Patent Grant
8083788
This invention relates generally to vascular catheters, and more specifically to stents and stent delivery catheters for deployment in the coronary arteries and other vessels.
Stenting has become an increasingly important treatment option for patients with coronary artery disease. Stenting involves the placement of a tubular prosthesis within a diseased coronary artery to expand the arterial lumen and maintain the patency of the artery. Early stent technology suffered from problems with restenosis, the tendency of the coronary artery to become re-occluded following stent placement. However, in recent years, improvements in stent design and the advent of drug-eluting stents have reduced restenosis rates dramatically. As a result, the number of stenting procedures being performed in the United States, Europe, and elsewhere has soared.
Stents are delivered to the coronary arteries using long, flexible vascular catheters typically inserted through a femoral artery. For self-expanding stents, the stent is simply released from the delivery catheter and it resiliently expands into engagement with the vessel wall. For balloon expandable stents, a balloon on the delivery catheter is expanded which expands and deforms the stent to the desired diameter, whereupon the balloon is deflated and removed.
Current stent delivery technology, however, suffers from a number of drawbacks. For example, current stent delivery catheters are not capable of customizing the length of the stent in situ to match the size of the lesion to be treated. While lesion size may be measured prior to stenting using angiography or fluoroscopy, such measurements may be inexact. If a stent is introduced that is found to be of inappropriate size, the delivery catheter and stent must be removed from the patient and replaced with a different device of correct size.
Moreover, current stent delivery devices cannot treat multiple lesions with a single catheter. Current devices are capable of delivering only a single stent with a single catheter, and if multiple lesions are to be treated, a new catheter and stent must be introduced for each lesion to be treated.
Further, current stent delivery devices are not well-adapted for treating vascular lesions that are very long and/or in curved regions of a vessel. Current stents have a discrete length that is relatively short due to their stiffness. If current stents were made longer so as to treat longer lesions, they would not conform well to the curvature of vessels or to the movement of vessels on the surface of the beating heart. On the other hand, any attempt to place multiple stents end-to-end in longer lesions is hampered by the inability to maintain appropriate inter-stent spacing and to prevent overlap of adjacent stents.
Additionally, some stent delivery catheters and angioplasty balloon catheters, particularly those having movable external sheaths to enclose the stent or balloon, suffer from poor tracking and cumbersome interaction with guidewires. Some such catheters utilize an “over-the-wire” design in which the guidewire extends through an inner lumen of the catheter from its proximal end to its distal end, a design that makes catheter exchanges cumbersome and time-consuming. Rapid exchange designs have also been proposed for such catheters wherein the guidewire extends through the distal end of the catheter and out through a port in a sidewall of the sheath. However, in these designs the guidewire inhibits smooth retraction of the sheath and, if the sheath is retracted a substantial distance, the port can become so displaced from the distal end of the catheter that the guidewire does not slide smoothly as the catheter is moved.
In some stent delivery catheters, stents are mounted on an expandable balloon member, and the balloon is inflated to expand the stents. Currently available catheters, however, do not typically provide for positioning stents on a balloon in situ. If a stent is advanced over a balloon on a catheter positioned in a vessel, it is often difficult or impossible to determine how far the stent should be advanced relative to the balloon. A stent may be advanced too far, pushing it off the distal end of the balloon, so that all or a portion of the stent does not expand properly with balloon expansion. At other times, a stent may not be advanced far enough along the balloon, in which case the balloon portion not covered by stent material (known as “balloon overhang”) may dilate the vessel when expanded, potentially causing trauma to the vessel.
Finally, many stent delivery catheters suffer from inflexibility and high cross-sectional profile, which hamper endovascular positioning.
For these and other reasons, stents and stent delivery catheters are needed which enable the customization of stent length in situ, and the treatment of multiple lesions of various sizes, without requiring removal of the delivery catheter from the patient. Such stents and stent delivery catheters should be capable of treating lesions of particularly long length and lesions in curved regions of a vessel, and should be highly flexible to conform to vessel shape and movement. Such stent delivery catheters should further be of minimal cross-sectional profile and should be highly flexible for endovascular positioning through tortuous vascular pathways. Ideally, such stent delivery catheters would also allow for accurate and repeatable positioning of one or more stents in a desired position for deployment from the catheter in situ. At least some of these objectives will be met by the present invention.
The invention provides apparatus and methods for delivering prostheses or stents into body lumens. In one aspect of the present invention, apparatus for delivering a prosthesis into a target vessel includes: a flexible catheter shaft having a proximal end and a distal end; an expandable member coupled with the catheter shaft near the distal end movable from a contracted configuration to an expanded configuration; a tubular prosthesis selectively movable in an axial direction over the expandable member; and a stop member disposed on the catheter shaft near the distal end for stopping the prosthesis at a deployment position on the expandable member.
In some embodiments, the stop member has a first shape when the expandable member is in the contracted configuration and a second shape when the expandable member is in the expanded configuration. In one embodiment, the stop member is resiliently biased into the first shape, whereby the stop member recoils from the second shape to the first shape when the expandable member contracts from the expanded configuration to the contracted configuration. Alternatively, the stop member may be movable relative to the expandable member from a first position when the expandable member is in the contracted configuration to a second position when the expandable member is in the expanded configuration. Optionally, such a stop member may be resiliently biased into the first position, whereby the stop member recoils from the second position to the first position when the expandable member contracts from the expanded configuration to the contracted configuration. Also optionally, the apparatus may further include an actuator for selectively moving the stop member between the first and second positions.
In some embodiments, the expandable member of the apparatus has a deployment portion and a tapered portion tapering distally from the deployment portion, the stop member being adapted to stop the tubular prosthesis on the deployment portion proximal to the tapered portion. In one embodiment, the tapered portion is everted within the deployment portion in the contracted configuration. Optionally, the expandable member may have a proximal end mounted at a first mounting point on the catheter shaft and a distal end mounted at a second mounting point that is movable relative to the first mounting point. In such an embodiment, the first mounting point and the second mounting point may be interconnected by a shaft, the shaft having an elongatable section which elongates upon expansion of the expandable member.
In some embodiments, the apparatus further includes a pusher slidably disposed over the catheter shaft and engaging the tubular prosthesis for positioning the tubular prosthesis over the expandable member. Optionally, the apparatus may further comprise a sheath slidably disposed over the catheter shaft and the tubular prosthesis and being axially movable relative thereto. In some embodiments, the prosthesis self-expands to a shape suitable for engaging the target vessel when the sheath is refracted to expose the prosthesis. In some embodiments, the sheath is axially positionable relative to the expandable member and configured to restrain expansion of a selected portion of the expandable member. Optionally, the sheath may be reinforced to prevent expansion thereof by the expandable member. In some embodiments, the tubular prosthesis comprises a plurality of prosthesis segments. In such embodiments, the sheath may be axially movable relative to the prosthesis segments and configured to restrain expansion of a selectable number of prosthesis segments.
In some embodiments, the stop member is external to the expandable member. Alternatively, the stop member may reside within the expandable member, be fixed to the expandable member and/or the like. In one embodiment, the stop member comprises a sleeve having a proximal portion disposed over a distal end of the expandable member. For example, in one embodiment, the sleeve has a compressible portion, wherein expanding the expandable member compresses the compressible portion thereby moving the proximal portion relative to the expandable member. In other embodiments, the stop member comprises a cone shaped member disposed over a tapered distal end of the expandable member. Optionally, the cone-shaped member may be movable between a contracted shape and an expanded shape upon expansion of the expandable member. In other embodiments, the stop member comprises a tubular member disposed distally of the expandable member. In some embodiments, a distal end of the expandable member is everted such that when the expandable member is inflated the everted portion becomes a tapered portion. Optionally, the distal end of the expandable member may be coupled to an elongatable shaft such that expanding the expandable member elongates the shaft.
In yet another embodiment, the stop member comprises a cone shaped member coupled with the catheter shaft inside the expandable member. Alternatively, the stop member may include a movable distal nose cone slidably disposed over the distal end of the catheter shaft from a first position over a distal end of the expandable member to a second position distal to the distal end of the expandable member and an inner shaft slidably coupled to the catheter shaft and attached to the nose cone. In another embodiment, the apparatus further includes a nosecone disposed distally of the expandable member, and the stop member comprises a sleeve extending proximally from the nose cone to cover a distal end of the expandable member. Such a sleeve may optionally be biased, such as with a flexible bend, to dispose a proximal end of the sleeve within a sheath of the apparatus, to thus avoid the proximal end of the sleeve from catching on the distal end of the sheath.
In alternative embodiments, the at least one stop member comprises one or more surface features on a distal portion of the expandable member. In some embodiments, for example, the surface features may include but are not limited to bumps, ridges, spines, ribs, scales, pleats and wings. In another embodiment, the surface feature comprises a thickened distal portion of the expandable member, the thickened distal portion including a proximal abutment. In other embodiments, the surface features comprise at least one material selected from the group consisting of Dacron, C-flex, high friction materials, gels and adhesives.
In another aspect of the present invention, an apparatus for delivering a prosthesis into a target vessel includes: a flexible catheter shaft having a proximal end and a distal end; a plurality of tubular prostheses slidably disposed over the catheter shaft; a sheath disposed over the catheter shaft and the tubular prostheses and being axially movable relative thereto; and a stop member coupled with the catheter shaft near the distal end for stopping at least one of the tubular prostheses at a deployment position along the catheter shaft. In some embodiments, the apparatus further includes a pusher axially movable relative to the catheter shaft and being in engagement with at least one tubular prosthesis for positioning the tubular prosthesis over the expandable member. In some embodiments, the tubular prostheses self-expand upon being exposed out of the sheath.
The apparatus may optionally include an expandable member coupled with the catheter shaft near the distal end movable from a contracted configuration to an expanded configuration. In one embodiment, the stop member has a first shape when the expandable member is in the contracted configuration and a second shape when the expandable member is in the expanded configuration. Optionally, the stop member may be resiliently biased into the first shape, whereby the stop member recoils from the second shape to the first shape when the expandable member contracts from the expanded configuration to the contracted configuration. In some embodiments, the stop member is movable relative to the expandable member from a first position when the expandable member is in the contracted configuration to a second position when the expandable member is in the expanded configuration. Optionally, the stop member may be resiliently biased into the first position, whereby the stop member recoils from the second position to the first position when the expandable member contracts from the expanded configuration to the contracted configuration. In some embodiments, the apparatus further includes an actuator for selectively moving the stop member between the first and second positions.
In one embodiment, the expandable member has a deployment portion and a tapered portion tapering distally from the deployment portion, the stop member being adapted to stop the tubular prosthesis on the deployment portion proximal to the tapered portion. In one embodiment, the tapered portion is everted within the deployment portion in the contracted configuration. The expandable member may have a proximal end mounted at a first mounting point on the catheter shaft and a distal end mounted at a second mounting point that is movable relative to the first mounting point. In one embodiment, the first mounting point and the second mounting point are interconnected by a shaft, the shaft having an elongatable section which elongates upon expansion of the expandable member.
In various embodiments, the stop member of the apparatus may have any or a plurality of the features and configurations described above.
In another aspect of the invention, an apparatus for delivering a prosthesis into a target vessel comprises: a flexible catheter shaft having a proximal end, a distal end and at least one lumen; an expandable member coupled with the catheter shaft near the distal end, the expandable member having a deployment portion and a tapered portion tapering distally from the deployment portion; a tubular prosthesis axially slidable over the expandable member; and a sheath slidably disposed over the expandable member and the tubular prosthesis and being axially movable relative thereto, an actuator for moving the expandable member a set distance relative to the sheath from a retracted position in which the tubular prosthesis is over the tapered portion to an extended position in which the tubular prosthesis is disposed over the deployment portion.
In some embodiments, the actuator is disposed on a handle at the proximal end of the catheter shaft for advancing the expandable member by the set distance. In some embodiments, the actuator comprises a compressible spring member associated with an element selected from the sheath, the catheter shaft, or the expandable member, wherein retracting the expandable member compresses the spring member and releasing the expandable member causes the spring member to recoil, thus moving the expandable member by the set distance.
In yet another aspect of the present invention, a method of delivering a prosthesis in a target vessel of a patient involves: advancing a tubular prosthesis along a delivery catheter; stopping the prosthesis at a deployment location on the delivery catheter with a stop member thereon; and expanding at least part of the tubular prosthesis into engagement with the target vessel. In a preferred embodiment, the tubular prosthesis comprises a plurality of prosthesis segments, and advancing the tubular prosthesis comprises positioning a first selected number of the prosthesis segments on an expandable member of the delivery catheter for expansion therewith. Some embodiments further involve positioning a sheath of the delivery catheter to expose the first selected number of prosthesis segments and to constrain expansion of a second selected number of the prosthesis segments. Optionally, such embodiments may further involve covering a proximal portion of the expandable member by the sheath to constrain the proximal portion from expansion while a distal portion of the expandable member expands. Alternatively, expanding at least part of the tubular prosthesis may involve exposing the first selected number of prosthesis segments by positioning the sheath, to allow the first selected number of segments to self-expand.
In some embodiments, advancing the tubular prosthesis comprises pushing the prosthesis using a pusher of the delivery catheter. Stopping the tubular prosthesis with the stop member may involve abutting the distal end of the prosthesis against the stop member. Alternatively, stopping the tubular prosthesis with the stop member may comprise advancing a distal end portion over the stop member to frictionally engage the prosthesis.
In some embodiments, expanding the tubular prosthesis comprises expanding an expandable member on the delivery catheter. In one embodiment, the stop member expands with the expandable member. Optionally, the stop member may move from a first position to a second position as the expandable member expands. The method may further involve retracting the expandable member after the tubular prosthesis is expanded, wherein the expandable member recoils to the first position when the expandable member is contracted. In some embodiments, the method also involves moving the stop member from a first position to a second position relative to the expandable member after stopping the tubular prosthesis.
In another aspect of the invention, a method of delivering a prosthesis in a target vessel of a patient comprises: advancing a plurality of prostheses along a delivery catheter; stopping a first selected number of the prostheses at a deployment location on the delivery catheter with a stop member thereon; and expanding the first selected number of prostheses into engagement with the target vessel. In some embodiments, advancing the tubular prosthesis comprises positioning the first selected number of the prostheses on an expandable member for expansion therewith. Optionally, the method may also include positioning a sheath of the delivery catheter to expose the first selected number of prostheses and to constrain expansion of a second selected number of the prostheses. In some embodiments, the method further includes covering a proximal portion of the expandable member by the sheath to constrain the proximal portion from expansion while a distal portion of the expandable member expands. In some embodiments, the first selected number of tubular prostheses self-expand when the sheath is retracted.
In some embodiments, the tubular prostheses are self-expanding, and the method further includes positioning a sheath of the delivery catheter to expose the first selected number of prosthesis segments and to constrain expansion of a second selected number of the prosthesis segments. The method may further involve, after the expanding step: advancing a second selected number of prostheses along the delivery catheter; stopping the second selected number of prostheses with the stop member; and expanding the second selected number of prostheses into engagement with the target vessel. In some embodiments, the first and second selected number of prostheses are expanded by expanding an expandable member of the delivery catheter. Alternatively, the first and second selected number of prostheses may be self-expanding. In some embodiments, advancing the tubular prosthesis comprises pushing the prosthesis using a pusher of the delivery catheter.
In some embodiments, expanding the first selected number of prostheses comprises expanding an expandable member on the delivery catheter. In some embodiments, the stop member expands with the expandable member. In some embodiments, the stop member moves from a first position to a second position as the expandable member expands. The method may optionally further include retracting the expandable member after the tubular prosthesis is expanded, wherein the expandable member recoils to the first position when the expandable member is contracted. In some embodiments, the method involves moving the stop member from a first position to a second position relative to the expandable member after stopping the tubular prosthesis.
Further aspects of the nature and advantages of the invention will become apparent from the detailed description below taken in conjunction with the drawings.
A first embodiment of a stent delivery catheter according to present invention is illustrated in
A handle 38 is mounted to a proximal end 23 of sheath 25 and includes an actuator 40 slidably mounted thereto for purposes described below. An adaptor 42 is mounted to the proximal end of handle 38 and provides a catheter port 44 through which inner shaft 27 is slidably positioned. A flush port 48 is mounted to the side of adaptor 42 through which a fluid such as saline can be introduced into the interior of catheter body 22. An annular seal (not shown) in catheter port 44 seals around inner shaft 27 to prevent fluid from leaking through catheter port 44. Optionally, a clamp (not shown) such as a threaded collar, can be mounted to catheter port 44 to lock inner shaft 27 relative to handle 38.
Inner shaft 27 has a proximal end 50 to which is mounted an inflation adaptor 52. Inflation adaptor 52 is configured to be fluidly coupled to an inflation device 54, which may be any commercially available balloon inflation device such as those sold under the trade name “Indeflator™,” available from Advanced Cardiovascular Systems of Santa Clara, Calif. Inflation adaptor 52 is in fluid communication with expandable member 24 via an inflation lumen (described below) in inner shaft 27 to enable inflation of expandable member 24.
In alternative embodiments, handle 38 may have any of a number of suitable configurations and features, such as those described in U.S. patent application Ser. Nos. 10/746,466, filed Dec. 23, 2003, and 10/814,593, filed Mar. 3, 2004, which are both fully incorporated herein by reference.
Referring now to
Sheath 25 has a distal extremity 62 configured to surround expandable member 24 and stent segments 32 disposed thereon when in an unexpanded configuration. Distal extremity 62 extends proximally to a junction 63, preferably aligned with the location of guidewire tube exit port 35, where distal extremity 62 is joined to a proximal extremity 64 that extends proximally to handle 38 (see
In some embodiments, distal extremity 62 includes a distal-most portion 59, which extends beyond stent valve 58 distally to the distal end of sheath 25. In some embodiments, distal-most portion 59 and the rest of distal extremity 62 are made of the same material or combination of materials and may even comprise a unitary piece or extrusion. In other embodiments, distal-most portion 59 may include different material(s) than those used for making the rest of distal extremity 62. In some embodiments, distal-most portion 59 is made of a relatively stiff material so that if a stent segment 32 is positioned therein distally of stent valve 58, distal-most portion 59 will prevent segment 32 from being deployed when expandable member 24 is expanded. In some embodiments, for example, distal-most portion 59 may comprise a metal ring or hypotube or a polymer with an embedded or attached metal braid, ribs or other reinforcement.
Referring to
Preferably, proximal extremity 64 has a smaller transverse dimension than distal extremity 62 to accommodate the added width of guidewire tube 34 within the vessel lumen, as well as to maximize flexibility and minimize profile. In one embodiment, shown in
In an alternative embodiment (not shown), a hole is formed in the sidewall of distal extremity 62 or proximal extremity 64 to create guidewire tube exit port 35. Proximally of guidewire tube exit port 35, the wall of sheath 25 adjacent to guidewire tube 34 is flattened or collapsible inwardly thereby reducing the transverse dimension of sheath 25 to accommodate the width of guidewire tube 34.
Guidewire tube 34 is slidably positioned through guidewire tube exit port 35. Preferably, guidewire tube exit port 35 is configured to provide a total or partial fluid seal around the periphery of guidewire tube 34 to limit blood flow into the interior of sheath 25 and to limit leakage of saline (or other flushing fluid) out of sheath 25. This may be accomplished by sizing guidewire tube exit port 35 appropriately so as to form a fairly tight frictional seal around guidewire tube 34 while still allowing the sliding motion thereof relative to sheath 25. Alternatively an annular sealing ring may be mounted in guidewire tube exit port 35 to provide the desired seal.
Guidewire tube exit port 35 will be positioned to provide optimal tracking of stent delivery catheter 20 through the vasculature and maximizing the ease with which the catheter can be inserted onto and removed from a guidewire to facilitate catheter exchanges. Usually, guidewire tube exit port 35 will be positioned at a location proximal to expandable member 24 when sheath 25 is extended fully distally up to nosecone 28, but a distance of no more than one-half the length of sheath 25 from distal end 57. In preferred embodiments for coronary applications, guidewire tube exit port 35 is spaced proximally a distance of about 20-35 cm from the distal end 57 of sheath 25.
Guidewire tube 34 should extend proximally from guidewire tube exit port 35 a distance at least as long as the longest possible stent that may be deployed, e.g. 30-200 mm, to allow for retraction of sheath 25 that distance while retaining a portion of guidewire tube 34 external to sheath 25. Preferably guidewire tube 34 extends proximally a distance of about 3-15 cm from guidewire tube exit port 35 when sheath 25 is in a fully distal position, with the proximal end thereof disposed a distance of about 23-50 cm from the distal tip of nosecone 28. Where stent delivery catheter 20 is to be positioned through a guiding catheter, the proximal end of guidewire tube 34 will preferably be positioned so as to be within the guiding catheter when expandable member 24 is positioned at the target site for stent deployment. Guidewire tube 34 is preferably a highly flexible polymer such as PTFE, FEP, polyimide, or Pebax, and may optionally have a metal or polymer braid embedded in it to increase kink-resistance.
Inner shaft 27 forms an inflation lumen 66 that is in communication with interior of expandable member 24. In the distal extremity of stent delivery catheter 20 inner shaft 27 is preferably formed of a polymer such as PTFE, FEP, polyimide, or Pebax, and may be reinforced with a metallic braid for added radial strength and kink resistance. In the proximal extremity of delivery catheter 20, inner shaft 27 may be a similar polymer or a metal such as stainless steel or Nitinol.
Expandable member 24 has an expandable balloon member 70 that is joined to a non-expandable tubular leg 72. Expandable balloon member 70 is a semi-compliant polymer such as Pebax or Nylon. Tubular leg 72 is preferably a polymer such as polyimide, PTFE, FEP or Pebax and may optionally be reinforced with a metal or polymer braid. Tubular leg 72 has an open proximal end 74 through which guidewire tube 34 extends. Proximal end 74 of tubular leg 72 is fixed to distal end 68 of inner shaft 27 and to guidewire tube 34, forming a fluid-tight seal. Balloon member 70 has a distal end 76 bonded to an annular stop 78, which is mounted to nosecone 28. Stop 78 has a size and shape selected to engage stent segment 32 and provide a stop against which stent segments 32 can be located in the ideal deployment position without being pushed beyond the distal end of balloon member 70. This embodiment of stop 78, as well as a number of other embodiments, are described more fully below with reference to
Optionally, within the interior of balloon member 70 an annular base member 80 is mounted to guidewire tube 34 and has a diameter selected to urge balloon member 70 against stent segments 32 in their unexpanded configuration, thereby providing frictional engagement with stent segments 32. This helps to limit unintended sliding movement of stent segments 32 on balloon member 70. Base member 80 may be made of a soft elastomer, foam, or other compressible material. Adjacent to the distal and proximal ends of base member 80 two annular radiopaque markers 82 are mounted to guidewire tube 34, facilitating visualization of the location of balloon member 70 with fluoroscopy and enabling appropriate positioning of stent segments 32 on balloon member 70. Alternatively, only a single marker 82 at the distal end of base member 80 may be used, or markers may be placed at other locations on nosecone 28, guidewire tube 34, or inner shaft 27. Such markers may be made of various radiopaque materials such as platinum/iridium, tantalum, and other materials.
Stent segments 32 are slidably positioned over balloon member 70. Depending upon the number of stent segments 32 loaded in stent delivery catheter 20, stent segments 32 may be positioned over both balloon member 70 and tubular leg 72. In an exemplary embodiment, each stent segment is about 2-8 mm in length, and up to 10-50 stent segments may be positioned end-to-end in a line over balloon member 70 and tubular leg 72. Stent segments 32 preferably are in direct contact with each other, but alternatively separate spacing elements may be disposed between adjacent stent segments, the spacing elements being movable with the stent segments along balloon member 70. Such spacing elements may be plastically deformable or self-expanding so as to be deployable with stent segments 32 into the vessel, but alternatively could be configured to remain on balloon member 70 following stent deployment; for example, such spacing elements could comprise elastic rings which elastically expand with balloon member 70 and resiliently return to their unexpanded shape when balloon member 70 is deflated. The spacing elements could be pushed to the distal end of balloon member 70 against stop 78 as additional stent segments 32 are advanced distally.
Stent segments 32 are preferably a malleable metal so as to be plastically deformable by expandable member 24 as they are expanded to the desired diameter in the vessel. Alternatively, stent segments 32 may be formed of an elastic or super elastic shape memory material such as Nitinol so as to self-expand upon release into the vessel by retraction of sheath 25. Stent segments 32 may also be composed of polymers or other suitable biocompatible materials, including biodegradable polymers, metals, salts, ceramics, and proteins. In embodiments including self-expanding stent segments 32, expandable member 24 may be used for predilatation of a lesion prior to stent deployment and/or for augmenting the expansion of the self-expanding stent segments 32. Predilatation methods and devices are described, for example, in U.S. patent application Ser. No. 10/794,405, filed Mar. 3, 2004, which is fully incorporated herein by reference.
In preferred embodiments, stent segments 32 are coated with a drug that inhibits restenosis, such as Rapamycin, Paclitaxel, analogs, prodrugs, or derivatives of the foregoing, or other suitable agent, preferably carried in a durable or bioerodable polymeric carrier. Alternatively, stent segments 32 may be coated with other types of drugs and therapeutic materials such as antibiotics, thrombolytics, anti-thrombotics, anti-inflammatories, cytotoxic agents, anti-proliferative agents, vasodilators, gene therapy agents, radioactive agents, immunosuppressants, and chemotherapeutics. Such materials may be coated over all or a portion of the surface of stent segments 32, or stent segments 32 may include apertures, pores, holes, channels, or other features in which such materials may be deposited.
Stent segments 32 may have a variety of configurations, including those described in copending application Ser. No. 10/738,666, filed Dec. 16, 2003, which is fully incorporated herein by reference. Other preferred stent configurations are described below. Stent segments 32 are preferably completely separate from one another without any interconnections, but alternatively may have couplings between two or more adjacent segments which permit flexion between the segments. As a further alternative, one or more adjacent stent segments may be connected by separable or frangible couplings that are separated prior to or upon deployment, as described in copending application Ser. No. 10/306,813, filed Nov. 27, 2002, which is incorporated herein by reference.
A pusher tube 86 is slidably disposed over inner shaft 27 and has a distal extension 88 coupled to a pusher ring 90. Pusher ring 90 is slidable over tubular leg 72 and engages the stent segment 32 at the proximal end of the line of stent segments 32. At its proximal end (not shown), pusher tube 86 is coupled to sliding actuator 40 on handle 38 (see
With sheath 25 retracted a desired distance, expandable member 24 is allowed to expand when inflation fluid is delivered through inflation lumen 66, thereby expanding a desired number of stent segments 32 exposed distally of sheath 25. The remaining portion of expandable member 24 and the remaining stent segments 32 within sheath 25 are constrained from expansion by sheath 25.
In order to confirm the positioning of stent segments 32 on expandable member 24, fluoroscopy is used to visualize stent segments 32 relative to markers 82 on inner shaft 27. In addition, by fluoroscopic visualization of markers 56 on sheath 25 the user can see the extent of retraction of sheath 25 relative to expandable member 24 and view the location of the exposed stent segments 32 relative to sheath 25. Visualization of stent segments 32 is further enhanced with the use of radiopaque markers and/or materials in or on the stent segments themselves. Markers of radiopaque materials may be applied to the exterior of stent segments 32, e.g., by applying a metal such as gold, platinum, a radiopaque polymer, or other suitable coating or mark on all or a portion of the stent segments. Alternatively, stent segments 32 may include a radiopaque cladding or coating or may be composed of radiopaque materials such as L-605 cobalt chromium (ASTM F90), other suitable alloys containing radiopaque elements, or multilayered materials having radiopaque layers. In yet another alternative, stent segments 32 may have a geometry conducive to fluoroscopic visualization, such as having struts of greater thickness, sections of higher density, or overlapping struts. Some of the possible materials that may be used in stent segments 32 include (by ASTM number):
A first preferred geometry of stent segments 32 is illustrated in
In a preferred embodiment, a spacing member 112 extends outwardly in the axial direction from a selected number of outer circumferential struts 109 and/or connecting struts 113. Spacing member 112 preferably itself forms a subcell 114 in its interior, but alternatively may be solid without any cell or opening therein. For those spacing members 112 attached to outer circumferential struts 109, subcell 114 preferably communicates with I-shaped cell 100. Spacing members 112 are configured to engage the curved outer ends 108 of an adjacent stent segment 32 so as to maintain appropriate spacing between adjacent stent segments. In one embodiment, spacing members 112 have outer ends 116 with two spaced-apart protrusions 118 that provide a cradle-like structure to index and stabilize the curved outer end 108 of the adjacent stent segment. Preferably, spacing members 112 have an axial length of at least about 10%, more preferably at least about 25%, of the long dimension L of I-shaped cells 100, so that the I-shaped cells 100 of adjacent stent segments are spaced apart at least that distance. Because spacing members 112 experience little or no axial shortening during expansion of stent segments 32, this minimum spacing between stent segments is maintained both in the unexpanded and expanded configurations.
As an additional feature, circumferential slots 104 provide a pathway through which vessel side branches can be accessed for catheter interventions or for treatment of bifurcation lesions. Should stent segment 32 be deployed at a location in which it covers the ostium of a side branch to which access is desired, a balloon dilatation catheter may be positioned through circumferential slot 104 and expanded. This deforms circumferential struts 109, 111 axially outward, thereby expanding circumferential slot 104 and further expanding upper and lower slots 102, as shown in phantom in
One of the differences between the embodiment of
The embodiment of
Referring now to
Optionally, lesion L may be predilated prior to stent deployment. Predilatation may be performed prior to introduction of stent delivery catheter 20 by inserting an angioplasty catheter over guidewire GW and dilating lesion L. Alternatively, stent delivery catheter 20 may be used for predilitation by retracting sheath 25 along with stent segments 32 to expose an extremity of expandable member 24 long enough to extend through the entire lesion. This may be done while delivery catheter 20 is positioned proximally of lesion L or with expandable member 24 extending through lesion L. Fluoroscopy enables the user to visualize the extent of sheath retraction relative to lesion L by observing the position of marker 56 on sheath 25 relative to marker 82 at the distal end of expandable member 24. To allow stent segments 32 to move proximally relative to expandable member 24, force is released from pusher tube 86 and valve member 58 engages and draws the stent segments proximally with sheath 25. With the appropriate length of expandable member 24 exposed, expandable member 24 is positioned within lesion L and inflation fluid is introduced through inflation lumen 66 to inflate expandable member 24 distally of sheath 25 and thereby dilate lesion L. Expandable member 24 is then deflated and retracted within sheath 25 while maintaining force on pusher tube 86 so that stent segments 32 are positioned up to the distal end of expandable member 24, surrounded by sheath 25.
Following any predilatation, stent delivery catheter 20 is repositioned in artery A so that nosecone 28 is distal to lesion L as shown in
With the desired number of stent segments 32 exposed distally of sheath 25, it is frequently desirable to create some spacing between the stent segments to be deployed and those remaining enclosed within sheath 25. This reduces the risk of dislodging or partially expanding the distal-most stent segment 32 within sheath 25 when expandable member 24 is inflated. Such spacing is created, as shown in
Expandable member 24 is then inflated by delivering inflation fluid through inflation lumen 66, as shown in
Expandable member 24 is then deflated, leaving stent segments 32 in a plastically-deformed, expanded configuration within lesion L, as shown in
When the movement of the pusher tube, sheath, or stent segments is described in relation to other components of the delivery catheter of the invention, such movement is relative and will encompass moving the sheath, pusher tube, or stent segments while keeping the other component(s) stationary, keeping the sheath, pusher tube or stent segments stationary while moving the other component(s), or moving multiple components simultaneously relative to each other.
As described above in reference to
Referring now to
An alternative embodiment, pictured in
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In another embodiment, shown in
Referring now to
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Another alternative embodiment is shown in
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With reference now to
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Referring to
In one embodiment (not pictured), a stent stop may not be included on the distal end of the delivery catheter. Instead, following an initial deployment of stent segments, the expandable member is retracted fully into the sheath. This positions the stents at the distal end of the expandable member. The expandable member is then advanced a set distance distally relative to the sheath without pushing on the pusher of the delivery catheter. This positions the stents just proximal to the distal taper on the expandable member. In some embodiments, an actuator on the handle of the device may be configured to automatically advance the expandable member the desired distance.
A variation of the embodiment just described is illustrated in
While the foregoing description of the invention is directed to a stent delivery catheter for deploying stents into vascular lumens to maintain patency, various other types of wire-guided catheters also may embody the principles of the invention. For example, balloon catheters for angioplasty and other purposes, particularly those having a slidable external sheath surrounding the balloon, may be constructed in accordance with the invention. Other types of catheters for deployment of prosthetic devices such as embolic coils, stent grafts, aneurism repair devices, annuloplasty rings, heart valves, anastomosis devices, staples or clips, as well as ultrasound and angiography catheters, electrophysiological mapping and ablation catheters, and other devices may also utilize the principles of the invention.
Although the above is complete description of the preferred embodiments of the invention, various alternatives, additions, modifications and improvements may be made without departing from the scope thereof, which is defined by the claims.
This application is a continuation of U.S. application Ser. No. 10/884,616, filed Jul. 2, 2004, which is a continuation-in-part of application Ser. No. 10/874,859, filed Jun. 22, 2004, which is a continuation-in-part of co-pending application Ser. No. 10/637,713, filed Aug. 8, 2003, which is a continuation-in-part of application Ser. No. 10/412,714, filed Apr. 10, 2003, which is a continuation-in-part of application Ser. No. 10/306,813, filed Nov. 27, 2002, which is a non-provisional of provisional application Ser. No. 60/336,967, filed Dec. 3, 2001, and a non-provisional of provisional application Ser. No. 60/364,389, filed Mar. 13, 2002, the disclosures of which are incorporated herein by reference.
| Number | Name | Date | Kind |
|---|---|---|---|
| 4069825 | Akiyama | Jan 1978 | A |
| 4468224 | Enzmann et al. | Aug 1984 | A |
| 4512338 | Balko | Apr 1985 | A |
| 4564014 | Fogarty et al. | Jan 1986 | A |
| 4580568 | Gianturco | Apr 1986 | A |
| 4681110 | Wiktor | Jul 1987 | A |
| 4690684 | McGreevy et al. | Sep 1987 | A |
| 4733665 | Palmaz | Mar 1988 | A |
| 4739762 | Palmaz | Apr 1988 | A |
| 4748982 | Horzewski et al. | Jun 1988 | A |
| 4762129 | Bonzel | Aug 1988 | A |
| 4770176 | McGreevy et al. | Sep 1988 | A |
| 4775337 | Van Wagener et al. | Oct 1988 | A |
| 4776337 | Palmaz | Oct 1988 | A |
| 4886062 | Wiktor | Dec 1989 | A |
| 4891225 | Langer et al. | Jan 1990 | A |
| 4950227 | Savin et al. | Aug 1990 | A |
| 4988356 | Crittenden et al. | Jan 1991 | A |
| 4994066 | Voss | Feb 1991 | A |
| 4994069 | Ritchart et al. | Feb 1991 | A |
| 5013318 | Spranza, III | May 1991 | A |
| 5035706 | Giantureo et al. | Jul 1991 | A |
| 5040548 | Yock | Aug 1991 | A |
| 5061273 | Yock | Oct 1991 | A |
| 5064435 | Porter | Nov 1991 | A |
| 5092877 | Pinchuk | Mar 1992 | A |
| 5102417 | Palmaz | Apr 1992 | A |
| 5104404 | Wolff | Apr 1992 | A |
| 5122154 | Rhodes | Jun 1992 | A |
| 5135535 | Kramer | Aug 1992 | A |
| 5192297 | Hull | Mar 1993 | A |
| 5195984 | Schatz | Mar 1993 | A |
| 5201757 | Heyn et al. | Apr 1993 | A |
| 5217495 | Kaplan et al. | Jun 1993 | A |
| 5219355 | Parodi et al. | Jun 1993 | A |
| 5226913 | Pinchuk | Jul 1993 | A |
| 5246421 | Saab | Sep 1993 | A |
| 5273536 | Savas | Dec 1993 | A |
| 5282824 | Gianturco | Feb 1994 | A |
| 5300085 | Yock | Apr 1994 | A |
| 5312415 | Palermo | May 1994 | A |
| 5334187 | Fischell et al. | Aug 1994 | A |
| 5391172 | Williams et al. | Feb 1995 | A |
| 5421955 | Lau et al. | Jun 1995 | A |
| 5445646 | Euteneuer et al. | Aug 1995 | A |
| 5456713 | Chuter | Oct 1995 | A |
| 5458615 | Klemm et al. | Oct 1995 | A |
| 5470315 | Adams | Nov 1995 | A |
| 5478349 | Nicholas | Dec 1995 | A |
| 5484444 | Braunschweiler et al. | Jan 1996 | A |
| 5490837 | Blaeser et al. | Feb 1996 | A |
| 5496346 | Horzewski et al. | Mar 1996 | A |
| 5501227 | Yock | Mar 1996 | A |
| 5507768 | Lau et al. | Apr 1996 | A |
| 5507771 | Gianturco | Apr 1996 | A |
| 5514093 | Ellis et al. | May 1996 | A |
| 5514154 | Lau et al. | May 1996 | A |
| 5527354 | Fontaine et al. | Jun 1996 | A |
| 5531735 | Thompson | Jul 1996 | A |
| 5534007 | St. Germain et al. | Jul 1996 | A |
| 5549551 | Peacock, III et al. | Aug 1996 | A |
| 5549563 | Kronner | Aug 1996 | A |
| 5549635 | Solar | Aug 1996 | A |
| 5554181 | Das | Sep 1996 | A |
| 5562725 | Schmitt et al. | Oct 1996 | A |
| 5571086 | Kaplan et al. | Nov 1996 | A |
| 5593412 | Martinez et al. | Jan 1997 | A |
| 5607444 | Lam | Mar 1997 | A |
| 5607463 | Schwartz et al. | Mar 1997 | A |
| 5628775 | Jackson et al. | May 1997 | A |
| 5634928 | Fischell et al. | Jun 1997 | A |
| 5639274 | Fischell et al. | Jun 1997 | A |
| 5662675 | Polanskyj Stockert et al. | Sep 1997 | A |
| 5670161 | Healy et al. | Sep 1997 | A |
| 5676654 | Ellis et al. | Oct 1997 | A |
| 5683451 | Lenker et al. | Nov 1997 | A |
| 5690644 | Yurek et al. | Nov 1997 | A |
| 5693085 | Buirge et al. | Dec 1997 | A |
| 5697948 | Marin et al. | Dec 1997 | A |
| 5697971 | Fischell et al. | Dec 1997 | A |
| 5702418 | Ravenscroft | Dec 1997 | A |
| 5709701 | Parodi | Jan 1998 | A |
| 5716393 | Lindenberg et al. | Feb 1998 | A |
| 5722669 | Shimizu et al. | Mar 1998 | A |
| 5723003 | Winston et al. | Mar 1998 | A |
| 5735869 | Fernandez-Aceytuno | Apr 1998 | A |
| 5741323 | Pathak et al. | Apr 1998 | A |
| 5749848 | Jang et al. | May 1998 | A |
| 5749921 | Lenker et al. | May 1998 | A |
| 5755772 | Evans et al. | May 1998 | A |
| 5755776 | Al-Saadon | May 1998 | A |
| 5755781 | Jayaraman | May 1998 | A |
| 5769882 | Fogarty et al. | Jun 1998 | A |
| 5772669 | Vrba | Jun 1998 | A |
| 5776141 | Klein et al. | Jul 1998 | A |
| 5797951 | Mueller et al. | Aug 1998 | A |
| 5800519 | Sandock | Sep 1998 | A |
| 5807398 | Shaknovich | Sep 1998 | A |
| 5824040 | Cox et al. | Oct 1998 | A |
| 5824041 | Lenker et al. | Oct 1998 | A |
| 5833694 | Poncet | Nov 1998 | A |
| 5836964 | Richter et al. | Nov 1998 | A |
| 5843092 | Heller et al. | Dec 1998 | A |
| 5855563 | Kaplan et al. | Jan 1999 | A |
| 5858556 | Eckert et al. | Jan 1999 | A |
| 5870381 | Kawasaki et al. | Feb 1999 | A |
| 5879370 | Fischell et al. | Mar 1999 | A |
| 5891190 | Boneau | Apr 1999 | A |
| 5895398 | Wensel et al. | Apr 1999 | A |
| 5899935 | Ding | May 1999 | A |
| 5902332 | Schatz | May 1999 | A |
| 5919175 | Sirhan | Jul 1999 | A |
| 5922020 | Klein et al. | Jul 1999 | A |
| 5941869 | Patterson et al. | Aug 1999 | A |
| 5951585 | Cathcart et al. | Sep 1999 | A |
| 5961536 | Mickley et al. | Oct 1999 | A |
| 5968069 | Dusbabek et al. | Oct 1999 | A |
| 5972027 | Johnson | Oct 1999 | A |
| 5976107 | Mertens et al. | Nov 1999 | A |
| 5976155 | Foreman et al. | Nov 1999 | A |
| 5980484 | Ressemann et al. | Nov 1999 | A |
| 5980486 | Enger | Nov 1999 | A |
| 5980514 | Kupiecki et al. | Nov 1999 | A |
| 5980552 | Pinchasik et al. | Nov 1999 | A |
| 5984957 | Laptewicz, Jr. et al. | Nov 1999 | A |
| 5997563 | Kretzers et al. | Dec 1999 | A |
| 6004328 | Solar | Dec 1999 | A |
| 6007517 | Anderson | Dec 1999 | A |
| 6022359 | Frantzen | Feb 2000 | A |
| 6022374 | Imran | Feb 2000 | A |
| 6033434 | Borghi | Mar 2000 | A |
| 6036725 | Avellanet | Mar 2000 | A |
| 6039721 | Johnson et al. | Mar 2000 | A |
| 6042589 | Marianne | Mar 2000 | A |
| 6056722 | Jayaraman | May 2000 | A |
| 6063111 | Hieshima et al. | May 2000 | A |
| 6066155 | Amann et al. | May 2000 | A |
| 6068655 | Seguin et al. | May 2000 | A |
| 6070589 | Keith et al. | Jun 2000 | A |
| 6090063 | Makower et al. | Jul 2000 | A |
| 6090136 | McDonald et al. | Jul 2000 | A |
| 6102942 | Ahari | Aug 2000 | A |
| 6106530 | Harada | Aug 2000 | A |
| RE36857 | Euteneuer et al. | Sep 2000 | E |
| 6120522 | Vrba et al. | Sep 2000 | A |
| 6123712 | Di Caprio et al. | Sep 2000 | A |
| 6123723 | Konya et al. | Sep 2000 | A |
| 6126685 | Lenker et al. | Oct 2000 | A |
| 6129756 | Kugler | Oct 2000 | A |
| 6132460 | Thompson | Oct 2000 | A |
| 6139572 | Campbell et al. | Oct 2000 | A |
| 6143016 | Bleam et al. | Nov 2000 | A |
| 6165167 | Delaloye | Dec 2000 | A |
| 6165210 | Lau et al. | Dec 2000 | A |
| 6171334 | Cox | Jan 2001 | B1 |
| 6179878 | Duerig | Jan 2001 | B1 |
| 6183509 | Dibie | Feb 2001 | B1 |
| 6187034 | Frantzen | Feb 2001 | B1 |
| 6190402 | Horton et al. | Feb 2001 | B1 |
| 6196995 | Fagan | Mar 2001 | B1 |
| 6200337 | Moriuchi et al. | Mar 2001 | B1 |
| 6238991 | Suzuki | May 2001 | B1 |
| 6241691 | Ferrera et al. | Jun 2001 | B1 |
| 6241758 | Cox | Jun 2001 | B1 |
| 6248122 | Klumb et al. | Jun 2001 | B1 |
| 6251132 | Ravenscroft et al. | Jun 2001 | B1 |
| 6251134 | Alt et al. | Jun 2001 | B1 |
| 6254612 | Hieshima | Jul 2001 | B1 |
| 6254628 | Wallace et al. | Jul 2001 | B1 |
| 6258117 | Camrud et al. | Jul 2001 | B1 |
| 6264688 | Herklotz et al. | Jul 2001 | B1 |
| 6267783 | Letendre et al. | Jul 2001 | B1 |
| 6270524 | Kim | Aug 2001 | B1 |
| 6273895 | Pinchuk et al. | Aug 2001 | B1 |
| 6273911 | Cox et al. | Aug 2001 | B1 |
| 6273913 | Wright et al. | Aug 2001 | B1 |
| 6287291 | Bigus et al. | Sep 2001 | B1 |
| 6312458 | Golds | Nov 2001 | B1 |
| 6315794 | Richter | Nov 2001 | B1 |
| 6319277 | Rudnick et al. | Nov 2001 | B1 |
| 6322586 | Monroe et al. | Nov 2001 | B1 |
| 6325823 | Horzewski et al. | Dec 2001 | B1 |
| 6334871 | Dor et al. | Jan 2002 | B1 |
| 6340366 | Wijay | Jan 2002 | B2 |
| 6344272 | Oldenburg et al. | Feb 2002 | B1 |
| 6348065 | Brown et al. | Feb 2002 | B1 |
| 6350277 | Kocur | Feb 2002 | B1 |
| 6357104 | Myers | Mar 2002 | B1 |
| 6361558 | Hieshima et al. | Mar 2002 | B1 |
| 6375676 | Cox | Apr 2002 | B1 |
| 6379365 | Diaz | Apr 2002 | B1 |
| 6383171 | Gifford et al. | May 2002 | B1 |
| 6409753 | Brown et al. | Jun 2002 | B1 |
| 6415696 | Erickeson et al. | Jul 2002 | B1 |
| 6416543 | Hilaire et al. | Jul 2002 | B1 |
| 6419693 | Fariabi | Jul 2002 | B1 |
| 6425898 | Wilson et al. | Jul 2002 | B1 |
| 6428811 | West et al. | Aug 2002 | B1 |
| 6451025 | Jervis | Sep 2002 | B1 |
| 6451050 | Rudakov et al. | Sep 2002 | B1 |
| 6464720 | Boatman et al. | Oct 2002 | B2 |
| 6468298 | Pelton | Oct 2002 | B1 |
| 6468299 | Stack et al. | Oct 2002 | B2 |
| 6485510 | Camrud et al. | Nov 2002 | B1 |
| 6488694 | Lau et al. | Dec 2002 | B1 |
| 6488702 | Besselink | Dec 2002 | B1 |
| 6511468 | Cragg et al. | Jan 2003 | B1 |
| 6520986 | Martin et al. | Feb 2003 | B2 |
| 6520987 | Plante | Feb 2003 | B1 |
| 6527789 | Lau et al. | Mar 2003 | B1 |
| 6527799 | Shanley | Mar 2003 | B2 |
| 6530944 | West et al. | Mar 2003 | B2 |
| 6540777 | Stenzel | Apr 2003 | B2 |
| 6551350 | Thornton et al. | Apr 2003 | B1 |
| 6555157 | Hossainy | Apr 2003 | B1 |
| 6562067 | Mathis | May 2003 | B2 |
| 6569180 | Sirhan et al. | May 2003 | B1 |
| 6575993 | Yock | Jun 2003 | B1 |
| 6579305 | Lashinski | Jun 2003 | B1 |
| 6579309 | Loos et al. | Jun 2003 | B1 |
| 6582394 | Reiss et al. | Jun 2003 | B1 |
| 6582460 | Cryer | Jun 2003 | B1 |
| 6585756 | Strecker | Jul 2003 | B1 |
| 6592549 | Gerdts et al. | Jul 2003 | B2 |
| 6599296 | Gillick et al. | Jul 2003 | B1 |
| 6599314 | Mathis | Jul 2003 | B2 |
| 6602226 | Smith et al. | Aug 2003 | B1 |
| 6602282 | Yan | Aug 2003 | B1 |
| 6605062 | Hurley et al. | Aug 2003 | B1 |
| 6605109 | Fiedler | Aug 2003 | B2 |
| 6607553 | Healy et al. | Aug 2003 | B1 |
| 6629992 | Bigus et al. | Oct 2003 | B2 |
| 6645517 | West | Nov 2003 | B2 |
| 6645547 | Shekalim et al. | Nov 2003 | B1 |
| 6656212 | Ravenscroft et al. | Dec 2003 | B2 |
| 6660031 | Tran et al. | Dec 2003 | B2 |
| 6660381 | Halas et al. | Dec 2003 | B2 |
| 6663660 | Dusbabek et al. | Dec 2003 | B2 |
| 6666883 | Seguin et al. | Dec 2003 | B1 |
| 6676693 | Belding et al. | Jan 2004 | B1 |
| 6676695 | Solem | Jan 2004 | B2 |
| 6679909 | McIntosh et al. | Jan 2004 | B2 |
| 6685730 | West et al. | Feb 2004 | B2 |
| 6692465 | Kramer | Feb 2004 | B2 |
| 6699280 | Camrud et al. | Mar 2004 | B2 |
| 6699281 | Vallana et al. | Mar 2004 | B2 |
| 6699724 | West et al. | Mar 2004 | B1 |
| 6702843 | Brown | Mar 2004 | B1 |
| 6709379 | Brandau et al. | Mar 2004 | B1 |
| 6709440 | Callol et al. | Mar 2004 | B2 |
| 6712827 | Ellis et al. | Mar 2004 | B2 |
| 6712845 | Hossainy | Mar 2004 | B2 |
| 6723071 | Gerdts et al. | Apr 2004 | B2 |
| 6736842 | Healy et al. | May 2004 | B2 |
| 6743219 | Dwyer et al. | Jun 2004 | B1 |
| 6743251 | Eder | Jun 2004 | B1 |
| 6761734 | Suhr | Jul 2004 | B2 |
| 6778316 | Halas et al. | Aug 2004 | B2 |
| 6800065 | Duane et al. | Oct 2004 | B2 |
| 6825203 | Pasternak et al. | Nov 2004 | B2 |
| 6837901 | Rabkin et al. | Jan 2005 | B2 |
| 6849084 | Rabkin et al. | Feb 2005 | B2 |
| 6852252 | Halas et al. | Feb 2005 | B2 |
| 6855125 | Shanley | Feb 2005 | B2 |
| 6858034 | Hijlkema et al. | Feb 2005 | B1 |
| 6878161 | Lenker | Apr 2005 | B2 |
| 6884257 | Cox | Apr 2005 | B1 |
| 6893417 | Gribbons et al. | May 2005 | B2 |
| 6896695 | Mueller et al. | May 2005 | B2 |
| 6913619 | Brown et al. | Jul 2005 | B2 |
| 6918928 | Wolinsky et al. | Jul 2005 | B2 |
| 6939376 | Shulze et al. | Sep 2005 | B2 |
| 6945989 | Betelia et al. | Sep 2005 | B1 |
| 6945995 | Nicholas | Sep 2005 | B2 |
| 6951053 | Padilla et al. | Oct 2005 | B2 |
| 6962603 | Brown et al. | Nov 2005 | B1 |
| 6964676 | Gerberding et al. | Nov 2005 | B1 |
| 6991646 | Clerc et al. | Jan 2006 | B2 |
| 6994721 | Israel | Feb 2006 | B2 |
| 7005454 | Brocchini et al. | Feb 2006 | B2 |
| 7022132 | Kocur | Apr 2006 | B2 |
| 7037327 | Salmon et al. | May 2006 | B2 |
| 7090694 | Morris et al. | Aug 2006 | B1 |
| 7101840 | Brocchini et al. | Sep 2006 | B2 |
| 7137993 | Acosta et al. | Nov 2006 | B2 |
| 7141063 | White et al. | Nov 2006 | B2 |
| 7147655 | Chermoni | Dec 2006 | B2 |
| 7147656 | Andreas et al. | Dec 2006 | B2 |
| 7169172 | Levine et al. | Jan 2007 | B2 |
| 7175654 | Bonsignore et al. | Feb 2007 | B2 |
| 7182779 | Acosta et al. | Feb 2007 | B2 |
| 7192440 | Andreas et al. | Mar 2007 | B2 |
| 7220755 | Betts et al. | May 2007 | B2 |
| 7238197 | Sequin et al. | Jul 2007 | B2 |
| 7241308 | Andreas et al. | Jul 2007 | B2 |
| 7244336 | Andreas et al. | Jul 2007 | B2 |
| 7270668 | Andreas et al. | Sep 2007 | B2 |
| 7294146 | Chew et al. | Nov 2007 | B2 |
| 7300456 | Andreas et al. | Nov 2007 | B2 |
| 7309350 | Landreville et al. | Dec 2007 | B2 |
| 7314480 | Eidenschink et al. | Jan 2008 | B2 |
| 7320702 | Hammersmark et al. | Jan 2008 | B2 |
| 7323006 | Andreas et al. | Jan 2008 | B2 |
| 7326236 | Andreas et al. | Feb 2008 | B2 |
| 7351255 | Andreas | Apr 2008 | B2 |
| 7534449 | Saltzman et al. | May 2009 | B2 |
| 20010020154 | Bigus et al. | Sep 2001 | A1 |
| 20010020173 | Klumb et al. | Sep 2001 | A1 |
| 20010020181 | Layne | Sep 2001 | A1 |
| 20010035902 | Iddan et al. | Nov 2001 | A1 |
| 20010044595 | Reydel et al. | Nov 2001 | A1 |
| 20010044632 | Daniel et al. | Nov 2001 | A1 |
| 20010049547 | Moore | Dec 2001 | A1 |
| 20020037358 | Barry et al. | Mar 2002 | A1 |
| 20020052642 | Cox et al. | May 2002 | A1 |
| 20020091439 | Baker et al. | Jul 2002 | A1 |
| 20020092536 | LaFontaine et al. | Jul 2002 | A1 |
| 20020107560 | Richter | Aug 2002 | A1 |
| 20020111671 | Stenzel | Aug 2002 | A1 |
| 20020123786 | Gittings et al. | Sep 2002 | A1 |
| 20020128706 | Ospyka | Sep 2002 | A1 |
| 20020138132 | Brown | Sep 2002 | A1 |
| 20020151924 | Shiber | Oct 2002 | A1 |
| 20020151955 | Tran et al. | Oct 2002 | A1 |
| 20020156496 | Chermoni | Oct 2002 | A1 |
| 20020168317 | Daighighian et al. | Nov 2002 | A1 |
| 20020177890 | Lenker | Nov 2002 | A1 |
| 20020183763 | Callol et al. | Dec 2002 | A1 |
| 20020188343 | Mathis | Dec 2002 | A1 |
| 20020188347 | Mathis | Dec 2002 | A1 |
| 20020193873 | Brucker et al. | Dec 2002 | A1 |
| 20030045923 | Bashiri et al. | Mar 2003 | A1 |
| 20030093143 | Zhao et al. | May 2003 | A1 |
| 20030097169 | Brucker et al. | May 2003 | A1 |
| 20030114912 | Sequin et al. | Jun 2003 | A1 |
| 20030114919 | McQuiston et al. | Jun 2003 | A1 |
| 20030114922 | Iwasaka et al. | Jun 2003 | A1 |
| 20030125791 | Sequin et al. | Jul 2003 | A1 |
| 20030125800 | Shulze et al. | Jul 2003 | A1 |
| 20030125802 | Callol et al. | Jul 2003 | A1 |
| 20030135259 | Simso | Jul 2003 | A1 |
| 20030135266 | Chew et al. | Jul 2003 | A1 |
| 20030139796 | Sequin et al. | Jul 2003 | A1 |
| 20030139797 | Johnson et al. | Jul 2003 | A1 |
| 20030139798 | Brown et al. | Jul 2003 | A1 |
| 20030163085 | Tanner et al. | Aug 2003 | A1 |
| 20030176909 | Kusleika | Sep 2003 | A1 |
| 20030191516 | Weldon et al. | Oct 2003 | A1 |
| 20030195609 | Berenstein | Oct 2003 | A1 |
| 20030199821 | Gerdts et al. | Oct 2003 | A1 |
| 20030204238 | Tedeschi | Oct 2003 | A1 |
| 20030208223 | Kleiner | Nov 2003 | A1 |
| 20030212447 | Euteneuer | Nov 2003 | A1 |
| 20030225446 | Hartley | Dec 2003 | A1 |
| 20040024450 | Shulze et al. | Feb 2004 | A1 |
| 20040030380 | Shulze et al. | Feb 2004 | A1 |
| 20040044395 | Nelson | Mar 2004 | A1 |
| 20040073290 | Chouinard | Apr 2004 | A1 |
| 20040093061 | Acosta et al. | May 2004 | A1 |
| 20040093067 | Israel | May 2004 | A1 |
| 20040106979 | Goicoechea | Jun 2004 | A1 |
| 20040111145 | Serino et al. | Jun 2004 | A1 |
| 20040117008 | Wnendt et al. | Jun 2004 | A1 |
| 20040143322 | Litvack et al. | Jul 2004 | A1 |
| 20040176832 | Hartley et al. | Sep 2004 | A1 |
| 20040181239 | Dorn et al. | Sep 2004 | A1 |
| 20040186551 | Kao et al. | Sep 2004 | A1 |
| 20040193245 | Deem et al. | Sep 2004 | A1 |
| 20040215165 | Coyle et al. | Oct 2004 | A1 |
| 20040215312 | Andreas et al. | Oct 2004 | A1 |
| 20040230285 | Gifford, III et al. | Nov 2004 | A1 |
| 20040243217 | Andersen et al. | Dec 2004 | A1 |
| 20040249434 | Andreas et al. | Dec 2004 | A1 |
| 20050010276 | Acosta et al. | Jan 2005 | A1 |
| 20050038494 | Eidenschink | Feb 2005 | A1 |
| 20050038505 | Shulze et al. | Feb 2005 | A1 |
| 20050049673 | Andreas et al. | Mar 2005 | A1 |
| 20050080474 | Andreas et al. | Apr 2005 | A1 |
| 20050080475 | Andreas et al. | Apr 2005 | A1 |
| 20050085897 | Bonsignore | Apr 2005 | A1 |
| 20050090846 | Pedersen et al. | Apr 2005 | A1 |
| 20050125051 | Eidenschink et al. | Jun 2005 | A1 |
| 20050131008 | Betts et al. | Jun 2005 | A1 |
| 20050143827 | Globerman et al. | Jun 2005 | A1 |
| 20050165378 | Heinrich et al. | Jul 2005 | A1 |
| 20050209674 | Kutscher et al. | Sep 2005 | A1 |
| 20050222671 | Schaeffer et al. | Oct 2005 | A1 |
| 20050228477 | Grainger et al. | Oct 2005 | A1 |
| 20050245637 | Hossainy et al. | Nov 2005 | A1 |
| 20050288764 | Snow et al. | Dec 2005 | A1 |
| 20050288766 | Plain et al. | Dec 2005 | A1 |
| 20060069424 | Acosta et al. | Mar 2006 | A1 |
| 20060173529 | Blank | Aug 2006 | A1 |
| 20060200223 | Andreas et al. | Sep 2006 | A1 |
| 20060206190 | Chermoni | Sep 2006 | A1 |
| 20060229700 | Acosta et al. | Oct 2006 | A1 |
| 20060229706 | Shulze et al. | Oct 2006 | A1 |
| 20060271150 | Andreas et al. | Nov 2006 | A1 |
| 20060271151 | McGarry et al. | Nov 2006 | A1 |
| 20060282147 | Andreas et al. | Dec 2006 | A1 |
| 20060282149 | Kao | Dec 2006 | A1 |
| 20060282150 | Olson et al. | Dec 2006 | A1 |
| 20060287726 | Segal et al. | Dec 2006 | A1 |
| 20070027521 | Andreas et al. | Feb 2007 | A1 |
| 20070043419 | Nikolchev et al. | Feb 2007 | A1 |
| 20070067012 | George et al. | Mar 2007 | A1 |
| 20070088368 | Acosta et al. | Apr 2007 | A1 |
| 20070088420 | Andreas et al. | Apr 2007 | A1 |
| 20070088422 | Chew et al. | Apr 2007 | A1 |
| 20070100424 | Chew et al. | May 2007 | A1 |
| 20070106365 | Andreas et al. | May 2007 | A1 |
| 20070118202 | Chermoni | May 2007 | A1 |
| 20070118203 | Chermoni | May 2007 | A1 |
| 20070118204 | Chermoni | May 2007 | A1 |
| 20070129733 | Will et al. | Jun 2007 | A1 |
| 20070135906 | Badylak et al. | Jun 2007 | A1 |
| 20070156225 | George et al. | Jul 2007 | A1 |
| 20070156226 | Chew et al. | Jul 2007 | A1 |
| 20070179587 | Acosta et al. | Aug 2007 | A1 |
| 20070219612 | Andreas et al. | Sep 2007 | A1 |
| 20070219613 | Kao et al. | Sep 2007 | A1 |
| 20070265637 | Andreas et al. | Nov 2007 | A1 |
| 20070270936 | Andreas et al. | Nov 2007 | A1 |
| 20070276461 | Andreas et al. | Nov 2007 | A1 |
| 20070281117 | Kaplan et al. | Dec 2007 | A1 |
| 20070292518 | Ludwig | Dec 2007 | A1 |
| 20080004690 | Robaina | Jan 2008 | A1 |
| 20080046067 | Toyokawa | Feb 2008 | A1 |
| 20080071345 | Hammersmark et al. | Mar 2008 | A1 |
| 20080077229 | Andreas et al. | Mar 2008 | A1 |
| 20080091257 | Andreas et al. | Apr 2008 | A1 |
| 20080097299 | Andreas et al. | Apr 2008 | A1 |
| 20080097574 | Andreas et al. | Apr 2008 | A1 |
| 20080132989 | Snow et al. | Jun 2008 | A1 |
| 20080147162 | Andreas et al. | Jun 2008 | A1 |
| 20080177369 | Will et al. | Jul 2008 | A1 |
| 20080199510 | Ruane et al. | Aug 2008 | A1 |
| 20080208311 | Kao et al. | Aug 2008 | A1 |
| 20080208318 | Kao et al. | Aug 2008 | A1 |
| 20080234795 | Snow et al. | Sep 2008 | A1 |
| 20080234798 | Chew et al. | Sep 2008 | A1 |
| 20080234799 | Acosta et al. | Sep 2008 | A1 |
| 20080243225 | Satasiya et al. | Oct 2008 | A1 |
| 20080249607 | Webster et al. | Oct 2008 | A1 |
| 20080269865 | Snow et al. | Oct 2008 | A1 |
| 20090076584 | Mao et al. | Mar 2009 | A1 |
| 20090105686 | Snow et al. | Apr 2009 | A1 |
| 20090149863 | Andreas et al. | Jun 2009 | A1 |
| 20090234428 | Snow et al. | Sep 2009 | A1 |
| 20090264979 | Kao et al. | Oct 2009 | A1 |
| 20100004729 | Chew et al. | Jan 2010 | A1 |
| Number | Date | Country |
|---|---|---|
| 1 953 1659 | Mar 1997 | DE |
| 1 963 0469 | Jan 1998 | DE |
| 199 50 756 | Aug 2000 | DE |
| 101 03 000 | Aug 2002 | DE |
| 0 282 143 | Sep 1988 | EP |
| 0 505 686 | Sep 1992 | EP |
| 0 714 640 | Jun 1996 | EP |
| 0 596 145 | May 1997 | EP |
| 1 290 987 | Mar 2003 | EP |
| 1 318 765 | Jun 2003 | EP |
| 03-133446 | Jun 1991 | JP |
| 10-503663 | Apr 1998 | JP |
| 10-295823 | Nov 1998 | JP |
| 2935561 | Aug 1999 | JP |
| 2001-190687 | Jul 2001 | JP |
| 2004-121343 | Apr 2004 | JP |
| WO 9526695 | Oct 1995 | WO |
| WO 9639077 | Dec 1996 | WO |
| WO 9901087 | Jan 1999 | WO |
| WO 0012832 | Mar 2000 | WO |
| WO 0015151 | Mar 2000 | WO |
| WO 0032136 | Jun 2000 | WO |
| WO 0056237 | Sep 2000 | WO |
| WO 0072780 | Dec 2000 | WO |
| WO 0191918 | Dec 2001 | WO |
| WO 02085253 | Oct 2002 | WO |
| WO 02098326 | Dec 2002 | WO |
| WO 03022178 | Mar 2003 | WO |
| WO 03051425 | Jun 2003 | WO |
| WO 2004043299 | May 2004 | WO |
| WO 2004052237 | Jun 2004 | WO |
| WO 2005009295 | Feb 2005 | WO |
| WO 2007053187 | May 2007 | WO |
| Number | Date | Country | |
|---|---|---|---|
| 20070100423 A1 | May 2007 | US |
| Number | Date | Country | |
|---|---|---|---|
| 60364389 | Mar 2002 | US | |
| 60336967 | Dec 2001 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 10884616 | Jul 2004 | US |
| Child | 11563793 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 10874859 | Jun 2004 | US |
| Child | 10884616 | US | |
| Parent | 10637713 | Aug 2003 | US |
| Child | 10874859 | US | |
| Parent | 10412714 | Apr 2003 | US |
| Child | 10637713 | US | |
| Parent | 10306813 | Nov 2002 | US |
| Child | 10412714 | US |
