The present invention relates to the field of active implantable medical devices (AIMDs). More particularly, the present invention describes various strain relief designs that are supported by a header assembly for an AIMD to help reduce tension and stress on a lead after the medical device is implanted in a body and the lead electrodes are connected to body tissue.
An AIMD has at least one implantable lead that is connected to a series of co-axially aligned terminal blocks in the device header. The proximal portion of the lead connected to the device header has a plurality of proximal electrical contacts that correspond to the number of terminal blocks in the header. The terminal block assembly in the header in turn is connected to control circuitry that is housed inside the device and powered by an electrical power source, such as a primary or rechargeable, secondary electrochemical cell. When the proximal electrical contacts of the lead are inserted into the terminal block assembly in the header, the lead contacts are electrically connected to the control circuitry. The lead is designed to deliver electrical stimulation to body tissue or sense biological signals from the body tissue, or both stimulate and sense.
It is important for an AIMD to have a strain relief member. Typically, the strain relief member is embedded in the device header where the lead exits the header, or the strain relief member is part of the implantable lead itself. Whether embedded in the device header or a fixed part of the lead, the strain relief member helps to reduce tension and stress on the lead after the medical device is implanted in a body and the distal electrodes are connected to body tissue. The strain relief member also helps to protect the lead from being damaged against sharp edges and to prevent sharp bends.
For example, when an AIMD is implanted in a skull during a craniometry procedure, the strain relief member is particularly important since it protects the lead from the edges of the cranial pocket when the lead transitions from the device header to the outer surface of the skull. If chafing and abrasion of the polymeric outer insulation of a lead against the edges of the cranial pocket is too severe, it could expose the electrical conductors of the lead to body fluids, which could result in an undesirable short circuit condition. A significant drawback with convention designs, however, is that the strain relief member is of a fixed length and geometry that does not permit any flexibility regarding the final implanted configuration.
However, simply lengthening a conventional strain relief member is not necessarily going to solve this problem. A longer strain relief member has the consequence of higher insertion forces when the lead is moved into the header assembly, which in turn can generate buckling issues that possibly prevent the electrical contacts of the lead from properly aligning with the terminal block assembly in the device header.
In that respect, there is a need for various designs for auxiliary strain relief members that are used in conjunction with conventional strain relief members to form a new strain relief assembly. The new strain relief assembly should be long enough to protect the lead from chafing and abrasion of its polymeric outer insulation and to help reduce tension and stress on the lead after the medical device is implanted in a body and the distal electrodes are connected to body tissue. An example of this is when a lead lays against the edges of a cranial pocket in the skull during a craniometry procedure. Additionally, the strain relief assembly must not adversely impact the force needed to insert a lead into the header assembly.
The present invention is directed to various auxiliary strain relief members that are connected to a conventional strain relief member to form a new strain relief assembly that improves protection of a lead for an extended length without increasing the force needed to insert the lead into the header assembly. This is particularly important in medical devices that are implanted in the skull or near bones. Moreover, possible lead buckling issues are also avoided.
Consequently, a strain relief system according to the present invention has two main parts, which gives a surgeon the option of using both parts. The first part is the conventional strain relief member that is embedded in the device header or is a fixed part of the lead. The other part is an auxiliary strain relief member that is connected to the conventional strain relief member. That way, the surgeon has the option of using only the embedded strain relief member or both the embedded and auxiliary strain relief members. Using both strain relief members as an assembly increases the length of the lead that is protected from tension and stress and possibly chafing against a sharp edge of the cranial pocket during, for example, a craniometry.
In that regard, the present inventive subject matter is directed to various designs for auxiliary strain relief members that are connected to a conventional strain relief member to provide a strain/bend relief assembly for an implantable lead. The strain relief assembly helps protect the lead from chafing and unintended wear when exiting the medical device and, for example, when passing over the edge of the cavity formed in the skull during a craniectomy. That is without increasing the size of the implantable medical device or without increasing the force needed to insert the lead into the device header. The lead must also be securely fixed and supported inside the strain relief assembly. Moreover, the present auxiliary strain relief members provide options for the strain relief geometry that can be selected by the surgeon during the implant procedure. This means that the strain relief assembly can be customized to suit each patient's anatomy. For example, one of the design concepts permits trimming the length of the auxiliary strain relief member during the implant procedure.
Also, it is important to highlight that the lead is not fixed to the header of the medical device by the present auxiliary strain relief members. Instead, the auxiliary strain relief members only add strain/bend relief to the lead in addition to the protection that is already provided by the conventional strain relief member. That way, the auxiliary strain relief members of the present invention add flexibility to the final implanted system without increasing the force needed to insert the lead into the device header.
These and other aspects of the present invention will become increasingly more apparent to those skilled in the art by reference to the following detailed description and to the appended drawings.
As used herein, the term “active implantable medical device” means an implantable medical device that is designed to deliver electrical stimulation to the body tissue of a patient or sense biological signals from the body tissue, or both stimulate and sense.
Turning now to the drawings,
The medical device 10 has a hermetically sealed housing 16 connected to a header assembly 18. The housing 16 provides an enclosure for the medical device including its control circuitry (not shown) and an electrical power source (not shown), such as a primary or rechargeable, secondary electrochemical cell connected to the control circuitry. Typically, the header assembly 18 is either molded directly onto a lid for the device housing 16 or it is a pre-molded assembly which is later secured to the housing lid. Suitable moldable polymeric materials for header body 110 include urethanes, such as e.g., TECOTHANE®, an aromatic polyether-based thermoplastic polyurethane sold by the Thermedics Polymeric Products Company of Wilmington, Mass.
In either case, the header assembly 18 serves as a structure that supports a plurality of co-axially aligned terminal blocks 20. An annular insulative member 22 between adjacent terminal blocks 20 prevents them from shorting to each other. The terminal blocks 20 are individually connected to the distal end of a feedthrough terminal pin 23 that extends into the device housing 16 where the pin is connected to the control circuitry. The arrangement shown in
A set screw block 24 molded into the header assembly 18 is aligned with the terminal blocks 20 and the insulative members 22. The set screw block 24 extends from a proximal outwardly extending rim to a distal outwardly extending rim abutting the first terminal block 20. An intermediate, upstanding portion of the set screw block 24 has a threaded lateral opening 26 that is in open communication with a lumen 28 that extends to the proximal and distal rims.
The header assembly 18 also has four proximally-facing openings 30 that align with the lumen 28 in a corresponding set screw block 24. This provides open communication for an implantable lead 32 to a respective row of the co-axially aligned terminal blocks 20. The drawings further show that the header assembly 18 supports a number of prior art or conventional cylindrically-shaped strain relief members 34 that are formed from a relatively pliable polymeric material, for example, polyurethane, and are received in one of the header openings 30, abutting the proximal end of a set screw block 24. The strain relief members 34 have an enlarged annular rim 34A with a diameter D1 (
In the exemplary embodiment shown in the drawings, each of the four implantable leads 32 has a number of electrical conductors (not shown) that extend along its length from at least one distal electrode (not shown) to a respective one of eight electrical contacts 36 located at a proximal end 38 of the lead. To connect an implantable lead 32 to the device's control circuitry, the proximal end 38 of the lead 32 is inserted into a strain relief member 34 and through the lumen 28 of a set screw block 24 to position its electrical contacts 36 inside a corresponding one of the aligned terminal blocks 20 encased in the header assembly 18. That way, the implantable lead 32 is detachably connected to the aligned terminal blocks 20 for electrically connecting the distal electrode to the device's control circuitry. When connected to a body organ or body tissue, the at least one distal electrode controlled by the control circuitry serves to deliver electrical stimulation to the body tissue of a patient or sense biological signals from the body tissue, or to both stimulate and sense.
As shown in
In a typical medical procedure, such as a craniotomy, the distance between the end of the fixed-length strain relief members 34 and the adjacent edge 12A of the cranial pocket 12 is relatively short. This means that the implantable leads 32 exit the strain relief members 34 and make a rather abrupt bend before resting against the edge 12A of the cranial pocket where they can rub against the skull 14. The concern is that this contact between the leads 32 and the edge 12A of the cranial pocket 12 could damage the polymeric outer insulation of the leads. If chafing and abrasion of the polymeric outer insulation of a lead is too severe, it could expose body fluids to the electrical conductors extending from the proximal electrical contacts 36 to the distal electrode. This could result in a short circuit condition for the implantable lead 32 which, of course, is undesirable.
A polymeric cap 48 is seated in the threaded lateral opening 26, abutting the set screw 46. The polymeric cap 48 helps to keep body fluids from entering the lumen 28 of the set screw block 24 and then into the terminal blocks 20. A pair of side-by-side O-rings 50 molded into the header assembly 18 surrounds a stem portion of the strain relief member 24. These O-rings 50 help to keep body fluids from entering the set screw block 24 and then into the terminal blocks 20.
Finally, a loop coil or wire 52 connected to the control circuitry inside the device housing 16 serves as a bidirectional telemetry antenna for transmitting and receiving telemetry signals or as a charging coil for wirelessly charging the electrical power source for the implantable medical device 10. In another embodiment, the loop wire 52 is used to both charge the medical device and to conduct telecommunications with the medical device 10.
There are several drawbacks attributed to the use of the conventional strain relief members 34. For one, the portion of the strain relief member that extends outwardly beyond the header assembly 18 is relatively short. As shown in
Each shaped opening 66 in the manifold 62 extends along an opening axis from a proximal wall 62A to a distal wall 62B of the manifold and has an opening 66A with a diameter X1 at the proximal wall 62A. The opening 66A leads to a tapered portion that extends downwardly towards and distally along the opening axis to a narrowed opening having a diameter X2 immediately adjacent to an enlarged inner annular recess 66B having a diameter X3. The diameter X3 of the enlarged annular recess 66B perpendicular to the opening axis is greater than both the diameter X1 of the opening 66A and the diameter X2 of the narrowed opening X2 immediately adjacent to the annular recess 66B. Further, the diameter X1 of the opening 66A at the proximal wall 62A is either greater than, equal to or less than the diameter D1 of the enlarged annular rim 34A. However, the compliant polymeric material comprising the auxiliary strain relief member 32 is compliant enough to permit the enlarged annular rim 34A to be moved into the opening 66A and slid down the tapered portion of the shaped opening until the enlarged annular rim 34A is snap-fit into the inner annular recess 66B. The annular recess 66B in turn is in open communication with a cylindrically-shaped open portion 66C that leads to the distal wall 62B of the manifold 62.
In use, with a manifold opening 66 in the auxiliary strain relief device 60 mated to a conventional strain relief member 34, the annular recess 66B receives the enlarged annular rim 34A of the strain relief member in a snap-fit connection. The snap-fit connection of each shaped opening 66 with a corresponding strain relief member 34 secures the auxiliary strain relief device to the plurality of conventional strain relief members connected to the header assembly 18 of the medical device 10.
The distal platform 64 of the auxiliary strain relief device 60 has a planar floor 67 interrupted by a number of spaced-apart open channels 68. Each channel 68 extends distally from the cylindrically-shaped open portion 66C of a shaped opening 66 in the manifold 62 to a distal edge of the platform. In that manner, the open channels 68 are aligned with a corresponding one of the manifold openings 66.
Then, with the number of shaped openings 66 in the auxiliary strain relief device 60 connected to the conventional strain relief members 34, an implantable lead 32 is connected to the device's header assembly 18 by moving its proximal portion 38 comprising the spaced-apart electrical contacts 36 into and through the cylindrically-shaped open portion 66C, then through the enlarged inner annular recess 66B and the tapered opening portion to the proximal wall 62A of the manifold portion 62 which, in turn, is in open communication with the conventional strain relief member 34 leading to the lumen 28 of the set screw block 24 and then the series of terminal blocks 20 and intermediate insulative members 22 of the header assembly.
With the proximal portion 38 of the implantable lead 32 securely connected to the header assembly 18, the distal portion of the lead 32 which extends distally from the manifold 62 is press-fit into an open channel 68 in the platform 64. In this position, the lower half of the lead 32 is nested in the open channel 68 with the upper half being exposed. However, as previously shown in
An advantage of the auxiliary strain relief device 60 of the present invention is that the planar floor 67 helps to further reduce contact between the lead 32 and the auxiliary strain relief device 60 as the lead is inserted into an opening 66 in the manifold 62. The open space at the entrance to the manifold opening 66 helps to reduce the force needed to position the proximal portion 38 of the lead 32 and its electrical contacts 36 in the axially aligned terminal blocks 20.
However, unlike the auxiliary strain relief device 60 shown in
In use, that portion of the lead 32 extending distally from the manifold 82 is received in an open channel 89 and then snap-fit into a groove 92 in the upstanding wall 90. That way, the planar floor 88 serves to further reduce the amount of contact between the lead 32 and the auxiliary strain relief device 80 as the lead is inserted into a shaped opening 86 in the manifold 82. The open space at the entrance to the shaped opening 86 helps to reduce the force needed to position the proximal portion 38 of the lead 32 and its electrical contacts 36 in the axially aligned terminal blocks 20.
Further, the platform 104 of the auxiliary strain relief device 100 shown in
This auxiliary strain relief device 100 further has an ear portion 110 extending outwardly from an upper edge 104A of the platform 104. The ear 110 has a blind bore 112. An outwardly extending moveable wing 114 is connected to a lower edge 104B of the platform 104 by a living hinge 116. The wing 114 supports an outwardly extending post 118. That way, after the leads 32 are secured in the header assembly 18 with the auxiliary strain relief device 100 snap-fit onto the conventional strain relief members 34 and with the leads nested in a respective open channel 108, the wing 114 is pivoted about its living hinge 116 until the post 118 is aligned with the blind bore 112 in the ear 110. The post 118 is then snap-fit into engagement with the blind bore 112 to secure the wing 114 over the leads 32 nested in the open channels 108. In that manner, the wing 114 serves as an additional structure that helps to secure the leads 32 extending through the conventional strain relief members 34 connected to the present invention strain relief device 100.
Additionally, it is within the scope of the present invention that the wing 114 connected to the blind bore 112 in the ear 110 of the auxiliary strain relief member shown in
Each shaped opening 122 extends along an opening axis from a proximal wall 120A to a distal wall 120B of the auxiliary strain relief device 120 and has a tapered opening portion 122A that begins at the proximal wall 120A. The tapered opening portion 122A extends downwardly towards and distally along the opening axis to an enlarged inner annular recess 122B. The enlarged annular recess 122B has a diameter about the opening axis that is greater than the diameter of the tapered portion 122A immediately adjacent to the annular recess 122B. The annular recess 122B in turn is in open communication with a cylindrically-shaped open portion 122C that leads to the distal wall 120B.
In use, an implantable lead 32 is moved first through the cylindrically-shaped open portion 122C, the enlarged inner annular recess 122B and then the tapered opening portion 122A extending to the proximal wall 120A of the auxiliary strain relief device 120. However, the auxiliary strain relief device 120 is not yet connected to the strain relief member 34 of the medical device 10. The lead 32 in then moved into the header assembly 18 until the electrical contacts 36 at its proximal portion 38 are connected to the terminal blocks 20. With the lead 32 secured in this position after the set screw 46 is threaded into contact with the lead and the polymeric cap 48 is seated in the threaded lateral opening 26 against the screw, the auxiliary strain relief device 120 is moved in a proximal direction towards the medical device 10 until the annular recess 122B receives the enlarged annular rim 34A of the strain relief member in a snap-fit connection. The snap-fit connection of each shaped opening 122 in the auxiliary strain relief device 120 with a corresponding strain relief member 34 secures the auxiliary strain relief device to the plurality of conventional strain relief members connected to the header assembly 18 of the medical device 10. With the auxiliary strain relief device 120 connected to the conventional strain relief members 34, the resulting strain relief assembly provides the leads 32 with additional protection from tension and stress after the medical device 10 is implanted in a body and the distal electrodes are connected to body tissue.
Thus, various auxiliary strain relief members have been described. The auxiliary strain relief members are detachably connected to a conventional strain relief member to form a new strain relief assembly that improves protection of a lead for an extended length without unduly increasing the force needed to insert the lead into the header assembly. This is particularly important in medical devices that are implanted in the skull or near bones.
It is appreciated that various modifications to the inventive concepts described herein may be apparent to those skilled in the art without departing from the spirit and scope of the present invention as defined by the hereinafter appended claims.
This application claims priority to U.S. Provisional Application Ser. No. 63/418,066, filed on Oct. 21, 2022.
Number | Date | Country | |
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20240131347 A1 | Apr 2024 | US |
Number | Date | Country | |
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63418066 | Oct 2022 | US |