The present disclosure relates generally to exemplary systems, methods and apparatus for providing imaging, including optical coherence tomography (OCT), and/or pressure measurement in, e.g., a single intravascular catheter device.
Intravascular pressure measurements are important for interventional procedures on blood vessels. One example of such a medical procedure is the measurement of Fractional Flow Reserve (FFR) where a guide wire that contains a pressure-sensing element is inserted into the artery. Maximal hyperemia is induced, typically by for example administration of adenosine, and the pressure distal to the stenosis is measured and divided by the aortic pressure measured proximally. This FFR parameter can be used to determine whether or not an intravascular lesion should be treated in order to improve patient outcomes.
Even though FFR has proven to be a valuable interventional diagnostic measurement, there are many cases where FFR cannot be used alone to guide intervention. Sometimes artifacts in pressure measurements can give FFR values that are not necessarily indicative of the severity of an intravascular lesion. For many cases, the blockage is at least in part due to thrombosis that has occurred at the lesion site and in these situations FFR is not a true measure of lesion severity. For these and other reasons, it is helpful to obtain information about the structure of the artery wall to provide additional data to guide management.
One such intravascular structural imaging technique is optical coherence tomography (OCT). With intravascular OCT, a catheter is inserted into artery to determine microstructural features in the artery wall. Intravascular OCT has been shown to provide a significant amount of detail about the coronary artery, information that may be used to guide lesion management.
While both OCT and FFR guide wires are available as single devices, they typically are used separately, which can increase the duration, complexity, and cost of the procedure.
Therefore, there is a need to address at least some of the deficiencies and/or issues described herein above.
Thus, apparatus and method according to exemplary embodiments of the present disclosure can be provided to facilitate imaging, including optical coherence tomography (OCT), and/or pressure measurement in, e.g., a single intravascular catheter device.
For example, conventionally, intravascular optical imaging methods, such as OCT and intravascular pressure measurements are obtained using two separate catheter devices. With the use of exemplary embodiments of the present disclosure, optical imaging and pressure measurements can be obtained using, e.g., in one exemplary variant, a single coronary catheter, which can simply the overall procedure, enhance operational efficiency, and improve patient safety, while providing a more comprehensive assessment of the vascular lesion under investigation.
Thus, it is one of the objects of the present disclosure is to provide both OCT imaging and pressure measurement in a single catheter device. In one exemplary embodiment, the pressure measurement can be obtained with an optical pressure measurement arrangement. In another exemplary embodiment, the exemplary device can include an optical fiber. Light or other electromagnetic radiation transmitted through the optical fiber can be used both for OCT imaging and pressure measurement. According to yet another exemplary embodiment, the same wavelengths of light or other electromagnetic radiation can be used for both the OCT imaging and the pressure measurement.
According to a further exemplary embodiment of the present disclosure, the exemplary device can further include a sheath that can be at least partially transparent to electromagnetic radiation, and which can be inserted into the vessel of interest. In one exemplary embodiment, OCT imaging can take place through this sheath. For example, the optical fiber that transmits the OCT electromagnetic radiation can be inside a driveshaft. The optical fiber can be distally terminated by, e.g., a lens and a beam-redirecting element. In another example, the driveshaft can be rotated within the sheath, spinning the beam around the artery wall. OCT axial scan lines (e.g., reflectivity depth profiles) can be obtained as the beam spins, comprising a cross-sectional OCT imaging of the vessel wall.
In a further exemplary embodiment of the device according to the present disclosure, the sheath can have an opening through which a pressure in the vessel can be transmitted. According to another exemplary embodiment, the sheath is closed but has a portion that is compliant and transduces pressure there through. In yet another embodiment, the sheath additionally contains a guide wire provision that allows the sheath to be guided over the guide wire. Such guide wire can be, e.g., an over-the-wire and/or a rapid exchange guide wire provision.
According to yet another exemplary embodiment of the device according to the present disclosure, an optical fiber can include a pressure sensor. For example, such exemplary optical fiber can be the same optical fiber that transceivers the OCT electromagnetic radiation. Further, the pressure sensing optical fiber and the OCT optical fiber can be different. In a further exemplary embodiment, the electromagnetic radiation from the pressure sensing fiber can illuminate a deformation arrangement, at least one portion of which can deform or move as a function of pressure within the vessel. This motion can be referenced to another portion of the exemplary arrangement that does not move and/or moves differently. The electromagnetic radiation can be transmitted from the moving portion to the fiber. In yet a further exemplary embodiment, this electromagnetic radiation can be combined with a further reference electromagnetic radiation and detected. Such exemplary interference between these electromagnetic radiations and the relative phase and/or the position can be used to determine the amount of motion of at least one portion of the deformation arrangement. The amount of motion can be processed (e.g., using a programmed computer arrangement) to compute the intravascular pressure. In still another exemplary embodiment of the present disclosure, the OCT imaging light can be transmitted through the deformation arrangement. Such exemplary deformation arrangement can be physically associated with the sheath, and/or can be a component of the imaging core that includes the optical fiber. The OCT electromagnetic light or radiation can be at least partially transmitted by the beam-redirecting element to the deformation arrangement.
In yet another exemplary embodiment of the device according to the present disclosure, the pressure sensing optical element can be or include a filter, a fiber Bragg grating, a polarization maintaining fiber, a Rayleigh scattering sensitive fiber, a photonic crystal fiber or the like. Certain wavelengths of light or electromagnetic radiation transmitted or reflected by the grating are dependent on pressure. The pressure can then be determined by measuring the spectral content of the returned light. In yet another exemplary embodiment, the filter can be based on Raman scattering and the intensity of the light can provide a measurement of the pressure. According to a still further exemplary embodiment, the optical fiber can be associated with a Fabry Perot device. The exemplary device can have a deformable portion that can move as a function of pressure. The motion can be determined by detecting electromagnetic radiation interference from the deformable portion.
According to a further exemplary embodiment of the device of the present disclosure, the outer sheath diameter can be small enough to not affect the pressure measurements inside the blood vessel. For example, the outer diameter can be less than 2.6 F, 1.5 F, etc.
Further, apparatus and method for obtaining information regarding at least one sample can be provided. For example, at least one optical data-obtaining first arrangement can be used which is configured to obtain data for the at least one sample based on a first light radiation provided from the sample(s). At least one pressure-sensing second arrangement can also be used which is configured to measure a pressure of at least one fluid that is provided at or near the sample(s) based on a second light radiation. In addition, e.g., a housing third arrangement can at least partially enclose the first and second arrangements.
For example, the second arrangement can be or include a deformable arrangement. The second light radiation can be the same as or different from the second light radiation. At least one portion of the second light radiation can be transmitted through the first arrangement. The third arrangement can include a deformable arrangement or an aperture.
According to yet another exemplary embodiment of the present disclosure, the second arrangement includes at least two portions. A first portion of the portions can be movable with respect to a second portion of the portions. A detector arrangement can be provided which is configured to receive a third light radiation reflected from the first portion and a fourth light radiation reflected from the second portion. The detector arrangement can be used to determine a position of the second portion with respect to the first portion based on an interference between the third and fourth light radiations. The position can be related to the pressure.
The third arrangement can comprise at least one channel that is structured to house a guidewire. A diameter of the third arrangement at a portion that at least partially encloses the first and second arrangements is less than 2.6 French, 1.5 French, etc. The first arrangement can include includes an interferometer, which can be a Fabry-Perot interferometer. The first arrangement can be further configured to perform a spectroscopy and/or an optical coherence tomography (OCT) procedure (e.g., including a time domain OCT, spectral-domain OCT and/or swept-source OCT). The first arrangement and/or the second arrangement can be rotatable within the third arrangement. The second arrangement can contain a fiber Bragg grating, a Rayleigh scattering fiber, and/or a photonic crystal fiber.
The first arrangement can be used to obtain data and the second arrangement can be used to measure pressure substantially simultaneously. The third arrangement can be sized to be insertable into a blood vessel. The second arrangement(s) can include a plurality of second arrangement position longitudinally along an extension of the third arrangement.
These and other objects, features and advantages of the exemplary embodiments of the present disclosure can become apparent upon reading the following detailed description of the exemplary embodiments of the present disclosure, when taken in conjunction with the appended claims.
Further objects, features and advantages of the present disclosure can become apparent from the following detailed description taken in conjunction with the accompanying Figures showing illustrative embodiments of the present disclosure, in which:
Throughout the drawings, the same reference numerals and characters, unless otherwise stated, are used to denote like features, elements, components, or portions of the illustrated embodiments. Moreover, while the present disclosure will now be described in detail with reference to the figures, it is done so in connection with the illustrative embodiments and is not limited by the particular embodiments illustrated in the figures, or the appended claims.
Various pressure measurements, including, e.g., FFR, can be obtained either simultaneously or sequentially over time. According to certain exemplary embodiments of the present disclosure, OCT procedures can operate by, e.g., interfering light or other electro-magnetic radiation reflected from a sample (e.g., including but not limited—an artery) with an additional electromagnetic radiation. The interference signal can be detected and processed (e.g., by a computer) to determine the axial reflectivity of the vessel wall. In a further exemplary embodiment of the present disclosure, the OCT signal can be collected in Time-Domain OCT (TD-OCT), where the path length delay of the reference light is changed in order to probe different distances within the artery wall. In another exemplary embodiment, the interference pattern can be detected as a function of wavelength of the electromagnetic radiation, e.g., Fourier Domain OCT. In a further exemplary embodiment of the present disclosure, which can include spectral domain OCT (SD-OCT), a broad bandwidth light source can be used as the source of electromagnetic radiation, and the interference is detected spectrally using a spectrometer.
In yet another exemplary embodiment of the present disclosure, a wavelength swept laser can be used as the source of the electromagnetic radiation, and the wavelength-dependent interference is detected as a function of time, e.g., swept-source OCT (SS-OCT) or optical frequency domain (FD) imaging (or optical frequency domain Interferometry—OFDI). For exemplary forms of FD-OCT, the reflectivity as a function of depth can be obtained, following a Fourier transformation of the spectral interference pattern. An image can be formed by scanning the beam over the sample and compiling multiple axial reflectivity profiles as a function of the beam's position. In one example, the beam can usually be focused on the sample using a lens, and redirected in a direction that is substantially perpendicular to the catheter's axis so that it illuminates the sample (e.g., the artery wall) to the side of the catheter.
In a further exemplary embodiment of the present disclosure, the electromagnetic radiation from one surface of the membrane 108 can be combined with another electromagnetic radiation from a reference and then detected. Such interference can be analyzed (e.g., by a specially-programmed computer) with respect to an amplitude and/or a phase of the resultant radiation to determine a displacement of the compliant tubing which is then related to a pressure based on at least one of a knowledge of the mechanical properties of the tubing or a predetermined calibration function. According to yet another exemplary embodiment, a common path interferometer can be provided and/or utilized, where a first electromagnetic radiation provided from the membrane 108 is combined with a second radiation from another source where the first and second radiations follow a substantially common path. A change in the pressure in the lumen of the vessel can cause a deformation of the soft membrane 108 because the pressure can be transmitted from the vessel to inside of the catheter device through the guide wire entry port 102 and the guide wire exit port 103.
In a further exemplary embodiment of the present disclosure, the path length between the lens and the membrane 108, and the lens and the artery wall can be different, such that the image of the coronary vessel and the shape of the soft membrane 108 can be displayed in, e.g., the same image window. According to still another embodiment of the present disclosure, the signal provided from and/or associated with the membrane 108 can be used to determine the distance of the motion of the membrane 108, which can be a function of the pressure. In yet another exemplary embodiment, the motion of the membrane 108 can be determined by measuring the phase of the interference signal that is created from the combination of the reflectance from the membrane 108 and the reference arm.
According to a further exemplary configuration at least very similar to the configuration shown in
According to a further exemplary configuration at least very similar to that shown in
In yet another exemplary embodiment of the present disclosure, these different compliant portions of the sheath can be configured so that they measure a difference or ratio of pressure across a vascular lesion. According to a further exemplary embodiment of the present disclosure, the electromagnetic radiation provided from one surface of the compliant portion of the sheath can be combined with another electromagnetic radiation from a reference and detected. Such exemplary interference can be analyzed (e.g., using a specifically-programmed computer) with respect to the amplitude or the phase of the resultant radiation to determine, e.g., a displacement of the compliant portion of the sheath which can then be related to a pressure based on at least one of a knowledge of the mechanical properties of the complaint portion of the sheath or a predetermined calibration function.
Further, other exemplary configuration according to certain exemplary embodiments of the present disclosure shown in
In yet other exemplary embodiments of the present disclosure, additional optical diagnosis or imaging modalities that utilize optical fibers such as fluorescence, time-resolved fluorescence, fluorescence lifetime, absorption spectroscopy, and Raman spectroscopy, etc. can be associated with the pressure sensing arrangement in the housing of the exemplary catheter for combined optical diagnostic capabilities and pressure sensing. These exemplary optical technologies can utilize the same fiber that is used for pressure sensing or via multiple different fibers disposed within the outer housing. Bragg gratings, Raman scattering, photonic crystal fibers or the like can be used in the fiber that can be used to transceive the electromagnetic radiation for exciting fluorescence, inelastic scattering, or detecting absorption within the sample. Such different exemplary modalities can be separated from one another by unique characteristics of the imaging modality radiation with respect to the pressure sensing radiation, such as wavelength or polarization state. When these other imaging modalities utilize multiple wave guiding regions for excitation and detection of radiation from the sample, according to various exemplary embodiments of the present disclosure, the pressure sensing fiber can be provided in one or more of the wave guiding regions. When the electromagnetic radiation with the same properties is used for imaging and pressure sensing, as may be the case of broadband illumination of the sample for spectroscopy, the spectrum returned from a Bragg grating can provide information regarding the pressure. For example, a portion of this spectrum can be utilized for pressure measurement, and a portion can be used for determining the absorption or scattering attenuation provided by the sample. These electromagnetic radiations can be discriminated by path-length determining means such as time-resolved detection or interferometry.
The foregoing merely illustrates the principles of the disclosure. Various modifications and alterations to the described embodiments can be apparent to those skilled in the art in view of the teachings herein. Indeed, the arrangements, systems and methods according to the exemplary embodiments of the present disclosure can be used with and/or implement any OCT system, OFDI system, SD-OCT system or other imaging systems including second or higher order harmonic microscopy, sum/difference frequency fluorescence microscopy (one-photon or multi-photon fluorescence), and Raman microscopy (CARS, SRS), and for example with those described in International Patent Application PCT/US2004/029148, filed Sep. 8, 2004 which published as International Patent Publication No. WO 2005/047813 on May 26, 2005, U.S. patent application Ser. No. 11/266,779, filed Nov. 2, 2005 which published as U.S. Patent Publication No. 2006/0093276 on May 4, 2006, and U.S. patent application Ser. No. 10/501,276, filed Jul. 9, 2004 which published as U.S. Patent Publication No. 2005/0018201 on Jan. 27, 2005, and U.S. Patent Publication No. 2002/0122246, published on May 9, 2002, the disclosures of which are incorporated by reference herein in their entireties. It will thus be appreciated that those skilled in the art can be able to devise numerous systems, arrangements, and procedures which, although not explicitly shown or described herein, embody the principles of the disclosure and can be thus within the spirit and scope of the disclosure. In addition, all publications and references referred to above can be incorporated herein by reference in their entireties. It should be understood that the exemplary procedures described herein can be stored on any computer accessible medium, including a hard drive, RAM, ROM, removable disks, CD-ROM, memory sticks, etc., and executed by a processing arrangement and/or computing arrangement which can be and/or include a hardware processors, microprocessor, mini, macro, mainframe, etc., including a plurality and/or combination thereof. In addition, certain terms used in the present disclosure, including the specification, drawings and claims thereof, can be used synonymously in certain instances, including, but not limited to, e.g., data and information. It should be understood that, while these words, and/or other words that can be synonymous to one another, can be used synonymously herein, that there can be instances when such words can be intended to not be used synonymously. Further, to the extent that the prior art knowledge has not been explicitly incorporated by reference herein above, it can be explicitly being incorporated herein in its entirety. All publications referenced above can be incorporated herein by reference in their entireties.
This application is based upon and claims the benefit of priority from U.S. patent application Ser. No. 62/022,791, filed on Jul. 10, 2014, the entire disclosure of which is incorporated herein by reference.
Filing Document | Filing Date | Country | Kind |
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PCT/US15/39867 | 7/10/2015 | WO | 00 |
Number | Date | Country | |
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62022791 | Jul 2014 | US |