USRE43300E1 - Apparatus having stabilization members for percutaneously performing surgery and methods of use - Google Patents

Apparatus having stabilization members for percutaneously performing surgery and methods of use Download PDF

Info

Publication number
USRE43300E1
USRE43300E1 US10/126,295 US12629502A USRE43300E US RE43300 E1 USRE43300 E1 US RE43300E1 US 12629502 A US12629502 A US 12629502A US RE43300 E USRE43300 E US RE43300E
Authority
US
United States
Prior art keywords
catheter shaft
end effector
organ
vessel
guide member
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Expired - Lifetime
Application number
US10/126,295
Inventor
Vahid Saadat
John H. Ream
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Abbott Cardiovascular Systems Inc
Original Assignee
Abbott Cardiovascular Systems Inc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from US08/863,877 external-priority patent/US5910150A/en
Application filed by Abbott Cardiovascular Systems Inc filed Critical Abbott Cardiovascular Systems Inc
Priority to US10/126,295 priority Critical patent/USRE43300E1/en
Application granted granted Critical
Publication of USRE43300E1 publication Critical patent/USRE43300E1/en
Anticipated expiration legal-status Critical
Expired - Lifetime legal-status Critical Current

Links

Images

Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32Surgical cutting instruments
    • A61B17/3205Excision instruments
    • A61B17/3207Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32Surgical cutting instruments
    • A61B17/3205Excision instruments
    • A61B17/3207Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions
    • A61B17/320758Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions with a rotating cutting instrument, e.g. motor driven
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12Surgical 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
    • A61B18/14Probes or electrodes therefor
    • A61B18/1492Probes or electrodes therefor having a flexible, catheter-like structure, e.g. for heart ablation
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00017Electrical control of surgical instruments
    • A61B2017/00022Sensing or detecting at the treatment site
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00017Electrical control of surgical instruments
    • A61B2017/00022Sensing or detecting at the treatment site
    • A61B2017/00026Conductivity or impedance, e.g. of tissue
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00017Electrical control of surgical instruments
    • A61B2017/00022Sensing or detecting at the treatment site
    • A61B2017/00039Electric or electromagnetic phenomena other than conductivity, e.g. capacity, inductivity, Hall effect
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00238Type of minimally invasive operation
    • A61B2017/00243Type of minimally invasive operation cardiac
    • A61B2017/00247Making holes in the wall of the heart, e.g. laser Myocardial revascularization
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00292Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/003Steerable
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00367Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
    • A61B2017/00398Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like using powered actuators, e.g. stepper motors, solenoids
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00681Aspects not otherwise provided for
    • A61B2017/00685Archimedes screw
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00982General structural features
    • A61B2017/00991Telescopic means
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22072Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with an instrument channel, e.g. for replacing one instrument by the other
    • A61B2017/22074Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with an instrument channel, e.g. for replacing one instrument by the other the instrument being only slidable in a channel, e.g. advancing optical fibre through a channel
    • A61B2017/22077Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with an instrument channel, e.g. for replacing one instrument by the other the instrument being only slidable in a channel, e.g. advancing optical fibre through a channel with a part piercing the tissue
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/30Surgical pincettes without pivotal connections
    • A61B2017/306Surgical pincettes without pivotal connections holding by means of suction
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34Trocars; Puncturing needles
    • A61B2017/348Means for supporting the trocar against the body or retaining the trocar inside the body
    • A61B2017/3482Means for supporting the trocar against the body or retaining the trocar inside the body inside
    • A61B2017/3484Anchoring means, e.g. spreading-out umbrella-like structure
    • A61B2017/3488Fixation to inner organ or inner body tissue
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00053Mechanical features of the instrument of device
    • A61B2018/00184Moving parts
    • A61B2018/00196Moving parts reciprocating lengthwise
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00053Mechanical features of the instrument of device
    • A61B2018/00184Moving parts
    • A61B2018/00202Moving parts rotating
    • A61B2018/00208Moving parts rotating actively driven, e.g. by a motor
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00053Mechanical features of the instrument of device
    • A61B2018/00214Expandable means emitting energy, e.g. by elements carried thereon
    • A61B2018/00267Expandable means emitting energy, e.g. by elements carried thereon having a basket shaped structure
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00053Mechanical features of the instrument of device
    • A61B2018/00273Anchoring means for temporary attachment of a device to tissue
    • A61B2018/00279Anchoring means for temporary attachment of a device to tissue deployable
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00053Mechanical features of the instrument of device
    • A61B2018/00273Anchoring means for temporary attachment of a device to tissue
    • A61B2018/00291Anchoring means for temporary attachment of a device to tissue using suction
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00345Vascular system
    • A61B2018/00351Heart
    • A61B2018/00392Transmyocardial revascularisation
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636Sensing and controlling the application of energy
    • A61B2018/00696Controlled or regulated parameters
    • A61B2018/00738Depth, e.g. depth of ablation
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636Sensing and controlling the application of energy
    • A61B2018/00696Controlled or regulated parameters
    • A61B2018/00761Duration
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636Sensing and controlling the application of energy
    • A61B2018/00773Sensed parameters
    • A61B2018/00839Bioelectrical parameters, e.g. ECG, EEG
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/0091Handpieces of the surgical instrument or device
    • A61B2018/00916Handpieces of the surgical instrument or device with means for switching or controlling the main function of the instrument or device
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12Surgical 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
    • A61B18/14Probes or electrodes therefor
    • A61B2018/1405Electrodes having a specific shape
    • A61B2018/1435Spiral
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12Surgical 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
    • A61B18/14Probes or electrodes therefor
    • A61B2018/1405Electrodes having a specific shape
    • A61B2018/1435Spiral
    • A61B2018/1437Spiral whereby the windings of the spiral touch each other such as to create a continuous surface
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/1815Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using microwaves
    • A61B2018/1861Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using microwaves with an instrument inserted into a body lumen or cavity, e.g. a catheter
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, 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
    • A61B90/03Automatic limiting or abutting means, e.g. for safety
    • A61B2090/033Abutting means, stops, e.g. abutting on tissue or skin
    • A61B2090/034Abutting means, stops, e.g. abutting on tissue or skin abutting on parts of the device itself
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, 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
    • A61B90/08Accessories or related features not otherwise provided for
    • A61B2090/0807Indication means
    • A61B2090/0811Indication means for the position of a particular part of an instrument with respect to the rest of the instrument, e.g. position of the anvil of a stapling instrument
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, 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
    • A61B90/36Image-producing devices or illumination devices not otherwise provided for
    • A61B90/37Surgical systems with images on a monitor during operation
    • A61B2090/378Surgical systems with images on a monitor during operation using ultrasound
    • A61B2090/3782Surgical systems with images on a monitor during operation using ultrasound transmitter or receiver in catheter or minimal invasive instrument
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B2217/00General characteristics of surgical instruments
    • A61B2217/002Auxiliary appliance
    • A61B2217/005Auxiliary appliance with suction drainage system
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B2218/00Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2218/001Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body having means for irrigation and/or aspiration of substances to and/or from the surgical site
    • A61B2218/002Irrigation
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B2218/00Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2218/001Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body having means for irrigation and/or aspiration of substances to and/or from the surgical site
    • A61B2218/007Aspiration
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, 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
    • A61B90/36Image-producing devices or illumination devices not otherwise provided for
    • A61B90/37Surgical systems with images on a monitor during operation
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES 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
    • A61M25/00Catheters; Hollow probes
    • A61M25/0067Catheters; Hollow probes characterised by the distal end, e.g. tips
    • A61M25/0082Catheter tip comprising a tool
    • A61M25/0084Catheter tip comprising a tool being one or more injection needles

Definitions

  • the present invention relates to apparatus and methods for performing surgery on an interior wall of a hollow-body organ such as the heart, or within the brain cavities and the like. More particularly, the present invention provides a device that enables a clinician to perform surgery on an interior wall of an organ or vessel using apparatus for stabilizing an end effector during the surgery.
  • a leading cause of death in the United States today is coronary artery disease, in which atherosclerotic plaque causes blockages in the coronary arteries, resulting in ischemia of the heart (i.e., inadequate blood flow to the myocardium).
  • the disease manifests itself as chest pain or angina.
  • approximately 7 million people suffered from angina in the United States In 1996, approximately 7 million people suffered from angina in the United States.
  • Coronary artery bypass grafting in which the patient's chest is surgically opened and an obstructed artery replaced with a native artery harvested elsewhere, has been the conventional treatment for coronary artery disease for the last thirty years. Such surgery creates significant trauma to the patient, requires long recuperation times, and causes a great deal of morbidity and mortality. In addition, experience has shown that the graft becomes obstructed with time, requiring further surgery.
  • PTCA percutaneous transluminal coronary angioplasty
  • atherectomy involves using an end effector, such as a mechanical cutting device (or laser) to cut (or ablate) a passage through the blockage.
  • an end effector such as a mechanical cutting device (or laser) to cut (or ablate) a passage through the blockage.
  • Such methods have drawbacks, however, ranging from re-blockage of dilated vessels with angioplasty to catastrophic rupture or dissection of the vessel during atherectomy.
  • these methods may only be used for that fraction of the patient population where the blockages are few and are easily accessible. Neither technique is suitable for the treatment of diffuse atherosclerosis.
  • transmyocardial revascularization a series of channels are formed in the left ventricular wall of the heart. Typically, between 15 and 30 channels about 1 mm in diameter and up to 3.0 cm deep are formed with a laser in the wall of the left ventricle to perfuse the heart muscle with blood coming directly from the inside of the left ventricle, rather than traveling through the coronary arteries. Apparatus and methods have been proposed to create those channels both percutaneously and intraoperatively (i.e., with the chest opened).
  • U.S. Pat. No. 5,389,096 to Aita et al. describes a catheter-based laser apparatus for percutaneously forming channels extending from the endocardium into the myocardium.
  • U.S. Pat. No. 5,380,316 to Aita et al. describes an intraoperative laser-based system for performing TMR.
  • U.S. Pat. No. 5,591,159 to Taheri describes a mechanical apparatus for performing TMR involving a catheter having an end effector formed from a plurality of spring-loaded needles.
  • U.S. Pat. Nos. 5,389,073 and 5,330,466 to Imran describe steerable catheters; U.S. Pat. No. 5,415,166 to Imran describes a device for endocardial mapping; U.S. Pat. No. 4,813,930 to Elliott describes a radially extendable member for stabilizing an angioplasty catheter within a vessel; U.S. Pat. No. 5,354,310 describes an expandable wire mesh and graft for stabilizing an aneurysm; and U.S. Pat. Nos. 5,358,472 and 5,358,485 to Vance et al. describe atherectomy cutters that provide for aspiration of severed material.
  • Apparatus constructed in accordance with the present invention comprises a catheter having a longitudinal axis and an end region movable to a series of positions along the longitudinal axis.
  • the end region may be selectively moved to a position at an angle relative to the longitudinal axis of the catheter, including a substantially orthogonal position.
  • the catheter includes means for stabilizing a distal region of the apparatus within a hollow-body organ, and for counter-acting reaction forces developed during actuation of an end effector.
  • the catheter in a preferred embodiment of the apparatus of the invention, includes a catheter shaft and a guide member disposed for longitudinal sliding movement within a groove of the catheter shaft.
  • the guide member includes an end region including an end effector maneuverable between a transit position wherein the end region lies parallel to a longitudinal axis of the catheter to a working position wherein the end region and end effector are oriented at an angle relative to the longitudinal axis, including a substantially orthogonal position.
  • the catheter shaft preferably may include adjustable outwardly projecting stabilization members to provide a stable platform to counteract reaction forces generated when the end effector contacts the wall of the hollow-body organ.
  • Methods of using the apparatus of the present invention to perform surgery such as transmyocardial revascularization, are also provided.
  • FIG. 1 is a view of a first illustrative embodiment of apparatus constructed in accordance with the present invention
  • FIG. 2 is a perspective view of the distal region and end effector of the apparatus of FIG. 1 ;
  • FIGS. 3A and 3B are, respectively, a perspective view and side view of stabilization members disposed on the distal region of the apparatus of FIG. 1 ;
  • FIG. 4 is sectional view of an illustrative end effector constructed in accordance with the present invention.
  • FIGS. 5A and 5B are, respectively, side and perspective views of an illustrative handle assembly for controlling and actuating the apparatus of the present invention
  • FIGS. 6A-6C are views showing deployment of the apparatus of FIG. 1 in a patient's left ventricle to perform TMR;
  • FIG. 7 is a perspective view of the distal region of an alternative embodiment of apparatus constructed in accordance with the present invention.
  • FIG. 8 is a perspective view of the distal region of the apparatus of the present invention showing an alternative embodiment of the stabilization members
  • FIGS. 9A , 9 B and 9 C are end views, taken along view line 9 - 9 of FIG. 8 , depicting various deployment positions of the stabilization members of FIG. 8 ;
  • FIG. 10 is a perspective view of the distal region of the apparatus of the present invention showing an alternative embodiment of the stabilization members
  • FIG. 11 is a perspective view of the distal region of the apparatus of the present invention showing another alternative embodiment of the stabilization members
  • FIGS. 12A-12C are end views, taken along view line 12 - 12 of FIG. 11 , depicting various deployment positions of the stabilization members of FIG. 11 ;
  • FIG. 13 is a view of an alternative embodiment of apparatus constructed in accordance with the present invention.
  • FIGS. 14A and 14B are, respectively, perspective top and bottom views of a distal region of the apparatus of FIG. 13 ;
  • FIG. 15 is a partial side view, partly in section, of the catheter shaft of FIGS. 13 and 14 deployed in contact with tissue;
  • FIG. 16 is a side view of the handle portion of the apparatus of FIG. 13 ;
  • FIGS. 17A and 17B are, respectively, top and side sectional views of the distal region of an alternative embodiment of the apparatus of the present invention.
  • FIG. 18 is a perspective top view of the distal region of a further alternative embodiment of the apparatus of the present invention.
  • FIG. 19 is a view of a further alternative embodiment of apparatus of the present invention.
  • FIGS. 20A and 20B are, respectively, perspective top and side views of a distal region of the apparatus of FIG. 19 .
  • the present invention relates generally to apparatus and methods for percutaneously performing surgery within an organ or vessel.
  • the apparatus of the present invention comprises a catheter including a stabilizing catheter shaft which percutaneously may be disposed within an organ.
  • a guide member engaged with the catheter shaft includes an end region that may be selectively articulated to a position at an angle to a longitudinal axis of the catheter, including a position substantially orthogonal to the longitudinal axis.
  • the end region carries an end effector (e.g., an ablative or mechanical cutting device) for treating tissue. Severed or ablated tissue may be aspirated through the catheter to its proximal end for disposal.
  • the catheter shaft either alone or in conjunction with stabilizing members, and the guide member, provides precise control over the location of the end region, and thus, the end effector.
  • the present invention therefore offers a device having a directable end region and end effector for performing surgery that provides a degree of control heretofore unattainable. While the invention is described hereinafter as particularly useful in the emerging field of transmyocardial revascularization, apparatus constructed in accordance with the present invention may be advantageously used in performing surgery on other organs or vessels, such as the intestines, blood vessels or the brain cavities. In addition, while the present invention is described herein in the context of a mechanical cutting system, the control and stabilization apparatus of the present invention may be advantageously used with other types of cutting elements, such as lasers, cryogenic cutters or radio-frequency ablation devices.
  • Apparatus 20 includes a two-part catheter formed of catheter shaft 21 and guide member 22 .
  • Apparatus 20 includes distal region 23 within which guide member 22 has end region 25 that is selectively movable between a transit position parallel to longitudinal axis 24 of catheter shaft 21 and a working position (as shown) substantially orthogonal to longitudinal axis 24 .
  • Distal region 23 preferably includes an end effector, described in greater detail hereinbelow, for ablatively or mechanically cutting tissue to attain a treatment goal.
  • End region 25 of guide member 22 may be positioned longitudinally with respect to catheter shaft 21 by imparting relative movement between guide member 22 and catheter shaft 21 using handle assembly 26 .
  • Catheter shaft 21 preferably includes a plurality of stabilizing members 27 to support and stabilize distal region 23 of the apparatus within the hollow-body organ.
  • Apparatus 20 is coupled via cable 28 to controller 29 .
  • controller 29 includes a motor and control logic for rotating the cutting head responsive to commands input at handle assembly 26 or a footpedal (not shown) and a vacuum source for aspirating severed tissue from the treatment site.
  • Controller 29 optionally may further include RF circuitry (shown in dotted line) for energizing the cutting head to cauterize tissue as it is cut.
  • controller 29 may include a laser source or radio frequency circuitry for causing laser or RF ablation, respectively, using a suitable end effector.
  • distal region 23 of apparatus 20 includes end region 25 of guide member 22 disposed in sliding engagement in groove 30 of catheter shaft 21 .
  • Catheter shaft 21 may be constructed of a flexible material commonly used in catheter products, such as nylon, polyethylene or polyurethane, and contains lateral grooves 31 and 32 that accept a mating portion of guide member 22 in sliding engagement.
  • Catheter shaft 21 may have an ellipsoidal shape to stabilize the catheter shaft and may include two spaced-apart wire stiffeners that terminate in barbs 33 .
  • Barbs 33 are designed to engage an interior surface of an organ, for example, the apex of the left ventricle, to reduce rotation of the catheter shaft when the end effector is actuated.
  • catheter shaft 21 may be formed of a material having sufficient stiffness that the wire stiffeners may be omitted over most of the length of the catheter shaft.
  • Guide member 22 includes end region 25 carrying an end effector and flanges 34 and 35 that slidingly engage grooves 31 and 32 .
  • End region 25 may be articulated in region 36 using control wires or a temperature actuated shape-memory alloy steering mechanism, such as described in the aforementioned patents to Imran.
  • Guide member 22 may be constructed of a spring material (commonly called a Bowden) with spaces in-between the coils to allow it to bend when it is pulled by a control wire asymmetrically, as previously known in the art.
  • guide member 22 may be constructed of a stiffer material such as polyimide coated over a braided steel tubular structure, such as employed in previously known neuro-navigational endoscope devices.
  • slits are provided on the inside of the bend in region 36 so that the guide member bends in the direction of the slits. The slits allow a tight bend radius which may not otherwise be achievable.
  • Guide member 22 preferably includes a lumen, as described hereinafter, through which tissue may be evacuated from a treatment site by suction. Accordingly, guide member 22 may also be formed from a loosely wound spring reinforced with a soft elastomeric coating.
  • the elastomeric coating advantageously serves the following functions: it provides sealing along the length of the guide member required to maintain adequate suction through the lumen; it prevents collapse of the lumen in the presence of applied suction; it resists kinking of the coils of the spring; and it also enables the guide member to be bent to relatively tight radii.
  • Reinforced tubing suitable for use as guide member 22 is available from Adam Spence Corporation, Wall, N.J.
  • end region 25 of guide member 22 is movable from a transit position lying parallel to the longitudinal axis of catheter shaft 21 to a working position wherein end region 25 is articulated to a position substantially orthogonal to the longitudinal axis of the catheter shaft.
  • end region 25 may be constructed to enable it to be locked in position at any angle a that may be desired for a given application.
  • stabilization members 27 project outwardly from apertures 37 on either side of catheter shaft 21 in distal region 23 .
  • stabilization members 27 comprise four circumferentially-oriented hoops formed of flexible wires 27 a- 27 d.
  • wires 27 a- 27 d comprise a continuous coil having its distal end affixed to catheter shaft 21 and its proximal end connected to handle assembly 26 via push wire 38 . The turns of the coil are slidably disposed in lumens within catheter shaft 21 that interconnect apertures 37 on either side of the catheter shaft.
  • wires 27 a- 27 d When push wire 38 is urged in the distal direction, wires 27 a- 27 d expands outwards by illustrative distances h 1 -h 4 to contact and conform to the topology of the interior wall of the hollow-body organ or vessel. Wires 27 a- 27 d also may be retracted against catheter shaft 21 by pulling push wire 38 in the proximal direction.
  • wires 27 a- 27 d may be moved from a retracted position in which they are retracted against distal region 23 of catheter shaft 21 to an expanded position in which they engage a wall of the organ and urge end region 25 into engagement with an opposing wall of the organ, thereby stabilizing catheter shaft 21 against rotation.
  • Stabilization members 27 may be constructed of any suitable elastic material, including stainless steel, spring steel, nickel-titanium alloys, and a variety of plastics. A nickel-titanium alloy is preferred where wires 27 a- 27 d comprise a continuous coil, as in FIG. 3B . In the contracted mode, catheter shaft 21 and guide member 22 have a relatively small profile, for example, 2-3 mm. Upon actuation of the control means in handle assembly 26 , wires 27 a- 27 d expand out as shown in FIG. 3B to form a basket shape that spans and conforms to the lumen of the organ or vessel.
  • stabilization members 27 comprise a single coil, as in FIG. 3B , they may be actuated by a single control means. Alternatively, as described hereinafter with respect to FIG. 8 , each of stabilization members 27 may be individually adjusted to conform to the shape of the cavity of the hollow-body organ. Stabilization members 27 may alternatively be oriented parallel to the longitudinal axis of apparatus 20 , as described hereinafter with respect to FIG. 8 .
  • the longitudinal position of end region 25 with respect to catheter shaft 21 may be adjusted by sliding guide member 22 in groove 30 of the catheter shaft.
  • Handle assembly 26 preferably includes means, described hereinafter, for moving guide member with respect to catheter shaft 21 so that end region 25 may be positioned at a series of vertical locations.
  • stabilization members 27 may be adjusted to provide some control over the lateral positioning of the catheter shaft and guide member with respect to the interior wall of the organ or vessel.
  • end effector 40 (also referred to hereinafter as a “micromorcellator”) is described as illustratively comprising a rotary cutting member and drive arrangement.
  • Micromorcellator 40 includes cutting head 41 comprising tubular element 42 .
  • Distal edge 42 a of tubular element 42 includes a sharpened bevel 43 .
  • Cutting head 41 is affixed to drive rod 45 , which preferably includes soft plastic or elastomeric coating 45 a, as described hereinabove, to maintain suction through lumen 44 .
  • the vacuum source in controller 29 aspirates the severed tissue through lumen 44 , if provided.
  • guide member 22 Orientation of end region 25 of guide member 22 is accomplished by control wire 46 , which is slidingly disposed in lumen 47 of guide member 22 .
  • guide member 22 preferably comprises a spring material with spaces in-between the coils to allow it to bend when control wire 46 is retracted in a proximal direction.
  • guide member 22 may be constructed of polyimide coated over a braided steel tube and includes slits on the inside of bend region 36 so that end region 25 bends in the direction of the slits when control wire 46 is retracted in a proximal direction.
  • Cutting head 41 is connected to the motor of controller 29 via drive rod 45 .
  • Drive rod 45 may be formed of a flexible tube such as a bowden or a covered coil or may be formed of a plastic having both high torquability and flexibility.
  • Drive rod 45 is disposed in lumen 44 for a limited range of reciprocation, e.g., up to 3.0 cm, to permit extension of cutting head 41 beyond the end of guide member 22 .
  • end region 25 is in its transit position, cutting head 41 is disposed just below distal endface 48 of guide member 22 .
  • Drive rod 45 is hollow and preferably includes a covering of a soft plastic or elastomeric material to allow the application of a negative pressure to aspirate the severed tissue.
  • tubular member 42 of cutting head 41 may comprise an electrically conductive material and be electrically coupled to the optional radio-frequency generator circuitry in controller 29 to provide coagulation of the edges of a channel formed in the tissue by cutting head 41 .
  • tubular element 42 serves as the electrode in a monopolar coagulation arrangement.
  • a second electrode (not shown) may be formed on the working end spaced apart from the cutting head 41 , so that tubular member 42 serves as one electrode of a bipolar coagulation arrangement. Applicant expects that the sealing action produced by RF coagulation, if provided, will simulate the lesions produced by a laser.
  • Handle assembly 50 includes lower portion 51 affixed to catheter shaft 21 and upper portion 52 affixed to guide member 22 .
  • Upper portion 52 is slidingly engaged in lower portion 51 , so that guide member 22 may be selectively translated longitudinally with respect to catheter shaft 21 by rotating knob 53 .
  • Lower portion 51 of handle assembly 50 includes hand grip 54 , and button 55 for controlling the extension of stabilization members 27 .
  • Button 55 slides in slot 56 of lower portion 51 to extend or retract stabilization members 27 via push wire 38 .
  • Upper portion 52 includes indicator 57 a that may be selectively aligned with indicators 57 b, so that the channels formed by end effector 40 are positioned at a series of spaced-apart locations.
  • Cable 28 extends from upper portion 52 and connects the working end of apparatus 20 to controller 29 .
  • Upper portion 52 also includes button 58 which may be moved in slot 59 to control the articulation of end region 25 of guide member 22 , and depth control lever 60 disposed in slot 61 .
  • Depth control lever 60 is moved within slot 61 to control reciprocation of cutting head 41 from end region 25 .
  • Slot 61 has a length so that when button 60 is moved to fully extend cutting head 41 from guide member 22 , a proximal portion of tubular member 42 remains within guide member 22 .
  • a user-adjustable limit bar (not shown) may be provided in slot 61 to select the maximum extension of cutting head 41 desired for a particular application.
  • RF button 62 also may be provided to control activation of the optional RF circuitry of controller 29 to coagulate tissue surrounding the channel formed by micromorcellator 40 .
  • RF button also could take the form of a microswitch located within slot 61 of handle assembly 50 , so as to provide automatic activation of the RF coagulation feature for a short period of time when depth control lever 60 is advanced to contact the user-adjustable limit bar.
  • handle assembly 50 provides for longitudinal movement of end region 25 with respect to catheter shaft 21 via relative movement between upper portion 52 and lower portion 51 (using knob 53 ); provides selective deployment of stabilization members 27 via button 55 ; selective orientation of end region 25 via button 58 ; control over the depth of the channels formed by end effector 40 via depth control lever 60 ; and, optionally, activation of an RF coagulation feature via button 62 .
  • distal region 23 of apparatus 20 is shown positioned in a patient's left ventricular cavity, using techniques which are per se known. Specifically, distal region 23 of apparatus 20 is inserted via a femoral artery, and is maneuvered under fluoroscopic guidance in a retrograde manner up through the descending aorta, through aortic arch 201 , and down through ascending aorta 202 and aortic valve 203 into left ventricle 204 .
  • Previously known imaging techniques such as ultrasound, MRI scan, CT scan, or fluoroscopy, may be used to verify the location of the distal region 23 within the heart.
  • Insertion of apparatus 20 into the left ventricle is with guide member 22 in its distal-most position with stabilization members 27 fully retracted and end region 25 in its transit position.
  • catheter shaft 21 (and guide member 22 ) preferentially bends in regions 65 and 66 to form a “dog-leg”, in which distal region 23 becomes urged against a lateral wall of the ventricle.
  • Regions 65 and 66 where the bends take place may be made flexurally weaker than the remainder of the catheter shaft to aid in the bending of the catheter at these locations.
  • button 55 is advanced in slot 56 of handle assembly 50 to extend stabilization members 27 so that they engage the septal wall of the left ventricle and urge the end effector against left ventricular wall 206 .
  • the dog-leg bends in regions 65 and 66 allow the catheter to be pushed onto the left ventricular wall while the stabilization members push against the septum.
  • End region 25 of guide member 22 is then rotated to its working position by retracting button 58 along slot 59 of handle assembly 50 , thus causing end region 25 to be positioned substantially orthogonally to the longitudinal axis of catheter shaft 21 .
  • controller 29 The motor and vacuum source of controller 29 are then actuated to cause cutting head 41 to rotate and to induce negative pressure in lumen 44 of micromorcellator 40 .
  • the clinician then pushes depth control lever 60 distally in slot 61 , causing cutting head 41 to be advanced beyond distal endface 48 of guide member 22 and engage the endocardium.
  • micromorcellator 40 engages the endocardium, a reaction force is generated in catheter shaft 21 that tends both to push end region 25 away from the tissue and to cause the catheter shaft to want to rotate.
  • the relatively flat configuration of catheter shaft 21 in conjunction with barbs 33 , is expected to adequately counteract the torque induced by operation of the micromorcellator.
  • stabilization members 27 function to counteract both these outward reaction and torque effects.
  • tissue severed by cutting head 41 is suctioned into lumen 44 and aspirated to the proximal end of apparatus 20 via the vacuum source of controller 29 .
  • the depth of channel 207 which is proportional to the movement of depth control lever 60 in slot 61 , may be predetermined using conventional ultrasound techniques, MRI scanning, or other suitable methods.
  • tissue severed from the ventricular wall is aspirated through lumen 44 of guide member 22 , thereby reducing the risk of embolization of the severed material.
  • suction through lumen 44 will assist in stabilizing the micromorcellator, and tend to draw tissue into the cutting head.
  • cutting head 41 is withdrawn from channel 207 by retracting depth control lever 60 to its proximal-most position, thereby returning cutting head 41 to a position just below distal endface 48 of end region 25 of guide member 22 . It is expected that rotation of cutting head 41 will generate sufficient frictional heat in the tissue contacting the exterior of cutting head 41 to coagulate the tissue defining the channel.
  • RF button 62 may be depressed on handle assembly 50 to apply a burst of RF energy to the edges of channel 207 as micromorcellator 40 achieves its maximum predetermined depth, and while cutting head 41 is stationary, rotating or being withdrawn from the channel. If provided, this burst of RF energy is expected to further coagulate the tissue defining the walls of channel 207 and modify the surface properties of the tissue.
  • a series of vertically aligned spaced-apart channels 207 may be formed in left ventricular wall 207 by sliding upper portion 52 proximally within lower portion 51 of handle assembly 50 (by rotating knob 53 ). Cutting head 41 is then advanced to form a further channel 207 in the tissue, and the tissue may also be coagulated with a burst of RF energy.
  • button 55 is adjusted as described above with respect to FIGS. 3A and 3B to cause the catheter shaft to rotate several degrees about its axis.
  • Stabilization members 27 are again extended to contact the septal wall, causing micromorcellator 40 to be urged against left ventricular wall 206 in a region laterally spaced apart from the initial line of channels 207 .
  • the foregoing methods enable a matrix of channels to be formed illustratively in the left ventricular wall. It will of course be understood that the same steps may be performed in mirror image to stabilize the apparatus against the left ventricular wall while actuating the end effector to produce a series of channels in the septal region.
  • the formation of such channels in the endocardium or septal region enables oxygenated blood in the left ventricle to flow directly into the myocardium and thus nourish and oxygenate the muscle. It is believed that these channels may be drilled anywhere on the walls of the heart chamber, including the septum, apex and left ventricular wall, and the above-described apparatus provides this capability.
  • Apparatus 70 is similar to apparatus 20 described hereinabove, but includes wires 71 and 72 forming a dual-rail on which catheter shaft 73 glides, thereby reducing unwanted rotation of distal region 74 and end region 75 .
  • Distal end 76 of the dual-rail includes cushion 77 having barbs 78 for anchoring the catheter shaft in the apex of the left ventricle to prevent inadvertent rotation of catheter shaft 73 .
  • Guide member 79 has an inner diameter suitable for carrying one of a variety of end effectors 81 , such as a laser fiber, a radio frequency applying device, micromorcellator as described hereinabove, or slit needles, as in the above-mentioned patent to Taheri.
  • end effectors 81 such as a laser fiber, a radio frequency applying device, micromorcellator as described hereinabove, or slit needles, as in the above-mentioned patent to Taheri.
  • Dual-rail embodiment 70 may be used without stabilization members, or alternatively catheter shaft 73 may include the stabilization members of FIGS. 3 or as described hereinbelow.
  • Wires 71 and 72 also may be formed from a resilient material, e.g., stainless steel or a nickel-titanium alloy, so that when they exit catheter shaft 73 they diverge from one another and give the catheter a larger and more stable base.
  • cushion 77 preferably comprises an elastomeric material that allows the distance between the tips of wires 71 and 72 to increase beyond the diameter of the catheter.
  • Wires 71 and 72 may have other than circular cross-sections and may take the form of, for example, ribbons.
  • Wires 71 and 72 in cooperation with a distally-directed axial force exerted on the handle assembly by the clinician, serve to anchor the catheter against a lateral wall of the left ventricle, while catheter shaft 74 and guide member 79 are advanced along the dual-rail.
  • apparatus 70 may include flexurally weaker locations along its length to aid in positioning distal region 74 within the left ventricle.
  • the dual-rail design of apparatus 70 also may be advantageously employed to determine the location of end region 75 and end effector 81 with respect to the interior of the hollow-body organ or vessel.
  • wires 71 and 72 are electrically connected within cushion 77 and have a uniform resistance per unit length.
  • Electrodes 80 are positioned in distal end 82 of catheter shaft 73 to measure the resistance of wires 71 and 72 between the electrodes.
  • the resistance between electrodes 80 may be measured, for example, by ohmmeter circuitry, to determine the distance between the distal end 82 of the catheter shaft and the apex of the left ventricle.
  • the position of end region 75 and end effector 81 may be determined relative to the apex of the heart. This position information may be sampled using suitable analog to digital circuitry, and displayed on a display unit to aid the physician in determining where to place the channels in the heart wall.
  • FIGS. 8 and 9 A- 9 C a first alternative embodiment of the stabilization members of the present invention are described.
  • Apparatus 90 includes catheter shaft 21 including barbs 33 and guide member 22 including end region 25 .
  • Stabilization members 91 a- 91 d project from proximal apertures 92 and distal apertures 93 , and comprise individual longitudinally-oriented flexible wires.
  • Wires 91 a- 91 d enter lumens in catheter shaft 21 through apertures 92 and extend proximally to handle assembly 26 .
  • Each of wires 91 a- 91 d preferably has a respective button (similar to button 55 in FIGS. 5 ) on handle assembly 26 for selectively controlling the extension of the wires.
  • wires 91 a- 91 d of the embodiment of FIG. 8 may be moved from a retracted position in which they are retracted against distal region 23 of catheter shaft 21 to an expanded position in which they engage a wall of the organ and urge end region 25 into engagement with an opposing wall of the organ, thus stabilizing catheter shaft 21 against rotation.
  • each of stabilization members 91 preferably may be selectively extended a different amount, therefore causing distal region 23 to rotate about its longitudinal axis.
  • wire 91 a is extended from distal region 23 a greater distance, causing a larger bow in wire 91 a, while wire 91 d is extended a smaller distance, causing a smaller bow therein. Consequently, if each of wires 91 a- 91 d contacts a wall of the organ, catheter shaft 23 will have a tendency to rotate in a counterclockwise direction (viewed from the distal end). Conversely, reversing the extensions of wires 91 a and 91 d, as in FIG. 9C , will cause rotation in the opposite direction. It is therefore seen that by individually controlling the extension of the stabilization members 91 , the position of the catheter with respect to an interior lateral wall of the hollow-body organ can be controlled.
  • Apparatus 100 includes catheter shaft 101 and guide member 102 . Except for stabilization members 103 , which in FIG. 10 comprise horizontal inflatable ribs, apparatus 100 is similar to apparatus 20 of FIG. 1 .
  • guide member 102 moves relative to catheter shaft 101 to enable the clinician to form a series of vertically aligned channels in the myocardium. Once a line of channels has been formed, the catheter must be moved laterally to a new location and the procedure repeated until the desired number of channels has been achieved.
  • One expedient for doing so for example, applicable to the apparatus of FIG. 7 , is to withdraw the catheter slightly, rotate it and reposition it at a different location on the left ventricular wall.
  • the stabilization arrangement of FIG. 10 instead facilitates lateral movement by deflating ribs 103 , rotating catheter shaft 21 , and then re-inflating ribs 103 .
  • stabilization members 103 when inflated, provide a degree of hoop strength that ensures proper contact of the distal face of end region 106 with the wall of the hollow-body organ or vessel at all times. Once a vertical row of channels has been formed, stabilization members 103 are deflated by the clinician and end region 106 is moved to a new lateral position. The stabilization members are fully re-inflated and another vertical row of channels is formed, as discussed hereinabove.
  • FIGS. 11 and 12 A- 12 C another embodiment of the apparatus of the present invention is described in which the stabilization members comprise longitudinally-oriented balloons.
  • Apparatus 110 is otherwise similar to the apparatus of FIG. 8 , and includes catheter shaft 111 , guide member 112 , and end region 113 .
  • Stabilization elements 114 a- 114 c comprise balloons, preferably formed of a compliant material, such as polyurethane, silicone or latex.
  • the handle assembly for apparatus 110 includes valving means for selectively individually inflating balloons 114 a- 114 c. As shown in FIGS.
  • balloons 114 a- 114 c may be selectively inflated via inflation lumens (not shown) in catheter shaft 111 to stabilize apparatus 110 within a hollow-body organ, and to rotate catheter shaft 111 (and end region 113 ) in a manner similar to that described above with respect to FIGS. 9A-9C .
  • Apparatus 120 comprises a two-part catheter formed of catheter shaft 121 and guide member 122 .
  • Apparatus 120 includes distal region 123 within which guide member 122 has end region 125 that is selectively movable between a transit position parallel to longitudinal axis 124 of catheter shaft 121 and a working position (as shown), substantially orthogonal to longitudinal axis 124 .
  • Distal region 123 preferably includes an end effector, as described in detail hereinabove.
  • End region 125 of guide member 122 may be positioned longitudinally with respect to catheter shaft 121 by imparting relative movement between guide member 122 and catheter shaft 121 using handle assembly 126 .
  • Catheter shaft 121 includes stabilizing assembly 127 to support and stabilize distal region 123 of the apparatus within an organ or vessel.
  • Apparatus 120 is coupled via cable 128 to controller 129 .
  • controller 129 includes a hydraulic or pneumatic piston, valve assembly and control logic for extending and retracting the end effector beyond the distal endface of end region 125 responsive to commands input at handle assembly 126 or a footpedal (not shown).
  • Controller 129 optionally may further contain RF generator circuitry for energizing electrodes disposed on the end effector to cause a controlled degree of necrosis at the treatment site.
  • distal region 123 of apparatus 120 is described in greater detail.
  • distal region 123 includes end region 125 of guide member 122 disposed in sliding engagement in track 130 of catheter shaft 121 , as described hereinabove with respect to the embodiment of FIG. 1 .
  • Guide member 122 includes end region 125 carrying end effector 134 and flanges 135 that slidingly engage grooves 131 and 132 .
  • End region 125 may be articulated in region 136 using control wires or a temperature actuated shape-memory alloy steering mechanism, as described hereinabove.
  • End region 125 of guide member 122 is movable from a transit position lying parallel to longitudinal axis 124 of catheter shaft 121 to a working position wherein end region 125 is articulated to a position substantially orthogonal to the longitudinal axis of the catheter shaft.
  • end region 125 may be constructed to enable it to be locked in position at any angle a that may be desired for a given application.
  • Stabilization assembly 127 comprises flat band 137 of resilient material, such as stainless steel, that projects outwardly from catheter shaft 121 in distal region 123 .
  • stabilization assembly 127 comprises multiple loops 127 a- 127 c of band 137 .
  • Band 137 has its distal end affixed to the distal end of catheter shaft 121 , and its proximal end connected to handle assembly 126 .
  • Band 137 passes through an interior lumen of catheter shaft 121 (see FIG. 15 ) and exits to the exterior surface of catheter shaft 121 in distal region 123 .
  • Crossbars 138 permit band 137 to be pulled flat against the exterior surface of catheter shaft 121 , as shown in FIG. 14B , or urged in a distal direction to form loops 127 a- 127 c.
  • loops 127 a- 127 c expand outwardly by illustrative distances h 1 -h 3 to contact and conform to the topology of interior wall T of an organ or vessel. Accordingly, loops 127 a- 127 c may be moved from a retracted position in which they are retracted against an exterior surface of distal region 123 of catheter shaft 121 ( FIG. 14B ) to an expanded position ( FIG. 14A ) in which they engage a wall of an organ or vessel.
  • stabilization assembly 127 urges end region 125 into engagement with an opposing wall of the organ, thereby stabilizing catheter shaft 121 against rotation.
  • Band 137 may be constructed of any suitable elastic material, including stainless steel, spring steel, nickel-titanium alloys, and a variety of plastics.
  • catheter shaft 121 and guide member 122 In the contracted mode, catheter shaft 121 and guide member 122 have a relatively small profile, for example, 2-3 mm.
  • the longitudinal position of end region 125 with respect to catheter shaft 121 may be adjusted by sliding guide member 122 in track 130 of the catheter shaft.
  • Handle assembly 126 preferably includes means, described hereinafter, for moving guide member 122 with respect to catheter shaft 121 so that end region 125 may be positioned at a series of longitudinal locations
  • stabilization assembly 127 may be adjusted to provide some control over the lateral positioning of the catheter shaft and guide member with respect to the interior wall of the organ or vessel.
  • Handle assembly 126 includes lower portion 140 affixed to catheter shaft 121 and upper portion 141 affixed to guide member 122 .
  • Upper portion 141 is slidingly engaged in lower portion 140 , so that guide member 122 may be selectively translated longitudinally with respect to catheter shaft 121 by rotating knob 142 .
  • Upper portion 141 includes ribbed bonnet 143 , which collapses and expands to enclose lower portion 140 as upper portion 141 is moved in the proximal and distal directions, respectively.
  • Lower portion 140 of handle assembly 126 includes indentations 144 forming a hand grip.
  • Threaded post 145 is coupled to the proximal end of band 137 , and slides in a slot (not visible in FIG. 16 ) in the lower surface of catheter shaft 121 .
  • Thumbwheel 146 is threaded onto post 145 .
  • Post 145 and thumbwheel 146 permit the proximal end of band 137 (see FIG. 15 ) to be urged in the proximal and distal directions, for example, to deploy stabilization assembly 127 .
  • Band 137 then is locked into position by tightening thumbwheel 146 on post 145 against the lower surface of catheter shaft 121 .
  • Upper portion 141 includes indicator 147 a that may be selectively aligned with indicators 147 b, so that the treatment sites are positioned at a series of spaced-apart locations.
  • Cable 128 extends from upper portion 141 and connects the end effector of apparatus 120 to controller 129 .
  • Button 148 disposed on the top surface of upper portion 141 may be depressed to command the control logic of controller 129 to reciprocate the end effector from end region 125 , and optionally, cause necrosis at the treatment site.
  • Button 149 disposed in a slot in the upper surface of the proximal end of guide tube 122 (not visible in FIG. 16 ) is coupled to a tendon affixed to end region 125 , and may be moved in the proximal and distal directions to control the degree of articulation of end region 125 and the end effector.
  • Handle assembly 126 therefore provides for longitudinal movement of end region 125 with respect to catheter shaft 121 via relative movement between upper portion 141 and lower portion 140 (using knob 142 ); provides selective deployment of stabilization assembly 127 (using post 145 and thumbwheel 146 ); selective orientation of end region 125 (using button 149 ); and control over operation of the end effector (using button 148 ).
  • Apparatus 150 is similar to apparatus 120 described hereinabove, but band 137 that forms stabilization assembly 127 of apparatus 120 is replaced by transversely mounted fixed wire hoops 151 a- 151 d.
  • the guide catheter is omitted from track 152 for clarity.
  • Wire hoops 151 a- 151 d illustratively four in number, have their ends affixed to the lateral faces of catheter shaft 153 so that, when unconstrained, the hoops return to a position substantially orthogonal to the longitudinal axis of catheter shaft 153 .
  • Wire hoops preferably comprise a sturdy, elastic plastic or metal alloy, such as nickel-titanium.
  • FIG. 18 a still further alternative embodiment of the stabilization assembly of the present invention is described.
  • the catheter shaft is omitted, and guide member 161 is supported by a plurality of bands 162 (only two are shown in FIG. 18 ).
  • Guide member 161 and bands 162 extend from within outer sheath 163 .
  • Each band 162 preferably terminates in spool 164 when it is extended from within outer sheath 163 .
  • Spools 164 contact one wall of the organ or vessel and urge end region 165 of guide member 161 into contact with the opposing wall of the organ or vessel.
  • the length of each band 162 may be adjusted using suitable means disposed on the handle assembly. Operation of guide member 161 and end effector 166 are the same as described herein for other embodiments of the present invention.
  • Apparatus 170 comprises a two-part catheter formed of catheter shaft 171 and guide member 172 , and is coupled via cable 178 to controller 179 that performs the functions described above with respect to controller 129 of the embodiment of FIG. 13 .
  • Apparatus 170 includes distal region 173 within which guide member 172 has end region 175 that is selectively movable between a transit position parallel to longitudinal axis 174 of catheter shaft 171 and a working position (as shown), substantially orthogonal to longitudinal axis 174 .
  • Distal region 173 preferably includes an end effector, as described in detail hereinabove.
  • End region 175 of guide member 172 may be positioned longitudinally with respect to catheter shaft 171 by imparting relative movement between guide member 172 and catheter shaft 171 using handle assembly 176 .
  • Catheter shaft 121 includes stabilizing element 177 to support and stabilize distal region 173 of the apparatus within an organ or vessel.
  • Distal region 173 of apparatus 170 is described in greater detail with respect to FIGS. 20A and 20B .
  • Distal region 173 includes end region 175 of guide member 172 disposed in sliding engagement in track 180 of catheter shaft 171 , as described hereinabove with respect to other embodiments.
  • Guide member 172 includes end region 175 carrying end effector 181 and flanges 182 that slidingly engage grooves 183 and 184 .
  • End region 175 may be articulated in region 185 , as may be constructed and operated as described hereinabove for other embodiments.
  • Stabilization element 177 comprises wire or band 186 of resilient material, such as stainless steel, that exits catheter shaft 171 through skive 187 , and is fixed to catheter shaft 171 near distal end 188 .
  • stabilization element 177 When deployed within a hollow organ, such as a chamber of the heart, as depicted in FIG. 20B , stabilization element 177 forms a plurality of sinusoidal bends 177 a- 177 c that support distal end 173 of catheter shaft 171 .
  • Stabilization element 177 preferably comprises a material having a shape-memory and that is capable of reforming to a desired shape when extended through skive 187 .

Abstract

Apparatus and methods for performing surgery within an organ or vessel are provided. A catheter is provided having a longitudinal axis and an end region carrying an end effector, the end region movable to a series of positions along the longitudinal axis and with an selectable orientation relative to the longitudinal axis. The catheter includes elements for stabilizing the end region of the apparatus within an organ or vessel, and for counteracting reaction forces developed during actuation of the end effector.

Description

REFERENCE TO RELATED APPLICATIONS
The present application is a continuation-in-part application of commonly assigned U.S. patent application Ser. No. 08/863,877, filed May 27, 1997, now U.S. Pat. No. 5,910,150 which claims the benefit of the filing date of U.S. provisional patent application Ser. No. 60/032,196, filed Dec. 2, 1996.
FIELD OF THE INVENTION
The present invention relates to apparatus and methods for performing surgery on an interior wall of a hollow-body organ such as the heart, or within the brain cavities and the like. More particularly, the present invention provides a device that enables a clinician to perform surgery on an interior wall of an organ or vessel using apparatus for stabilizing an end effector during the surgery.
BACKGROUND OF THE INVENTION
A leading cause of death in the United States today is coronary artery disease, in which atherosclerotic plaque causes blockages in the coronary arteries, resulting in ischemia of the heart (i.e., inadequate blood flow to the myocardium). The disease manifests itself as chest pain or angina. In 1996, approximately 7 million people suffered from angina in the United States.
Coronary artery bypass grafting (CABG), in which the patient's chest is surgically opened and an obstructed artery replaced with a native artery harvested elsewhere, has been the conventional treatment for coronary artery disease for the last thirty years. Such surgery creates significant trauma to the patient, requires long recuperation times, and causes a great deal of morbidity and mortality. In addition, experience has shown that the graft becomes obstructed with time, requiring further surgery.
More recently, catheter-based therapies such as percutaneous transluminal coronary angioplasty (PTCA) and atherectomy have been developed. In PTCA, a mechanical dilatation device is disposed across an obstruction in the patient's artery and then dilated to compress the plaque lining the artery to restore patency to the vessel. Atherectomy involves using an end effector, such as a mechanical cutting device (or laser) to cut (or ablate) a passage through the blockage. Such methods have drawbacks, however, ranging from re-blockage of dilated vessels with angioplasty to catastrophic rupture or dissection of the vessel during atherectomy. Moreover, these methods may only be used for that fraction of the patient population where the blockages are few and are easily accessible. Neither technique is suitable for the treatment of diffuse atherosclerosis.
A more recent technique, which holds promise of treating a larger percentage of the patient population, including those patients suffering from diffuse atherosclerosis, is referred to as transmyocardial revascularization (TMR). In this method, a series of channels are formed in the left ventricular wall of the heart. Typically, between 15 and 30 channels about 1 mm in diameter and up to 3.0 cm deep are formed with a laser in the wall of the left ventricle to perfuse the heart muscle with blood coming directly from the inside of the left ventricle, rather than traveling through the coronary arteries. Apparatus and methods have been proposed to create those channels both percutaneously and intraoperatively (i.e., with the chest opened).
U.S. Pat. No. 5,389,096 to Aita et al. describes a catheter-based laser apparatus for percutaneously forming channels extending from the endocardium into the myocardium. U.S. Pat. No. 5,380,316 to Aita et al. describes an intraoperative laser-based system for performing TMR. U.S. Pat. No. 5,591,159 to Taheri describes a mechanical apparatus for performing TMR involving a catheter having an end effector formed from a plurality of spring-loaded needles.
Neither the Aita nor Taheri devices describe apparatus wherein the laser-tip or spring-loaded needles are stabilized during the channel-forming process. Because the end effector of such devices may shift position while in use, such previously known devices may not provide the ability to reliably determine the depth of the channels, nor the relative positions between channels if multiple channels are formed.
In view of the shortcomings of previously known TMR devices, it would be desirable to provide apparatus and methods for performing percutaneous surgery, such as TMR, that permit precise control of the end region of the device carrying the end effector.
It also would be desirable to control the location of the end region of the device within the ventricle both with respect to features of the ventricular walls and in relation to other channels formed by the device, and to stabilize the end region of the device within the organ, for example, to counteract reaction forces created by the actuation of the end effector during treatment.
A number of devices are known in the medical arts that provide certain aspects of the desired functionality. For example, U.S. Pat. Nos. 5,389,073 and 5,330,466 to Imran describe steerable catheters; U.S. Pat. No. 5,415,166 to Imran describes a device for endocardial mapping; U.S. Pat. No. 4,813,930 to Elliott describes a radially extendable member for stabilizing an angioplasty catheter within a vessel; U.S. Pat. No. 5,354,310 describes an expandable wire mesh and graft for stabilizing an aneurysm; and U.S. Pat. Nos. 5,358,472 and 5,358,485 to Vance et al. describe atherectomy cutters that provide for aspiration of severed material.
None of the foregoing references overcomes problems associated with locating an end region of a catheter against a position on the inside wall of a heart chamber. Moreover, the prior art is devoid of a comprehensive solution to the above-noted shortcomings of previously-known apparatus for percutaneously performing surgery, and especially for performing TMR.
SUMMARY OF THE INVENTION
In view of the foregoing, it is an object of this invention to provide apparatus and methods for performing surgery, such as TMR, that permit precise control of an end effector disposed in an end region of the apparatus.
It is another object of this invention to provide apparatus and methods, suitable for use in performing TMR and surgery of other hollow-body organs, that include the capability to stabilize within the organ an end region of the device carrying an end effector, for example, to counteract reaction forces created by the end effector during treatment.
These and other objects of the present invention are accomplished by providing apparatus having a directable end region carrying an end effector for performing surgery. Apparatus constructed in accordance with the present invention comprises a catheter having a longitudinal axis and an end region movable to a series of positions along the longitudinal axis. The end region may be selectively moved to a position at an angle relative to the longitudinal axis of the catheter, including a substantially orthogonal position. The catheter includes means for stabilizing a distal region of the apparatus within a hollow-body organ, and for counter-acting reaction forces developed during actuation of an end effector.
In a preferred embodiment of the apparatus of the invention, the catheter includes a catheter shaft and a guide member disposed for longitudinal sliding movement within a groove of the catheter shaft. The guide member includes an end region including an end effector maneuverable between a transit position wherein the end region lies parallel to a longitudinal axis of the catheter to a working position wherein the end region and end effector are oriented at an angle relative to the longitudinal axis, including a substantially orthogonal position. The catheter shaft preferably may include adjustable outwardly projecting stabilization members to provide a stable platform to counteract reaction forces generated when the end effector contacts the wall of the hollow-body organ.
Methods of using the apparatus of the present invention to perform surgery, such as transmyocardial revascularization, are also provided.
BRIEF DESCRIPTION OF THE DRAWINGS
Further features of the invention, its nature and various advantages will be more apparent from the accompanying drawings and the following detailed description of the preferred embodiments, in which:
FIG. 1 is a view of a first illustrative embodiment of apparatus constructed in accordance with the present invention;
FIG. 2 is a perspective view of the distal region and end effector of the apparatus of FIG. 1;
FIGS. 3A and 3B are, respectively, a perspective view and side view of stabilization members disposed on the distal region of the apparatus of FIG. 1;
FIG. 4 is sectional view of an illustrative end effector constructed in accordance with the present invention;
FIGS. 5A and 5B are, respectively, side and perspective views of an illustrative handle assembly for controlling and actuating the apparatus of the present invention;
FIGS. 6A-6C are views showing deployment of the apparatus of FIG. 1 in a patient's left ventricle to perform TMR;
FIG. 7 is a perspective view of the distal region of an alternative embodiment of apparatus constructed in accordance with the present invention;
FIG. 8 is a perspective view of the distal region of the apparatus of the present invention showing an alternative embodiment of the stabilization members;
FIGS. 9A, 9B and 9C are end views, taken along view line 9-9 of FIG. 8, depicting various deployment positions of the stabilization members of FIG. 8;
FIG. 10 is a perspective view of the distal region of the apparatus of the present invention showing an alternative embodiment of the stabilization members;
FIG. 11 is a perspective view of the distal region of the apparatus of the present invention showing another alternative embodiment of the stabilization members;
FIGS. 12A-12C are end views, taken along view line 12-12 of FIG. 11, depicting various deployment positions of the stabilization members of FIG. 11;
FIG. 13 is a view of an alternative embodiment of apparatus constructed in accordance with the present invention;
FIGS. 14A and 14B are, respectively, perspective top and bottom views of a distal region of the apparatus of FIG. 13;
FIG. 15 is a partial side view, partly in section, of the catheter shaft of FIGS. 13 and 14 deployed in contact with tissue;
FIG. 16 is a side view of the handle portion of the apparatus of FIG. 13;
FIGS. 17A and 17B are, respectively, top and side sectional views of the distal region of an alternative embodiment of the apparatus of the present invention;
FIG. 18 is a perspective top view of the distal region of a further alternative embodiment of the apparatus of the present invention;
FIG. 19 is a view of a further alternative embodiment of apparatus of the present invention; and
FIGS. 20A and 20B are, respectively, perspective top and side views of a distal region of the apparatus of FIG. 19.
DETAILED DESCRIPTION OF THE INVENTION
The present invention relates generally to apparatus and methods for percutaneously performing surgery within an organ or vessel. The apparatus of the present invention comprises a catheter including a stabilizing catheter shaft which percutaneously may be disposed within an organ. A guide member engaged with the catheter shaft includes an end region that may be selectively articulated to a position at an angle to a longitudinal axis of the catheter, including a position substantially orthogonal to the longitudinal axis. The end region carries an end effector (e.g., an ablative or mechanical cutting device) for treating tissue. Severed or ablated tissue may be aspirated through the catheter to its proximal end for disposal. The catheter shaft, either alone or in conjunction with stabilizing members, and the guide member, provides precise control over the location of the end region, and thus, the end effector.
The present invention therefore offers a device having a directable end region and end effector for performing surgery that provides a degree of control heretofore unattainable. While the invention is described hereinafter as particularly useful in the emerging field of transmyocardial revascularization, apparatus constructed in accordance with the present invention may be advantageously used in performing surgery on other organs or vessels, such as the intestines, blood vessels or the brain cavities. In addition, while the present invention is described herein in the context of a mechanical cutting system, the control and stabilization apparatus of the present invention may be advantageously used with other types of cutting elements, such as lasers, cryogenic cutters or radio-frequency ablation devices.
Referring to FIG. 1, illustrative apparatus 20 constructed in accordance with the present invention is described. Apparatus 20 includes a two-part catheter formed of catheter shaft 21 and guide member 22. Apparatus 20 includes distal region 23 within which guide member 22 has end region 25 that is selectively movable between a transit position parallel to longitudinal axis 24 of catheter shaft 21 and a working position (as shown) substantially orthogonal to longitudinal axis 24. Distal region 23 preferably includes an end effector, described in greater detail hereinbelow, for ablatively or mechanically cutting tissue to attain a treatment goal.
End region 25 of guide member 22 may be positioned longitudinally with respect to catheter shaft 21 by imparting relative movement between guide member 22 and catheter shaft 21 using handle assembly 26. Catheter shaft 21 preferably includes a plurality of stabilizing members 27 to support and stabilize distal region 23 of the apparatus within the hollow-body organ.
Apparatus 20 is coupled via cable 28 to controller 29. In a preferred embodiment wherein the end effector comprises a rotating cutting head, controller 29 includes a motor and control logic for rotating the cutting head responsive to commands input at handle assembly 26 or a footpedal (not shown) and a vacuum source for aspirating severed tissue from the treatment site. Controller 29 optionally may further include RF circuitry (shown in dotted line) for energizing the cutting head to cauterize tissue as it is cut. Alternatively, controller 29 may include a laser source or radio frequency circuitry for causing laser or RF ablation, respectively, using a suitable end effector.
Referring now to FIGS. 2 and 3, distal region 23 of apparatus 20 is described in greater detail. In FIG. 2, distal region 23 includes end region 25 of guide member 22 disposed in sliding engagement in groove 30 of catheter shaft 21. Catheter shaft 21 may be constructed of a flexible material commonly used in catheter products, such as nylon, polyethylene or polyurethane, and contains lateral grooves 31 and 32 that accept a mating portion of guide member 22 in sliding engagement. Catheter shaft 21 may have an ellipsoidal shape to stabilize the catheter shaft and may include two spaced-apart wire stiffeners that terminate in barbs 33. Barbs 33 are designed to engage an interior surface of an organ, for example, the apex of the left ventricle, to reduce rotation of the catheter shaft when the end effector is actuated. Alternatively, catheter shaft 21 may be formed of a material having sufficient stiffness that the wire stiffeners may be omitted over most of the length of the catheter shaft.
Guide member 22 includes end region 25 carrying an end effector and flanges 34 and 35 that slidingly engage grooves 31 and 32. End region 25 may be articulated in region 36 using control wires or a temperature actuated shape-memory alloy steering mechanism, such as described in the aforementioned patents to Imran. Guide member 22 may be constructed of a spring material (commonly called a Bowden) with spaces in-between the coils to allow it to bend when it is pulled by a control wire asymmetrically, as previously known in the art. Alternatively, guide member 22 may be constructed of a stiffer material such as polyimide coated over a braided steel tubular structure, such as employed in previously known neuro-navigational endoscope devices. In this case, slits are provided on the inside of the bend in region 36 so that the guide member bends in the direction of the slits. The slits allow a tight bend radius which may not otherwise be achievable.
Guide member 22 preferably includes a lumen, as described hereinafter, through which tissue may be evacuated from a treatment site by suction. Accordingly, guide member 22 may also be formed from a loosely wound spring reinforced with a soft elastomeric coating. The elastomeric coating advantageously serves the following functions: it provides sealing along the length of the guide member required to maintain adequate suction through the lumen; it prevents collapse of the lumen in the presence of applied suction; it resists kinking of the coils of the spring; and it also enables the guide member to be bent to relatively tight radii. Reinforced tubing suitable for use as guide member 22 is available from Adam Spence Corporation, Wall, N.J.
In the above-described embodiments, end region 25 of guide member 22 is movable from a transit position lying parallel to the longitudinal axis of catheter shaft 21 to a working position wherein end region 25 is articulated to a position substantially orthogonal to the longitudinal axis of the catheter shaft. In addition, end region 25 may be constructed to enable it to be locked in position at any angle a that may be desired for a given application.
With respect to FIGS. 3A and 3B, stabilization members 27 project outwardly from apertures 37 on either side of catheter shaft 21 in distal region 23. Illustratively, stabilization members 27 comprise four circumferentially-oriented hoops formed of flexible wires 27a-27d. In one preferred embodiment, depicted in FIGS. 3, wires 27a-27d comprise a continuous coil having its distal end affixed to catheter shaft 21 and its proximal end connected to handle assembly 26 via push wire 38. The turns of the coil are slidably disposed in lumens within catheter shaft 21 that interconnect apertures 37 on either side of the catheter shaft. When push wire 38 is urged in the distal direction, wires 27a-27d expands outwards by illustrative distances h1-h4 to contact and conform to the topology of the interior wall of the hollow-body organ or vessel. Wires 27a-27d also may be retracted against catheter shaft 21 by pulling push wire 38 in the proximal direction.
Accordingly, wires 27a-27d may be moved from a retracted position in which they are retracted against distal region 23 of catheter shaft 21 to an expanded position in which they engage a wall of the organ and urge end region 25 into engagement with an opposing wall of the organ, thereby stabilizing catheter shaft 21 against rotation.
Stabilization members 27 may be constructed of any suitable elastic material, including stainless steel, spring steel, nickel-titanium alloys, and a variety of plastics. A nickel-titanium alloy is preferred where wires 27a-27d comprise a continuous coil, as in FIG. 3B. In the contracted mode, catheter shaft 21 and guide member 22 have a relatively small profile, for example, 2-3 mm. Upon actuation of the control means in handle assembly 26, wires 27a-27d expand out as shown in FIG. 3B to form a basket shape that spans and conforms to the lumen of the organ or vessel.
Where stabilization members 27 comprise a single coil, as in FIG. 3B, they may be actuated by a single control means. Alternatively, as described hereinafter with respect to FIG. 8, each of stabilization members 27 may be individually adjusted to conform to the shape of the cavity of the hollow-body organ. Stabilization members 27 may alternatively be oriented parallel to the longitudinal axis of apparatus 20, as described hereinafter with respect to FIG. 8.
The longitudinal position of end region 25 with respect to catheter shaft 21 may be adjusted by sliding guide member 22 in groove 30 of the catheter shaft. Handle assembly 26 preferably includes means, described hereinafter, for moving guide member with respect to catheter shaft 21 so that end region 25 may be positioned at a series of vertical locations. In addition, stabilization members 27 may be adjusted to provide some control over the lateral positioning of the catheter shaft and guide member with respect to the interior wall of the organ or vessel. Thus, apparatus 20 enables a matrix of treatment sites to be accessed without removing and repositioning the apparatus.
Referring now to FIG. 4, end effector 40 (also referred to hereinafter as a “micromorcellator”) is described as illustratively comprising a rotary cutting member and drive arrangement. Micromorcellator 40 includes cutting head 41 comprising tubular element 42. Distal edge 42a of tubular element 42 includes a sharpened bevel 43. Cutting head 41 is affixed to drive rod 45, which preferably includes soft plastic or elastomeric coating 45a, as described hereinabove, to maintain suction through lumen 44. The vacuum source in controller 29 aspirates the severed tissue through lumen 44, if provided.
Orientation of end region 25 of guide member 22 is accomplished by control wire 46, which is slidingly disposed in lumen 47 of guide member 22. As described hereinabove, guide member 22 preferably comprises a spring material with spaces in-between the coils to allow it to bend when control wire 46 is retracted in a proximal direction. Alternatively, guide member 22 may be constructed of polyimide coated over a braided steel tube and includes slits on the inside of bend region 36 so that end region 25 bends in the direction of the slits when control wire 46 is retracted in a proximal direction.
Cutting head 41 is connected to the motor of controller 29 via drive rod 45. Drive rod 45 may be formed of a flexible tube such as a bowden or a covered coil or may be formed of a plastic having both high torquability and flexibility. Drive rod 45 is disposed in lumen 44 for a limited range of reciprocation, e.g., up to 3.0 cm, to permit extension of cutting head 41 beyond the end of guide member 22. When end region 25 is in its transit position, cutting head 41 is disposed just below distal endface 48 of guide member 22. Drive rod 45 is hollow and preferably includes a covering of a soft plastic or elastomeric material to allow the application of a negative pressure to aspirate the severed tissue.
Applicant expects that high speed rotation of cutting head 41 will generate frictional heating of the tissue surrounding the cutting head, thereby causing coagulation of the tissue with minimal thermal damage to the surrounding tissue. Alternatively, tubular member 42 of cutting head 41 may comprise an electrically conductive material and be electrically coupled to the optional radio-frequency generator circuitry in controller 29 to provide coagulation of the edges of a channel formed in the tissue by cutting head 41. In this embodiment, tubular element 42 serves as the electrode in a monopolar coagulation arrangement. In addition, a second electrode (not shown) may be formed on the working end spaced apart from the cutting head 41, so that tubular member 42 serves as one electrode of a bipolar coagulation arrangement. Applicant expects that the sealing action produced by RF coagulation, if provided, will simulate the lesions produced by a laser.
With respect to FIGS. 5A and 5B, illustrative handle assembly 50 is described. Handle assembly 50 includes lower portion 51 affixed to catheter shaft 21 and upper portion 52 affixed to guide member 22. Upper portion 52 is slidingly engaged in lower portion 51, so that guide member 22 may be selectively translated longitudinally with respect to catheter shaft 21 by rotating knob 53. Lower portion 51 of handle assembly 50 includes hand grip 54, and button 55 for controlling the extension of stabilization members 27. Button 55 slides in slot 56 of lower portion 51 to extend or retract stabilization members 27 via push wire 38.
Upper portion 52 includes indicator 57a that may be selectively aligned with indicators 57b, so that the channels formed by end effector 40 are positioned at a series of spaced-apart locations. Cable 28 extends from upper portion 52 and connects the working end of apparatus 20 to controller 29. Upper portion 52 also includes button 58 which may be moved in slot 59 to control the articulation of end region 25 of guide member 22, and depth control lever 60 disposed in slot 61. Depth control lever 60 is moved within slot 61 to control reciprocation of cutting head 41 from end region 25. Slot 61 has a length so that when button 60 is moved to fully extend cutting head 41 from guide member 22, a proximal portion of tubular member 42 remains within guide member 22. In addition, or alternatively, a user-adjustable limit bar (not shown) may be provided in slot 61 to select the maximum extension of cutting head 41 desired for a particular application.
RF button 62 also may be provided to control activation of the optional RF circuitry of controller 29 to coagulate tissue surrounding the channel formed by micromorcellator 40. RF button also could take the form of a microswitch located within slot 61 of handle assembly 50, so as to provide automatic activation of the RF coagulation feature for a short period of time when depth control lever 60 is advanced to contact the user-adjustable limit bar.
It will therefore be seen that handle assembly 50 provides for longitudinal movement of end region 25 with respect to catheter shaft 21 via relative movement between upper portion 52 and lower portion 51 (using knob 53); provides selective deployment of stabilization members 27 via button 55; selective orientation of end region 25 via button 58; control over the depth of the channels formed by end effector 40 via depth control lever 60; and, optionally, activation of an RF coagulation feature via button 62.
Referring now to FIGS. 6A-6C, operation of apparatus 20 in the context of performing transmyocardial revascularization is described. In FIG. 6A, distal region 23 of apparatus 20 is shown positioned in a patient's left ventricular cavity, using techniques which are per se known. Specifically, distal region 23 of apparatus 20 is inserted via a femoral artery, and is maneuvered under fluoroscopic guidance in a retrograde manner up through the descending aorta, through aortic arch 201, and down through ascending aorta 202 and aortic valve 203 into left ventricle 204. Previously known imaging techniques, such as ultrasound, MRI scan, CT scan, or fluoroscopy, may be used to verify the location of the distal region 23 within the heart.
Insertion of apparatus 20 into the left ventricle is with guide member 22 in its distal-most position with stabilization members 27 fully retracted and end region 25 in its transit position. As barbs 33 of catheter shaft 21 engage apex 205 of the left ventricle, catheter shaft 21 (and guide member 22) preferentially bends in regions 65 and 66 to form a “dog-leg”, in which distal region 23 becomes urged against a lateral wall of the ventricle. Regions 65 and 66 where the bends take place may be made flexurally weaker than the remainder of the catheter shaft to aid in the bending of the catheter at these locations.
Referring to FIG. 6B, button 55 is advanced in slot 56 of handle assembly 50 to extend stabilization members 27 so that they engage the septal wall of the left ventricle and urge the end effector against left ventricular wall 206. The dog-leg bends in regions 65 and 66 allow the catheter to be pushed onto the left ventricular wall while the stabilization members push against the septum. End region 25 of guide member 22 is then rotated to its working position by retracting button 58 along slot 59 of handle assembly 50, thus causing end region 25 to be positioned substantially orthogonally to the longitudinal axis of catheter shaft 21.
The motor and vacuum source of controller 29 are then actuated to cause cutting head 41 to rotate and to induce negative pressure in lumen 44 of micromorcellator 40. The clinician then pushes depth control lever 60 distally in slot 61, causing cutting head 41 to be advanced beyond distal endface 48 of guide member 22 and engage the endocardium. When micromorcellator 40 engages the endocardium, a reaction force is generated in catheter shaft 21 that tends both to push end region 25 away from the tissue and to cause the catheter shaft to want to rotate. The relatively flat configuration of catheter shaft 21, in conjunction with barbs 33, is expected to adequately counteract the torque induced by operation of the micromorcellator. In addition, stabilization members 27 function to counteract both these outward reaction and torque effects.
As micromorcellator 40 is advanced to form channel 207 in the left ventricular wall, tissue severed by cutting head 41 is suctioned into lumen 44 and aspirated to the proximal end of apparatus 20 via the vacuum source of controller 29. The depth of channel 207, which is proportional to the movement of depth control lever 60 in slot 61, may be predetermined using conventional ultrasound techniques, MRI scanning, or other suitable methods. As channel 207 is formed, tissue severed from the ventricular wall is aspirated through lumen 44 of guide member 22, thereby reducing the risk of embolization of the severed material. In addition, applicant expects that the use of suction through lumen 44 will assist in stabilizing the micromorcellator, and tend to draw tissue into the cutting head.
Once micromorcellator 40 has achieved its maximum predetermined depth, cutting head 41 is withdrawn from channel 207 by retracting depth control lever 60 to its proximal-most position, thereby returning cutting head 41 to a position just below distal endface 48 of end region 25 of guide member 22. It is expected that rotation of cutting head 41 will generate sufficient frictional heat in the tissue contacting the exterior of cutting head 41 to coagulate the tissue defining the channel.
Optionally, RF button 62 may be depressed on handle assembly 50 to apply a burst of RF energy to the edges of channel 207 as micromorcellator 40 achieves its maximum predetermined depth, and while cutting head 41 is stationary, rotating or being withdrawn from the channel. If provided, this burst of RF energy is expected to further coagulate the tissue defining the walls of channel 207 and modify the surface properties of the tissue.
As shown in FIG. 6C, a series of vertically aligned spaced-apart channels 207 may be formed in left ventricular wall 207 by sliding upper portion 52 proximally within lower portion 51 of handle assembly 50 (by rotating knob 53). Cutting head 41 is then advanced to form a further channel 207 in the tissue, and the tissue may also be coagulated with a burst of RF energy. When upper portion 52 has been retracted to its proximal-most position, button 55 is adjusted as described above with respect to FIGS. 3A and 3B to cause the catheter shaft to rotate several degrees about its axis. Stabilization members 27 are again extended to contact the septal wall, causing micromorcellator 40 to be urged against left ventricular wall 206 in a region laterally spaced apart from the initial line of channels 207.
The foregoing methods enable a matrix of channels to be formed illustratively in the left ventricular wall. It will of course be understood that the same steps may be performed in mirror image to stabilize the apparatus against the left ventricular wall while actuating the end effector to produce a series of channels in the septal region. In accordance with presently accepted theory, the formation of such channels in the endocardium or septal region enables oxygenated blood in the left ventricle to flow directly into the myocardium and thus nourish and oxygenate the muscle. It is believed that these channels may be drilled anywhere on the walls of the heart chamber, including the septum, apex and left ventricular wall, and the above-described apparatus provides this capability.
Referring now to FIG. 7, the distal region of an alternative embodiment of the apparatus of the present invention is described. Apparatus 70 is similar to apparatus 20 described hereinabove, but includes wires 71 and 72 forming a dual-rail on which catheter shaft 73 glides, thereby reducing unwanted rotation of distal region 74 and end region 75. Distal end 76 of the dual-rail includes cushion 77 having barbs 78 for anchoring the catheter shaft in the apex of the left ventricle to prevent inadvertent rotation of catheter shaft 73. Guide member 79 has an inner diameter suitable for carrying one of a variety of end effectors 81, such as a laser fiber, a radio frequency applying device, micromorcellator as described hereinabove, or slit needles, as in the above-mentioned patent to Taheri.
Dual-rail embodiment 70 may be used without stabilization members, or alternatively catheter shaft 73 may include the stabilization members of FIGS. 3 or as described hereinbelow. Wires 71 and 72 also may be formed from a resilient material, e.g., stainless steel or a nickel-titanium alloy, so that when they exit catheter shaft 73 they diverge from one another and give the catheter a larger and more stable base. In this case, cushion 77 preferably comprises an elastomeric material that allows the distance between the tips of wires 71 and 72 to increase beyond the diameter of the catheter. Wires 71 and 72 may have other than circular cross-sections and may take the form of, for example, ribbons.
Wires 71 and 72, in cooperation with a distally-directed axial force exerted on the handle assembly by the clinician, serve to anchor the catheter against a lateral wall of the left ventricle, while catheter shaft 74 and guide member 79 are advanced along the dual-rail. Like apparatus 20, apparatus 70 may include flexurally weaker locations along its length to aid in positioning distal region 74 within the left ventricle.
The dual-rail design of apparatus 70 also may be advantageously employed to determine the location of end region 75 and end effector 81 with respect to the interior of the hollow-body organ or vessel. In this embodiment, wires 71 and 72 are electrically connected within cushion 77 and have a uniform resistance per unit length. Electrodes 80 are positioned in distal end 82 of catheter shaft 73 to measure the resistance of wires 71 and 72 between the electrodes.
The resistance between electrodes 80 may be measured, for example, by ohmmeter circuitry, to determine the distance between the distal end 82 of the catheter shaft and the apex of the left ventricle. In conjunction with the displacement between the upper and lower portions of the handle assembly (see FIGS. 5), the position of end region 75 and end effector 81 may be determined relative to the apex of the heart. This position information may be sampled using suitable analog to digital circuitry, and displayed on a display unit to aid the physician in determining where to place the channels in the heart wall.
Referring now to FIGS. 8 and 9A-9C, a first alternative embodiment of the stabilization members of the present invention are described. In FIG. 8, the distal region of apparatus 90 similar to that of FIG. 1 is shown, in which like components are indicated by like reference numerals. Apparatus 90 includes catheter shaft 21 including barbs 33 and guide member 22 including end region 25. Stabilization members 91a-91d project from proximal apertures 92 and distal apertures 93, and comprise individual longitudinally-oriented flexible wires. Wires 91a-91d enter lumens in catheter shaft 21 through apertures 92 and extend proximally to handle assembly 26. Each of wires 91a-91d preferably has a respective button (similar to button 55 in FIGS. 5) on handle assembly 26 for selectively controlling the extension of the wires.
Accordingly, wires 91a-91d of the embodiment of FIG. 8 may be moved from a retracted position in which they are retracted against distal region 23 of catheter shaft 21 to an expanded position in which they engage a wall of the organ and urge end region 25 into engagement with an opposing wall of the organ, thus stabilizing catheter shaft 21 against rotation.
As illustrated in FIGS. 9A-9B, each of stabilization members 91 preferably may be selectively extended a different amount, therefore causing distal region 23 to rotate about its longitudinal axis. For example, in FIG. 9A, wire 91a is extended from distal region 23 a greater distance, causing a larger bow in wire 91a, while wire 91d is extended a smaller distance, causing a smaller bow therein. Consequently, if each of wires 91a-91d contacts a wall of the organ, catheter shaft 23 will have a tendency to rotate in a counterclockwise direction (viewed from the distal end). Conversely, reversing the extensions of wires 91a and 91d, as in FIG. 9C, will cause rotation in the opposite direction. It is therefore seen that by individually controlling the extension of the stabilization members 91, the position of the catheter with respect to an interior lateral wall of the hollow-body organ can be controlled.
Referring now to FIG. 10 an alternative embodiment of a stabilization arrangement is described. Apparatus 100 includes catheter shaft 101 and guide member 102. Except for stabilization members 103, which in FIG. 10 comprise horizontal inflatable ribs, apparatus 100 is similar to apparatus 20 of FIG. 1.
As described hereinabove, guide member 102 moves relative to catheter shaft 101 to enable the clinician to form a series of vertically aligned channels in the myocardium. Once a line of channels has been formed, the catheter must be moved laterally to a new location and the procedure repeated until the desired number of channels has been achieved. One expedient for doing so, for example, applicable to the apparatus of FIG. 7, is to withdraw the catheter slightly, rotate it and reposition it at a different location on the left ventricular wall. The stabilization arrangement of FIG. 10 instead facilitates lateral movement by deflating ribs 103, rotating catheter shaft 21, and then re-inflating ribs 103.
Specifically, when inflated, stabilization members 103 provide a degree of hoop strength that ensures proper contact of the distal face of end region 106 with the wall of the hollow-body organ or vessel at all times. Once a vertical row of channels has been formed, stabilization members 103 are deflated by the clinician and end region 106 is moved to a new lateral position. The stabilization members are fully re-inflated and another vertical row of channels is formed, as discussed hereinabove.
With respect to FIGS. 11 and 12A-12C, another embodiment of the apparatus of the present invention is described in which the stabilization members comprise longitudinally-oriented balloons. Apparatus 110 is otherwise similar to the apparatus of FIG. 8, and includes catheter shaft 111, guide member 112, and end region 113. Stabilization elements 114a-114c comprise balloons, preferably formed of a compliant material, such as polyurethane, silicone or latex. The handle assembly for apparatus 110 includes valving means for selectively individually inflating balloons 114a-114c. As shown in FIGS. 12A-12C, balloons 114a-114c may be selectively inflated via inflation lumens (not shown) in catheter shaft 111 to stabilize apparatus 110 within a hollow-body organ, and to rotate catheter shaft 111 (and end region 113) in a manner similar to that described above with respect to FIGS. 9A-9C.
Referring now to FIG. 13, a further alternative embodiment of apparatus constructed in accordance with the present invention is described. Apparatus 120 comprises a two-part catheter formed of catheter shaft 121 and guide member 122. Apparatus 120 includes distal region 123 within which guide member 122 has end region 125 that is selectively movable between a transit position parallel to longitudinal axis 124 of catheter shaft 121 and a working position (as shown), substantially orthogonal to longitudinal axis 124. Distal region 123 preferably includes an end effector, as described in detail hereinabove.
End region 125 of guide member 122 may be positioned longitudinally with respect to catheter shaft 121 by imparting relative movement between guide member 122 and catheter shaft 121 using handle assembly 126. Catheter shaft 121 includes stabilizing assembly 127 to support and stabilize distal region 123 of the apparatus within an organ or vessel.
Apparatus 120 is coupled via cable 128 to controller 129. In a preferred embodiment, wherein the end effector comprises a flexible wire having a sharpened tip, controller 129 includes a hydraulic or pneumatic piston, valve assembly and control logic for extending and retracting the end effector beyond the distal endface of end region 125 responsive to commands input at handle assembly 126 or a footpedal (not shown). Controller 129 optionally may further contain RF generator circuitry for energizing electrodes disposed on the end effector to cause a controlled degree of necrosis at the treatment site.
Referring now to FIGS. 14A and 14B, distal region 123 of apparatus 120 is described in greater detail. In FIG. 14A, distal region 123 includes end region 125 of guide member 122 disposed in sliding engagement in track 130 of catheter shaft 121, as described hereinabove with respect to the embodiment of FIG. 1. Guide member 122 includes end region 125 carrying end effector 134 and flanges 135 that slidingly engage grooves 131 and 132. End region 125 may be articulated in region 136 using control wires or a temperature actuated shape-memory alloy steering mechanism, as described hereinabove.
End region 125 of guide member 122 is movable from a transit position lying parallel to longitudinal axis 124 of catheter shaft 121 to a working position wherein end region 125 is articulated to a position substantially orthogonal to the longitudinal axis of the catheter shaft. In addition, end region 125 may be constructed to enable it to be locked in position at any angle a that may be desired for a given application.
Stabilization assembly 127 comprises flat band 137 of resilient material, such as stainless steel, that projects outwardly from catheter shaft 121 in distal region 123. Illustratively, stabilization assembly 127 comprises multiple loops 127a-127c of band 137. Band 137 has its distal end affixed to the distal end of catheter shaft 121, and its proximal end connected to handle assembly 126. Band 137 passes through an interior lumen of catheter shaft 121 (see FIG. 15) and exits to the exterior surface of catheter shaft 121 in distal region 123. Crossbars 138 permit band 137 to be pulled flat against the exterior surface of catheter shaft 121, as shown in FIG. 14B, or urged in a distal direction to form loops 127a-127c.
Referring to FIG. 15, in which guide member 122 is omitted for clarity, when the proximal end of band 137 is urged in the distal direction, loops 127a-127c expand outwardly by illustrative distances h1-h3 to contact and conform to the topology of interior wall T of an organ or vessel. Accordingly, loops 127a-127c may be moved from a retracted position in which they are retracted against an exterior surface of distal region 123 of catheter shaft 121 (FIG. 14B) to an expanded position (FIG. 14A) in which they engage a wall of an organ or vessel.
In the position shown in FIG. 14A, stabilization assembly 127 urges end region 125 into engagement with an opposing wall of the organ, thereby stabilizing catheter shaft 121 against rotation. Band 137 may be constructed of any suitable elastic material, including stainless steel, spring steel, nickel-titanium alloys, and a variety of plastics. In the contracted mode, catheter shaft 121 and guide member 122 have a relatively small profile, for example, 2-3 mm.
The longitudinal position of end region 125 with respect to catheter shaft 121 may be adjusted by sliding guide member 122 in track 130 of the catheter shaft. Handle assembly 126 preferably includes means, described hereinafter, for moving guide member 122 with respect to catheter shaft 121 so that end region 125 may be positioned at a series of longitudinal locations In addition, stabilization assembly 127 may be adjusted to provide some control over the lateral positioning of the catheter shaft and guide member with respect to the interior wall of the organ or vessel. Thus, apparatus 120 enables a matrix of treatment sites to be accessed without removing and repositioning the apparatus.
With respect to FIG. 8, illustrative handle assembly 126 is described. Handle assembly 126 includes lower portion 140 affixed to catheter shaft 121 and upper portion 141 affixed to guide member 122. Upper portion 141 is slidingly engaged in lower portion 140, so that guide member 122 may be selectively translated longitudinally with respect to catheter shaft 121 by rotating knob 142. Upper portion 141 includes ribbed bonnet 143, which collapses and expands to enclose lower portion 140 as upper portion 141 is moved in the proximal and distal directions, respectively. Lower portion 140 of handle assembly 126 includes indentations 144 forming a hand grip.
Threaded post 145 is coupled to the proximal end of band 137, and slides in a slot (not visible in FIG. 16) in the lower surface of catheter shaft 121. Thumbwheel 146 is threaded onto post 145. Post 145 and thumbwheel 146 permit the proximal end of band 137 (see FIG. 15) to be urged in the proximal and distal directions, for example, to deploy stabilization assembly 127. Band 137 then is locked into position by tightening thumbwheel 146 on post 145 against the lower surface of catheter shaft 121.
Upper portion 141 includes indicator 147a that may be selectively aligned with indicators 147b, so that the treatment sites are positioned at a series of spaced-apart locations. Cable 128 extends from upper portion 141 and connects the end effector of apparatus 120 to controller 129. Button 148 disposed on the top surface of upper portion 141 may be depressed to command the control logic of controller 129 to reciprocate the end effector from end region 125, and optionally, cause necrosis at the treatment site. Button 149, disposed in a slot in the upper surface of the proximal end of guide tube 122 (not visible in FIG. 16) is coupled to a tendon affixed to end region 125, and may be moved in the proximal and distal directions to control the degree of articulation of end region 125 and the end effector.
Handle assembly 126 therefore provides for longitudinal movement of end region 125 with respect to catheter shaft 121 via relative movement between upper portion 141 and lower portion 140 (using knob 142); provides selective deployment of stabilization assembly 127 (using post 145 and thumbwheel 146); selective orientation of end region 125 (using button 149); and control over operation of the end effector (using button 148).
Referring now to FIGS. 17A and 17B, a yet further alternative embodiment of the stabilization assembly of the apparatus of the present invention is described. Apparatus 150 is similar to apparatus 120 described hereinabove, but band 137 that forms stabilization assembly 127 of apparatus 120 is replaced by transversely mounted fixed wire hoops 151a-151d. In FIG. 17A, the guide catheter is omitted from track 152 for clarity. Wire hoops 151a-151d, illustratively four in number, have their ends affixed to the lateral faces of catheter shaft 153 so that, when unconstrained, the hoops return to a position substantially orthogonal to the longitudinal axis of catheter shaft 153. Wire hoops preferably comprise a sturdy, elastic plastic or metal alloy, such as nickel-titanium.
In FIG. 17B, catheter shaft 153 is shown disposed within outer sheath 154. When retracted within outer sheath 154, hoops 151a-151d are deformed so that they lie adjacent to the exterior surface of catheter shaft 153. Guide member 155 and catheter shaft 153 are delivered to the left ventricle while enclosed within outer sheath 154. Once distal endface 156 is positioned against the apex of the left ventricle, for example, as determined by fluoroscopy, outer sheath 154 is retracted proximally. This permits hoops 151a-151d to resume their preferred shape, and urge guide member 155 against the opposing wall of the left ventricle. Hoops 151a-151d serve to stabilize and counteract reaction forces generated by operation of the end effector.
With respect to FIG. 18, a still further alternative embodiment of the stabilization assembly of the present invention is described. In apparatus 160 of FIG. 18, the catheter shaft is omitted, and guide member 161 is supported by a plurality of bands 162 (only two are shown in FIG. 18). Guide member 161 and bands 162 extend from within outer sheath 163. Each band 162 preferably terminates in spool 164 when it is extended from within outer sheath 163. Spools 164 contact one wall of the organ or vessel and urge end region 165 of guide member 161 into contact with the opposing wall of the organ or vessel. Preferably, the length of each band 162 may be adjusted using suitable means disposed on the handle assembly. Operation of guide member 161 and end effector 166 are the same as described herein for other embodiments of the present invention.
Referring to FIGS. 19 and 20, another embodiment of apparatus of the present invention is described. Apparatus 170 comprises a two-part catheter formed of catheter shaft 171 and guide member 172, and is coupled via cable 178 to controller 179 that performs the functions described above with respect to controller 129 of the embodiment of FIG. 13.
Apparatus 170 includes distal region 173 within which guide member 172 has end region 175 that is selectively movable between a transit position parallel to longitudinal axis 174 of catheter shaft 171 and a working position (as shown), substantially orthogonal to longitudinal axis 174. Distal region 173 preferably includes an end effector, as described in detail hereinabove. End region 175 of guide member 172 may be positioned longitudinally with respect to catheter shaft 171 by imparting relative movement between guide member 172 and catheter shaft 171 using handle assembly 176. Catheter shaft 121 includes stabilizing element 177 to support and stabilize distal region 173 of the apparatus within an organ or vessel.
Distal region 173 of apparatus 170 is described in greater detail with respect to FIGS. 20A and 20B. Distal region 173 includes end region 175 of guide member 172 disposed in sliding engagement in track 180 of catheter shaft 171, as described hereinabove with respect to other embodiments. Guide member 172 includes end region 175 carrying end effector 181 and flanges 182 that slidingly engage grooves 183 and 184. End region 175 may be articulated in region 185, as may be constructed and operated as described hereinabove for other embodiments.
Stabilization element 177 comprises wire or band 186 of resilient material, such as stainless steel, that exits catheter shaft 171 through skive 187, and is fixed to catheter shaft 171 near distal end 188. When deployed within a hollow organ, such as a chamber of the heart, as depicted in FIG. 20B, stabilization element 177 forms a plurality of sinusoidal bends 177a-177c that support distal end 173 of catheter shaft 171. Stabilization element 177 preferably comprises a material having a shape-memory and that is capable of reforming to a desired shape when extended through skive 187.
While preferred illustrative embodiments of the invention are described, it will be apparent to one skilled in the art that various changes and modifications may be made without departing from the invention, and the appended claims are intended to cover all such changes and modifications that fall within the true spirit and scope of the invention.

Claims (27)

What is claimed is:
1. Apparatus for treating an organ or vessel defining a cavity, the apparatus comprising:
a catheter shaft adapted for insertion into the cavity, the catheter shaft having a distal region and a portion defining a groove,
a guide member including an end effector to treat an interior wall of the hollow-body organ, the guide member disposed in the groove for translation along the catheter shaft;
means for disposing the end effector at a selected orientation relative to the catheter shaft; and
a stabilization assembly, disposed in the distal region, that stabilizes the catheter shaft and guide member within the organ or vessel during actuation of the end effector.
2. The apparatus as defined in claim 1 wherein the stabilization assembly comprises a band movable from a first position, wherein the band is disposed adjacent to an exterior surface of the catheter shaft, to a second position, wherein the band forms a plurality of loops extending from the exterior surface of the catheter shaft. Apparatus for treating an organ or vessel defining a cavity, the apparatus comprising:
a catheter shaft adapted for insertion into the cavity, the catheter shaft having a distal region and a portion defining a groove,
a guide member carrying an end effector formed separately from the guide member to treat an interior wall of the organ or vessel, the guide member slidably engaged in the groove for selective translation along a longitudinal axis of the catheter shaft;
means for disposing the end effector at a selected orientation relative to the longitudinal axis of the catheter shaft; and
a stabilization assembly, formed separately from the catheter shaft and disposed in the distal region of the catheter shaft, that stabilizes the catheter shaft when activated within the organ or vessel during actuation of the end effector, wherein while the stabilization assembly is activated, the end effector is capable of making a plurality of treatment sites which are orthogonally disposed relative to a portion of the distal region of the catheter shaft, and which are placed longitudinally relative to the distal region of the catheter shaft, through translation of the guide member without repositioning at least a portion of the catheter shaft within the organ or vessel, wherein the stabilization assembly comprises a band movable from a first position, wherein the band is disposed adjacent to an exterior surface of the catheter shaft, to a second position, wherein the band forms a plurality of loops extending from the exterior surface of the catheter shaft.
3. The apparatus as defined in claim 1 Apparatus for treating an organ or vessel defining a cavity, the apparatus comprising:
a catheter shaft adapted for insertion into the cavity, the catheter shaft having a distal region and a portion defining a groove,
a guide member carrying an end effector formed separately from the guide member to treat an interior wall of the organ or vessel, the guide member slidably engaged in the groove for selective translation along a longitudinal axis of the catheter shaft;
means for disposing the end effector at a selected orientation relative to the longitudinal axis of the catheter shaft; and
a stabilization assembly, formed separately from the catheter shaft and disposed in the distal region of the catheter shaft, that stabilizes the catheter shaft when activated within the organ or vessel during actuation of the end effector, and wherein while the stabilization assembly is activated the end effector is capable of making a plurality of treatment sites which are orthogonally disposed relative to a portion of the distal region of the catheter shaft, and which are placed longitudinally relative to the distal region of the catheter shaft, through translation of the guide member without repositioning at least a portion of the catheter shaft within the organ or vessel, wherein the end effector comprises a rotating cutting head.
4. The apparatus as defined in claim 3 wherein the end effector further comprises an electrode adapted to deliver RF energy.
5. The apparatus as defined in claim 1 Apparatus for treating an organ or vessel defining a cavity, the apparatus comprising:
a catheter shaft adapted for insertion into the cavity, the catheter shaft having a distal region and a portion defining a groove,
a guide member including an end effector to treat an interior wall of the organ or vessel, the guide member slidably engaged in the groove for selective translation along a longitudinal axis of the catheter shaft;
means for disposing the end effector at a selected orientation relative to the longitudinal axis of the catheter shaft; and
a stabilization assembly, formed separately from the catheter shaft and disposed in the distal region of the catheter shaft, that stabilizes the catheter shaft when activated within the organ or vessel during actuation of the end effector, and wherein while the stabilization assembly is activated the end effector is capable of making a plurality of treatment sites which are orthogonally disposed relative to a portion of the distal region of the catheter shaft, and which are placed longitudinally relative to the distal region of the catheter shaft, through translation of the guide member and without repositioning at least a portion of the catheter shaft within the organ or vessel, wherein the apparatus further comprises an outer sheath and the stabilization assembly comprises a plurality of wire hoops affixed to the catheter shaft, the plurality of wire hoops movable from a first position wherein the wire hoops are confined within the outer sheath, and a second position, wherein the wire hoops project outwardly from the catheter shaft to engage an interior surface of the organ or vessel.
6. The apparatus as defined in claim 5 wherein the end effector comprises a rotating cutting head.
7. The apparatus as defined in claim 6 wherein the end effector further comprises an electrode adapted to deliver RF energy.
8. Apparatus for treating an organ or vessel comprising:
an outer sheath;
a guide member extending from the outer sheath, the guide member including carrying an end effector formed separately from the guide member for treating an interior region of an the organ or vessel, an end region of the guide catheter movable to dispose the end effector at a selected orientation and position relative to the a longitudinal axis of a catheter shaft; and
a stabilization assembly, which is formed separately from the outer sheath, comprising a plurality of bands extending from within the outer sheath, each one of the plurality of bands terminating in a spool that contacts is adapted to be in contact with an interior wall of the organ or vessel, the stabilization assembly stabilizing the guide member during actuation of the end effector.
9. The apparatus as defined in claim 8 wherein the end effector further comprises an electrode adapted to deliver RF energy to the treatment site.
10. Apparatus for performing transmyocardial revascularization, the apparatus comprising:
a catheter shaft adapted for insertion into a patient's left ventricle, the catheter shaft having a distal region including a portion adapted to engage an interior wall in a vicinity of an apex of the patient's left ventricle;
a guide member having an end effector to treat the interior wall of the left ventricle, the guide member disposed for translation along the catheter shaft; and
a stabilization assembly, disposed in the distal region, that stabilizes the catheter shaft and guide member within the left ventricle during actuation of the end effector.
11. The apparatus as defined in claim 10 Apparatus for performing transmyocardial revascularization, the apparatus comprising:
a catheter shaft adapted for insertion into a patient's left ventricle, the catheter shaft having a distal region including a portion adapted to engage an interior wall in a vicinity of an apex of the patient's left ventricle;
a guide member carrying an end effector formed separately from the guide member to treat the interior wall of the left ventricle, the guide member disposed for selective translation along a longitudinal axis of the catheter shaft; and
a stabilization assembly, formed separately from the catheter shaft and disposed in the distal region of the catheter shaft, to alternate between a retracted position and an expanded position, that stabilizes the catheter shaft within the left ventricle during actuation of the end effector, wherein the stabilization assembly comprises a band movable from a first position, wherein the band is disposed adjacent to an exterior surface of the catheter shaft, to a second position, wherein the band forms a plurality of loops extending from the exterior surface of the catheter shaft.
12. The apparatus as defined in claim 10 Apparatus for performing transmyocardial revascularization, the apparatus comprising:
a catheter shaft adapted for insertion into a patient's left ventricle, the catheter shaft having a distal region including a portion adapted to engage an interior wall in a vicinity of an apex of the patient's left ventricle;
a guide member carrying an end effector formed separately from the guide member to treat the interior wall of the left ventricle, the guide member disposed for selective translation along a longitudinal axis of the catheter shaft; and
a stabilization assembly, formed separately from the catheter shaft and disposed in the distal region of the catheter shaft, to alternate between a retracted position and an expanded position, that stabilizes the catheter shaft within the left ventricle during actuation of the end effector, wherein the stabilization assembly comprises a wire movable from a first position, wherein the wire is partially retracted within a lumen of the catheter shaft, to a second position, wherein the wire forms a plurality of sinusoidal bends that contact and support the catheter shaft.
13. The apparatus as defined in claim 10 Apparatus for performing transmyocardial revascularization, the apparatus comprising:
a catheter shaft adapted for insertion into a patient's left ventricle, the catheter shaft having a distal region including a portion adapted to engage an interior wall in a vicinity of an apex of the patient's left ventricle;
a guide member carrying an end effector formed separately from the guide member, wherein a distal portion of the end effector is configured for selective bending at an angle relative to a main body of the guide member to treat the interior wall of the left ventricle, the guide member disposed for selective translation along a longitudinal axis of the catheter shaft; and
a stabilization assembly, formed separately from the catheter shaft and disposed in the distal region of the catheter shaft to alternate between a retracted position and an expanded position, that stabilizes the catheter shaft within the left ventricle during actuation of the end effector, and wherein while the stabilization assembly is expanded the end effector is capable of making a plurality of treatment sites which are orthogonally disposed relative to a portion of the distal region of the catheter shaft, and which are placed longitudinally relative to the distal region of the catheter shaft, through translation of the guide member without repositioning at least a portion of the catheter shaft within the left ventricle, wherein the end effector comprises a rotating cutting head.
14. The apparatus as defined in claim 12 wherein the end effector further comprises an electrode adapted to deliver RF energy.
15. A method of treating an interior region of an organ or vessel comprising:
providing apparatus having a catheter shaft adapted for insertion into an organ or vessel, a guide member mounted in a groove on the catheter shaft and having an end effector for treating an interior region of the organ or vessel, and a stabilization assembly mounted on the catheter shaft;
inserting the apparatus within an organ or vessel;
deploying the stabilization assembly to stabilize the catheter shaft and guide member within the organ or vessel;
translating the guide member within the groove of the catheter shaft to dispose the end effector at a selected location relative to the catheter shaft; and
actuating the end effector to form a channel in an interior region of the organ or vessel.
16. The method as defined in claim 15 further comprising A method of treating an interior region of an organ or vessel comprising:
providing an apparatus having a catheter shaft adapted for insertion into the organ or vessel, a guide member slidably mounted in a groove on the catheter shaft and carrying an end effector formed separately from the guide member for treating an interior region of the organ or vessel, and a stabilization assembly mounted on the catheter shaft and formed separately from the catheter shaft;
inserting the apparatus within the organ or vessel;
deploying the stabilization assembly to stabilize the catheter shaft within the organ or vessel;
slidably translating the guide member within the groove of the catheter shaft to dispose the end effector at a selected position relative to a longitudinal axis of the catheter shaft;
actuating the end effector to form a channel in an interior region of the organ or vessel; and
delivering RF energy to the channel to create a controlled depth of necrosis.
17. The method as defined in claim 15 further comprising, following actuating the end effector:
translating the guide member in the groove relative to the catheter shaft to relocate the end effector; and
repeating actuation of the end effector.
18. The method as defined in claim 15 A method of treating an interior region of an organ or vessel comprising:
providing an apparatus having a catheter shaft adapted for insertion into the organ or vessel, a guide member slidably mounted in a groove on the catheter shaft and carrying an end effector formed separately from the guide member for treating an interior region of the organ or vessel, and a stabilization assembly formed separately from the catheter shaft and mounted on the catheter shaft, wherein the stabilization assembly comprises a band movable from a first position, wherein the band is disposed adjacent to an exterior surface of the catheter shaft, to a second position, wherein the band forms a plurality of loops extending from the exterior surface of the catheter shaft, and deploying the stabilization assembly to stabilize the catheter shaft and guide member within the organ or vessel further comprises moving the band from the first position to the second position ;
inserting the apparatus within the organ or vessel;
deploying the stabilization assembly to stabilize the catheter shaft within the organ or vessel, wherein deploying the stabilization assembly comprises moving the band from the first position to the second position;
slidably translating the guide member within the groove of the catheter shaft to dispose the end effector at a selected position relative to a longitudinal axis of the catheter shaft;
actuating the end effector to form a channel in an interior region of the organ or vessel.
19. The method as defined in claim 15 A method of treating an interior region of an organ or vessel comprising:
providing an apparatus having a catheter shaft adapted for insertion into the organ or vessel, a guide member slidably mounted in a groove on the catheter shaft and carrying an end effector formed separately from the guide member for treating an interior region of the organ or vessel, and a stabilization assembly mounted on the catheter shaft and formed separately from the catheter shaft;
inserting the apparatus within the organ or vessel;
deploying the stabilization assembly to stabilize the catheter shaft within the organ or vessel;
slidably translating the guide member within the groove of the catheter shaft to dispose the end effector at a selected position relative to a longitudinal axis of the catheter shaft; and
actuating the end effector to form a channel in an interior region of the organ or vessel, wherein actuating the end effector comprises rotating a cutting head.
20. The method as defined in claim 15 A method of treating an interior region of an organ or vessel comprising:
providing an apparatus having a catheter shaft adapted for insertion into the organ or vessel, a guide member slidably mounted in a groove on the catheter shaft and carrying an end effector formed separately from the guide member for treating an interior region of the organ or vessel, and a stabilization assembly, formed separately from the catheter shaft and mounted on the catheter shaft, wherein the stabilization assembly comprises a plurality of wire hoops affixed to the catheter shaft, the plurality of wire hoops movable from a first position wherein the wire hoops are confined within the outer sheath, and a second position, wherein the wire hoops project outwardly from the catheter shaft to engage an interior surface of the organ or vessel, and deploying the stabilization assembly to stabilize the catheter shaft and guide member within the organ or vessel further comprises retracting the outer sheath;
inserting the apparatus within the organ or vessel;
deploying the stabilization assembly to stabilize the catheter shaft within the organ or vessel;
slidably translating the guide member within the groove of the catheter shaft to dispose the end effector at a selected position relative to a longitudinal axis of the catheter shaft; and
actuating the end effector to form a channel in an interior region of the organ or vessel.
21. The method as defined in claim 15 A method of treating an interior region of an organ or vessel comprising:
providing an apparatus having a catheter shaft adapted for insertion into the organ or vessel, a guide member slidably mounted in a groove on the catheter shaft and carrying an end effector formed separately from the guide member for treating an interior region of the organ or vessel, and a stabilization assembly, formed separately from the catheter shaft and mounted on the catheter shaft, wherein the stabilization assembly comprises a wire movable from a first position wherein the wire is partially retracted within the catheter shaft, and a second position, wherein the wire forms a plurality of interconnected bends that engage an interior surface of the organ or vessel, and deploying the stabilization assembly to stabilize the catheter shaft and guide member within the organ or vessel, and the method further comprises extending the wire so that it resumes a preformed shape;
inserting the apparatus within the organ or vessel;
deploying the stabilization assembly to stabilize the catheter shaft within the organ or vessel;
slidably translating the guide member within the groove of the catheter shaft to dispose the end effector at a selected position relative to a longitudinal axis of the catheter shaft;
actuating the end effector to form a channel in an interior region of the organ or vessel.
22. A method of treating an interior region of an organ or vessel comprising:
providing an apparatus having an outer sheath, a guide member extending from the outer sheath, the guide member including carrying an end effector formed separately from the guide member for treating an interior region of the an organ or vessel; and a stabilization assembly, which is formed separately from the outer sheath, comprising a plurality of bands extendable from within the outer sheath, each one of the plurality of bands terminating in a spool that contacts an interior wall of the organ or vessel when extended;
inserting the apparatus within an organ or vessel;
extending the plurality of bands from the outer sheath to form spools, each spool contacting an interior wall of the organ or vessel to stabilize the guide member within the organ or vessel;
translating the guide member to dispose the end effector at a selected location position relative to a longitudinal axis of the apparatus; and
actuating the end effector to form a channel in an interior region of the organ or vessel.
23. An apparatus for performing transmyocardial revascularization, the apparatus comprising:
a catheter shaft adapted for insertion into a patient's left ventricle;
a guide member carrying an end effector formed separately from the catheter shaft to treat an interior wall of the left ventricle, the end effector disposed for selective translation relative to a longitudinal axis of the catheter shaft; and
a stabilization assembly, formed separately from the catheter shaft and disposed in a distal region of the catheter shaft to alternate between a retracted position and an expanded position, that stabilizes the catheter shaft within the left ventricle during actuation of the end effector, wherein the stabilization assembly comprises a band movable from a first position, wherein the band is disposed adjacent to an exterior surface of the catheter shaft, to a second position, wherein the band forms a plurality of loops extending from the exterior surface of the catheter shaft.
24. An apparatus for performing transmyocardial revascularization, the apparatus comprising:
a catheter shaft adapted for insertion into a patient's left ventricle;
a guide member carrying an end effector formed separately from the catheter shaft to treat an interior wall of the left ventricle, the end effector disposed for selective translation relative to a longitudinal axis of the catheter shaft; and
a stabilization assembly, formed separately from the catheter shaft and disposed in a distal region of the catheter shaft, to alternate between a retracted position and an expanded position, that stabilizes the catheter shaft within the left ventricle during actuation of the end effector, wherein the stabilization assembly comprises a wire movable from a first position, wherein the wire is partially retracted within a lumen of the catheter shaft, to a second position, wherein the wire forms a plurality of sinusoidal bends that contact and support the catheter shaft.
25. An apparatus for improving ischemic cardiac tissue, the apparatus comprising:
a catheter shaft adapted for insertion into a patient's left ventricle;
a member carrying an end effector formed separately from the catheter shaft, wherein the end effector comprises a needle, to treat an interior wall of the left ventricle, the end effector disposed for selective translation relative to a longitudinal axis of the catheter shaft; and
a stabilization assembly, formed separately from the catheter shaft and disposed in a distal region of the catheter shaft, to alternate between a retracted position and an expanded position, that stabilizes the catheter shaft and member within the left ventricle during actuation of the end effector, wherein the stabilization assembly comprises a band movable from a first position, wherein the band is disposed adjacent to an exterior surface of the catheter shaft, to a second position, wherein the band forms a plurality of loops extending from the exterior surface of the catheter shaft.
26. An apparatus for improving ischemic cardiac tissue, the apparatus comprising:
a catheter shaft adapted for insertion into a patient's left ventricle;
a member carrying an end effector formed separately from the catheter shaft, wherein the end effector comprises a needle, to treat an interior wall of the left ventricle, the end effector disposed for selective translation relative to a longitudinal axis of the catheter shaft; and
a stabilization assembly, formed separately from the catheter shaft and disposed in a distal region of the catheter shaft, to alternate between a retracted position and an expanded position, that stabilizes the catheter shaft and member within the left ventricle during actuation of the end effector, wherein the stabilization assembly comprises a wire movable from a first position, wherein the wire is partially retracted within a lumen of the catheter shaft, to a second position, wherein the wire forms a plurality of sinusoidal bends that contact and support the catheter shaft.
27. An apparatus for improving ischemic cardiac tissue, the apparatus comprising:
a catheter shaft adapted for insertion into a patient's left ventricle;
a member carrying an end effector formed separately from the catheter shaft, wherein the end effector comprises a needle, to treat an interior wall of the left ventricle, the end effector disposed for selective translation relative to a longitudinal axis of the catheter shaft; and
a stabilization assembly, formed separately from the catheter shaft and disposed in a distal region of the catheter shaft, to alternate between a retracted position and an expanded position, that stabilizes the catheter shaft and member within the left ventricle during actuation of the end effector, wherein while the stabilization assembly is expanded, the end effector is capable of making a plurality of treatment sites through transition of the member without repositioning at least a portion of the catheter shaft within the left ventricle, wherein the stabilization assembly comprises at least one inflatable hoop member.
US10/126,295 1996-12-02 2002-04-18 Apparatus having stabilization members for percutaneously performing surgery and methods of use Expired - Lifetime USRE43300E1 (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
US10/126,295 USRE43300E1 (en) 1996-12-02 2002-04-18 Apparatus having stabilization members for percutaneously performing surgery and methods of use

Applications Claiming Priority (4)

Application Number Priority Date Filing Date Title
US3219696P 1996-12-02 1996-12-02
US08/863,877 US5910150A (en) 1996-12-02 1997-05-27 Apparatus for performing surgery
US09/213,089 US6051008A (en) 1996-12-02 1998-12-15 Apparatus having stabilization members for percutaneously performing surgery and methods of use
US10/126,295 USRE43300E1 (en) 1996-12-02 2002-04-18 Apparatus having stabilization members for percutaneously performing surgery and methods of use

Related Parent Applications (1)

Application Number Title Priority Date Filing Date
US09/213,089 Reissue US6051008A (en) 1996-12-02 1998-12-15 Apparatus having stabilization members for percutaneously performing surgery and methods of use

Publications (1)

Publication Number Publication Date
USRE43300E1 true USRE43300E1 (en) 2012-04-03

Family

ID=45877520

Family Applications (2)

Application Number Title Priority Date Filing Date
US09/213,089 Expired - Lifetime US6051008A (en) 1996-12-02 1998-12-15 Apparatus having stabilization members for percutaneously performing surgery and methods of use
US10/126,295 Expired - Lifetime USRE43300E1 (en) 1996-12-02 2002-04-18 Apparatus having stabilization members for percutaneously performing surgery and methods of use

Family Applications Before (1)

Application Number Title Priority Date Filing Date
US09/213,089 Expired - Lifetime US6051008A (en) 1996-12-02 1998-12-15 Apparatus having stabilization members for percutaneously performing surgery and methods of use

Country Status (1)

Country Link
US (2) US6051008A (en)

Cited By (34)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20100204684A1 (en) * 2009-01-13 2010-08-12 Garrison Michi E Methods and systems for performing neurointerventional procedures
US20110087147A1 (en) * 2008-12-23 2011-04-14 Garrison Michi E Methods and systems for treatment of acute ischemic stroke
US20110166496A1 (en) * 2007-07-18 2011-07-07 Enrique Criado Methods and systems for establishing retrograde carotid arterial blood flow
US8858490B2 (en) 2007-07-18 2014-10-14 Silk Road Medical, Inc. Systems and methods for treating a carotid artery
US8961551B2 (en) 2006-12-22 2015-02-24 The Spectranetics Corporation Retractable separating systems and methods
US9028520B2 (en) 2006-12-22 2015-05-12 The Spectranetics Corporation Tissue separating systems and methods
US9126018B1 (en) 2014-09-04 2015-09-08 Silk Road Medical, Inc. Methods and devices for transcarotid access
US9265512B2 (en) 2013-12-23 2016-02-23 Silk Road Medical, Inc. Transcarotid neurovascular catheter
US9283040B2 (en) 2013-03-13 2016-03-15 The Spectranetics Corporation Device and method of ablative cutting with helical tip
US9291663B2 (en) 2013-03-13 2016-03-22 The Spectranetics Corporation Alarm for lead insulation abnormality
US9413896B2 (en) 2012-09-14 2016-08-09 The Spectranetics Corporation Tissue slitting methods and systems
USD765243S1 (en) 2015-02-20 2016-08-30 The Spectranetics Corporation Medical device handle
US9456872B2 (en) 2013-03-13 2016-10-04 The Spectranetics Corporation Laser ablation catheter
USD770616S1 (en) 2015-02-20 2016-11-01 The Spectranetics Corporation Medical device handle
US9603618B2 (en) 2013-03-15 2017-03-28 The Spectranetics Corporation Medical device for removing an implanted object
US9668765B2 (en) 2013-03-15 2017-06-06 The Spectranetics Corporation Retractable blade for lead removal device
US9669191B2 (en) 2008-02-05 2017-06-06 Silk Road Medical, Inc. Interventional catheter system and methods
US9883885B2 (en) 2013-03-13 2018-02-06 The Spectranetics Corporation System and method of ablative cutting and pulsed vacuum aspiration
US9925366B2 (en) 2013-03-15 2018-03-27 The Spectranetics Corporation Surgical instrument for removing an implanted object
US9980743B2 (en) 2013-03-15 2018-05-29 The Spectranetics Corporation Medical device for removing an implanted object using laser cut hypotubes
US10136913B2 (en) 2013-03-15 2018-11-27 The Spectranetics Corporation Multiple configuration surgical cutting device
US10327790B2 (en) 2011-08-05 2019-06-25 Route 92 Medical, Inc. Methods and systems for treatment of acute ischemic stroke
US10383691B2 (en) 2013-03-13 2019-08-20 The Spectranetics Corporation Last catheter with helical internal lumen
US10405924B2 (en) 2014-05-30 2019-09-10 The Spectranetics Corporation System and method of ablative cutting and vacuum aspiration through primary orifice and auxiliary side port
US10448999B2 (en) 2013-03-15 2019-10-22 The Spectranetics Corporation Surgical instrument for removing an implanted object
US10779855B2 (en) 2011-08-05 2020-09-22 Route 92 Medical, Inc. Methods and systems for treatment of acute ischemic stroke
US10835279B2 (en) 2013-03-14 2020-11-17 Spectranetics Llc Distal end supported tissue slitting apparatus
US10842532B2 (en) 2013-03-15 2020-11-24 Spectranetics Llc Medical device for removing an implanted object
US11020133B2 (en) 2017-01-10 2021-06-01 Route 92 Medical, Inc. Aspiration catheter systems and methods of use
US11027104B2 (en) 2014-09-04 2021-06-08 Silk Road Medical, Inc. Methods and devices for transcarotid access
US11065019B1 (en) 2015-02-04 2021-07-20 Route 92 Medical, Inc. Aspiration catheter systems and methods of use
US11229770B2 (en) 2018-05-17 2022-01-25 Route 92 Medical, Inc. Aspiration catheter systems and methods of use
US11633571B2 (en) 2015-02-04 2023-04-25 Route 92 Medical, Inc. Rapid aspiration thrombectomy system and method
US11925770B2 (en) 2023-04-07 2024-03-12 Route 92 Medical, Inc. Aspiration catheter systems and methods of use

Families Citing this family (53)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6102926A (en) 1996-12-02 2000-08-15 Angiotrax, Inc. Apparatus for percutaneously performing myocardial revascularization having means for sensing tissue parameters and methods of use
US6051008A (en) * 1996-12-02 2000-04-18 Angiotrax, Inc. Apparatus having stabilization members for percutaneously performing surgery and methods of use
US6120520A (en) 1997-05-27 2000-09-19 Angiotrax, Inc. Apparatus and methods for stimulating revascularization and/or tissue growth
US6645217B1 (en) * 1999-05-15 2003-11-11 Advanced Cardiovascular Systems, Inc. Over-the-wire atherectomy catheter
US6306132B1 (en) * 1999-06-17 2001-10-23 Vivant Medical Modular biopsy and microwave ablation needle delivery apparatus adapted to in situ assembly and method of use
WO2001010287A2 (en) * 1999-08-06 2001-02-15 Houser Russell A Percutaneous transmyocardial revascularization (ptmr) system
JP5090600B2 (en) 2000-02-18 2012-12-05 トーマス ジェイ. フォガーティー, Improved device for accurately marking tissues
US6564806B1 (en) 2000-02-18 2003-05-20 Thomas J. Fogarty Device for accurately marking tissue
US6722371B1 (en) 2000-02-18 2004-04-20 Thomas J. Fogarty Device for accurately marking tissue
US6558382B2 (en) * 2000-04-27 2003-05-06 Medtronic, Inc. Suction stabilized epicardial ablation devices
US6514250B1 (en) 2000-04-27 2003-02-04 Medtronic, Inc. Suction stabilized epicardial ablation devices
US20030204188A1 (en) * 2001-11-07 2003-10-30 Artemis Medical, Inc. Tissue separating and localizing catheter assembly
US7534242B2 (en) * 2003-02-25 2009-05-19 Artemis Medical, Inc. Tissue separating catheter assembly and method
US7686799B2 (en) * 2000-07-13 2010-03-30 Abbott Cardiovascular Systems Inc. Deployment system for myocardial cellular material
WO2002076281A2 (en) * 2000-11-07 2002-10-03 Artemis Medical Inc. Tissue separator assembly and method
US6692466B1 (en) 2000-12-21 2004-02-17 Advanced Cardiovascular Systems, Inc. Drug delivery catheter with retractable needle
US6878147B2 (en) 2001-11-02 2005-04-12 Vivant Medical, Inc. High-strength microwave antenna assemblies
US6752767B2 (en) 2002-04-16 2004-06-22 Vivant Medical, Inc. Localization element with energized tip
US7197363B2 (en) 2002-04-16 2007-03-27 Vivant Medical, Inc. Microwave antenna having a curved configuration
AU2003237588A1 (en) * 2002-07-11 2004-02-02 Sightline Technologies Ltd. Piston-actuated endoscopic steering system
US6863668B2 (en) * 2002-08-16 2005-03-08 Edwards Lifesciences Corporation Articulation mechanism for medical devices
US7087064B1 (en) * 2002-10-15 2006-08-08 Advanced Cardiovascular Systems, Inc. Apparatuses and methods for heart valve repair
US8187324B2 (en) * 2002-11-15 2012-05-29 Advanced Cardiovascular Systems, Inc. Telescoping apparatus for delivering and adjusting a medical device in a vessel
US7981152B1 (en) 2004-12-10 2011-07-19 Advanced Cardiovascular Systems, Inc. Vascular delivery system for accessing and delivering devices into coronary sinus and other vascular sites
US7404824B1 (en) * 2002-11-15 2008-07-29 Advanced Cardiovascular Systems, Inc. Valve aptation assist device
US9149602B2 (en) 2005-04-22 2015-10-06 Advanced Cardiovascular Systems, Inc. Dual needle delivery system
US8308708B2 (en) * 2003-07-15 2012-11-13 Abbott Cardiovascular Systems Inc. Deployment system for myocardial cellular material
US7311703B2 (en) * 2003-07-18 2007-12-25 Vivant Medical, Inc. Devices and methods for cooling microwave antennas
US7998112B2 (en) * 2003-09-30 2011-08-16 Abbott Cardiovascular Systems Inc. Deflectable catheter assembly and method of making same
US7273469B1 (en) * 2003-12-31 2007-09-25 Advanced Cardiovascular Systems, Inc. Modified needle catheter for directional orientation delivery
US7632262B2 (en) * 2004-07-19 2009-12-15 Nexeon Medical Systems, Inc. Systems and methods for atraumatic implantation of bio-active agents
US20070055259A1 (en) * 2005-08-17 2007-03-08 Norton Britt K Apparatus and methods for removal of intervertebral disc tissues
US7766937B2 (en) * 2006-03-13 2010-08-03 Mini-Lap Technologies, Inc. Minimally invasive surgical assembly and methods
EP1897506B1 (en) * 2006-09-08 2010-03-03 Ethicon Endo-Surgery, Inc. A surgical instrument for performing controlled myotomies
US8068921B2 (en) * 2006-09-29 2011-11-29 Vivant Medical, Inc. Microwave antenna assembly and method of using the same
WO2008112870A2 (en) * 2007-03-13 2008-09-18 University Of Virginia Patent Foundation Epicardial ablation catheter and method of use
EP2134253B1 (en) * 2007-03-19 2022-01-26 University Of Virginia Patent Foundation Access needle pressure sensor device
US9468396B2 (en) 2007-03-19 2016-10-18 University Of Virginia Patent Foundation Systems and methods for determining location of an access needle in a subject
US11058354B2 (en) 2007-03-19 2021-07-13 University Of Virginia Patent Foundation Access needle with direct visualization and related methods
US9211405B2 (en) 2007-03-22 2015-12-15 University Of Virginia Patent Foundation Electrode catheter for ablation purposes and related method thereof
WO2009062061A1 (en) * 2007-11-09 2009-05-14 University Of Virginia Patent Foundation Steerable epicardial pacing catheter system placed via the subxiphoid process
US8292880B2 (en) 2007-11-27 2012-10-23 Vivant Medical, Inc. Targeted cooling of deployable microwave antenna
EP2078507A1 (en) * 2008-01-10 2009-07-15 Ludwig-Maximilians-Universität München Small probing hook for arthroscopy
US9642534B2 (en) 2009-09-11 2017-05-09 University Of Virginia Patent Foundation Systems and methods for determining location of an access needle in a subject
US9326757B2 (en) * 2009-12-31 2016-05-03 Teleflex Medical Incorporated Surgical instruments for laparoscopic aspiration and retraction
US9218752B2 (en) 2010-02-18 2015-12-22 University Of Virginia Patent Foundation System, method, and computer program product for simulating epicardial electrophysiology procedures
US8811693B2 (en) * 2010-07-13 2014-08-19 Siemens Aktiengesellschaft Method and system for indicating a feeding vessel of a malformation in a medical image
US20120136197A1 (en) * 2010-11-30 2012-05-31 Van Gerwen Peter B J Hearing prosthesis having a flexible elongate energy transfer mechanism
US9408662B2 (en) * 2012-05-07 2016-08-09 Cook Medical Technologies Llc Sphincterotome having expandable tines
US10512482B2 (en) 2012-10-05 2019-12-24 Board Of Regents Of The University Of Texas System System and method for scoring the left ventricular endocardium to increase left ventricular compliance
US10342565B2 (en) * 2013-04-24 2019-07-09 Hologic, Inc. Surgical system with expandable shield
WO2015031476A1 (en) 2013-08-27 2015-03-05 Board Of Regents, The University Of Texas System System and method for cutting trabeculae carneae of the left ventricle to increase lv compliance
US10321247B2 (en) 2015-11-27 2019-06-11 Cochlear Limited External component with inductance and mechanical vibratory functionality

Citations (219)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US1162901A (en) 1915-10-08 1915-12-07 Edward B Cantey Instrument for cutting cores from solid substances.
US2710000A (en) 1952-02-19 1955-06-07 Cromer Jeremiah Keith Cutting instrument
US2749909A (en) 1956-06-12 Biopsy knife
US3120845A (en) 1961-02-20 1964-02-11 David B Horner Self-powered surgical drill
US3470876A (en) 1966-09-28 1969-10-07 John Barchilon Dirigible catheter
US3477423A (en) 1967-01-09 1969-11-11 Baxter Laboratories Inc Biopsy instrument
US3557794A (en) 1968-07-30 1971-01-26 Us Air Force Arterial dilation device
US3614953A (en) 1968-01-30 1971-10-26 Nat Res Dev Drills for clearing obstructions in arteries
US3692020A (en) 1971-04-29 1972-09-19 Robert J Schied Rotary punch for excising uniform diopsy specimens
US3780246A (en) 1972-08-22 1973-12-18 Black & Decker Mfg Co Hand-operated tool with switch actuator having three-position lock-off assembly
US4207874A (en) 1978-03-27 1980-06-17 Choy Daniel S J Laser tunnelling device
US4362161A (en) 1980-10-27 1982-12-07 Codman & Shurtleff, Inc. Cranial drill
US4381037A (en) 1979-10-29 1983-04-26 Black & Decker Inc. Portable electric tool
US4461305A (en) 1981-09-04 1984-07-24 Cibley Leonard J Automated biopsy device
US4464738A (en) 1980-02-22 1984-08-07 Sonic Tape Public Limited Company Sonar distance sensing apparatus
US4468224A (en) 1982-01-28 1984-08-28 Advanced Cardiovascular Systems, Inc. System and method for catheter placement in blood vessels of a human patient
US4479896A (en) 1981-12-11 1984-10-30 Antoniades Harry N Method for extraction localization and direct recovery of platelet derived growth factor
US4576162A (en) 1983-03-30 1986-03-18 Mccorkle Charles E Apparatus and method for separation of scar tissue in venous pathway
US4578057A (en) 1984-08-31 1986-03-25 Cordis Corporation Ventricular right angle connector and system
US4582056A (en) 1983-03-30 1986-04-15 Mccorkle Jr Charles E Endocardial lead extraction apparatus and method
WO1986003122A1 (en) 1984-11-29 1986-06-05 Curatech, Inc. Wound healing agents
US4600014A (en) 1984-02-10 1986-07-15 Dan Beraha Transrectal prostate biopsy device and method
US4640296A (en) 1983-11-12 1987-02-03 Schnepp Pesch Wolfram Biopsy cannula
US4646738A (en) 1985-12-05 1987-03-03 Concept, Inc. Rotary surgical tool
US4702261A (en) 1985-07-03 1987-10-27 Sherwood Medical Company Biopsy device and method
US4729763A (en) 1986-06-06 1988-03-08 Henrie Rodney A Catheter for removing occlusive material
US4788975A (en) 1987-11-05 1988-12-06 Medilase, Inc. Control system and method for improved laser angioplasty
US4790812A (en) 1985-11-15 1988-12-13 Hawkins Jr Irvin F Apparatus and method for removing a target object from a body passsageway
US4792327A (en) 1986-09-15 1988-12-20 Barry Swartz Lipectomy cannula
US4813930A (en) 1987-10-13 1989-03-21 Dimed, Inc. Angioplasty guiding catheters and methods for performing angioplasty
US4850354A (en) 1987-08-13 1989-07-25 Baxter Travenol Laboratories, Inc. Surgical cutting instrument
US4856529A (en) 1985-05-24 1989-08-15 Cardiometrics, Inc. Ultrasonic pulmonary artery catheter and method
US4895166A (en) 1987-11-23 1990-01-23 Interventional Technologies, Inc. Rotatable cutter for the lumen of a blood vesel
US4895156A (en) 1986-07-02 1990-01-23 Schulze John E Sensor system using fluorometric decay measurements
US4898577A (en) 1988-09-28 1990-02-06 Advanced Cardiovascular Systems, Inc. Guiding cathether with controllable distal tip
US4917102A (en) * 1988-09-14 1990-04-17 Advanced Cardiovascular Systems, Inc. Guidewire assembly with steerable adjustable tip
US4923462A (en) 1987-03-17 1990-05-08 Cordis Corporation Catheter system having a small diameter rotatable drive member
USRE33258E (en) 1984-07-23 1990-07-10 Surgical Dynamics Inc. Irrigating, cutting and aspirating system for percutaneous surgery
US4957742A (en) 1984-11-29 1990-09-18 Regents Of The University Of Minnesota Method for promoting hair growth
US4964854A (en) 1989-01-23 1990-10-23 Luther Medical Products, Inc. Intravascular catheter assembly incorporating needle tip shielding cap
US4976710A (en) 1987-01-28 1990-12-11 Mackin Robert A Working well balloon method
US4985028A (en) 1989-08-30 1991-01-15 Angeion Corporation Catheter
US5030201A (en) 1989-11-24 1991-07-09 Aubrey Palestrant Expandable atherectomy catheter device
US5087265A (en) * 1989-02-17 1992-02-11 American Biomed, Inc. Distal atherectomy catheter
US5093877A (en) 1990-10-30 1992-03-03 Advanced Cardiovascular Systems Optical fiber lasing apparatus lens
US5104393A (en) 1989-08-30 1992-04-14 Angelase, Inc. Catheter
US5106386A (en) 1989-08-30 1992-04-21 Angelase, Inc. Catheter
US5123904A (en) 1988-04-28 1992-06-23 Olympus Optical Co., Ltd. Surgical resecting instrument
WO1992010142A1 (en) * 1990-12-10 1992-06-25 Howmedica Inc. A device and method for interstitial laser energy delivery
US5125924A (en) 1990-09-24 1992-06-30 Laser Engineering, Inc. Heart-synchronized vacuum-assisted pulsed laser system and method
US5125926A (en) 1990-09-24 1992-06-30 Laser Engineering, Inc. Heart-synchronized pulsed laser system
US5133713A (en) 1990-03-27 1992-07-28 Huang Jong Khing Apparatus of a spinning type of resectoscope for prostatectomy
US5135531A (en) 1984-05-14 1992-08-04 Surgical Systems & Instruments, Inc. Guided atherectomy system
US5152744A (en) 1990-02-07 1992-10-06 Smith & Nephew Dyonics Surgical instrument
US5195988A (en) 1988-05-26 1993-03-23 Haaga John R Medical needle with removable sheath
US5197968A (en) 1991-08-14 1993-03-30 Mectra Labs, Inc. Disposable tissue retrieval assembly
US5224951A (en) 1991-02-19 1993-07-06 Dexide, Inc. Surgical trocar and spike assembly
US5242460A (en) 1990-10-25 1993-09-07 Devices For Vascular Intervention, Inc. Atherectomy catheter having axially-disposed cutting edge
US5263959A (en) 1991-10-21 1993-11-23 Cathco, Inc. Dottering auger catheter system and method
US5269785A (en) 1990-06-28 1993-12-14 Bonutti Peter M Apparatus and method for tissue removal
US5273051A (en) 1993-03-16 1993-12-28 Wilk Peter J Method and associated device for obtaining a biopsy of tissues of an internal organ
US5281218A (en) 1992-06-05 1994-01-25 Cardiac Pathways Corporation Catheter having needle electrode for radiofrequency ablation
US5285795A (en) 1991-09-12 1994-02-15 Surgical Dynamics, Inc. Percutaneous discectomy system having a bendable discectomy probe and a steerable cannula
US5287861A (en) 1992-10-30 1994-02-22 Wilk Peter J Coronary artery by-pass method and associated catheter
US5292309A (en) 1993-01-22 1994-03-08 Schneider (Usa) Inc. Surgical depth measuring instrument and method
US5313949A (en) * 1986-02-28 1994-05-24 Cardiovascular Imaging Systems Incorporated Method and apparatus for intravascular two-dimensional ultrasonography
US5324284A (en) 1992-06-05 1994-06-28 Cardiac Pathways, Inc. Endocardial mapping and ablation system utilizing a separately controlled ablation catheter and method
US5323781A (en) 1992-01-31 1994-06-28 Duke University Methods for the diagnosis and ablation treatment of ventricular tachycardia
US5330466A (en) 1992-12-01 1994-07-19 Cardiac Pathways Corporation Control mechanism and system and method for steering distal extremity of a flexible elongate member
US5336237A (en) 1993-08-25 1994-08-09 Devices For Vascular Intervention, Inc. Removal of tissue from within a body cavity
US5339799A (en) 1991-04-23 1994-08-23 Olympus Optical Co., Ltd. Medical system for reproducing a state of contact of the treatment section in the operation unit
US5342393A (en) 1992-08-27 1994-08-30 Duke University Method and device for vascular repair
US5342300A (en) 1992-03-13 1994-08-30 Stefanadis Christodoulos I Steerable stent catheter
US5354310A (en) 1993-03-22 1994-10-11 Cordis Corporation Expandable temporary graft
US5358485A (en) 1992-01-13 1994-10-25 Schneider (Usa) Inc. Cutter for atherectomy catheter
US5358472A (en) 1992-01-13 1994-10-25 Schneider (Usa) Inc. Guidewire atherectomy catheter and method of using the same
US5366490A (en) * 1992-08-12 1994-11-22 Vidamed, Inc. Medical probe device and method
US5366468A (en) 1993-11-09 1994-11-22 Linvatec Corporation Double bladed surgical router having aspiration ports within flutes
US5379772A (en) 1993-09-14 1995-01-10 Intelliwire, Inc. Flexible elongate device having forward looking ultrasonic imaging
US5380316A (en) 1990-12-18 1995-01-10 Advanced Cardiovascular Systems, Inc. Method for intra-operative myocardial device revascularization
US5383884A (en) 1992-12-04 1995-01-24 American Biomed, Inc. Spinal disc surgical instrument
US5389096A (en) 1990-12-18 1995-02-14 Advanced Cardiovascular Systems System and method for percutaneous myocardial revascularization
US5389073A (en) 1992-12-01 1995-02-14 Cardiac Pathways Corporation Steerable catheter with adjustable bend location
US5392917A (en) 1993-08-03 1995-02-28 Ethicon, Inc. Easy open 1-2-3 instrumentation package
US5396897A (en) 1992-01-16 1995-03-14 The General Hospital Corporation Method for locating tumors prior to needle biopsy
US5403334A (en) 1989-09-12 1995-04-04 Devices For Vascular Intervention, Inc. Atherectomy device having helical blade and blade guide
US5409000A (en) 1993-09-14 1995-04-25 Cardiac Pathways Corporation Endocardial mapping and ablation system utilizing separately controlled steerable ablation catheter with ultrasonic imaging capabilities and method
US5415166A (en) 1991-02-15 1995-05-16 Cardiac Pathways Corporation Endocardial mapping apparatus and cylindrical semiconductor device mounting structure for use therewith and method
US5419777A (en) 1994-03-10 1995-05-30 Bavaria Medizin Technologie Gmbh Catheter for injecting a fluid or medicine
US5425376A (en) 1993-09-08 1995-06-20 Sofamor Danek Properties, Inc. Method and apparatus for obtaining a biopsy sample
US5429144A (en) 1992-10-30 1995-07-04 Wilk; Peter J. Coronary artery by-pass method
US5439474A (en) 1993-10-08 1995-08-08 Li Medical Technologies, Inc. Morcellator system
US5443443A (en) 1984-05-14 1995-08-22 Surgical Systems & Instruments, Inc. Atherectomy system
US5456689A (en) 1993-10-13 1995-10-10 Arnold J. Kresch Method and device for tissue resection
US5464395A (en) * 1994-04-05 1995-11-07 Faxon; David P. Catheter for delivering therapeutic and/or diagnostic agents to the tissue surrounding a bodily passageway
US5465717A (en) 1991-02-15 1995-11-14 Cardiac Pathways Corporation Apparatus and Method for ventricular mapping and ablation
US5488958A (en) 1992-11-09 1996-02-06 Vance Products Incorporated Surgical cutting instrument for coring tissue affixed thereto
US5492119A (en) 1993-12-22 1996-02-20 Heart Rhythm Technologies, Inc. Catheter tip stabilizing apparatus
US5497784A (en) 1991-11-18 1996-03-12 Intelliwire, Inc. Flexible elongate device having steerable distal extremity
US5505725A (en) 1990-10-30 1996-04-09 Cardiogenesis Corporation Shapeable optical fiber apparatus
US5507802A (en) 1993-06-02 1996-04-16 Cardiac Pathways Corporation Method of mapping and/or ablation using a catheter having a tip with fixation means
US5520634A (en) 1993-04-23 1996-05-28 Ethicon, Inc. Mechanical morcellator
US5531780A (en) 1992-09-03 1996-07-02 Pacesetter, Inc. Implantable stimulation lead having an advanceable therapeutic drug delivery system
WO1996025097A1 (en) 1995-02-17 1996-08-22 Ep Technologies, Inc. Systems and methods for examining heart tissue
US5551427A (en) 1995-02-13 1996-09-03 Altman; Peter A. Implantable device for the effective elimination of cardiac arrhythmogenic sites
WO1996026675A1 (en) 1995-02-28 1996-09-06 Boston Scientific Corporation Deflectable catheter for ablating cardiac tissue
US5562694A (en) 1994-10-11 1996-10-08 Lasersurge, Inc. Morcellator
US5569178A (en) 1995-10-20 1996-10-29 Henley; Julian L. Power assisted suction lipectomy device
US5569254A (en) 1995-04-12 1996-10-29 Midas Rex Pneumatic Tools, Inc. Surgical resection tool having an irrigation, lighting, suction and vision attachment
US5569284A (en) 1994-09-23 1996-10-29 United States Surgical Corporation Morcellator
WO1996035469A1 (en) 1995-05-10 1996-11-14 Cardiogenesis Corporation System for treating or diagnosing heart tissue
US5575810A (en) 1993-10-15 1996-11-19 Ep Technologies, Inc. Composite structures and methods for ablating tissue to form complex lesion patterns in the treatment of cardiac conditions and the like
US5575787A (en) 1993-09-20 1996-11-19 Abela Laser Systems, Inc. Cardiac ablation catheters and method
US5575293A (en) 1995-02-06 1996-11-19 Promex, Inc. Apparatus for collecting and staging tissue
US5575772A (en) 1993-07-01 1996-11-19 Boston Scientific Corporation Albation catheters
US5578067A (en) 1994-04-14 1996-11-26 Pacesetter Ab Medical electrode system having a sleeve body and control element therefor for selectively positioning an exposed conductor area
US5584842A (en) * 1992-12-02 1996-12-17 Intramed Laboratories, Inc. Valvulotome and method of using
US5588432A (en) 1988-03-21 1996-12-31 Boston Scientific Corporation Catheters for imaging, sensing electrical potentials, and ablating tissue
US5591159A (en) 1994-11-09 1997-01-07 Taheri; Syde A. Transcavitary myocardial perfusion apparatus
US5593405A (en) * 1994-07-16 1997-01-14 Osypka; Peter Fiber optic endoscope
US5601588A (en) 1994-09-29 1997-02-11 Olympus Optical Co., Ltd. Endoscopic puncture needle
US5601573A (en) 1994-03-02 1997-02-11 Ethicon Endo-Surgery, Inc. Sterile occlusion fasteners and instruments and method for their placement
US5601586A (en) 1992-09-30 1997-02-11 Linvatec Corporation Variable angle rotating shaver
US5606974A (en) 1995-05-02 1997-03-04 Heart Rhythm Technologies, Inc. Catheter having ultrasonic device
US5607421A (en) 1991-05-01 1997-03-04 The Trustees Of Columbia University In The City Of New York Myocardial revascularization through the endocardial surface using a laser
US5609591A (en) 1993-10-05 1997-03-11 S.L.T. Japan Co., Ltd. Laser balloon catheter apparatus
US5609621A (en) 1995-08-04 1997-03-11 Medtronic, Inc. Right ventricular outflow tract defibrillation lead
US5611803A (en) 1994-12-22 1997-03-18 Urohealth Systems, Inc. Tissue segmentation device
US5613972A (en) 1992-07-15 1997-03-25 The University Of Miami Surgical cutting heads with curled cutting wings
WO1997010753A1 (en) 1995-09-20 1997-03-27 Medtronic, Inc. Method and apparatus for temporarily immobilizing a local area of tissue
WO1997013471A1 (en) 1995-10-13 1997-04-17 Transvascular, Inc. A device, system and method for interstitial transvascular intervention
US5640955A (en) * 1995-02-14 1997-06-24 Daig Corporation Guiding introducers for use in the treatment of accessory pathways around the mitral valve using a retrograde approach
US5643253A (en) 1995-06-06 1997-07-01 Rare Earth Medical, Inc. Phototherapy apparatus with integral stopper device
US5651781A (en) 1995-04-20 1997-07-29 Grace-Wells Technology Partners No. 1, L.P. Surgical cutting instrument
US5658263A (en) 1995-05-18 1997-08-19 Cordis Corporation Multisegmented guiding catheter for use in medical catheter systems
US5662124A (en) 1996-06-19 1997-09-02 Wilk Patent Development Corp. Coronary artery by-pass method
US5662671A (en) 1996-07-17 1997-09-02 Embol-X, Inc. Atherectomy device having trapping and excising means for removal of plaque from the aorta and other arteries
US5665062A (en) * 1995-01-23 1997-09-09 Houser; Russell A. Atherectomy catheter and RF cutting method
US5669920A (en) 1993-07-09 1997-09-23 Devices For Vascular Intervention, Inc. Atherectomy catheter
US5680860A (en) 1994-07-07 1997-10-28 Cardiac Pathways Corporation Mapping and/or ablation catheter with coilable distal extremity and method for using same
US5683362A (en) 1994-05-13 1997-11-04 Rowland; Christopher A. Apparatus for performing diagnostic and therapeutic modalities in the biliary tree
US5688234A (en) 1996-01-26 1997-11-18 Cardiometrics Inc. Apparatus and method for the treatment of thrombotic occlusions in vessels
EP0807412A1 (en) 1996-05-13 1997-11-19 United States Surgical Corporation Coring device and method
US5702412A (en) 1995-10-03 1997-12-30 Cedars-Sinai Medical Center Method and devices for performing vascular anastomosis
US5709697A (en) 1995-11-22 1998-01-20 United States Surgical Corporation Apparatus and method for removing tissue
WO1998005307A1 (en) 1996-08-08 1998-02-12 Localmed, Inc. Transmural drug delivery method and apparatus
US5722400A (en) * 1995-02-16 1998-03-03 Daig Corporation Guiding introducers for use in the treatment of left ventricular tachycardia
US5724975A (en) 1996-12-12 1998-03-10 Plc Medical Systems, Inc. Ultrasonic detection system for transmyocardial revascularization
US5725521A (en) * 1996-03-29 1998-03-10 Eclipse Surgical Technologies, Inc. Depth stop apparatus and method for laser-assisted transmyocardial revascularization and other surgical applications
US5730741A (en) * 1997-02-07 1998-03-24 Eclipse Surgical Technologies, Inc. Guided spiral catheter
US5743870A (en) 1994-05-09 1998-04-28 Somnus Medical Technologies, Inc. Ablation apparatus and system for removal of soft palate tissue
WO1998017186A1 (en) 1996-10-21 1998-04-30 Plc Medical Systems, Inc. Percutaneous transmyocardial revascularization marking system
US5755714A (en) * 1996-09-17 1998-05-26 Eclipse Surgical Technologies, Inc. Shaped catheter for transmyocardial revascularization
US5766163A (en) * 1996-07-03 1998-06-16 Eclipse Surgical Technologies, Inc. Controllable trocar for transmyocardial revascularization (TMR) via endocardium method and apparatus
US5776092A (en) 1994-03-23 1998-07-07 Erbe Elektromedizin Gmbh Multifunctional surgical instrument
US5782823A (en) 1996-04-05 1998-07-21 Eclipse Surgical Technologies, Inc. Laser device for transmyocardial revascularization procedures including means for enabling a formation of a pilot hole in the epicardium
EP0853921A2 (en) 1996-12-27 1998-07-22 Eclipse Surgical Technologies, Inc. Laser assisted drug delivery
US5797870A (en) 1995-06-07 1998-08-25 Indiana University Foundation Pericardial delivery of therapeutic and diagnostic agents
WO1998038916A1 (en) 1997-03-07 1998-09-11 Cardiogenesis Corporation Apparatus and method of myocardial revascularization using ultrasonic pulse-echo distance ranging
WO1998039045A1 (en) 1997-03-07 1998-09-11 Cardiogenesis Corporation Catheter with three sections of different flexibilities
US5807401A (en) 1994-11-07 1998-09-15 Grieshaber & Co. Ag Schaffhausen Ophthalmic surgical apparatus for pulverizing and removing the lens nucleus from the eye of a living being
US5807384A (en) 1996-12-20 1998-09-15 Eclipse Surgical Technologies, Inc. Transmyocardial revascularization (TMR) enhanced treatment for coronary artery disease
US5814028A (en) 1993-11-03 1998-09-29 Daig Corporation Curved guiding introducers for cardiac access
EP0868923A2 (en) 1997-04-04 1998-10-07 Eclipse Surgical Technologies, Inc. Steerable catheter
US5830210A (en) 1996-10-21 1998-11-03 Plc Medical Systems, Inc. Catheter navigation apparatus
US5834418A (en) 1996-03-20 1998-11-10 Theratechnologies, Inc. Process for the preparation of platelet growth factors extract
EP0876796A2 (en) 1997-05-07 1998-11-11 Eclipse Surgical Technologies, Inc. Device for use in the treatment of cardiovascular or other tissue
US5840059A (en) 1995-06-07 1998-11-24 Cardiogenesis Corporation Therapeutic and diagnostic agent delivery
US5846225A (en) 1997-02-19 1998-12-08 Cornell Research Foundation, Inc. Gene transfer therapy delivery device and method
US5851171A (en) * 1997-11-04 1998-12-22 Advanced Cardiovascular Systems, Inc. Catheter assembly for centering a radiation source within a body lumen
US5857995A (en) 1996-08-15 1999-01-12 Surgical Dynamics, Inc. Multiple bladed surgical cutting device removably connected to a rotary drive element
EP0895752A1 (en) 1997-08-08 1999-02-10 Eclipse Surgical Technologies, Inc. Apparatus for sampling heart tissue and/or myocardial revascularization by mechanical cutting
US5871495A (en) 1996-09-13 1999-02-16 Eclipse Surgical Technologies, Inc. Method and apparatus for mechanical transmyocardial revascularization of the heart
US5873366A (en) 1996-11-07 1999-02-23 Chim; Nicholas Method for transmyocardial revascularization
US5878751A (en) 1996-03-04 1999-03-09 Myocardial Stents, Inc. Method for trans myocardial revascularization (TMR)
US5885272A (en) 1990-10-30 1999-03-23 Aita; Michael System and method for percutaneous myocardial revascularization
US5885276A (en) 1997-12-02 1999-03-23 Galil Medical Ltd. Method and device for transmyocardial cryo revascularization
US5893848A (en) 1996-10-24 1999-04-13 Plc Medical Systems, Inc. Gauging system for monitoring channel depth in percutaneous endocardial revascularization
US5899874A (en) 1992-04-30 1999-05-04 Stiftelsen For Medicinsk-Teknisk Utveckling Preparation and method for production of platelet concentrates with significantly prolonged viabilty during storage
US5906594A (en) 1997-01-08 1999-05-25 Symbiosis Corporation Endoscopic infusion needle having dual distal stops
US5910150A (en) * 1996-12-02 1999-06-08 Angiotrax, Inc. Apparatus for performing surgery
US5916214A (en) 1995-05-01 1999-06-29 Medtronic Cardiorhythm Dual curve ablation catheter
US5921982A (en) * 1993-07-30 1999-07-13 Lesh; Michael D. Systems and methods for ablating body tissue
US5925012A (en) 1996-12-27 1999-07-20 Eclipse Surgical Technologies, Inc. Laser assisted drug delivery
US5928943A (en) 1994-11-22 1999-07-27 Institut Fur Pflanzengenetik Und Kulturpflanzenforschung Embryonal cardiac muscle cells, their preparation and their use
US5938632A (en) 1997-03-06 1999-08-17 Scimed Life Systems, Inc. Radiofrequency transmyocardial revascularization apparatus and method
US5941868A (en) 1995-12-22 1999-08-24 Localmed, Inc. Localized intravascular delivery of growth factors for promotion of angiogenesis
US5944716A (en) * 1996-12-09 1999-08-31 Scimed Life Systems, Inc. Radio frequency transmyocardial revascularization corer
US5951567A (en) 1997-07-24 1999-09-14 Cardiogenesis Corporation Introducer for channel forming device
US5964757A (en) 1997-09-05 1999-10-12 Cordis Webster, Inc. Steerable direct myocardial revascularization catheter
US5964754A (en) 1996-05-24 1999-10-12 Sulzer Osypka Gmbh Device for perforating the heart wall
US5968059A (en) 1997-03-06 1999-10-19 Scimed Life Systems, Inc. Transmyocardial revascularization catheter and method
US5971993A (en) 1996-11-07 1999-10-26 Myocardial Stents, Inc. System for delivery of a trans myocardial device to a heart wall
US5980548A (en) 1997-10-29 1999-11-09 Kensey Nash Corporation Transmyocardial revascularization system
US6045530A (en) 1998-10-14 2000-04-04 Heyer-Schulte Neurocare Inc. Adjustable angle catheter
US6045565A (en) 1997-11-04 2000-04-04 Scimed Life Systems, Inc. Percutaneous myocardial revascularization growth factor mediums and method
US6051008A (en) * 1996-12-02 2000-04-18 Angiotrax, Inc. Apparatus having stabilization members for percutaneously performing surgery and methods of use
US6056743A (en) * 1997-11-04 2000-05-02 Scimed Life Systems, Inc. Percutaneous myocardial revascularization device and method
US6056760A (en) 1997-01-30 2000-05-02 Nissho Corporation Device for intracardiac suture
US6066126A (en) 1997-12-18 2000-05-23 Medtronic, Inc. Precurved, dual curve cardiac introducer sheath
US6102887A (en) 1998-08-11 2000-08-15 Biocardia, Inc. Catheter drug delivery system and method for use
US6106520A (en) 1997-09-30 2000-08-22 Hearten Medical, Inc. Endocardial device for producing reversible damage to heart tissue
US6165164A (en) 1999-03-29 2000-12-26 Cordis Corporation Catheter for injecting therapeutic and diagnostic agents
US6179809B1 (en) * 1997-09-24 2001-01-30 Eclipse Surgical Technologies, Inc. Drug delivery catheter with tip alignment
US6197324B1 (en) 1997-12-18 2001-03-06 C. R. Bard, Inc. System and methods for local delivery of an agent
US6224584B1 (en) 1997-01-14 2001-05-01 Eclipse Surgical Technologies, Inc. Therapeutic and diagnostic agent delivery
US6238389B1 (en) 1997-09-30 2001-05-29 Boston Scientific Corporation Deflectable interstitial ablation device
US6251104B1 (en) 1995-05-10 2001-06-26 Eclipse Surgical Technologies, Inc. Guiding catheter system for ablating heart tissue
US6270496B1 (en) 1998-05-05 2001-08-07 Cardiac Pacemakers, Inc. Steerable catheter with preformed distal shape and method for use
US6309370B1 (en) 1998-02-05 2001-10-30 Biosense, Inc. Intracardiac drug delivery
US6322548B1 (en) 1995-05-10 2001-11-27 Eclipse Surgical Technologies Delivery catheter system for heart chamber
US6589232B1 (en) 1997-11-25 2003-07-08 Richard L. Mueller Selective treatment of endocardial/myocardial boundary
US6613062B1 (en) 1999-10-29 2003-09-02 Medtronic, Inc. Method and apparatus for providing intra-pericardial access
US6620139B1 (en) 1998-12-14 2003-09-16 Tre Esse Progettazione Biomedica S.R.L. Catheter system for performing intramyocardiac therapeutic treatment
US6638233B2 (en) * 1999-08-19 2003-10-28 Fox Hollow Technologies, Inc. Apparatus and methods for material capture and removal
US20040010231A1 (en) 2000-07-13 2004-01-15 Leonhardt Howard J Deployment system for myocardial cellular material
US6905476B2 (en) 1998-06-04 2005-06-14 Biosense Webster, Inc. Catheter with injection needle
US6994716B2 (en) 2002-09-18 2006-02-07 Kabushiki Kaisha Toshiba Medical manipulator
US7094201B1 (en) 1996-07-17 2006-08-22 Medtronic, Inc. System and method for genetically treating cardiac conduction disturbances

Family Cites Families (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US33258A (en) * 1861-09-10 Improvement in gas-burners

Patent Citations (234)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US2749909A (en) 1956-06-12 Biopsy knife
US1162901A (en) 1915-10-08 1915-12-07 Edward B Cantey Instrument for cutting cores from solid substances.
US2710000A (en) 1952-02-19 1955-06-07 Cromer Jeremiah Keith Cutting instrument
US3120845A (en) 1961-02-20 1964-02-11 David B Horner Self-powered surgical drill
US3470876A (en) 1966-09-28 1969-10-07 John Barchilon Dirigible catheter
US3477423A (en) 1967-01-09 1969-11-11 Baxter Laboratories Inc Biopsy instrument
US3614953A (en) 1968-01-30 1971-10-26 Nat Res Dev Drills for clearing obstructions in arteries
US3557794A (en) 1968-07-30 1971-01-26 Us Air Force Arterial dilation device
US3692020A (en) 1971-04-29 1972-09-19 Robert J Schied Rotary punch for excising uniform diopsy specimens
US3780246A (en) 1972-08-22 1973-12-18 Black & Decker Mfg Co Hand-operated tool with switch actuator having three-position lock-off assembly
US4207874A (en) 1978-03-27 1980-06-17 Choy Daniel S J Laser tunnelling device
US4381037A (en) 1979-10-29 1983-04-26 Black & Decker Inc. Portable electric tool
US4464738A (en) 1980-02-22 1984-08-07 Sonic Tape Public Limited Company Sonar distance sensing apparatus
US4362161A (en) 1980-10-27 1982-12-07 Codman & Shurtleff, Inc. Cranial drill
US4461305A (en) 1981-09-04 1984-07-24 Cibley Leonard J Automated biopsy device
US4479896A (en) 1981-12-11 1984-10-30 Antoniades Harry N Method for extraction localization and direct recovery of platelet derived growth factor
US4468224A (en) 1982-01-28 1984-08-28 Advanced Cardiovascular Systems, Inc. System and method for catheter placement in blood vessels of a human patient
US4576162A (en) 1983-03-30 1986-03-18 Mccorkle Charles E Apparatus and method for separation of scar tissue in venous pathway
US4582056A (en) 1983-03-30 1986-04-15 Mccorkle Jr Charles E Endocardial lead extraction apparatus and method
US4640296A (en) 1983-11-12 1987-02-03 Schnepp Pesch Wolfram Biopsy cannula
US4600014A (en) 1984-02-10 1986-07-15 Dan Beraha Transrectal prostate biopsy device and method
US5135531A (en) 1984-05-14 1992-08-04 Surgical Systems & Instruments, Inc. Guided atherectomy system
US5443443A (en) 1984-05-14 1995-08-22 Surgical Systems & Instruments, Inc. Atherectomy system
USRE33258E (en) 1984-07-23 1990-07-10 Surgical Dynamics Inc. Irrigating, cutting and aspirating system for percutaneous surgery
US4578057A (en) 1984-08-31 1986-03-25 Cordis Corporation Ventricular right angle connector and system
US4957742A (en) 1984-11-29 1990-09-18 Regents Of The University Of Minnesota Method for promoting hair growth
WO1986003122A1 (en) 1984-11-29 1986-06-05 Curatech, Inc. Wound healing agents
US4856529A (en) 1985-05-24 1989-08-15 Cardiometrics, Inc. Ultrasonic pulmonary artery catheter and method
US4702261A (en) 1985-07-03 1987-10-27 Sherwood Medical Company Biopsy device and method
US4790812A (en) 1985-11-15 1988-12-13 Hawkins Jr Irvin F Apparatus and method for removing a target object from a body passsageway
US4646738A (en) 1985-12-05 1987-03-03 Concept, Inc. Rotary surgical tool
US5313949A (en) * 1986-02-28 1994-05-24 Cardiovascular Imaging Systems Incorporated Method and apparatus for intravascular two-dimensional ultrasonography
US4729763A (en) 1986-06-06 1988-03-08 Henrie Rodney A Catheter for removing occlusive material
US4895156A (en) 1986-07-02 1990-01-23 Schulze John E Sensor system using fluorometric decay measurements
US4792327A (en) 1986-09-15 1988-12-20 Barry Swartz Lipectomy cannula
US4976710A (en) 1987-01-28 1990-12-11 Mackin Robert A Working well balloon method
US4923462A (en) 1987-03-17 1990-05-08 Cordis Corporation Catheter system having a small diameter rotatable drive member
US4850354A (en) 1987-08-13 1989-07-25 Baxter Travenol Laboratories, Inc. Surgical cutting instrument
US4813930A (en) 1987-10-13 1989-03-21 Dimed, Inc. Angioplasty guiding catheters and methods for performing angioplasty
US4788975A (en) 1987-11-05 1988-12-06 Medilase, Inc. Control system and method for improved laser angioplasty
US4788975B1 (en) 1987-11-05 1999-03-02 Trimedyne Inc Control system and method for improved laser angioplasty
US4895166A (en) 1987-11-23 1990-01-23 Interventional Technologies, Inc. Rotatable cutter for the lumen of a blood vesel
US5588432A (en) 1988-03-21 1996-12-31 Boston Scientific Corporation Catheters for imaging, sensing electrical potentials, and ablating tissue
US5123904A (en) 1988-04-28 1992-06-23 Olympus Optical Co., Ltd. Surgical resecting instrument
US5195988A (en) 1988-05-26 1993-03-23 Haaga John R Medical needle with removable sheath
US4917102A (en) * 1988-09-14 1990-04-17 Advanced Cardiovascular Systems, Inc. Guidewire assembly with steerable adjustable tip
US4898577A (en) 1988-09-28 1990-02-06 Advanced Cardiovascular Systems, Inc. Guiding cathether with controllable distal tip
US4964854A (en) 1989-01-23 1990-10-23 Luther Medical Products, Inc. Intravascular catheter assembly incorporating needle tip shielding cap
US5087265A (en) * 1989-02-17 1992-02-11 American Biomed, Inc. Distal atherectomy catheter
US5104393A (en) 1989-08-30 1992-04-14 Angelase, Inc. Catheter
US5106386A (en) 1989-08-30 1992-04-21 Angelase, Inc. Catheter
US4985028A (en) 1989-08-30 1991-01-15 Angeion Corporation Catheter
US5403334A (en) 1989-09-12 1995-04-04 Devices For Vascular Intervention, Inc. Atherectomy device having helical blade and blade guide
US5030201A (en) 1989-11-24 1991-07-09 Aubrey Palestrant Expandable atherectomy catheter device
US5152744A (en) 1990-02-07 1992-10-06 Smith & Nephew Dyonics Surgical instrument
US5133713A (en) 1990-03-27 1992-07-28 Huang Jong Khing Apparatus of a spinning type of resectoscope for prostatectomy
US5269785A (en) 1990-06-28 1993-12-14 Bonutti Peter M Apparatus and method for tissue removal
US5125926A (en) 1990-09-24 1992-06-30 Laser Engineering, Inc. Heart-synchronized pulsed laser system
US5125924A (en) 1990-09-24 1992-06-30 Laser Engineering, Inc. Heart-synchronized vacuum-assisted pulsed laser system and method
US5242460A (en) 1990-10-25 1993-09-07 Devices For Vascular Intervention, Inc. Atherectomy catheter having axially-disposed cutting edge
US5505725A (en) 1990-10-30 1996-04-09 Cardiogenesis Corporation Shapeable optical fiber apparatus
US5093877A (en) 1990-10-30 1992-03-03 Advanced Cardiovascular Systems Optical fiber lasing apparatus lens
US5885272A (en) 1990-10-30 1999-03-23 Aita; Michael System and method for percutaneous myocardial revascularization
WO1992010142A1 (en) * 1990-12-10 1992-06-25 Howmedica Inc. A device and method for interstitial laser energy delivery
US5554152A (en) 1990-12-18 1996-09-10 Cardiogenesis Corporation Method for intra-operative myocardial revascularization
US5380316A (en) 1990-12-18 1995-01-10 Advanced Cardiovascular Systems, Inc. Method for intra-operative myocardial device revascularization
US5389096A (en) 1990-12-18 1995-02-14 Advanced Cardiovascular Systems System and method for percutaneous myocardial revascularization
US5465717A (en) 1991-02-15 1995-11-14 Cardiac Pathways Corporation Apparatus and Method for ventricular mapping and ablation
US5415166A (en) 1991-02-15 1995-05-16 Cardiac Pathways Corporation Endocardial mapping apparatus and cylindrical semiconductor device mounting structure for use therewith and method
US5224951A (en) 1991-02-19 1993-07-06 Dexide, Inc. Surgical trocar and spike assembly
US5339799A (en) 1991-04-23 1994-08-23 Olympus Optical Co., Ltd. Medical system for reproducing a state of contact of the treatment section in the operation unit
US5607421A (en) 1991-05-01 1997-03-04 The Trustees Of Columbia University In The City Of New York Myocardial revascularization through the endocardial surface using a laser
US5197968A (en) 1991-08-14 1993-03-30 Mectra Labs, Inc. Disposable tissue retrieval assembly
US5285795A (en) 1991-09-12 1994-02-15 Surgical Dynamics, Inc. Percutaneous discectomy system having a bendable discectomy probe and a steerable cannula
US5263959A (en) 1991-10-21 1993-11-23 Cathco, Inc. Dottering auger catheter system and method
US5497784A (en) 1991-11-18 1996-03-12 Intelliwire, Inc. Flexible elongate device having steerable distal extremity
US5358485A (en) 1992-01-13 1994-10-25 Schneider (Usa) Inc. Cutter for atherectomy catheter
US5358472A (en) 1992-01-13 1994-10-25 Schneider (Usa) Inc. Guidewire atherectomy catheter and method of using the same
US5396897A (en) 1992-01-16 1995-03-14 The General Hospital Corporation Method for locating tumors prior to needle biopsy
US5323781A (en) 1992-01-31 1994-06-28 Duke University Methods for the diagnosis and ablation treatment of ventricular tachycardia
US5342300A (en) 1992-03-13 1994-08-30 Stefanadis Christodoulos I Steerable stent catheter
US5899874A (en) 1992-04-30 1999-05-04 Stiftelsen For Medicinsk-Teknisk Utveckling Preparation and method for production of platelet concentrates with significantly prolonged viabilty during storage
US5281218A (en) 1992-06-05 1994-01-25 Cardiac Pathways Corporation Catheter having needle electrode for radiofrequency ablation
US5324284A (en) 1992-06-05 1994-06-28 Cardiac Pathways, Inc. Endocardial mapping and ablation system utilizing a separately controlled ablation catheter and method
US5613972A (en) 1992-07-15 1997-03-25 The University Of Miami Surgical cutting heads with curled cutting wings
US5366490A (en) * 1992-08-12 1994-11-22 Vidamed, Inc. Medical probe device and method
US5370675A (en) * 1992-08-12 1994-12-06 Vidamed, Inc. Medical probe device and method
US5342393A (en) 1992-08-27 1994-08-30 Duke University Method and device for vascular repair
US5833715A (en) 1992-09-03 1998-11-10 Pacesetter, Inc. Implantable stimulation lead having an advanceable therapeutic drug delivery system
US5531780A (en) 1992-09-03 1996-07-02 Pacesetter, Inc. Implantable stimulation lead having an advanceable therapeutic drug delivery system
US5601586A (en) 1992-09-30 1997-02-11 Linvatec Corporation Variable angle rotating shaver
US5429144A (en) 1992-10-30 1995-07-04 Wilk; Peter J. Coronary artery by-pass method
US5287861A (en) 1992-10-30 1994-02-22 Wilk Peter J Coronary artery by-pass method and associated catheter
US5488958A (en) 1992-11-09 1996-02-06 Vance Products Incorporated Surgical cutting instrument for coring tissue affixed thereto
US5527279A (en) 1992-12-01 1996-06-18 Cardiac Pathways Corporation Control mechanism and system and method for steering distal extremity of a flexible elongate member
US5330466A (en) 1992-12-01 1994-07-19 Cardiac Pathways Corporation Control mechanism and system and method for steering distal extremity of a flexible elongate member
US5389073A (en) 1992-12-01 1995-02-14 Cardiac Pathways Corporation Steerable catheter with adjustable bend location
US5584842A (en) * 1992-12-02 1996-12-17 Intramed Laboratories, Inc. Valvulotome and method of using
US5383884A (en) 1992-12-04 1995-01-24 American Biomed, Inc. Spinal disc surgical instrument
US5292309A (en) 1993-01-22 1994-03-08 Schneider (Usa) Inc. Surgical depth measuring instrument and method
US5273051A (en) 1993-03-16 1993-12-28 Wilk Peter J Method and associated device for obtaining a biopsy of tissues of an internal organ
US5354310A (en) 1993-03-22 1994-10-11 Cordis Corporation Expandable temporary graft
US5520634A (en) 1993-04-23 1996-05-28 Ethicon, Inc. Mechanical morcellator
US5507802A (en) 1993-06-02 1996-04-16 Cardiac Pathways Corporation Method of mapping and/or ablation using a catheter having a tip with fixation means
US5575772A (en) 1993-07-01 1996-11-19 Boston Scientific Corporation Albation catheters
US5669920A (en) 1993-07-09 1997-09-23 Devices For Vascular Intervention, Inc. Atherectomy catheter
US5921982A (en) * 1993-07-30 1999-07-13 Lesh; Michael D. Systems and methods for ablating body tissue
US5392917A (en) 1993-08-03 1995-02-28 Ethicon, Inc. Easy open 1-2-3 instrumentation package
US5336237A (en) 1993-08-25 1994-08-09 Devices For Vascular Intervention, Inc. Removal of tissue from within a body cavity
US5425376A (en) 1993-09-08 1995-06-20 Sofamor Danek Properties, Inc. Method and apparatus for obtaining a biopsy sample
US5409000A (en) 1993-09-14 1995-04-25 Cardiac Pathways Corporation Endocardial mapping and ablation system utilizing separately controlled steerable ablation catheter with ultrasonic imaging capabilities and method
US5379772A (en) 1993-09-14 1995-01-10 Intelliwire, Inc. Flexible elongate device having forward looking ultrasonic imaging
US5575787A (en) 1993-09-20 1996-11-19 Abela Laser Systems, Inc. Cardiac ablation catheters and method
US5609591A (en) 1993-10-05 1997-03-11 S.L.T. Japan Co., Ltd. Laser balloon catheter apparatus
US5439474A (en) 1993-10-08 1995-08-08 Li Medical Technologies, Inc. Morcellator system
US5456689A (en) 1993-10-13 1995-10-10 Arnold J. Kresch Method and device for tissue resection
US5575810A (en) 1993-10-15 1996-11-19 Ep Technologies, Inc. Composite structures and methods for ablating tissue to form complex lesion patterns in the treatment of cardiac conditions and the like
US5814028A (en) 1993-11-03 1998-09-29 Daig Corporation Curved guiding introducers for cardiac access
US5366468A (en) 1993-11-09 1994-11-22 Linvatec Corporation Double bladed surgical router having aspiration ports within flutes
US5492119A (en) 1993-12-22 1996-02-20 Heart Rhythm Technologies, Inc. Catheter tip stabilizing apparatus
US5601573A (en) 1994-03-02 1997-02-11 Ethicon Endo-Surgery, Inc. Sterile occlusion fasteners and instruments and method for their placement
US5419777A (en) 1994-03-10 1995-05-30 Bavaria Medizin Technologie Gmbh Catheter for injecting a fluid or medicine
US5776092A (en) 1994-03-23 1998-07-07 Erbe Elektromedizin Gmbh Multifunctional surgical instrument
US5464395A (en) * 1994-04-05 1995-11-07 Faxon; David P. Catheter for delivering therapeutic and/or diagnostic agents to the tissue surrounding a bodily passageway
US5578067A (en) 1994-04-14 1996-11-26 Pacesetter Ab Medical electrode system having a sleeve body and control element therefor for selectively positioning an exposed conductor area
US5743870A (en) 1994-05-09 1998-04-28 Somnus Medical Technologies, Inc. Ablation apparatus and system for removal of soft palate tissue
US5683362A (en) 1994-05-13 1997-11-04 Rowland; Christopher A. Apparatus for performing diagnostic and therapeutic modalities in the biliary tree
US5680860A (en) 1994-07-07 1997-10-28 Cardiac Pathways Corporation Mapping and/or ablation catheter with coilable distal extremity and method for using same
US5593405A (en) * 1994-07-16 1997-01-14 Osypka; Peter Fiber optic endoscope
US5569284A (en) 1994-09-23 1996-10-29 United States Surgical Corporation Morcellator
US5601588A (en) 1994-09-29 1997-02-11 Olympus Optical Co., Ltd. Endoscopic puncture needle
US5562694A (en) 1994-10-11 1996-10-08 Lasersurge, Inc. Morcellator
US5807401A (en) 1994-11-07 1998-09-15 Grieshaber & Co. Ag Schaffhausen Ophthalmic surgical apparatus for pulverizing and removing the lens nucleus from the eye of a living being
US5591159A (en) 1994-11-09 1997-01-07 Taheri; Syde A. Transcavitary myocardial perfusion apparatus
US5928943A (en) 1994-11-22 1999-07-27 Institut Fur Pflanzengenetik Und Kulturpflanzenforschung Embryonal cardiac muscle cells, their preparation and their use
US5611803A (en) 1994-12-22 1997-03-18 Urohealth Systems, Inc. Tissue segmentation device
US5665062A (en) * 1995-01-23 1997-09-09 Houser; Russell A. Atherectomy catheter and RF cutting method
US5575293A (en) 1995-02-06 1996-11-19 Promex, Inc. Apparatus for collecting and staging tissue
US5551427A (en) 1995-02-13 1996-09-03 Altman; Peter A. Implantable device for the effective elimination of cardiac arrhythmogenic sites
US5640955A (en) * 1995-02-14 1997-06-24 Daig Corporation Guiding introducers for use in the treatment of accessory pathways around the mitral valve using a retrograde approach
US5722400A (en) * 1995-02-16 1998-03-03 Daig Corporation Guiding introducers for use in the treatment of left ventricular tachycardia
WO1996025097A1 (en) 1995-02-17 1996-08-22 Ep Technologies, Inc. Systems and methods for examining heart tissue
WO1996026675A1 (en) 1995-02-28 1996-09-06 Boston Scientific Corporation Deflectable catheter for ablating cardiac tissue
US5569254A (en) 1995-04-12 1996-10-29 Midas Rex Pneumatic Tools, Inc. Surgical resection tool having an irrigation, lighting, suction and vision attachment
US5651781A (en) 1995-04-20 1997-07-29 Grace-Wells Technology Partners No. 1, L.P. Surgical cutting instrument
US5916214A (en) 1995-05-01 1999-06-29 Medtronic Cardiorhythm Dual curve ablation catheter
US5606974A (en) 1995-05-02 1997-03-04 Heart Rhythm Technologies, Inc. Catheter having ultrasonic device
US6322548B1 (en) 1995-05-10 2001-11-27 Eclipse Surgical Technologies Delivery catheter system for heart chamber
US6251104B1 (en) 1995-05-10 2001-06-26 Eclipse Surgical Technologies, Inc. Guiding catheter system for ablating heart tissue
WO1996035469A1 (en) 1995-05-10 1996-11-14 Cardiogenesis Corporation System for treating or diagnosing heart tissue
US5658263A (en) 1995-05-18 1997-08-19 Cordis Corporation Multisegmented guiding catheter for use in medical catheter systems
US5643253A (en) 1995-06-06 1997-07-01 Rare Earth Medical, Inc. Phototherapy apparatus with integral stopper device
US5797870A (en) 1995-06-07 1998-08-25 Indiana University Foundation Pericardial delivery of therapeutic and diagnostic agents
US5840059A (en) 1995-06-07 1998-11-24 Cardiogenesis Corporation Therapeutic and diagnostic agent delivery
US5609621A (en) 1995-08-04 1997-03-11 Medtronic, Inc. Right ventricular outflow tract defibrillation lead
WO1997010753A1 (en) 1995-09-20 1997-03-27 Medtronic, Inc. Method and apparatus for temporarily immobilizing a local area of tissue
US5702412A (en) 1995-10-03 1997-12-30 Cedars-Sinai Medical Center Method and devices for performing vascular anastomosis
WO1997013471A1 (en) 1995-10-13 1997-04-17 Transvascular, Inc. A device, system and method for interstitial transvascular intervention
US5830222A (en) 1995-10-13 1998-11-03 Transvascular, Inc. Device, system and method for intersititial transvascular intervention
US5569178A (en) 1995-10-20 1996-10-29 Henley; Julian L. Power assisted suction lipectomy device
US5709697A (en) 1995-11-22 1998-01-20 United States Surgical Corporation Apparatus and method for removing tissue
US5941868A (en) 1995-12-22 1999-08-24 Localmed, Inc. Localized intravascular delivery of growth factors for promotion of angiogenesis
US5688234A (en) 1996-01-26 1997-11-18 Cardiometrics Inc. Apparatus and method for the treatment of thrombotic occlusions in vessels
US5878751A (en) 1996-03-04 1999-03-09 Myocardial Stents, Inc. Method for trans myocardial revascularization (TMR)
US5834418A (en) 1996-03-20 1998-11-10 Theratechnologies, Inc. Process for the preparation of platelet growth factors extract
US5725521A (en) * 1996-03-29 1998-03-10 Eclipse Surgical Technologies, Inc. Depth stop apparatus and method for laser-assisted transmyocardial revascularization and other surgical applications
US5782823A (en) 1996-04-05 1998-07-21 Eclipse Surgical Technologies, Inc. Laser device for transmyocardial revascularization procedures including means for enabling a formation of a pilot hole in the epicardium
EP0807412A1 (en) 1996-05-13 1997-11-19 United States Surgical Corporation Coring device and method
US5980545A (en) 1996-05-13 1999-11-09 United States Surgical Corporation Coring device and method
US5964754A (en) 1996-05-24 1999-10-12 Sulzer Osypka Gmbh Device for perforating the heart wall
US5662124A (en) 1996-06-19 1997-09-02 Wilk Patent Development Corp. Coronary artery by-pass method
US5766163A (en) * 1996-07-03 1998-06-16 Eclipse Surgical Technologies, Inc. Controllable trocar for transmyocardial revascularization (TMR) via endocardium method and apparatus
US7094201B1 (en) 1996-07-17 2006-08-22 Medtronic, Inc. System and method for genetically treating cardiac conduction disturbances
US5662671A (en) 1996-07-17 1997-09-02 Embol-X, Inc. Atherectomy device having trapping and excising means for removal of plaque from the aorta and other arteries
WO1998005307A1 (en) 1996-08-08 1998-02-12 Localmed, Inc. Transmural drug delivery method and apparatus
US5857995A (en) 1996-08-15 1999-01-12 Surgical Dynamics, Inc. Multiple bladed surgical cutting device removably connected to a rotary drive element
US5989278A (en) 1996-09-13 1999-11-23 Eclipse Surgical Technologies, Inc. Method and apparatus for mechanical transmyocardial revascularization of the heart
US5871495A (en) 1996-09-13 1999-02-16 Eclipse Surgical Technologies, Inc. Method and apparatus for mechanical transmyocardial revascularization of the heart
US5755714A (en) * 1996-09-17 1998-05-26 Eclipse Surgical Technologies, Inc. Shaped catheter for transmyocardial revascularization
WO1998017186A1 (en) 1996-10-21 1998-04-30 Plc Medical Systems, Inc. Percutaneous transmyocardial revascularization marking system
US6030377A (en) 1996-10-21 2000-02-29 Plc Medical Systems, Inc. Percutaneous transmyocardial revascularization marking system
US5830210A (en) 1996-10-21 1998-11-03 Plc Medical Systems, Inc. Catheter navigation apparatus
US5893848A (en) 1996-10-24 1999-04-13 Plc Medical Systems, Inc. Gauging system for monitoring channel depth in percutaneous endocardial revascularization
US5873366A (en) 1996-11-07 1999-02-23 Chim; Nicholas Method for transmyocardial revascularization
US5971993A (en) 1996-11-07 1999-10-26 Myocardial Stents, Inc. System for delivery of a trans myocardial device to a heart wall
US6051008A (en) * 1996-12-02 2000-04-18 Angiotrax, Inc. Apparatus having stabilization members for percutaneously performing surgery and methods of use
US5910150A (en) * 1996-12-02 1999-06-08 Angiotrax, Inc. Apparatus for performing surgery
US5941893A (en) * 1996-12-02 1999-08-24 Angiotrax, Inc. Apparatus for transluminally performing surgery
US5931848A (en) * 1996-12-02 1999-08-03 Angiotrax, Inc. Methods for transluminally performing surgery
US5944716A (en) * 1996-12-09 1999-08-31 Scimed Life Systems, Inc. Radio frequency transmyocardial revascularization corer
US5724975A (en) 1996-12-12 1998-03-10 Plc Medical Systems, Inc. Ultrasonic detection system for transmyocardial revascularization
US5807384A (en) 1996-12-20 1998-09-15 Eclipse Surgical Technologies, Inc. Transmyocardial revascularization (TMR) enhanced treatment for coronary artery disease
US5925012A (en) 1996-12-27 1999-07-20 Eclipse Surgical Technologies, Inc. Laser assisted drug delivery
EP0853921A2 (en) 1996-12-27 1998-07-22 Eclipse Surgical Technologies, Inc. Laser assisted drug delivery
US5906594A (en) 1997-01-08 1999-05-25 Symbiosis Corporation Endoscopic infusion needle having dual distal stops
US6224584B1 (en) 1997-01-14 2001-05-01 Eclipse Surgical Technologies, Inc. Therapeutic and diagnostic agent delivery
US6056760A (en) 1997-01-30 2000-05-02 Nissho Corporation Device for intracardiac suture
US5730741A (en) * 1997-02-07 1998-03-24 Eclipse Surgical Technologies, Inc. Guided spiral catheter
US5846225A (en) 1997-02-19 1998-12-08 Cornell Research Foundation, Inc. Gene transfer therapy delivery device and method
US5938632A (en) 1997-03-06 1999-08-17 Scimed Life Systems, Inc. Radiofrequency transmyocardial revascularization apparatus and method
US5968059A (en) 1997-03-06 1999-10-19 Scimed Life Systems, Inc. Transmyocardial revascularization catheter and method
WO1998039045A1 (en) 1997-03-07 1998-09-11 Cardiogenesis Corporation Catheter with three sections of different flexibilities
US6036677A (en) 1997-03-07 2000-03-14 Cardiogenesis Corporation Catheter with flexible intermediate section
US6093177A (en) 1997-03-07 2000-07-25 Cardiogenesis Corporation Catheter with flexible intermediate section
WO1998038916A1 (en) 1997-03-07 1998-09-11 Cardiogenesis Corporation Apparatus and method of myocardial revascularization using ultrasonic pulse-echo distance ranging
US5876373A (en) 1997-04-04 1999-03-02 Eclipse Surgical Technologies, Inc. Steerable catheter
EP0868923A2 (en) 1997-04-04 1998-10-07 Eclipse Surgical Technologies, Inc. Steerable catheter
US6126654A (en) 1997-04-04 2000-10-03 Eclipse Surgical Technologies, Inc. Method of forming revascularization channels in myocardium using a steerable catheter
EP0876796A2 (en) 1997-05-07 1998-11-11 Eclipse Surgical Technologies, Inc. Device for use in the treatment of cardiovascular or other tissue
US5951567A (en) 1997-07-24 1999-09-14 Cardiogenesis Corporation Introducer for channel forming device
EP0895752A1 (en) 1997-08-08 1999-02-10 Eclipse Surgical Technologies, Inc. Apparatus for sampling heart tissue and/or myocardial revascularization by mechanical cutting
US5964757A (en) 1997-09-05 1999-10-12 Cordis Webster, Inc. Steerable direct myocardial revascularization catheter
US6179809B1 (en) * 1997-09-24 2001-01-30 Eclipse Surgical Technologies, Inc. Drug delivery catheter with tip alignment
US6106520A (en) 1997-09-30 2000-08-22 Hearten Medical, Inc. Endocardial device for producing reversible damage to heart tissue
US6238389B1 (en) 1997-09-30 2001-05-29 Boston Scientific Corporation Deflectable interstitial ablation device
US5980548A (en) 1997-10-29 1999-11-09 Kensey Nash Corporation Transmyocardial revascularization system
US6056743A (en) * 1997-11-04 2000-05-02 Scimed Life Systems, Inc. Percutaneous myocardial revascularization device and method
US5851171A (en) * 1997-11-04 1998-12-22 Advanced Cardiovascular Systems, Inc. Catheter assembly for centering a radiation source within a body lumen
US6045565A (en) 1997-11-04 2000-04-04 Scimed Life Systems, Inc. Percutaneous myocardial revascularization growth factor mediums and method
US6589232B1 (en) 1997-11-25 2003-07-08 Richard L. Mueller Selective treatment of endocardial/myocardial boundary
US5885276A (en) 1997-12-02 1999-03-23 Galil Medical Ltd. Method and device for transmyocardial cryo revascularization
US6066126A (en) 1997-12-18 2000-05-23 Medtronic, Inc. Precurved, dual curve cardiac introducer sheath
US6197324B1 (en) 1997-12-18 2001-03-06 C. R. Bard, Inc. System and methods for local delivery of an agent
US6309370B1 (en) 1998-02-05 2001-10-30 Biosense, Inc. Intracardiac drug delivery
US6270496B1 (en) 1998-05-05 2001-08-07 Cardiac Pacemakers, Inc. Steerable catheter with preformed distal shape and method for use
US6905476B2 (en) 1998-06-04 2005-06-14 Biosense Webster, Inc. Catheter with injection needle
US6102887A (en) 1998-08-11 2000-08-15 Biocardia, Inc. Catheter drug delivery system and method for use
US6045530A (en) 1998-10-14 2000-04-04 Heyer-Schulte Neurocare Inc. Adjustable angle catheter
US6620139B1 (en) 1998-12-14 2003-09-16 Tre Esse Progettazione Biomedica S.R.L. Catheter system for performing intramyocardiac therapeutic treatment
US6165164A (en) 1999-03-29 2000-12-26 Cordis Corporation Catheter for injecting therapeutic and diagnostic agents
US6638233B2 (en) * 1999-08-19 2003-10-28 Fox Hollow Technologies, Inc. Apparatus and methods for material capture and removal
US6613062B1 (en) 1999-10-29 2003-09-02 Medtronic, Inc. Method and apparatus for providing intra-pericardial access
US20040010231A1 (en) 2000-07-13 2004-01-15 Leonhardt Howard J Deployment system for myocardial cellular material
US6994716B2 (en) 2002-09-18 2006-02-07 Kabushiki Kaisha Toshiba Medical manipulator

Non-Patent Citations (40)

* Cited by examiner, † Cited by third party
Title
A Collection of Abstracts, Society of Thoracic Surgeons, 1999.
Assmus, Transplantation of Progenitor Cells and Regeneration Enhancement in Acute Myocardial Infarction (TOPCARE-AMI), Clinical Investigation and Reports, Oct. 8, 2002, pp. 3009-3017, Department of Molecular Cardiology and Department of Hematology (H.M., D.H.) University of Frankfurt, Frankfurt, Germany, Circulation available at http://www.circulationha.org DOI: 10.1161/01.CIR.0000043246.74879CD.
Cooley, Denton A., M.D. et al., "Transmyocardial Laser Revascularization: Anatomic Evidence of Long-Term Channel Patency," Texas heart Institute Journal, vol. 21, No. 3 (1994), pp. 220-224.
Cooley, Denton A., M.D. et al., "Transmyocardial Laser Revascularization: Clinical Experience with Twelve-Month Follow-Up," The Journal of Thoracic and Cardiovascular Surgery, (Apr. 1996), pp. 791-799.
Fenton II, John W. et al. "Thrombin and Antithrombotics," Seminars in Thrombosis and Hemostasis, vol. 24, No. 2, 1998, pp. 1987-1991.
Folkman, Judah, "Angiogenic Therapy of the Human Heart," circulation, 1998, 97:628-629.
Frazier, O.H., M.D., "Myocardial Revascularization With Laser: Preliminary Findings," Supplement II Circulation, vol. 92, No. 9, (Nov. 1995), pp. II-58-II-65.
Hardy, Roger Ian, "A Histologic Study of Laser-Induced Transmyocardial Channels," Lasers in Surgery and Medicine, (1987), pp. 6:563-573.
Henry, Timothy D., Can We Really Grow New Blood Vessels, The Lancet, vol. 351, Jun 20, 1998, pp. 1926-1827.
Hershey, John E. et al., "Transmyocardial Puncture Revascularization: A Possible Emergency Adjunct to Arterial Implant Surgery," Geriatrics, (Mar. 1969), pp. 101-108.
Horvath, Keith A., M.D., et al., "Recovery and Viability of an Acute Myocardial Infarct After Transmyocardial Laser Revascularization," Journal of American College of Cardiology, vol. 25, No. 1 (Jan. 1995), pp. 258-263.
Horvath, Keith A., M.D., et al., "Transmyocardial Laser Revascularization: Operative Techniques and Clinical Results at Two Years," The Journal of Thoracic and Cardiovascular Surgery, (May 1996) pp. 1047-1053.
Khazei, Hassan A., "A New Method of Myocardial Revasularization," The Annals of Thoracic Surgery, vol. 6, No. 2, (Aug. 1968) pp. 163-171.
Knighton, David R., et al., "Role of Platelets and Fibrin in the Healing Sequence," Annals of Surgery, vol. 196, No. 4, Oct. 1982, pp. 379-388.
Kohmoto, Takushi, M.D., "Does Blood Flow Through Holmium: YAG Transmyocardial Laser Channels?," Ann. Thorac. Surg., (1996) pp. 61:861-868.
Kuzela, Ladislaw, "Experimental Evaluation of Direct Transventricular Revascularization," Journal ofThoracic and Cardiovasuclar Surger, vol. 57, No. 6, (Jun. 1969), pp. 770-773.
Lee, Garrett, M.D., "Effects of Laser Irradiation Delivered by Flexible Fiberoptic System on the Left Ventricular Internal Myocardium," American Heart Journal, (Sep. 1983), pp. 587-590.
Losordo, Douglas, W., et al., "Gene Therapy for Myocardial Angiogenesis Initial Clinical Results with Direct Myocardial Injection of phVEGF 165 as Sole Therapy Myocardial Ischemia," Circulation, 1998, 98:2800-2804.
Maloney, James P. et al., "In Vitro Release of Vascular Endothelial Growth Factor During Platelet Aggregation," American Physiological Society, H1054-H1061, 1998.
Mandrusov, Membrane-Based Cell Affinity Chromatography to Retrieve Viable Cells, Biotechnol, Prob. 1995, 11, 208-213, Artificial Organs Research Laboratory, Department of Chemical Engineering, Material Science and Metallurgy, Columbia University, New York, New York 10027, and Lousville, Lousville, Kentucky 40292.
Miyazono, Kohei et al, "Platelet-Derived Endothelial Cell Growth Factor, " Progress in Growth Factor Research, vol. 3, 1991, pp. 207-217.
NASA's Jet Propulsion Laboratory, "Swivel-Head Sampling Drill Bit," NASA Tech Briefs, Nov. 1998.
PCT Communication-Supplementary European Search Report, Aug. 3, 2001, 3 pages.
PCT International Search Report Mar. 18, 1998, 4 pages.
PCT Notification of Transmittal of International Preliminary Examination Report, Apr. 15, 1999, 13 pages.
PCT Written Opinion, Dec. 23, 1998, 4 pages.
Pipili-Synetos, E. et al., "Evidence That Platelets Promote Tube Formation By Endothelial Cells on Matrigel," British Journal of Pharmacology, vol. 125, 1998, pp. 1252-1257.
PMR Poduct, Axcis.TM. PMR.TM. System, http://www.cardiogenesis.com/percutaneous/product.html, Jan. 27, 1999.
PMR Product, Axcis tm PMR. System, http://www.cardiogenesis.com/percutaneous/product.html, Jan. 27, 1999.
Sen, P.K. et al., "Further Studies in Multiple Transmyocardial Acupuncture as a Method of Myocardial Revascularization," Surgery, vol. 64, No. 5, (Nov. 1968), pp. 861-870.
Simons, Michael et al. "Food for Starving Hearts," Nature Medicine, vol. 2, No. 5, pp. 519-520 (May 1996).
Thaning, Otto, "Transmyocardial Laser Revascularisation in South Africa," SAMJ, vol. 85, No. 8 (Aug. 1995) pp. 787-788.
The PMR.TM. Procedure, http://www.cardiogenesis.com/percutaneous/procedure.html, Jan. 27, 1999.
Tsopanoglou, Nikos E. et al., "Thrombin Promotes Angiogenesis By a Mechanism Independent of Fibrin Formation," American Physiological Society, 0363-6143/93, C1302-1307, 1993.
Verheul, Henk M. W., et al., "Platelet: Transporter of Vascular Endothelial Growth Factor," Clinical Cancer Research, vol. 3, Dec. 1997, pp. 2187-2190.
Von Oppell, Ulrich O., "Transmyocardial Laser Revascularisation," SAMJ, vol. 85, No. 9, (Sep. 1995), p. 930.
Wakabayashi, Akio, "Myocardial Boring For the Ischemic Heart,"Arch. Surgery, vol. 95, (Nov. 1967), pp. 743-752.
Wartiovaara, Ulla et al., Peripheral Blood Platelets Express VEGF-C and VEGF Which are Released During Platelet Activation, Thromb Haemost, 9198, 80:171-5, 1999.
Washington Adventist Hospital, "Washington Area Cardiologist Performs First State-of-the-Art Heart Procedure In U.S.," PR Newswire, Dec. 15, 1999, 2 pages.
White, Manuel et al., "Multiple Transmyocardial Puncture Revascularization in Refractory Ventricular Fibrillation due to Myocardial Ischemia," The Annals of Thoracic Surgery, vol. 6, No. 6, (Dec. 1968), pp. 557-563.

Cited By (110)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8961551B2 (en) 2006-12-22 2015-02-24 The Spectranetics Corporation Retractable separating systems and methods
US9808275B2 (en) 2006-12-22 2017-11-07 The Spectranetics Corporation Retractable separating systems and methods
US9801650B2 (en) 2006-12-22 2017-10-31 The Spectranetics Corporation Tissue separating systems and methods
US10537354B2 (en) 2006-12-22 2020-01-21 The Spectranetics Corporation Retractable separating systems and methods
US10869687B2 (en) 2006-12-22 2020-12-22 Spectranetics Llc Tissue separating systems and methods
US9289226B2 (en) 2006-12-22 2016-03-22 The Spectranetics Corporation Retractable separating systems and methods
US9028520B2 (en) 2006-12-22 2015-05-12 The Spectranetics Corporation Tissue separating systems and methods
US10426885B2 (en) 2007-07-18 2019-10-01 Silk Road Medical, Inc. Methods and systems for establishing retrograde carotid arterial blood flow
US10543307B2 (en) 2007-07-18 2020-01-28 Silk Road Medical, Inc. Methods and systems for establishing retrograde carotid arterial blood flow
US8858490B2 (en) 2007-07-18 2014-10-14 Silk Road Medical, Inc. Systems and methods for treating a carotid artery
US9833555B2 (en) 2007-07-18 2017-12-05 Silk Road Medical, Inc. Methods and systems for establishing retrograde carotid arterial blood flow
US20110166496A1 (en) * 2007-07-18 2011-07-07 Enrique Criado Methods and systems for establishing retrograde carotid arterial blood flow
US9259215B2 (en) 2007-07-18 2016-02-16 Silk Road Medical, Inc. Systems and methods for treating a carotid artery
US10286139B2 (en) 2007-07-18 2019-05-14 Silk Road Medical, Inc. Methods and systems for establishing retrograde carotid arterial blood flow
US9789242B2 (en) 2007-07-18 2017-10-17 Silk Road Medical, Inc. Methods and systems for establishing retrograde carotid arterial blood flow
US9011364B2 (en) 2007-07-18 2015-04-21 Silk Road Medical, Inc. Methods and systems for establishing retrograde carotid arterial blood flow
US8784355B2 (en) 2007-07-18 2014-07-22 Silk Road Medical, Inc. Methods and systems for establishing retrograde carotid arterial blood flow
US11364332B2 (en) 2007-07-18 2022-06-21 Silk Road Medical, Inc. Methods and systems for establishing retrograde carotid arterial blood flow
US10709832B2 (en) 2007-07-18 2020-07-14 Silk Road Medical, Inc. Methods and systems for establishing retrograde carotid arterial blood flow
US9655755B2 (en) 2007-07-18 2017-05-23 Silk Road Medical, Inc. Systems and methods for treating a carotid artery
US10085864B2 (en) 2007-07-18 2018-10-02 Silk Road Medical, Inc. Systems and methods for treating a carotid artery
US20110166497A1 (en) * 2007-07-18 2011-07-07 Enrique Criado Methods and systems for establishing retrograde carotid arterial blood flow
US8740834B2 (en) 2007-07-18 2014-06-03 Silk Road Medical, Inc. Methods and systems for establishing retrograde carotid arterial blood flow
US10485917B2 (en) 2007-07-18 2019-11-26 Silk Road Medical, Inc. Methods and systems for establishing retrograde carotid arterial blood flow
US11364369B2 (en) 2008-02-05 2022-06-21 Silk Road Medical, Inc. Interventional catheter system and methods
US9669191B2 (en) 2008-02-05 2017-06-06 Silk Road Medical, Inc. Interventional catheter system and methods
US10226598B2 (en) 2008-02-05 2019-03-12 Silk Road Medical, Inc. Interventional catheter system and methods
US10226563B2 (en) 2008-12-23 2019-03-12 Silk Road Medical, Inc. Methods and systems for treatment of acute ischemic stroke
US20110087147A1 (en) * 2008-12-23 2011-04-14 Garrison Michi E Methods and systems for treatment of acute ischemic stroke
US11103627B2 (en) 2008-12-23 2021-08-31 Silk Road Medical, Inc. Methods and systems for treatment of acute ischemic stroke
US11654222B2 (en) 2008-12-23 2023-05-23 Silk Road Medical, Inc. Methods and systems for treatment of acute ischemic stroke
US20100204684A1 (en) * 2009-01-13 2010-08-12 Garrison Michi E Methods and systems for performing neurointerventional procedures
US10327790B2 (en) 2011-08-05 2019-06-25 Route 92 Medical, Inc. Methods and systems for treatment of acute ischemic stroke
US10779855B2 (en) 2011-08-05 2020-09-22 Route 92 Medical, Inc. Methods and systems for treatment of acute ischemic stroke
US11871944B2 (en) 2011-08-05 2024-01-16 Route 92 Medical, Inc. Methods and systems for treatment of acute ischemic stroke
US10743893B2 (en) 2011-08-05 2020-08-18 Route 92 Medical, Inc. Methods and systems for treatment of acute ischemic stroke
US10722251B2 (en) 2011-08-05 2020-07-28 Route 92 Medical, Inc. Methods and systems for treatment of acute ischemic stroke
US10646239B2 (en) 2011-08-05 2020-05-12 Route 92 Medical, Inc. Methods and systems for treatment of acute ischemic stroke
US9949753B2 (en) 2012-09-14 2018-04-24 The Spectranetics Corporation Tissue slitting methods and systems
US10368900B2 (en) 2012-09-14 2019-08-06 The Spectranetics Corporation Tissue slitting methods and systems
US11596435B2 (en) 2012-09-14 2023-03-07 Specrtranetics Llc Tissue slitting methods and systems
US9413896B2 (en) 2012-09-14 2016-08-09 The Spectranetics Corporation Tissue slitting methods and systems
US9763692B2 (en) 2012-09-14 2017-09-19 The Spectranetics Corporation Tissue slitting methods and systems
US9724122B2 (en) 2012-09-14 2017-08-08 The Spectranetics Corporation Expandable lead jacket
US10531891B2 (en) 2012-09-14 2020-01-14 The Spectranetics Corporation Tissue slitting methods and systems
US10799293B2 (en) 2013-03-13 2020-10-13 The Spectranetics Corporation Laser ablation catheter
US10485613B2 (en) 2013-03-13 2019-11-26 The Spectranetics Corporation Device and method of ablative cutting with helical tip
US9456872B2 (en) 2013-03-13 2016-10-04 The Spectranetics Corporation Laser ablation catheter
US9937005B2 (en) 2013-03-13 2018-04-10 The Spectranetics Corporation Device and method of ablative cutting with helical tip
US10383691B2 (en) 2013-03-13 2019-08-20 The Spectranetics Corporation Last catheter with helical internal lumen
US9925371B2 (en) 2013-03-13 2018-03-27 The Spectranetics Corporation Alarm for lead insulation abnormality
US9291663B2 (en) 2013-03-13 2016-03-22 The Spectranetics Corporation Alarm for lead insulation abnormality
US9283040B2 (en) 2013-03-13 2016-03-15 The Spectranetics Corporation Device and method of ablative cutting with helical tip
US10265520B2 (en) 2013-03-13 2019-04-23 The Spetranetics Corporation Alarm for lead insulation abnormality
US9883885B2 (en) 2013-03-13 2018-02-06 The Spectranetics Corporation System and method of ablative cutting and pulsed vacuum aspiration
US10835279B2 (en) 2013-03-14 2020-11-17 Spectranetics Llc Distal end supported tissue slitting apparatus
US9668765B2 (en) 2013-03-15 2017-06-06 The Spectranetics Corporation Retractable blade for lead removal device
US9956399B2 (en) 2013-03-15 2018-05-01 The Spectranetics Corporation Medical device for removing an implanted object
US11160579B2 (en) 2013-03-15 2021-11-02 Spectranetics Llc Multiple configuration surgical cutting device
US10219819B2 (en) 2013-03-15 2019-03-05 The Spectranetics Corporation Retractable blade for lead removal device
US10314615B2 (en) 2013-03-15 2019-06-11 The Spectranetics Corporation Medical device for removing an implanted object
US10849603B2 (en) 2013-03-15 2020-12-01 Spectranetics Llc Surgical instrument for removing an implanted object
US10842532B2 (en) 2013-03-15 2020-11-24 Spectranetics Llc Medical device for removing an implanted object
US10136913B2 (en) 2013-03-15 2018-11-27 The Spectranetics Corporation Multiple configuration surgical cutting device
US10448999B2 (en) 2013-03-15 2019-10-22 The Spectranetics Corporation Surgical instrument for removing an implanted object
US9603618B2 (en) 2013-03-15 2017-03-28 The Spectranetics Corporation Medical device for removing an implanted object
US10052129B2 (en) 2013-03-15 2018-08-21 The Spectranetics Corporation Medical device for removing an implanted object
US9918737B2 (en) 2013-03-15 2018-03-20 The Spectranetics Corporation Medical device for removing an implanted object
US10524817B2 (en) 2013-03-15 2020-01-07 The Spectranetics Corporation Surgical instrument including an inwardly deflecting cutting tip for removing an implanted object
US9925366B2 (en) 2013-03-15 2018-03-27 The Spectranetics Corporation Surgical instrument for removing an implanted object
US9980743B2 (en) 2013-03-15 2018-05-29 The Spectranetics Corporation Medical device for removing an implanted object using laser cut hypotubes
US9492637B2 (en) 2013-12-23 2016-11-15 Silk Road Medical, Inc. Transcarotid neurovascular catheter
US9265512B2 (en) 2013-12-23 2016-02-23 Silk Road Medical, Inc. Transcarotid neurovascular catheter
US10569049B2 (en) 2013-12-23 2020-02-25 Route 92 Medical, Inc. Methods and systems for treatment of acute ischemic stroke
US11534575B2 (en) 2013-12-23 2022-12-27 Route 92 Medical, Inc. Methods and systems for treatment of acute ischemic stroke
US9861783B2 (en) 2013-12-23 2018-01-09 Silk Road Medical, Inc. Transcarotid neurovascular catheter
US11318282B2 (en) 2013-12-23 2022-05-03 Route 92 Medical, Inc. Methods and systems for treatment of acute ischemic stroke
US11291799B2 (en) 2013-12-23 2022-04-05 Silk Road Medical, Inc. Transcarotid neurovascular catheter
US10471233B2 (en) 2013-12-23 2019-11-12 Route 92 Medical, Inc. Methods and systems for treatment of acute ischemic stroke
US9561345B2 (en) 2013-12-23 2017-02-07 Route 92 Medical, Inc. Methods and systems for treatment of acute ischemic stroke
US10384034B2 (en) 2013-12-23 2019-08-20 Silk Road Medical, Inc. Transcarotid neurovascular catheter
US10213582B2 (en) 2013-12-23 2019-02-26 Route 92 Medical, Inc. Methods and systems for treatment of acute ischemic stroke
US10864351B2 (en) 2013-12-23 2020-12-15 Route 92 Medical, Inc. Methods and systems for treatment of acute ischemic stroke
US10405924B2 (en) 2014-05-30 2019-09-10 The Spectranetics Corporation System and method of ablative cutting and vacuum aspiration through primary orifice and auxiliary side port
US9662480B2 (en) 2014-09-04 2017-05-30 Silk Road Medical, Inc. Methods and devices for transcarotid access
US9126018B1 (en) 2014-09-04 2015-09-08 Silk Road Medical, Inc. Methods and devices for transcarotid access
US11027104B2 (en) 2014-09-04 2021-06-08 Silk Road Medical, Inc. Methods and devices for transcarotid access
US11759613B2 (en) 2014-09-04 2023-09-19 Silk Road Medical, Inc. Methods and devices for transcarotid access
US9241699B1 (en) 2014-09-04 2016-01-26 Silk Road Medical, Inc. Methods and devices for transcarotid access
US10864357B2 (en) 2014-09-04 2020-12-15 Silk Road Medical, Inc. Methods and devices for transcarotid access
US10039906B2 (en) 2014-09-04 2018-08-07 Silk Road Medical, Inc. Methods and devices for transcarotid access
US9399118B2 (en) 2014-09-04 2016-07-26 Silk Road Medical, Inc. Methods and devices for transcarotid access
US11633571B2 (en) 2015-02-04 2023-04-25 Route 92 Medical, Inc. Rapid aspiration thrombectomy system and method
US11806032B2 (en) 2015-02-04 2023-11-07 Route 92 Medical, Inc. Aspiration catheter systems and methods of use
US11793529B2 (en) 2015-02-04 2023-10-24 Route 92 Medical, Inc. Aspiration catheter systems and methods of use
US11065019B1 (en) 2015-02-04 2021-07-20 Route 92 Medical, Inc. Aspiration catheter systems and methods of use
US11576691B2 (en) 2015-02-04 2023-02-14 Route 92 Medical, Inc. Aspiration catheter systems and methods of use
US11224450B2 (en) 2015-02-04 2022-01-18 Route 92 Medical, Inc. Aspiration catheter systems and methods of use
USD819204S1 (en) 2015-02-20 2018-05-29 The Spectranetics Corporation Medical device handle
USD854682S1 (en) 2015-02-20 2019-07-23 The Spectranetics Corporation Medical device handle
USD770616S1 (en) 2015-02-20 2016-11-01 The Spectranetics Corporation Medical device handle
USD765243S1 (en) 2015-02-20 2016-08-30 The Spectranetics Corporation Medical device handle
USD806245S1 (en) 2015-02-20 2017-12-26 The Spectranetics Corporation Medical device handle
US11399852B2 (en) 2017-01-10 2022-08-02 Route 92 Medical, Inc. Aspiration catheter systems and methods of use
US11020133B2 (en) 2017-01-10 2021-06-01 Route 92 Medical, Inc. Aspiration catheter systems and methods of use
US11607523B2 (en) 2018-05-17 2023-03-21 Route 92 Medical, Inc. Aspiration catheter systems and methods of use
US11229770B2 (en) 2018-05-17 2022-01-25 Route 92 Medical, Inc. Aspiration catheter systems and methods of use
US11925380B2 (en) 2020-11-17 2024-03-12 Spectranetics Llc Distal end supported tissue slitting apparatus
US11925334B2 (en) 2020-11-30 2024-03-12 Spectranetics Llc Surgical instrument for removing an implanted object
US11925770B2 (en) 2023-04-07 2024-03-12 Route 92 Medical, Inc. Aspiration catheter systems and methods of use

Also Published As

Publication number Publication date
US6051008A (en) 2000-04-18

Similar Documents

Publication Publication Date Title
USRE43300E1 (en) Apparatus having stabilization members for percutaneously performing surgery and methods of use
US5931848A (en) Methods for transluminally performing surgery
EP1011460A1 (en) Apparatus and methods for percutaneously performing surgery
US7214234B2 (en) Delivering a conduit into a heart wall to place a coronary vessel in communication with a heart chamber and removing tissue from the vessel or heart wall to facilitate such communication
US6165188A (en) Apparatus for percutaneously performing myocardial revascularization having controlled cutting depth and methods of use
JP4125482B2 (en) Percutaneous myocardial revascularization device
US6102926A (en) Apparatus for percutaneously performing myocardial revascularization having means for sensing tissue parameters and methods of use
US6200311B1 (en) Minimally invasive TMR device
US8657815B2 (en) Delivery system for delivering a medical device to a location within a patient's body
JP2001521795A (en) Guide catheter system for cardiac tissue resection
JP2001524844A (en) Apparatus and method for intraoperative surgery
US5935141A (en) Interventional cardiology instrument controlled from an intracoronary reference
JP2007533410A (en) Ablation device having sensor structure
JP2001518345A (en) Myocardial revascularization using high frequency energy
EP2777744B1 (en) Catheter with needles for ablating tissue layers in vessel
US20230277208A1 (en) Steerable Endoluminal Punch with Introducer and Guidewire

Legal Events

Date Code Title Description
CC Certificate of correction