The present disclosure relates generally to implantable medical leads, particularly leads having expandable distal portions for anchoring the lead in tissue when implanted in a patient, and related systems and methods.
A variety of implantable medical devices have been proven to be effective for treatment of a variety of diseases. Many of such devices, such as cardiac pacemakers, defibrillators, spinal cord or deep brain stimulators, gastric stimulators, and the like, employ accessory medical leads to deliver electrical signals from a signal-generating device to tissue of a patient at a location removed from the signal generating device. Typically the lead is tunneled from a subcutaneous region of the patient in which the signal generating device is implanted to a target tissue location.
It is often important that the lead, or portions thereof, does not shift or move once implanted to ensure that a therapeutic signal continues to be delivered to the target tissue. One mechanism for retaining the implanted position of a lead or portion thereof is the use of tines. The tines are typically attached to various locations of the lead and are deployed once the lead is properly positioned in the patient. Most often, tines prevent retrograde movement of the lead. However, once the tines are deployed, it can be difficult to change the position of the lead.
Prior to deploying the tines, it is often desirable to apply electrical signals to the patient via electrodes of the lead, as the lead is being implanted, to determine whether the lead is being positioned in an appropriate location or if the tract of implantation is proceeding in a desired direction. This process is sometimes referred to a trolling, where test electrical signals are applied as the lead is advanced to aid in the proper placement of the lead. However, with the use of standard lead introducer devices, it is not possible to perform such trolling when the tines are disposed on the lead distal to the electrodes. That is, absent tines being distal electrodes of the lead, the lead may extended distally beyond the introducer (or the introducer may be withdrawn to expose the distal end of the lead) such that a test electrical signal may be delivered to the patient via electrodes of the lead, and the lead may be withdrawn into the introducer (or introducer advanced) and repositioned. This process may be repeated until the lead is determined to be in an appropriate location, and the introducer may be completely withdrawn. However, when the tines are disposed on the lead distal to the electrodes, the tines will be deployed during the initial test stimulation (when extended beyond the distal end of the introducer), and the ability to reposition the lead will be compromised, if not lost.
This disclosure, among other things, describes implantable medical leads having deployable anchoring mechanisms that may be retracted so that the lead may be withdrawn back into an introducer and repositioning may occur.
In various embodiments, a lead includes a proximal body having a longitudinal axis and a distal portion extending from the proximal portion. The distal portion has a changeable width and includes a central body portion including a plurality of electrodes aligned with the longitudinal axis of the proximal body. The distal portion also includes first and second edge portions on opposing sides of the central body portion. The edge portions define the width of the distal portion and have a collapsed configuration and an expanded configuration. When the first and second edge portions are in the collapsed configuration, the distal portion of the lead has a first width and is configured to be received by a lumen of an introducer. When the first and second edge portions are biased towards the expanded configuration, and when in the expanded configuration the distal portion of the lead has a second width greater than the first width, and the second width is greater than or equal to an outer diametric dimension of the introducer. The first and second edge portions are free of electrodes. The first and second edge portions, in the expanded configuration, may have (i) ramped a distal portions configured to facilitate conversion to the collapsed configuration as the distal portion is pushed into the lumen of the introducer, and (ii) ramped proximal portions configured to facilitate conversion to the collapsed configuration as the distal portion is pulled into the lumen of the introducer, allowing retraction of the lead into the introducer for repositioning of the lead during an implant procedure.
In various embodiments, an implantable medical lead includes an elongate body member having a proximal end and a distal end, a plurality of contacts in proximity to the proximal end, and a plurality of electrodes in proximity to the distal end. Each of the plurality of electrodes is electrical coupled to a discrete contact of the plurality of contacts. The lead also includes a plurality of protrusions extending from the body in proximity to the distal end. The protrusions are resilient and have a collapsed configuration and an expanded configuration. The protrusions are biased in the expanded configuration. The elongate body member has a diametric dimension smaller than the inner diametric dimension defined by a lumen of an introducer such that the body member is capable of being slidably received by the lumen of the introducer. The lead, in the distal region having the plurality of protrusions, has (i) a diametric dimension greater than or equal to the outer diametric dimension of the introducer when the protrusions are in the expanded configuration, and (ii) a diametric dimension less than the inner diametric dimension of the introducer when the protrusions are in the collapsed configuration. The protrusions have ramped distal portions configured to facilitate conversion to the collapsed configuration as the distal portion is pushed into the lumen of the introducer, and have ramped proximal portions configured to facilitate conversion to the collapsed configuration as the distal portion is pulled into the lumen of the introducer, allowing retraction of the lead into the introducer for repositioning of the lead during an implant procedure.
One or more embodiments described herein provide one or more advantages over prior leads, devices, systems and methods where the leads employ distal anchoring mechanisms such as tines. Such advantages will be apparent to those of skilled in the art upon reading the following detailed description.
The accompanying drawings, which are incorporated into and form a part of the specification, illustrate several embodiments of the present disclosure and, together with the description, serve to explain the principles of the disclosure. The drawings are only for the purpose of illustrating embodiments of the disclosure and are not to be construed as limiting the disclosure.
The schematic drawings presented herein are not necessarily to scale. Like numbers used in the figures refer to like components, steps and the like. However, it will be understood that the use of a number to refer to a component in a given figure is not intended to limit the component in another figure labeled with the same number. In addition, the use of different numbers to refer to components is not intended to indicate that the different numbered components cannot be the same or similar.
In the following detailed description, reference is made to the accompanying drawings that form a part hereof, and in which are shown by way of illustration several embodiments of devices, systems and methods. It is to be understood that other embodiments are contemplated and may be made without departing from the scope or spirit of the present disclosure. The following detailed description, therefore, is not to be taken in a limiting sense.
All scientific and technical terms used herein have meanings commonly used in the art unless otherwise specified. The definitions provided herein are to facilitate understanding of certain terms used frequently herein and are not meant to limit the scope of the present disclosure.
As used in this specification and the appended claims, the singular forms “a”, “an”, and “the” encompass embodiments having plural referents, unless the content clearly dictates otherwise.
As used in this specification and the appended claims, the term “or” is generally employed in its sense including “and/or” unless the content clearly dictates otherwise. As used herein, “have”, “having”, “include”, “including”, “comprise”, “comprising” or the like are used in their open ended sense, and generally mean “including, but not limited to.”
“Exemplary” or “representative” is used in the sense of “for example” or “for the purpose of illustration”, and not in a limiting sense.
As used herein, “aligned”, as it relates to aligning one or more electrodes an axis, means that at least a portion of each of the one or more electrodes overlaps with a plane through the axis.
In various embodiments, this disclosure, among other things, describes implantable medical leads having deployable anchoring mechanisms that may be retracted so that the lead may be withdrawn back into an introducer and repositioning may occur. The deployable anchoring mechanisms are located in proximity to electrodes at the distal portion of the lead and can serve to prevent undesired movement or migration of the electrodes relative to the tissue in which they are implanted.
Referring now to
The distal portion 900 of the lead 20 also includes first 930 and second 931 edge portions that define the width of the distal portion 900. The edge portions 930, 931 have expanded and collapsed configurations, e.g. as will be discussed in more detail below with regard to, e.g.,
The distal portion 900 of the lead 20 also includes one or more resilient members 920 that span the gap between the central body 910 and the first edge portion 930 and the central body 910 and the second edge portion 931. The resilient members 920 bias the first 930 and second 931 edge portions towards the expanded configurations. The resilient members 920 may be formed from a shape-memory metal or alloy, such as nitinol, or any suitable biocompatible polymer, such as nylon, polyurethane, polycarbonate, or the like. In some embodiments, the resilient member(s) 920 are compressible foam. The resilient members 920 can be bent or folded, as desired or needed, but in the absence of external folding or bending forces, or the like, assume a position that causes the first 930 and second 931 edge portions to assume the expanded configuration. The resilient members 920 may be integrally formed with the central body 910 or the first 930 and second 931 edge portions or may be bonded, adhered, welded, affixed or otherwise operably coupled to the central body 910 and the first 930 and second 931 edge portions. The resilient members 920 may take any suitable form, such as a web (see
With reference to
The first and second edge portions 930, 931 may be formed of any suitable material such as a biocompatible polymer material. The edge portions 930, 931 may be formed separately or may be formed as a single unit or piece. In some embodiments, the edge portions and the central portion 910 are formed from a single unit or piece. The edge portions 930, 931 may be of solid or hollow core constructions and may be molded, extracted or the like. In embodiments, where the edge portions 930, 931 are formed from one or more units separate from the central body portion 910 or the body member 25, the edge portions may be attached to the central portion 910 or the body portion 25 via adhesive, bonding, welding, or the like.
Referring now to
In the leads 20 depicted in
Referring now to
In
As shown in
As the ramped portions 950, 951, 960, 961 are pushed or pulled against the proximal or distal end of the body member 410 of the introducer, the force of pushing or pulling, along with the ramped configuration of the edge portions 931), 931 causes the edges to assume a collapsed configuration, allowing the distal portion 900 of the lead to enter the lumen 420 of the introducer. Preferably, the lead body is formed of material and constructed in a way such that the lead is sufficiently pushable to allow the distal portion 900 of the lead to collapse and enter the lumen when the lead body is pushed against the body of the introducer. Well-known lead manufacturing techniques and materials may be employed to impart such pushability. Of course, the lead body may have a lumen open to the proximal end to allow a stylet to enter and push the lead if the lead body does not have sufficient pushability.
Referring now to
Referring now to
In some embodiments, the protrusions 990 are collapsible and expandable. For example the protrusions 990 may be of solid core construction (
Referring now to
A plurality of contacts 80 are in proximity to the proximal end, and a plurality of electrodes 90 are in proximity to the distal end. Each of the plurality of electrodes 90 is electrical coupled to a discrete contact 80. The distal end portion 900 of the lead includes a plurality of protrusions 990 extending from the body 25. The protrusions 990 are resilient and have a collapsed configuration (see
The lead body, contacts, electrodes, and protrusions of the lead shown in
It will be understood that the leads described herein may be used for any suitable purpose. A general overview of systems that may employ such leads is provided in
Referring to
Any suitable active implantable medical device employing leads for transmission or receipt of electrical signals may be employed in accordance with the teachings presented herein. For example, a lead may be associated with an active implantable medical device, such as a hearing implant; a cochlear implant; a sensing or monitoring device; a signal generator such as a cardiac pacemaker or defibrillator, a neurostimulator (such as a spinal. cord stimulator, a brain or deep brain stimulator, a peripheral nerve stimulator, a vagal nerve stimulator, an occipital nerve stimulator, a subcutaneous stimulator, etc.), a gastric stimulator; or the like.
By way of example and referring to
By way of further example and referring to
Application of electrical signals to an occipital nerve for treatment of headache, such as migraine, is one particular example or where it may be desirable to employ a lead having a tine distal the electrodes.
Those skilled in the art will recognize that the preferred embodiments may be altered or amended without departing from the true spirit and scope of the disclosure, as defined in the accompanying claims.
This patent application claims priority to U.S. Provisional Patent Application Ser. No. 61/299,674, filed Jan. 29, 1010, the entire disclosure of which is expressly incorporated herein by reference.
Number | Date | Country | |
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61299569 | Jan 2010 | US |