Patent Application
20100030256
The present invention relates to medical devices and methods.
One aspect of this invention relates to a removal device for a biological occlusion and more particularly to a catheter and occlusion engaging element which is adapted to the removal of blockages in hemodialysis grafts. There are many techniques and devices known in the art for removing blockages in the vascular system and other passageways of the human body.
Another aspect of the present invention is directed to procedures, including biopsy and tumorectomy methods, and associated apparatus which provide for less invasive techniques while also providing for enhanced tissue specimens being retrieved.
Another aspect of the present invention relates to improved guide wires or catheters and method for their use, where the devices have a distal mechanism that acts as a mechanism for: 1. Flow Directed, using the natural flowing fluids, pressure differentials or contractile forces of the body onto the distal mechanism to direct its motion and direction or 2. Anchored, so that once the device is in the desired location, it can be anchored against the tissue where it rests; 3. Tensioned, so that placement of a device, over the guide wire is accomplished with less difficulty and 4. Occluded, so that vessels and aneurysms can be occluded.
Guide wire management in the operating room is problematic, and threading the needle of the arteries or other vessels including, but not limited to veins, intestines, fallopian tubes, etc. to reach the area to be treated is difficult. Further, once the guide is in the desired location, it is often difficult to make certain that the it remains in that location. Even further, once the guide wire, catheter, endoscope or other device is in the desired location and another device is placed over, through or along side it, the initially placed device has a tendency to move due to the forces exerted on it when other devices are using it as a guide.
Additionally, other anchors are required for attaching tissue or other matter to improved or different locations within the body.
Even further, vessel occluders are often required for a variety of medical procedures.
For these reasons, it is desirable to provide an improved devices and methods for their use, which facilitate 1. using the physiologic motions of the body to help direct the device. In addition, flow pressure differential can be artificially created or enhanced by the technician/physician so that this same technology can be used when physiologic means is unavailable or insufficient. Further, the natural contractile forces of the body (e.g. those of the intestinal tract, gall bladder, esophagus, etc.) can be harnessed so that the device including, but not limited to guide wires, catheters, endoscopes, etc. are moved along with those forces. 2. Even further, it is desirable to provide a device that has an anchoring mechanism on it so that it will not move once in its desired position. 3. And yet even another desired characteristic would be to provide an anchored device that has a tensioning characteristic applied to it for placement of other devices over through or along side the first placed device. 4. And finally, another desired characteristic is that of a simple and effective occlusion system.
In general, this invention relates to a removal device for a biological occlusion and more particularly to a catheter and occlusion engaging element which is adapted to the removal of blockages in hemodialysis grafts.
There are many techniques and devices known in the art for removing blockages in the vascular system and other passageways of the human body.
There is a continuing need for improved devices to meet at least the following objectives.
The first objective is to reduce cost. This is particularly important in recent years where it is clear for safety and sanitary reasons that these will be single use devices. A device, even though it performs a function in some improved manner, will not be widely used if it is considerably more costly than the alternatives available.
A second objective is to provide a device that is simple to use and in a very real sense simple to understand. This will encourage its adoption and use by medical personnel. It will also tend to keep cost low.
The third objective is to provide a device that entails a procedure with which the medical profession is familiar so that the skills that have been learned from previous experience will continue to have applicability.
A fourth objective relates to the effectiveness and thoroughness with which the device performs, such as blockage removal or anastomotic device placement. For example, it is important that a maximum amount of the blockage be removed; recognizing that no device is likely to provide one hundred percent removal. With regard to bypassing or re-joining, it is important that an optimum amount of the tissue be removed and therefore replaced; recognizing that no device is likely to provide one hundred percent optimization.
A fifth objective concerns safety; a matter which is often so critical as to trump the other considerations. It is important to avoid tissue trauma. In many circumstances, it is critically important to avoid breaking up a blockage in a fashion that leads to flushing elements of the blockage throughout the body involved. In the case of using an anastomotic device in the tubular channels of the body, it is critically that the joining of the anastomosis does so while minimizing tissue trauma. Often this trauma is not realized immediately after surgery. Even further, leakage must be kept near zero.
There are trade-offs in design considerations to achieve the above five interrelated objectives. Extreme simplicity and a very simple procedure might over compromise safety. Addressing all of these considerations calls for some trade-off between the objectives.
Accordingly, an object of this invention is to provide an improved removal device for a body passageway blockage which achieves the objectives of reduced cost, enhanced simplicity, a standard procedure, high effectiveness and a high degree of safety. Most particularly, it is an object of this invention to achieve these objectives with an enhanced trade-off value for the combined objectives.
Another object of this invention is to provide an improved occlusion, tensioning, anchoring and flow device that achieves the objectives of reduced cost, enhanced simplicity, a standard procedure, high effectiveness and a high degree of safety. Most particularly, it is an object of this invention to achieve these objectives with an enhanced trade-off value for the combined objectives.
For these reasons, it is desirable to provide an improved device that may circumvent some of the problems associated with previous techniques. This improved medical device provides a new configuration that will eliminate some of those problems and methods for their use, which facilitate removal of vascular obstructions in the operating room or interventional suite.
Occlusive vascular disease is a common ailment in people resulting in enormous costs to the health care system. Blood clots and their accompanying plaque buildup are the most common type of occlusion. Removal of this disease from the body has been studied for several years and many techniques (devices and methods) have been studied and practiced. Sometimes the diseased/stenosed areas of the vessels may be removed by use of Embolectomy, Atherectomy, thrombolysis, etc. or angioplasty and/or stenting can repair the diseased vessel but all of these are not always effective. The deposit of sinuous plaque (arteriosclerosis) to the inner wall of arteries usually precedes clot formation. Several expensive devices (dilatation balloons, stents, mechanical cutters, etc.) have been introduced to fight this vascular occlusive disease, but none of which has proven to be the ‘magic bullet’ to treat this ubiquitous disease. Even when effective, these technologies often are effective for a short period of time. Because of the various problems with all of the techniques and approaches to solving this medical condition, there exists no particular method or device that is considered the most accepted mode of treatment.
Unfortunately, cancer too is a common ailment resulting in over 1,500 deaths every day in the U.S. (550,000 every year; the number two killer in the U.S. after vascular disease). Therapy modalities for cancer are plentiful and continued to be researched with vigor. Still, the preferred treatment continues to be physical removal of the cancer. When applicable, surgical removal is preferred (breast, colon, brain, lung, kidney, etc.). Often these cancers occur in the body channels that are actually not dissimilar to occlusions in the vasculature.
Even though there are many techniques and devices known in the art for removing blockages in the tubular channels of the body and/or for bypassing them with autogenous or synthetic means (both surgically and via a percutaneous, less invasive technique) and other passageways of the human body as well as removing other diseased tissue, there is a need to removed the diseased tissue and re-join healthy pieces of the tissue once the diseased tissue has been removed. This removed tissue may be removed because of many reasons some of which are (but certainly not limited to) cancerous or potentially cancerous material, vascular disease (or potential vascular disease), trauma to tissue, congenital disease of the tissue, etc.
An aspect of the invention is directed to a vessel-occluding medical device for the use in diagnosis and/or treatment of cardiovascular disease in the human body. The catheter has a proximal catheter end and a distal catheter end and defines a lumen extending from the distal catheter end towards the proximal catheter end. The catheter is adapted for use in diagnosis and/or treatment of cardiovascular disease in the human body. An expandable and contractible, vessel-occluding element is positionable near the distal catheter end and is placeable in radially expanded and contracted states. The expandable and contractible, vessel-occluding element comprises a braided element and a membrane contacting the braided element so that the braided element is substantially impermeable when in the radially expanded state. The expandable and contractible element has a funnel-shaped surface, when in the radially expanded state, and a longitudinally-extending opening to permit material to pass therethrough for receipt of material. A vessel-occluding assembly is housed at least partially within and is axially slidable through the lumen. The vessel-occluding assembly comprises an elongate support element, having a distal end portion, and a second expandable and contractible, fully-vessel-occluding element at the distal end portion. The second expandable and contractible, fully-vessel-occluding element is positionable at, is extendable from the catheter distal end, and is placeable in a collapsed and expanded, fully-vessel-occluding states.
Another aspect of the invention is directed to method of deploying an occluder in a body passageway. The method includes the following. A catheter is inserted into a body passageway, said catheter having a balloon-less blood flow blocking element affixed to the catheter. The balloon-less blood flow blocking element comprises a blood flow blocking surface with structural members which define openings therebetween. The blood flow blocking element is provided in a radially compressed state during the inserting step. The blood flow blocking element is radially expanded into a radially expanded, passageway sealing state extending to the wall of the body passageway after the inserting step. The radially expanding step is carried out without inflating a balloon using a fluid. The radially expanding step includes providing said blood flow blocking element in said radially expanded, passageway sealing state with an outer, distally facing, generally funnel surface extending out from said distal end of said catheter. The generally funnel surface is the blood flow blocking surface. The radially expanded, passageway sealing state of said blood flow blocking element is used for completely blocking passage of material around the outside of said catheter.
A further aspect of the invention is directed to a catheter/dilator assembly including a catheter assembly and a dilator. The catheter assembly includes a catheter having a proximal catheter end, a distal catheter end, a lumen, and an outer catheter surface. The catheter assembly also includes a material-directing element, movable between radially expanded and radially collapsed states, secured to and extending past the distal catheter end. The material-directing element has an axial length when in the radially collapsed state. The dilator includes a hollow shaft within the lumen of the catheter. The hollow shaft has an outer shaft surface, a proximal shaft end, a distal shaft end and a recessed region in the outer shaft surface at the distal shaft end. The recessed region and the material-directing element are generally aligned with one another. A compression element covers the material-directing element to temporarily retain the material-directing element in a radially collapsed state. The recessed region is sized for receipt of at least substantially the entire axial length of the material-directing element so to reduce the radial cross-sectional dimension of the assembly at the material-directing element.
In brief one embodiment of this invention is particularly adapted to the removal of blockages in hemodialysis grafts. That embodiment combines a catheter having a blocking feature that blocks the annulus between the catheter and the graft and a support wire having an occlusion engaging element.
The support wire extends through the catheter, through or around the occlusion and at its distal end has an annular braided element attached thereto. The support wire is a dual element support wire having a core and an annular shell that slides on the core. The distal end of the core is attached to the distal end of the annular braided element and the distal end of the shell is attached to the proximal end of the annular braided element. Thus movement of the core and shell relative to one another moves the braided element from a radially retracted position which is useful for insertion through the catheter to a radially expanded position which expands it to the sidewall of the graft. When the annular braided element is in its radially compressed state, it can be passed through the occlusion together with the rest of the wire to reside on the distal end of the occlusion. When the braided element is expanded and moved proximally (that is, in a retrograde fashion), it will engage the occlusion and force the occlusion into the catheter. Alternatively, no motion of the engaging element may be required if aspiration is applied. In this case, the engaging element acts as a seal to prevent the suction from aspiration to remove much material beyond its point of deployment in the channel.
The distal end of the catheter is proximal of the occlusion and contains a blocking mechanism that extends radially from the distal end of the catheter to the wall of the graft or body passageway. This catheter blocking element also has a radially retracted insertion state and a radially expanded blocking state. The blocking element is a multi-wing malecot type device which is covered by a thin elastomeric film or membrane.
This malecot type of device is bonded to the distal end of the catheter or an integral part of the catheter. The distal tip of the dilator, over which the catheter is inserted, has a slightly increased diameter. This tip is in the nature of a ferrule. When the dilator is removed, the ferrule abuts against the distal end of the multi-wing malecot pushing this blocking element from its radially compressed state into its radially expanded state. Alternatively, the tip of the dilator can be bonded to the catheter with a break-away bond so that when the dilator is removed, the blocking element is expanded in a similar fashion. In this radially expanded state, the malecot and its film cover blocks the annulus around the catheter so that the occluded blood or other obstruction which is being removed is forced into the catheter where it is aspirated or otherwise removed.
Conversely, it is understood that the blocking element could be fabricated from tubular braid and the engaging element could be formed from the malecot style configuration.
Another embodiment of this invention is particularly adapted to the anchoring of wires or tubes within the tubular channels of the body including, but not limited to veins, arteries, intestines, nasal passages, ear canal, etc. Further, this anchoring embodiment has a applicability in applying an anchor to tissues or other matter to areas of the body other than in tubular channels including, but not limited to the face, breast joints, etc. This embodiment has a support wire with an engaging element.
The support wire is a dual element support wire having a core and an annular shell that slides on the core. The distal end of the core is attached to the distal end of the annular braided element and the distal end of the shell is attached to the proximal end of the annular braided element. Thus movement of the core and shell relative to one another moves the braided element from a radially retracted position which is useful for insertion into the body to a radially expanded position which expands it to the sidewall of the tubular channel or against other tissue or matter within the body. When the annular braided element is in its radially compressed (smaller diameter) state, it can be passed through or around occlusions together with the rest of the wire to reside on the distal end of the occlusion in the case of tubular channels with occlusions. It is a preferred embodiment of the instant invention that it can be made very small. When the braided element is expanded and pulled proximally (that is, in a retrograde fashion), it will engage the walls of the tubular channel and the elongate support wire can be put into tension. This distal engaging tubular braid element may or may not be covered by or integrated with a thin film or membrane to create patency or other desirable characteristics.
The instant invention also describes another use of the same device of the instant invention with minor changes. In this case, the tubular braid distal expansile mechanism may be used on the end of a guide wire or catheter so that once deployed in a tubular channel with flow such as arteries and veins, the expanded mechanism can carry the support wire in the direction of the flow. In order to accomplish this flow characteristic of the instant invention, it may be desirable to deploy the distal expanding tubular braid whereby the support wire becomes ‘floppy’ in nature so that it will flow with the expanded ‘umbrella’. The author uses the phrase ‘umbrella’ only as a communication tool in that an umbrella starts out with a small diameter shaft in its un-deployed condition (radially compressed condition) and ends up with a large diameter configuration when deployed. The shape of the expanding mechanism is varied and includes, but is not limited to an umbrella shape, a spheroid shape, an ovoid shape, a conical shape, a disc-shape, etc. The inventors have fabricated at least all of the aforementioned shapes using tubular/annular braid and successfully tested the flow, anchoring, tensioning and occlusion characteristics in both a static and dynamic in vitro environment. Creating the expanded annular braided mechanism is accomplished by pulling the inner wire of the support wire out of the outer tube. The outer tube can be made of very flexible material so that the inner wire gives the structure all of the support. When the ‘umbrella reaches the desired location which is usually determined by image intensification including, but not limited to x-ray, ultrasound, MRI, etc., the inner wire can be re-inserted into the flexible outer tube of the support wire to give the desired support required. Also once the ‘umbrella’ with the flexible outer tube needs to be removed, the inner wire can be an actuator to un-deploy the expanded braided element back to its smaller and radially compressed size. This is accomplished by bonding the outer tube of the support wire to the distal end of the tubular braid expanding element and the inner wire of the support wire is slightly bonded to the distal end of the braided expanding element. This slight bond could also be an interference fit where the inner wire snaps into and out of the distal end of the braided expanding element.
Even further, by making another minor change to the instant invention would be to use the braided expanding element as a permanent or temporary occluder without the support wire being left in place. This is accomplished by having the outer tube not bonded to the proximal end of the expanding element and the inner wire of the support wire to be only slightly bonded to the distal end of the expanding braided element. In this case, the inner wire is pulled in a retrograde direction relative to the outer tube. This action causes the expanding braided element to expand radially. Once the expanding element expands to the desired shape for the particular application and occlusion, the inner wire is pulled out of the ‘snap’ or interference fit on the distal end of the expanding braided element and the expanded braid occluder is left in place when both the inner and outer member of the support wire is removed from the body.
Hence, nearly the same invention allows the use for four different applications in the health care field.
Pertinent descriptions are set forth in a number of issued U.S. patents, including U.S. Pat. Nos. 5,275,611, 5,312,360, 4,696,304, 5,176,659, 5,437,631, 5,606,979, 5,779,672, 5,456,667, 5,733,294 and 5,209,727. A pin vise for helping grip the proximal end of a guide wire is illustrated in U.S. Pat. No. 4,858,810. U.S. Pat. Nos. 5,275,611, 5,312,360 describe a tension guide and dilator. U.S. Pat. No. 5,779,672 describes a detachable inflatable occlusion balloon. U.S. Pat. No. 5,456,667 describes a temporary stent on a catheter. U.S. Pat. No. 5,733,294 describes a self-expanding cardiovascular occlusion device. U.S. Pat. Nos. 5,437,631, 5,591,204 and 5,383,897 describe a puncture wound sealer. U.S. Pat. No. 5,626,614 describes a tissue anchor for anchoring the stomach to the abdominal wall. U.S. Pat. No. 4,372,293 describes an instrument for the surgical correction of ptotic breasts. U.S. Pat. Nos. 5,730,733 and 5,336,205 describe flow-assisted catheters.
Various features and advantages of the invention will appear from the following description in which the preferred embodiments have been set forth in detail in conjunction with the accompanying drawings.
One aspect of the instant invention relates to a locking mechanism for the blocking or engaging element. Of particular relevance is the locking mechanism of the engaging element. One such preferred embodiment incorporates an interference fit when and inner and outer slidable elongate member is used. Once deployed, the force required to keep the engaging element is usually small in relation to the force required to deploy (in the case of a non-self-expanding mechanism). In this case, a slight interference fit between the inner and outer slidable elongate members can be overcome easily by the interventionalist, but when the engaging or blocking element is deployed (partially or fully), the interference fit creates enough force of the system to remained deployed. The same invention could be used in the case where either the engaging element or blocking element is self-expanding, but in this case the interference fit would keep either element in the un-deployed, un-expanded condition.
This aspect is particularly useful for the engaging element because such an interference fit can be constructed particularly small. In the case of where the matter removal system of the instant invention is used percutaneously (through the skin) and a needle is used for the initial entry of the engaging element, it may be inserted through the small needle (usually 19, 18 or 21 gauge needle that is typically used for such intervention) and then deployed. In this case the needle is removed and it needs to be removed over the elongate shaft of the engaging element (wire guide). In order for it to be removed easily, the locking mechanism must be small or negligible with respect to the shaft of the elongate engaging element. A preferred embodiment of this locking mechanism in the case where the engaging element has an inner elongate member is to put a slight bend or kink in the inner member that interferes/impinges against an outer tubular elongate member. In particular, there may be three components to the outer tubular elongate member to facilitate said locking of the engaging element. The first component is the main and longest part of the shaft of the elongate member. This material can be matched to the required characteristics required for the shaft such as torqueability, steeriblity, flexural modulus, softness, stiffness, etc. This first component may be attached to the proximal side of the engaging element mechanism, but not attached to the inner tubular or wire elongate member contained within. The second component could be located proximal to the main shaft. This embodiment would be a handle type tubular element that would be sized to fit the physician's fingers, approximately 0.5-2.0 inches in length. It would not be glued or otherwise attached to the inner member. It would be manufactured of a material that might be different from the main shaft where characteristics of the first and second component could be different. The outside surface of this handle may be roughened or have some high friction coating put on it that would aid with the physician grasping the handle. This second component may require some ‘stiffness’ in it in such a case where the inner tubular or wire elongate member is kinked or otherwise bent. This second material may be harder or stiffer so that the kink on the inner member that prevents axial motion does not flex or distort the material. This second material stiffness might be such that it is important that the kink or bend in the inner member interfere enough and have enough force to hold the expanding element in place once deployed (or un-deployed in the case of the expanding mechanism being in the smaller unexpanded condition). Further, to create the appropriate interference, the inner diameter of this second component could be even smaller than the inner tubular or wire elongate member. It is possible to design an inner diameter of this second component to be 0.0001 to 0.002 inches smaller in diameter than the inner elongate member. This interference fit would be sufficient to hold the expanding mechanism expanded or unexpanded yet the interference force would not be too great that the physician could not overcome the force easily to deploy or un-deploy the mechanisms. Further a combination of smaller or equal or slightly larger inner diameter of this second component than the diameter of the inner elongate member could be coupled with the kink/bend/ferrule or other diametrical addition such as a drop of glue or epoxy to cause a brief interference fit could be used for locking either expandable mechanism.
The third component may be approximately the same outside diameter of the first and second component, but would like be glued or otherwise attached to the inner tubular member by glue or other adhesive, heat staking (or melting the polymeric handle to the inner member) or a ‘pressed’ interference fit so that this third component would move in tandem with the inner elongate member.
Hence in such a configuration, the physician would use his/her two hands (two fingers on each hand) to deploy and un-deploy and lock and unlock the expanding and contracting mechanisms respectively. This is accomplished by the physician grasping the third component with one hand and the second component with the second hand and pulling the two components apart so that a space would be created between the two components nearly equal to the distance that is changed from the deploying/undeploying distal element.
To aid with ease of use, the two handles may be color coded so that the physician would realize the difference between the two handles and for education in training them to use the locking mechanism.
Another aspect of this invention is particularly adapted to the removal of blockages or particulate (matter) in hollow tissues. This aspect combines a catheter having a blocking feature that block the annulus between the catheter and the vessel or other hollow tissue. Said catheter may have an inner support wire having an occlusion-engaging element also.
Said support wire extends through the catheter, through or around the occlusion, and at its distal end has an annular braided element attached thereto or a malecot style element with two or more slits in a tube. The support wire is a dual element support wire having a core and an annular shell that slides on the core. The distal end of the core is attached to the distal end of the annular braided element (or slit-tube/malecot) and the distal end of the shell is attached to the proximal end of the annular braided element (or slit-tube/malecot). Thus movement of the core and shell relative to one another moves the braided element from a radially retracted position, which is useful for insertion through the catheter to a radially expanded position, which expands it to the sidewall of the graft. When the annular engaging element is in its radially compressed state, it can be passed through or around the occlusion together with the rest of the wire to reside on the distal end of the occlusion. When the engaging element is expanded and moved proximally (that is, in a retrograde fashion), it will engage the occlusion and force the occlusion into the catheter. Alternatively, no motion of the engaging element may be required if aspiration is applied. Further, aspiration and proximal motion of the engaging element may be used together in a synergistic fashion to remove the occlusion.
The distal end of the catheter is proximal of the occlusion and contains a blocking mechanism that extends radially from the distal end of the catheter to the wall of the graft or body passageway. This catheter-blocking element also has a radially retracted insertion state and a radially expanded blocking state. The blocking element is a multi-wing malecot type device, which may be covered by a thin elastomeric film or membrane. An alternative design of the blocking element is a mechanism of tubular mesh braid, which may be covered as well.
This malecot (or the mechanism of tubular mesh braid) is bonded to the distal end of the catheter or an integral part of the catheter. The blocking element (or the engaging element for that matter) is deployed in several different ways: 1.) The distal tip of the dilator, over which the catheter is inserted, has a slightly increased diameter. This tip is in the nature of a ferrule. When the dilator is removed or pulled in a retrograde (out of the body), the ferrule abuts against the distal end of the multi-wing malecot (or tubular mesh braid) pushing this blocking element from its radially compressed state into its radially expanded state. 2.) Alternatively, the tip of the dilator can be bonded to the catheter with a breakaway bond so that when the dilator is removed, the blocking element is expanded in a similar fashion. In this radially expanded state, the malecot (or tubular mesh braid) and its film cover (if required) blocks the annulus around the catheter so that the occluded blood, emboli, plaque or other obstruction which is being removed is forced into the catheter where it is aspirated, obliterated or otherwise removed. 3.) Further, both the blocking element or the engaging element could be formed of such materials that have a memory and hence are self-expanding. These materials are varied from polymers to metals including, but certainly not limited to: PEBAX, nylons, ployurethanes, polyethylenes (HDPE, UHWPE, LDPE, or any blend of the aforementioned polyethylenes), PET, NiTi, MYLAR, Nickel Titanium Alloy; with or without TWSM (Two Way Shape Memory or superelastic properties). In the case of self-expanding blocking or engaging elements, the larger, expanded configuration could be constrained by an outer tube to keep it in a smaller unexpanded configuration; alternatively an inner support member could be used to keep the elements in the smaller unexpanded configuration. 4.) Even further, both the blocking and engaging elements can be deployed by moving two slidable elongated elements with respect to one another. This motion of the two slidable elements would cause the blocking or engaging element to become expanded and/or unexpanded.
Another aspect of the instant invention is related to the expanding mechanism on the blocking or engaging element, but likely more pertinent to that of the blocking element on the catheter or tubular device. This aspect is related to decreasing the space required for placement of the blocking element in the un-deployed, unexpanded condition. In the case where a percutaneous entry is made into a hollow organ, the most common approach to entry is a technique known as ‘dilation’ or more specifically the ‘Seldinger Approach’ to dilatation (after a Dr. Seldinger in the mid 1900's). This is where the interventionalist uses a needle to enter the body, then a guidewire is placed through the needle and the needle is removed as stated above. Then an assembly known as a dilator/sheath assembly is inserted over the guide wire and into the body. The dilator/sheath assembly is made up of an inner dilator with a hole though the middle of the usually somewhat solid cylindrical dilatory for inserting the guidewire there through. The dilator is tapered like a cone usually on a small degree taper approximately 4-20 degrees. The sheath consists of a thin walled tube usually made from PTFE, FEP, polyurethane, PEBAX or similar material and fits snugly over the inner dilator. Conventionally, once the physician dilates into the body, the inner dilator is removed so that the physician has access to the body thorough the thin walled dilatory (0.004-0.018 inches thick). How this relates to the instant invention is interesting in that the inner dilator usually tends to be somewhat ‘solid’ in it's cylindrical configuration, but it can have a recess or groove in the cylindrical portion of the dilator for a certain portion of the dilator usually located near the distal end of the device. This recess or groove is a convenient place for the expanding blocking (or engaging for that matter) element to rest in while the device is being placed within the body. This placement of the blocking or engaging element for that matter allows more material to be placed in the device without increasing the overall diameter of the device which is particularly important so that the physician does not have to make an access site/puncture/hole into the body larger than what is absolutely necessary. This dilator may have a lumen with a side port to enable the monorail configuration described below under Rapid Exchange. A long dilator configuration can be used to support devices traversing vessels spanning the length of the human body. By incorporating the monorail feature, the dilator can be removed from a device and guidewire that is only slightly longer than the dilator shaft.
Another aspect of the invention relates to designs that provide for the manufacture and function of the matter removal system. One such aspect has been often referred to as a ‘Rapid Exchange’ or ‘Mono Rail’ feature. This common feature is usually used for elongated catheters when used in conjunction with guide wires (AKA wire guides). Usually an interventionalist inserts a guidewire into the body via an existing opening or through a percutaneous opening often created by a needle. The guidewire, because it is a small wire, is easier to manipulate into position than would be a catheter or other elongated device. Once in place the interventionalist usually inserts the elongated catheter or other device over the guidewire to the appropriate position hence the reason for the name guide wire. Before the development of Rapid Exchange or Mono Rail techniques, the interventionalist would need to use a guide wire that was more than twice the length of the elongated catheter or device so that the device could be inserted over the wire outside of the body while the guidewire stayed in place in the appropriate position within the body. This ‘double length feature’ provided the interventionalist the safety of inserting the device over the guidewire and at the same time holding the guidewire in place so that it does not move from the desired location within the body. This technique was cumbersome because of the double length of the guidewire. The Rapid Exchange or Mono Rail technique provide for a small hole at the distal end of the catheter or device with that hole/lumen exiting the catheter or device a short distance from the distal end, usually approximating 3-12 (7.6-30 cm) inches from the distal end of the device.
This aspect of the invention is a variation of the Rapid Exchange feature. A dilator is used within the tubular catheter or device of the instant invention whereby the dilator has the feature of having an hole from or near the distal end and then exiting some 3-12 inches from the distal end, but instead of sliding the catheter or device of the instant invention ‘over’ the guidewire, the guide wire is loaded in place inside the dilator which is inside the tubular elongate lumen of the instant invention. When the assembly gets near the trouble area in the body to be intervened, the interventionalist would then be able to steer the wire from within the dilator, but outside of the body. This allows the similar feature of the aforementioned Rapid Exchange or Mono Rail technique. When the interventionalist is near the area to be treated, he/she can remove the inner dilator leaving the inner guidewire in place and hence obviating the need for a double length guidewire.
Assembly 116 also includes a dilator 144, having a distal portion 146 and a proximal portion 148, and a guide wire 150 extending generally parallel to dilator 144. In the assembled configuration of
Catheter 118 also includes an expandable braid 164 connected to the distal ends of outer and inner catheters 124, 126. Pulling inner catheter fitting 138 relative to outer catheter fitting 130 causes braid 164 to expand. While braid 164 may expand in a manner similar to that shown in
Dilator 144 is then removed by pulling on dilator proximal portion 148 while holding inner catheter fitting 138 and proximal end 156 of guide wire 150. Doing so leaves catheter 118 and guide wire 156 in place. This is possible because of the rapid exchange nature of assembly 116 provided by the passage of guide wire 150 externally of most of the length of dilator 144. The expandable braid 164 may then be extended to a use, material-directing state, such as the funnel shape shown in
A further aspect of the invention relates to devices and methods for manufacturing thermoplastic materials. As the name thermoplastic implies, temperature can be used to shape, make, bend, mold, join, tip, bond, shape polymers (or metal to polymers) for use in production of components or other products. There is a plethora of techniques well known to those ordinarily skilled in the art of ‘plastics manipulation’ using heat to change the physical shape or properties of the plastic material. Injection, plug, insert, blow molding as well as heating tubes, hot water or other liquids, flame, heat guns, heat shrink tubing and other technologies too numerous to mention.
This aspect of the invention utilizes a constant temperature alloy that can be near instantly brought to a particular curie temperature. The present invention employs a temperature self regulating heater, with regulation of temperature being accomplished by employing a high density material such as a ferromagnetic, ferromagnetic or the like material having a Curie temperature at the desired maximum temperature of operation. The Curie point also known, as Curie temperature is the point/temperature at which a ferromagnetic material exhibits paramagnetism. Once this point is achieved, no additional energy is required to be put into the system and the temperature (Curie temperature) is maintained. This pre-chosen temperature can be set at a variety of temperatures depending on the chemical makeup of the ferromagnetic material and this choice can match the melt or near melt temperature of a particular plastic.
To be able to control a heating element for manufacturing/production of thermoplastic materials that does not require a temperature feedback loop to control the temperature of the particular element/die or other mechanism is desirable for several reasons. This aspect of the invention uses a ferromagnetic metal with low electrical conductivity that can be excited by a high frequency alternating current. By selecting dimensions and material parameters for the heating element, temperature regulation in a narrow range around the Curie temperature of the ferromagnetic material can be produced, despite thermal load (i.e. the melting or near melting of plastic).
This therefore does not require a conventional feedback loop (and required controllers and no necessary calibration) to control the temperature of the heating element. Specific ferromagnetic materials can be chosen that reach particular Curie temperatures, so that choosing a particular ferromagnetic material for the heating element with a particular Curie temperature for a particular application can choose a temperature. This allows a narrow range of temperatures to be achieved. Because the mechanism of use for the excitation of the ferromagnetic element is instantaneous with the alternating current source, the ferromagnetic material/element comes to its pre-destined Curie temperature very quickly. This instantaneous heat source is vital in forming thermoplastics quickly for efficient manufacturing conditions and a low cost manufacturing environment.
In brief, one embodiment of the present invention is particularly adapted to the manipulating thermoplastic materials with a die/element, mold (“heater”) for manufacturing of components or other products in the manufacturing environment. By purchasing an ‘off the shelf’ RF generator/alternating current power source, one can excite a ferromagnetic heater to its Curie temperature and then by choosing a particular ferromagnetic alloy, different temperatures can be used for the heater in the manufacture/processing of particular thermoplastic materials.
Examples of ferromagnetic materials that exhibit different Curie temperatures when excited by an alternating radio frequency source is a metal alloy composed of approximately 36% nickel and the balance iron. Often referred to as Invar or Alloy 36 due to the nickel content. When alloy 36 is excited to it's Curie temperature, that temperature is controlled to a near temperature of ˜230 degrees Fahrenheit. (˜230° F. or 110° C.). Choosing alloy 42 (meaning ˜42% nickel and the remaining iron), the Curie temperature achieved is ˜380° F. or 193° C. For alloy 49, a temperature of ˜475° F. or 246° C. For alloy 32, approximately 130° F. or 54° C. For alloy 34, 165° F. or 74° C. and for alloy 42-6, 290° F. or 143° C. So one can see that by choosing a particular ferromagnetic alloy, one can choose a particular melt or near melt temperature of a particular thermoplastic. Such ferromagnetic materials can be readily purchased from a wide variety of vendors including SCIENTIFIC ALLOYS in Westerly, R.I. ((401) 596-4947).
By connecting the power supply to the alloy though a trial and error approach the alloy became excited to its particular Curie temperature and was measured. These temperatures were delineated above. By machining different configurations in the heater element, the inventor was able to join thermoplastic materials with a variety of other materials (metals, thermoplastics, Thermoset polymers, fabrics and the like). Further, the inventor was able to form or program the thermoplastic material into what appears to be an endless variety of shapes and conditions for use.
Another aspect of the invention pertains to the engaging or blocking element. In the case where either element is somehow bonded to a tubular elongate member, this bond should be strong, but minimal in its overall size. In the case of using tubular mesh braid to attach the mechanism to the tube, often times an additional collar can be used to overlap both the tubular elongate member and the tubular mesh braid. However this aspect of the invention allows this ‘joint’ to be accomplished by joining the two components together without the addition of this collar, which is preferred because in such interventions any additional space required for ‘joints’ is a detriment to the overall functionality of the device. If collars or other assembly mechanisms are used either on the outside of the two materials or on the inside of the materials, either a larger hole/puncture into the body is required, which has an increased mortality/morbidity associated with it, or the internal diameter of the tubular elongate member is decreased, and hence the annular space is decreased and compromised because the interventionalist has less space to deliver other instruments or less space to remove matter from the body. Hence this aspect of the invention relates to the ability to ‘connect’ the tubular mesh braid to the tubular section of the catheter or device and at the same time minimizing any increased wall thickness due to collars or other assembly components. This can be accomplished in several ways.
Inmost cases the wall of the tubular elongate member is in the range of 0.002-0.015 inches (0.051-0.38 mm) thick, but more usually in the 0.004-0.006 (0.10-0.15 mm) inches thick range. Because of the way it is manufactured (with a Maypole type braider described below), the yarns used to manufacture the tubular mesh braid are usually fabricated from filaments in the range of 0.0001 to 0.005 inches (0.0025-0.13 mm) in diameter, but more usually in the 0.0015-0.003 inch (0.038-0.076 mm) diameter range. Because these individual yarns overlap, the wall thickness of the tubular mesh braid is usually double the thickness of the yarns used in its manufacture. The instant invention relates to the fact that the tubular mesh braid can be melted into the wall of the tubular elongate member with the use of heat. This is especially applicable when thermoplastic polymers are used with either one or both of the tubular mesh braid or the tubular elongate member. Using a die that conforms to the outside diameter of the tubular elongate member, both materials can be forced into the die when heat is applied and at the same time an inner mandril is placed inside the assembly that equals the internal diameter of the tubular elongate member. Using then the heat and force, the two components (the tubular mesh braid and the tubular elongate member) can meld into one unit thus minimizing the wall thickness of the two components thusly joined together. This heated die is usually accomplished using a glass or metal die. Heat is applied to the die in any of a number of ways know those normally skilled in the art including, but not limited to convection heating, electrical resistance heating, RF excitement of the metal to create heat, by merely blowing hot air over the die, etc.
A preferred embodiment of the instant invention utilizes an RF heater made from an RF power supply and a nickel iron alloy. By coordinating the radio-frequency (RF) energy with an appropriate nickel-iron alloy die, the metal alloy die can be excited by the radio-frequency energy, said excitement generating heat to the curie temperature of the alloy. The blend of nickel-iron alloy can be adjusted to reach different curie temperatures. This RF excitement is extremely fast which is critical to the efficacious manufacture of the devices. The dies can be made very small, that is with a very small amount of alloy, so that they not only heat up immediately, but they can be cooled quickly as well. Hence the less alloy in the die the faster the throughput in the manufacturing process. This technique is extremely repeatable as well due to the repeatability of the RF and the alloy interaction. These different temperatures are important as different temperatures are required for different heat bonding procedures (that are dependent both on the geometrical configuration of the heat bond as well as the materials used in the heat bond). Using this configuration, expanding mechanisms described above have been manufactured where in a preferred embodiment of the instant invention, NiTi (Nickel Titanium) tubular mesh braid with 0.003″ (0.076 mm) individual yarns have been melded into the wall of PEBAX and polyurethane sheath tubes that have a wall thickness of 0.005-0.006″ (0.13-0.15 mm) without compromising the internal or external diameters. (Have also melded 0.002″ (0.051 mm) diameter yarns into both polyethylene and FEP). Because no extra material is used for this bond and no additional area is required to make this bond this is extremely important so as to allow more matter to be removed through the internal diameter (being optimized and not decreased or compromised) and the initial puncture into the body is minimal due to the minimized/optimized external diameter of the assembly as is further described below and herewith.
Braid Shapes with Heat Treating and Elastomer (Variable Vessel Diameter)
Another aspect of the invention pertains to a funnel manufactured using tubular mesh braid. In a preferred embodiment the funnel is made of the aforementioned tubular mesh braid. In particular, the yarns in the braid are made of metal and even more particularly, of Nickel Titanium alloy (NiTi). The preferred embodiment of this aspect of the invention is such that the tubular mesh braid is attached to an inner elongate member on the distal end and an outer elongate tubular member where the braid is attached at the proximal end. As the inner member is pulled in a retrograde/proximal direction, the braid is pulled inward so that it buckles, and folds inside itself like ‘rolling a sock’. In this preferred embodiment, the braid takes on a funnel shape. In some cases the braid is covered with an inelastic or elastic membrane. This membrane can be applied by dipping, casting or spraying the braid with a dispersion including, but not limited to silicone or polyurethane. Alternatively, the membrane could be in the form of a tubular extrusion, which is then bonded with heat, or adhesive on the two (proximal and distal) ends of the braid where it is attached to the inner and outer elongate member. In the case of using the extrusion, this material includes, but is not limited to silicone, polyurethane, Chronoprene, polyethylene, C-Flex, etc
Of particular importance to the design of the tubular mesh braid is the way in which the tubular mesh braid is formed. The preferred embodiment of the instant invention forms the tubular mesh braid on a maypole braider described below using 48 carriers of yarns made from NiTi on a 48 carrier or 96 carrier maypole braider, although in some instances it may be beneficial to use machines with more or fewer yarn carriers to adjust braid performance The NiTi yarns used are small in diameter, in the range of 0.001-0.005 inches (0.025-0.13 mm) in diameter, but more specifically 0.0015-0.0025 inches (0.038-0.064 mm) in diameter. They can be formed on a cylindrical mandril on the braider usually 5-6 mm in diameter or more preferred would be a conically shaped mandril to create a mesh braid with varying wire density and varying maximum expanded diameter to facilitate funnel deployment in lumens of various sizes. In fact, the mandril shape can be set to any axisymetric shape (for instance, a rotated parabolic arc) to further optimize the performance of the expanding member. In some cases, a non axisymmetric shaped mandril may be used as well, such as an elliptical cone or a pyramid. Further, the tubular mesh braid could be self-expanding where the yarns are programmed to be in the expanded funnel configuration. In this embodiment, the system could be constrained with an over sheath to keep in the smaller, contracted condition. Conversely, the inner and outer elongate members could be held in a tensile configuration with respect to one another so that the braid is in the un-expanded shape. When the tension is removed on the inner and out elongate member, the braid expands to the funnel configuration usually 1.5-7 mm in diameter, but more specifically from 2.5-5.5 mm. In addition, any combination of active or forced expansion and self-expansion may be used to optimize the design.
An additional aspect of the invention as it pertains to how the braid opens up into a funnel shape is the way that one ‘programs’ the tubular mesh braid. When the braid is pulled together so that it folds into itself to make the funnel shape, it may be important that there is a shape memory to the braid so that it folds in a particular way both to create the funnel, but also so that when it impinges on the wall of the vessel, it does so in a least traumatic fashion so as not too damage the intima of the vessel. The NiTi wires are preferably conditioned as to behave as super-elastic or pseudo-elastic material. In the case of expanding the funnel and trying to occlude blood, it is important is that the funnel has an outward radial force onto the vessel so that it in fact occludes the vessel and stops blood flow. This is important in the case of using the invention for ‘proximal occlusion’.
Proximal occlusion, as the name indicates, is where the blood vessel is occluded proximally (up-stream) to where an intervention takes place (i.e. balloon angioplasty, stenting etc.). When the flow is stopped or reduced upstream to where the intervention is taking place, this prevents loose embolic material that may be dislodged from traveling downstream during the intervention. This dislodged emboli can be very dangerous and even cause stroke or in the worse case death.
By shaping the braid by braiding/winding it on a shaped mandril such as a tapered mandril or a mandril with various shapes on it, one can affect different characteristics of the tubular mesh braid. Braiding over a mandril tool of varying diameter with constant braiding machine speed varies the pitch of the braid and number of crossings over a given length of braid. Varying these parameters along a single braided component helps dictate where the braid will first collapse to then work as a “rolling sock”. Further, heat-treating to modify the material or braid shape has positive effects as well. One may alter the material properties of the braid only in certain parts of it so that gradients of stiffness are present along the length of the braid. These changes in stiffness may be extremely rapid to incite buckling (funnel formation) at a particular location or actuation force, or may be gradual to prevent buckling and perhaps maintain radial force. This allows the braid to fold, and to form a funnel in a particular fashion as it is being deployed. Additionally, by heat-treating the braid in such a way so as to effect a geometrical change, the braid will tend to fold/roll in a desired way so that the deployed braid/funnel occludes properly with the desired amount of radial force and at the same time expands to a desired diameter and shape, as well as expanding in an a traumatic fashion. For instance, a shape step may be formed into the braid wire so that upon actuation, the distal portion of the braid extends radially out to make contact with the vessel wall creating a deployment shape that is conducive to braid buckling. The size and geometry of this step can be adjusted to a particular application. Any sort of geometrical change can be formed during the actual braiding process, or through secondary mechanical or thermal means at any time in the manufacturing process.
Another secondary operation that may be used to improve the performance of the expanding braid section is the inversion of the braid. By turning the mesh braid “inside out”, it exhibits properties different from those of a “right side out” braid section. These differences may be greatest when the braid wire material is nitinol, and it is inverted after heat treatment, but some desirable performance characteristics may be present when using other braid wire materials, such as stainless steel, or when inverting the braid without heat treatment.
As previously mentioned, the overall profile of the device is of critical importance so that the physician can use the smallest incision necessary while still having the largest size lumen available for other therapeutic devices. With this in mind, another preferred design embodiment employs a braided shaft with an integral expanding braid section at the distal end. The braided shaft can be constructed with the desired wall thickness (specifically between 0.002″ and 0.015″ (0.051-0.38 mm)) and stiffness characteristics, and the expanding braid portions can be formed by simply continuing the braid beyond the shaft's polymer components. This process eliminates any secondary bond between the expanding braid and the shaft, and simultaneously creates a device that is stronger and more durable. One of many possible manufacturing methods entails placing the polymeric inner liner of the braided shaft on a mandril, and loading the mandril and liner assembly through the maypole braider. The mandril may have a distal shaped section that can be used to form the desired expanding braid shape. Braiding is continued over the expanding braid section of the mandril, and heat-treated if necessary. The outer polymeric component, or components are then laminated over the braided shaft section.
Using different coverings over the tubular mesh braid as well can modify all of these characteristics. For example, one embodiment of the invention would be a thermoplastic extrusion that has variable wall thickness. The wall thickness of the membrane may be varied along the length of the braid to have one or more zones of increased or decreased resistance to actuation (expansion), or zones of increased durability. These variable wall thicknesses will also allow the thinnest sections of the tubular mesh braid to expand first or to a larger overall diameter in contrast with zones having thicker membrane thicknesses. The adjustment of the order or degree of actuation of various sections along the length of the expanding braid will allow the device to achieve an optimum balance of actuation reliability, actuation force, and radial force exerted on the vessel wall. Generally, an extruder can extrude to approximately 0.003″ (0.076 mm) wall thickness of the tubing. In the manufacturing process, the technician can ‘pre-dilate’ the extrusion (all or part) and in doing so can controllably change and vary the expansion properties and wall thickness to achieve better device performance as compared to pre-dilated membranes. The easiest way to accomplish this ‘pre-dilation’ is to apply air pressure to the extrusion when it is sealed off at one end. Most thermoplastic elastomers used for this application have elastic modulus characteristics from 300-1500%, but more particularly from 600-1000%. Examples such as Chronoprene, polyurethane, C-Flex, latex, polyisoprene and silicone exhibit these properties.
Other methods to achieve a funnel catheter that reliably creates a distally directed open funnel end will be described below with reference to
The proximal end 238 of sleeve 236 is secured to a first position 240 on outer tube 230 and the distal end 242 of sleeve 236 is secured to a second position 244 on inner tube 232. The greater taper at distal taper portion 222, θ1>θ2, helps to ensure that the distal portion 246 of sleeve 236 buckles before the proximal portion 248 of the sleeve. See
A variable pic count funnel catheter 274 is shown in
The variable pic count braided structure 278 of
A Balloon that is a Funnel
Another aspect of the invention relates to a funnel shaped balloon. This is easily accomplished by shaping the balloon in such a way so that when it is expanded by gas or liquid, it expands in the shape of a funnel. This can be accomplished in several ways. In the case of making a balloon from a thermoplastic material including, but not limited to Chronoprene, polyurethane, C-Flex, Latex rubber, etc., these can be dipped, cast, sprayed or otherwise coated on a mandril that is in the shape of a funnel, or alternatively, they can be an extrusion that is then placed on a mandril that is the shape of a funnel and then by applying heat, the polymer will take the shape of the mandril. Even further, the extrusion can be placed inside a mold that is the shape of the funnel and with the addition of heat and then applying air pressure to the inside of the extrusion, the polymer will expand to the shape of the internal configuration of the mold cavity. After heat is removed from either of the above-mentioned processes and the system is allowed to cool, the result is a balloon that is in the shape of a funnel.
Alternatively the polymer could be made of an inelastic material including, but not limited to polyethylene, PET, HDPE, etc. These shapes can be accomplished in a similar manner stated above. Further because they are inelastic in nature they can be plastically deformed to create the shape of the funnel.
A balloon funnel catheter 290 is shown in
Expanding the Elastomer with the Braid and Applying Heat
The interaction of a braid and a membrane is obviously critical and can be optimized to provide various funnel shapes and properties. Additionally, the elastomer may be free from attachment to the expanding braid over one or more sections but still bonded proximally and distally to the outer member, and inner member, respectively. This construction has the benefit of eliminating any protrusions created by bonds or braid geometries. More specifically, it is preferred to use this technique on the distal end of the expanding braid section, creating a smooth, uninterrupted funnel shape. This smooth shape may improve fluid dynamics, perhaps by eliminating eddy currents, and allow for more complete aspiration of emboli.
It is desirable to create a membrane that is firmly attached to the braid over a section, yet is free from attachment in another section. In this manner the braid can be held in the desired shape (may be final deployed shape or any other intermediate position), and the membrane is placed over the braid. This assembly can then be placed into a heated mold, or other apparatus to heat the membrane, allowing it to flow and meld with the braid wires. Insulation may be placed in the mold to prevent the heating of certain sections of the membrane, thus keeping the membrane free from the braid.
Another aspect of the invention relates to a configuration where the polymer is shaped with the use of heat in conjunction with the expanding braid. For example, a thermoplastic elastomer (including, but not limited to polyurethane, C-Flex, Chronoprene, etc.) could be applied to the tubular mesh braid (this application could be sprayed, cast dipped, or an extrusion that lies over the braid) and then the tubular mesh braid is actuated so that it expands in any desired shape (including but not limited to funnel, disc-shape, ovaloid, spherical, conical or any other desired shape). In this case, the addition of heat would be advantageous because it would allow the polymer to form into the desired shape. This could be accomplished during and/or after the tubular mesh braid is expanded. Further, since the interaction of the braid and the membrane is obviously critical it may be necessary to control this interaction by bonding the braid to the membrane along its entire length or in discrete sections. The elastomer may be free from attachment to the expanding braid over one or more sections but still bonded proximally and distally to the outer member, and inner member, respectively. This construction has the benefit of eliminating any protrusions created by bonds or braid geometries. More specifically, a preferred embodiment is to use this technique on the distal end of the expanding braid section, creating a smooth, uninterrupted funnel shape. This smooth shape may improve fluid dynamics, perhaps by eliminating eddy currents, and allow for more complete aspiration of emboli.
In some situations it may be desirable to create a membrane that is firmly attached to the braid over a section, yet is free from attachment in another section. The braid can be held in the desired shape (may be final deployed shape or any other undeployed or intermediate position), and the membrane is placed over the braid. This assembly can then be placed into a heated mold, or other apparatus to heat the membrane, allowing it to flow and meld with the braid wires. Insulation (PTFE tubing, for example) may be placed in the mold to prevent the heating of certain sections of the membrane, thus keeping the membrane free from the braid. This forming method is viable for use with any thermoplastic braid (elastic or inelastic).
Additionally in the case of inelastic polymers, the tubular mesh braid could be used to actually plastically deform the inelastic polymer. In this case it may be advantageous to use tubular mesh braid that has a greater outward radial force so that the plastic deformation may be accomplished. This increased radial force of the tubular mesh braid could be accomplished by using yarns in the braid that are larger and stronger or both. In both instances of using the tubular mesh braid as a ‘tool’ for creating the shape of the elastomers, air pressure and heat may be used to aid with the process. In the case of the aforementioned embodiment, where one is creating a balloon in the shape of a funnel, disc, ovaloid, cone, etc, this braid could be used as a tool as well.
A method for securing an end 306 of a tubular braid 308 to a softenable end portion 310 of a tube 312 is illustrated in
Heated tool 314 can be heated in a variety of conventional or unconventional manners, including electrical resistance heating and RF heating. While sensors and feedback loops may be used to keep heated tool 314 at a desired temperature, heated tool 314 may be made of a material having a Curie temperature at the desired operational temperature to maintain the tool at the desired operational temperature.
The shape of a radially expandable and contractible tubular device can be controlled in a manner indicated in
In some cases it may be desired to impart a shape to a thermoplastic membrane which can then be used in conjunction with a radially expandable element, such as a tubular braid element or a malecot element, to help the radially expandable element achieve a desired radially expanded shape.
This aspect of the invention relates to a device/implant, which is particularly useful for bypassing, joining or re-joining pieces of tissue in the body. Further, this aspect of the invention relates to a means for bypassing or re-joining tubular structures within the body. The system is applicable for performing an anastomosis between a vascular graft and the ascending aorta in coronary artery bypass surgery, particularly in port-access CABG surgery. Alternatively it may be used to bypass any diseased vessel (vascular or other vessel/lumen in the body. A first configuration has two parts: an anchor member, forming the attachment with the target vessel wall and a coupling member forming the attachment with the bypass graft vessel. Inserting the coupling member, with the graft vessel attached, into vessel, completes the anastomosis. A second feature of the invention includes an anastomotic fitting, having an expandable flange, which the vessel is attached which contacts the exterior surface of the target vessel. A tailored amount of pressure is applied by an expandable mechanism that then grips the target vessel wall and creates a leak-proof seal between the anastomotic mechanism and the target vessel. A third feature of the invention has a flange to which the vessel attaches, by attaching hooks that are incorporated in the expandable anastomotic device to attach to the wall of the target vessel to form the anastomosis. A method for sealing or joining a graft vessel to a target vessel at an anastomosis site, the target vessel having an opening formed therein. The method includes positioning a fastener made from a deformable material radially adjacent to a free end portion of the graft vessel. The material is transformable between a smaller and then larger size, upon application of energy to the material. The method further includes inserting at least the free end portion of the device in the target vessel through the opening in the target vessel. The free end portion of the device is radially expanded to expand the device into intimate contact with an inner wall of the target vessel. The methods and devices represented above have been at least generally represented in the attached drawings for the instant inventions.
Another aspect of the invention is particularly adapted to the anastomotic repair of hollow conduits within the body. For example if a tubular conduit in the body is partially, generally, relatively or completely blocked, diseased, restricted, etc. and the preferred solution is removal of the diseased conduit and subsequent anastomotic repair or perhaps anastomotic repair via a bypass where the instant inventions could be used for joining, re-joining or bypass of the suspect part of the conduit.
In the case where diseased conduits are removed and it is preferred that the conduit be re-joined or even replaced with other autogenous or synthetic conduit (or a combination thereof), the instant embodiments would allow the physician to insert a radially expanding tubular structure within (or over) the remaining ends of the conduit in the body. It is likely that the radially expanding tubular structure would be placed into the vessel in a condition where it is not fully expanded or in a partially radially contracted condition (or at least a somewhat radially contracted condition; although this is not a condition for the instant inventions). However, in this case, the device would be placed into both ends of the vessel (with perhaps pulling the vessels toward one another) in a condition at least equal to or less than the inside diameter of the vessel, but more likely in a somewhat slightly contracted condition. Both ends of the device may have hooks or other fasteners or even other connection areas where the device may (or may not) be attached to the visceral conduits. Additionally tissue glues commonly available today are likely to be used and may in fact be incorporated into the procedures taught herein. This may be aided with mechanical, chemical or other means or no connection at all may be required. In the case where some connection mechanism is used/required, those mechanisms may include, but are not limited to hooks, sutures, staples, adhesives, mechanical interlocking, friction, compression, etc.
This instant invention may be enhanced by the use of a tubular mesh weave or braid that has been weaved of individual yarns. The use of such a braid is common both in industry as well as medical device/implants. See, for example, U.S. Pat. Nos. 6,179,860; 6,221,006; 6,635,068; 6,258,115 and 6,450,989.
One particular advantage of this tubular mesh braid discussed in the preceding paragraph is its ability to contract and expand in a tubular fashion. The description of the tubular braid element and coatings of it are included below in this disclosure. (The coating discussed in the preceding sentence as well as below may or may not be required.) Further, instead of or in addition to the ‘coating’, the braid could be accomplished with multiple (18-144 or even more or less) ‘yarns’ so that some of the yarns could be designed such that they could act as the coating, so that it is not a coating at all, but is part of the actual braided mesh itself.
This contraction/expansion phenomenon of the tubular braid element may be useful in the instant embodiment. For example, a particular length of the braid could be formed of a particular diameter. The braid could be stretched or elongated by putting it into a somewhat tensile condition. This would allow the braid diameter to contract and hence fit easily within the tubular conduit(s) of the body. Then the braid could be allowed to relax and the diameter would expand radially to a pre-determined diameter or to the inside diameter of the visceral conduit. Conversely, the braid could be fabricated a particular diameter smaller than the visceral conduit and then put into compression to expand it radially to the appropriate diameter to join or re-join the visceral conduit. This compression or tension could then be permanently controlled if so desired by keeping the braid in an expanded condition for an appropriate period of time. Certainly this could be controlled with the use of ‘memory’ of the braid as is described below in the discussion of the tubular braid element and elsewhere. Alternatively the braid could be kept in an elongated/smaller diameter or a shortened/larger diameter by mechanical attachment that keeps the braid in the preferred condition.
This tubular mesh braid could be composed of many different materials used now in the medical device industry as well as newer yet to be released or discovered materials including, but certainly not limited to polymers such as PET's, Silicones, Nylons, Polyesters, Mylar, etc. metals and metal alloys such as Stainless Steels, Elgiloys, NiTIi's (Nickel Titanium alloys, both TWSM (Two Way Shaped Memory) and Super Elastic NiTi's), etc.
Additionally, these radially expanded devices and methods could be accomplished with a ‘slit tubular’ structure commonly referred to as a Malecot structure that can be easily expanded and contracted by putting the tube in compression or extension respectively.
Even further, these radially dilating mechanisms can be accomplished by curling material like a ‘cinnamon roll’ such that in its smaller/contracted condition, the walls of the material would be contracted and touch one another (as with a cinnamon roll) and in its larger diameter state the walls may not be in contact with one another. This cinnamon roll can be accomplished by ‘rolling’ the sheet (with porosity, holes, coverings, films, membranes, drugs, compounds, etc.) of material into a tube/cylindrical like condition in a small diameter and then when in the desired location, the rolled sheet is allowed to or effected to at least partially ‘unroll’ into at least a partially tubular structure desired.
Even further yet, the instant inventions and methods can be accomplished by a system of a sheet of material that is longer than it is wide (e.g. like a ribbon). The longer dimension is then programmed to a tubular configuration by ‘wrapping’ it around a small cylindrical mandril (or other means) and treating it to keep in that small tubular configuration. Then when in the desired location, the smaller tube can be activated to become a larger tubular configuration. One such way to accomplish this is with TWSM NiTi mentioned above and disclosed as a Multi-Porous Stent in U.S. Pat. No. 6,258,115.
In all instances these mechanisms may be covered with a film of elastic or inelastic material. Further this film may be incorporated into the mechanisms as opposed to covering them. Such films, coverings or other incorporated materials may be, but are not limited to the following: silicone, nylons, polyethylenes, wovens, hybrids, PET's, woven metals, PTFE'S, Expandable PTFE's, FEP's, Teflon's, and a variety of bioabsorbable materials such as hydromers, collagens, polymers, vicryls, autogenous substances (animal, human or plant).
There may be a support wire(s) that may extend through or alongside the expandable channel devices at its distal and proximal ends (or near them). These wires may be used to help deploy or undeploy the radially expanding elements. Further, these wire(s) may be used to help keep the preferred condition when in the preferred position in the host. The support wire(s) may be one, two, three, four or more in number and may be located inside or outside the tubular structure. They may be used to put the mechanism into a tensile or compressive condition that will allow it to become a small diameter or larger diameter condition. These wires can be made permanently attachable to keep the desired configuration by attaching them permanently to keep the mechanism in the desired shape. The distal end of the core is attached to the distal end of the annular braided element (or other mechanism described herein) and the distal end of the shell is attached to the proximal end of the annular braided element. Thus movement of the core and shell relative to one another moves the braided element from a radially retracted position, which is useful for insertion into the body in a small condition to a radially expanded position, which expands it to the sidewall of the channel in the body.
A device made according to this aspect of the invention is used for intervention into the tubular channels (arteries, veins, biliary tract, urological tract, gastro-intestinal tract, stents, grafts, sinuses, nasopharynx, heart, ears, etc.) or hollow cavities (stomach, gall bladder, urinary bladder, peritoneum, etc.) of the body. Additionally the instant invention may be used in solid or semi-solid tissue including, but not limited to breast, liver, brain, pancreas, lungs etc. It is particularly convenient to use in an operating room, surgical suite, interventional suite, Emergency Room, patient's bedside, etc. environment. One preferred embodiment of this device is that the flexible shaft is inserted into the tissue, tubular channel or hollow cavity of the body usually through percutaneous access or via a surgical incision. In the case of lumens that enter and exit the body naturally, the device may enter through one of those entry or exit paths (i.e. rectal opening, mouth, ear, etc.).
Additionally, other techniques may be used for removal assistance such as the use of lytic agents, laser energy, dissolving agents, hydraulic assistance, mechanical agitation, vibration, ultrasonic energy or any other variety of assistance that will aid in the removal. Image intensification (Ultrasound, fluoroscopy, MRI, etc.) may be used as well to help with assuring the technique/removal is successful. Additionally, direct visualization using cameras or endoscopes may be used as well.
Further, materials disclosed could be of some hybrid elastic/inelastic material or compliant material. Even further, the balloon may be aided with some other mechanical substructure that aids in the outward radial force that is created by the balloon. Further when balloons are used, filaments such as thin strips of polymers such as Mylar, pet, polyethylene, etc., could be used to create a desired effect when inflating the balloon (such as shape). All of these configurations may or may not have a roughened texture on the exterior surface that will aid in the removal of the obstruction or adherence to tissue. Alternatively, all of the above mentioned configurations could have a separate or additional material applied over the expandable mechanism that is a membrane, which may or may not be roughened. The roughened surface on the expandable mechanism is easily accomplished in the manufacturing environment. One such way is to create bubbles in a liquid slurry of the polymer prior to its solid curing. Another might be the addition of dissolvable crystals to the surface of the liquid polymer prior to its cure. These dissolvable crystals could then be removed (washed off) after curing of the polymer.
Another configuration that could be used for the expandable mechanism is a mechanism(s) known as a malecot. This malecot is a common configuration used in catheters for holding them in place (in the case of feeding tubes in the intestines or stomach). It is usually a polymeric tube that has more than one, but usually two or more slits symmetrically opposed. When the distal tip of the malecot is put into compression (usually by pulling an inner wire or mandril or tube), the sides of the polymer are pushed outward to create a larger diameter on the distal tip. This larger diameter is larger than the body/shaft of the device. In the case of a malecot type configuration (as with the inflatable mechanism(s) mentioned above), the surface of the malecot could be roughened or a separate membrane (attached or not) could be put over or under the malecot so that it is roughened or strengthened. Further, a membrane that connects the ribs or wings of a malecot is easily fabricated to increase the surface area of the malecot ribs or wings alone.
Yet, another alternative design of the expandable mechanism is one that has similarities to the malecot, but uses a multi-stranded braid on the distal end. When the braid is put into compression, the braid is pulled together and it flares out to create a larger diameter on the distal end. Changing the pore size along the braid so that the holes in the braid go from none to large holes/pores easily modifies the braid. This can be accomplished by braiding the braid with metals and polymers and melting the polymers away or by simply braiding at different rates while braiding that causes different pore sizes also known in the braiding industry as pics per inch. This is easily accomplished ‘on the fly’ while braiding by using a programmable braider. The braid pics per inch change with time as the tubular mesh braid is being braided. This varying pore size may have a number of advantages to the current invention. It could aid with stopping porosity when needed and allowing porosity when you need it. For example, it is possible that ingrowth would be desired in contact with tubular body structures at certain times and that there be no porosity when trying to achieve a leak free environment (perhaps in between the two tubular structures being attached or when bypassing.
Alternatively, either the braid or the malecot can have a permanent set put into in so that it is normally open with the larger diameter. In this case, when it is put into tension (usually from some inner (or outer) core wire or mandril), it collapses down to the diameter of the shaft of the device.
Alternatively, too much abrasive action on the surface of the mechanism(s) may be deleterious to the patient as well. In the case of the braided configuration, some smoothener may be required so that just the appropriate amount of friction is realized for effective obstruction removal. Further, the realized rigidity of any of the type of mechanism(s)s must be optimized for this removal in the particular application.
A radially collapsible tubular channel can also be fabricated from several materials and configurations. One preferred configuration is a multi-stranded braided device. The strands can be made of any material that would be useful for a particular application (polymers like polyester, nylon, Mylar, etc.) or, metal (stainless steel, Nickel Titanium Allow (Nitinol), platinum, etc.). Certainly, the potentially useful materials are not constrained to those materials listed. Additionally, the mechanism channel may be coated or encased in an elastomeric or other covering. Further, the mechanism channel may be fabricated of a material that will enlarge due to different forces than that of the braid mentioned previously. One other such force derived mechanism could be a material that swells/enlarges when put into a moist environment. Another such force derived mechanism is one that swells/enlarges when thermal energy is applied such as Two Way Shaped Memory Alloy (TWSMA) such as a Nickel-Titanium alloy. Yet, another may be one that occurs from an electrical, magnetic or other mechanical configuration/design/force.
The mechanisms described above include an elongate tube; an elongate mandril inside the tube and an expandable tubular braid. The elongate mandril extends from the proximal end of the device to the distal end. The elongate tube usually extends from close to the proximal end of the device to close to the distal end. The distal end of the tubular braid is bonded to the distal end of the inner elongate mandril. The mandril may extend beyond the tubular braid. The proximal end of the tubular braid is bonded to the distal end of the elongate tube.
The braid may be open, but may be laminated or covered with a coating of elastic, generally inelastic, plastic or plastically deformable material, such as silicone rubber, latex, polyethylene, thermoplastic elastomers (such as C-Flex, commercially available from Consolidated Polymer Technology), polyurethane and the like. The assembly of tube, mandril and braid is introduced percutaneously in its radially compressed state. In this state, the outside diameter of the braid is close to the outside diameter of the elongate tube. This diameter is in the range of 10 to 500 mils, and usually 25 to 250 mils (i.e. thousandth of an inch) (0.25 to 12.7 mm, usually 0.64 to 6.4 mm). After insertion, moving the mandril proximally with respect to the tube expands the tubular braid.
The tubular braid is preferably formed as a mesh of individual non-elastic filaments (called “yarns” in the braiding industry). However, it can have some elastic filaments interwoven to create certain characteristics. The non-elastic yarns can be materials such as polyester, PET, polypropylene, polyamide fiber (Kevlar, Dupont), composite filament wound polymer, extruded polymer tubing (such as Nylon II or Ultem, commercially available from General Electric), stainless steel, Nickel Titanium (Nitinol), or the like so that axial shortening causes radial expansion of the braid. These materials have sufficient strength so that the tubular braided element will retain its expanded condition in the lumen of the body while removing the matter therefrom. Further, all expandable mechanisms described heretofore, can be manufactured using shape memory materials so that they are self expanding or even expandable when certain temperatures or thermal energies are delivered to the mechanisms. Such material characteristics can be accomplished with different programming methods such as, but not limited to Two Way Shape Memory (TWSM) alloys.
The braid may be of conventional construction, comprising round filaments, flat or ribbon filaments, square filaments, or the like. Non-round filaments may be advantageous to decrease the axial force required for expansion to create a preferred surface area configuration or to decrease the wall thickness of the tubular braid. The filament width or diameter will typically be from about 0.5 to 50 mils (0.013 to 1.3 mm), usually being from about 5 to 20 mils (0.13 to 0.51 mm). Suitable braids are commercially available from a variety of commercial suppliers.
The tubular braids are typically formed by a “Maypole” dance of yarn carriers. The braid consists of two systems of yarns alternately passing over and under each other causing a zigzag pattern on the surface. One system of yarns moves helically clockwise with respect to the fabric axis while the other moves helically counter-clockwise. The resulting fabric is a tubular braid. Common applications of tubular braids are lacings, electrical cable covers (i.e. insulation and shielding), “Chinese hand-cuffs” and reinforcements for composites. To form a balanced, torque-free fabric (tubular braid), the structure must contain the same number of yarns in each helical direction. The tubular braid may also be pressed flat to form a double thickness fabric strip. The braid weave used in the tubular braid of the present invention will preferably be of the construction known as “two dimensional, tubular, diamond braid” that has a 1/1 intersection pattern of the yarns which is referred to as the “intersection repeat”. Alternatively, a Regular braid with a 2/2-intersection repeat and a Hercules braid with an intersection repeat of 3/3 may be used. In all instances, the helix angle (that being the angle between the axis of the tubular braid and the yarn) will increase as the braid is expanded. Even further, Longitudinal Lay-Ins can be added within the braid yarns and parallel to the axis to aid with stability, improve tensile and compressive properties and modulus of the fabric. When these longitudinal “Lay-In” yarns are elastic in nature, the tubular braid is known as an elastic braid. When the longitudinal yarns are stiff, the fabric is called a rigid braid. Biaxially braided fabrics such as those of the present invention are not dimensionally stable. This is why the braid can be placed into an expanded state from a relaxed state (in the case of putting it into the compressive mode). Alternatively this could be a decreased/reduced (braid diameter decreases) state when put into tension from the relaxed state. When put into tension (or compression for that matter) the braid eventually reaches a state wherein the diameter will decrease no more. This is called the “Jammed State”. On a stress strain curve, this corresponds to increase modulus. Much of the engineering analyses concerning braids are calculated using the “Jammed State” of the structure/braid. These calculations help one skilled in the art to design a braid with particular desired characteristics. Further, material characteristics are tensile strength, stiffness and Young's modulus. In most instances, varying the material characteristics will vary the force with which the expanded condition of the tubular can exert radially. Even further, the friction between the individual yarns has an effect on the force required to compress and un-compress the tubular braid. For the present invention, friction should be relatively low for a chosen yarn so that the user will have little trouble deploying the engaging element. This is particularly important when the engaging element is located a significant distance from the user. Such is the case when the percutaneous entry is the groin (Femoral Artery for vascular interventions) and the point of engaging the engaging element is some distance away (i.e. the Carotid Artery in the neck). Similarly, this is true for long distances that are not vascular or percutaneous applications.
Throughout this disclosure, it is mentioned that the tubular braid may be coated with a material so that it may have no porosity or variable porosity within the individual filaments of the braid. This is an important configuration of the present invention and in certain instances may be critical (i.e. when a cancer is being removed from a small puncture hole, cancerous tissue must not be able to leak out through the walls of the tubular braid because the cancer may be seeded along the tract. This is important in the case of laparoscopic surgery as well. In fact, it may be important in many instances, not only where cancer is apparent.) One simple way to cover the tubular braid is to attach tubing over it. This has been done to prototypes of the present invention and works quite well. Elastomeric and inelastic coverings have been used. In some instances thermoplastic coverings were used and then heat and compression was applied along the tubular braid to melt it into the braid filaments. This works well. The braid was expanded from its original small diameter by sliding a mandril into the tubular braid. Once the braid is expanded, a liquid thermoset elastomer including, but not limited to silicone rubber, latex rubber, etc. or thermoplastic material including, but not limited to polyurethane was coated via a spray, dip, brush or other method. When the material cured, the mandril was removed and the tubular braid could be pulled on both ends (put into compression) and the tubular braid would go back to its original diameter. This is important for several reasons; the method described here allows the material to be applied within the filaments instead of over the filaments. This decreases the overall diameter of the tubular braid significantly as opposed to putting a covering over it. Further, the integrity of the material in between the filaments as opposed to over the filaments is increased because as the expandable channel is pushed forward, the material is hidden within the braid and hence doesn't see the forces of the tissue against it. Using a covering over the braid, the forces during the pushing are directly transmitted to the covering over the braid. Even further, the reliability and cost to manufacture are greatly improved. Even further and of extreme import is the fact that using a liquid that cures or a thermoplastic covering that is melted into the braid as opposed to covering it allows for varying the porosity along the tubular braid. This is extremely important in those cases where variable porosity is desired.
Prototypes of the mechanisms were fabricated from the materials disclosed heretofore and of the dimensions commensurate with this disclosure.
Further, several different types of tubular braid were coated and/or covered with polymer elastomers and inelastomers as described heretofore. In one case, the braid was expanded to some diameter greater than the relaxed and smaller diameter. This was accomplished using a Teflon mandril. With the tubular braid in this somewhat expanded condition, the assembly was coated with liquid silicone rubber. When it dried, putting the system into tension so that the smaller original diameter was achieved again could elongate the assembly. It could then be put into compression and thusly shortened so that it would expand and the braid was covered so that there could be no holes in between the filaments of the braid. Further, the overall diameter of the tubular braid as not increased except for maybe 0.0001″ (0.0025 mm). Even further, trap devices were made whereby the silicone rubber was sprayed or painted onto the tubular braid when it was in the deployed/expanded condition. Once dried, the assembly could be un-deployed and then re-deployed with ease and without any holes between the filaments. Lastly, tubular braids were coated as described above with only partial coating to create variable porosity along the braid. Even further, the totally coated tubular braid was easy to puncture so that variable porosity was achieved as well. Further, multi-stranded braided tubing was braided using over 100 individual yarns made of thermoplastic materials and metallic materials. After braiding was completed, individual yarns were removed to change porosity. Alternatively when a combination of metal and thermoplastic yarns were used, the thermoplastic yarns were heated and melted away from the tubular mesh to change the pore size by leaving the metal or polymers with higher melt temperatures (or in the case of thermoset polymers, higher temperature resistant materials) leaving the metal or higher temperature resistant materials in place.
An exemplary device has the following characteristics:
The expandable mechanism has an outer diameter that ranges from 0.006″ to 0.450″ (0.15 mm to 1.14 cm), but can extend to smaller and larger sizes as technology and procedures require. The expandable mechanisms of the instant invention would be small in its un-deployed state in the range of 0.020-0.090 inches (0.51 mm to 2.3 mm) but would be expandable to diameters of with a tenfold increase or even larger.
The device of the instant invention may have conventional lubricious coatings to enhance introduction into the target body lumen, e.g. hyaluronic or other equivalent coatings. Further, the technician may apply a lubricious coating just before surgery. Also, a variety of drugs may be used with the device, as well as the above-described devices, for a variety of reasons such as reducing infection and/or rejection, and in the case of vascular situations, drug eluting mechanism can be added to help prevent stenosis or restenosis. Such drugs or compounds may be but are not limited to Sirolimus—an immunosuppressant drug usually used to prevent rejection in organ transplants—elutes from the stent into the vessel wall over the period when the scar tissue may be growing. Paclitaxel, a chemotherapy drug, may also be used. The Paclitaxel may gradually release directly into the coronary artery wall to prevent the restenosis process; this may be accomplished by embedding the material in the polymer as opposed to coating the device. The same may be true for Sirolimus.
As an advantage of the instant invention, the device will be less difficult to feed it to the desired location in the body due to its decreased size. Another advantage of the instant invention would be the ease with which bypassing or anastomosis can be accomplished. It can be done in a percutaneous fashion as opposed to an open, surgical procedure as well. Over the past decades, it has been proven that percutaneous intervention as compared to open surgical intervention has shown a great decrease in morbidity and mortality as well. This decreased difficulty will decrease cost due to time in the Operating Room (Operating Rooms costs are estimated in excess of $90 dollars per minute in the U.S.)
An example of tubular mesh braid 372 is shown in
Anastomotic medical device 348 may have second end 356 positioned externally of a patient's body and provide access to a single tubular structure. However, two anastomotic medical device 340 may be used in a patient and connected to two different tubular structures within a patient or may be used to bypass a portion of the same tubular structure. In either case, the second ends 256 of the two anastomotic medical devices 348 are secured to one another in an appropriate fashion. The following
An anastomotic device 422 is shown
More particular one embodiment of this invention which has been partly tested, was designed for use in a hemodialysis graft 10 having an I.D. of approximately six to seven mm. In that case, the catheter 16 has a 8 French O.D. (2.7 mm) and a 7 French I.D. (2.3 mm). The support wire 22 is a fairly standard movable core guide wire of 35 mils (that is, 0.35 inches, which is slightly under 1 mm). The actuator rod 26 in the support wire is approximately 15 mils and thus slightly under 0.5 mm. The braided element 24 has an insertion diameter that is approximately one mm and expands to cover the seven mm diameter of the graft. In order to achieve this seven fold increase in diameter, the braided element has a length of 11 to 13 mm Thus the catheter has an annulus of about 2.3 mm around the support wire, through which annulus the blood occlusion is aspirated.
The distal tip of the braided element 24 is connected to the distal tip of the actuator rod 26. The proximal edge of the braided element 24 is bonded to the distal end of the support wire 22. Thus when the actuator rod 26 is pushed in a distal direction relative to the wire 22, the braided device is forced into its collapsed state shown in
With reference to
There might be applications of the invention where the passageway involved is a tissue passageway such as a blood vessel or other channel within the body, where this braided element 24 is expanded to nearly the diameter of the vessel so that when it is moved to push out an occlusion, it will avoid trauma to the wall of the vessel. Further, the membrane on the expanding element will aid in decreasing the trauma to native vessels as described above. In such a case, the engaging element (and the blocking element) may be used only as a ‘seal’ so that the obstruction may be removed or otherwise obliterated. This seal allows the rest of the vessel to be uncontaminated and provides for a ‘closed system’ for irrigation and/or aspiration and subsequent obliteration or removal of the obstruction
It should be noted that the retention catheter described in U.S. Pat. No. 3,799,172 issued on Mar. 26, 1974 to Roman Szpur illustrates a structure that is similar to the malecot type device 18 illustrated in
This blocking element 18 is often called a malecot in the industry. It should be understood herein that the term malecot is used to refer in general to this type of multi-wing device.
More specifically, as shown in
What then occurs is shown in
The engaging apparatus includes an elongate tube; an elongate mandril inside the tube and an expandable tubular braid. The elongate mandril extends from the proximal end of the device to the distal end. The elongate tube extends from close to the proximal end of the device to close to the distal end. The distal end of the tubular braid is bonded to the distal end of the inner elongate mandril. The mandril may extend beyond the tubular braid. The proximal end of the tubular braid is bonded to the distal end of the elongate tube.
The braid may be open, but may be laminated or covered with a coating of elastic, generally inelastic, plastic or plastically deformable material, such as silicone rubber, latex, polyethylene, thermoplastic elastomers (such as C-Flex, commercially available from Consolidated Polymer Technology), polyurethane and the like. The assembly of tube, mandril and braid is introduced percutaneously in its radially compressed state. In this state, the outside diameter of the braid is close to the outside diameter of the elongate tube. This diameter is in the range of 10 to 50 mils, and usually 25 to 40 mils (i.e. thousandth of an inch). After insertion, the tubular braid is expanded by moving the mandril proximally with respect to the tube.
The tubular braid is preferably formed as a mesh of individual non-elastic filaments (called “yarns” in the braiding industry). But it can have some elastic filaments interwoven to create certain characteristics. The non-elastic yarns can be materials such as polyester, PET, polypropylene, polyamide fiber (Kevlar, DuPont), composite filament wound polymer, extruded polymer tubing (such as Nylon II or Ultem, commercially available from General Electric), stainless steel, Nickel Titanium (Nitinol), or the like so that axial shortening causes radial expansion of the braid. These materials have sufficient strength so that the engaging element will retain its expanded condition in the lumen of the body while removing the obstruction therefrom.
The braid may be of conventional construction, comprising round filaments, flat or ribbon filaments, square filaments, or the like. Non-round filaments may be advantageous to decrease the axial force required for expansion to create a preferred surface area configuration or to decrease the wall thickness of the tubular braid. The filament width or diameter will typically be from about 0.5 to 25 mils, usually being from about 5 to 10 mils. Suitable braids are commercially available from a variety of commercial suppliers.
The tubular braids are typically formed by a “Maypole” dance of yarn carriers. The braid consists of two systems of yarns alternately passing over and under each other causing a zigzag pattern on the surface. One system of yarns moves helically clockwise with respect to the fabric axis while the other moves helically counter-clockwise. The resulting fabric is a tubular braid. Common applications of tubular braids are lacings, electrical cable covers (i.e. insulation and shielding), “Chinese hand-cuffs” and reinforcements for composites. To form a balanced, torque-free fabric (tubular braid), the structure must contain the same number of yarns in each helical direction. The tubular braid may also be pressed flat so as to form a double thickness fabric strip. The braid weave used in the tubular braid of the present invention will preferably be of the construction known as “two dimensional, tubular, diamond braid” that has a 1/1 intersection pattern of the yarns which is referred to as the “intersection repeat”. Alternatively, a Regular braid with a 2/2 intersection repeat and a Hercules braid with an intersection repeat of 3/3 may be used. In all instances, the helix angle (that being the angle between the axis of the tubular braid and the yarn) will increase as the braid is expanded. Even further, Longitudinal Lay-Ins can be added with the braid yarns and parallel to the axis to aid with stability, improve tensile and compressive properties and modulus of the fabric. When these longitudinal “Lay-In” yarns are elastic in nature, the tubular braid is known as an elastic braid. When the longitudinal yarns are stiff, the fabric is called a rigid braid. Biaxially braided fabrics such as those of the present invention are not dimensionally stable. This is why the braid can be placed into an expanded state from a relaxed state (in the case of putting it into the compressive mode). Alternatively this could be a decreased/reduced (braid diameter decreases) state when put into tension from the relaxed state. When put into tension (or compression for that matter) the braid eventually reaches a state wherein the diameter will decrease no more. This is called the “Jammed State”. On a stress strain curve, this corresponds to increase modulus. Much of the engineering analysis concerning braids are calculated using the “Jammed state” of the structure/braid. These calculations help one skilled in the art to design a braid with particular desired characteristics. Further, material characteristics are tensile strength, stiffness and Young's modulus. In most instances, varying the material characteristics will vary the force with which the expanded condition of the tubular can exert radially. Even further, the friction between the individual yarns has an effect on the force required to compress and un-compress the tubular braid. For the present invention, function should be relatively low for a chosen yarn so that the user will have little trouble deploying the engaging element. This is particularly important when the engaging element is located a significant distance from the user. Such is the case when the percutaneous entry is the groin (Femoral Artery for vascular interventions) and the point of engaging the engaging element is some distance away (i.e. the Carotid Artery in the neck). Similarly, this is true for long distances that are not vascular or percutaneous applications.
An important consideration of the invention described herein is that the support wire with its expanding element can be fabricated with a very small diameter. This is important because it allows an optimally large annular space between the wire and the inside of the catheter for maximum obstruction removal. Previous engaging elements have been used that use a balloon for the engaging element. This balloon design requires a larger shaft diameter than that of the present invention. Hence in these previous devices the annular space is not maximized as in the present invention. The term wire is used to refer to the support portion of the removal device. The material of the wire need not necessarily be metal. Further, it may be desirable to use a ‘double’ engaging element (i.e. two braided or malecot expanding elements separated a distance appropriate to entrap the occlusion) in the case for example where the occlusion is desired to be trapped in the vessel. The term wire is used herein to refer to a dual element device having a shell component and a core or mandril component which are longitudinally moveable relative to one another so as to be able to place the braided occlusion engaging element into its small diameter insertion state and its large diameter occlusion removal state.
Although the blocking element is described as a multi-malecot type of device, it should be understood that the blocking element may be designed in various fashions which are known in the art. See, for example,
The particular embodiment disclosed was designed for an application to remove congealed blood in a dialysis graft. For some applications, like removing clots from remote vascular areas, the blocking mechanism and engaging elements may be used only as distal and proximal seals around the device to be removed so that the clot or other obstruction can be removed with aspiration or can be obliterated with some therapy such as a chemical dissolving agent or acoustical energy or lithotripsy and the like. The residual obstruction in that case would be aspirated from the tubular catheter.
It should be further understood that there might be a situation in which the blocking element or even the occlusion engaging element would be provided to the physician in a normal expanded state so that when the device is deployed, it would, through plastic memory or elastic memory, automatically snap into its expanded state.
Appropriate sensors 122 are mounted to one or more of wires 110 and shaft 104. Sensors 122 could be portions of wires 110 themselves. Sensors 122 may include strain gauge sensors, pressure sensors, temperature sensors, etc. Sensors 122 are coupled to a feedback device 124 through sheath 105; feedback device 124 is connected to energy source 114 to ensure that energy source 114 provides an appropriate level of energy to wires 110.
Assembly 102 is used to percutaneously access a target site 126 through an access site 128 in skin surface 120 while in the retracted state. The tip 130 of shaft 104 is positioned distally of the target tissue mass 132. In some situations it may be desirable to pass tip 130 directly through target tissue mass 132 while in other situations it may be desirable to have shaft 104 pass to one side of target tissue mass 132 or proximal to the tissue mass as in
Once fully expanded, tissue removal assembly 102 is rotated, typically by the user manually grasping and rotating handle 106. If desired, a motorized or other non-manual rotation of assembly 102 could be provided for. Sensors 122 provide appropriate information to feedback device 124 so to ensure a proper amount of energy is supplied to wires 110 to, among other things, ensure proper cauterization of the tissue as wires 110 are moved readily outwardly while not overly damaging the tissue. Therefore, if wires 110 cease to be driven and thus stop moving through the tissue, feedback can result in a halt in the supply of energy to wires 110. Once in the fully extended state of
In the embodiment of
Access to a void 152 within a patient can be maintained by placing sleeve 136 along tissue track 138 and leaving it in place. This method may be accomplished after removal of, for example, a biopsy specimen or an entire suspect tissue mass. This provides convenient and accurate re-access to void 152. Such re-access may be used, for example, when additional tissue samples are needed, therapeutic agents (including heat treatment agents, mechanical treatment agents, chemical agents and radioactive agents) need to be delivered to void 152, a prosthesis is to be implanted into void 152, or for other reasons. See the discussion below with reference to
At this point a sample of the target tissue 144 may be removed from the patient by simultaneously removing shaft 154 in its enlarge diameter form, sleeve 162 and device 145 as a unit. Alternatively, stabilizing sleeve 162 may be removed as device 145 pulls tissue 144 into shaft 154 while shaft 154 remains in place. This suggested in
The entire shaft 154 was enlarged in the embodiment of
The entire suspect tissue mass, that is the mass including target tissue 144 and an amount of surrounding tissue (or only a portion of target tissue 144, such as for biopsy), can be removed through access site 128. To help prevent trauma to access site 128 during such removal, mesh device 146 and tubular mesh device 172 are caused to contract radially, thus compressing target tissue 144 into a smaller diameter mass for ease of removal from the patient. This is suggested in
Turning now to
Another intraoperative treatment method, which may advantageously take place following the removal of target tissue from a target site leaving access, typically using sheath 105, to void 190 at the target site, relates to placing a flexible implant 216 into the void through the sheath.
A further intraoperative tissue treatment method using suction is disclosed in
Modification and variation can be made to the disclosed embodiments of
Although the instant invention of
The device of the instant invention is used for intervention into the tubular channels (lumens) of the body including, but not limited to arteries, veins, biliary tract, urological tract, intestines, nasal passages, ear canals, etc. Further, it can be useful as a suturing anchor in places of the body including, but not limited to adhering the stomach or other intestine to the abdominal wall in the case of feeding gastrostomies, jejunostomies, etc. Other anchoring applications of the instant invention include MIS facelifts and the repair of ptotic breasts. Even further, the instant invention is used for the repair of aneurysms of other permanent vessel occlusions. Such other permanent vessel occlusions would have applicability for occlusion of tributaries of vessels for vessel harvesting. The instant invention is particularly convenient to use in an operating room, interventional suite, patients' bedside, in an emergency room environment or in any emergency situation. One preferred embodiment of the instant invention is that it is inserted into the tubular channel of the body to utilize the flow directed characteristics of the invention. Once the device is in a flow/differential pressure situation, the inner core, mandrel/wire/string/member is deployed (usually pulled by the physician outside the body) so that the umbrella/trap configuration on the distal portion of the device opens. At the same time, the distal portion of the device becomes ‘floppy’ in nature so that it will follow the tortuous paths of the lumen without causing deleterious complications normally realized with conventional guide wires where they inadvertently damage the inner wall of the vessel when trying to cross said tortuous paths. The device is then carried in the direction of flow or of lower pressure (or with any contractile forces that may exist).
Once the device is in the desired position within the body, the umbrella like mechanism may or may not be un-deployed. In this case, once the device is removed from the package and before insertion into the body, the mechanism on the distal portion of the guide wire may be unopened (normally closed).
Alternatively, the device could have a distal configuration that causes it be moved in the direction of flow or in the direction of less pressure (or with the contractile forces) at the time it is opened from the package (e.g. normally opened). In this case the device is placed in the motion situation in the tubular channel of the body and is carried to the desired location. In the normally open position, the device may be very floppy in nature so that it will easily travel through the lumen of the body due to the pressure differential/flow/contractile forces. Once in position, the mechanism at the distal portion of the device may or may not be closed by some other mechanical means by the technician outside the body. One way of undeploying the distal ‘umbrella’ mechanism is by re-inserting the inner core so that the expanded mechanism becomes small or in its radially compressed state. Another advantage of re-inserting the inner core wire into the outer ‘floppy’ tube would be to make the support wire somewhat stiff, facilitating the insertion of another device over, through or along side the support wire that is attached to the expandable mechanism. Further, the umbrella like mechanism could become enlarged so that it will anchor in the lumen to keep its desired position.
Possible configurations of the distal mechanism are varied. One such mechanism is a balloon that is inflated for flow and deflated when not required. Another configuration that could be used is a mechanism known as a malecot. This malecot is a common configuration used in catheters for holding them in place (in the case of feeding tubes in the intestines). It is usually a polymeric tube that has four slits diametrically opposed. When the distal tip of the malecot is put into compression (usually by pulling an inner wire or member), the four sides of the polymer are pushed outward so as to create a larger diameter on the distal tip. Alternatively, the normal configuration of the malecot could be an open configuration whereby, when put into tension (large or small), the malecot closes to come near to or equal to the diameter of the elongated member. This larger diameter is larger than the body length of the catheter or wire. Another alternative is one that is similar to the malecot, but uses a multi-stranded braid on the distal end. When the braid is put into compression, the braid is pulled together and it flares out to create a larger diameter only the distal end. Alternatively either the braid or the malecot can have a permanent set put into in so that it is normally open or of the larger diameter. In this case, when it is put into tension (usually from some inner core wire or mandrel) it collapses down to the diameter of the body of the wire or catheter. Even further, the expandable mechanism on the distal end of these devices could be programmed to be thermally sensitive so that they expand or contract when placed in desired thermal gradients. One such mechanism for ‘programming’ materials like this is known as Shaped Memory Alloys (SMA) or Two Way Shaped Memory Alloys (TWSMA). Another exemplary embodiment of the instant invention is that once the device is placed in its desired location the mechanism (usually near the distal portion of the device) is deployed to ‘lock’ or ‘anchor’ it in the desired position.
Another embodiment is the tensioning characteristic of the instant invention. When the device is in or near a desired location of the body, the distal mechanism is deployed so that it anchors or has a tendency not to move. In this configuration, the wire, catheter or other device can be put into tension that will allow the passage of another device over or with the inner support wire. Even further and discussed heretofore, the instant invention can be ‘detached’ from the support wire and act as a tubular channel occluder.
This anchoring mechanism may or may not be used with the other embodiments. Further, the flow/contractile force characteristic may or may not be used with the other embodiments. Even further, the tensioning characteristic may or may not be used with the other embodiments. Last, the occluder may be used independently of the other three. In other words, although the distal mechanism that is used for all four embodiments may be similar to one another, the separate four embodiments may be used alone or in combination with the other embodiments.
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In any of these instances, the ‘desired’ location of the device is usually determined using Image Intensification (Fluoroscopy, Ultrasound Imaging, MRI, etc.). Further, the location could be monitored using cameras or other visualization techniques.
The apparatus of the instant invention includes an elongate tube; an elongate mandril inside the tube and an expandable tubular braid. The elongate mandril extends from the proximal end of the device to the distal end. The elongate tube usually extends from close to the proximal end of the device to close to the distal end. The distal end of the tubular braid is bonded to the distal end of the inner elongate mandril. The mandril may extend beyond the tubular braid. The proximal end of the tubular braid is bonded to the distal end of the elongate tube.
The braid may be open, but may be laminated or covered with a coating of elastic, generally inelastic, plastic or plastically deformable material, such as silicone rubber, latex, polyethylene, thermoplastic elastomers (such as C-Flex, commercially available from Consolidated Polymer Technology), polyurethane and the like. The assembly of tube, mandril and braid is introduced percutaneously in its radially compressed state. In this state, the outside diameter of the braid is close to the outside diameter of the elongate tube. This diameter is in the range of 10 to 500 mils, and usually 25 to 250 mils (i.e. thousandth of an inch). After insertion, moving the mandril proximally with respect to the tube expands the tubular braid.
The tubular braid is preferably formed as a mesh of individual non-elastic filaments (called “yarns” in the braiding industry). However, it can have some elastic filaments interwoven to create certain characteristics. The non-elastic yarns can be materials such as polyester, PET, polypropylene, polyamide fiber (Kevlar, DuPont), composite filament wound polymer, extruded polymer tubing (such as Nylon II or Ultem, commercially available from General Electric), stainless steel, Nickel Titanium (Nitinol), or the like so that axial shortening causes radial expansion of the braid. These materials have sufficient strength so that the expanding element will retain its expanded condition in the lumen of the body while removing the matter therefrom. Further, all expandable mechanisms described heretofore, can be manufactured using shape memory materials so that they are self expanding or even expandable when certain temperatures or thermal energies are delivered to the mechanisms. Such material characteristics can be accomplished with different programming methods such as, but not limited to Two Way Shape Memory (TWSM) alloys.
The braid may be of conventional construction, comprising round filaments, flat or ribbon filaments, square filaments, or the like. Non-round filaments may be advantageous to decrease the axial force required for expansion to create a preferred surface area configuration or to decrease the wall thickness of the tubular braid. The filament width or diameter will typically be from about 0.5 to 50 mils, usually being from about 5 to 20 mils. Suitable braids are commercially available from a variety of commercial suppliers.
The tubular braids are typically formed by a “Maypole” dance of yarn carriers. The braid consists of two systems of yarns alternately passing over and under each other causing a zigzag pattern on the surface. One system of yarns moves helically clockwise with respect to the fabric axis while the other moves helically counter-clockwise. The resulting fabric is a tubular braid. Common applications of tubular braids are lacings, electrical cable covers (i.e. insulation and shielding), “Chinese hand-cuffs” and reinforcements for composites. To form a balanced, torque-free fabric (tubular braid), the structure must contain the same number of yarns in each helical direction. The tubular braid may also be pressed flat to form a double thickness fabric strip. The braid weave used in the tubular braid of the present invention will preferably be of the construction known as “two dimensional, tubular, diamond braid” that has a 1/1 intersection pattern of the yarns which is referred to as the “intersection repeat”. Alternatively, a Regular braid with a 2/2 intersection repeat and a Hercules braid with an intersection repeat of 3/3 may be used. In all instances, the helix angle (that being the angle between the axis of the tubular braid and the yarn) will increase as the braid is expanded. Even further, Longitudinal Lay-Ins can be added within the braid yarns and parallel to the axis to aid with stability, improve tensile and compressive properties and modulus of the fabric. When these longitudinal “Lay-In” yarns are elastic in nature, the tubular braid is known as an elastic braid. When the longitudinal yarns are stiff, the fabric is called a rigid braid. Biaxially braided fabrics such as those of the present invention are not dimensionally stable. This is why the braid can be placed into an expanded state from a relaxed state (in the case of putting it into the compressive mode). Alternatively this could be a decreased/reduced (braid diameter decreases) state when put into tension from the relaxed state. When put into tension (or compression for that matter) the braid eventually reaches a state wherein the diameter will decrease no more. This is called the “Jammed State”. On a stress strain curve, this corresponds to increase modulus. Much of the engineering analyses concerning braids are calculated using the “Jammed State” of the structure/braid. These calculations help one skilled in the art to design a braid with particular desired characteristics. Further, material characteristics are tensile strength, stiffness and Young's modulus. In most instances, varying the material characteristics will vary the force with which the expanded condition of the tubular can exert radially. Even further, the friction between the individual yarns has an effect on the force required to compress and un-compress the tubular braid. For the present invention, friction should be relatively low for a chosen yarn so that the user will have little trouble deploying the engaging element. This is particularly important when the engaging element is located a significant distance from the user. Such is the case when the percutaneous entry is the groin (Femoral Artery for vascular interventions) and the point of engaging the engaging element is some distance away (i.e. the Carotid Artery in the neck). Similarly, this is true for long distances that are not vascular or percutaneous applications.
An exemplary device has the following characteristics:
a. Working Length:
i. 30-500 cm
b. Working Diameter:
i. The guide wire, catheter, endoscope or other device of the present idea has an outer diameter that ranges from 0.006″ to 0.315″, but can extend to smaller and larger sizes as technology and procedures require.
c. Physical Configuration:
i. The device of the present idea will have a predetermined shaped (probably circular in diameter of 6-10″) coiled in the package, “as supplied”. Alternatively the product/device may be supplied straight but may have a shape at the distal end. The distal end may be tapered to a smaller distal diameter. This tapering may occur in the distal 6-12″ of the device, but could occur over a greater length and there may be more than one taper along its length. Optionally, the device may have a shaped tip or a tip that may be malleable so that the user prior to introduction may shape it.
The device of the instant invention may have conventional lubricious coatings to enhance introduction into the target body lumen, e.g. hyaluronic or other equivalent coatings. Further, the user, prior to insertion may apply a lubricious coating. This may be extremely useful in the case of a reusable device (like an endoscope). As an advantage of the present idea, the device will be less difficult to feed it to the desired location in the body. Further difficulty will be greatly decreased for placement of other devices over or with the inner device. Even further, the instant invention will be less difficult to remain in the target location. This decreased difficulty will decrease cost due to time in the Operating Room (Operating Rooms costs are estimated in excess of $90 dollars per minute in the U.S.) or other environment. Additionally, the decrease in difficulty will aid in patient care and the potential in deleterious effects due to the inability to place the device in the appropriate position in the patient and keep it there or to place other devices with the present idea.
An exemplary device having an expanding ‘umbrella’ mechanism located on its distal tip is illustrated in the figures. This mechanism may be at the tip or somewhere else in the distal portion of the device. Additionally, this mechanism may be any of a number of mechanisms that will help aid in moving the device using the physiological environment of the body. Alternatively, this distal mechanism may be used for anchoring, flow direction, tensioning or occluding. In this particular embodiment, a distal portion of the device may not coiled and will thus retain the malleable or resilient characteristics typical of conventional devices.
Although the foregoing idea has been described in some detail by way of illustration and example, for purposes of clarity of understanding, it will be obvious that certain changes and modifications may be practiced within the scope of the appended claims.
The disclosures of any and all patents, patent applications and printed publications referred to above are hereby incorporated by reference.
The following sets of descriptions describe various inventive aspects discussed above and shown in the attached drawings. Although these descriptions are similar to claims, they are not claims. The claims are found in the section of the application entitled CLAIMS.
A. First Set
1. A medical device for the use in diagnosis and/or treatment of cardiovascular disease in the human body comprising:
a catheter having a proximal catheter end and a distal catheter end and defining a lumen extending from the distal catheter end towards the proximal catheter end, the catheter adapted for use in diagnosis and/or treatment of cardiovascular disease in the human body;
a first expandable and contractible, vessel-occluding element positioned distal of the distal catheter end;
a second expandable and contractible, annular-space-blocking element positioned between the first expandable and contractible element and the proximal catheter end; and
at least one of the first and second expandable and contractible elements comprising spaced apart structural members and a membrane associated therewith.
2. The medical device according to claim 1 wherein the second expandable and contractible element is positioned at and extends from the catheter distal end.
3. The medical device according to claim 1 wherein the second expandable and contractible element comprises a multiple wing, malecot type of expandable and contractible element.
4. The medical device according to claim 1 wherein the second expandable and contractible element comprises a membrane.
5. The medical device according to claim 1 wherein the second expandable and contractible element comprises a multiple wing, malecot type of expandable and contractible element and a membrane associated therewith.
6. The medical device according to claim 5 wherein the membrane covers the multiple wing, malecot type of expandable and contractible element.
7. The medical device according to claim 1 wherein the first expandable and contractible element comprises a braided element.
8. The medical device according to claim 1 wherein the first expandable and contractible element comprises spaced apart structural members.
9. The medical device according to claim 1 wherein the first expandable and contractible element comprises spaced apart structural members and a membrane associated therewith.
10. The medical device according to claim 1 wherein the second expandable and contractible element comprises spaced apart structural members.
11. The medical device according to claim 1 wherein the second expandable and contractible element comprises spaced apart structural members and a membrane associated therewith.
12. The medical device according to claim 1 wherein the first and second expandable and contractible elements comprises spaced apart structural members.
13. The medical device according to claim 1 wherein at least one of the first and second expandable and contractible elements comprises spaced apart structural members and a membrane associated therewith.
14. The medical device according to claim 1 wherein the first and second expandable and contractible elements comprises spaced apart structural members and a membrane associated therewith.
15. The medical device according to claim 1 wherein the first expandable and contractible element comprises a braided element covered with a membrane.
16. The medical device according to claim 1 wherein the first expandable and contractible element comprises a native vessel sealing element.
17. The medical device according to claim 1 wherein a chosen one of the first and second expandable and contractible elements is funnel-shaped when in an expanded state.
18. The medical device according to claim 1 wherein a chosen one of the first and second expandable and contractible elements has a longitudinally-extending opening to permit material to pass therethrough.
19. The medical device according to claim 1 wherein the first expandable and contractible element is movable relative to the second expandable and contractible element.
20. The medical device according to claim 1 wherein the membrane is impermeable.
21. The medical device according to claim 1 wherein the membrane is elastomeric.
22. A medical device for the use in diagnosis and/or treatment of cardiovascular disease in the human body comprising:
a catheter having a proximal catheter end and a distal catheter end and defining a lumen extending from the distal catheter end towards the proximal catheter end, the catheter adapted for use in diagnosis and/or treatment of cardiovascular disease in the human body;
a first expandable and contractible, vessel-occluding element positioned distal of the distal catheter end;
a second expandable and contractible, annular-space-blocking element positioned between the first expandable and contractible element and the proximal catheter end; and
a chosen one of the first and second expandable and contractible elements being having a funnel-shaped surface, when in an expanded state, and having a longitudinally-extending opening to permit material to pass therethrough for receipt of material.
23. The medical device according to claim 22 wherein the second expandable and contractible element is positioned at and extends from the catheter distal end.
24. The medical device according to claim 22 wherein the second expandable and contractible element comprises a multiple wing, malecot type of expandable and contractible element.
25. The medical device according to claim 22 wherein the second expandable and contractible element comprises a membrane.
26. The medical device according to claim 22 wherein the second expandable and contractible element comprises a multiple wing, malecot type of expandable and contractible element and a membrane associated therewith.
27. The medical device according to claim 26 wherein the membrane covers the multiple wing, malecot type of expandable and contractible element.
28. The medical device according to claim 22 wherein the first expandable and contractible element comprises a braided element.
29. The medical device according to claim 22 wherein the first expandable and contractible element comprises spaced apart structural members.
30. The medical device according to claim 22 wherein the first expandable and contractible element comprises spaced apart structural members and a membrane associated therewith.
31. The medical device according to claim 22 wherein the second expandable and contractible element comprises spaced apart structural members.
32. The medical device according to claim 22 wherein the second expandable and contractible element comprises spaced apart structural members and a membrane associated therewith.
33. The medical device according to claim 22 wherein at least one of the first and second expandable and contractible elements comprises spaced apart structural members.
34. The medical device according to claim 22 wherein the first and second expandable and contractible elements comprises spaced apart structural members.
35. The medical device according to claim 22 wherein at least one of the first and second expandable and contractible elements comprises spaced apart structural members and a membrane associated therewith.
36. The medical device according to claim 22 wherein the first and second expandable and contractible elements comprises spaced apart structural members and a membrane associated therewith.
37. The medical device according to claim 22 wherein the first expandable and contractible element comprises a braided element covered with a membrane.
38. The medical device according to claim 22 wherein the first expandable and contractible element comprises a native vessel sealing element.
39. The medical device according to claim 22 wherein the first expandable and contractible element is movable relative to the second expandable and contractible element.
40. The medical device according to claim 22 wherein at least one of the first and second expandable and contractible elements comprises a balloon.
41. A medical device for the use in diagnosis and/or treatment of cardiovascular disease in the human body comprising:
a catheter having a proximal catheter end and a distal catheter end and defining a lumen extending from the distal catheter end towards the proximal catheter end, the catheter adapted for use in diagnosis and/or treatment of cardiovascular disease in the human body;
a support element extending distally of the distal catheter end;
a first expandable and contractible, vessel-occluding element mounted to the support element and positioned distal of the distal catheter end;
a second expandable and contractible, annular-space-blocking element mounted to the catheter and positioned between the first expandable and contractible element and the proximal catheter end; a chosen one of the first and second expandable and contractible elements being having a funnel-shaped surface, when in an expanded state, and having a longitudinally-extending opening to permit material to pass therethrough for receipt of material; and
at least one of the first and second expandable and contractible elements comprising spaced apart structural members and a membrane associated therewith.
42. The medical device according to claim 41 wherein a portion of the support element is housed within the catheter.
43. The medical device according to claim 41 wherein a portion of the support element is slidably housed within the catheter.
44. The medical device according to claim 41 wherein the first expandable and contractible element comprises a braided element.
45. The medical device according to claim 41 wherein the first expandable and contractible element comprises a braided element covered with a membrane.
46. The medical device according to claim 41 wherein the first expandable and contractible element comprises a native vessel sealing element.
47. A medical device for the use in diagnosis and/or treatment of cardiovascular disease in the human body comprising:
a catheter having a proximal catheter end and a distal catheter end and defining a lumen extending from the distal catheter end towards the proximal catheter end, the catheter adapted for use in diagnosis and/or treatment of cardiovascular disease in the human body;
a first expandable and contractible, vessel-occluding element positioned distal of the distal catheter end; and
a second expandable and contractible, annular-space-blocking device-occluding element positioned between the first expandable and contractible element and the proximal catheter end.
48. The medical device according to claim 47 wherein the second expandable and contractible element is positioned at and extends from the catheter distal end.
49. The medical device according to claim 47 wherein the second expandable and contractible element comprises a multiple wing, malecot type of expandable and contractible element.
50. The medical device according to claim 47 wherein the second expandable and contractible element comprises a membrane.
51. The medical device according to claim 47 wherein the second expandable and contractible element comprises a multiple wing, malecot type of expandable and contractible element and a membrane associated therewith.
52. The medical device according to claim 51 wherein the membrane covers the multiple wing, malecot type of expandable and contractible element.
53. The medical device according to claim 47 wherein the first expandable and contractible element comprises a braided element.
54. The medical device according to claim 47 wherein the first expandable and contractible element comprises spaced apart structural members.
55. The medical device according to claim 47 wherein the first expandable and contractible element comprises spaced apart structural members and a membrane associated therewith.
56. The medical device according to claim 47 wherein the second expandable and contractible element comprises spaced apart structural members.
57. The medical device according to claim 47 wherein the second expandable and contractible element comprises spaced apart structural members and a membrane associated therewith.
58. The medical device according to claim 47 wherein at least one of the first and second expandable and contractible elements comprises spaced apart structural members.
59. The medical device according to claim 47 wherein the first and second expandable and contractible elements comprises spaced apart structural members.
60. The medical device according to claim 47 wherein at least one of the first and second expandable and contractible elements comprises spaced apart structural members and a membrane associated therewith.
61. The medical device according to claim 47 wherein the first and second expandable and contractible elements comprises spaced apart structural members and a membrane associated therewith.
62. The medical device according to claim 47 wherein the first expandable and contractible element comprises a braided element covered with a membrane.
63. The medical device according to claim 47 wherein the first expandable and contractible element comprises a native vessel sealing element.
64. The medical device according to claim 47 wherein a chosen one of the first and second expandable and contractible elements is funnel-shaped when in an expanded state.
65. The medical device according to claim 47 wherein a chosen one of the first and second expandable and contractible elements has a longitudinally-extending opening to permit material to pass therethrough.
66. The medical device according to claim 47 wherein the first expandable and contractible element is movable relative to the second expandable and contractible element.
67. The medical device according to claim 47 wherein the second expandable and contractible, device-occluding element comprises an artificial vessel-occluding element.
68. The medical device according to claim 47 wherein at least one of the first and second expandable and contractible elements comprises a balloon.
69. A medical device for the use in diagnosis and/or treatment of cardiovascular disease in the human body comprising:
a catheter having a proximal catheter end and a distal catheter end and defining a lumen extending from the distal catheter end towards the proximal catheter end, the catheter adapted for use in diagnosis and/or treatment of cardiovascular disease in the human body;
an expandable and contractible, annular-space-blocking element carried by the catheter at or near the distal catheter end;
the expandable and contractible element having a funnel-shaped surface, when in an expanded state, for receipt of material; and
the expandable and contractible element comprising spaced apart structural members and a membrane associated therewith.
70. The medical device according to claim 69 wherein the membrane is an impermeable membrane.
71. The medical device according to claim 69 wherein the membrane is elastomeric.
72. The medical device according to claim 69 wherein the expandable and contractible element comprises a braided element.
73. The medical device according to claim 69 wherein the expandable and contractible element comprises a braided element covered with the membrane.
74. The medical device according to claim 69 wherein the expandable and contractible element comprises a native vessel sealing element.
Second Set
1. An occluder for use in a body passageway comprising:
a catheter having a distal end,
a multi-wing blood flow blocking element positioned near the distal end of the catheter,
said multi-wing blood flow blocking element having a radially compressed insertion state and a radially expanded blocking state,
an actuator associated with said catheter to move said blood flow blocking element from said compressed state to said expanded state, and
said blood flow blocking element in said radially expanded blocking state having a generally funnel surface extending out from said distal end of said catheter.
2. The occluder of claim 1 further comprising an annular membrane around said wings of said blood flow blocking element.
3. The occluder of claim 1 wherein said multiwing blood flow blocking element is a malecot style device.
4. The occluder of claim 2 wherein said membrane is an elastomeric, impermeable membrane.
5. The occluder of claim 1 wherein said actuator extends, through said lumen, distal of said blood flow blocking element and when moved in a proximal direction, engages said blood flow blocking element to switch said blood flow blocking element from said retracted insertion state into said radially expanded blocking state.
6. The method of deploying an occluder in a body passageway comprising:
inserting a catheter into a body passageway, said catheter having a multi-wing blood flow blocking element,
providing said blood flow blocking element in a radially compressed state during said step of inserting,
radially expanding said blood flow blocking element into a radially expanded state extending to or near to the wall of the body passageway after said step of inserting,
said step of radially expanding including providing said expanded state with a generally funnel surface extending out from said distal end of said catheter, and
using said expanded state of said blood flow blocking element for blocking passage of material around the outside of said catheter.
7. The method according to claim 6 wherein said blood flow blocking element is a malecot-style blood flow blocking device covered with an annular elastomeric, impermeable membrane.
8. A method of capturing tissue in a body comprising:
inserting an elongate tubular member, having a lumen, a proximal end and a distal end, into a body,
providing a malecot-style tissue capture element in a radially compressed state during the step of inserting,
radially expanding the tissue capture element into a radially expanded state after the step of inserting, and
providing a proximal surface on said the capture element, the proximal surface extending out from the distal end of the elongate tubular member wherein the tissue is captured along the proximal surface.
9. The method according to claim 8 wherein the tissue capture element is generally funnel shaped when in the radially expanded state.
10. An occluder for use in a body passageway comprising:
a catheter having a distal end,
a blood flow blocking element comprising structural members which define openings therebetween, the blood flow blocking element positioned near the distal end of the catheter,
said blood flow blocking element having a radially compressed insertion state and a radially expanded blocking state,
an actuator associated with said catheter to move said blood flow blocking element from said compressed state to said expanded state, and
said blood flow blocking element in said radially expanded blocking state having a generally funnel surface extending out from said distal end of said catheter.
11. The occluder of claim 10 further comprising an annular membrane around said structural members of said blood flow blocking element.
12. The occluder of claim 11 wherein said blood flow blocking element is a malecot style device.
13. The occluder of claim 11 wherein said membrane is an elastomeric, impermeable membrane.
14. The occluder of claim 10 wherein said actuator extends, through said lumen, distal of said blood flow blocking element and when moved in a proximal direction, engages said blood flow blocking element to switch said blood flow blocking element from said retracted insertion state into said radially expanded blocking state.
15. A method of deploying an occluder in a body passageway comprising:
inserting a catheter into a body passageway, said catheter having a blood flow blocking element comprising structural members which define openings therebetween and an axially movable actuator operably coupleable to the blood flow blocking element,
providing said blood flow blocking element in a radially compressed state during said step of inserting,
moving the actuator thereby radially expanding said blood flow blocking element into a radially expanded state extending to or near to the wall of the body passageway after said step of inserting,
said step of radially expanding including providing said expanded state with a generally funnel surface extending out from said distal end of said catheter, and
using said expanded state of said blood flow blocking element for blocking passage of material around the outside of said catheter.
16. The method according to claim 15 wherein said blood flow blocking element is a malecot-style blood flow blocking device covered with an annular elastomeric, impermeable membrane.
17. A method of capturing tissue in a body comprising:
inserting an elongate tubular member, having a lumen, an actuator passing through the lumen, a proximal end and a distal end, into a body,
providing a tissue capture element in a radially compressed state during the step of inserting, the tissue capture element comprising structural members which define openings therebetween, the actuator operably coupleable to the tissue capture element,
moving the actuator thereby radially expanding the tissue capture element into a radially expanded state after the step of inserting, and
providing a proximal surface on said the capture element, the proximal surface extending out from the distal end of the elongate tubular member wherein the tissue is captured along the proximal surface.
18. The method according to claim 17 wherein the tissue capture element is generally funnel shaped when in the radially expanded state.
19. A medical instrument for use in a body comprising:
an elongate tubular member having a lumen and a distal end,
a blood flow blocking element comprising structural members which define openings therebetween, the blood flow blocking element positioned near said distal end of said elongate member,
an annular membrane around said structural members of said blood flow blocking element,
said blood flow blocking element having a radially compressed state and a radially expanded blocking state,
an actuator associated with said elongate member to move said blood flow blocking element from said compressed state and to said blocking state,
said blood flow blocking element in said radially expanded blocking state having a generally funnel shape surface extending from said distal end of said elongate tubular member.
20. The medical instrument of claim 19 wherein said membrane is an elastomeric, impermeable membrane.
21. The medical instrument of claim 19 wherein said actuator extends, through said lumen, distal of said blood flow blocking element and when moved in a proximal direction, engages said blood flow blocking element to switch said blood flow blocking element from said retracted compressed state into said radially expanded state.
22. An occluder for use in a body passageway comprising:
a catheter having a distal end,
a blood flow blocking element comprising structural members which define openings therebetween, the blood flow blocking element positioned near the distal end of the catheter, and
an annular membrane around said structural members of said blood flow blocking element,
said blood flow blocking element having a radially compressed insertion state and a radially expanded blocking state,
an actuator associated with said catheter to move said blood flow blocking element from said compressed state to said expanded state.
23. The occluder of claim 22 wherein said membrane is an elastomeric, impermeable membrane.
24. The occluder of claim 22 wherein said actuator extends, through said lumen, distal of said blood flow blocking element and when moved in a proximal direction, engages said blood flow blocking element to switch said blood flow blocking element from said retracted insertion state into said radially expanded blocking state.
25. The method of deploying an occluder in a body passageway comprising the steps of:
inserting a catheter into a body passageway, said catheter having a blood flow blocking element comprising structural members which define openings therebetween, the blood flow blocking element covered with an annular elastomeric, impermeable membrane, and an axially movable actuator operably coupleable to a distal portion of the blood flow blocking element,
providing said blood flow blocking element in a radially compressed state during said step of inserting, and
moving the actuator thereby radially expanding said blood flow blocking element into a radially expanded state extending to or near to the wall of the body passageway after said step of inserting, and
using said expanded state of said blood flow blocking element for blocking passage of material around the outside of said catheter.
26. The method of claim 25 wherein said step of radially expanding includes providing said expanded state with a generally funnel surface extending out from said distal end of said catheter.
27. The method of claim 25 wherein the actuator moving step comprises proximally pulling the actuator.
Third Set
1. A catheter/dilator assembly comprising:
a catheter assembly comprising:
a dilator comprising a hollow shaft within the lumen of the catheter, the hollow shaft having an outer shaft surface, a proximal shaft end, a distal shaft end and a recessed region in the outer shaft surface at the distal shaft end;
the recessed region and the material-directing element being generally aligned with one another; a compression element covering the material-directing element to temporarily retain the material-directing element in a radially collapsed state; and
the recessed region sized for receipt of at least substantially the entire axial length of the material-directing element so to reduce the radial cross-sectional dimension of the assembly at the material-directing element.
2. The assembly according to claim 1 wherein the compression element comprises a sleeve slidable between a position covering the material-directing element and a position along the catheter between the proximal and distal catheter ends.
3. The assembly according to claim 1 wherein the material-directing element comprises a funnel element.
4. The assembly according to claim 3 wherein the funnel element comprises a braided funnel element.
5. The assembly according to claim 3 wherein the funnel element comprises an inflatable funnel element.
6. The assembly according to claim 3 wherein the funnel element comprises a malecot funnel element.
7. The assembly according to claim 1 wherein the compression element comprises a sleeve, the sleeve comprising distal and proximal portions, the distal portion covering the material-directing element and the proximal portion covering the distal catheter end.
8. The assembly according to claim 7 wherein at least a part of the distal portion of the sleeve is sufficiently weak so that when the sleeve is pulled in a proximal direction to uncover the material-directing element, at least the part of the distal portion of the sleeve substantially expands as it passes over the distal catheter end.
9. The assembly according to claim 7 wherein the distal portion has an outside diameter and the proximal portion has an inside diameter.
10. The assembly according to claim 9 wherein the outside and inside diameters are about equal to one another.
11. The assembly according to claim 9 wherein the catheter has an outside catheter diameter substantially equal to the outside diameter of the distal portion of the sleeve.
12. The assembly according to claim 9 wherein the outside diameter of the distal portion is within 25% of the outside diameter of the catheter.
13. The assembly according to claim 9 wherein the outside diameter of the distal portion is within 15% of the outside diameter of the catheter.
14. The assembly according to claim 9 wherein the outside diameter of the distal portion is within 10% of the outside diameter of the catheter.
15. The assembly according to claim 9 wherein:
the outside and inside diameters are about equal to one another;
the catheter has an outside catheter diameter substantially equal to the outside diameter of the distal portion of the sleeve and the inside diameter of the proximal portion of the sleeve; and
at least a part of the distal portion of the sleeve is sufficiently weak so that when the sleeve is pulled in a proximal direction to uncover the material-directing element, at least the part of the distal portion of the sleeve substantially expands as it passes over the distal catheter end.
16. The assembly according to claim 15 wherein said part of the distal portion comprises a weakened region.
17. The assembly according to claim 16 wherein the weakened region comprises a material separation region within the distal portion of the sleeve.
18. The assembly according to claim 16 wherein the weakened region comprises a reduced thickness region in the distal portion of the sleeve.
19. The assembly according to claim 8 further comprising a spacer sleeve slidably mounted on the outer catheter surface between the sleeve and the proximal catheter end, the spacer sleeve sized to help properly locate the distal portion of the sleeve over the material-directing element and the proximal portion of the sleeve over the distal catheter end.
20. The assembly according to claim 19 wherein the spacer sleeve is configured to permit the sleeve to be pulled proximally to a material-directing element deployed position so that the sleeve no longer covers the material-directing element.
21. The assembly according to claim 19 wherein the spacer sleeve comprises a yieldable sleeve portion that yields when the sleeve is pulled proximally to the material-directing element deployed position.
22. The assembly according to claim 7 wherein the material-directing element comprises a funnel element.
23. A method for assembling a catheter/dilator assembly comprising:
selecting a catheter assembly comprising:
inserting a hollow shaft of a dilator through the proximal catheter end and into the lumen of the catheter;
positioning a recess formed in the distal shaft end of the hollow shaft to underlie the material-directing element;
placing the material-directing element in the radially collapsed state; and
sliding a first sleeve in a proximal direction to a first position covering the distal shaft end of the dilator and over the material-directing element to maintain the material-directing element in the radially collapsed state.
24. The method according to claim 23 wherein the sliding step is carried out so that when the first sleeve is in the first position, a distal portion of the sleeve covers the funnel element and a proximal portion of the sleeve covers the distal catheter end.
25. The method according to claim 23 wherein the placing step comprises moving a second sleeve, slidably mounted on the outer catheter surface, in a distal direction to cover the funnel element.
26. The method according to claim 25 wherein the sliding step causes the second sleeve to move in a proximal direction to a third position on the outer catheter surface.
27. A method for removing material from a tubular structure within a body comprising:
selecting a catheter/dilator assembly comprising:
a sleeve comprising distal and proximal portions, the distal portion covering the material-directing element to temporarily retain the material-directing element in a radially collapsed state, the proximal portion covering the distal catheter end; and
the recessed region sized for receipt of at least substantially the entire axial length of the material-directing element so to reduce the radial cross-sectional dimension of the assembly at the material-directing element;
locating the material-directing element at a first target location within a lumen of a tubular structure;
uncovering the material-directing element to place the material-directing element in a radially expanded state with the material-directing element contacting an inner surface of the tubular structure;
causing material within the lumen to move into the catheter/dilator assembly; and
removing the catheter/dilator assembly from the body.
28. The method according to claim 27 wherein the locating step comprises:
positioning a tip of a guide wire at a second target location within the lumen of the tubular structure, the guide wire having a proximal end; and
passing the proximal end of the guide wire into the distal shaft end of the dilator and at least partially through the dilator; and further comprising
removing the guide wire from the body.
29. The method according to claim 28 wherein the guide wire positioning step comprises:
puncturing the tubular structure to access the lumen with a hollow needle;
passing the guide wire through the hollow needle until the tip of the guide wire is at the second target location; and
removing the needle leaving the guide wire in place.
30. The method according to claim 28 further comprising:
selecting a guide wire having a radially expandable and contractible element at the tip of the guide wire; and
placing the radially expandable and contractible element in a radially expanded state when the tip of the guide wire is at the second target location.
31. The method according to claim 30 wherein the causing element comprises:
creating a suction force between the catheter and the hollow shaft of the dilator; and
moving the material-directing element and the radially expandable and contractible element toward one another.
32. The method according to claim 31 further comprising:
sliding the sleeve distally to cover the material-directing element to place the material-directing element in a radially collapsed state prior to the catheter/dilator assembly removing step; and
placing the radially expandable and contractible element in a radially contracted state prior to the guide wire removing step.
33. The method according to claim 27 wherein the causing element comprises creating a suction force between the catheter and the hollow shaft of the dilator.
34. The method according to claim 27 further comprising sliding the sleeve distally to cover the material-directing element to place the material-directing element in a radially collapsed state prior to the catheter/dilator assembly removing step.
35. The method according to claim 27 wherein the locating step is carried out with the tubular structure comprising a blood vessel.
36. The method according to claim 27 wherein the locating step is carried out with the tubular structure comprising a graft.
37. A method for removing material from a tubular structure within a body comprising:
selecting a catheter/dilator assembly assembled according to claim 23 ;
locating the material-directing element at a first target location within a lumen of a tubular structure;
uncovering the material-directing element to place the material-directing element in a radially expanded state with the material-directing element contacting an inner surface of the tubular structure;
causing material within the lumen to move into the catheter/dilator assembly; and
removing the catheter/dilator assembly from the body.
38. A dilator assembly comprising:
an elongate dilator comprising proximal and distal portions, a dilator tip at the distal portion, and a dilator lumen extending from the dilator tip to at least a first position along the dilator;
the dilator comprising a guide wire pathway extending from a second position at the proximal portion of the dilator to the first position;
an opening in the dilator at the first position connecting the guide wire pathway and the dilator lumen; and
a flexible guide wire extending along the guide wire pathway, through the opening, through the dilator lumen and out of the dilator tip.
39. The assembly according to claim 38 wherein the guide wire pathway comprises a groove formed in the dilator.
40. A rapid exchange dilator assembly comprising:
a catheter comprising a catheter lumen extending between a distal catheter end and a proximal catheter end;
an elongate dilator, removably housed within the catheter lumen, comprising a proximal portion extending to a proximal dilator end, a distal portion extending to a dilator tip, and a dilator lumen extending from the dilator tip to at least a first position along the dilator;
the dilator comprising a guide wire pathway extending from the proximal portion of the dilator to the first position;
an opening in the dilator at the first position connecting the guide wire pathway and the dilator lumen;
a flexible guide wire, comprising a guide wire proximal end and a guide wire distal end, extending along the guide wire pathway, through the opening, through the dilator lumen and out of the dilator tip; and
the guide wire proximal end and the proximal dilator end are positioned proximally of the proximal catheter end, the guide wire distal end and the distal dilator end is positioned distally of the distal catheter end;
whereby when the assembly is at a desired position within a body, the dilator can be removed leaving the catheter and guide wire in position.
41. The assembly according to claim 40 wherein the catheter comprises:
a material-directing element, movable between radially expanded and radially collapsed states, secured to the distal catheter end.
42. The assembly according to claim 41 wherein the material-directing element comprises an expandable braid element.
43. The assembly according to claim 41 wherein the material-directing element comprises an expandable braid funnel element.
44. The assembly according to claim 41 wherein the material-directing element comprises an inflatable element.
45. The assembly according to claim 41 wherein the material-directing element comprises an inflatable funnel element.
46. The assembly according to claim 41 wherein the material-directing element comprises an expandable malecot element.
47. The assembly according to claim 41 wherein the material-directing element comprises an expandable malecot funnel element.
48. The assembly according to claim 40 wherein the catheter comprises:
outer and inner catheters, the inner catheter slidably mounted within the outer catheter, the outer and inner catheters comprising distal outer and inner catheter ends; and
a material-directing element, movable between radially expanded and radially collapsed states, secured to the distal outer and inner catheter ends.
49. The assembly according to claim 48 wherein the material-directing element comprises an expandable braid funnel element.
50. A method for providing access to a target site within a tubular structure of a patient, comprising:
positioning a distal catheter end of a first, guide catheter at a first position within a tubular structure of a patient;
passing a rapid exchange dilator assembly into the first catheter, the rapid exchange dilator assembly comprising a second catheter, the second catheter comprising a removable dilator, a guide wire and a second catheter lumen, the second catheter lumen housing the dilator and the guide wire;
removing the dilator from the patient leaving the second catheter and the guide wire within the patient; and
passing an operational device through the second catheter for performing a procedure at the target site.
51. The method according to claim 50 wherein the positioning step is carried out by:
placing a distal end of a second guide wire at a second position within the tubular structure;
passing the first catheter over the second guide wire; and
removing the second guide wire from the patient while leaving the first catheter within the patient.
52. The method according to claim 50 further comprising radially expanding a material-directing element, mounted to the second catheter, to a radially expanded state.
53. The method according to claim 50 further comprising radially expanding a material-directing funnel element, mounted to an extending from the second catheter, to a radially expanded state with the funnel element contacting an inner wall of the tubular structure.
54. The method according to claim 50 wherein the operational device passing step comprises passing a stent through the second catheter, and further comprising placing the stent at the target site.
55. The method according to claim 50 wherein the operational device passing step comprises passing a balloon catheter, comprising a balloon, through the second catheter, and further comprising expanding the balloon at the target site.
56. A method for providing access to a target site within a tubular structure of a patient, comprising:
selecting a rapid exchange dilator assembly comprising:
a catheter comprising a catheter lumen, extending between a distal catheter end and a proximal catheter end, and a material-directing element, movable between radially expanded and radially collapsed states, secured to the distal catheter end;
an elongate dilator, removably housed within the catheter lumen, comprising a proximal portion extending to a proximal dilator end, a distal portion extending to a dilator tip, and a dilator lumen extending from the dilator tip to at least a first position along the dilator;
the dilator comprising a guide wire pathway extending from the proximal portion of the dilator to the first position;
an opening in the dilator at the first position connecting the guide wire pathway and the dilator lumen;
a flexible guide wire, comprising a guide wire proximal end and a guide wire distal end, extending along the guide wire pathway, through the opening, through the dilator lumen and out of the dilator tip; and
the guide wire proximal end and the proximal dilator end position proximally of the proximal catheter end, the guide wire distal end and the distal dilator end position the distally of the distal catheter end;
positioning a distal catheter end of a guide catheter at a second position within a tubular structure of a patient;
passing the rapid exchange dilator assembly into the guide catheter;
removing the dilator from the patient leaving the catheter and the guide wire of the rapid exchange dilator assembly within the patient; and
passing an operational device through the catheter of the rapid exchange dilator assembly for performing a procedure at the target site.
57. The method according to claim 56 wherein the positioning step is carried out by:
placing a distal end of a second guide wire at a second position within the tubular structure;
passing the guide catheter over the second guide wire; and
removing the second guide wire from the patient while leaving the guide catheter within the patient.
58. A funnel catheter having a distal funnel catheter end, the funnel catheter comprising:
an outer tube;
an inner tube slidably located within the outer tube;
a tubular sleeve having first and second ends and movable between a radially expanded, use state and a radially contracted, deployment state;
the first end of the sleeve being secured to a distal end of the outer tube;
the second end of the sleeve being secured to a distal end of the inner tube; and
the sleeve having a movable, generally U-shaped direction-reversing region so that when the first and second ends move relative to one another the position of the direction-reversing region moves relative to the distal ends of the inner and outer tubes, the direction-reversing region constituting the distal funnel catheter end.
59. The funnel catheter according to claim 58 wherein the tubular sleeve comprises a braided material.
60. The funnel catheter according to claim 59 wherein the tubular sleeve comprises a fluid passage-inhibiting film in contact with the braided material.
61. The funnel catheter according to claim 60 wherein the film impregnates the braided material.
62. The funnel catheter according to claim 60 wherein the film covers the braided material.
63. The funnel catheter according to claim 60 wherein the film is an elastic material.
64. The funnel catheter according to claim 58 wherein the sleeve defines a distally opening funnel when the first and second distal ends are generally aligned.
65. The funnel catheter according to claim 64 wherein the funnel has a generally cylindrical distal portion and a generally conical proximal portion.
66. The funnel catheter according to claim 58 wherein the tubular sleeve is a resilient tubular sleeve and the radially expanded, use state is a relaxed state.
67. A funnel catheter comprising:
an outer tube having a first distal end and an inner surface, the inner surface defining an outer lumen;
an inner tube, slidably located within the outer lumen, having a second distal end and an outer surface positioned opposite the inner surface;
a tubular sleeve having first and second ends and movable between a radially expanded, use state and a radially contracted, deployment state;
the first end of the sleeve being secured to the first distal end;
the second end of the sleeve being secured to the second distal end so to extend from other than the outer surface; and
the sleeve having a movable, generally U-shaped direction-reversing region when the first and second distal ends move relative to one another with the position of the direction-reversing region moving relative to the first and second distal ends.
68. A method for deploying a material-directing element within a tubular structure within a patient comprising:
selecting a funnel catheter having a distal funnel catheter end, the funnel catheter comprising:
an outer tube;
an inner tube slidably located within the outer tube;
a tubular sleeve having first and second ends and movable between a radially expanded, use state and a radially contracted, deployment state;
the first end of the sleeve being secured to a distal end of the outer tube;
the second end of the sleeve being secured to a distal end of the inner tube; and
the sleeve having a movable, generally U-shaped direction-reversing region, the direction-reversing region constituting the distal funnel catheter end;
deploying the funnel catheter with the sleeve in a reduced diameter, deployment state and with the sleeve being generally parallel to the outer and inner tubes;
positioning the direction-reversing region at a chosen position within a tubular structure within a patient; and
moving the distal ends of the inner and outer tubes relative to one another:
causing the position of the direction-reversing region to move relative to the first and second ends;
69. The method according to claim 68 wherein the distal ends moving step causes the sleeve to form a funnel having a generally cylindrical distal portion and a generally conical proximal portion.
70. A method for making a funnel catheter comprising:
winding material onto a mandril to create a tubular braided sleeve having a proximal portion, a distal portion, a proximal end, and a distal end;
removing the tubular braided sleeve from the mandril; and
securing the proximal end to a first position on an outer tube and securing a distal end to a second position on an inner tube to create a funnel catheter.
71. The apparatus according to claim 70 further comprising selecting a mandril comprising a radially expanding proximal taper region connected to a radially contracting distal taper region, the distal taper region having a faster taper than the proximal taper region.
72. The apparatus according to claim 71 wherein the selecting step is carried out to select a mandril have a constant-diameter central region connecting the proximal and distal taper region.
73. The apparatus according to claim 70 wherein the winding step is carried out so that the pic count, that is the material crossing count per unit length, is generally constant along the proximal and distal portions.
74. The apparatus according to claim 70 further comprising aiding the creation of a distally opening funnel when the inner and outer tubes are moved from a first orientation, with the sleeve in a generally tubular state and with the first and second positions separated by a first distance, to a second orientation, with the sleeve in a generally funnel state and with first and second positions separated by a second distance, the second distance being less than the first distance.
75. The apparatus according to claim 74 wherein the aiding step comprises applying a radial expansion restriction material to the proximal portion of the sleeve.
76. The apparatus according to claim 74 wherein the aiding step comprises applying a radial expansion restriction material to the proximal and distal portions of the sleeve, the radial expansion restriction material at the proximal portion being more stretch-resistant than the radial expansion restriction material at the distal portion.
77. The apparatus according to claim 74 wherein the aiding step comprises varying the pic count, that is the material crossing count per unit length, along the sleeve.
78. The apparatus according to claim 77 wherein the pic count varying step comprises creating a lesser pic count at the distal portion of the sleeve than the pic count at the proximal portion of the sleeve.
79. The apparatus according to claim 78 wherein the lesser pic count creating step is carried out by removing selected strands of the winding material at the distal portion of the sleeve.
80. The apparatus according to claim 77 wherein the pic count varying step comprises creating a greater pic count at the distal portion of the sleeve than at the proximal portion of the sleeve.
81. The apparatus according to claim 74 wherein the aiding step comprises the increasing a resistance to radial expansion at the proximal end of the sleeve.
82. The apparatus according to claim 70 wherein the material winding step comprises winding multiple strands of the material onto the mandril.
83. The apparatus according to claim 70 wherein the material winding step comprises winding the material in the form of ribbons of material onto the mandril.
84. A balloon funnel catheter comprising:
a shaft having an end, a main lumen and an inflation lumen;
an annular balloon mounted to the end of the shaft and fluidly coupled to the inflation lumen for movement between a radially contracted, uninflated state and a radially expanded, inflated state;
the balloon defining an open region opening into the main lumen when in the inflated state; and
the balloon extending distally past the end of the shaft when in the inflated state.
85. The catheter according to claim 84 wherein the open region is a funnel shaped open region.
86. The catheter according to claim 84 wherein the main lumen at the end of the shaft has a cross-sectional area and the open region has an average cross-sectional area greater than said cross-sectional area of the main lumen.
87. A method for securing a tubular braid to a tube comprising:
bringing a first end of a tubular braid into engagement with an end portion of a tube, said end portion comprising a temporarily softenable tube material;
softening the temporarily softenable tube material; and
merging the end portion of the tube and the first end of the tubular braid into one another to create a tube material/tubular braid matrix.
88. The method according to claim 87 wherein the bringing step is carried out by inserting a chosen one of the first end and the end portion into the other of the first end and the end portion.
89. The method according to claim 88 wherein the softening step comprises heating the end portion of the tube.
90. The method according to claim 89 wherein the heating step comprises placing the end portion within a tool.
91. The method according to claim 89 wherein the heating step comprises placing the end portion within a heatable tool.
92. The method according to claim 89 wherein the heating step comprises placing the end portion within a tool heatable by RF energy.
93. The method according to claim 89 wherein the heating step comprises placing the end portion within a tool made of a material having a Curie temperature at a desired operational temperature to facilitate maintaining the tool at the desired operational temperature.
94. The method according to claim 90 where the merging step is carried with the end portion and the first end within an open region of the tool.
95. The method according to claim 94 wherein the merging step comprises squeezing the end portion and the first end between the tool and a mandril, the mandril located within the end portion and the first end.
96. A method for controlling the shape of a radially expandable and contractible tubular braid device comprising:
choosing a radially expanded shape for the braid device when the braid device is in a radially expanded state, the radially expanded shape having a length and different cross-sectional dimensions at selected positions along the length;
selectively applying a material to at least some of the selected positions along the braid device; and
adjusting the stretch resistance of the material according to the selected positions;
whereby the different stretch resistances at the selected positions cause the braid device to assume the chosen radially expanded shape when the braid device is in the radially expanded state.
97. The method according to claim 96 wherein the selectively applying step is carried out using a generally elastic material.
98. The method according to claim 96 wherein the selectively applying step is carried out using a generally inelastic material.
99. The method according to claim 96 wherein the selectively applying step is carried out by selectively impregnating the braid device.
100. The method according to claim 96 wherein the choosing step comprises choosing a funnel shape as the radially expanded shape.
101. The method according to claim 100 wherein the adjusting step comprises decreasing the stretch resistance of the material from a first end towards a second end of the braid device.
102. The method according to claim 96 wherein the selectively applying step applies the material to the braid device along a portion of the length of the braid device.
103. The method according to claim 96 wherein the adjusting step is carried out by changing the thickness of the material according to the desired stretch resistance at the selected positions.
104. The method according to claim 96 wherein the adjusting step comprises selecting an material having different stretch resistance characteristics.
105. The method according to claim 96 wherein the adjusting step comprises selecting different materials having different stretch resistance characteristics.
106. A method for imparting a shape to a thermoplastic membrane comprising:
surrounding at least a portion of a radially expandable device with a thermoplastic membrane;
radially expanding the radially expandable device to a chosen expanded configuration thereby reshaping the thermoplastic membrane to assume an expanded state corresponding to the chosen expanded configuration; and
imparting a set to the thermoplastic membrane while in the expanded state.
107. The method according to claim 106 wherein the surrounding step is carried out using a generally elastic thermoplastic membrane.
108. The method according to claim 106 wherein the surrounding step is carried out using a generally inelastic thermoplastic membrane.
109. The method according to claim 106 further comprising preventing at least a portion of the thermoplastic membrane from adhering to the radially expandable device.
110. The method according to claim 106 wherein the surrounding step is carried out by sliding a tubular thermoplastic membrane over the radially expandable device.
111. The method according to claim 106 wherein the surrounding step is carried out by coating the radially expandable device with a thermoplastic liquid material to create the thermoplastic membrane.
112. The method according to claim 106 further comprising selecting a tubular braid radially expandable device.
113. The method according to claim 106 wherein the set-imparting step comprises heating and cooling the thermoplastic membrane.
114. The method according to claim 106 wherein the set-imparting step comprises heating and cooling the thermoplastic membrane a plurality of times.
115. An anastomotic medical device comprising:
a tube having first and second ends and a lumen extending therebetween;
an anchor member at the first end for securing the first end to a first tubular structure of a patient, the first tubular structure having a first open interior, with the first open interior opening into the lumen.
116. The medical device according to claim 115 further comprising a second anchor member at the second end for securing the second end to a second tubular structure of a patient, the second tubular structure having a second open interior, with the second open interior opening into the lumen.
117. The medical device according to claim 115 wherein the anchor member comprises a tubular braid element.
118. The medical device according to claim 115 wherein the anchor member comprises a radially expandable tubular braid element having tubular structure piercing elements.
119. The medical device according to claim 118 wherein the piercing elements comprise hooks.
120. The medical device according to claim 115 wherein the anchor member comprises an annular inflatable element sealingly engageable with an opening in the first tubular structure.
121. A medical device according to claim 115 wherein the anchor member comprises a malecot device.
122. An anastomotic medical assembly comprising:
a first anastomotic medical device comprising:
a first tube having first and second ends and a first lumen extending therebetween; and
a first anchor member at the first end of the first tube for securing the first end of the first tube to a first tubular structure of a patient, the first tubular structure having a first open interior, with the first open interior opening into the first lumen;
a second anastomotic medical device comprising:
a second tube having first and second ends and a first lumen extending therebetween; and
a second anchor member at the first end of the second tube for securing the first end of the second tube to a second tubular structure of a patient, the second tubular structure having a second open interior, with the second open interior opening into the second lumen; and
the second ends of the first and second tubes connected to one another to create a fluid path between the first and second anchor members, whereby the first and second open interiors of the first and second tubular structures of the patient may be fluidly connected.
This application is a continuation in part of Biological Passageway Occlusion Removal, application Ser. No. 10/747,813 filed 29 Dec. 2003 attorney docket number GTEC 1001-4, which is a continuation in part of Tissue Removal Device and Method, application Ser. No. 09/819,350 Filed 28 Mar. 2001, which is a continuation of Biological Passageway Occlusion Removal, application Ser. No. 09/189,574 Filed 11 Nov. 1998, now U.S. Pat. No. 6,238,412 issued May 29, 2001, which claims the priority of U.S. Provisional Application Ser. No. 60/065,118, filed on Nov. 12, 1997; This application is a continuation in part of Body Passageway Occluder and Method, application Ser. No. 10/765,564 filed 27 Jan. 2004, attorney docket number GTEC 1001-5, which is a continuation of Tissue Removal Device and Method, application Ser. No. 09/819,350 filed 28 Mar. 2001, which is a continuation of Biological Passageway Occlusion Removal, application Ser. No. 09/189,574 filed 11 Nov. 1998, now U.S. Pat. No. 6,238,412 issued May 29, 2001, which claims the priority of U.S. Provisional Application Ser. No. 60/065,118, filed on Nov. 12, 1997, the disclosures of which are incorporated by reference. This application is a continuation in part of Medical Device and Method U.S. patent application Ser. No. 10/824,779 entitled Medical Device and Method, filed 15 Apr. 2004, attorney docket number GTEC 1002-1, which is a continuation in part of U.S. patent application Ser. No. 10/765,564 filed Jan. 27, 2004 which is a continuation of U.S. patent application Ser. No. 09/819,350, now U.S. Pat. No. 6,699,260, filed Mar. 28, 2001, which is a continuation of U.S. patent application Ser. No. 09/189,574, now U.S. Pat. No. 6,238,412, filed Nov. 11, 1998, and claiming the benefit of provisional Patent Application No. 60/065,118 filed Nov. 12, 1997. U.S. patent application Ser. No. 10/824,779 also claims the benefit of provisional Patent Application No. 60/463,203 entitled Anastomotic Apparatus and Methods for Use, filed on Apr. 16, 2003 and provisional Patent Application No. 60/496,811 entitled Thermoplastic Manufacturing Apparatus and Methods for Use, filed on Aug. 21, 2003. The full disclosures of each are incorporated herein by reference.
| Number | Date | Country | |
|---|---|---|---|
| 60065118 | Nov 1997 | US | |
| 60065118 | Nov 1997 | US | |
| 60065118 | Nov 1997 | US | |
| 60463203 | Apr 2003 | US | |
| 60496811 | Aug 2003 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 09189574 | Nov 1998 | US |
| Child | 09819350 | US | |
| Parent | 09819350 | Mar 2001 | US |
| Child | 10765564 | US | |
| Parent | 09189574 | Nov 1998 | US |
| Child | 09819350 | US | |
| Parent | 09819350 | Mar 2001 | US |
| Child | 10765564 | US | |
| Parent | 09189574 | Nov 1998 | US |
| Child | 09819350 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 10747813 | Dec 2003 | US |
| Child | 12477371 | US | |
| Parent | 09819350 | Mar 2001 | US |
| Child | 10747813 | US | |
| Parent | 10765564 | Jan 2004 | US |
| Child | 09189574 | US | |
| Parent | 10824779 | Apr 2004 | US |
| Child | 09189574 | US | |
| Parent | 10765564 | Jan 2004 | US |
| Child | 10824779 | US |
