Patent Application
20090234231
The present invention relates to imaging catheters, and more particularly to imaging catheters with integrated contrast agent injectors.
Intravascular ultrasound (IVUS) is an established tool for obtaining ultrasound images within the vascular system. IVUS is a method by which a catheter-based transducer is used to obtain images of the lumen and vascular wall of larger vessels. It is an established interventional cardiology tool for gaining insight into the size, structure, and composition of atherosclerotic plaque located within coronary arteries.
Ultrasound contrast imaging employs a contrast agent to enhance the detection and imaging of organs, blood vessels, or tissues within the body. Contrast agents may be comprised of echogenic microbubbles or other substances having ultrasound scattering properties that are distinct from those of the surrounding media (tissue and blood), thereby enhancing the visibility of organs, blood vessels or tissues containing the contrast agent. Materials having suitable sound reflection properties to be used as ultrasound contrast agents include solid particles and air or gas-filled microbubbles. Contrast agents are typically composed of particles of a size that allows them to flow freely through, but remain within, the vessels of the microcirculatory system. By increasing the visibility of organs, blood vessels or tissues being studied, contrast agents can aid the clinician in determining the presence and extent of disease or injury. Contrast imaging enables the viewing and differentiation of fine structures that are not normally distinguishable from surrounding tissue.
Contrast agent microbubbles can also be used to deliver a drug or other pharmaceutical agent in the patient. In drug delivery applications, the microbubbles encapsulate a drug or pharmaceutical agent instead of an inert gas. The microbubbles may be administered intravenously and travel through the vascular system. The drug remains encapsulated and inert, and therefore biologically unavailable, until a source of ultrasound energy bursts the microbubbles to release the drug.
Contrast agents are used primarily with non-invasive or intracardiac ultrasound imaging methods. In these methods, a contrast agent is injected into the bloodstream, e.g., by an intravenous drip or syringe. The injected contrast agent flows throughout the vascular system, not just the region of interest in the body. As a result, a larger quantity of contrast agent must be injected into the patient than needed to image the region of interest. Another problem with these methods is the difficulty of synchronizing the injection of contrast agent with imaging. This is due in part to the difficulty of estimating the time its takes the injected contrast agent to reach the region of interest, which can be as long as two minutes. In addition, these methods use two separate instruments for the injection of the contrast agent and the imaging.
Currently, contrast agents are administered by intravenous drip, or by manual injection through a syringe or guide catheter. Such methods cannot control the volume of contrast agent in a blood vessel accurately enough to ensure a uniform concentration. As a result, the frame-to-frame brightness of the contrast agent can vary as different ultrasound images are taken of the blood vessel, making interpretation of the ultrasound images difficult.
Described herein are systems and methods that integrate the injection of contrast agents with imaging catheters.
In an embodiment, an imaging catheter comprises a catheter sheath and an imager, e.g., ultrasound transducer, which may be mounted on the sheath or slidably received within the sheath. The imaging catheter further comprises a contrast lumen having one or more exit ports for injecting contrast agent into the patient. The contrast lumen extends along the catheter sheath and may be external to or integrated into the catheter sheath. Preferably, the exit port of the contrast lumen is positioned along the catheter sheath at a relatively short known distance, e.g., 20 cm or less, from the imager. The catheter may include multiple contrast lumens for injecting different types of contrast agents.
The imaging catheter with the integrated contrast agent injector advantageously reduces the volume of contrast agent that needs to be injected into the patient by injecting the contrast agent locally near the region to be imaged. The imaging catheter also provides easier synchronization between the injection of contrast agent and imaging. This is because the exit port of the contrast lumen is located at a short known distance from the imager, making it easier to estimate the time for the injected contrast agent to reach the region being imaged by the imager. In addition, the imaging catheter provides more precise control over the volume of contrast agent in a particular blood vessel by injecting the contrast agent directly into the blood vessel.
In an embodiment, a synchronizing controller is provided to automatically synchronize the injection of contrast agent with the imaging. The synchronizing controller controls the injection rate by controlling a pump, e.g., an electric pump, that pumps the contrast agent into the contrast lumen. In one embodiment, the synchronizing controller injects contrast agent at a uniform rate during imaging to provide a more consistent image brightness.
In another embodiment, drug-filled microbubbles in combination with ultrasound imaging are used to deliver a controlled drug dose to a specific treatment site. In this embodiment, the drug-filled microbubbles are delivered to the treatment site and subjected to high-level ultrasound energy to burst the microbubbles and release the drug into the treatment site. The amount of microbubbles that are ruptured, and hence the amount of the drug released into the treatment site, is determined by examining images taken before and after the microbubble bursting. This cycle of bursting microbbubles and determining the amount of the drug released can be repeated until a desired drug dose has been delivered to the treatment site.
Other systems, methods, features and advantages of the invention will be or will become apparent to one with skill in the art upon examination of the following figures and detailed description. It is intended that all such additional systems, methods, features and advantages be included within this description, be within the scope of the invention, and be protected by the accompanying claims.
In order to better appreciate how the above-recited and other advantages and objects of the present inventions are objected, a more particular description of the invention briefly described above will be rendered by reference to specific embodiments thereof, which are illustrated in the accompanying drawings. It should be noted that the components in the figures are not necessarily to scale, emphasis instead being placed upon illustrating the principles of the invention. Moreover, in the figures, like reference numerals designate corresponding parts throughout the different views. However, like parts do not always have like reference numerals. Moreover, all illustrations are intended to convey concepts, where relative sizes, shapes and other detailed attributes may be illustrated schematically rather than literally or precisely.
a-5c show an imaging catheter with a contrast agent lumen integrated in the catheter sheath according to an embodiment of the present invention.
The catheter 105 further comprises an ultrasound imager 125. The ultrasound imager 125 may comprise one or more ultrasound transducers, e.g., piezoelectric transducers or capacitive micromachined transducers (CMUTs). The ultrasound imager 125 may be mounted on the catheter sheath 110. Alternatively, the ultrasound imager 125 may be part of an imaging core that is slidably received within an inner lumen of the catheter sheath 110. The imager 125 may be side-looking and/or forward looking. Examples of intravascular catheters having side-looking and/or forward looking imagers can be found, for example, in U.S. patent application Ser. No. 11/104,865, titled “Intravascular Imaging System With Forward Looking Element,” filed on Apr. 12, 2005, the specification of which is incorporated in its entirely herein by reference.
Returning to
The imaging catheter 105 according to the preferred embodiment provides several advantages over prior art methods in which contrast agent is injected into the patient at a injection point located away from the region of interest by an intravenous drip or a syringe. In these prior art methods, the patient's circulatory system not only carries injected contrast agent to the region of interest, but also distributes injected contrast agent throughout the vascular system. As a result, a larger quantity of contrast agent must be injected into the patient than needed to locally image the region of interest. The imaging catheter 105 reduces the quantity of contrast agent that needs to be injected into the patient by injecting the contrast agent locally near the region of interest from the exit port 120 of the catheter 105. For example, the catheter 105 allows the contrast agent to be injected into the same vascular structure, e.g., artery, as the region of interest.
The imaging catheter 105 also provides easier synchronization between the injection of contrast agent and imaging. This is because the exit port 120 of the catheter lumen 115 injects the contrast agent at a short known distance, e.g., 20 cm or less, from the imager 125, making it much easier to estimate the time for the contrast agent to reach the region of interest being imaged by the imager 125. The imager 125 may be aligned with the region of interest by using non-contrast imaging to locate the region of interest. Contrast imaging can then be injected, e.g., to image fine structures within the region of interest. For a slidable imaging core 175, the distance between the exit port 120 can be determined using the known position of the exit port 120 along the sheath 110 and monitoring the relative position of the imaging core 125 within the catheter sheath 110.
The imaging catheter 105 also provides more precise control over the volume of contrast agent in a blood vessel by injecting contrast agent directly into the blood vessel. In prior art methods where the contrast agent is injected by an intravenous drip or a syringe, it is difficult to control the volume of contrast agent in a particular blood vessel because the injected contrast agent also flows to other blood vessels throughout the vascular system. An advantage of controlling the volume of contrast agent is that the volume of contrast agent in the blood flow can be controlled to ensure that a certain amount of blood continues to flow to downstream tissue (unlike the injection of x-ray contrast or a saline flush), thereby minimizing ischemic insult to downstream tissue.
The imaging catheter 105 may be used for contrast enhanced imaging of vulnerable plaque in the blood vessel, the diameter of the blood vessel, the vasa vasorum associated with the blood vessel, and the like. The imaging catheter 105 may also be used for contrast enhanced imaging of surrounding tissue by imaging the perfusion of contrast agent from the blood vessel into microvessels feeding blood to the surrounding tissue. The imaging catheter 105 may also be used to inject a targeted contrast agent into the blood vessel to image a certain tissue type, e.g., for tissue characterization. To do this, the targeted contrast agent may contain a ligand that is attracted to receptors of the tissue of interest. The imaging catheter 105 may also be used to inject a contrast agent containing a drug, or other pharmaceutical agent. For example, the contrast agent may comprise microbubbles containing the drug that burst and release the drug when subjected to sufficiently high ultrasound energy. Methods of delivering a drug in a patient using drug-filled microbubbles are discussed further below. The imaging catheter 105 may also be used to image the myocardium in the heart and other structures in the body.
The imaging catheter 105 may also be used to measure blood flow in a blood vessel. This may be done by measuring the transit time of contrast agent from the exit port 120 to the imager 125, and dividing the transit time by the known distance between the exit port 120 and the contrast lumen 115. A method for measuring blood flow according to an exemplary embodiment will now be discussed with reference to
Contrast imaging can be used to calculate or observe other characteristics. For example, blood flow can be calculated by injecting a pulse of contrast agent into the bloodstream and using ultrasound imaging to measure the volume of microbubbles in a period of time to calculate blood flow. Contrast imaging can be used to calculate micro-vessel density in a vessel wall, blood velocity, and stenosis (narrowing of the blood vessel) by measuring blood velocity proximal to, inside of, and distal to the stenosis. Contrast imaging can also be used to determine lumen border by detection of contrast agent density.
Although
Further, the contrast lumen 115 may be external to the catheter sheath or integrated into the catheter sheath.
A method for synchronizing the injection of contrast agent with imaging during a pullback procedure will now be described. In this embodiment, the synchronizing controller 160 activates the imager 125 and pulls back the imager 125, e.g., at a uniform rate, with the MDU of the ultrasound system 150. As the imager 125 is pulled back, the imager 125 may acquire cross-sectional images of the blood vessel, e.g., at evenly spaced intervals. The pull back procedure can last several minutes depending on the rate of pullback and the length of blood vessel being imaged. During the pullback procedure, the synchronizing controller 160 may control the pump 156 to inject contrast agent into the blood vessel at a uniform rate. The uniform injection of contrast agent during pullback provides a more uniform concentration of contrast agent in the blood. This results in more uniform contrast imaging along the entire length of the pullback. In this embodiment, the exit port 120 may be located far enough toward the proximal end of the catheter so that the exit port 120 remains proximal to the imager 125 throughout the pullback.
In one embodiment, the synchronizing controller 160 injects contrast agent into the blood vessel for a period of time before initiating pullback to allow the surrounding tissue time to absorb the contrast agent and the concentration of contrast agent in the surrounding tissue to reach a steady-state. The period of time may be based on a predetermined estimate or measurement of the absorption time for the surrounding tissue. Typically, the flow rate of blood in microvessels is typically 10 to 20 times slower than in the blood vessel. The period of time may also be determined in real time by analyzing images acquired by the imager 125 during the initial contrast injection. In this example, the absorption of contrast agent into the surrounding tissue may be determined based on areas of the surrounding tissue that appear bright in the ultrasound images due to the presence of the contrast agent. This analysis may be performed by the synchronizing controller 160, which may receive the ultrasound images from an image processor in the ultrasound system 150.
The catheter apparatus 205 is advantageous over prior art methods in which contrast agent is injected into the patient by an intravenous drip, or manual injection through a syringe or guide catheter. In these prior art methods, it is difficult to control the volume of contrast agent in the blood vessel accurately enough to provide a uniform concentration during pullback. As a results, the frame-to-frame brightness of the contrast agent is not uniform, making interpretation of the ultrasound images more difficult. The catheter apparatus 205 addresses this problem by providing a more uniform concentration of contrast agent in the blood during the entire pullback procedure.
In an exemplary embodiment, the synchronizing controller 160 is coupled to an electrocardiogram (EKG) monitor 163 to synchronize the acquisition of images from the imager 125 with the cardiac cycles of the patient. During each cardiac cycle, the blood vessel expands and contracts due to the pumping action of the heart. The resulting cardiac motion in images of the blood vessel can be reduced by acquiring the images at the same phase in the cardiac cycles. To do this, the EKG monitor 163 may send a signal to the synchronizing controller 160 indicating when the desired phase occurs in each cardiac cycle, and the synchronizing controller 160 may trigger an image acquisition and/or contrast agent injection when the signal indicates that the desired phase has occurred.
The synchronizing controller 160 may also control the injection rate based on the brightness of the contrast agent in the ultrasound images. For example, the synchronizing controller 160 may monitor the image brightness from the ultrasound image processor. When the image brightness decreases, the controller 160 may increase the injection rate of the contrast agent, and when the image brightness increases, the controller 160 may decrease the injection rate. Thus, the injection rate of the contrast agent can be adjusted based on image feedback to maintain a more uniform brightness in the ultrasound images.
The contrast agent injection may also be synchronized with a particular blood pressure. In this embodiment, the pressure may be measured, e.g., using a pressure wire. The contrast agent injection may also be synchronized with a particular volume of blood flow.
The contrast agent may be injected in an injection pulse, e.g., a square pulse (i.e., uniform injection over a period or time), a sloped pulse, or other shaped pulse. For an injection pulse, image acquisition may be triggered at the beginning of injection (or a fixed delay after) or at the end of the injection (or a fixed delay after). The image acquisition may also be triggered at the peak of an injection pulse (or a fixed delay after), e.g., for a non-uniform injection pulse. For a complex pulse shape, imaging can be triggered at any inflection point or at a fixed delay afterwards.
A method for locally delivering a controlled dose of a drug or other pharmaceutical agent to a treatment site using drug-filled microbubbles will now be described with reference to
The treatment site 305 may be identified before the delivery of the drug by first imaging the blood vessel and analyzing the resulting images to identify the area to be treated. The blood vessel may be imaged, e.g., using non-drug-filled microbbubles or no contrast agent. After the treatment site has been identified, a controlled dose of the drug or pharmaceutical agent may be delivered to the treatment site 305 using the method described in the flowchart show in
Turing now to the flowchart of
In step 710, microbubbles containing the drug or pharmaceutical agent is injected into the blood vessel near the treatment site 305. Preferably, the drug-filled microbubbles are released upstream of the treatment site 305. The drug-filled microbubbles perfuse into the treatment site 305, increasing the echocentricity of the treatment site 305.
In step 715, the catheter is used to image the treatment site 305 as the microbbubles perfuse into the treatment site 305. The perfusion of the microbubbles into the treatment site 305 causes the image brightness of the treatment site 305 to increase. The image brightness can be used to estimate the concentration of the unreleased drug in the treatment site 305. This is because the image brightness is a function of the concentration of microbubbles in the treatment site 305. The greater the image brightness, the higher the concentration of microbubbles, and hence the drug contained in the microbubbles. Preferably, the treatment site 305 is imaged using low-level ultrasound energy that is insufficient to burst the microbubbles. The image brightness of the treatment site 305 is monitored to determine when a desired concentration of the microbubbles containing the drug has been reached.
In step 720, when the desired concentration has been reached, the imager 125 is energized to an energy level sufficient to burst the microbubbles in the treatment site 305, thereby releasing the drug contained in the microbubbles into the treatment site 305. The imager 125 may be pulled back as the imager 125 is energized to burst the microbubbles along the entire length of the treatment site 305.
In step 725, the treatment site 305 is imaged after the imager 125 has been energized to determine the post-energizing microbubble concentration. Since additional microbubbles may perfuse into the treatment site 305 between the time the microbubbles burst and the time the post-energizing image is acquired, the post-energizing microbubble concentration may be adjusted to take this into account, e.g., based on the perfusion rate of microbubbles into the treatment site 305.
In step 730, the drug dose released in the treatment site 305 by the bursting of the microbubbles is estimated. This may be done by subtracting the post-energizing microbubble concentration from the pre-energizing microbubble concentration to determine the drug concentration released into the treatment site 305 and using the volume of the treatment site 305 to determine the drug dose. The volume of the treatment site 305 may be estimated based on a three-dimensional ultrasound image of the treatments site 305.
In step 735, the dose of the released drug is recorded and compared to the desired total dose to be delivered to the treatment site 305. If the desired total dose has not been reached, then steps 705 through 735 may be repeated until the desired amount of drug has been delivered to the treatment site 305.
Therefore, the drug delivery method enables a physician to more precisely deliver a controlled drug dose to a specific treatment site 305 in the body. Further, the drug delivery method reduces the amount of the drug that is delivered to other areas of the body outside of the treatments site 305. This is because the drug-filled microbubbles are injected locally near the treatment site 305 and controllably destroyed within the treatment site 305 to release the drug in the treatments site 305. The targeted delivery of the drug to the treatment site 305 is important, e.g., when the drug is harmful to surrounding healthy tissue.
The drug delivery method is based on the principle that the concentration of contrast agent microbubbles can be determined analytically by comparing the reflected ultrasound energy before and after administration of the contrast agent. By knowing the microbubble concentration, an estimation of the number of microbubbles and, therefore, the volume of the drug or pharmaceutical agent contained within the microbubbles can be calculated. Since the drug or pharmaceutical agent is inert until the microbubbles are destroyed, controlled ultrasound can be applied in short pulses to incrementally burst the microbbubles, and imaging before and after microbubble bursting can be used to determine the amount of drug released in the treatment site. This cycle can be continued until the proper dose of the drug or pharmaceutical agent has been delivered.
The drug-filled microbubbles may be injected into the patient using an imaging catheter with an integrated injector or a separate injection device. For example, the microbubbles may be injected using a separate guide catheter, or by an external means such an intravenous drip or a syringe. Also, the microbubbles may be imaged and destroyed using the same transducer or different transducers. Further, the drug-filled microbubbles may comprise microbubbles that have a frequency-generated non-linear response. This allows ultrasound waves reflected from the microbubbles to be isolated from ultrasound waves reflected from surrounding tissue, e.g. using a filter that filters out ultrasound waves at the fundamental frequency (i.e., frequency of the transmit signal). For example, the microbubbles may comprise harmonic microbubbles, sub-harmonic microbubbles, etc.
In the foregoing specification, the invention has been described with reference to specific embodiments thereof. It will, however, be evident that various modifications and changes may be made thereto without departing from the broader spirit and scope of the invention. For example, although ultrasound imaging was used in the preferred embodiment, the invention can be used with other imaging modalities that use contrast agents. As another example, the reader is to understand that the specific ordering and combination of process actions described herein is merely illustrative, and the invention can be performed using different or additional process actions, or a different combination or ordering of process actions. As a further example, each feature of one embodiment can be mixed and matched with other features shown in other embodiments. Additionally and obviously, features may be added or subtracted as desired. Accordingly, the invention is not to be restricted except in light of the attached claims and their equivalents.
