WO2000049956A1 - Pmr catheter - Google Patents
Pmr catheter Download PDFInfo
- Publication number
- WO2000049956A1 WO2000049956A1 PCT/US2000/004977 US0004977W WO0049956A1 WO 2000049956 A1 WO2000049956 A1 WO 2000049956A1 US 0004977 W US0004977 W US 0004977W WO 0049956 A1 WO0049956 A1 WO 0049956A1
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- WIPO (PCT)
- Prior art keywords
- conductor
- catheter
- catheter assembly
- distal end
- elongate shaft
- Prior art date
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Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1492—Probes or electrodes therefor having a flexible, catheter-like structure, e.g. for heart ablation
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00238—Type of minimally invasive operation
- A61B2017/00243—Type of minimally invasive operation cardiac
- A61B2017/00247—Making holes in the wall of the heart, e.g. laser Myocardial revascularization
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
- A61B2018/00345—Vascular system
- A61B2018/00351—Heart
- A61B2018/00392—Transmyocardial revascularisation
Definitions
- the present invention relates generally to devices and methods for promoting blood circulation to the heart muscle. More particularly, the present invention relates to devices and methods for forming holes or channels in the walls of a heart chamber such as those created during a percutaneous myocardial revascularization (PMR) procedure.
- PMR percutaneous myocardial revascularization
- a stenosis may be formed by an atheroma which is typically a harder, calcified substance which forms on the walls of a blood vessel.
- Coronary bypass surgery typically involves utilizing vascular tissue from another part of the patient's body to construct a shunt around the obstructed vessel.
- Angioplasty techniques such as percutaneous transluminal angioplasty (PTA) and percutaneous transluminal coronary angioplasty (PTCA) are relatively non-invasive methods of treating a stenotic lesion.
- PTA percutaneous transluminal angioplasty
- PTCA percutaneous transluminal coronary angioplasty
- These angioplasty techniques typically involve the use of a guidewire and a balloon catheter. In these procedures, a balloon catheter is advanced over a guidewire such that the balloon is positioned proximate a restriction in a diseased vessel.
- a third technique which may be used to treat a stenotic lesion is atherectomy. During an atherectomy procedure, the stenotic lesion is mechanically cut or abraded away from the blood vessel wall.
- Coronary bypass, angioplasty, and atherectomy procedures have all been found effective in treating individual stenotic lesions in relatively large blood vessels.
- the heart muscle is perfused with blood through a network of small vessels and capillaries.
- a large number of stenotic lesions may occur in a large number of locations throughout this network of small blood vessels and capillaries.
- the torturous path and small diameter of these blood vessels limit access to the stenotic lesions.
- the sheer number and small size of these stenotic lesions make techniques such as cardiovascular bypass surgery, angioplasty, and atherectomy impractical
- PMR percutaneous myocardial revascularization
- a PMR procedure generally involves the creation of holes, craters or channels directly into the myocardium of the heart.
- PMR was inspired in part by observations that reptilian heart muscles are supplied with oxygen primarily by blood perfusing directly from within heart chambers to the heart muscle. This contrasts with the human heart, which is supplied by coronary vessels receiving blood from the aorta. Positive clinical results have been demonstrated in human patients receiving PMR treatments. These results are believed to be caused in part by blood flowing within a heart chamber through channels in myocardial tissue formed by PMR.
- Increased blood flow to the myocardium is also believed to be caused in part by the healing response to wound formation. Specifically, the formation of new blood vessels is believed to occur in response to the newly created wound. This response is sometimes referred to as angiogenisis.
- PMR improves a patient's condition through denervation. Denervation is the elimination of nerves endings. Specifically, the creation of wounds during a PMR procedure results in the elimination of nerve endings which were previously sending pain signals to the brain as a result of hibernating tissue.
- the present invention pertains to devices and methods for performing percutaneous myocardial revascularization (PMR).
- PMR percutaneous myocardial revascularization
- a device in accordance with the present invention may be used to form wounds in the myocardium of a patient's heart.
- this device may be used to form a channel wound (e.g., a wound with a depth greater than its width).
- this device may be used to form a crater wound (e.g., a wound with a width greater than its depth).
- a catheter in accordance with the present invention includes an elongate shaft having a proximal end and a distal end.
- the elongate shaft defines a lumen which extends substantially through the elongate shaft.
- An insulator is fixably attached to the elongate shaft at its distal end.
- the insulator includes at least two holes.
- the catheter also includes a conductor having a bent portion, a first leg portion and a second leg portion. The first and second leg portions of the conductor pass through the holes of the insulator and are disposed in the lumen of the catheter.
- the bent portion of the conductor substantially forms an electrode protruding from the distal end of the catheter.
- the electrode proceeds to penetrate the heart until the insulator contacts the heart tissue.
- the insulator includes two landing zones which extend away from the electrode. The width of the landing zones is generally larger than the width of the electrode. The relatively large area of the landing zones assures that the travel of the electrode into the heart will stop when the landing zones contact the heart tissue.
- the landing zones extend beyond the wound created in the heart tissue during a PMR procedure. This is because the wounded tissue is substantially softened, and it is possible for a PMR catheter to be pushed through soft, injured tissue.
- a therapeutically effective wound will, at a minimum, perforate through the endocardium and damage blood vessels and capillaries in the myocardium.
- the likelihood of unintentionally perforating through the myocardium to the epicardium is reduced when the depth of the wound created is only enough to penetrate the endocardium adjacent the myocardium.
- the conductor defines a conductor lumen and at least one hole in fluid communication with the conductor lumen.
- the conductor lumen may be used during a PMR procedure to deliver fluid to the distal end of the catheter.
- the fluid delivered during the PMR procedure may include contrast, saline, therapeutic agents, etc.
- the fluid may be used for a number of tasks, including mapping a heart, marking an injury site or promoting angiogenic effects.
- pressurized fluid may be delivered to the wound site during or after wound formation. The formation of the wound may be enhanced by collateral damage to the myocardium induced by directing this pressurized fluid into the wound site.
- the impact of pressurized fluid causes vessels, capillaries and sinuses to rupture.
- the number of wounds which need be made during a PMR procedure may be substantially reduced.
- a second benefit of this collateral damage is that the depth of the wounds required to achieve a therapeutic effect may be reduced.
- the injection of contrast creates a fluoroscopic marker of the treatment location.
- Figure 1 is a plan view of the distal end of a catheter in accordance with the present invention
- Figure 2 is a plan view of the distal portion of a catheter in accordance with the present invention with the catheter shown in partial cross section;
- Figure 3 is a plan view of a distal portion 22 of a catheter 20 in accordance with a bi-polar embodiment of the present invention
- Figure 4 is a plan view of a distal portion 22 of a catheter 20 in accordance with a further bi-polar embodiment of the present invention.
- Figure 5 is a plan view of a distal portion 22 of a catheter 20 in accordance with an additional bi-polar embodiment of the present invention
- Figure 6 is a plan view of the distal end of a catheter in accordance with the present invention
- Figure 7 is a plan view of the distal end of a catheter in accordance with the present invention
- Figure 8 is a plan view of a distal portion of a catheter in accordance with the present invention with the catheter being shown in partial cross section;
- Figure 9 is a plan view of the distal portion of a catheter in accordance with the present invention with the catheter being shown in partial cross section;
- Figure 10 is a plan view of the distal portion of a catheter in accordance with the present invention with the catheter shown in partial cross section;
- Figure 11 is a plan view of the distal end of a catheter in accordance with the present invention with the catheter being shown in partial cross section;
- Figure 12 is a plan view of the distal portion of a catheter in accordance with the present invention with the catheter being shown in partial cross section
- Figure 13 is a plan view of the distal portion of a catheter in accordance with the present invention with the catheter being shown in partial cross section;
- Figure 14 is a plan view of the distal portion of a catheter in accordance with the present invention.
- Figure 15 is a perspective view of the distal end of the catheter including an alternate electrode assembly
- Figure 16 is a perspective view of the distal end of a catheter including a further alternate embodiment of an electrode assembly
- Figure 17 is a perspective view of the distal end of a catheter including another embodiment of an electrode assembly
- Figure 18 is a perspective view of the distal end of the catheter including a further alternate embodiment of an electrode assembly
- Figure 19 is a perspective view of the distal end of a catheter including a further alternate embodiment of an electrode assembly
- Figure 20 is a perspective view of a distal end of a catheter including an alternate embodiment of an electrode assembly
- Figure 21 is a perspective view of the distal end of a catheter including a further alternate embodiment of an electrode assembly.
- Figure 22 is a perspective view of the distal end of a catheter including a further alternate embodiment of an electrode assembly.
- Figures 1 and 2 are plan views of a catheter 20 in accordance with the present invention.
- Figure 1 is a plan view of a distal end 18 of catheter 20.
- Catheter 20 includes an elongate shaft 24, a proximal end 26 (not shown) and a distal portion 22.
- An electrode portion 30 and an insulator 32 are disposed proximate distal end 18 of catheter 20.
- Insulator 32 includes a plurality of insulator lumens 34.
- a distal portion of catheter 20 is shown in partial cross-section.
- elongate shaft 24 includes a shaft lumen 36.
- Catheter 20 includes a conductor 40 having a bent portion 42, a first leg 44, and a second leg 46. First leg 44 and second leg 46 are disposed in lumen 36 of elongate shaft 24.
- electrode 30 of catheter 20 is generally formed from bent portion 42 of conductor 40.
- insulator 32 defines two holes 48 which are adapted to allow legs 44, 46 of conductor 40 to pass through insulator 32.
- conductor 40 is adapted to be connected to a radio frequency generator.
- One or more retaining elements 50 are formed on conductor 40 proximate insulator 32.
- retaining elements 50 have been created by forming two kinks in conductor 40. It will be understood that other embodiments of retaining elements 50 are possible without deviating from the spirit or scope of the present invention. It will also be understood that although two retaining elements are shown in Figure 2, additional embodiments have been envisioned which utilize a single retaining element 50.
- electrode 30 protrudes beyond insulator 32 of catheter 20. The distance which electrode 30 protrudes is determined in part by the shape of bent region 42 of conductor 40. The distance which electrode 30 protrudes is carefully controlled during the manufacture of catheter 20.
- insulator 32 includes two landing zones 60 which extend away from electrode 30.
- the width of landing zones 60 is substantially greater than the width of electrode 30.
- the relatively large area of landing zones 60 assures that the travel of electrode 30 into the heart will stop when landing zones 60 contact the heart tissue. It is a desirable feature of this invention that landing zones 60 extend beyond the wound created in the heart tissue during a PMR procedure. This is because the wounded tissue is substantially softened, and it is possible for a PMR catheter to be pushed through soft, injured tissue.
- a therapeutically effective wound generally must perforate the endocardium and damage blood vessels and capillaries in the myocardium.
- the likelihood of unintentionally perforating the myocardium is reduced when the depth of wound created is only enough to penetrate the endocardium.
- the dimensions below have been found effective in creating therapeutically effective wounds while reducing the likelihood that the myocardium will be punctured through to the epicardium.
- the distance electrode 30 protrudes from landing zones 60 is between about 0.005 and about 0.4 inches. In a presently most preferred embodiment the distance electrode 30 protrudes from landing zones 60 is between about 0.010 and about 0.035 inches.
- the diameter of conductor 40 in bent portion 42 is between 0.003 and about 0.030 inches. In a presently most prefened embodiment, in accordance with Figure 2, the diameter of conductor 40 in bent portion 42 is between about 0.008 and about 0.012 inches. It should be understood that the diameter of conductor 40 may vary along its length, and conductor 40 may include one or more tapered sections to optimize shaft support and flexibility. In a presently preferred embodiment, conductor 40 is about 70 inches long having a distal portion with a diameter of about 0.010 inches and a proximal portion with a diameter of about 0.022 inches.
- conductor 40 includes a transition portion which is about 8 inches long and which tapers from the diameter of the proximal portion to the diameter of the distal portion.
- the bend radius of electrode 30 is between about 0.004 and about 0J inches.
- the bend radius of electrode 30 is between about 0.012 and about 0.023 inches.
- the width of landing zones 60 extending from two sides of electrode 30 is between about 0.007 and about 0.050 inches.
- the width of landing zones 60 extending from two sides of electrode 30 is between about 0.015 and about 0.030 inches. As described above, and shown in Figure 1, there are two landing zones 60 extending away from electrode 30 in the embodiment of Figures 1 and 2.
- the physician may prefer to penetrate the myocardium with electrode 30 a certain distance.
- the depth which electrode 30 penetrates heart tissue may be controlled by the geometry of electrode 30 and landing zones 60. The distance which electrode 30 protrudes from landing zones 60 is carefully controlled during the manufacture of catheter 20.
- a number of models of catheter 20 may be supplied to a physician, each model being adapted to produce wounds of a specific depth.
- the depth of the wound created is influenced by the depth which the electrode penetrates the heart tissue. Other factors may influence the depth of wound created without deviating from the spirit or scope of the present invention.
- the depth of wound created may be effected by the magnitude and frequency of the radiofrequency energy applied to electrode 30.
- the depth of wound produced may be effected by the length of time the electrode is energized.
- Conductor 40 and electrode portion 30 may be comprised of stainless steel, Nitinol, or a number of other materials which are conductive and biocompatable. In a presently prefened embodiment, conductor 40 and electrode portion 30 are comprised of Nitinol. Embodiments of electrode 30 have also been envisioned wherein electrode 30 includes a radiopaque material. Examples of radiopaque material which may be included in electrode 30 include: gold, platinum, silver, and tungsten.
- Insulator 32 may be formed from ceramic, glass, glass-ceramic, polytetrafluoroethylene (PTFE), polyimide, or a number of other materials which are non-conductive and biocompatible and/or thermally insulated and biocompatible.
- insulator 32 is formed from ceramic.
- Further embodiments of insulator 32 have been envisioned which include a radiopaque material.
- the radiopaque materials which may be suitable for inclusion in an insulator 32 in some embodiments, include: gold, platinum, silver, tungsten, barium sulfide and bismuth oxide.
- a radiopaque material is selectively applied to the outer diameter of insulator 32.
- a presently prefened radiopaque material is a platinum/iridium blend.
- conductor 40 in the embodiment of Figures 1 and 2 is circular in cross section, it should be understood that other cross-sectional shapes are possible without deviating from the spirit or scope of the invention.
- the cross-sectional shape of conductor 40 could be rectangular, square, triangular, oval, etc.
- elongate shaft 24 is comprised of polyether block amide (PEBA).
- PEBA polyether block amide
- Polyether block amide is commercially available from Atomchel Polymers of Birsdsboro Pennsylvania under the trade name PEBAX.
- Elongate shaft 24 may be comprised of other materials without departing from the spirit of scope of this invention. Examples of materials which may be suitable in some applications include: polyethylene (PE), polypropylene (PP), polyvinylchloride (PNC), polyurethane, polyimide, and polytetrafluoroethylene (PTFE).
- insulator 32 and elongate shaft 24 are separate elements comprised of ceramic and PEBA respectively. However, it should be understood that these two elements could be combined into one element formed of one material without deviating from the spirit or scope of the present invention.
- elongate shaft 24 has a single lumen 36. It will be understood that embodiments of the present invention have been envisioned in which shaft 26 has multiple lumens 36.
- catheter 20 is preferably advanced through the vasculature of a patient until distal end 18 is proximate the endocardium of a patient's heart. The route taken by catheter 20 will normally be by way of the femoral artery and the aorta to the left ventricle.
- catheter 20 may enter the right ventricle by way of the pulmonary vein or femoral vein.
- catheter 20 may enter the right ventricle from the left ventricle by passing through the septal wall.
- catheter 20 may enter the body at the carotid artery and reach the heart therethrough.
- catheter 20 may include a slippery material disposed on the outer surfaces of elongate shaft 24.
- distal end 18 of catheter 20 is positioned proximate the endocardium, preferably, such that electrode portion 30 is in contact with the endocardium. Electrode portion 30 may then be energized to form a wound.
- an additional step in a method in accordance with the present invention is to identify areas of tissue within the patient's heart which are candidates for PMR.
- areas of tissue in the heart muscle may be generally classified healthy or hibernating. Healthy tissue is tissue which is well perfused with blood, and subsequently well supplied with oxygen. Hibernating tissue is tissue which is not cunently contracting to assist in the pumping of blood. However, if hibernating tissue is adequately supplied with blood, it will once again begin contracting and contribute to the pumping of blood.
- a number of methods may be used to identify hibernating tissue.
- contrast media may be injected into the coronary vessels to identify regions of the heart into which the contrast medium does not flow due to obstruction of the vessels into which the media was injected.
- the hibernating region will be identified by the lack of flow or abnormally low flow distally of the obstruction in the coronary vessel or vessels.
- a second method which may be used to identify hibernating regions of the heart involves injecting contrast media directly into the heart chambers. Hibernating tissue may then be identified by locating areas of generally poor wall motion of the heart chambers. When this method is selected, the contrast media may be delivered to the heart chambers via catheter 20. Shaft lumen 36 and insulator lumens 34 of catheter 20 provide a suitable channel for delivering contrast media from a location outside the patient's body to distal end 18 of catheter 20.
- Electrode 30 will be positioned proximate the targeted heart tissue.
- a contact detecting means in conjunction with electrode 30 will be used to sense contact between electrode 30 and heart tissue. This method is further detailed in a co-pending U.S. Patent Application
- electrode 30 will proceed to penetrate the heart until landing zones 60 of insulator 32 contact the heart tissue.
- landing zones 60 have a relatively large surface area to assure that the depth of electrode penetration will be controlled.
- the depth of the wound is also influenced by the distance which electrode 30 protrudes from landing zones 60. As described above, this distance is carefully controlled during the manufacture of catheter 20.
- the distance which electrode 30 protrudes from landing zones 60 and the relative surface areas of these elements are carefully selected to create a therapeutically effective wound while reducing the likelihood of unintentionally perforating the myocardium.
- a therapeutically effective wound will perforate through the endocardium and damage blood vessels and capillaries in the myocardium. The likelihood of unintentionally perforating the myocardium to the epicardium is reduced when the depth of wound created is only enough to penetrate the endocardium.
- a physician may desire to penetrate the myocardium with electrode 30 a certain distance.
- the depth which electrode 30 penetrates the heart tissue may be controlled by the geometry of electrode 30 and landing zones 60.
- a number of models of catheter 20 may be provided to a physician, each model being adapted to create wounds of a particular depth.
- the depth of wound created is influenced by the depth which electrode 30 penetrates heart tissue. Other factors may influence wound depth without deviating from the spirit and scope of the present invention.
- the magnitude and frequency of the radiofrequency energy applied to electrode 30 may effect the depth of wound created during a PMR procedure.
- the length of time electrode 30 is energized may effect the depth of wound created.
- a fluid under pressure is forced into the wound by way of shaft lumen 36 and insulator lumens 34.
- This fluid may include saline, radiopaque contrast media, a therapeutic agent, a caustic agent, or any combination of these.
- the formation of the wound may be enhanced by collateral damage to the myocardium induced by directing this pressurized fluid into the wound site.
- the impact of the pressurized fluid causes vessels, capillaries, and sinuses to rupture. By creating this collateral damage, the number of wounds which must be made during a PMR procedure can be substantially reduced.
- Injecting a fluid including a radiopaque contrast media into the wound serves to create a radiopaque marker of the treatment site.
- Injecting a fluid, including a therapeutic agent serves to promote angiogenisis.
- Forcing fluid under pressure into the wound may be used to create collateral damage. Collateral damage is created when vessels, capillaries, and sinuses within the myocardium are ruptured. Thus collateral damage will increase the healing response of the body.
- the fluid under pressure may be forced into the wound while electrode 30 is energized or during a time when electrode 30 is not energized. In either case, the distal end of catheter 20 is positioned proximate the wound. Because electrode 30 was used to create the wound, catheter 20 is in an ideal position to inject fluid into the wound. If a separate catheter was used to deliver fluid, the distal end of that catheter would need to be positioned over the wound.
- a PMR system for use with catheter 20 may include a means for controlling the flow of fluid through catheter 20.
- the means for controlling would direct fluid to be injected into the wound immediately after each spark.
- a PMR system for use with catheter 20 would include a foot pedal capable of activating the means for controlling fluid flow, and the means for energizing electrode 30.
- fluid would flow from the distal end of catheter 20 while electrode 30 was energized.
- fluid may be delivered a set time after energy is delivered.
- a second benefit of collateral damage is that it may reduce the wound depth needed to create clinically effective results.
- the depth of the wound may be limited so that the wound just passes through the endocardium. Once the endocardium is perforated, pressure from infused fluid may be used to rupture myocardial vessels, capillaries and sinuses without further ablation or removal of tissue. As discussed previously, limiting the depth of ablation reduces the likelihood of unintentional myocardial perforation.
- catheter 20 may also be used in procedures where collateral damage is deemed undesirable. Collateral damage may be avoided by not delivering fluid through catheter 20, or by delivering fluid through catheter 20 at a relatively low pressure.
- PMR improves a patient's condition through denervation. Specifically, the PMR induced wounds result in elimination of nerve endings which were previously sending pain signals to the brain as a result of hibernating tissue.
- the PMR procedure includes the step of delivering a therapeutic agent to the wound site via catheter 20.
- Shaft lumen 36 and insulator lumens 34 of catheter 20 provide a suitable channel for delivering a therapeutic agent to the wound site from a location outside the patient's body. Fluids delivered via catheter 20 during a PMR procedure may provide additional benefits.
- fluid delivered via catheter 20 may serve to cool electrode 30 during a PMR procedure.
- fluid delivered via catheter 20 may serve to remove debris from the wound.
- catheter 20 may be used with bi-polar or mono-polar PMR techniques.
- a return or neutral electrode is generally attached to the exterior of the patient.
- a return or neutral electrode is positioned in close proximity to distal end 18 of catheter 20.
- a tubular return electrode may be disposed on the outer surface of catheter 20 proximate its distal end 18.
- FIG 3 is a plan view of a distal portion 22 of a catheter 20.
- catheter 20 includes an elongate shaft 24, a proximal end 26 (not shown), and a distal portion 22.
- An electrode portion 30 and a return electrode 332 are disposed proximate a distal end 18 of catheter 20.
- elongate shaft 24 includes a lumen 36.
- Catheter 20 includes a conductor 40 having a bent portion 42, a first leg 44, and a second leg 46. First leg 44 and second leg 46 are disposed in lumen 36.
- Electrode 30 of catheter 20 is generally formed from bent portion 42 of conductor 40.
- Return electrode 332 defines two holes 48. Two sleeves 302 are disposed inside holes 48.
- First leg 44 and second leg 46 pass through sleeves 302.
- return electrode 332 is comprised of a conductive material allowing it to serve as a return electrode in a bi-polar PMR configuration.
- Sleeves 302 are comprised of a non-conductive material, and serve to insulate conductor 40 from return electrode 332.
- a return conductor 304 is coupled to return electrode 332.
- Return conductor 332 is suitably insulated so that it will not make electrical contact with conductor 40.
- return conductor 332 is disposed in a separate lumen of elongate shaft 24.
- Figure 4 is a plan view of a distal portion 22 of a catheter 20 in accordance with a bi-polar embodiment of the present invention. As in the embodiment of
- catheter 20 includes an elongate shaft 24, a proximal end 26 (not shown), and a distal portion 22.
- An electrode portion 30 and an insulator 32 are disposed proximate a distal end 18 of catheter 20.
- elongate shaft 24 includes a lumen 36.
- Catheter 20 includes a conductor 40 having a bent portion 42, a first leg 44, and a second leg 46. First leg 44 and second leg 46 are disposed in lumen 36.
- Electrode 30 of catheter 20 is generally formed from bent portion 42 of conductor 40. Insulator 32 defines two holes 48 which are adapted to allow legs 44, 46 of conductor 40 to pass through insulator 32.
- a return electrode 332 is disposed about the outer surface of insulator 32.
- Return electrode 332 is comprised of a conductive material allowing it to serve as a return electrode in a bi-polar PMR configuration.
- a return conductor 304 is coupled to return electrode 332.
- Return conductor 332 is suitably insulated so that it will not make electrical contact with conductor 40.
- return conductor 332 is disposed in a separate lumen of elongate shaft 24. As shown in Figure 4, return electrode 332 protrudes beyond the distal end of elongate shaft 24.
- FIG. 5 is a plan view of a distal portion 22 of a catheter 20 in accordance with a bi-polar embodiment of the present invention.
- catheter 20 includes an elongate shaft 24, a proximal end 26 (not shown), and a distal portion 22.
- An electrode portion 30 and an insulator 32 are disposed proximate a distal end 18 of catheter 20.
- elongate shaft 24 is comprised of an outer tubular member 312 and an inner tubular member 310 having a lumen 36.
- a conductive coating 314 is disposed on the outer diameter of inner tubular member 310.
- Outer tubular member 312 is comprised of a non-conductive material and generally overlays conductive coating 314.
- outer tubular member 312 is comprised of shrink tubing.
- outer tubular member 312 is comprised of a non-conductive coating.
- a portion of conductive coating 314 proximate distal end 18 is not covered by outer tubular member 312.
- Embodiments of the present invention have been envisioned in which exposed portions of conductive coating 314 act as a return electrode.
- a return electrode 316 is disposed about and electrically coupled to conductive coating 314.
- return electrode 316 is comprised of a material which is conductive and radiopaque. Examples of suitable materials include gold, platinum, silver, and tungsten.
- conductive coating 314 acts as an electrical conductor coupling return electrode 316 to the radio frequency generator used in a PMR procedure.
- Catheter 20 of Figure 5 also includes an electrode 30 generally formed from bent portion 42 of conductor 40.
- conductor 40 is electrically coupled to a radio frequency generator (not shown) by a cable (not shown). In a presently prefened embodiment, conductor 40 is directly attached to the cable.
- Figure 6 is a plan view of a distal portion 22 of a catheter 20 in accordance with one embodiment of the present invention. As in the embodiment of Figures
- catheter 20 includes an elongate shaft 24, a proximal end 26 (not shown), and a distal portion 22.
- An electrode portion 30 and a insulator 32 are disposed proximate a distal end 18 of catheter 20.
- elongate shaft 24 includes a lumen 36.
- Catheter 20 includes a conductor 40 having a bent portion 42, a first leg 44, and a second leg 46. First leg 44 and second leg 46 are disposed in lumen 36.
- Electrode 30 of catheter 20 is generally formed from bent portion 42 of conductor 40.
- Insulator 32 defines two holes 48 which are adapted to allow legs 44, 46 of conductor 40 to pass through insulator 32.
- a groove 340 is disposed on the outer diameter of insulator 32.
- a band 342 is disposed in groove 340. In a presently prefened embodiment, band 342 is comprised of a radiopaque material.
- band 342 aids the physician in locating distal end 18 of catheter 20.
- Band 342 may be comprised of a number of radiopaque materials including gold, platinum, silver, tungsten, barium sulfate, and bismuth oxide. In a presently prefened embodiment, band 342 is a platinum/iridium blend.
- FIG. 8 is a plan view of distal portion 22 of catheter 20 shown in partial cross section.
- Figure 7 is a plan view of distal end 18 of the embodiment of catheter 20 shown in Figure 8.
- catheter 20 includes an elongate shaft 24, a proximal end 26 (not shown), a distal portion 22, and a distal end 18.
- An electrode portion 30 and an insulator 32 are disposed proximate distal end 18 of catheter 20.
- insulator 32 includes two landing zones 60 which extend away from electrode 30.
- elongate catheter 20 includes a conductor 140 having a bent portion 142, a first leg 144, and a second leg 146.
- Conductor 140 also defines a lumen 200 and two holes 202 which are in fluid communication with lumen 200. Holes 202 in conductor 40 are shown most clearly in Figure 7.
- Electrode 30 is generally formed from bent portion 142 of conductor 140.
- insulator 32 defines two holes 48 which are adapted to allow legs 144, 146 of conductor 140 to pass through insulator 32.
- a retaining element 150 is formed on conductor 140 proximate insulator 32.
- retaining element 150 has been created by forming a weld bead 204 on conductor 140.
- Weld bead 204 may be formed using a number of manufacturing processes. For example, welding, solder, and brazing are all suitable processes of creating weld bead 204. It will be understood that other embodiments of retaining element 150 are possible without deviating from the spirit or scope of the present invention.
- weld bead 204 also serves the function of sealing the end of lumen 200.
- electrode 30 protrudes beyond insulator 32 of catheter 20.
- the distance which electrode 30 protrudes is determined in part by the shape of bent region 142 of conductor 140.
- the distance which electrode 30 protrudes is carefully controlled during the manufacture of catheter 20. This helps to control the depth of the wounds created by catheter 20 during a PMR procedure. During such a procedure electrode 30 will proceed to penetrate the heart until insulator 32 contacts the heart tissue.
- insulator 32 includes two landing zones 60 which extend away from electrode 30.
- the width of landing zones 60 is substantially greater than the width of electrode 30 in Figure 7.
- the relatively large area of landing zones 60 assure that the travel of electrode 30 into the heart tissue will stop when landing zones 60 contact the heart tissue. It is a desirable feature of this invention that landing zones 60 generally extend beyond the wound created in the heart tissue created during a PMR procedure. This is because the wounded tissue is substantially softened, and it is possible for a PMR catheter to be pushed through soft, injured tissue.
- a therapeutically effective wound will at a minimum perforate through the endocardium and damage blood vessels and capillaries in the myocardium.
- the likelihood of unintentionally perforating through the myocardium to the epicardium is reduced when the depth of wound created is only enough to penetrate the endocardium.
- catheter 20 is preferably advanced through the vasculature of a patient until distal end 18 is proximate the endocardium of the patient's heart.
- the route taken by catheter 20 will normally be by way of the femoral artery and the aorta to the left ventricle.
- the right ventricle may be accessed via the pulmonary vein or the femoral vein.
- the septal approach may be used. In a septal approach, the distal end of catheter 20 first enters one ventricle (the left or the right). A PMR procedure may be performed in that ventricle. The distal end of catheter 20 may then enter the other ventricle by passing through the septal wall.
- a third example of a route which may be taken by catheter 20 is a route via the carotid artery.
- catheter 20 may include a slippery material disposed on the outer surfaces of elongate shaft 24.
- distal end 18 of catheter 20 is positioned proximate the endocardium, preferably, such that electrode portion 30 is in contact with the endocardium. Contact between the endocardium and electrode 30 may be detected electronically.
- a method is further detailed in co- pending U.S. Patent Application Serial No. , filed by the same assignee on even date herewith and entitled "Device and Method for Percutaneous Myocardial RevascularizationJ. The disclosure of this co-pending application is hereby inco ⁇ orated by reference into the present application.
- radiographic techniques An additional method which may be used to determine the location of electrode 30 is through radiographic techniques.
- the use of radiographic techniques may be enhanced by selectively incorporating radiopaque material into catheter 20.
- a radiopaque material is disposed about the outer diameter of insulator 32.
- the radiopaque material may be comprised of a band of metal. Materials which may be suitable for this marker band include: gold, platinum, silver, and tungsten.
- a radiopaque material may also be included in electrode 30 and/or insulator 32.
- an additional step in a method in accordance with the present invention is to identify areas of tissue within the patient's heart which are candidates for PMR.
- areas of tissue in the heart muscle may be generally classified healthy or hibernating. Healthy tissue is tissue which is well perfused with blood, and subsequently well supplied with oxygen.
- Hibernating tissue is tissue which is not cunently contracting to assist in the pumping of blood. However, if hibernating tissue is adequately supplied with blood, it will once again begin contracting and contribute to the pumping of blood.
- a number of methods may be used to identify hibernating tissue.
- contrast media may be injected into the coronary vessels to identify regions of the heart into which the contrast medium does not flow due to obstruction of the vessels into which the media was injected.
- the hibernating region will be identified by the lack of flow or abnormally low flow distally of the obstruction in the coronary vessel or vessels.
- a second method which may be used to identify hibernating regions of the heart involves injecting contrast media directly into the heart chambers. Hibernating tissue may then be identified by locating areas of generally poor wall motion of the heart chambers. When this method is selected, the contrast media may be delivered to the heart chambers via catheter 20. Lumen 200 and holes 202 of conductor 140 provide a channel for delivering contrast media from a location outside the patients body to distal end 18 of catheter 20. Once hibernating regions within the heart area identified, these regions are candidates for PMR. During the PMR procedure, electrode 30 will proceed to penetrate the heart until landing zones 60 of insulator 32 contact the heart tissue. As described above, landing zones 60 have a relatively large surface area to assure that the depth of the wound will be controlled. The depth of the wound is also controlled by the distance which electrode 30 protrudes from landing zones 60. As described above, this distance is carefully controlled during the manufacture of catheter 20.
- a therapeutically effective wound generally will, at a minimum, perforate through the endocardium and damage blood vessels and capillaries in the myocardium. The likelihood of unintentionally perforating through the myocardium to the epicardium is reduced when the depth of wound created is only enough to penetrate the endocardium.
- a fluid under pressure is forced into the wound through lumen 200 and holes 202 of conductor 140.
- This fluid may include saline, contrast media, a therapeutic agent, a caustic agent, or any combination of these.
- the formation of the wound may be enhanced by collateral damage to the myocardium induced by directing this pressurized fluid into the wound site.
- the impact of the pressurized fluid causes vessels, capillaries, and sinuses to rupture.
- This collateral damage By creating this collateral damage, the number of wounds which need to be made during a PMR procedure may be substantially reduced.
- a second benefit of collateral damage is that it may reduce the wound depth needed to create clinically effective results.
- the depth of the wound may be limited so that the wound just passes through the endocardium.
- pressure from infused fluid may be used to rupture the myocardial vessels, capillaries and sinuses without further ablation or removal of tissue. Limiting the depth of ablation reduces the likelihood of unintentional myocardial perforation.
- the injection of a fluid containing a radiopaque contrast solution creates a fluoroscopic marker of the treatment location.
- holes 202 disposed at the distal end of catheter 20 permit the fluid to be injected into the wound immediately after it is created. This eliminates the need to withdraw catheter 20 and position a second catheter to deliver fluid to the wound.
- the PMR procedure includes the step of delivering a therapeutic agent though lumen 200 and holes 202 of conductor 140.
- a fluid is delivered via catheter 20 to the patient proximate the wound.
- This fluid may include saline, radiopaque contrast media, a therapeutic agent, a caustic agent, or any combination of these.
- Injecting a fluid including a radiopaque contrast media acts to create a radiopaque marker of the treatment site.
- Injecting a fluid into a wound which includes a therapeutic agent acts to enhance the angiogenisis response of the body.
- An embodiment of the present invention has been envisioned where the same control means which enables radiofrequency energy to energize electrode 30 may be used to enable fluid to be injected into the wound from the distal end of catheter 20.
- the control means of the PMR system directs fluid to be injected into the wound immediately after each spark.
- Fluids delivered via catheter 20 during a PMR procedure may provide additional benefits.
- fluid delivered via lumen 200 of conductor 140 may serve to cool electrode 30 during a PMR procedure.
- fluid delivered via catheter 20 may serve to remove debris from the wound. It should be understood that steps may be omitted from the method described above, or the order of the steps may be changed without deviating from the spirit or scope of the present invention.
- Figure 9 is a plan view of a distal portion 22 of a catheter 20 in accordance with an alternate embodiment of the present invention.
- catheter 20 includes an elongate shaft 24, a proximal end 26 (not shown), and a distal portion 22.
- An electrode portion 30 and an insulator 32 are disposed proximate a distal end 18 of catheter 20.
- elongate shaft 24 includes two lumens 36A, 36B.
- Catheter 20 includes a conductor 40 having a bent portion 42, a first leg 44, and a second leg 46. First leg 44 and second leg 46 are disposed in lumens 36A and 36B respectively.
- Electrode 30 of catheter 20 is general formed from bent portion 42 of conductor 40. Insulator 32 defines two holes 48 which are adapted to allow legs 44, 46 of conductor 40 to pass through insulator 32. Insulator 32 defines additional holes (not shown) which allow fluid to pass therethrough.
- Each retaining element 50 is a sleeve sunounding conductor 40.
- Each retaining element 50 has been fixed to conductor 40 with a crimping process.
- Retaining elements 50 assist in maintaining the position of bent portion 42; preventing it from moving before, or during a PMR procedure.
- Figure 10 is a plan view of a distal portion 22 of a catheter 20 in accordance with an alternate embodiment of the present invention.
- catheter 20 includes an elongate shaft 24, a proximal end
- Elongate shaft 24 includes two lumens 36 A, 36B.
- Catheter 20 includes a conductor 640 having a bent portion 642, a first portion 652, and a second portion 654. As shown in Figure 10, the outer diameter of second portion 654 is smaller than the outer diameter of first portion 652.
- Conductor 640 includes a step 650 proximate the intersection between first portion 652 and second portion 654.
- First portion 652 of conductor 640 is substantially disposed in lumen 36A of elongate shaft 24.
- Second portion 654 of conductor 640 passes through insulator 32 via two holes 48. The remaining portion of second portion 654 is disposed in lumen 36B of elongate shaft 24.
- a bent portion 642 of conductor 640 extends beyond insulator 32; an electrode 30 is general formed by bent portion 642.
- a retaining element 50 is located on second portion 654 proximate insulator 32.
- retaining element 50 is a sleeve sunounding conductor 640.
- a number of processes may be used to fix retaining element 50 onto conductor 640. For example, there may be an interference fit between the sleeve and conductor 640.
- Other examples of acceptable retention methods include soldering, brazing, welding, crimping, and adhering with an adhesive.
- Retaining element 50 and step 650 assist in maintaining the position of bent portion 642; preventing it from moving before, or during a PMR procedure.
- Insulator 32 acting in conjunction with retaining element 50, supports bent portion 642 of conductor 640, preventing it from being deformed during a PMR procedure.
- FIG 11 is a plan view of a distal portion 22 of a catheter 20 in accordance with an alternate embodiment of the present invention.
- catheter 20 includes an elongate shaft 24, a proximal end 26 (not shown), and a distal portion 22.
- elongate shaft 24 includes a lumen 36.
- Electrode 30 of catheter 20 is general formed by bent portion 742 of conductor 740. Insulator 32 defines two holes 48 which are adapted to allow legs
- a bond 750 is formed between first leg 744 and second leg 746 of conductor 740.
- a number of process may be used to create bond 750.
- bond 750 may be created by applying an adhesive between first leg 744 and second leg 746.
- Other techniques which may be used to fabricate bond 750 include welding, brazing, and soldering.
- Figure 12 is a plan view of a distal portion 22 of a catheter 20 in accordance with an alternate embodiment of the present invention. As in the previous embodiments catheter 20 includes an elongate shaft 24, a proximal end
- An electrode portion 30 and an insulator 32 are disposed proximate a distal end 18 of catheter 20.
- elongate shaft 24 includes two lumens 36 A, 36B.
- Catheter 20 includes a conductor 40 having a bent portion 42, a first leg 44, and a second leg 46. First leg 44 and second leg 46 are substantially disposed in lumens 36A and 36B respectively.
- Electrode 30 of catheter 20 is general formed from bent portion 42 of conductor 40. Insulator 32 defines two holes 48 which are adapted to allow legs 44, 46 of conductor 40 to pass through insulator 32.
- each retaining element 50 is located on conductor 40 proximate insulator 32.
- each retaining element 50 is formed from material of conductor 40 which has been displaced to create a localized area with a greater width. A crimping or staking process may be used to create deformations of this type in conductor 40.
- Retaining elements 50 assist in maintaining the position of bent portion 42; preventing it from moving before, or during a PMR procedure. Insulator 32 acting in conjunction with retaining elements 50 supports bent portion 42 of conductor 40, preventing it from being deformed during a PMR procedure.
- Figure 13 is a plan view of a distal portion 22 of a catheter 20 in accordance with an alternate embodiment of the present invention.
- catheter 20 includes an elongate shaft 24, a proximal end 26 (not shown), and a distal portion 22.
- An electrode portion 30 and an insulator 32 are disposed proximate a distal end 18 of catheter 20.
- elongate shaft 24 includes two lumens 36 A, 36B.
- Catheter 20 includes a conductor 40 having a bent portion 42, a first leg 44, and a second leg 46. First leg 44 and second leg 46 are substantially disposed in lumens 36 A and 36B respectively.
- Electrode 30 of catheter 20 is general formed from bent portion 42 of conductor 40. Insulator 32 defines two holes 48 which are adapted to allow legs 44, 46 of conductor 40 to pass through insulator 32.
- Conductor 40 is fixed to insulator 32 by two adhesive bonds 902A, 902B which prevent bent portion 42 from moving before, or during a PMR procedure.
- Insulator 32 acting in conjunction with adhesive bonds 902A, 902B supports bent portion 42 of conductor 40, preventing it from being deformed during a PMR procedure.
- Figure 14 is a plan view of a distal portion 22 of a catheter 20 in accordance with an alternate embodiment of the present invention.
- catheter 20 includes an elongate shaft 24, a proximal end
- elongate shaft 24 includes two lumens 36A, 36B.
- Catheter 20 includes a conductor 40 having a bent portion 42, a first leg 44, and a second leg 46. First leg 44 and second leg 46 are substantially disposed in lumens
- Electrode 30 of catheter 20 is general formed from bent portion 42 of conductor 40.
- Insulator 32 defines two holes 48 which are adapted to allow legs 44, 46 of conductor 40 to pass through insulator 32.
- lumens 36 A, 36B of elongate shaft 24 are substantially filled with potting material 950.
- Potting material 950 serves to fix the location of conductor 30 relative to insulator 32 and elongate shaft 24.
- Potting material 950 may be comprised of a number of materials. Examples of suitable materials include silicone rubber and urethane.
- Catheter 20 and insulator 32 may include additional lumens (not shown in Figure 14) which allow a fluid to be conducted from proximal end 26 of catheter 20 to distal end 18 of catheter 20.
- Figure 15 is a perspective view of a distal portion 22 of a catheter 20 in accordance with an alternate embodiment of the present invention.
- catheter 20 includes an elongate shaft 24, a proximal end 26 (not shown), and a distal portion 22.
- Elongate shaft 24 includes a distal end 910.
- An electrode 930 projects from distal end 910 of elongate shaft 24.
- electrode 930 is comprised of a conductor 932 which is generally cylindrical in shape.
- electrode 930 is energized with radio frequency energy causing it to create a wound.
- electrode 930 penetrates the tissue of the heart. Electrode 930 continues penetrating heart tissue until distal end 910 of elongate shaft 24 contacts the surface of the heart tissue.
- FIG 16 is a perspective view of a distal portion 22 of a catheter 20 in accordance with an additional alternate embodiment of the present invention.
- catheter 20 includes an elongate shaft 24, a proximal end 26 (not shown), and a distal portion 22.
- Elongate shaft 24 includes a distal end 910.
- An electrode 930 projects from distal end 910 of elongate shaft 24.
- electrode 930 is comprised of two conductors 934 and 936. Conductors 934 and 936 are both generally cylindrical in shape.
- electrode 930 is energized with radio frequency energy causing it to create a wound. During wound formation, electrode 930 penetrates the tissue of the heart. Electrode 930 continues penetrating heart tissue until distal end 910 of elongate shaft 24 contacts the surface of the heart tissue.
- FIG 17 is a perspective view of a distal portion 22 of a catheter 20 in accordance with an additional alternate embodiment of the present invention.
- catheter 20 includes an elongate shaft 24, a proximal end 26 (not shown), and a distal portion 22.
- Elongate shaft 24 includes a distal end 910.
- An electrode 930 projects from distal end 910 of elongate shaft 24.
- electrode 930 is comprised of two conductors 938 and 940. Conductors 938 and 940 are both generally arch shaped.
- electrode 930 is energized with radio frequency energy causing it to create a wound.
- FIG. 18 is a perspective view of a distal portion 22 of a catheter 20 in accordance with an additional alternate embodiment of the present invention.
- catheter 20 includes an elongate shaft 24, a proximal end 26 (not shown), and a distal portion 22.
- Elongate shaft 24 includes a distal end 910.
- An electrode 930 projects from distal end 910 of elongate shaft 24.
- electrode 930 is comprised of a straight portion 942 and a curved portion 944.
- electrode 930 is energized with radio frequency energy causing it to create a wound. During wound formation, electrode 930 penetrates the tissue of the heart. Electrode 930 continues penetrating heart tissue until distal end 910 of elongate shaft 24 contacts the surface of the heart tissue.
- FIG 19 is a perspective view of a distal portion 22 of a catheter 20 in accordance with an additional alternate embodiment of the present invention.
- catheter 20 includes an elongate shaft 24, a proximal end 26 (not shown), and a distal portion 22.
- Elongate shaft 24 includes a distal end 910.
- An electrode 930 projects from distal end 910 of elongate shaft 24.
- electrode 930 is comprised of a straight portion 946 and a ring portion 948.
- electrode 930 is energized with radio frequency energy causing it to create a wound.
- electrode 930 penetrates the tissue of the heart. Electrode 930 continues penetrating heart tissue until distal end 910 of elongate shaft 24 contacts the surface of the heart tissue.
- FIG 20 is a perspective view of a distal portion 22 of a catheter 20 in accordance with an additional alternate embodiment of the present invention.
- catheter 20 includes an elongate shaft 24, a proximal end 26 (not shown), and a distal portion 22.
- Elongate shaft 24 includes a distal end 910.
- An electrode 930 projects from distal end 910 of elongate shaft 24.
- electrode 930 includes two straight portions 952 and 954 projecting from distal end 910 of elongate shaft 24.
- Electrode 930 also includes a hoop portion 956 having two ends 958. One end 958 of hoop 956 is joined to the distal end of straight portion 952.
- electrode 930 is energized with radio frequency energy causing it to create a wound. During wound formation, electrode 930 penetrates the tissue of the heart. Electrode 930 continues penetrating heart tissue until distal end 910 of elongate shaft 24 contacts the surface of the heart tissue.
- FIG 21 is a perspective view of a distal portion 22 of a catheter 20 in accordance with an additional alternate embodiment of the present invention.
- catheter 20 includes an elongate shaft 24, a proximal end 26 (not shown), and a distal portion 22.
- Elongate shaft 24 includes a distal end 910.
- An electrode 930 projects from distal end 910 of elongate shaft 24.
- electrode 930 includes two straight portions 962 and 964 projecting from distal end 910 of elongate shaft 24.
- Electrode 930 also includes an interconnecting portion 966 having two ends 968. One end 968 of interconnecting portion 966 is joined to the distal end of straight portion 962.
- interconnecting portion 966 is joined to the distal end of straight portion 964.
- interconnecting portion 966 is generally "U" shaped.
- FIG 22 is a perspective view of a distal portion 22 of a catheter 20 in accordance with an additional alternate embodiment of the present invention.
- catheter 20 includes an elongate shaft 24, a proximal end 26 (not shown), and a distal portion 22.
- Elongate shaft 24 includes a distal end 910.
- An electrode 930 projects from distal end 910 of elongate shaft 24.
- electrode 930 includes two straight portions 972 and 974 projecting from distal end 910 of elongate shaft 24.
- Electrode 930 also includes an interconnecting portion 976 having two ends 978. One end 978 of interconnecting portion 976 is joined to the distal end of straight portion 972.
- interconnecting portion 976 is joined to the distal end of straight portion 974.
- interconnecting portion 976 is generally "S" shaped.
- a PMR method in accordance with the present invention may include the step of delivering a fluid to the wound site via catheter 102.
- Contact detecting means 706 may be used to verify that distal end 18 is proximate myocardial tissue before delivering the fluid.
- This fluid may include saline, radiopaque contrast media, a therapeutic agent, a caustic agent, or any combination of these.
- Injecting a fluid including a radiopaque contrast media into the wound serves to create a radiopaque marker of a treatment site.
- Injecting a fluid, including a therapeutic agent serves to promote angiogenisis.
- the formation of the wound may also be enhanced by collateral damage to the myocardium induced by directing pressurized fluid into the wound site.
Abstract
Description
Claims
Priority Applications (3)
Application Number | Priority Date | Filing Date | Title |
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JP2000600571A JP2002537059A (en) | 1999-02-24 | 2000-02-24 | PMR catheter |
EP00913630A EP1154726A1 (en) | 1999-02-24 | 2000-02-24 | Pmr catheter |
CA002362921A CA2362921A1 (en) | 1999-02-24 | 2000-02-24 | Pmr catheter |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
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US09/256,831 | 1999-02-24 | ||
US09/256,831 US6217575B1 (en) | 1999-02-24 | 1999-02-24 | PMR catheter |
Publications (1)
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WO2000049956A1 true WO2000049956A1 (en) | 2000-08-31 |
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Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
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PCT/US2000/004977 WO2000049956A1 (en) | 1999-02-24 | 2000-02-24 | Pmr catheter |
Country Status (5)
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US (2) | US6217575B1 (en) |
EP (1) | EP1154726A1 (en) |
JP (1) | JP2002537059A (en) |
CA (1) | CA2362921A1 (en) |
WO (1) | WO2000049956A1 (en) |
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Also Published As
Publication number | Publication date |
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CA2362921A1 (en) | 2000-08-31 |
EP1154726A1 (en) | 2001-11-21 |
US6217575B1 (en) | 2001-04-17 |
JP2002537059A (en) | 2002-11-05 |
US20010049523A1 (en) | 2001-12-06 |
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