascular aspiration system |
US5879324A (en) * | 1997-03-06 | 1999-03-09 | Von Hoffmann; Gerard | Low profile catheter shaft |
US6159170A (en) | 1997-03-13 | 2000-12-12 | Borodulin; German | Universal mechanical dilator combined with massaging action |
US6007991A (en) | 1997-03-28 | 1999-12-28 | The Research Foundation Of Suny | Antisense oligonucleotides for mitogen-activated protein kinases as therapy for cancer |
WO1999055868A2 (en) * | 1998-04-24 | 1999-11-04 | Genentech, Inc. | Fizz proteins |
US6524299B1 (en) | 1997-04-09 | 2003-02-25 | Target Therapeutics, Inc. | Flow-directed catheter |
US5941816A (en) | 1997-04-15 | 1999-08-24 | Clarus Medical Systems, Inc. | Viewing system with adapter handle for medical breathing tubes |
US6019777A (en) | 1997-04-21 | 2000-02-01 | Advanced Cardiovascular Systems, Inc. | Catheter and method for a stent delivery system |
US5862693A (en) * | 1997-05-02 | 1999-01-26 | Fort Lock Corporation | Electronically controlled security lock |
US6016429A (en) * | 1997-05-28 | 2000-01-18 | Northern Telecom Limited | Method and apparatus for minimizing cellular network costs when upgrading the electronics in an existing cellular system |
EP0988081A1 (en) | 1997-06-04 | 2000-03-29 | Advanced Cardiovascular Systems, Inc. | Steerable guidewire with enhanced distal support |
US5997562A (en) * | 1997-06-13 | 1999-12-07 | Percusurge, Inc. | Medical wire introducer and balloon protective sheath |
US5938660A (en) | 1997-06-27 | 1999-08-17 | Daig Corporation | Process and device for the treatment of atrial arrhythmia |
DE19728273C1 (en) | 1997-07-02 | 1998-12-10 | Fuss Fritz Gmbh & Co | Locking device for furniture |
US6514249B1 (en) | 1997-07-08 | 2003-02-04 | Atrionix, Inc. | Positioning system and method for orienting an ablation element within a pulmonary vein ostium |
US7799337B2 (en) * | 1997-07-21 | 2010-09-21 | Levin Bruce H | Method for directed intranasal administration of a composition |
US20010004644A1 (en) | 1997-07-21 | 2001-06-21 | Levin Bruce H. | Compositions, kits, apparatus, and methods for inhibiting cephalic inflammation |
US6491940B1 (en) | 1999-01-27 | 2002-12-10 | Bruce H. Levin | Apparatus for administering composition for inhibiting cerebral neurovascular disorders and muscular headaches |
US6432986B2 (en) | 1997-07-21 | 2002-08-13 | Bruce H. Levin | Compositions, kits, and methods for inhibiting cerebral neurovascular disorders and muscular headaches |
US5928192A (en) * | 1997-07-24 | 1999-07-27 | Embol-X, Inc. | Arterial aspiration |
DE19732031C1 (en) | 1997-07-25 | 1999-04-22 | Solvay Fluor & Derivate | 2-phase production of carboxylic acid esters |
US5908407A (en) | 1997-07-25 | 1999-06-01 | Neuroperfusion, Inc. | Retroperfusion catheter apparatus and method |
US6015414A (en) * | 1997-08-29 | 2000-01-18 | Stereotaxis, Inc. | Method and apparatus for magnetically controlling motion direction of a mechanically pushed catheter |
US5902247A (en) | 1997-09-09 | 1999-05-11 | Bioenterics Corporation | Transilluminating catheter |
US6066149A (en) | 1997-09-30 | 2000-05-23 | Target Therapeutics, Inc. | Mechanical clot treatment device with distal filter |
IL135360A (en) | 1997-10-01 | 2005-07-25 | Boston Scient Ltd | Body track dilation systems and related methods |
US6027478A (en) | 1997-10-09 | 2000-02-22 | Medical Purchasing Group, Inc. | Nasal cavity drainage and stoppage system |
US6042561A (en) | 1997-10-22 | 2000-03-28 | Ash Medical Systems, Inc. | Non-intravascular infusion access device |
US6056702A (en) | 1998-10-02 | 2000-05-02 | Cordis Corporation | Guidewire with outer sheath |
FR2770409B1 (en) | 1997-10-31 | 2000-06-23 | Soprane Sa | UNIVERSAL CATHETER |
JP4121615B2 (en) | 1997-10-31 | 2008-07-23 | オリンパス株式会社 | Endoscope |
US6048299A (en) | 1997-11-07 | 2000-04-11 | Radiance Medical Systems, Inc. | Radiation delivery catheter |
US6212419B1 (en) | 1997-11-12 | 2001-04-03 | Walter M. Blume | Method and apparatus using shaped field of repositionable magnet to guide implant |
US6179811B1 (en) | 1997-11-25 | 2001-01-30 | Medtronic, Inc. | Imbedded marker and flexible guide wire shaft |
EP0920882A3 (en) | 1997-12-04 | 2000-01-05 | Schneider Inc. | Balloon dilatation-drug delivery catheter and stent deployment-drug delivery catheter in rapid exchange configuration |
WO1999029363A1 (en) | 1997-12-08 | 1999-06-17 | Cardeon Corporation | Aortic catheter and methods for inducing cardioplegic arrest and for selective aortic perfusion |
DE69839526D1 (en) | 1997-12-15 | 2008-07-03 | Arthrocare Corp | SYSTEMS FOR ELECTRO-SURGICAL TREATMENT OF HEAD AND NECK |
AU1720199A (en) | 1997-12-23 | 1999-07-12 | Somnus Medical Technologies, Inc. | Apparatus for reducing tissue volumes by the use of energy |
US6093150A (en) | 1997-12-31 | 2000-07-25 | Acuson Corporation | Ultrasound otoscope |
US7008412B2 (en) | 1998-01-06 | 2006-03-07 | Cathlogic, Inc. | Subcutaneous port catheter system and associated method |
US5989231A (en) | 1998-01-15 | 1999-11-23 | Scimed Life Systems, Inc. | Optical gastrostomy and jejunostomy |
US6159178A (en) | 1998-01-23 | 2000-12-12 | Heartport, Inc. | Methods and devices for occluding the ascending aorta and maintaining circulation of oxygenated blood in the patient when the patient's heart is arrested |
US6295990B1 (en) * | 1998-02-03 | 2001-10-02 | Salient Interventional Systems, Inc. | Methods and systems for treating ischemia |
US6083188A (en) | 1998-02-04 | 2000-07-04 | Becker; Bruce B. | Lacrimal silicone stent with very large diameter segment insertable transnasally |
US7169141B2 (en) | 1998-02-24 | 2007-01-30 | Hansen Medical, Inc. | Surgical instrument |
US6176829B1 (en) * | 1998-02-26 | 2001-01-23 | Echocath, Inc. | Multi-beam diffraction grating imager apparatus and method |
US6183461B1 (en) | 1998-03-11 | 2001-02-06 | Situs Corporation | Method for delivering a medication |
JPH11265567A (en) | 1998-03-17 | 1999-09-28 | Mitsumi Electric Co Ltd | Disk drive |
DE19813383A1 (en) | 1998-03-26 | 1999-10-07 | Storz Karl Gmbh & Co | Device with a transmitter unit, via which the position of a medical instrument can be detected in the context of a CAS system |
JP4184602B2 (en) | 1998-03-31 | 2008-11-19 | メドトロニック バスキュラー インコーポレイテッド | Catheter, system and method for percutaneous in situ arterio-venous bypass |
US6013019A (en) * | 1998-04-06 | 2000-01-11 | Isostent, Inc. | Temporary radioisotope stent |
US6364856B1 (en) * | 1998-04-14 | 2002-04-02 | Boston Scientific Corporation | Medical device with sponge coating for controlled drug release |
US5968085A (en) | 1998-04-20 | 1999-10-19 | Medtronic, Inc. | Pacing lead with integral guidance using ultrasound |
US6450989B2 (en) | 1998-04-27 | 2002-09-17 | Artemis Medical, Inc. | Dilating and support apparatus with disease inhibitors and methods for use |
US6175752B1 (en) | 1998-04-30 | 2001-01-16 | Therasense, Inc. | Analyte monitoring device and methods of use |
US6306105B1 (en) | 1998-05-14 | 2001-10-23 | Scimed Life Systems, Inc. | High performance coil wire |
US6280411B1 (en) | 1998-05-18 | 2001-08-28 | Scimed Life Systems, Inc. | Localized delivery of drug agents |
US6183464B1 (en) | 1998-06-01 | 2001-02-06 | Inviro Medical Devices Ltd. | Safety syringe with retractable needle and universal luer coupling |
US6048358A (en) | 1998-07-13 | 2000-04-11 | Barak; Shlomo | Method and apparatus for hemostasis following arterial catheterization |
US6290689B1 (en) * | 1999-10-22 | 2001-09-18 | Corazón Technologies, Inc. | Catheter devices and methods for their use in the treatment of calcified vascular occlusions |
US6352503B1 (en) | 1998-07-17 | 2002-03-05 | Olympus Optical Co., Ltd. | Endoscopic surgery apparatus |
US5979290A (en) | 1998-07-20 | 1999-11-09 | Simeone; Salvatore | Mine clearing device |
NL1009738C2 (en) * | 1998-07-24 | 2000-01-25 | Cordis Europ | Balloon catheter with filler for stent delivery. |
US6226542B1 (en) | 1998-07-24 | 2001-05-01 | Biosense, Inc. | Three-dimensional reconstruction of intrabody organs |
US20040064105A1 (en) | 2002-09-27 | 2004-04-01 | Capes David Francis | Single-use syringe |
US6168586B1 (en) | 1998-08-07 | 2001-01-02 | Embol-X, Inc. | Inflatable cannula and method of using same |
US5954694A (en) | 1998-08-07 | 1999-09-21 | Embol-X, Inc. | Nested tubing sections and methods for making same |
US6129713A (en) | 1998-08-11 | 2000-10-10 | Embol-X, Inc. | Slidable cannula and method of use |
CN2352818Y (en) | 1998-08-12 | 1999-12-08 | 李平 | Medical use light guide |
US6152943A (en) | 1998-08-14 | 2000-11-28 | Incept Llc | Methods and apparatus for intraluminal deposition of hydrogels |
JP3244660B2 (en) | 1998-08-17 | 2002-01-07 | 旭光学工業株式会社 | Endoscope treatment tool |
AU5196999A (en) | 1998-08-17 | 2000-03-06 | Kazuhiro Noda | Operation balloon |
USD413629S (en) | 1998-08-18 | 1999-09-07 | HA-LO Industries, Inc. | Nasal tract model |
DE69914609T2 (en) | 1998-08-19 | 2005-01-05 | Cook Inc., Bloomington | Preformed guidewire |
US6149213A (en) | 1998-10-01 | 2000-11-21 | Southco, Inc. | Blind latch keeper |
US6613066B1 (en) | 1998-10-05 | 2003-09-02 | Kaneka Corporation | Balloon catheter and production method therefor |
AU1317700A (en) | 1998-10-21 | 2000-05-08 | John T. Frauens | Apparatus for percutaneous interposition balloon arthroplasty |
WO2000027461A1 (en) | 1998-11-09 | 2000-05-18 | Datascope Investment Corp. | Intra-aortic balloon catheter having an ultra-thin stretch blow molded balloon membrane |
US6174280B1 (en) * | 1998-11-19 | 2001-01-16 | Vision Sciences, Inc. | Sheath for protecting and altering the bending characteristics of a flexible endoscope |
US6234958B1 (en) | 1998-11-30 | 2001-05-22 | Medical Access Systems, Llc | Medical device introduction system including medical introducer having a plurality of access ports and methods of performing medical procedures with same |
US20030018291A1 (en) | 1999-12-08 | 2003-01-23 | Hill Frank C. | Ear tube and method of insertion |
US6464650B2 (en) | 1998-12-31 | 2002-10-15 | Advanced Cardiovascular Systems, Inc. | Guidewire with smoothly tapered segment |
US6206870B1 (en) | 1999-01-21 | 2001-03-27 | Quest Medical, Inc. | Catheter stylet handle |
DE19906191A1 (en) | 1999-02-15 | 2000-08-17 | Ingo F Herrmann | Mouldable endoscope for transmitting light and images with supplementary device has non-round cross section along longitudinal section for inserting in human or animal body opening |
US6332891B1 (en) | 1999-02-16 | 2001-12-25 | Stryker Corporation | System and method for performing image guided surgery |
US6398758B1 (en) | 1999-02-16 | 2002-06-04 | Stephen C. Jacobsen | Medicament delivery system |
US6468297B1 (en) | 1999-02-24 | 2002-10-22 | Cryovascular Systems, Inc. | Cryogenically enhanced intravascular interventions |
US10973397B2 (en) * | 1999-03-01 | 2021-04-13 | West View Research, Llc | Computerized information collection and processing apparatus |
WO2000051672A1 (en) | 1999-03-03 | 2000-09-08 | Optinose As | Nasal delivery device |
AU2876200A (en) | 1999-03-08 | 2000-09-28 | University Of Virginia Patent Foundation | Device and method for delivering a material into the paranasal sinus cavities |
US6148823A (en) | 1999-03-17 | 2000-11-21 | Stereotaxis, Inc. | Method of and system for controlling magnetic elements in the body using a gapped toroid magnet |
US6200257B1 (en) | 1999-03-24 | 2001-03-13 | Proxima Therapeutics, Inc. | Catheter with permeable hydrogel membrane |
US6389313B1 (en) | 1999-03-26 | 2002-05-14 | Kevin S. Marchitto | Laser probes for drug permeation |
US6258065B1 (en) | 1999-03-26 | 2001-07-10 | Core Dynamics, Inc. | Surgical instrument seal assembly |
EP1040842B1 (en) | 1999-03-29 | 2004-05-12 | William Cook Europe ApS | A guidewire |
DE69927474T2 (en) | 1999-03-29 | 2006-07-06 | William Cook Europe A/S | A guidewire |
US6425877B1 (en) | 1999-04-02 | 2002-07-30 | Novasys Medical, Inc. | Treatment of tissue in the digestive circulatory respiratory urinary and reproductive systems |
US6231543B1 (en) | 1999-04-15 | 2001-05-15 | Intella Interventional Systems, Inc. | Single lumen balloon catheter |
EP1171032A4 (en) | 1999-04-15 | 2008-10-29 | Surgi Vision | Methods for in vivo magnetic resonance imaging |
EP1055397B1 (en) | 1999-04-29 | 2001-05-23 | Karl Storz GmbH & Co. KG | Medical instrument for preparing tissue |
US6268574B1 (en) | 1999-04-29 | 2001-07-31 | Rudolph R. Edens | Electrical and pneumatic lock-out device |
US6689146B1 (en) | 1999-04-29 | 2004-02-10 | Stryker Corporation | Powered surgical handpiece with integrated irrigator and suction application |
WO2000065987A1 (en) * | 1999-04-30 | 2000-11-09 | Applied Medical Resources Corporation | Guidewire |
WO2000067670A1 (en) | 1999-05-07 | 2000-11-16 | Salviac Limited | An embolic protection device |
US6146415A (en) * | 1999-05-07 | 2000-11-14 | Advanced Cardiovascular Systems, Inc. | Stent delivery system |
US6758830B1 (en) | 1999-05-11 | 2004-07-06 | Atrionix, Inc. | Catheter positioning system |
US6394093B1 (en) | 1999-05-13 | 2002-05-28 | Scott Lethi | Nasopharyngeal airway with inflatable cuff |
US20020006961A1 (en) * | 1999-05-14 | 2002-01-17 | Katz Stanley E. | Method and composition for treating mammalian nasal and sinus diseases caused by inflammatory response |
DE19924440A1 (en) | 1999-05-28 | 2000-12-07 | Storz Karl Gmbh & Co Kg | Shaft for a flexible endoscope |
US6079755A (en) | 1999-06-07 | 2000-06-27 | Chang; Chih Chung | Electromagnetic lock device |
US6206900B1 (en) * | 1999-06-11 | 2001-03-27 | The General Hospital Corporation | Clot evacuation catheter |
EP1196212A2 (en) | 1999-06-15 | 2002-04-17 | Cryocath Technologies inc. | Steerable catheter |
US6890329B2 (en) | 1999-06-15 | 2005-05-10 | Cryocath Technologies Inc. | Defined deflection structure |
US6280433B1 (en) | 1999-09-09 | 2001-08-28 | Medtronic, Inc. | Introducer system |
DE29923582U1 (en) | 1999-07-08 | 2000-12-14 | Hintersdorf Steffen | Device for use within the area of the nose, in particular for insertion into the nasal cavities |
US6364900B1 (en) | 1999-07-14 | 2002-04-02 | Richard R. Heuser | Embolism prevention device |
JP3447984B2 (en) | 1999-07-21 | 2003-09-16 | 朝日インテック株式会社 | Medical guidewire |
US6596009B1 (en) | 1999-07-28 | 2003-07-22 | Jeffrey Jelic | Retrievable endoscopic orbital floor splint |
US6445939B1 (en) | 1999-08-09 | 2002-09-03 | Lightlab Imaging, Llc | Ultra-small optical probes, imaging optics, and methods for using same |
AU760700B2 (en) * | 1999-08-12 | 2003-05-22 | Wilson-Cook Medical Inc. | Dilation balloon having multiple diameters |
US6638233B2 (en) | 1999-08-19 | 2003-10-28 | Fox Hollow Technologies, Inc. | Apparatus and methods for material capture and removal |
CN1370086A (en) | 1999-08-24 | 2002-09-18 | 神经细胞治疗学公司 | Lumbar drainage catheter |
US6249180B1 (en) | 1999-09-08 | 2001-06-19 | Atmel Corporation | Phase noise and additive noise estimation in a QAM demodulator |
US6221042B1 (en) | 1999-09-17 | 2001-04-24 | Scimed Life Systems, Inc. | Balloon with reversed cones |
US6939361B1 (en) | 1999-09-22 | 2005-09-06 | Nmt Medical, Inc. | Guidewire for a free standing intervascular device having an integral stop mechanism |
JP2001095815A (en) | 1999-09-28 | 2001-04-10 | Olympus Optical Co Ltd | Microwave coagulation applicator |
WO2001022897A1 (en) | 1999-09-28 | 2001-04-05 | Novasys Medical, Inc. | Treatment of tissue by application of energy and drugs |
US6436119B1 (en) | 1999-09-30 | 2002-08-20 | Raymedica, Inc. | Adjustable surgical dilator |
US6398775B1 (en) * | 1999-10-21 | 2002-06-04 | Pulmonx | Apparatus and method for isolated lung access |
US7366562B2 (en) | 2003-10-17 | 2008-04-29 | Medtronic Navigation, Inc. | Method and apparatus for surgical navigation |
US6381485B1 (en) | 1999-10-28 | 2002-04-30 | Surgical Navigation Technologies, Inc. | Registration of human anatomy integrated for electromagnetic localization |
US6536437B1 (en) | 1999-10-29 | 2003-03-25 | Branislav M. Dragisic | Cuffed nasal airway and anesthetic wand system |
US6529756B1 (en) | 1999-11-22 | 2003-03-04 | Scimed Life Systems, Inc. | Apparatus for mapping and coagulating soft tissue in or around body orifices |
US6533754B1 (en) | 1999-11-26 | 2003-03-18 | Terumo Kabushiki Kaisha | Catheter |
US6156294A (en) | 1999-11-28 | 2000-12-05 | Scientific Development And Research, Inc. | Composition and method for treatment of otitis media |
DK200001852A (en) | 1999-12-14 | 2001-06-15 | Asahi Optical Co Ltd | Manipulation section for an endoscopic treatment instrument |
EP1241993B1 (en) | 1999-12-22 | 2007-03-28 | Boston Scientific Limited | Endoluminal occlusion-irrigation catheter |
DE10042330A1 (en) * | 1999-12-22 | 2002-03-14 | Hans Sachse | Small intestine probe, wall-reinforced |
US6450975B1 (en) | 1999-12-30 | 2002-09-17 | Advanced Cardiovascular Systems, Inc. | Ultrasonic transmission guide wire |
DE10102433B4 (en) | 2000-01-21 | 2008-07-10 | Pentax Corp. | Flexible tube for an endoscope |
US7184827B1 (en) | 2000-01-24 | 2007-02-27 | Stuart D. Edwards | Shrinkage of dilatations in the body |
US20010034530A1 (en) | 2000-01-27 | 2001-10-25 | Malackowski Donald W. | Surgery system |
US6386197B1 (en) | 2000-01-27 | 2002-05-14 | Brook D. Miller | Nasal air passageway opening device |
US6312438B1 (en) | 2000-02-01 | 2001-11-06 | Medtronic Xomed, Inc. | Rotary bur instruments having bur tips with aspiration passages |
JP4841788B2 (en) | 2000-02-04 | 2011-12-21 | コンメド エンドスコピック テクノロジーズ インコーポレイテッド | 3-lumen stone balloon catheter and method thereof |
US6589164B1 (en) * | 2000-02-15 | 2003-07-08 | Transvascular, Inc. | Sterility barriers for insertion of non-sterile apparatus into catheters or other medical devices |
US6527753B2 (en) | 2000-02-29 | 2003-03-04 | Olympus Optical Co., Ltd. | Endoscopic treatment system |
US6485475B1 (en) | 2000-03-01 | 2002-11-26 | The Board Of Regents Of The University Texas System | Introducer needle for continuous perineural catheter placement |
US6443947B1 (en) | 2000-03-01 | 2002-09-03 | Alexei Marko | Device for thermal ablation of a cavity |
US6494894B2 (en) | 2000-03-16 | 2002-12-17 | Scimed Life Systems, Inc. | Coated wire |
AU143359S (en) | 2000-03-17 | 2001-03-28 | Astrazeneca Ab | Connector for a catheter |
US6485500B1 (en) | 2000-03-21 | 2002-11-26 | Advanced Cardiovascular Systems, Inc. | Emboli protection system |
US6440061B1 (en) | 2000-03-24 | 2002-08-27 | Donald E. Wenner | Laparoscopic instrument system for real-time biliary exploration and stone removal |
JP2003528688A (en) * | 2000-03-30 | 2003-09-30 | シビヨン, インコーポレイテッド | Apparatus and method for calibrating an endoscope |
US6517478B2 (en) | 2000-03-30 | 2003-02-11 | Cbyon, Inc. | Apparatus and method for calibrating an endoscope |
US6984203B2 (en) | 2000-04-03 | 2006-01-10 | Neoguide Systems, Inc. | Endoscope with adjacently positioned guiding apparatus |
US6478776B1 (en) | 2000-04-05 | 2002-11-12 | Biocardia, Inc. | Implant delivery catheter system and methods for its use |
US6638268B2 (en) | 2000-04-07 | 2003-10-28 | Imran K. Niazi | Catheter to cannulate the coronary sinus |
US6283908B1 (en) | 2000-05-04 | 2001-09-04 | Radioactive Isolation Consortium, Llc | Vitrification of waste with conitnuous filling and sequential melting |
US6860849B2 (en) | 2000-05-08 | 2005-03-01 | Pentax Corporation | Flexible tube for an endoscope |
GB0011053D0 (en) | 2000-05-09 | 2000-06-28 | Hudson John O | Medical device and use thereof |
JP2003534056A (en) | 2000-05-19 | 2003-11-18 | シー・アール・バード・インク | Guide wire with observation function |
ATE383823T1 (en) | 2000-05-31 | 2008-02-15 | Fox Hollow Technologies Inc | EMBOLIZATION PROTECTION SYSTEM FOR VASCULAR TREATMENTS |
US6719749B1 (en) | 2000-06-01 | 2004-04-13 | Medical Components, Inc. | Multilumen catheter assembly and methods for making and inserting the same |
US6409863B1 (en) | 2000-06-12 | 2002-06-25 | Scimed Life Systems, Inc. | Methods of fabricating a catheter shaft having one or more guidewire ports |
US6847976B1 (en) * | 2000-06-15 | 2005-01-25 | Terrence B. Peace | Method and apparatus for significance testing and confidence interval construction based on user-specified distribution |
FR2810458B1 (en) | 2000-06-16 | 2004-04-09 | Entrelec Sa | ELECTRIC INTERCONNECTION COMB |
US6663589B1 (en) | 2000-06-20 | 2003-12-16 | Haim Halevy | Catheter system |
JP3345645B2 (en) | 2000-06-20 | 2002-11-18 | 東京大学長 | Body cavity observation device |
US6875212B2 (en) | 2000-06-23 | 2005-04-05 | Vertelink Corporation | Curable media for implantable medical device |
US6572590B1 (en) | 2000-07-13 | 2003-06-03 | Merit Medical Systems, Inc. | Adjustable quick-release valve with toggle capability |
JP2002028166A (en) | 2000-07-18 | 2002-01-29 | Olympus Optical Co Ltd | Treatment device for nasal cavity |
US6440389B1 (en) * | 2000-07-19 | 2002-08-27 | The General Hospital Corporation | Fluorescent agents for real-time measurement of organ function |
US20050107738A1 (en) | 2000-07-21 | 2005-05-19 | Slater Charles R. | Occludable intravascular catheter for drug delivery and method of using the same |
US6817364B2 (en) | 2000-07-24 | 2004-11-16 | Stereotaxis, Inc. | Magnetically navigated pacing leads, and methods for delivering medical devices |
RU2213530C2 (en) | 2000-07-26 | 2003-10-10 | Сунцов Виктор Владимирович | Method and device for treating the cases of paranasal sinusitis |
JP4429495B2 (en) | 2000-07-28 | 2010-03-10 | オリンパス株式会社 | Endoscope |
DE10038376C2 (en) | 2000-08-07 | 2003-04-30 | Zangenstein Elektro | Door lock for the door of an electrical household appliance |
US6569146B1 (en) | 2000-08-18 | 2003-05-27 | Scimed Life Systems, Inc. | Method and apparatus for treating saphenous vein graft lesions |
US7625335B2 (en) | 2000-08-25 | 2009-12-01 | 3Shape Aps | Method and apparatus for three-dimensional optical scanning of interior surfaces |
US6607546B1 (en) | 2000-09-01 | 2003-08-19 | Roger E. Murken | Nasal catheter |
US6564800B1 (en) * | 2000-09-20 | 2003-05-20 | Juan Rodriguez Olivares | Nasal air passage device |
US6503263B2 (en) | 2000-09-24 | 2003-01-07 | Medtronic, Inc. | Surgical micro-shaving instrument with elevator tip |
US6719763B2 (en) | 2000-09-29 | 2004-04-13 | Olympus Optical Co., Ltd. | Endoscopic suturing device |
US7052474B2 (en) | 2000-10-02 | 2006-05-30 | Sandhill Scientific, Inc. | Pharyngoesophageal monitoring systems |
US6702735B2 (en) | 2000-10-17 | 2004-03-09 | Charlotte Margaret Kelly | Device for movement along a passage |
US6537294B1 (en) | 2000-10-17 | 2003-03-25 | Advanced Cardiovascular Systems, Inc. | Delivery systems for embolic filter devices |
US6585639B1 (en) | 2000-10-27 | 2003-07-01 | Pulmonx | Sheath and method for reconfiguring lung viewing scope |
US20020055746A1 (en) | 2000-11-03 | 2002-05-09 | Alan Burke | Method and apparatus for extracting foreign bodies from nasal passages and the like |
JP2002146659A (en) | 2000-11-07 | 2002-05-22 | Sumitomo Electric Ind Ltd | Metallic nonwoven fabric and method for producing the same |
US6571131B1 (en) | 2000-11-10 | 2003-05-27 | Biosense Webster, Inc. | Deflectable catheter with modifiable handle |
JP2004529676A (en) * | 2000-11-13 | 2004-09-30 | ダブリュ アイ ティー アイ ピー コーポレーション | Treatment catheter with insulated area |
US6543452B1 (en) | 2000-11-16 | 2003-04-08 | Medilyfe, Inc. | Nasal intubation device and system for intubation |
US6714809B2 (en) | 2000-11-20 | 2004-03-30 | Surgi-Vision, Inc. | Connector and guidewire connectable thereto |
US6716813B2 (en) * | 2000-11-28 | 2004-04-06 | House Ear Institute | Use of antimicrobial proteins and peptides for the treatment of otitis media and paranasal sinusitis |
WO2002055136A2 (en) | 2000-12-01 | 2002-07-18 | Nephros Therapeutics Inc | Intrasvascular drug delivery device and use therefor |
WO2002045598A2 (en) | 2000-12-05 | 2002-06-13 | Lumend, Inc. | Catheter system for vascular re-entry from a sub-intimal space |
US6562022B2 (en) | 2000-12-13 | 2003-05-13 | Advanced Cardiovascular Systems, Inc. | Catheter with enhanced reinforcement |
US6500130B2 (en) | 2000-12-21 | 2002-12-31 | Scimed Life Systems, Inc. | Steerable guidewire |
US6672773B1 (en) | 2000-12-29 | 2004-01-06 | Amkor Technology, Inc. | Optical fiber having tapered end and optical connector with reciprocal opening |
US6544223B1 (en) * | 2001-01-05 | 2003-04-08 | Advanced Cardiovascular Systems, Inc. | Balloon catheter for delivering therapeutic agents |
KR100731007B1 (en) | 2001-01-15 | 2007-06-22 | 앰코 테크놀로지 코리아 주식회사 | stack-type semiconductor package |
US7043961B2 (en) | 2001-01-30 | 2006-05-16 | Z-Kat, Inc. | Tool calibrator and tracker system |
US6997931B2 (en) | 2001-02-02 | 2006-02-14 | Lsi Solutions, Inc. | System for endoscopic suturing |
DE10104663A1 (en) | 2001-02-02 | 2002-08-08 | Solvay Fluor & Derivate | Production of fluorine compounds |
DE10105592A1 (en) | 2001-02-06 | 2002-08-08 | Achim Goepferich | Placeholder for drug release in the frontal sinus |
JP3939158B2 (en) | 2001-02-06 | 2007-07-04 | オリンパス株式会社 | Endoscope device |
US8162816B2 (en) * | 2001-03-09 | 2012-04-24 | Boston Scientific Scimed, Inc. | System for implanting an implant and method thereof |
US6585718B2 (en) * | 2001-05-02 | 2003-07-01 | Cardiac Pacemakers, Inc. | Steerable catheter with shaft support system for resisting axial compressive loads |
US6796960B2 (en) | 2001-05-04 | 2004-09-28 | Wit Ip Corporation | Low thermal resistance elastic sleeves for medical device balloons |
US7041046B2 (en) | 2001-05-07 | 2006-05-09 | Xoft, Inc. | Combination ionizing radiation and immunomodulator delivery devices and methods for inhibiting hyperplasia |
US6712757B2 (en) | 2001-05-16 | 2004-03-30 | Stephen Becker | Endoscope sleeve and irrigation device |
US8403954B2 (en) | 2001-05-22 | 2013-03-26 | Sanostec Corp. | Nasal congestion, obstruction relief, and drug delivery |
US7532920B1 (en) | 2001-05-31 | 2009-05-12 | Advanced Cardiovascular Systems, Inc. | Guidewire with optical fiber |
US7140480B2 (en) | 2001-06-07 | 2006-11-28 | Drussel Wilfley Design, Llc | Centrifugal clutch and cover mount assembly therefor |
US6966906B2 (en) | 2001-06-08 | 2005-11-22 | Joe Denton Brown | Deflection mechanism for a surgical instrument, such as a laser delivery device and/or endoscope, and method of use |
CA2450771C (en) * | 2001-06-12 | 2010-09-07 | Johns Hopkins University School Of Medicine | Reservoir device for intraocular drug delivery |
US20030013985A1 (en) * | 2001-07-12 | 2003-01-16 | Vahid Saadat | Method for sensing temperature profile of a hollow body organ |
US7160255B2 (en) * | 2001-07-12 | 2007-01-09 | Vahid Saadat | Method and device for sensing and mapping temperature profile of a hollow body organ |
WO2003007797A2 (en) | 2001-07-17 | 2003-01-30 | Kerberos Proximal Solutions | Fluid exchange system for controlled and localized irrigation and aspiration |
AUPR649601A0 (en) | 2001-07-20 | 2001-08-09 | Redfern Polymer Optics Pty Ltd | Casting preforms for optical fibres |
US7438701B2 (en) | 2001-07-26 | 2008-10-21 | Durect Corporation | Local concentration management system |
US6616659B1 (en) | 2001-07-27 | 2003-09-09 | Starion Instruments Corporation | Polypectomy device and method |
JP2005508676A (en) | 2001-08-17 | 2005-04-07 | アンタレス・ファーマ・インコーポレーテッド | Insulin administration with a jet syringe |
JP4761671B2 (en) | 2001-08-29 | 2011-08-31 | テルモ株式会社 | Shape memory balloon, manufacturing method thereof, and balloon catheter |
US20040127820A1 (en) | 2001-09-05 | 2004-07-01 | Clayman Ralph V. | Guidewire |
US20070112358A1 (en) | 2001-09-06 | 2007-05-17 | Ryan Abbott | Systems and Methods for Treating Septal Defects |
AUPR785001A0 (en) | 2001-09-21 | 2001-10-18 | Kleiner, Daniel E. | Tamponade apparatus and method of using same |
US6918882B2 (en) | 2001-10-05 | 2005-07-19 | Scimed Life Systems, Inc. | Guidewire with stiffness blending connection |
JP3772107B2 (en) | 2001-10-12 | 2006-05-10 | オリンパス株式会社 | Endoscope system |
US20030073900A1 (en) * | 2001-10-12 | 2003-04-17 | Pranitha Senarith | System and method for monitoring the movement of an interventional device within an anatomical site |
FR2832516B1 (en) | 2001-11-19 | 2004-01-23 | Tokendo Sarl | ROTARY ENDOSCOPES WITH A DEVIED DISTAL VIEW |
JP3504935B2 (en) | 2001-11-27 | 2004-03-08 | 富士通株式会社 | Figure processing method |
US7488313B2 (en) * | 2001-11-29 | 2009-02-10 | Boston Scientific Scimed, Inc. | Mechanical apparatus and method for dilating and delivering a therapeutic agent to a site of treatment |
US6832715B2 (en) | 2001-12-03 | 2004-12-21 | Scimed Life Systems, Inc. | Guidewire distal tip soldering method |
US6612999B2 (en) | 2001-12-06 | 2003-09-02 | Cardiac Pacemakers, Inc. | Balloon actuated guide catheter |
US6755812B2 (en) | 2001-12-11 | 2004-06-29 | Cardiac Pacemakers, Inc. | Deflectable telescoping guide catheter |
US20030144683A1 (en) | 2001-12-13 | 2003-07-31 | Avantec Vascular Corporation | Inflatable members having concentrated force regions |
EP1319366A1 (en) | 2001-12-14 | 2003-06-18 | BrainLAB AG | Magnetic navigation for a catheter |
US7736301B1 (en) | 2001-12-18 | 2010-06-15 | Advanced Cardiovascular Systems, Inc. | Rotatable ferrules and interfaces for use with an optical guidewire |
US20030114732A1 (en) | 2001-12-18 | 2003-06-19 | Advanced Cardiovascular Systems, Inc. | Sheath for guiding imaging instruments |
US6939374B2 (en) | 2001-12-21 | 2005-09-06 | Scimed Life Systems, Inc. | Stents, stenting systems, and related methods for agent delivery |
US6955657B1 (en) | 2001-12-31 | 2005-10-18 | Advanced Cardiovascular Systems, Inc. | Intra-ventricular substance delivery catheter system |
US6740030B2 (en) | 2002-01-04 | 2004-05-25 | Vision Sciences, Inc. | Endoscope assemblies having working channels with reduced bending and stretching resistance |
US7493156B2 (en) | 2002-01-07 | 2009-02-17 | Cardiac Pacemakers, Inc. | Steerable guide catheter with pre-shaped rotatable shaft |
US20040158229A1 (en) | 2002-01-24 | 2004-08-12 | Quinn David G. | Catheter assembly and method of catheter insertion |
SE0200300D0 (en) | 2002-02-01 | 2002-02-01 | Aerocrine Ab | Diagnostic device and method |
US7381205B2 (en) | 2002-02-07 | 2008-06-03 | Carag Ag | Displacement device for a catheter |
US6610059B1 (en) * | 2002-02-25 | 2003-08-26 | Hs West Investments Llc | Endoscopic instruments and methods for improved bubble aspiration at a surgical site |
JP2003320031A (en) | 2002-02-26 | 2003-11-11 | Buaayu:Kk | Balloon catheter |
US7128718B2 (en) | 2002-03-22 | 2006-10-31 | Cordis Corporation | Guidewire with deflectable tip |
US7074426B2 (en) | 2002-03-27 | 2006-07-11 | Frank Kochinke | Methods and drug delivery systems for the treatment of orofacial diseases |
US6855136B2 (en) | 2002-04-03 | 2005-02-15 | Gore Enterprise Holdings, Inc. | Infusion catheter having an atraumatic tip |
US6942635B2 (en) | 2002-04-04 | 2005-09-13 | Angiodynamics, Inc. | Blood treatment catheter and method |
EP1499235B1 (en) | 2002-04-17 | 2016-08-17 | Covidien LP | Endoscope structures and techniques for navigating to a target in branched structure |
DE10217559B4 (en) | 2002-04-19 | 2004-02-19 | Universitätsklinikum Freiburg | Device for minimally invasive, intravascular aortic valve extraction |
WO2003092765A2 (en) * | 2002-05-02 | 2003-11-13 | Dubrul William R | Upper airway device and method |
US7610104B2 (en) | 2002-05-10 | 2009-10-27 | Cerebral Vascular Applications, Inc. | Methods and apparatus for lead placement on a surface of the heart |
WO2003099346A2 (en) | 2002-05-24 | 2003-12-04 | Angiotech International Ag | Compositions and methods for coating medical implants |
EP1513440A2 (en) | 2002-05-30 | 2005-03-16 | The Board of Trustees of The Leland Stanford Junior University | Apparatus and method for coronary sinus access |
US7993353B2 (en) | 2002-06-04 | 2011-08-09 | Brainlab Ag | Medical tracking system with universal interface |
US20030229332A1 (en) | 2002-06-11 | 2003-12-11 | Scimed Life Systems, Inc. | Adjustable double balloon catheter with a through lumen for stone management |
IL150189A0 (en) | 2002-06-12 | 2002-12-01 | Acoustitech Ltd | Acoustic diagnosis of sinusitis |
US7248914B2 (en) | 2002-06-28 | 2007-07-24 | Stereotaxis, Inc. | Method of navigating medical devices in the presence of radiopaque material |
GB0215270D0 (en) | 2002-07-02 | 2002-08-14 | Optinose As | Nasal devices |
US7318831B2 (en) * | 2002-07-13 | 2008-01-15 | Stryker Corporation | System and method for performing irrigated nose and throat surgery |
KR20050059075A (en) | 2002-08-20 | 2005-06-17 | 더 리전트 오브 더 유니버시티 오브 캘리포니아 | Vibration detectors, sound detectors, hearing aids, cochlear implants and related methods |
US7174774B2 (en) | 2002-08-30 | 2007-02-13 | Kimberly-Clark Worldwide, Inc. | Method and apparatus of detecting pooling of fluid in disposable or non-disposable absorbent articles |
US6783522B2 (en) | 2002-09-09 | 2004-08-31 | Angel Medical Systems, Inc. | Implantable catheter having an improved check valve |
US6619085B1 (en) | 2002-09-12 | 2003-09-16 | Hui-Hua Hsieh | Remote-controlled lock |
DK1549379T3 (en) | 2002-09-18 | 2014-01-20 | Asap Breathe Assist Pty Ltd | Nasal dilatation device |
ITVR20020094A1 (en) | 2002-09-25 | 2002-12-24 | Vittorio Marinello | APPARATUS FOR THE PROCESSING OF THE NEW SYSTEM OF TREATMENT OF THE MAXILLARY SINUSITIES, OF THE FRONTAL AND OF THE TRIGE NEVRITES AND NEVRALGIES |
US7488337B2 (en) | 2002-09-30 | 2009-02-10 | Saab Mark A | Apparatus and methods for bone, tissue and duct dilatation |
US7169163B2 (en) * | 2002-09-30 | 2007-01-30 | Bruce Becker | Transnasal method and catheter for lacrimal system |
US8317816B2 (en) | 2002-09-30 | 2012-11-27 | Acclarent, Inc. | Balloon catheters and methods for treating paranasal sinuses |
US6909263B2 (en) | 2002-10-23 | 2005-06-21 | Honeywell International Inc. | Gas turbine engine starter-generator exciter starting system and method including a capacitance circuit element |
ATE291384T1 (en) | 2002-10-25 | 2005-04-15 | Brainlab Ag | APPARATUS AND METHOD FOR CALIBRATING AN ELEMENT |
US20040220516A1 (en) * | 2002-11-04 | 2004-11-04 | Stephen Solomon | Food extraction apparatus and method |
US6899672B2 (en) | 2002-11-08 | 2005-05-31 | Scimed Life Systems, Inc. | Endoscopic imaging system including removable deflection device |
US7881769B2 (en) * | 2002-11-18 | 2011-02-01 | Mediguide Ltd. | Method and system for mounting an MPS sensor on a catheter |
AU2003295741A1 (en) | 2002-11-18 | 2004-06-15 | Stereotaxis, Inc. | Magnetically navigable balloon catheters |
US7172562B2 (en) | 2002-11-22 | 2007-02-06 | Mckinley Laurence M | System, method and apparatus for locating, measuring and evaluating the enlargement of a foramen |
DE10254814A1 (en) * | 2002-11-23 | 2004-06-03 | Fag Kugelfischer Ag | Load bearing |
US7343920B2 (en) | 2002-12-20 | 2008-03-18 | Toby E Bruce | Connective tissue repair system |
TW589170B (en) * | 2002-12-25 | 2004-06-01 | De-Yang Tian | Endoscopic device |
EP1435757A1 (en) | 2002-12-30 | 2004-07-07 | Andrzej Zarowski | Device implantable in a bony wall of the inner ear |
US20060047261A1 (en) * | 2004-06-28 | 2006-03-02 | Shailendra Joshi | Intra-arterial catheter for drug delivery |
US8016752B2 (en) | 2003-01-17 | 2011-09-13 | Gore Enterprise Holdings, Inc. | Puncturable catheter |
EP1438942A1 (en) | 2003-01-17 | 2004-07-21 | Schering Oy | An otorhinological drug delivery device |
US20040230156A1 (en) | 2003-02-13 | 2004-11-18 | Schreck Stefan Georg | Methods and devices for in-situ crosslinking of vascular tissue |
US6893393B2 (en) * | 2003-02-19 | 2005-05-17 | Boston Scientific Scimed., Inc. | Guidewire locking device and method |
NZ579430A (en) | 2003-02-21 | 2011-03-31 | Electro Cat Llc | System and method for measuring cross-sectional areas and pressure gradients in luminal organs |
US8167821B2 (en) | 2003-02-26 | 2012-05-01 | Boston Scientific Scimed, Inc. | Multiple diameter guidewire |
US7182735B2 (en) | 2003-02-26 | 2007-02-27 | Scimed Life Systems, Inc. | Elongated intracorporal medical device |
US10376711B2 (en) | 2003-03-14 | 2019-08-13 | Light Sciences Oncology Inc. | Light generating guide wire for intravascular use |
JP2006520786A (en) | 2003-03-14 | 2006-09-14 | シネクサス, インコーポレイテッド | Sinus delivery of sustained-release therapeutic agents |
CA2523777C (en) | 2003-03-14 | 2016-05-10 | Light Sciences Corporation | Light generating device to intravascular use |
US20040193073A1 (en) | 2003-03-31 | 2004-09-30 | Demello Richard M. | Composite guidewire with a linear elastic distal portion |
US7303533B2 (en) * | 2003-04-10 | 2007-12-04 | Intraluminal Therapeutics, Inc. | Shapeable intraluminal device and method therefor |
US20040267347A1 (en) | 2003-05-01 | 2004-12-30 | Cervantes Marvin John | Protective elongated sleeve for stent systems |
US7431694B2 (en) | 2003-05-16 | 2008-10-07 | Ethicon Endo-Surgery, Inc. | Method of guiding medical devices |
US7641668B2 (en) | 2003-05-16 | 2010-01-05 | Scimed Life Systems, Inc. | Fluid delivery system and related methods of use |
US20040236231A1 (en) | 2003-05-23 | 2004-11-25 | Embro Corporation | Light catheter for illuminating tissue structures |
US7108706B2 (en) | 2003-05-28 | 2006-09-19 | Rose Biomedical Development Corporation | Inflatable nasal packing device with two non-elastic, flexible bags oversized relative to nasal cavities |
JP4323221B2 (en) | 2003-05-30 | 2009-09-02 | テルモ株式会社 | Catheter assembly |
US7632291B2 (en) | 2003-06-13 | 2009-12-15 | Trivascular2, Inc. | Inflatable implant |
JP4398184B2 (en) * | 2003-06-24 | 2010-01-13 | オリンパス株式会社 | Endoscope |
US8002740B2 (en) | 2003-07-18 | 2011-08-23 | Broncus Technologies, Inc. | Devices for maintaining patency of surgically created channels in tissue |
US7097612B2 (en) | 2003-07-29 | 2006-08-29 | Endoscopic Technologies, Inc. | Tissue positioner |
US7359755B2 (en) | 2003-08-08 | 2008-04-15 | Advanced Neuromodulation Systems, Inc. | Method and apparatus for implanting an electrical stimulation lead using a flexible introducer |
US6851290B1 (en) | 2003-08-11 | 2005-02-08 | Absolute Access & Security Products, Inc. | Door lock assembly and locking system for hinged double-acting impact-traffic doors |
US20050038319A1 (en) | 2003-08-13 | 2005-02-17 | Benad Goldwasser | Gastrointestinal tool over guidewire |
US8740844B2 (en) | 2003-08-20 | 2014-06-03 | Boston Scientific Scimed, Inc. | Medical device with drug delivery member |
WO2005018466A2 (en) | 2003-08-26 | 2005-03-03 | Endius, Inc. | Access systems and methods for minimally invasive surgery |
US7313430B2 (en) | 2003-08-28 | 2007-12-25 | Medtronic Navigation, Inc. | Method and apparatus for performing stereotactic surgery |
US20050055077A1 (en) | 2003-09-05 | 2005-03-10 | Doron Marco | Very low profile medical device system having an adjustable balloon |
WO2005027994A2 (en) | 2003-09-15 | 2005-03-31 | Atrium Medical Corporation | Application of a therapeutic substance to a tissue location using a porous medical device |
US20050059930A1 (en) * | 2003-09-16 | 2005-03-17 | Michi Garrison | Method and apparatus for localized drug delivery |
US20050059931A1 (en) | 2003-09-16 | 2005-03-17 | Venomatrix | Methods and apparatus for localized and semi-localized drug delivery |
US20050113850A1 (en) | 2003-10-08 | 2005-05-26 | Tagge Bryan C. | Apparatus, system, and method for middle turbinate medializer |
US7004176B2 (en) * | 2003-10-17 | 2006-02-28 | Edwards Lifesciences Ag | Heart valve leaflet locator |
US8014849B2 (en) | 2003-11-21 | 2011-09-06 | Stryker Corporation | Rotational markers |
JP3864344B2 (en) | 2003-12-05 | 2006-12-27 | フジノン株式会社 | Endoscope insertion aid |
US7237313B2 (en) | 2003-12-05 | 2007-07-03 | Boston Scientific Scimed, Inc. | Elongated medical device for intracorporal use |
USD501677S1 (en) * | 2003-12-11 | 2005-02-08 | Bruce B. Becker | Dilatation balloon catheter |
US20050131316A1 (en) | 2003-12-15 | 2005-06-16 | Cook Incorporated | Guidewire with flexible tip |
US20070020196A1 (en) * | 2003-12-31 | 2007-01-25 | Pipkin James D | Inhalant formulation containing sulfoalkyl ether cyclodextrin and corticosteroid prepared from a unit dose suspension |
ATE534426T1 (en) | 2004-02-10 | 2011-12-15 | Synecor Llc | INTRAVASCULAR DELIVERY SYSTEM FOR THERAPEUTIC AGENTS |
CA2555473A1 (en) | 2004-02-17 | 2005-09-01 | Traxtal Technologies Inc. | Method and apparatus for registration, verification, and referencing of internal organs |
US7988705B2 (en) | 2004-03-06 | 2011-08-02 | Lumen Biomedical, Inc. | Steerable device having a corewire within a tube and combination with a functional medical component |
WO2005089670A1 (en) | 2004-03-15 | 2005-09-29 | Durect Corporation | Pharmaceutical compositions for administration to a sinus |
US20060211752A1 (en) | 2004-03-16 | 2006-09-21 | Kohn Leonard D | Use of phenylmethimazoles, methimazole derivatives, and tautomeric cyclic thiones for the treatment of autoimmune/inflammatory diseases associated with toll-like receptor overexpression |
US7282057B2 (en) | 2004-03-30 | 2007-10-16 | Wilson-Cook Medical, Inc. | Pediatric atresia magnets |
US20050234507A1 (en) | 2004-04-16 | 2005-10-20 | Jeff Geske | Medical tool for access to internal tissue |
US7452351B2 (en) | 2004-04-16 | 2008-11-18 | Kyphon Sarl | Spinal diagnostic methods and apparatus |
US7410480B2 (en) | 2004-04-21 | 2008-08-12 | Acclarent, Inc. | Devices and methods for delivering therapeutic substances for the treatment of sinusitis and other disorders |
US8146400B2 (en) * | 2004-04-21 | 2012-04-03 | Acclarent, Inc. | Endoscopic methods and devices for transnasal procedures |
US20070208252A1 (en) * | 2004-04-21 | 2007-09-06 | Acclarent, Inc. | Systems and methods for performing image guided procedures within the ear, nose, throat and paranasal sinuses |
US20110004057A1 (en) * | 2004-04-21 | 2011-01-06 | Acclarent, Inc. | Systems and methods for transnasal dilation of passageways in the ear, nose or throat |
US8864787B2 (en) | 2004-04-21 | 2014-10-21 | Acclarent, Inc. | Ethmoidotomy system and implantable spacer devices having therapeutic substance delivery capability for treatment of paranasal sinusitis |
US20060284428A1 (en) * | 2005-06-13 | 2006-12-21 | Darryl Beadle | High reliability gate lock for exterior use |
US9101384B2 (en) | 2004-04-21 | 2015-08-11 | Acclarent, Inc. | Devices, systems and methods for diagnosing and treating sinusitis and other disorders of the ears, Nose and/or throat |
US9554691B2 (en) * | 2004-04-21 | 2017-01-31 | Acclarent, Inc. | Endoscopic methods and devices for transnasal procedures |
US7419497B2 (en) * | 2004-04-21 | 2008-09-02 | Acclarent, Inc. | Methods for treating ethmoid disease |
US7361168B2 (en) | 2004-04-21 | 2008-04-22 | Acclarent, Inc. | Implantable device and methods for delivering drugs and other substances to treat sinusitis and other disorders |
US9399121B2 (en) | 2004-04-21 | 2016-07-26 | Acclarent, Inc. | Systems and methods for transnasal dilation of passageways in the ear, nose or throat |
US9089258B2 (en) | 2004-04-21 | 2015-07-28 | Acclarent, Inc. | Endoscopic methods and devices for transnasal procedures |
US8702626B1 (en) | 2004-04-21 | 2014-04-22 | Acclarent, Inc. | Guidewires for performing image guided procedures |
US7462175B2 (en) * | 2004-04-21 | 2008-12-09 | Acclarent, Inc. | Devices, systems and methods for treating disorders of the ear, nose and throat |
US8747389B2 (en) | 2004-04-21 | 2014-06-10 | Acclarent, Inc. | Systems for treating disorders of the ear, nose and throat |
US20070167682A1 (en) | 2004-04-21 | 2007-07-19 | Acclarent, Inc. | Endoscopic methods and devices for transnasal procedures |
US7803150B2 (en) | 2004-04-21 | 2010-09-28 | Acclarent, Inc. | Devices, systems and methods useable for treating sinusitis |
US7654997B2 (en) * | 2004-04-21 | 2010-02-02 | Acclarent, Inc. | Devices, systems and methods for diagnosing and treating sinusitus and other disorders of the ears, nose and/or throat |
US20060063973A1 (en) | 2004-04-21 | 2006-03-23 | Acclarent, Inc. | Methods and apparatus for treating disorders of the ear, nose and throat |
US7559925B2 (en) | 2006-09-15 | 2009-07-14 | Acclarent Inc. | Methods and devices for facilitating visualization in a surgical environment |
US8764729B2 (en) | 2004-04-21 | 2014-07-01 | Acclarent, Inc. | Frontal sinus spacer |
US7720521B2 (en) * | 2004-04-21 | 2010-05-18 | Acclarent, Inc. | Methods and devices for performing procedures within the ear, nose, throat and paranasal sinuses |
US8894614B2 (en) * | 2004-04-21 | 2014-11-25 | Acclarent, Inc. | Devices, systems and methods useable for treating frontal sinusitis |
US9351750B2 (en) * | 2004-04-21 | 2016-05-31 | Acclarent, Inc. | Devices and methods for treating maxillary sinus disease |
US20060004323A1 (en) * | 2004-04-21 | 2006-01-05 | Exploramed Nc1, Inc. | Apparatus and methods for dilating and modifying ostia of paranasal sinuses and other intranasal or paranasal structures |
WO2005110374A1 (en) | 2004-04-30 | 2005-11-24 | Allergan, Inc. | Intraocular drug delivery systems containing a therapeutic component, a cyclodextrin, and a polymeric component |
US7775968B2 (en) | 2004-06-14 | 2010-08-17 | Pneumrx, Inc. | Guided access to lung tissues |
US9289576B2 (en) | 2004-06-17 | 2016-03-22 | W. L. Gore & Associates, Inc. | Catheter assembly |
US7207981B2 (en) * | 2004-06-28 | 2007-04-24 | Medtronic Vascular, Inc. | Multi-exchange catheter guide member with improved seal |
EP1773439A4 (en) | 2004-07-14 | 2010-01-20 | By Pass Inc | Material delivery system |
US8075476B2 (en) | 2004-07-27 | 2011-12-13 | Intuitive Surgical Operations, Inc. | Cannula system and method of use |
US8277386B2 (en) | 2004-09-27 | 2012-10-02 | Volcano Corporation | Combination sensor guidewire and methods of use |
FR2859377B1 (en) | 2004-10-22 | 2006-05-12 | Bertrand Lombard | THREE DIMENSIONAL LOCATION DEVICE |
US7347868B2 (en) * | 2004-10-26 | 2008-03-25 | Baronova, Inc. | Medical device delivery catheter |
US7235099B1 (en) | 2004-12-14 | 2007-06-26 | Micromedics, Inc. | Sphenoid sinus stent |
US7840254B2 (en) | 2005-01-18 | 2010-11-23 | Philips Electronics Ltd | Electromagnetically tracked K-wire device |
US8109981B2 (en) | 2005-01-25 | 2012-02-07 | Valam Corporation | Optical therapies and devices |
US20060173382A1 (en) | 2005-01-31 | 2006-08-03 | John Schreiner | Guidewire with superelastic core |
US20080188803A1 (en) * | 2005-02-03 | 2008-08-07 | Jang G David | Triple-profile balloon catheter |
US7195612B2 (en) | 2005-03-31 | 2007-03-27 | Gordis Corporation | Esophageal balloon catheter with visual marker |
KR20080005939A (en) | 2005-04-04 | 2008-01-15 | 시네수스 인코포레이티드 | Device and methods for treating paranasal sinus conditions |
US7896891B2 (en) | 2005-05-20 | 2011-03-01 | Neotract, Inc. | Apparatus and method for manipulating or retracting tissue and anatomical structure |
US8951225B2 (en) * | 2005-06-10 | 2015-02-10 | Acclarent, Inc. | Catheters with non-removable guide members useable for treatment of sinusitis |
US8197433B2 (en) | 2005-06-20 | 2012-06-12 | Otomedics Advanced Technologies, Ltd. | Ear tubes |
ATE481938T1 (en) | 2005-09-20 | 2010-10-15 | Medsys S A | DEVICE AND METHOD FOR CONTROLLING A REMOTE DEVICE |
GB0519259D0 (en) | 2005-09-21 | 2005-10-26 | Imp College Innovations Ltd | A device |
USD534216S1 (en) * | 2005-09-23 | 2006-12-26 | Acclarent, Inc. | Anatomical model and demonstration/training device |
US7648367B1 (en) * | 2005-09-23 | 2010-01-19 | Acclarent, Inc. | Anatomical models and methods for training and demonstration of medical procedures |
US8114113B2 (en) * | 2005-09-23 | 2012-02-14 | Acclarent, Inc. | Multi-conduit balloon catheter |
US7833282B2 (en) | 2006-02-27 | 2010-11-16 | Mandpe Aditi H | Eustachian tube device and method |
US8585753B2 (en) | 2006-03-04 | 2013-11-19 | John James Scanlon | Fibrillated biodegradable prosthesis |
US7520876B2 (en) * | 2006-04-21 | 2009-04-21 | Entellus Medical, Inc. | Device and method for treatment of sinusitis |
WO2007134215A2 (en) | 2006-05-12 | 2007-11-22 | Entrigue Surgical, Inc. | Middle turbinate medializer |
US8190389B2 (en) | 2006-05-17 | 2012-05-29 | Acclarent, Inc. | Adapter for attaching electromagnetic image guidance components to a medical device |
US7927271B2 (en) | 2006-05-17 | 2011-04-19 | C.R. Bard, Inc. | Endoscope tool coupling |
US20070269385A1 (en) | 2006-05-18 | 2007-11-22 | Mercator Medsystems, Inc | Devices, methods, and systems for delivering therapeutic agents for the treatment of sinusitis, rhinitis, and other disorders |
US8535707B2 (en) * | 2006-07-10 | 2013-09-17 | Intersect Ent, Inc. | Devices and methods for delivering active agents to the osteomeatal complex |
US9820688B2 (en) | 2006-09-15 | 2017-11-21 | Acclarent, Inc. | Sinus illumination lightwire device |
WO2008036368A2 (en) | 2006-09-20 | 2008-03-27 | University Of Virginia Patent Foundation | Tube, stent and collar insertion device |
US7535991B2 (en) | 2006-10-16 | 2009-05-19 | Oraya Therapeutics, Inc. | Portable orthovoltage radiotherapy |
WO2008051918A2 (en) | 2006-10-23 | 2008-05-02 | Allux Medical, Inc. | Methods, devices and kits for phototherapy and photodynamic therapy treatment of body cavities |
US7634233B2 (en) | 2006-11-27 | 2009-12-15 | Chung Shan Institute Of Science And Technology | Transmission system with interference avoidance capability and method thereof |
US8104483B2 (en) | 2006-12-26 | 2012-01-31 | The Spectranetics Corporation | Multi-port light delivery catheter and methods for the use thereof |
JP2008161491A (en) | 2006-12-28 | 2008-07-17 | Asahi Intecc Co Ltd | Medical guide wire |
US8439687B1 (en) | 2006-12-29 | 2013-05-14 | Acclarent, Inc. | Apparatus and method for simulated insertion and positioning of guidewares and other interventional devices |
US20080172033A1 (en) * | 2007-01-16 | 2008-07-17 | Entellus Medical, Inc. | Apparatus and method for treatment of sinusitis |
US20080183128A1 (en) | 2007-01-24 | 2008-07-31 | John Morriss | Methods, devices and systems for treatment and/or diagnosis of disorders of the ear, nose and throat |
US8052693B2 (en) | 2007-04-19 | 2011-11-08 | Acclarent, Inc. | System and method for the simultaneous automated bilateral delivery of pressure equalization tubes |
FR2916144A1 (en) | 2007-05-14 | 2008-11-21 | Olivier Pascal Bruno Rollet | Endotracheal catheter for use during surgery, has tube including distal end connected to collar and another end connected to circular pusher, where pusher is actuated outside buccal cavity by user after endotracheal intubation |
EP2160140B1 (en) | 2007-06-26 | 2014-11-05 | Galit Avior | Eustachian tube device |
EP2190520A4 (en) | 2007-09-20 | 2011-01-26 | Estimme Ltd | Electrical stimulation in the middle ear for treatment of hearing related disorders |
US20090088728A1 (en) | 2007-09-28 | 2009-04-02 | Dollar Michael L | Malleable sleeve for balloon catheter and endoscopic surgical method |
USD590502S1 (en) | 2007-11-13 | 2009-04-14 | Karl Storz Gmbh & Co. Kg | Grip for laparoscope |
US20100198191A1 (en) | 2007-12-20 | 2010-08-05 | Acclarent, Inc. | Method and system for treating target tissue within the eustachian tube |
US20100274188A1 (en) | 2007-12-20 | 2010-10-28 | Acclarent, Inc. | Method and System for Treating Target Tissue Within the Eustachian Tube |
US20090163890A1 (en) | 2007-12-20 | 2009-06-25 | Acclarent, Inc. | Method and System for Accessing, Diagnosing and Treating Target Tissue Regions Within the Middle Ear and the Eustachian Tube |
USD586916S1 (en) | 2008-05-09 | 2009-02-17 | Lifescan Scotland, Ltd. | Handheld lancing device |
USD586465S1 (en) | 2008-05-09 | 2009-02-10 | Lifescan Scotland Limited | Handheld lancing device |
US8642631B2 (en) | 2008-05-27 | 2014-02-04 | University Of Melbourne | Methods of treating mammals with eustachian tube dysfunctions |
US20100030031A1 (en) | 2008-07-30 | 2010-02-04 | Acclarent, Inc. | Swing prism endoscope |
AU2009293312B2 (en) * | 2008-09-18 | 2015-07-09 | Acclarent, Inc. | Methods and apparatus for treating disorders of the ear nose and throat |
US20100087811A1 (en) | 2008-10-06 | 2010-04-08 | Coaptus Medical Corporation | Systems and Methods for Controlling Patient Catheters |
USD630321S1 (en) * | 2009-05-08 | 2011-01-04 | Angio Dynamics, Inc. | Probe handle |
US8608360B2 (en) | 2009-05-18 | 2013-12-17 | Günther Nath | Liquid light guide having position retaining function |
USD633207S1 (en) | 2009-09-11 | 2011-02-22 | Stryker Trauma Ag | Multi-planar coupling |
-
2005
- 2005-01-18 US US11/037,548 patent/US7462175B2/en active Active
-
2006
- 2006-01-18 WO PCT/US2006/002004 patent/WO2006078884A2/en active Application Filing
-
2007
- 2007-10-26 US US11/925,357 patent/US8088101B2/en active Active
- 2007-10-26 US US11/925,540 patent/US7500971B2/en not_active Expired - Lifetime
- 2007-10-29 US US11/926,377 patent/US7641644B2/en not_active Expired - Lifetime
- 2007-10-29 US US11/926,326 patent/US7645272B2/en active Active
- 2007-10-29 US US11/926,467 patent/US8123722B2/en active Active
- 2007-10-29 US US11/926,565 patent/US8961495B2/en active Active
- 2007-10-29 US US11/926,524 patent/US7727226B2/en active Active
-
2010
- 2010-04-07 US US12/756,099 patent/US8852143B2/en not_active Expired - Lifetime
- 2010-06-30 US US12/828,170 patent/US8764709B2/en active Active
-
2011
- 2011-11-21 US US13/301,406 patent/US20120071824A1/en not_active Abandoned
-
2014
- 2014-03-21 US US14/221,621 patent/US9241834B2/en not_active Expired - Lifetime
Patent Citations (3)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US6332089B1 (en) | 1996-02-15 | 2001-12-18 | Biosense, Inc. | Medical procedures and apparatus using intrabody probes |
US6328564B1 (en) | 1999-04-06 | 2001-12-11 | Raymond C. Thurow | Deep ear canal locating and head orienting device |
EP1042998A2 (en) | 1999-04-07 | 2000-10-11 | Medtronic Ave, Inc. | Endolumenal prosthesis delivery assembly and method of use |
Cited By (60)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US11019989B2 (en) | 2004-04-21 | 2021-06-01 | Acclarent, Inc. | Methods and apparatus for treating disorders of the ear nose and throat |
US10695080B2 (en) | 2004-04-21 | 2020-06-30 | Acclarent, Inc. | Devices, systems and methods for diagnosing and treating sinusitis and other disorders of the ears, nose and/or throat |
US11529502B2 (en) | 2004-04-21 | 2022-12-20 | Acclarent, Inc. | Apparatus and methods for dilating and modifying ostia of paranasal sinuses and other intranasal or paranasal structures |
US10500380B2 (en) | 2004-04-21 | 2019-12-10 | Acclarent, Inc. | Devices, systems and methods useable for treating sinusitis |
US10492810B2 (en) | 2004-04-21 | 2019-12-03 | Acclarent, Inc. | Devices, systems and methods for diagnosing and treating sinusitis and other disorders of the ears, nose and/or throat |
US10441758B2 (en) | 2004-04-21 | 2019-10-15 | Acclarent, Inc. | Frontal sinus spacer |
US9055965B2 (en) | 2004-04-21 | 2015-06-16 | Acclarent, Inc. | Devices, systems and methods useable for treating sinusitis |
US11511090B2 (en) | 2004-04-21 | 2022-11-29 | Acclarent, Inc. | Devices, systems and methods useable for treating sinusitis |
US10631756B2 (en) | 2004-04-21 | 2020-04-28 | Acclarent, Inc. | Guidewires for performing image guided procedures |
US9089258B2 (en) | 2004-04-21 | 2015-07-28 | Acclarent, Inc. | Endoscopic methods and devices for transnasal procedures |
US11202644B2 (en) | 2004-04-21 | 2021-12-21 | Acclarent, Inc. | Shapeable guide catheters and related methods |
US10702295B2 (en) | 2004-04-21 | 2020-07-07 | Acclarent, Inc. | Methods and apparatus for treating disorders of the ear nose and throat |
US9610428B2 (en) | 2004-04-21 | 2017-04-04 | Acclarent, Inc. | Devices, systems and methods useable for treating frontal sinusitis |
US10779752B2 (en) | 2004-04-21 | 2020-09-22 | Acclarent, Inc. | Guidewires for performing image guided procedures |
US11065061B2 (en) | 2004-04-21 | 2021-07-20 | Acclarent, Inc. | Systems and methods for performing image guided procedures within the ear, nose, throat and paranasal sinuses |
US10188413B1 (en) | 2004-04-21 | 2019-01-29 | Acclarent, Inc. | Deflectable guide catheters and related methods |
US11020136B2 (en) | 2004-04-21 | 2021-06-01 | Acclarent, Inc. | Deflectable guide catheters and related methods |
US9649477B2 (en) | 2004-04-21 | 2017-05-16 | Acclarent, Inc. | Frontal sinus spacer |
US10098652B2 (en) | 2004-04-21 | 2018-10-16 | Acclarent, Inc. | Systems and methods for transnasal dilation of passageways in the ear, nose or throat |
US11864725B2 (en) | 2004-04-21 | 2024-01-09 | Acclarent, Inc. | Devices, systems and methods for diagnosing and treating sinusitis and other disorders of the ears, nose and/or throat |
US10034682B2 (en) | 2004-04-21 | 2018-07-31 | Acclarent, Inc. | Devices, systems and methods useable for treating frontal sinusitis |
US10874838B2 (en) | 2004-04-21 | 2020-12-29 | Acclarent, Inc. | Systems and methods for transnasal dilation of passageways in the ear, nose or throat |
US10856727B2 (en) | 2004-04-21 | 2020-12-08 | Acclarent, Inc. | Endoscopic methods and devices for transnasal procedures |
US10806477B2 (en) | 2004-04-21 | 2020-10-20 | Acclarent, Inc. | Systems and methods for transnasal dilation of passageways in the ear, nose or throat |
US9826999B2 (en) | 2004-04-21 | 2017-11-28 | Acclarent, Inc. | Methods and apparatus for treating disorders of the ear nose and throat |
US9039657B2 (en) | 2004-08-04 | 2015-05-26 | Acclarent, Inc. | Implantable devices and methods for delivering drugs and other substances to treat sinusitis and other disorders |
US9084876B2 (en) | 2004-08-04 | 2015-07-21 | Acclarent, Inc. | Implantable devices and methods for delivering drugs and other substances to treat sinusitis and other disorders |
US9039680B2 (en) | 2004-08-04 | 2015-05-26 | Acclarent, Inc. | Implantable devices and methods for delivering drugs and other substances to treat sinusitis and other disorders |
US10842978B2 (en) | 2005-06-10 | 2020-11-24 | Acclarent, Inc. | Catheters with non-removable guide members useable for treatment of sinusitis |
US10124154B2 (en) | 2005-06-10 | 2018-11-13 | Acclarent, Inc. | Catheters with non-removable guide members useable for treatment of sinusitis |
US9999752B2 (en) | 2005-09-23 | 2018-06-19 | Acclarent, Inc. | Multi-conduit balloon catheter |
US10639457B2 (en) | 2005-09-23 | 2020-05-05 | Acclarent, Inc. | Multi-conduit balloon catheter |
US9050440B2 (en) | 2005-09-23 | 2015-06-09 | Acclarent, Inc. | Multi-conduit balloon catheter |
US9629656B2 (en) | 2006-05-17 | 2017-04-25 | Acclarent, Inc. | Adapter for attaching electromagnetic image guidance components to a medical device |
US9603506B2 (en) | 2006-09-15 | 2017-03-28 | Acclarent, Inc. | Methods and devices for facilitating visualization in a surgical environment |
US10716629B2 (en) | 2006-09-15 | 2020-07-21 | Acclarent, Inc. | Methods and devices for facilitating visualization in a surgical environment |
US9820688B2 (en) | 2006-09-15 | 2017-11-21 | Acclarent, Inc. | Sinus illumination lightwire device |
US9615775B2 (en) | 2007-04-30 | 2017-04-11 | Acclarent, Inc. | Methods and devices for ostium measurements |
US10206821B2 (en) | 2007-12-20 | 2019-02-19 | Acclarent, Inc. | Eustachian tube dilation balloon with ventilation path |
US11311419B2 (en) | 2007-12-20 | 2022-04-26 | Acclarent, Inc. | Eustachian tube dilation balloon with ventilation path |
US9861793B2 (en) | 2008-03-10 | 2018-01-09 | Acclarent, Inc. | Corewire design and construction for medical devices |
US10271719B2 (en) | 2008-07-30 | 2019-04-30 | Acclarent, Inc. | Paranasal ostium finder devices and methods |
US11116392B2 (en) | 2008-07-30 | 2021-09-14 | Acclarent, Inc. | Paranasal ostium finder devices and methods |
US9750401B2 (en) | 2008-07-30 | 2017-09-05 | Acclarent, Inc. | Paranasal ostium finder devices and methods |
RU2506056C2 (en) * | 2008-09-18 | 2014-02-10 | Аккларент, Инк. | Methods and apparatus for treating ear, nose and throat diseases |
US11207087B2 (en) | 2009-03-20 | 2021-12-28 | Acclarent, Inc. | Guide system with suction |
US10524814B2 (en) | 2009-03-20 | 2020-01-07 | Acclarent, Inc. | Guide system with suction |
US9636258B2 (en) | 2009-03-31 | 2017-05-02 | Acclarent, Inc. | System and method for treatment of non-ventilating middle ear by providing a gas pathway through the nasopharynx |
US10376416B2 (en) | 2009-03-31 | 2019-08-13 | Acclarent, Inc. | System and method for treatment of non-ventilating middle ear by providing a gas pathway through the nasopharynx |
US9072626B2 (en) | 2009-03-31 | 2015-07-07 | Acclarent, Inc. | System and method for treatment of non-ventilating middle ear by providing a gas pathway through the nasopharynx |
US10806891B2 (en) | 2009-09-21 | 2020-10-20 | Cook Regentec Llc | Method for infusing stem cells |
RU2572745C2 (en) * | 2009-12-28 | 2016-01-20 | Аккларент, Инк. | Removing tissue from paranasal sinus and nasal cavity |
KR101825346B1 (en) * | 2009-12-29 | 2018-02-05 | 아클라런트, 인코포레이션 | System for treating target tissue within the eustachian tube |
KR20180014855A (en) * | 2009-12-29 | 2018-02-09 | 아클라런트, 인코포레이션 | System for treating target tissue within the eustachian tube |
KR101885510B1 (en) | 2009-12-29 | 2018-08-07 | 아클라런트, 인코포레이션 | System for treating target tissue within the eustachian tube |
WO2011082139A1 (en) * | 2009-12-29 | 2011-07-07 | Acclarent, Inc. | System for treating target ti s sue within the eustachian tube |
EP2519300B1 (en) | 2009-12-29 | 2020-08-12 | Acclarent, Inc. | System for treating target tissue within the eustachian tube |
CN102740920A (en) * | 2009-12-29 | 2012-10-17 | 阿克拉伦特公司 | System for treating target tissue within the eustachian tube |
US9629684B2 (en) | 2013-03-15 | 2017-04-25 | Acclarent, Inc. | Apparatus and method for treatment of ethmoid sinusitis |
US10524869B2 (en) | 2013-03-15 | 2020-01-07 | Acclarent, Inc. | Apparatus and method for treatment of ethmoid sinusitis |
Also Published As
Publication number | Publication date |
---|---|
US20080097400A1 (en) | 2008-04-24 |
US7500971B2 (en) | 2009-03-10 |
WO2006078884A3 (en) | 2007-11-01 |
US20080097514A1 (en) | 2008-04-24 |
US7641644B2 (en) | 2010-01-05 |
US20140200443A1 (en) | 2014-07-17 |
US8961495B2 (en) | 2015-02-24 |
US7727226B2 (en) | 2010-06-01 |
US20100268245A1 (en) | 2010-10-21 |
US7462175B2 (en) | 2008-12-09 |
US8088101B2 (en) | 2012-01-03 |
US20080234720A1 (en) | 2008-09-25 |
US20080132938A1 (en) | 2008-06-05 |
US20080097515A1 (en) | 2008-04-24 |
US20100198247A1 (en) | 2010-08-05 |
US8764709B2 (en) | 2014-07-01 |
US20080097239A1 (en) | 2008-04-24 |
US8852143B2 (en) | 2014-10-07 |
US20060095066A1 (en) | 2006-05-04 |
US9241834B2 (en) | 2016-01-26 |
US7645272B2 (en) | 2010-01-12 |
US20120071824A1 (en) | 2012-03-22 |
US8123722B2 (en) | 2012-02-28 |
US20080097516A1 (en) | 2008-04-24 |
Similar Documents
Publication | Publication Date | Title |
---|---|---|
US9241834B2 (en) | Devices, systems and methods for treating disorders of the ear, nose and throat | |
EP2532300B1 (en) | Paranasal insertion device | |
US10695080B2 (en) | Devices, systems and methods for diagnosing and treating sinusitis and other disorders of the ears, nose and/or throat | |
US9101384B2 (en) | Devices, systems and methods for diagnosing and treating sinusitis and other disorders of the ears, Nose and/or throat |
Legal Events
Date | Code | Title | Description |
---|---|---|---|
121 | Ep: the epo has been informed by wipo that ep was designated in this application | ||
NENP | Non-entry into the national phase |
Ref country code: DE |
|
WWE | Wipo information: entry into national phase |
Ref document number: 2006718986 Country of ref document: EP |