Cardiovascular imaging system

Information

  • Patent Grant
  • 10959699
  • Patent Number
    10,959,699
  • Date Filed
    Thursday, March 15, 2018
    6 years ago
  • Date Issued
    Tuesday, March 30, 2021
    3 years ago
Abstract
Embodiments of the present invention include a laser catheter that includes a catheter body, a light guide, and a distal tip that extends beyond the exit aperture of the light guide. In some embodiments, an imaging device is disposed on the distal tip such that the imaging device is distal relative to the exit aperture of the light guide. In some embodiments, the imaging device can be gated to record images during and or slightly beyond periods when the laser catheter is not activated.
Description
BACKGROUND

Arteries are the primary blood vessels that are responsible for providing blood and oxygen to the heart muscle. Arterial disease occurs when arteries become narrowed or blocked by a buildup of plaque (as some examples, atherosclerotic plaque or other deposits). When the blockage is severe, the flow of blood and oxygen to the heart muscle is reduced, causing chest pain. Arterial blockage by clots formed in a human body may be relieved in a number of traditional ways. Drug therapy, including nitrates, beta-blockers, and peripheral vasodilatator drugs to dilate the arteries of thrombolytic drugs to dissolve the clot, can be effective. If drug treatment fails, angioplasty may be used to reform or remove the atherosclerotic plaque or other deposits in the artery.


Traditional balloon angioplasty is sometimes used to address the blockage by inserting a narrow, flexible tube having a balloon into an artery in the arm or leg. The blocked area in the artery can be stretched apart by passing the balloon to the desired treatment site and gently inflating it a certain degree. In the event drug therapy is ineffective or angioplasty is ineffective or too risky (often introduction of a balloon in an occluded artery can cause portions of the atherosclerotic material to become dislodged, which may cause a total blockage at a point downstream of the subject occlusion, thereby requiring emergency procedures), the procedure known as excimer laser angioplasty may be indicated.


Excimer laser angioplasty procedure is similar in some respects to conventional coronary balloon angioplasty. A narrow, flexible tube, the laser catheter, is inserted into an artery in the arm or leg. The laser catheter contains one or more optical fibers, which can transmit laser energy. The laser catheter is then advanced inside the artery to the targeted obstruction at the desired treatment site. After the laser catheter has been positioned, the laser is energized to “remove” the obstruction.


In many procedures, the lesion is often engaged similar to conventional balloon angioplasty by crossing the blockage with a guidewire. The laser catheter's thin, flexible optical fibers facilitate the desired positioning and alignment of the catheter. Using the excimer laser, the clinician performs a controlled blockage removal by sending bursts of ultraviolet light through the catheter and against the blockage, a process called “ablation.” The catheter is then slowly advanced through the blockage reopening the artery. If there are multiple blockages, the catheter is advanced to the next blockage site and the above step is repeated. When the indicated blockages appear to be cleared, the catheter is withdrawn.


Due to the configuration of the optical fibers in most prior art laser catheters, the clinician is able to ablate only material that is typically directly in front of the distal end of the catheter. Thus, the debulked tissue area is limited to an area approximately the size of the optical fiber area at the distal end of the catheter. Typically, follow-up balloon angioplasty is recommended.


Imaging during atherectomy or angioplasty procedures often uses fluoroscopy imaging techniques for targeting and ablation of blockages. Fluoroscopy, however, has limitations. For example, does not allow a doctor or technician to visualize plaque or vessel walls.


BRIEF SUMMARY

Embodiments of the invention are directed toward laser catheters. In one embodiment, a laser catheter can include a catheter body, a light guide, a distal tip, and an imaging device disposed distal relative to the exit aperture of the light guide. The catheter body, for example may include a central axis, a proximal end and a distal end. The catheter body may also include a lumen disposed between the proximal end and the distal end, the lumen having an opening at the distal end. The light guide may also include a proximal end and a distal end. In some embodiments, the light guide may also include at least one fiber optic and may at least partially be disposed within the lumen and/or movable therein. The distal tip may be positioned at the periphery of the catheter body and may extend from the distal end of the catheter body. The imaging device can be disposed on the distal tip, for example, at a position distal from the exit aperture of the light guide. The distal tip may also include a guidewire lumen that includes a guidewire port at the distal end of the distal tip. A retaining wire may also be used in some embodiments and can be coupled with the distal tip and slidably coupled with the light guide. A balloon, for example, may be positioned between the opening at first distal end of the catheter body and distal tip.


Some embodiments of the invention can also include a balloon catheter. The balloon catheter can include a catheter body, for example may include a central axis, a proximal end and a distal end. The catheter body may also include a lumen disposed between the proximal end and the distal end, the lumen having an opening at the distal end. The balloon catheter can also include a light guide that may also include a proximal end and a distal end. In some embodiments, the light guide may also include at least one fiber optic and may at least partially be disposed within the lumen and/or moveable therein. The balloon can be disposed at the radial exterior of the catheter body. In use, for example, the balloon can be inflated such that the balloon makes contact with the vessel wall. Contact with the vessel wall can move the distal tip of the catheter away from vessel wall toward an opposing vessel wall.


Some embodiments of the invention can also include an imaging catheter that gates imaging during ablation. For example, an imaging catheter can include a light guide coupled with a laser and an imaging device disposed distally relative to the light guide exit aperture. During operation, in some embodiments, images from the light guide can be filtered and/or gated while the laser is activated. In other embodiments, the imaging device can be deactivated during ablation.


The following detailed description, together with the accompanying drawings, will provide a better understanding of the nature and advantage of the embodiments disclosed herein.





BRIEF DESCRIPTION OF THE DRAWINGS


FIG. 1 shows a laser catheter system according to one embodiment.



FIGS. 2A and 2B show examples of laser catheters with a distal imaging device according to some embodiments of the invention.



FIG. 3A shows a side view of a laser catheter according to one embodiment of the invention.



FIG. 3B shows a side view of a balloon laser catheter according to one embodiment of the invention.



FIG. 4A shows a section of the catheter in FIG. 3A along line A-A.



FIG. 4B shows a cross section of the catheter in FIG. 3A along line B-B.



FIG. 4C shows a cross section of the catheter in FIG. 3A along line C-C.



FIG. 4D shows a cross section of the catheter in FIG. 3A along line D-D.



FIG. 4E shows a cross section of the catheter in FIG. 3A along line E-E.



FIG. 4F shows a cross section of the catheter in FIG. 3B along line F-F.



FIG. 5A shows a side view of a laser catheter with a ramp according to one embodiment of the invention.



FIG. 5B shows a side view of an engaged laser catheter with a ramp according to one embodiment of the invention.



FIG. 6A shows a cross section of the catheter in FIG. 5A along line A-A.



FIG. 6B shows a cross section of the catheter in FIG. 5A along line B-B.



FIG. 6C shows a cross section of the catheter in FIG. 5A along line C-C.



FIG. 6D shows a cross section of the catheter in FIG. 5A along line D-D.



FIG. 6E shows a cross section of the catheter in FIG. 5B along line E-E.



FIG. 7A shows a side view of a balloon catheter with the balloon deflated according to another embodiment of the invention.



FIG. 7B shows a side view of a balloon catheter with the balloon inflated according to another embodiment of the invention.



FIG. 8 is a side view of a balloon biasing catheter according to one embodiment.



FIGS. 9A, 9B, 10A, and 10B show a cutaway view of a balloon biasing catheter in use within a vessel according to one embodiment.



FIG. 11 is a flowchart describing one embodiment for using a biasing catheter.



FIG. 12 is another flowchart describing another embodiment for using a biasing catheter.



FIG. 13 is a flowchart describing another embodiment for using a biasing catheter in conjunction with an imaging device.





DETAILED DESCRIPTION

Embodiments of the present invention include a laser catheter that employs an imaging device. In some embodiments, the imaging device is disposed distal (or forward) relative to the exit aperture of the laser catheter. In some embodiments, the laser catheters can employ gating techniques to ensure that laser pulses don't interfere with imaging. Other embodiments include laser catheters that include balloons or tamps that can deflect the exit aperture of the laser catheter.



FIG. 1 shows a laser catheter system 100 in use according to one embodiment. A laser 130 is shown coupled with a user interface 180. In this embodiment the user interface 180 is computer programmed to control the laser 130. The laser, for example, may be an excimer laser. The laser, for example, may also produce light in the ultraviolet range. The laser is connected with a catheter 170 that may be inserted into a vessel of the human body 110. The laser catheter system 100 may employ one or more tapered waveguides that guide laser light from the laser 130 through the catheter 170 toward a target.



FIG. 2A shows laser catheter 200 with distal imaging device 260 according to some embodiments. Laser catheter 200 can include a catheter body 205 (or sheath) within which a fiber optic bundle 210 (or any other light guide) is disposed. Fiber optic bundle can include any number of optical fibers and, in some embodiments, can include a separate sheath. Catheter body 205 can include a distal end and a proximal end. The proximal end of catheter body 205 can include a coupler that is configured to couple with a laser source as shown in FIG. 1. The proximal end of the fiber optic bundle can also be coupled with the coupler in order to receive and conduct laser light through the optical fibers. The distal end of catheter body 205 includes opening 207 from which the distal end of fiber optic bundle 210 extends.


As shown in FIG. 2A, imaging device 260 is disposed distal relative to the exit aperture of optical light guide 210 (e.g., a fiber optic bundle). Light guide 210 can be disposed within sheath 205. In some embodiments, imaging device 260 can be disposed on eccentric distal tip 213. In other embodiments, imaging device 260 can be disposed on an axially placed distal tip. Distal tip can also extend. In yet other embodiments, imaging device 260 can be disposed distal relative to the exit aperture of light guide 210 in any configuration. In some embodiments, imaging device 260 can be positioned at least 0.4, 0.5, 0.6, 0.7, 0.8, 0.9, 1.0 cm longitudinally (or forward) from the distal end (or exit aperture) of light guide 210.


Imaging device 260, for example, can be an ultrasonic device such as an Intracoronary/Intravascular Ultrasound (ICUS/IVUS) device, which can employ very small transducers arranged on a catheter and provides electronic transduced echo signals to an external imaging system in order to produce a two of three-dimensional image of the lumen, the arterial tissue, plague, blockages, and/or tissue surrounding the artery. These images can be generated in substantially real time and can provide images of superior quality to the known x-ray imaging applications would also benefit from enhanced image resolution. An ultrasound device, for example, can include a flexible polyimide film layer.


Imaging device 260 can be coupled with a number of wires and/or fiber optics that extend through catheter body 205 toward the proximal end of catheter 200. For example, for IVUS imaging devices, seven braided wires can be used. Some or all of these wires, for example, can have a diameter less than 0.01 inches.



FIG. 3A shows laser catheter 300 according to another embodiment of the invention. Laser catheter 300 can include a catheter body 205 (or sheath) within which a fiber optic bundle 210 (or any other light guide) is disposed. Fiber optic bundle can include any number of optical fibers and, in some embodiments, can include a separate sheath. Catheter body 205 can include a distal end and a proximal end. The proximal end of catheter body 205 can include a coupler that is configured to couple with a laser source as shown in FIG. 1. The proximal end of the fiber optic bundle can also be coupled with the coupler in order to receive and conduct laser light through the optical fibers. The distal end of catheter body 205 includes opening 207 from which the distal end of fiber optic bundle 210 extends. Fiber optic bundle can include a marker band 211 at the distal tip of the fiber optic bundle that can include any number of sizes and/or shapes. Marker band 211, for example, can include a radiopaque material.


Catheter body 205 can include tip 213, that extends from opening 207. In some embodiments, tip 213 can be coupled with catheter body 205. In other embodiments, tip 213 can be integral with catheter body 205. In some embodiments, tip 213 can support the distal end of fiber optic bundle 210. Fiber optic bundle 205 can include a guidewire lumen that extends through a portion of the catheter body. During use guidewire 215 can be positioned within a vessel, laser catheter 200 can be threaded over guidewire 215 using the guidewire lumen in order to direct the catheter through a vessel toward a target. In some embodiments, guidewire lumen can extend through at least a portion of tip 213. Retaining wire 216 can extend from the distal tip of fiber optic bundle 210 and be coupled with tip 213. In some embodiments, retaining wire 216 and guidewire can be the same wire.


In some embodiments, tip 213 can also include an imaging device 260 disposed at the distal end of tip 213. Imaging device 260 can be located at least 0.4, 0.5, 0.6, 0.7, 0.8, 0.9, 1.0 cm longitudinally (or forward) from the distal end for exit aperture) of fiber optic bundle 210. Any type of imaging device can be used.


Imaging device 260 can include any ultrasound sensor or laser interferometry device. A laser interferometry device can include a plurality of fiber optics with an exit aperture disposed near the distal end of the laser catheter and extending through a sheath of the catheter. Imaging device 260, for example, can be formed cylindrically around tip 213 as a patch, or a ring. In some embodiments, imaging device 260 can include any shape or size.


In some embodiments, balloon 227 can be disposed between fiber optic bundle 210 and tip 213. In FIG. 3A balloon 227 is in the deflated state and not shown. Balloon 227 can be coupled with a balloon tube that can be used to inflate and/or deflate the balloon. Balloon tube can extend proximally through at least a portion of catheter body 205. In some embodiments, a balloon tube coupler can be provided that allows a doctor to attach a syringe (or other device) that can be activated to inflate and/or debate the balloon. FIG. 3B shows as example of laser catheter 300 with balloon 227 relisted. As seen, balloon 227 can be inflated in order to laterally shift the exit aperture of fiber optic bundle 210 relative to tip 213.



FIG. 4A shows a cross section of catheter 300 along line A-A according to some embodiments. As shown, catheter body 205 surrounds a plurality of fiber optics 217, guidewire lumen 240, balloon tube 230, and imaging wire bundle 235. In some embodiments, balloon tube 230 can have an outside diameter of about 0.008, 0.009, 0.010, 0.011, 0.012, 0.013, 0.014, or 0.015 inches. Any of these components may be included in a different combination or order, or excluded altogether. Guidewire 215 is shown within guidewire lumen 240. In some embodiments, balloon tube 235 and/or guidewire lumen 230 can be disposed within a sheath and/or a tube.



FIG. 4B shows a cross section of catheter 200 along line B-B according to some embodiments. In this embodiment, tip 213 includes balloon 206 in a deflated state. At some point, balloon tube 230 terminates within or at the boundary of balloon 206. Thus, balloon tube 230 can terminate at a number of different positions within balloon 206. Imaging wire bundle 235 extends through balloon 206. The junctions of imaging wire bundle 235 and balloon 206 can be sealed to ensure balloon inflates without a leak at the junction. Guidewire lumen 240 is placed concentrically within catheter body 205. In other embodiments guidewire lumen 240 can be located anywhere within catheter body 205, for example, guidewire lumen can be disposed eccentrically with catheter body (e.g., as shown in FIG. 6B). In some embodiments, guidewire lumen 230 can extend through balloon when a retaining wire is used.



FIG. 4C shows a cross section of catheter 200 along line C-C according to some embodiments. At this point, balloon tube 230 terminated within balloon 206 and only wire bundle 235 is found within balloon 206. FIG. 4D is a cross section of catheter 200 along line D-D showing imaging wire bundle 230 extending through tip 213 distal from balloon 206 according to some embodiments. In some embodiments, guidewire lumen 230 can extend through balloon when a retaining wire is used.



FIG. 4E is a cross section of catheter 200 along line E-E. Line E-E is distal relative to probe 260. Hence, distal tip portion 207 only includes guidewire lumen 240. In some embodiments, distal tip portion 207 can have an inside diameter similar or slightly larger than the outside diameter of guidewire lumen 240. FIG. 4F shows a cross section of catheter 210 in FIG. 3B along line F-F. Imaging wire bundle 235 is shown passing through balloon 206 while inflated.


In some embodiments, catheter body 205 may have a diameter of approximately 2.0 mm. Each fibers 217, for example, may be less than about 0.1 mm. As another example, the fibers may be less than about 0.05 mm. The fiber optics may be contained within bundle 210. For example, bundle 210 can be about 1.0 mm by about 2.0 mm. Guidewire lumen 230, for example, can have an inside diameter of approximately 0.024 inches and inside diameter of approximately 0.018 inches. In other embodiments, guidewire lumen 230 may have an outside diameter less than about 0.025 inches and/or an inside diameter less than about 0.02 inches.


While a fiber optic bundle 210 is shown in the figures, any type of light guide can be used. For example, a liquid light guide and or a solid light guide can be used in place of the fiber optic bundle without limitation.



FIG. 5A shows a side view of laser catheter 500 with ramp 505 according to one embodiment of the invention. Imaging device 260 can be found at the distal tip of the catheter body 205 forward (more distal) than the distal tip of fiber optic bundle 210. Fiber optic bundle 210 can be located at a first position relative to ramp 505 and can extend from aperture 207 of catheter body 205. Fiber optic bundle can be actuated forward into a second position as shown in FIG. 5B, such that distal end of fiber optic bundle 210 has actuated distally up and past ramp 505 toward the distal end of catheter 500. Retaining wire 216 can provide a restraining force on the distal end of fiber optic bundle 210 in order to keep the distal end substantially parallel with catheter body 205 while in the second position. In some embodiments, guidewire 215 can extend through a guidewire lumen through catheter body 205. In other embodiments, retaining wire 216 and guidewire 215 can be the same wire.


In some embodiments that include retaining wire 216, retaining wire 216 may be detachably coupled with either or both distal tip 213 and/or light guide 210. For example, retaining wire 216 may be connected with the distal tip using solder, clamps, glue, feed, etc. In some embodiments, retaining wire is soldered with radiopaque marker band 211. In other embodiments, retaining wire 216 may be coiled around the distal tip and glued or fused with distal tip 213. In some embodiments, retaining wire 216 may be sandwiched between distal tip 213 and radiopaque marker band 211. In some embodiments, retaining wire 216 may extend through a portion of light guide 210. For example, retaining wire 216 may extend through light guide 210 next to and/or with a plurality of optical fibers. Retaining wire 216 may aid in retaining the position and/or bias of the light guide when light guide is extended up ramp 505. Retaining wire 216 may also aid in providing the proper bias when light guide is extended up ramp 505. For example, retaining wire 216 may be lengthened and/or include elasticity such that biasing catheter may be more or less biased when light guide is extended up ramp 505. In some embodiments, retaining wire provides resistance to light guide 210 when balloon 705 is inflated and/or when light guide is extended up tamp 505, which may align light guide 210 parallel with distal tip 213 and/or catheter body 205.


Various other configurations of biasing laser catheters can be used. In some embodiments, laser catheters described in U.S. Pat. No. 7,572,254, entitled “Rapid Exchange Bias Laser Catheter Design,” which is incorporated herein by reference in its entirety, can be used in conjunction with various aspects described herein. Similarly, the laser catheters described in U.S. patent application Ser. No. 12/406,807, entitled “Apparatus and Methods for Directional Delivery of Laser Energy;” Ser. No. 12/265,441, entitled “Biasing Laser Catheter: Monorail Design;” Ser. No. 12/337,190, entitled “Eccentric Balloon Laser Catheter,” and/or Ser. No. 12/337,232, entitled “Rapid Exchange Bias Laser Catheter Design,” each of which are incorporated herein by reference in their entirety, can also be used in conjunction with various aspects described herein. For example, laser catheters described in any of the documents incorporated by reference can be implemented with distal imaging device.



FIG. 6A shows a cross section of catheter 500 along line A-A. Catheter body 205 surrounds a number of fiber optics 217, guidewire lumen 240, and imaging wire bundle 235. Any of these components may be included in a different combination, order, or excluded altogether. In some embodiments, guidewire lumen 240 can be positioned at any position within the catheter body. In some embodiments, balloon tube 235 and/or guidewire lumen 230 can be disposed within a sheath and/or a tube. In some embodiments, fiber optics 217 and/or guidewire lumen 240 can be bundled within a sheath. Thus, when the fiber optic bundle is actuated forward fiber optics 217 do not tangle with balloon lumen 235. Moreover, balloon lumen, in some embodiments, can be embedded within catheter body 205.



FIG. 6B shows a cross section of catheter 500 along line B-B. In some embodiments, guidewire lumen 217 is arranged eccentrically within fiber optic bundle 210 as shown in the figure. Guidewire 215 is shown within guidewire lumen 240. In other embodiments guidewire lumen 240 can be located anywhere within catheter body 205, for example, guidewire lumen can be disposed concentrically within catheter body (e.g., as shown in FIG. 2B). Imaging wire bundle 235 also extends through this portion of catheter 500.



FIG. 6C shows a cross section of catheter 500 along line C-C. This portion of catheter 500 includes tip 213 that extend more distally from aperture 207 and proximal to imaging device 260. Imaging wire bundle 235 also extends through this portion of catheter 500. FIG. 6D shows a cross section of catheter 500 along line D-D. This portion of catheter 500 is distal with respect to imaging device 260 and only the guidewire lumen 24 extends through this portion. FIG. 6E shows a cross section of catheter 500 alone line E-E showing fiber optic bundle 210 having been actuated up the ramp as shown in FIG. 5B.



FIG. 7A shows a side view of balloon catheter 700 with balloon 705 deflated according to another embodiment of the invention. In the deflated state, balloon catheter 700 is somewhat similar to catheter 200 shown in FIG. 3A. However, balloon catheter 700 differs from catheter 200 in that balloon 705 inflates radially as shown in FIG. 7B. In some embodiments, a physician can oblate blockage within a vessel (e.g., a human artery) using catheter 700. Catheter 700 can be positioned in front of the blockage with balloon 705 deflated. The laser can then be activated. During lasing catheter 700 can ablate a central portion of the blockage roughly the size of the exit aperture of catheter 210. In order to ablate portions of the blockage near the vessel's interior walls, balloon 705 can be inflated and pressed against an interior wall within the vessel. The pressure against the interior wall can shift the exit aperture of catheter 210 toward the opposite interior wall within the vessel allowing catheter 700 to ablate material near the vessel wall by activating the laser. Catheter 700 can be rotated by the physician in order to ablate the material near other portions of the interior wall of the vessel.


In some embodiments, catheter 700 can include imaging device 260 and in other embodiments imaging device 206 can be excluded. Similarly, catheters in some embodiments can include radiopaque band 211, while catheters in other embodiments do not.



FIG. 8 is a side view of balloon biasing catheter 800 according to one embodiment. A balloon biasing catheter may include a catheter body 205 (or elongated housing) with a light guide 210 disposed within a lumen of catheter body 205 and extending from an aperture within catheter body 205. For example, light guide 210 may include a plurality of fiber optics. As another example, the light guide may be a liquid light guide and/or a combination of a liquid light guide and a fiber optic light guide. In some embodiments, the light guide is free to slide within the lumen of the catheter body. In some embodiments, the light guide lumen may slide relative to the catheter body. In other embodiments, the light guide may be fixed within the lumen of the catheter body. Light guide 210 may be located within catheter body 205 and may extend from the proximal end of the catheter body to the distal end of the catheter body. At the proximal end of the catheter body, light guide 210 may terminate with laser coupler 715. The light guide lumen may include an aperture at or near the distal end of catheter body 205 from which light guide 210 may extend. In some embodiments, light guide 210 may extend 1-10 mm from the aperture. In some embodiments, light guide 210 may also include a radiopaque marker band 211 near the distal end.


A balloon biasing catheter may also include a guidewire lumen. The guidewire lumen may be configured to allow a guidewire to pass and/or slide therethrough. In some embodiments, the guidewire lumen may extend, for example, from distal guidewire port through a portion of catheter body 205. In some embodiments, the guidewire lumen may extend to or near the proximal end of catheter body 205. In other embodiments, guidewire lumen may extend from the distal end to a position proximal with the light guide aperture and/or proximal with balloon 227. The guidewire lumen may be configured to accept a guidewire and allow the guidewire to slide within the guidewire lumen. Proximal guidewire port 720 may be located anywhere along catheter body 205.


In some embodiments, catheter 800 can include balloon tube port 725 that can be coupled with balloon 227 via a balloon tube (e.g. balloon tube 230). In some embodiments balloon lumen may couple with a luer fitting at balloon tube port 725. Balloon tube port 725 can be configured to accept any type of syringe or pump that can pressurize and depressurize balloon 227. For example, the inner diameter of balloon lumen may be approximately 0.001 inches. In some embodiments, the inner diameter of the balloon lumen (or tube) may be between 0.0005 and 0.01 inches. The outside diameter of the balloon lumen, for example, may be 0.016 inches. In some embodiments, the outside diameter of the balloon lumen may be 0.05 to 0.005 inches. At balloon port or luer, the balloon may be coupled with a syringe or an indeflator. Balloon 705 may be inflated by injecting fluid through balloon lumen using either a syringe or an indeflator. In some embodiments, the balloon may be inflated using a contrast agent fluid or saline solution. The balloon lumen 1813 may include any type of plastic tubing known in the art. For example, balloon lumen 1813 may comprise nylon, Teflon, polyethylene, etc.


Guidewire lumen port 720 can also be included. Guidewire lumen port 720 can be coupled with guidewire lumen 240 and can allow a guidewire to extend through the distal end toward the proximal end of the catheter. A bifurcated cover can be used to separate the ports from the body of the catheter.



FIG. 9A shows a cutaway of a balloon biasing catheter in use within vessel 810 near target 805. The balloon biasing catheter may be inserted into vessel 810 by following guidewire 215 that may have been previously placed within vessel 810. Guidewire 215 may run through the guidewire lumen as shown in the figure. Balloon 705 is deflated in FIG. 9A. Light guide 210 may be activated and a portion of target 215 may be ablated. FIG. 18B shows results of ablation of target 805 with the balloon biasing catheter positioned as shown in FIG. 9A. Target 805 may not be completely ablated leaving portions 806, 807. In some embodiments, a hole within target 805 may result.



FIG. 9B shows light guide 210 biased axially by inflating balloon 705. When balloon 705 is inflated, the laser catheter can be axially biased toward target portion 807. Moreover, balloon 705 may be partially or fully inflated as needed to align light guide 210 with target portion 807. FIG. 10A shows a resulting example of ablation using the configuration in FIG. 9B. Target portion 807 has been at least partially ablated. In some embodiments, target portion 807 may be completely ablated.


After ablation of target portion 807, balloon 705 can be deflated and the catheter rotated within vessel 810 as shown in FIG. 10A. As shown in FIG. 108, balloon 705 can be inflated positioning light guide 210 toward target portion 806. In some embodiments, balloon 705 may remain inflated during rotation. In some embodiments, balloon biasing catheter and/or guidewire 215 may be advanced during any of the ablation steps. In some embodiment, balloon biasing catheter may be rotated 90° or any other angle in order to ablate other target portions and/or material near or adhering to a vessel wall. In some embodiments, during ablation as shown in FIGS. 9A, 9B, 10A and 10B, imaging of the interior of vessel 810 can occur using imaging device 260.


In some embodiments, laser catheters can include a balloon (e.g., balloon 705). Such balloons, for example, can have a diameter of about 1 mm to 3 mm when inflated. In some embodiments, balloon may have an inflated diameter up to about 5 mm and as little as 0.5 mm. In some embodiments, the balloon may compromise a portion of tubing with a sealed distal end. In some embodiments, a portion of tubing may form the balloon and have thinner walls and/or a larger diameter such that the balloon portion of the tubing inflates under pressure. A balloon, for example, may compromise any type of plastic, for example, the balloon may comprise nylon, Teflon, polyethylene, etc. A balloon, in some embodiments, may extend the entire length of distal tip 213. For example, balloon 705 may be 10 cm, 9 cm, 8 cm, 7 cm, 6 cm, 5 cm, 4 cm, 3 cm, 2 cm, or 1 cm in length.


In some embodiments, a balloon can be used to deflect a light guide, fiber optic bundle and/or catheter body. In doing so, the balloon, for example, may deflect the light guide, fiber optic bundle and/or catheter body 205 1.0 mm. In other embodiments, the light guide, fiber optic bundle and/or catheter body may be biased 0.5 mm, 1.5 mm, 2.0 mm, 2.5 mm, 3.0 mm etc. from a deflated position. By biasing the light inside, fiber optic bundle and/or catheter body, the balloon biasing catheter may ablate a larger diameter area than if the light guide is not biased.



FIG. 11 shows a flowchart of a process for using a biasing catheter according to one embodiment. Various other processes may be used that add to or take away from the process shown in FIG. 11 and described below. The proximal end of a guidewire is inserted through the distal guidewire port at the distal tip of the balloon biasing catheter at block 1005. The balloon biasing catheter may then be inserted into a vessel at block 1010 and slid over the guidewire and positioned near a target at block 1015. At block 1020 the laser may be activated ablating a portion of the target area. The balloon biasing catheter may be advanced at block 1023. Once ablation is complete, the laser is deactivated at block 1025. If portions of the target are not completely ablated, for example, if material remains near the vessel walls, then the balloon may be inflated at block 1030. When the balloon is inflated the distal tip of the balloon biasing catheter may be radially biased yet substantially parallel with the balloon biasing catheter and positioned to ablate unablated portions of the target. The laser may again be activated at block 1035 and portions of the target ablated. At block 1038 the balloon biasing catheter may be advanced toward the target. At block 1040 the laser is deactivated after a period of time and the balloon deflated at block 1045. If the ablation area is satisfactory and no more ablation is required as decided at block 1050 the balloon biasing catheter is removed at block 1060. However, if more ablation is required, the balloon biasing catheter may be rotated axially within the vessel at block 1055 and the process returns to block 1030.



FIG. 12 shows a flowchart of a process for using a biasing catheter according to one embodiment. This flow chart is substantially similar to the flowchart shown in FIG. 11. In this embodiment, however, at blocks 1123 and 1138 the light guide is advanced relative to the balloon biasing catheter. In such embodiments, the catheter body remains substantially still as the light guide is advanced to ablate target material.


While FIG. 11 and FIG. 12 are described in conjunction with a balloon biasing catheter, other types of biasing catheters can be used. For example, biasing catheters as those shown in FIG. 5A can also be used.



FIG. 13 is a flowchart describing another embodiment for using a biasing catheter in conjunction with an imaging device. Blocks 1005, 1010, and 1015 are similar to those described above in conjunction with FIG. 11. According to some embodiments, once the bias catheter has been positioned within a vessel (e.g., at block 1015), the interior of the vessel can be imaged using an imaging device (e.g., an ICUS/IVUS device). In some embodiments, the image of the interior of the vessel can be displayed on a display (e.g., the display associated with computer 180 shown in FIG. 1) such that a physician or doctor can view the interior of the vessel. In some embodiments, based on the image provided, the doctor can reposition the laser catheter.


At block 1210 if the laser is activated images produced by the imaging device can be filtered at block 1215. In some embodiments, the filtering can occur in real time. In other embodiments, the filtering can occur after the imaging has occurred. In some embodiments, filtering can occur by disabling the imaging device while the laser is activated. Moreover, imaging can be filtered for an extended period of time beyond the time the laser is activated. Filtering can also occur at a display, such, that, images produced while the laser is activated are not displayed to a user. If the laser is not activated at block 1215, the interior of the vessel can continued to be imaged at block 1210.


At block 1220, if the laser is not deactivated, images of the interior of the vessel can continue to be filtered at block 1215. Otherwise, the process continues to block 1225. At block 1225, if the procedure is not complete, the process returns to block 1205, otherwise imaging ceases at block 1230.


Various embodiments disclosed herein describe the use of an imaging device in conjunction with a laser catheter. Any type of imaging can be used. For example, the imaging device can include an ultrasound sensor or a laser interferometry device. A laser interferometry device can include a plurality of fiber optics with an exit aperture disposed near the distal end of the laser catheter and extending through a sheath of the catheter. The imaging device, for example, can be formed cylindrically, as a patch, or a ring.


An ultrasound device can include an Intracoronary/Intravascular Ultrasound (ICUS/IVUS) device that can employ very small transducers arranged on a catheter and provides electronic transduced echo signals to an external imaging system in order to produce a two or three-dimensional image of the lumen, the arterial tissue, plaque, blockages, and/or tissue surrounding the artery. These images can be generated in substantially real time and can provide images of superior quality to the known x-ray Imaging methods and apparatuses. Other imaging methods and intravascular ultrasound imaging applications would also benefit from enhanced image resolution. An ultrasound device, for example, can include a flexible polyimide film layer.


In some embodiments of the invention, imaging can be gated while the laser catheter is pulsing. Signal processing techniques can be implemented (e.g. at computer 180 in FIG. 1) that filters out optical, mechanical, and electronic interference effects. An electron plasma can be created within the vessel during ablation. This electron plasma can interfere with imaging from an imaging device (e.g. imaging device 260). In some embodiments, electromagnetic interference can be avoided by filtering out data during the set time period, while the laser is pulsing. In other embodiments, filtering can occur for a longer duration such as for a period greater than the pulsing period. For example, filtering can occur 30%, 40%, 50%, 60%, or 70% longer than, the laser pulsing period in order to filter out any latent electromagnetic interference. For examples if the laser poises laser light for 135 ns, filtering can eliminate imaging data during the 200 ns after the beginning of the pulse and/or data capture can be delayed for 200 ns after the beginning of the pulse.


Moreover, photochemical effects in an area ablated by a laser catheter can remain for up to about 0.6 ms. Thus, imaging data recorded using a forward imaging device can also include filtering data recorded 0.4, 0.5, 0.6, 0.7, 0.8, 1.0, 1.1, 1.2, 1.5 or 1.4 ms after the laser pulse has begun. Thus, for example, signal capture (or data retention) can begin after 1.0 ms after the beginning of the laser pulse. Delaying signal capture until 1 ms after the laser pulse still allows for a better than 10 frames per second data acquisition and signal processing even operating at 80 Hz.


In some embodiments, elimination of data using filtering techniques can be implemented in software operating at computer 180. In other embodiments, dedicated electrical circuitry can be used to filter the data after the data has been received. In some embodiments, data filtering can occur well after the imaging data has been captured and recorded. In yet other embodiments, filtering can occur in real time. That is, for example, the data from the imaging device can be ignored, deleted, or not displayed while the laser is active and/or during some post activation time period. As another example the imaging device can be disabled during filtering periods. In other embodiments, gating can prevent images from being displayed on a display (e.g., a display associated with computer 180 shown in FIG. 1) while the laser catheter is activated.


In some embodiments, the laser can be electrically, mechanically, or optically interrupted to allow for data acquisition. For example, imaging can occur at predetermined intervals during which laser pulses are stopped to allow for better imaging. As another example, imaging can be initiated by a doctor or technician. During this time, the laser can be deactivated to allow for better imaging. Once imaging is complete, the laser can be reactivated and pulsing can recommence (whether automatically or manually).


Circuits, logic modules, processors, and/or other components may be described herein as being “configured” to perform various operations. Those skilled in the art will recognize that depending on implementation, such configuration can be accomplished through design, setup, interconnection, and/or programming of the particular components and that again depending on implementation, a configured component might or might not be reconfigurable for a different operation. For example, a programmable processor can be configured by providing suitable executable code; a dedicated logic circuit can be configured by suitably connecting logic gates and other circuit elements; and so on.


While embodiments of the invention are described herein with reference to particular blocks to be understood that the blocks are defined for convenience of description and are not intended to imply a particular physical arrangement of component parts. Further, the blocks need not correspond to physically distinct components.


While the embodiments described above may make reference to specific hardware and software components, those skilled in the art will appreciate that different combinations of hardware and/or software components may also be used and that particular operations described as being implemented in hardware might also be implemented in software or vice versa.


Computer programs incorporating various features of the present invention may be encoded on various computer readable storage media; suitable media include magnetic disk or tape, optical storage media such as compact disk (CD) or digital versatile disk (DVD), flash memory, and the like. Computer readable storage media encoded with the program code may be packaged with a compatible device or provided separately from other devices. In addition program code may be encoded and transmitted via wired optical, and/or wireless networks conforming to a variety of protocols, including the Internet, thereby allowing distribution, e.g., via Internet download.

Claims
  • 1. A laser catheter comprising: a catheter body having a distal end;a fiber optic bundle with an exit aperture, the fiber optic bundle being longitudinally moveable relative to the catheter body;an imaging device disposed at the distal end of the catheter body and disposed distally relative to the exit aperture of the fiber optic bundle, wherein the fiber optic bundle is longitudinally movable relative to the imaging device; anda retaining wire extending from the exit aperture of the fiber optic bundle and coupled to the distal end of the catheter body, the retaining wire configured to restrain the fiber optic bundle relative to the distal end of the catheter body.
  • 2. The laser catheter of claim 1, wherein the imaging device is an ultrasound imaging device.
  • 3. The laser catheter of claim 2, wherein the ultrasound imaging device comprises a probe.
  • 4. The laser catheter of claim 1, wherein the imaging device is disposed at least 0.9 cm from the exit aperture of the fiber optic bundle.
  • 5. The laser catheter of claim 1, further comprising a distal tip coupled to the catheter body and disposed distally relative to the exit aperture of the fiber optic bundle.
  • 6. The laser catheter of claim 5, wherein the imaging device is disposed on the distal tip.
  • 7. The laser catheter of claim 5, wherein the distal tip is disposed eccentrically relative to the fiber optic bundle.
  • 8. The laser catheter of claim 7, wherein the imaging device is disposed on the distal tip.
  • 9. A laser catheter comprising: a catheter body having a proximal end, a distal end, and a lumen disposed between the proximal end and the distal end, the lumen having a distal opening at the distal end;a light guide having a proximal end and a distal end, the light guide being at least partially disposed within the lumen and the distal end of the light guide extending from within the distal opening of the catheter body, wherein the light guide is longitudinally moveable relative to the catheter body, and wherein the light guide is configured to conduct light from a laser source coupled to the proximal end of the light guide to the distal end of the light guide;a tip extending distally from the distal end of the catheter body, wherein the tip is disposed eccentrically to the light guide;a ramp disposed on the tip, wherein the distal end of the light guide is laterally moveable relative to the catheter body by sliding the light guide longitudinally over the ramp;an ultrasound imaging device disposed on the tip and positioned distally from the distal opening of the catheter body and the distal end of the light guide; anda retaining wire extending from the distal end of the light guide and coupled to the tip, the retaining wire configured to restrain the distal end of the light guide relative to the tip.
  • 10. The laser catheter of claim 9, wherein the distal end of the light guide is laterally moveable relative to the catheter body by sliding the light guide distally and longitudinally over the ramp.
  • 11. The laser catheter of claim 9, wherein the retaining wire is detachably coupled to at least one of the tip and the light guide.
  • 12. The laser catheter of claim 9, further comprising a guide wire lumen extending through the catheter body.
  • 13. The laser catheter of claim 12, wherein the guide wire lumen extends through the light guide.
  • 14. The laser catheter of claim 9, further comprising a guide wire lumen extending through at least a portion of the tip.
  • 15. The laser catheter of claim 14, wherein the guide wire lumen extends through the light guide.
CROSS-REFERENCES TO RELATED APPLICATIONS

This application is continuation of U.S. Non-Provisional application Ser. No. 13/968,993 filed on Aug. 16, 2013, which is a divisional of U.S. Non-Provisional application Ser. No. 12/649,759 filed on Dec. 30, 2009, now U.S. Pat. No. 8,545,488, which is a continuation in part of U.S. Non-Provisional application Ser. No. 12/337,232 filed on Dec. 17, 2008, now U.S. Pat. No. 8,628,519, which is a continuation in part of U.S. Non-Provisional application Ser. No. 11/228,845 filed on Sep. 16, 2005, now U.S. Pat. No. 7,572,254, which claims the benefit of U.S. Provisional Application Ser. No. 60/611,191 filed Sep. 17, 2004. Each of these disclosures are incorporated by reference in their entirety.

US Referenced Citations (195)
Number Name Date Kind
4053845 Gould Oct 1977 A
4641912 Goldenberg Feb 1987 A
4669465 Moore et al. Jun 1987 A
4686979 Gruen et al. Aug 1987 A
4732448 Goldenberg Mar 1988 A
4747405 Leckrone May 1988 A
4769005 Ginsburg et al. Sep 1988 A
4784132 Fox et al. Nov 1988 A
4788975 Shturman et al. Dec 1988 A
4799754 Goldenberg Jan 1989 A
4807620 Strul et al. Feb 1989 A
4830460 Goldenberg May 1989 A
4844062 Wells Jul 1989 A
4848336 Fox et al. Jul 1989 A
4850686 Morimoto et al. Jul 1989 A
4913142 Kittrell et al. Apr 1990 A
4919508 Grace et al. Apr 1990 A
4924863 Sterzer May 1990 A
4925265 Rink et al. May 1990 A
5016964 Donnelly May 1991 A
5024234 Leary et al. Jun 1991 A
5026366 Leckrone Jun 1991 A
5029588 Yock et al. Jul 1991 A
5034010 Kittrell et al. Jul 1991 A
5040548 Yock Aug 1991 A
5041108 Fox et al. Aug 1991 A
5047952 Kramer et al. Sep 1991 A
5107516 Dressel Apr 1992 A
5154680 Drzewiecki et al. Oct 1992 A
5165897 Johnson Nov 1992 A
5176674 Hofmann Jan 1993 A
5188632 Goldenberg Feb 1993 A
5207672 Roth et al. May 1993 A
5217454 Khoury Jun 1993 A
5243546 Maggard Sep 1993 A
5250045 Bohley Oct 1993 A
5263953 Bagby Nov 1993 A
5267341 Shearin Nov 1993 A
5300085 Yock Apr 1994 A
5304171 Gregory et al. Apr 1994 A
5318032 Lonsbury et al. Jun 1994 A
5350375 Deckelbaum et al. Sep 1994 A
5350377 Winston et al. Sep 1994 A
5350395 Yock Sep 1994 A
5352197 Hammersmark et al. Oct 1994 A
5377683 Barken Jan 1995 A
5395361 Fox et al. Mar 1995 A
5400428 Grace Mar 1995 A
5415653 Wardle et al. May 1995 A
5423740 Sullivan et al. Jun 1995 A
5425355 Kulick Jun 1995 A
5429604 Hammersmark et al. Jul 1995 A
5429617 Hammersmark et al. Jul 1995 A
5440664 Harrington et al. Aug 1995 A
5451233 Yock Sep 1995 A
5464395 Faxon et al. Nov 1995 A
5470330 Goldenberg et al. Nov 1995 A
5483080 Tam Jan 1996 A
5484433 Taylor et al. Jan 1996 A
5492131 Galel Feb 1996 A
5514128 Hillsman et al. May 1996 A
5536242 Willard et al. Jul 1996 A
5571151 Gregory Nov 1996 A
5573531 Gregory Nov 1996 A
5623940 Daikuzono Apr 1997 A
5643251 Hillsman et al. Jul 1997 A
5649923 Gregory et al. Jul 1997 A
5657760 Ying et al. Aug 1997 A
5713894 Murphy-Chutorian et al. Feb 1998 A
5722972 Power et al. Mar 1998 A
5755714 Murphy-Chutorian May 1998 A
5792118 Kurth et al. Aug 1998 A
5800350 Coppleson et al. Sep 1998 A
5803083 Buck et al. Sep 1998 A
5807377 Madhani et al. Sep 1998 A
5817144 Gregory Oct 1998 A
5824005 Motamedi et al. Oct 1998 A
5824026 Diaz Oct 1998 A
5830209 Savage et al. Nov 1998 A
5836946 Diaz et al. Nov 1998 A
RE36104 Solar Feb 1999 E
5891133 Murphy-Chutorian Apr 1999 A
5938609 Pomeranz Aug 1999 A
5976124 Reiser Nov 1999 A
5986643 Harvill et al. Nov 1999 A
5989243 Goldenberg Nov 1999 A
6022342 Mukherjee Feb 2000 A
6024703 Zanelli Feb 2000 A
6033402 Tu et al. Mar 2000 A
6036715 Yock Mar 2000 A
6056743 Ellis et al. May 2000 A
6066130 Gregory et al. May 2000 A
6117128 Gregory Sep 2000 A
6231563 White et al. May 2001 B1
6251104 Kesten et al. Jun 2001 B1
6287297 Woodruff et al. Sep 2001 B1
6290668 Gregory et al. Sep 2001 B1
6302875 Makower et al. Oct 2001 B1
6370411 Osadchy et al. Apr 2002 B1
6419684 Heisler et al. Jul 2002 B1
6432115 Mollenauer et al. Aug 2002 B1
6447504 Ben-Haim et al. Sep 2002 B1
6447525 Follmer et al. Sep 2002 B2
6458098 Kanesaka Oct 2002 B1
6539132 Ivtsenkov et al. Mar 2003 B2
6575993 Yock Jun 2003 B1
6597829 Cormack Jul 2003 B2
6733495 Bek et al. May 2004 B1
6743208 Coyle Jun 2004 B1
6792390 Burnside et al. Sep 2004 B1
7238178 Maschke Jul 2007 B2
7319566 Prince et al. Jan 2008 B2
7568619 Todd et al. Aug 2009 B2
7572254 Hebert et al. Aug 2009 B2
7846153 Hebert et al. Dec 2010 B2
7930065 Larkin et al. Apr 2011 B2
7959608 Nash et al. Jun 2011 B2
7988633 Hossack et al. Aug 2011 B2
8016745 Hassler et al. Sep 2011 B2
8016748 Mourlas et al. Sep 2011 B2
8050739 Eck et al. Nov 2011 B2
8100893 Dadisman Jan 2012 B2
8361097 Patel et al. Jan 2013 B2
8545488 Taylor et al. Oct 2013 B2
8628519 Taylor et al. Jan 2014 B2
9623211 Hendrick et al. Apr 2017 B2
9757200 Magee et al. Sep 2017 B2
9827055 Hendrick et al. Nov 2017 B2
20010014805 Burbank et al. Aug 2001 A1
20020013572 Berlin Jan 2002 A1
20020026118 Govari Feb 2002 A1
20020045811 Kittrell et al. Apr 2002 A1
20020072661 Wiesmann et al. Jun 2002 A1
20020103459 Sparks Aug 2002 A1
20020107445 Govari Aug 2002 A1
20020159685 Cormack Oct 2002 A1
20030032936 Lederman Feb 2003 A1
20030045798 Hular et al. Mar 2003 A1
20030078566 Elliott et al. Apr 2003 A1
20030204185 Sherman et al. Oct 2003 A1
20030219202 Loeb et al. Nov 2003 A1
20040010204 Weber et al. Jan 2004 A1
20040057659 Baugh Mar 2004 A1
20040059280 Makower et al. Mar 2004 A1
20040075919 Diaz et al. Apr 2004 A1
20040111016 Casscells et al. Jun 2004 A1
20040127889 Zhang et al. Jul 2004 A1
20040133154 Flaherty et al. Jul 2004 A1
20040162548 Reiser Aug 2004 A1
20050004453 Tearney et al. Jan 2005 A1
20050149176 Heggestuen et al. Jul 2005 A1
20050203416 Angelsen et al. Sep 2005 A1
20060020260 Dover et al. Jan 2006 A1
20060094930 Sparks et al. May 2006 A1
20060217695 DeBenedictis et al. Sep 2006 A1
20060247532 Ramanujam et al. Nov 2006 A1
20070060879 Weitzner et al. Mar 2007 A1
20070106289 O'Sullivan May 2007 A1
20070115152 Bjorklund et al. May 2007 A1
20070177008 Bayer Aug 2007 A1
20080019657 Maitland et al. Jan 2008 A1
20080058629 Seibel et al. Mar 2008 A1
20080106388 Knight May 2008 A1
20080108867 Zhou May 2008 A1
20080154296 Taylor et al. Jun 2008 A1
20090177095 Aeby et al. Jul 2009 A1
20090203989 Burnside et al. Aug 2009 A1
20090248041 Williams Oct 2009 A1
20100114081 Keeler et al. May 2010 A1
20100152717 Keeler Jun 2010 A1
20100168569 Sliwa et al. Jul 2010 A1
20100177309 Scaiano et al. Jul 2010 A1
20100200076 Hieb et al. Aug 2010 A1
20110009750 Taylor et al. Jan 2011 A1
20110160681 Dacey et al. Jun 2011 A1
20110196291 Vischer et al. Aug 2011 A1
20110224649 Duane et al. Sep 2011 A1
20110270091 Hossack et al. Nov 2011 A1
20120181331 Beden et al. Jul 2012 A1
20120253360 White et al. Oct 2012 A1
20120302828 Toledo-Crow et al. Nov 2012 A1
20130131579 Mantell et al. May 2013 A1
20130253490 Bitzer et al. Sep 2013 A1
20140114298 Taylor et al. Apr 2014 A1
20140275982 Hendrick et al. Sep 2014 A1
20140276603 Magee et al. Sep 2014 A1
20140276689 Grace Sep 2014 A1
20140276690 Grace Sep 2014 A1
20150011843 Toth et al. Jan 2015 A1
20150141768 Yu et al. May 2015 A1
20160183804 Kowalewski et al. Jun 2016 A1
20160184020 Kowalewski et al. Jun 2016 A1
20160184021 Kowalewski et al. Jun 2016 A1
20170348058 Magee et al. Dec 2017 A1
20180036085 Hendrick et al. Feb 2018 A1
Foreign Referenced Citations (7)
Number Date Country
0211984 Mar 1987 EP
2319404 May 2011 EP
2208807 Apr 1989 GB
1998019614 May 1998 WO
WO0057228 Sep 2000 WO
2007115152 Oct 2007 WO
2010042249 Aug 2010 WO
Non-Patent Literature Citations (183)
Entry
File Wrapper U.S. Appl. No. 09/947,171, filed Sep. 4, 2001, 71 pages.
Final Official Action for U.S. Appl. No. 12/337,232 dated Apr. 23, 2013, 11 pages.
Fung et al. A Pmma-Based Micro Pressure Sensor Chip Using Carbon Nanotubes as Sensing Elements; IEEE International Conference on Micro Electro Mechanical Systems, vol. 18, 2005 pp. 251-254.
Ghosh et al. Laser Lead Extraction: Is There a Learning Curve?; Pace, vol. 28; Mar. 2005 pp. 180-184.
Golzio et al. Prevention and Treatment of Lead Extraction Complications; Transvenous Lead Extraction; Springer-Verlag Italia 2011 pp. 129-136.
Griffin et al. Calibration and Mapping of a Human Hand for Dexterous Telemanipulation; ASME IMECE Conference, 2000, 8 pages.
Grundfest, Warren S., MD, et al., “Laser Ablation of Human Atherosclerotic Plaque Without Adjacent Tissue Injury,” JACC vol. 5, No. 4, (Apr. 1985), pp. 929-933.
Hager-Ross et al. Quantifying the Independence of Human Finger Movements: Comparisons of Digits, Hands, and Movement Frequencies; the Journal of Neurosciences, vol. 20 No. 22, Nov. 15, 2000, pp. 8542-8550.
Hajjarian et al. Intravascular Laser Speckle Imaging Catheter for the Mechanical Evaluation of the Arterial Wall; Journal of Biomedical Optics vol. 16(2) Feb. 2011, 7 pages.
Hanke et al. Morphological Changes and Smooth Muscle Cell Proliferation After Experimental Excimer Laser Treatment; Circulation vol. 83, 1991 pp. 1380-1389.
Hattori et al. Invivo Raman Study of the Living Rat Esophagus and Stomach Using a Micro-Raman Probe Under an Endoscope; Applied Spectroscopy vol. 61, No. 6, 2007, 8 pages.
Hauser Deaths and Cardiovascular Injuries Due to Device-Assisted Implantable Cardioverter-Defibrillator and Pacemaker Lead Extraction; Eurospace vol. 12, 2010, pp. 395-401.
Henning et al. An In Vivo Strain Gage Study of Elongation of the Anterior Cruciate Ligament; The American Journal of Sports Medicine, vol. 13, No. 1 1985, pp. 22-26.
Inmann et al. An Instrument Object for Evaluation of Lateral Hand Grasp During Functional Tasks; Journal of Medical Engineering & Technology, vol. 25. No. 5, Sep./Oct. 2001, pp. 207-211.
Insull the Pathology of Atherosclerosis; Plaque Development and Plaque Responses to Viedical Treatment; The American Journal of Medicine, vol. 122, No. 1A, Jan. 2009, 12 pages.
Interlink Electronics. State-of-the-Art Pointing Solutions for the OEM—FSR Force Sensing Resistor Integration Guide and Evaluation Parts Catalog: 400 Series Evaluation Parts With Suggested Electrical Interfaces. Interlink Electronics, Version 1.0 (90-45632 Rev. D), Camarillo, CA, pp. 1-26.
International Preliminary Report on Patentability issued in PCT/US2009/066133, dated Jun. 21, 2011, 8 pages.
International Search Report and Written Opinion issued in PCT/2014/019258, dated Aug. 8, 2014, 21 pages.
International Search Report and Written Opinion issued in PCT/2014/019283, dated Jun. 20, 2014, 15 pages.
International Search Report and Written Opinion issued in PCT/2014019278, dated May 7, 2014, 14 pages.
International Search Report and Written Opinion issued in PCT/US2005/033029, dated Oct. 3, 2006, 1 page.
International Search Report and Written Opinion issued in PCT/US2009/066133, dated Jan. 26, 2010, 8 pages.
Jagsi et al. Original Investigation: Residents Report on Adverse Events and Their Causes; Arch Intern Med/ vol. 163 Dec. 12-26, 2005, 7 pages.
Johns et al. Determination of Reduced Scattering Coefficient of Biological Tissue From a Needle-Like Probe; Optics Express vol. 13, No. 13, Jun. 27, 2005 pp. 4828-4842.
Kahol, K. et al. Effect of Fatigue on Psychomotor and Cognitive Skills. The American Journal of Surgery: Association for Surgical Education, 195, 2008, pp. 195-204.
Kane et al. A Traction Stress Sensor Array for Use in High-Resolution Robotic Tactile Imaging; Journal of Microelectromechanical Systems, vol. 9, No. 4, Dec. 2000, pp. 425-434.
Kang et al. A Carbon Nanotube Strain Sensor for Structural Health Monitoring; Smart Matter. Struct. vol. 15, 2006, pp. 737-748.
Karimov et al. A Carbon Nanotube-Based Pressure Sensor, Phys. Scr. 83, 2011, 5 pages.
Karsch et al. Percutaneous Coronary Excimer Laser Angioplasty Initial Clinical Results; The Lancet, Sep. 16, 1989, pp. 647-650.
Kennergren Excimer Laser Assisted Extraction of Permanent Pacemaker and ICD Leads: Present Experiences of a European Multi-Centre Study; European Journal of Cardio-Thoracic Surgery 15, 1990, pp. 856-860.
Khairy et al. Laser Lead Extraction in Adult Congenital Heart Disease; J. Cardiovasc Electrophysiol, vol. 18, 2006, pp. 507-511.
Khalil et al. Tissue Elasticity Estimation With Optical Coherence Elastography: Toward Mechanical Characterization of In Vivo Soft Tissue; Annals of Biomedical Engineering, vol. 33, No. 11, Nov. 2005, pp. 1631-1639.
Kochiadakis et al. The Role of Laser-Induced Fluorescence in Myocardial Tissue Characterization: An Experimental Invitro Study; Chest vol. 120, 2001, pp. 233-239.
Koulouris et al. Intravascular Lead Extractions: Tips and Tricks; Intech Open Science/Open Minds http//creativecommons.org/licenses/by/3.0, 2012 pp. 189-216.
Kremers et al. The National ICD Registry Report: Version 2.1 Including Leads and Pediatrics for Years 2010 and 2011; pp. 59-65.
Lathan et al. The Effects of Operator Spatial Perception and Sensory Feedback on Human-Robot Teleoperation Performance; Presence, vol. 11, No. 4, Aug. 2002, pp. 368-377.
Levine et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary; Journal of the American College of Cardiology vol. 58, No. 24, 2011, pp. 2250-2583.
Li et al. Strain and Pressure Sensing Using Single-Walled Carbon Nanotubes; Nanotechnology vol. 15, 2004, pp. 1493-1496.
Lieber et al. Sarcomere Length Determination Using Laser Diffraction: Effect of Beam and Fiber Diameter; Biophys J. vol. 45, May 1984, pp. 1007-1016.
Lipomi et al. Skin-Like Pressure and Strain Sensors Based on Transparent Elastic Films of Carbon Nanotubes; Nature Nanotechnology, vol. 6, Dec. 2011, pp. 788-792.
Maréchal, L. et al. “Measurement System for Gesture Characterization During Chest Physiotherapy Act on Newborn Babies Suffering from Bronchiolitis.” Proceedings of the 29th Annual International Conference of the IEEE EMBS, Cité Internationale, Lyon, France. Aug. 23-26, 2007. pp. 5770-5773.
Maytin et al. Multicenter Experience With Extraction of the Sprint Fidelis Implantable Cardioverter-Defibrillator Lead; Journal of the American College of Cardiology vol. 56, No. 8, 2010, pp. 642-646.
Maytin et al. The Challenges of Transvenous Lead Extraction; Heart vol. 97, 2011, pp. 425-434.
Medtronic's Brochure; Implantable Pacemaker and Defibrillator Information; Apr. 2006, 2 pages.
Meier-Ewert et al. Endocardial Pacemaker or Defibrillator Leads With Infected Vegetations: A Single-Center Experience and Consequences of Transvenous Extraction; AM Heart Journal vol. 146, 2003, pp. 339-344.
Menciassi et al. Force Sensing Microinstrument for Measuring Tissue Properties and Pulse in Microsurgery, IEEE/ASME Transactions on Mechatronics, vol. 8, No. 1, Mar. 2003, pp. 10-17.
Mishra et al. Fiber Grating Sensors in Medicine: Current and Emerging Applications; Sensors and Actualtors A, 167, 2011, pp. 279-290.
Missinne Flexible Miniature Shear Sensors for Prosthetics; SPIE Newsroom SPIE, May 13, 2013, 4 pages.
Missinne, Jeroen et al. “Embedded Flexible Optical Shear Sensor.” IEEE Sensors 2010 Conference, 2010, pp. 987-990.
Mond et al. The Electrode-Tissue Interface: The Revolutionary Role of Steroid Elution; Pace vol. 15, Jan. 1992, pp. 95-107.
Spectranetics X80 User Manual ELCA Coronary Laser Atherectomy Catheter, Mar. 2012, 16 pages.
Spectranetics ELCA Coronary Laser Atherectomy Catheter: Instructions for Use, 0.9 mm OTW and 0.9 mm RX X-80 Catheter Models, Mar. 14, 2012, pp. 1-16.
SPI2006 Shear Sensor Brochure—Real-Time Surface Shear Sensing Application: Human Interface; Tactilus Technology, 2006, 1 page.
Sturman et al. A Survey of Glove-Based Input; Clumsy Intermediary Devices Constrain Our Interaction With Computers and Their Applications. Glove-Based Input Devices Let Us Apply Our Manual Dexterity to the Task: IEEE Computer Graphics & Applications, Jan. 1994. pp. 30-39.
Sun et al. A Sub-Millemetric, 0.25 Mn Resolution Fully Integrated Fiber-Optic Force Sensing Tool for Retinal Microsurgery; Int J Comput Assist Radiol Surg. vol. 4(4): Jun. 2009, pp. 383-390.
Takano et al. Changes in Coronary Plaque Color and Morphology by Lipid-Lowering Therapy With Atorvastatin: Serial Evaluation by Coronary Angioscopy; The Journal of the American college of Cardiology, vol. 42, No. 4, 2003 pp. 680-686.
Taroni et al. In Vivo Absorption and Scattering Spectroscopy of Biological Tissues; Photochem. Photobiol. Sci. vol. 2, 2003. pp. 124-129.
Turchin et al. Novel Algorithm of Processing Optical Coherence Tomography Images for Differentiation of Biological Tissue Pathologies; Journal of Biomedical Optics 10(6), Nov./Dec. 2005, 11 pages.
Turner et al. Development and Testing of a Telemanipulation System With Arm and Hand Motion; Accepted to 2000 ASME IMECE Symp. Haptic Interfaces, 2000, 7 pages.
U.S. Appl. No. 14/586,312, filed Dec. 30, 2014.
U.S. Appl. No. 14/586,529, filed Dec. 30, 2014.
U.S. Appl. No. 14/586,543, filed Dec. 30, 2014.
Valdastri et al. Integration of a Miniaturized Triaxial Force Sensor in a Minimally Invasive Surgical Tool; IEEE Transactions on Biomedical Engineering, vol. 53, No. 11, Nov. 2006 pp. 2397-2400.
Van der Meer et al. Quantitative Optical Coherence Tomography of Arterial Wall Components; Lasers in Medical Science vol. 20, 2005, pp. 45-51.
Van der Meijden et al. The Valve of Haptic Feedback in Conventional and Robot-Assisted Minimal Invasive Surgery and Virtual Reality Training: A Current Review; Surg. Endosc vol. 23, 2009, pp. 1180-1190.
Van Leeuwen et al. Origin of Arterial Wall Dissections Induced by Pulsed Excimer and Mid-Infrared Laser Ablation in the PIGL; JACC vol. 19, No. 7, Jun. 1992, pp. 1610-1618.
Van Lindert et al. The Influence of Surgical Experience on the Rate of Intraoperative Aneurysm Rupture and Its Impact on Aneurysm Treatment Outcome; Surg Neurol vol. 56, 2001, pp. 151-158.
Wagner et al. The Role of Force Feedback in Surgery: Analysis of Blunt Dissection; Presented at the Tenth Symposium on Haptic Interfaces for Virtual Environment and Teleoperator Systems, Mar. 24, 25, 2002, 7 pages.
Walker et al. Surgical Safety Checklists: Do They Improve Outcomes?; British Journal of Anaesthesia, 2012, pp. 1-8.
Wang et al. Characterization of a Silicon=Based Shear-Force Sensor on Human Subjects; IEEE Trans Biomed Eng., 2002 1 page.
Wang et al. Miniature All-Silica Optical Fiber Pressure Sensor With an Ultrathin Uniform Diaphragm; Optics Express vol. 18, No. 9, Apr. 26, 2010, pp. 9006-9014.
Wang et al. Review: The Physiological and Computational Approaches for Atherosclerosis Treatment; IJCA-15372, 2012, 13 pages.
Wang, Lin et al. “Characterization of a Silicon-Based Shear-Force Sensor on Human Subjects.” IEEE Transactions on Biomedical Engineering, vol. 49, No. 11. Nov. 2002, pp. 1340-1347.
Wazni et al. Lead Extraction in the Contemporary Setting: The Lexicon Study; Journal of the American College of Cardiology vol. 55, No. 6, 2010, pp. 579-586.
Weiss et al. Muscular and Postural Synergies of the Human Hand; J. Neurophysiol 92, 2004, pp. 523-535.
Wikipedia, Linear discriminant analysis, Dec. 21, 2013, available at http://en.wikipedia.org/wiki/Linear_discriminant_analysis.
Wilkoff et al. Transvenous Lead Extraction: Heart Rhythm Society Expert Consensus on Facilities, Training, Indications, and Patient Management; Heart Rhythm, vol. 6, No. 7, Jul. 2009, pp. 1086-1104.
Wise et al. Evaluation of a Fiber Optic Glove for Semi-Automated Goniometric Measurements; Journal of Rehabilitation Research and Development vol. 27 No. 4, 1990, pp. 411-424.
Wollmann et al. Two Different Therapeutic Strategies in ICD Lead Defects: Additional Combined Lead Versus Replacement of the Lead; Journal of Cardiovascular Electrophysiology vol. 18, No. 11, Nov. 2007, pp. 1172-1177.
Yamamoto et al. Tissue Property Estimation and Graphical Display for Teleoperated Robot-Assisted Surgery; 2009 IEEE International Conference on Robotics and Automation, May 12, 17, 2009, 7 pages.
Yokoyama et al. Novel Contact Force Sensor Incorporated in Irrigated Radiofrequency Ablation Catheter Predicts Lesion Size and Incidence of Steam Pop and Thrombus Clinical Perspective; Circulation Arrhythmia and electrophysiology: Journal of the American Heart Association, Dec. 2008, pp. 353-362.
Yun et al. An Instrumented Glove for Grasp Specification in Virtual-Reality-Based Point and Direct Telerobotics; IEEE Transactions on Systems, Man, and Cybernetics—Bart B: Cybernetics, vol. 27, No. 5, Oct. 1997, pp. 835-846.
Zhan et al. Excess Length of Stay, Charges, and Mortality Attributable to Medical Injuries During Hospitalization; Journal of American Medical Association, vol. 290, No. 14, Oct. 8, 2003, pp. 1868-1874.
Abeysinghe et. al. A Novel Mems Pressure Sensor Fabricated on an Optical Fiber; IEEE Photonics Technology Letters, vol. 13. No. 9, Sep. 2001, pp. 993-995.
Advisory Action for U.S. Appl. No. 12/337,232 dated Aug. 8, 2013, 3 pages.
Advisory Action issued in U.S. Appl. No. 12/337,232, dated Aug. 8, 2013, 3 pages.
Agency for Healthcare Research and Quality Adjunctive Devices in PCI to Remove Thrombi or Protect Against Distal Embolization in Patients With ACS: A Clinician Research Summary; Effective Health Care Program; AHRQ Pub. No. 11 (12)-EHC089-3 May 2012, 4 pages.
Arifler et. al. Light Scattering From Collagen Fiber Networks: Micro-Optical Properties of Normal and Neoplastic Stroma; Biophysical Journal, vol. 92, May 2007, pp. 3260-3274.
Ashok et al. Raman Spectroscopy Sensor for Surgical Robotics—Instrumentation and Tissue Differentiation Algorithm Biomedical Optics and 3D Imaging OSA 2012, 4 pages.
Bach et al., Design and Fabrication of 60-Gb/s InP-Based Monolithic Photoreceiver OEICs and Modules, IEEE Journal of Selected Topics in Quantum Electronics, vol. 8, No. 6, Nov. 1, 2002, 6 pages.
Baddour et al. Update on Cardiovascular Implantation Electronic Device Infections and Their Management: A Scientific Statement From the American Heart Association Circulation 121: Jan. 2010, pp. 458-477.
Badr et al. The State of the Excimer Laser for Coronary Intervention in the Drug-Eluting Stent Era Cardiovascular Revascularization Medicine 14, 2013, pp. 93-98.
Bann et al. Attitudes Towards Skills Examinations for Basic Surgical Trainees J. Clin Pract Jan. 2005, 59, 1, pp. 107-113.
Baztarrica et al. Transvenous Extraction of Pacemaker Leads in Infective Endocarditis With Vegetations 20MM: Our Experience; Clinl. Cardiol 35, 4, 2012, pp. 244-249.
Beauvoit et al. Contribution of the Mitochondrial Compartment to the Optical Properties of the Rat Liver: A Theoretical and Practical Approach Biophysical Journal, vol. 67, Dec. 1994 pp. 2501-2510.
Beccai et al. Design and Fabrication of a Hybrid Silicon Three-Axial Force Sensor for Biomechanical Applications; Sensors and Actuators A 120, 2005, pp. 370-382.
Berkelman et al. A Miniature Microsurgical Instrument Tip Force Sensor for Enhanced Force Feedback During Robot-Assisted Manipulation; IEEE Transactions on Robotics and Automaton, vol. 19, No. 5, Oct. 2003, pp. 917-922.
Bilodeau et al. Novel Use of a High-Energy Excimer Laser Catheter for Calcified and Complex Coronary Artery Lesions Catheterization and Cardiovascular Interventions 62: 2004 pp. 155-161.
Bindig et al. Fiber-Optical and Microscopic Detection of Malignant Tissue by Use of Infrared Spectrometry Journal of Biomedical Optics vol. 7 No. 1 Jan. 2002, pp. 100-108.
Bishop et al. Paid Malpractice Claims for Adverse Events in Inpatient and Outpatient Settings; JAMA vol. 205 No. 23 Jun. 15, 2011, pp. 2427-2431.
Bittl et al. Meta-Analysis of Randomized Trials of Percutaneous Transluminal Coronary Angioplasty Versus Atherectomy, Cutting Balloon Atherotomy, or Laser Angioplasty Journal of the American College of Cardiology, vol. 43 No. 6, 2004, pp. 936-942.
Bongiorni et al. Transvenous Removal of Pacing and Implantable Cardiac Defibrillating Leads Using Single Sheath Mechanical Dilatation and Multiple Venous Approaches; High Success Rate and Safety in More Than 200 Leads; European Heart Journal vol. 29, 2008, pp. 2886-2893.
Vracke et al. Pacemaker Lead Complications: When Is Extraction Appropriate and What Can We Learn From Published Data? Heart 2001 vol. 85, pp. 254-259.
Brennan et al. Analysis of Errors Reported by Surgeons at Three Teaching Hospitals, Surgery vol. 3, No. 6, 2003, pp. 614-621.
Britton Chance Optical Method; Annu Rev. Biophys. Chem, vol. 20 1991, pp. 1-30.
Buch et al. Pacemaker and Defibrillator Lead Extraction; Circulation 2011:123, pp. 378-380.
Byrd et al. Clinical Study of the Laser Sheath for Lead Extraction: The Total Experience in the United States; Journal of Pacing and Clinical Electrophysiology, vol. 25 No. 5, May 2002, pp. 804-808.
Byrd et al. Intravascular Lead Extraction Using Locking Stylets and Sheaths; Pace vol. 13 Dec. 1990, pp. 1871-1875.
Candefjord et al. Combining Fibre Optic Raman Spectroscopy and Tactile Resonance Measurement for Tissue Characterization; Meas. Sci Technol. vol. 21, 2010 125801 8 pages.
Candinas et al. Postmortem Analysis of Encapsulation Around Long-Term Ventricular Endocardial Pacing Leads; Mayo Clin Proc. vol. 74, Feb. 1999, pp. 120-125.
Carlson et al. Motion Capture Measures Variability in Laryngoscopic Movement During Endotracheal Intubation: A Preliminary Report; 2012 Society for Simulation in Healthcare, vol. 7, No. 1, Aug. 2012, pp. 255-260.
Chan et al. Effects of Compression on Soft Tissue Optical Properties; IEEE Journal of Selected Topics in Quantum Electronics, vol. 2 No. 4, Dec. 1996, pp. 943-950.
Cheong et al. A Review of the Optical Properties of Biological Tissues; IEEE Journal of Quantum Electronics vol. 26, No. 12, Dec. 1990, pp. 2166-2185.
Chung et al. Advanced Fibre BRAGG Grating and Microfibre Bragg Grating Fabrication Techniques; A Thesis Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy the Hong Kong Polytechnic University; Mar. 2012; 130 pages.
Cruz et al. Internal Mammary Arterial Injury From Lead Extraction: A Clinically Subtle Yet Important Complication of Implantable Device Removal; Cardiology Research and Practice vol. 2011, Article ID 408640, (2011) 5 pages.
Da et al. Overview of the Vascular Interventional Robot; The International Journal of Medical Robotics and computer assisted surgery 2008;4: pp. 289-294.
Dallon et al. A Mathematical Model for Spatially Varying Extracellular Matrix Alighment; Siam J. Appl. Math. vol. 61, No. 2, 2000, pp. 506-527.
Deharo et al. Pathways for Training and Accreditation for Transvenous Lead Extraction: A European Heart Rhythm Association Position Paper; Europace 14 (2012) pp. 124-134.
Dipietro et al. Evaluaton of an Instrumented Glove for Hand-Movement Acquisition; Journal of Rehabilitation Research and Development vol. 40, No. 2, Mar./Apr. 2003, pp. 179-190.
Eichhorn et al. Carbon Nanotube Filled Composite Material Analysis Utilizing Nano and Conventional Testing Techniques; NIP & Digital Fabrication Conference, 2010 International Conference on Digital Printing Technologies, 5 pages.
Eichhorn et al. Flexible Carbon Nanotube Composite Sensors for Medical Device Application; J. Med. Devices 7(2), 020943 (Jun. 11, 2013) (2 pages)Paper No. MED-13-1050; doi: 10.1115/1.4024311.
ELCA Coronary Laser Atherectomy Catheter Brochure, Spectranetics, 2012.
El-Sawah et al. A Prototype for 3-D Hand Tracking and Posture Estimation; IEEE Transactions on Instrumentation and Measurement, vol. 57, No. 8, Aug. 2008, pp. 1627-1636.
Endo et al. Clinical Utility of Intraprocedural Transesophagael Echocardiography During Transvenous Lead Extraction; Journal of the American Society of Echocardiography vol. 21 No. 7, Jul. 2008, pp. 862-867.
Epstein et al. Gross and Microscopic Pathological Changes Associated With Nonthoracotomy Implantable Defibrillator Lead; Circulation 1998:98: pp. 1517-1524.
Erturk et al. Outcome of Surgery for Acromegaly Performed by Different Surgeons: Importance of Surgical Experience; Pituitary 8: 2005, pp. 93-97.
Esenaliev, O.R., et al. Laser Ablation of Atherosclerotic Blood Vessel Tissue Under Various Irradiation Conditions, IEEE Transactions on Biomedical Engineering, 36(12), Dec. 1989, pp. 1188-1194.
Esposito et al. Morphologic and Immunohistochemical Observations of Tissues Surrounding Retrieved Transvenous Pacemaker Leads; Wiley Periodicals, Inc. 2002, pp. 548-558.
European Search Report issued in EP Application No. 05796879.4 dated Mar. 6, 2008, 7 pages.
European Search Report issued in EP Application No. 08010688.3. dated Feb. 17, 2009, 6 pages.
Extended European Search Report issued in European Patent Application 14773432.1, dated Oct. 4, 2016, 6 pages.
Faber et al. Light Absorption of (OXY-) Hemoglobin Assessed by Spectroscopic Optical Coherence Tomography; Optics Letters vol. 28, No. 16, Aug. 15, 2003, pp. 1436-1438.
Fanson et al. A System for Laparoscopic Surgery Ergonomics and Skills Evaluation; Journal of Endourology vol. 25, No. 7, Jul. 2011, pp. 1111-1114.
Moscato et al. A Micromachined Intensity-Modulated Fiber Optic Sensor for Strain Measurements: Working Principle and Static Calibration; 34th Annual International Conference of the IEEE EMBS, 2012, pp. 5790-5793.
Mujat et al.; Automated Algorithm for Breast Tissue Differentiation in Optical Coherence Tomogrpahy; Journal of Biomedical Optics 14(3), 2009, 9 pages.
Neuzil et al. Pacemaker and ICD Lead Extraction With Electrosurgical Dissection Sheaths and Standard Transvenous Extraction Systems: Results of a Randomized Trial; Europace 9 , 2007, pp. 98-104.
Nikonovas et al. The Application of Force-Sensing Resistor Sensors for Measuring Forces Developed by the Human Hand; Proc. Instn Mech Engrs. vol. 218 Part H, 2004, 9 pages.
Nilsson et al Near Infrared Diffuse Reflection and Laser-Induced Fluorescence Spectroscopy for Myocardial Tissue Characterization; Spectrochimica Acta Part A 53, 1997, pp. 1901-1912.
Noble et al. High Energy Excimer Laser to Treat Coronary In-Stent Restenosis in an Under Expanded Stent; Catheter and Cardiovascular Interventions vol. 71, 2008, pp. 803-807.
Noonan et al. A Dual-Function Wheeled Probe for Tissue Viscoelastic Property Identification During Minimally Invasive Surgery; IEEE International Conference on Robotics and Automation, Apr. 10-14, 2007, 6 pages.
Notice of Allowance for U.S. Appl. No. 12/649,759 dated May 16, 2013, 12 pages.
Notice of Allowance for U.S. Appl. No. 11/228,845 dated Jun. 5, 2009, 8 pages.
Notice of Allowance for U.S. Appl. No. 12/406,807 dated Aug. 2, 2010, 7 pages.
Notice of Alowance for U.S. Appl. No. 12/337,232 dated Sep. 6, 2013, 11 pages.
Official Action for U.S. Appl. No. 11/228,845 dated Jan. 12, 2009, 13 pages.
Official Action for U.S. Appl. No. 11/228,845 dated Sep. 3, 2008, 10 pages.
Official Action for U.S. Appl. No. 12/337,232 dated Mar. 23, 2012, 9 pages.
Official Action for U.S. Appl. No. 12/337,232 dated Sep. 13, 2012, 10 pages.
Official Action for U.S. Appl. No. 12/649,759 dated Aug. 30, 2012, 11 pages.
Official Action for U.S. Appl. No. 12/649,759 dated Jul. 16, 2012, 9 pages.
Okumura et al. A Systematic Analysis of In Vivo Contact Forces on Virtual Catheter Tip/Tissue Surface Contact During Cardiac Mapping and Intervention; J. Cardiovasc Electrophysiol, vol. 19, Jun. 2008, pp. 632-640.
Orengo et al. Characterization of Piezoresistive Sensors for Goniometric Glove in Hand Prostheses; Wireless VITAE, 2009 pp. 684-687.
Park et al. Exoskeletal Force-Sensing End-Effectors With Embedded Optical Fiber-BRAGG Grating Sensors; IEEE Transactions on Robotics, vol. 25, No. 6, Dec. 2009, pp. 1319-1331.
Park et al. Fingertip Force Control With Embedded Fiber BRAGG Grating Sensors; IEEE conference on Robotics and Automation, May 19-23, 2008, pp. 3431-3436.
Park et al. Force Sensing Robot Fingers Using Embedded Fiber BRAGG Grating Sensors and Shape Deposition Manufacturing; ; IEEE International Conference on Robotics and Automation, Apr. 10-14, 2007, pp. 1510-1516.
Parker et al. Advanced Imaging Catheter Gives Surgeons the Inside Picture; Brochure Jun. 12, 2013, available at https//www.llnl.gov/str/DaSilva.html.
Patterson et al. Time Resolved Reflectance and Transmittance for the Non-Invasive Measurement of Tissue Optical Properties; Applied Optics vol. 28, No. 12, Jun. 15, 1989 pp. 2331-2336.
Peracchia Surgical Education in the Third Millennium; Annuals of Surgery, vol. 234, No. 6. 2001. pp. 709-712.
Pettit et al. Dynamic Optical Properties of Collagen-Based Tissue During Arf Excimer Laser Ablation; Applied Optics vol. 32, No. 4 Feb. 1, 1993, pp. 488-493.
Piers et al. A Micro Optical Force Sensor for Force Feedback During Minimally Invasive Robotic Surgery; Elsevier Sensors and Actuators A 115, 2004, pp. 447-455.
Polygerinos et al. MRI-Compatible Fiber-Optic Force Sensors for Catheterization Procedures; IEEE Sensors Journal vol. 10 No. 10, Oct. 2010, pp. 1598-1608.
Post et al.; Outcome After Complete Percutaneous Removal of Infected Pacemaker Systems and Implantable Cardiac Defibrillators; Internal Medicine Journal 36, 2006, pp. 790-792.
Prasad et al. A Modular 2-DOF Force-Sensing Instrument for Laparoscopic Surgery; MICCAI 2003, LNCS 2878 pp. 279-286.
Puangmali et al. State-Of-The Art in Force and Tactile Sensing for Minimally Invasive Surgery; IEEE Sensors Journal vol. 8, No. 4, Apr. 2008, pp. 371-381.
Rajan et al. Photonic Crystal Fiber Sensors for Minimally Invasive Surgical Devices; IEEE Transactions on Biomedical Engineering, vol. 59, No. 2, Feb. 2012, pp. 332-338.
Reiley et al. Review of Methods for Objective Surgical Skill Evaluation Surg Endosc, vol. 25, 2011 pp. 356-366.
Richards et al. Skills Evaluation in Minimally Invasive Surgery Using Force/Torque Signatures; Surg Endosc vol. 14, 2000, pp. 791-798.
Rinaldi et al. Determinants of Procedural Outcome of Chronically Implanted Pacemaker and Defibrillator Leads Using the Excimer Laser Sheath Heart.bmj.com, Dec. 5, 2012, 3 pages.
Rocha et al. Fluorescence and Reflectance Spectroscopy for Identification of Atherosclerosis in Human Carotid Arteries Using Principal Components Analysis; Photomedicine and Laser Surgery vol. 26, No. 4, 2008, pp. 329-335.
Rosen et al. Markov Modeling of Minimally Invasive Surgery Based on Tool/Tissue Interaction and Force/Torque Signatures for Evaluating Surgical Skills; IEEE Transactions on Biomedical Engineering, vol. 48, No. 5 May 2001, 13 pages.
Rovithakis Artificial Neural Networks for Discriminating Pathologic From Normal Peripheral Vascular Tissue; IEEE Transactions on Biomedical Engineering, vol. 48, No. 10, Oct. 2001 pp. 1088-1097.
Ruttmann et al. Transvenous Pacemaker Lead Removal Is Safe and Effective Even in Large Vegetations: An Analysis of 53 Cases of Pacemaker Lead Endocarditis; Pace vol. 26, Mar. 2006 pp. 231-236.
Sangpradit et al. Tissue Identification Using Inverse Finite Element Analysis of Rolling Indentation; 2009 IEEE International Conference on Robotics and Automation; Kobe, Japan, May 12-17, 2009, 6 pages.
Schroeder et al. Visualizing Surgical Training Databases: Exploratory Visualization, Data Modeling, and Formative Feedback for Improving Skill Acquisition: IEEE Computer Graphics and Applications, 2011, 11 pages; DOI 10.1109/MCG.2012.67.
Seibold et al. Prototype of Instrument for Minimally Invasive Surgery With 6-Axis Force Sensing Capability ; Proceedings of the 2005 IEEE International Conference on Robotics and Automation, Apr. 2005, 6 pages.
Sensor-Response-Compressive Force versus CNT sensor readout Chart, 2 pages.
Shah et al. Evaluation of a New Catheter Sensor for Real-Time Measurement of Tissue Contact; Heart Rhythm, vol. 3, No. 5, Supplement, May 2006 pp. S75-S76.
Simone et al. A Low Cost Instrumented Glove for Extended Monitoring and Functional Hand Assessment; Journal of Neuroscience Methods 160, 2007, pp. 335-348.
Smith et al. Extraction of Transvenous Pacing and ICD Leads; Pace vol. 31 Jun. 2008, pp. 736-752.
Bohail et al. Management and Outcome of Permanent Pacemaker and Implantable Cardioverter-Defibrillator Infections; Journal of the American College of Cardiology, vol. 49, No. 18, 2007 pp. 1851-1859.
Sokollik et al. New Model for Skills Assessment and Training Progress in Minimally Invasive Surgery; Surg Endosc vol. 18, 2004, pp. 495-500.
Sosa et al. The Importance of Surgeon Experience for Clinical and Economic Outcomes From Thyroidectomy; Annals of Surgery vol. 228, No. 3, Sep. 1998, pp. 320-330.
Spectranetics User Manual VisiSheath Dilator Sheath, 2011, 112 pages.
Related Publications (1)
Number Date Country
20180199913 A1 Jul 2018 US
Provisional Applications (1)
Number Date Country
60611191 Sep 2004 US
Divisions (1)
Number Date Country
Parent 12649759 Dec 2009 US
Child 13968993 US
Continuations (1)
Number Date Country
Parent 13968993 Aug 2013 US
Child 15922636 US
Continuation in Parts (2)
Number Date Country
Parent 12337232 Dec 2008 US
Child 12649759 US
Parent 11228845 Sep 2005 US
Child 12337232 US