DE19537084A1 - Catheter for transmyocardial revasculation with guidable multi=ID main catheter - Google Patents

Catheter for transmyocardial revasculation with guidable multi=ID main catheter

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Publication number
DE19537084A1
DE19537084A1 DE19537084A DE19537084A DE19537084A1 DE 19537084 A1 DE19537084 A1 DE 19537084A1 DE 19537084 A DE19537084 A DE 19537084A DE 19537084 A DE19537084 A DE 19537084A DE 19537084 A1 DE19537084 A1 DE 19537084A1
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Germany
Prior art keywords
catheter
wall
fixation
heart
catheters
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Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
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Application number
DE19537084A
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German (de)
Inventor
Hans-Hinrich Prof Dr M Sievers
Wolfgang Kloess
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SIEVERS HANS HINRICH PROF DR M
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SIEVERS HANS HINRICH PROF DR M
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Priority to DE19537084A priority Critical patent/DE19537084A1/en
Publication of DE19537084A1 publication Critical patent/DE19537084A1/en
Withdrawn legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
    • A61B18/22—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor
    • A61B18/24—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor with a catheter
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1492—Probes or electrodes therefor having a flexible, catheter-like structure, e.g. for heart ablation
    • 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
    • A61B17/3203—Fluid jet cutting instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00017—Electrical control of surgical instruments
    • A61B2017/00022—Sensing or detecting at the treatment site
    • A61B2017/00106—Sensing or detecting at the treatment site ultrasonic
    • A61B2017/0011—Sensing or detecting at the treatment site ultrasonic piezoelectric
    • 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
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00005—Cooling or heating of the probe or tissue immediately surrounding the probe
    • A61B2018/00041—Heating, e.g. defrosting
    • 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
    • A61B2018/00053—Mechanical features of the instrument of device
    • A61B2018/00214—Expandable means emitting energy, e.g. by elements carried thereon
    • 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
    • A61B2018/00053—Mechanical features of the instrument of device
    • A61B2018/00273—Anchoring means for temporary attachment of a device to 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
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/1206—Generators therefor
    • A61B2018/1246—Generators therefor characterised by the output polarity
    • A61B2018/1253—Generators therefor characterised by the output polarity monopolar
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/1206—Generators therefor
    • A61B2018/1246—Generators therefor characterised by the output polarity
    • A61B2018/126—Generators therefor characterised by the output polarity bipolar
    • 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
    • A61B90/37—Surgical systems with images on a monitor during operation
    • A61B2090/378—Surgical systems with images on a monitor during operation using ultrasound
    • A61B2090/3782—Surgical systems with images on a monitor during operation using ultrasound transmitter or receiver in catheter or minimal invasive instrument
    • A61B2090/3784—Surgical systems with images on a monitor during operation using ultrasound transmitter or receiver in catheter or minimal invasive instrument both receiver and transmitter being in the instrument or receiver being also transmitter
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N7/00—Ultrasound therapy
    • A61N7/02—Localised ultrasound hyperthermia

Abstract

The catheter has a main catheter (10) and multiple auxiliary catheters (12, 14). At least two of the auxiliary catheters are provided with a unit (16) for fixation at the inner wall of the heart. Some of the auxiliary catheters at least are provided with piezoelectric elements in the region of their distal ends, to be controlled across the catheter, for the transmission and the reception of ultrasonic energy. The piezoelectric element of the fixation catheter is designed as a piezofoil (20), surround annularly the fixation unit (16). The auxiliary catheter (14) has a unit (18) for piercing a fine hole in the inner wall of the heart. This unit is a laser beam unit.

Description

Die Erfindung betrifft einen Katheter zur transmyokar­ dialen Revaskularisation mit einem lenkbaren, mehrlumi­ gen Mutterkatheter und einer Mehrzahl von von dem Mut­ terkatheter geführten, einzeln lenkbaren Tochterkathe­ tern, wobei wenigstens zwei der Tochterkatheter an ihrem distalen Ende mit einer Einrichtung zu des sen Fixation an der Innenwandung des Herzens versehen ist und ein weiteres der Tochterkatheter mit einer Einrichtung zum Einbringen eines feinen Lochs in die Innenwandung des Herzens versehen ist.The invention relates to a catheter for transmyocaric dial revascularization with a steerable, multi-lumi gene catheter and a plurality of of the courage guided catheter, individually steerable daughter cat tern, with at least two of the daughter catheters on their  distal end with a device for its fixation is provided on the inner wall of the heart and a another of the daughter catheters with a device for Make a fine hole in the inner wall of the Heart is provided.

In der EP 0 515 867 A2 wird ein Katheter beschrieben, das zur transmyokardialen Revaskularisation dient, also zur Einbringung von Löchern in die Innenwandung des Her­ zens.EP 0 515 867 A2 describes a catheter that serves for transmyocardial revascularization, so for making holes in the inner wall of the Her zens.

Die Einbringung von Löchern in die Myokardwand kann be­ wirken, daß minder durchblutete Herzmuskelbezirke mit Sauerstoff aus der linken Herzkammer versorgt werden. Ein solcher Eingriff kann in vielen Fällen ansonsten er­ forderliche Bypassoperationen oder Ballondilatationen langfristig vermeiden lassen.The introduction of holes in the myocardial wall can be work that less circulated cardiac muscle areas with Oxygen are supplied from the left ventricle. Such an intervention can otherwise he in many cases required bypass surgery or balloon dilation long-term avoidance.

Bei einem solchen Eingriff sind die Kontrolle und die Steuerung des Ortes und der Tiefe des in das Myokard einzubringenden Loches von großer Bedeutung: Die Löcher sind in einem vorgegebenen Bereich mit möglichst regel­ mäßigen Abständen einzubringen, die Tiefe der Löcher ist der Dicke des Myokard entsprechend zu bestimmen, wobei ein Durchdringen des Myokards zuverlässig ausgeschlossen sein muß.With such an intervention, the control and the Control the location and depth of the myocardium hole of great importance: the holes are in a given area with rules as possible spacing, the depth of the holes is to determine the thickness of the myocardium, whereby penetration of the myocardium is reliably excluded have to be.

Der Erfindung liegt damit die Aufgabe zugrunde, ein Kat­ heter zur transmyokardialen Revaskularisation zu schaf­ fen, bei der eine bessere Kontrolle des Ortes und der Tiefe der in das Myokard eingebrachten Löcher möglich ist. The invention is therefore based on the task of a cat hetero to transmyocardial revascularization where better control of the place and the Depth of the holes made in the myocardium possible is.  

Erfindungsgemäß wird diese Aufgabe dadurch gelöst, daß wenigstens einige der Tochterkatheter im Bereich ihrer distalen Enden mit über das Katheter anzusteuernden pie­ zoelektrischen Elementen zum Aussenden und zum Empfangen von Ultraschallenergie versehen sind.According to the invention this object is achieved in that at least some of the daughter catheters in the area of theirs distal ends with pie to be controlled via the catheter zoelectric elements for sending and receiving are provided with ultrasonic energy.

Dabei können die piezoelektrischen Elemente der Fixati­ onskatheter, aber auch des Lochungskatheters als die Fi­ xationseinrichtung bzw. die Lochungseinrichtung ringför­ mig umgebende Piezofolie ausgebildet sein.The piezoelectric elements of the Fixati on catheter, but also of the perforated catheter as the fi xationseinrichtung or the perforation device ringför mig surrounding piezo film.

Die Ausgestaltung der Fixationseinrichtung ist nicht Ge­ genstand der Erfindung, es kann sich dabei beispielswei­ se um einen Bohrhaken handeln oder aber um einen Saug­ kopf. Auch die Ausgestaltung der Lochungseinrichtung ist nicht Gegenstand der Erfindung, dabei kann es sich um eine Laserfiber, eine Nadel, einen Heizdraht oder einen Hochdruckstrahl handeln.The design of the fixation device is not Ge subject of the invention, it can for example se a hook or a suction head. The design of the punching device is also not the subject of the invention, it can be a laser fiber, a needle, a heating wire or one Act high pressure jet.

Die Erfindung wird im folgenden anhand einer Zeichnung erläutert. Dabei zeigt:The invention is described below with reference to a drawing explained. It shows:

Fig. 1 eine schematische Darstellung des Katheters, Fig. 1 is a schematic illustration of the catheter,

Fig. 2 eine vergrößerte Schnittansicht durch das Kat­ heter, Fig. 2 is an enlarged sectional view through the heter Kat,

Fig. 3 eine vergrößerte Darstellung des distalen Tei­ les des Katheters, wobei anders als bei dem in den Fig. 1 und 2 dargestellten Katheter 3 Fixations-Tochterkatheter vorgesehen sind, und Fig. 3 is an enlarged view of the distal Tei les of the catheter, unlike the example shown in Figs. 1 and 2 catheter 3 fixation daughter catheters are provided, and

Fig. 4 einen zur Darstellung dienenden PC. Fig. 4 is a PC used for illustration.

Das in Fig. 1 gezeigte Katheter besteht aus einem Mut­ terkatheter 10, das drei Tochterkatheter 12, 14 führt. Die beiden Tochterkatheter 12 sind an ihrem distalen En­ de mit einem Bohrhaken 16 versehen, der zur Fixation des freien Endes des Katheters an der Innenwandung des Her­ zens dient. Das dritte Tochterkatheter 14 ist an seinem freien Ende mit einer Einrichtung 18 versehen, die dazu in der Lage ist, ein feines Loch in die Innenwandung des Herzens einzubringen. Bei dem dargestellten Ausführungs­ beispiel kann es sich dabei insbesondere um das Ende ei­ nes Laserfibers oder aber um einen mit hochfrequenter Energie beaufschlagten Draht handeln.The catheter shown in Fig. 1 consists of a Mut terkatheter 10 , which leads three daughter catheters 12 , 14 . The two daughter catheters 12 are provided at their distal end with a hook 16 , which serves to fix the free end of the catheter to the inner wall of the heart. The third daughter catheter 14 is provided at its free end with a device 18 which is able to make a fine hole in the inner wall of the heart. In the illustrated embodiment, for example, it can be, in particular, the end of a laser fiber or a wire subjected to high-frequency energy.

Die Fixationskatheter 12 sind am proximalen Ende des Katheters über jeweils einen Steuerdraht 18 in ihrer Ausrichtung steuerbar, der Steuerdraht 18 dient weiter dazu, den Bohrkopf 16 in die Wandung des Myokards einzu­ schrauben und die Tochterkatheter so zu fixieren. Das Lochungskatheter 14 ist mit einem Steuerdraht 20 verse­ hen, der zur Ausrichtung seines distalen Endes dient, sowie mit einer die Energie - im dargestellten Ausfüh­ rungsbeispiel Laserlicht - zu dem distalen Ende zu füh­ ren.The fixation catheter 12 can be controlled at the proximal end of the catheter via a control wire 18 in each case in its orientation, the control wire 18 also serves to screw the drill head 16 into the wall of the myocardium and thus fix the daughter catheter. The perforated catheter 14 is provided with a control wire 20 , which serves to align its distal end, and with an energy — in the exemplary embodiment shown, laser light — to lead to the distal end.

Die Tochterkatheter sind über jeweils ein haemostati­ sches Ventil 24 bzw. 26 aus dem Mutterkatheter 10 her­ ausgeführt. Das Mutterkatheter 10 ist über einen Lenkka­ nal 26 steuerbar.The daughter catheters are each made via a haemostatic valve 24 or 26 from the mother catheter 10 . The mother catheter 10 can be controlled via a Lenkka channel 26 .

Die Fixationskatheter 14 tragen im Bereich ihrer dista­ len Austrittsenden eine ringförmige Piezofolie 28, das distale Austrittsende des Lochungskatheters 14 eine ringförmig ausgebildete Piezofolie 30. Die Piezofolien 28, 30 werden über - nicht dargestellte - sehr feine elektrische Leitungen angesteuert und zum Aussenden von Ultraschallwellen erregt. Entsprechend werden empfangene Ultraschallwellen über diese Leitungen zu einer Auswert­ eausrichtung geführt.The fixation catheters 14 carry an annular piezofilm 28 in the region of their distal outlet ends, and the distal outlet end of the perforated catheter 14 an annular piezofilm 30 . The piezo foils 28 , 30 are controlled via very fine electrical lines (not shown) and excited to emit ultrasonic waves. Correspondingly, received ultrasound waves are guided to an evaluation orientation via these lines.

Bei Verwendung des Katheters werden zunächst die Fixati­ onskatheter 14 am Myokard angeheftet. Wenn nun die Pie­ zofolie 30 auf dem Lochungskatheter 16 erregt wird, sen­ det dieses Ultraschallwellen aus, die von den Piezofo­ lien 28 an den Enden der Katheter 14 empfangen werden. Durch eine Messung der Laufzeit, die der Ultraschall be­ nötigt, um von dem Lochungskatheter 16 zu den Fixations­ kathetern 14 zu wandern, kann in als Peiltechnik bekann­ ten Verfahren der Ort der Lochungseinrichtung 18 relativ zu den Fixationseinrichtungen 16 ermittelt werden. Auf entsprechende Weise kann auch der Ort der Fixationsein­ richtungen 16 relativ zueinander und zu der Lochungsein­ richtung 18 ermittelt werden. Auf diese Weise können der Ort der freien Enden der wenigstens drei Katheter ein­ deutig bestimmt und auf einer Auswerteeinrichtung in Fig. 4 durch den PC 34 angedeutet, auf einem Bildschirm dargestellt werden.When using the catheter, the fixation catheters 14 are first attached to the myocardium. If the piezo film 30 on the perforated catheter 16 is now excited, this detects ultrasonic waves which are received by the piezo films 28 at the ends of the catheters 14 . By measuring the transit time, which the ultrasound requires to travel from the perforation catheter 16 to the fixation catheters 14 , the location of the perforation device 18 relative to the fixation devices 16 can be determined in methods known as bearing technology. In a corresponding manner, the location of the Fixationsein devices 16 relative to each other and to the Lochungsein device 18 can be determined. In this way, the location of the free ends of the at least three catheters can be clearly determined and indicated on an evaluation device in FIG. 4 by the PC 34 and displayed on a screen.

Dabei ist es möglich, die Orte, an denen bereits eine Lasion in Form eines Loches in das Myokard eingebracht worden ist, markieren, der Ort, an dem sich die Lo­ chungseinrichtung 18 befindet (in Fig. 4 durch ein "x" angedeutet) kann dargestellt und so ein geeigneter Ort für das Setzen eines weiteren Lochs von dem Operateur bestimmt werden.It is possible to mark the locations at which a lesion in the form of a hole has already been introduced into the myocardium, the location at which the loosening device 18 is located (indicated by an "x" in FIG. 4) shown and so a suitable location for making another hole can be determined by the surgeon.

Die piezoelektrischen Elemente 20, 22 an den Austritt­ senden der Katheter 14, 16 können auch dazu genutzt wer­ den, die Dicke des Myokards zu ermitteln, um eine für den jeweiligen Fall geeignete Tiefe des in die Herzin­ nenwandung einzubringenden Lochs zu bestimmen. Eine ent­ sprechende Darstellung des Myokards in ihrer Dicke und der Ort der in das Loch einzudringenden Lochungseinrich­ tung 18 ist auf einfache Weise durch ein bildgebendes Verfahren unter Nutzung der von den Piezoelementen 20, 22 ausgesandten und wieder empfangenen Signalen möglich, indem das Echo von der Grenzlinie zwischen der Außensei­ te des Myokards und des dieses umgebenden Gewebes erfaßt und ausgewertet wird.The piezoelectric elements 20 , 22 send to the outlet of the catheters 14 , 16 can also be used to determine the thickness of the myocardium in order to determine a depth of the hole to be made in the inner wall of the heart that is suitable for the respective case. A corresponding representation of the myocardium in its thickness and the location of the hole to be penetrated Lochungseinrich device 18 is possible in a simple manner by an imaging method using the signals emitted by the piezo elements 20 , 22 and received again by the echo from the boundary line between the outside of the myocardium and the surrounding tissue is detected and evaluated.

Claims (5)

1. Katheter zur transmyokardialen Revaskularisation, mit einem lenkbaren, mehrlumigen Mutterkatheter (10) und einer Mehrzahl von von dem Mutterkatheter (10) geführten, einzeln lenkbaren Tochterkathetern (12, 14), wobei wenigstens zwei der Tochterkatheter (12) an ihrem distalen Ende mit einer Einrichtung (16) zu dessen Fixation an der Innenwandung des Herzens versehen ist und ein weiteres der Tochterkatheter (14) mit einer Einrichtung (18) zum Einbringen eines feinen Lochs in die Innenwandung des Herzens versehen ist, dadurch gekennzeichnet, daß wenigstens einige der Toch­ terkatheter (12, 14) im Bereich ihrer distalen Enden mit über das Katheter anzusteuernden piezoelektrischen Elementen (20, 22) zum Aussenden und zum Empfangen von Ultraschallenergie versehen sind.1. Catheter for transmyocardial revascularization, with a steerable, multi-lumen mother catheter ( 10 ) and a plurality of individually steerable daughter catheters ( 12 , 14 ) guided by the mother catheter ( 10 ), at least two of the daughter catheters ( 12 ) at their distal end a device ( 16 ) for fixing it to the inner wall of the heart and another of the daughter catheters ( 14 ) is provided with a device ( 18 ) for making a fine hole in the inner wall of the heart, characterized in that at least some of the daughter The catheter ( 12 , 14 ) is provided in the region of its distal ends with piezoelectric elements ( 20 , 22 ) to be controlled via the catheter for transmitting and receiving ultrasonic energy. 2. Katheter nach Anspruch 1, dadurch gekennzeichnet, daß die piezoelektrischen Elemente der Fixationskathe­ ter (12) als die Fixationseinrichtung (16) ringförmig umgebende Piezofolie (20) ausgebildet ist. 2. Catheter according to claim 1, characterized in that the piezoelectric elements of the fixation catheter ter ( 12 ) as the fixation device ( 16 ) is formed annularly surrounding piezo film ( 20 ). 3. Katheter nach Anspruch 1 oder Anspruch 2, dadurch gekennzeichnet, daß die piezoelektrischen Elemente des Lochungskatheters (12) als die Lochungseinrichtung (16) ringförmig umgebende Piezofolie (20) ausgebildet ist.3. Catheter according to claim 1 or claim 2, characterized in that the piezoelectric elements of the perforation catheter ( 12 ) as the perforation device ( 16 ) is formed in a ring-surrounding piezo film ( 20 ). 4. Katheter nach einem der vorangehenden Ansprüche, dadurch gekennzeichnet, daß die Einrichtung zum Ein­ bringen eines feinen Lochs in die Innenwandung des Her­ zens eine Laserstrahl-Einrichtung ist.4. Catheter according to one of the preceding claims, characterized in that the device for a make a fine hole in the inner wall of the Her zens is a laser beam device. 5. Katheter nach einem der Ansprüche 1 bis 4, dadurch gekennzeichnet, daß die Einrichtung zum Einbringen eines feinen Lochs in die Innenwandung des Herzens ein mit hochfrequenter Energie beaufschlagter Draht ist.5. Catheter according to one of claims 1 to 4, characterized characterized in that the insertion device a fine hole in the inner wall of the heart wire loaded with high-frequency energy.
DE19537084A 1995-10-05 1995-10-05 Catheter for transmyocardial revasculation with guidable multi=ID main catheter Withdrawn DE19537084A1 (en)

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US5873855A (en) * 1992-01-07 1999-02-23 Arthrocare Corporation Systems and methods for electrosurgical myocardial revascularization
DE19745488A1 (en) * 1997-10-15 1999-04-29 Wolf Gmbh Richard Endoscopic instrument for heart muscle therapy
EP0876796A3 (en) * 1997-05-07 1999-05-26 Eclipse Surgical Technologies, Inc. Device for use in the treatment of cardiovascular or other tissue
US5938632A (en) * 1997-03-06 1999-08-17 Scimed Life Systems, Inc. Radiofrequency transmyocardial revascularization apparatus and method
US5944716A (en) * 1996-12-09 1999-08-31 Scimed Life Systems, Inc. Radio frequency transmyocardial revascularization corer
US5968059A (en) * 1997-03-06 1999-10-19 Scimed Life Systems, Inc. Transmyocardial revascularization catheter and method
US6030380A (en) * 1996-12-09 2000-02-29 Bsc Northwest Technology Center, Inc. Radio frequency transmyocardial revascularization
US6045565A (en) * 1997-11-04 2000-04-04 Scimed Life Systems, Inc. Percutaneous myocardial revascularization growth factor mediums and method
EP0934728A3 (en) * 1997-11-25 2000-04-26 ECLIPSE SURGICAL TECHNOLOGIES, Inc. Selective treatment of endocardial/myocardial boundary
US6056743A (en) * 1997-11-04 2000-05-02 Scimed Life Systems, Inc. Percutaneous myocardial revascularization device and method
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US6530914B1 (en) 2000-10-24 2003-03-11 Scimed Life Systems, Inc. Deflectable tip guide in guide system
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US6508783B2 (en) 2001-03-14 2003-01-21 Scimed Life Systems, Inc. Ultrasound method for revascularization and drug delivery
US8012153B2 (en) 2003-07-16 2011-09-06 Arthrocare Corporation Rotary electrosurgical apparatus and methods thereof
US7416551B2 (en) 2003-07-28 2008-08-26 A.F.M. Medical Systems Ltd. Catheter for delivering a tissue ablation probe
WO2005009265A1 (en) * 2003-07-28 2005-02-03 A.F.M. Medical Systems Ltd. Catheter for delivering a tissue ablation probe
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