1. Field of the Invention
This invention relates to a method of fabricating implantable medical devices such as stents.
2. Description of the State of the Art
This invention relates to radially expandable endoprostheses which are adapted to be implanted in a bodily lumen. An “endoprosthesis” corresponds to an artificial device that is placed inside the body. A “lumen” refers to a cavity of a tubular organ such as a blood vessel. A stent is an example of these endoprostheses. Stents are generally cylindrically-shaped devices which function to hold open and sometimes expand a segment of a blood vessel or other anatomical lumen such as urinary tracts and bile ducts. Stents are often used in the treatment of atherosclerotic stenosis in blood vessels. “Stenosis” refers to a narrowing or constriction of the diameter of a bodily passage or orifice. In such treatments, stents reinforce body vessels and prevent restenosis following angioplasty in the vascular system. “Restenosis” refers to the reoccurrence of stenosis in a blood vessel or heart valve after it has been treated (as by balloon angioplasty or valvuloplasty) with apparent success.
A treatment involving a stent involves both delivery and deployment of the stent. “Delivery” refers to introducing and transporting the stent through a bodily lumen to a region requiring treatment. “Deployment” corresponds to the expanding of the stent within the lumen at the treatment region. Delivery and deployment of a stent are accomplished by positioning the stent about one end of a catheter, inserting the end of the catheter through the skin into a bodily lumen, advancing the catheter in the bodily lumen to a desired treatment location, expanding the stent at the treatment location, and removing the catheter from the lumen. In the case of a balloon expandable stent, the stent is mounted about a balloon disposed on the catheter. The stent is then expanded by inflating the balloon. The balloon may then be deflated and the catheter withdrawn. In the case of a self-expanding stent, the stent may be held in place on the catheter via a retractable sheath. When the stent is in a desired bodily location, the sheath may be withdrawn allowing the stent to self-expand.
Stents have been made of many materials such as metals and plastic, including biodegradable plastic materials. Stents have been formed from wire, tube stock, etc. Stents have also been made from sheets of material which are rolled into a cylindrical shape. The structure of a stent is typically composed of a pattern that allows the stent to be radially expandable. The pattern should be designed to maintain the longitudinal flexibility and radial rigidity required of the stent. Longitudinal flexibility facilitates delivery of the stent and radial rigidity is needed to hold open a bodily lumen.
A number of techniques have been suggested for the fabrication of stents from polymer and metal sheets and tubes. One such technique involves laser cutting or etching a pattern onto a material. Laser cutting may be performed on a sheet of material which is then rolled into a tube. Alternatively, a desired pattern may be formed directly onto a tube. Other techniques involve cutting a desired pattern onto a sheet or a tube via chemical etching or electrical discharge machining Laser cutting of stents has been described in a number of publications including U.S. Pat. No. 5,780,807 to Saunders, U.S. Pat. No. 5,922,005 to Richter, and U.S. Pat. No. 5,906,759 to Richter.
Laser cutting techniques applied to forming patterns for stents have certain shortcomings. For instance, laser cutting a desired pattern onto a tube or sheet can be limited by the kerf width of the laser, the width of a cut made by a laser beam on a material. For example, the kerf width of a laser may make it difficult to cut a desired fine, intricate pattern onto a tube or a sheet. Therefore, methods that address this shortcoming of laser cutting techniques are desirable.
The present invention is directed to a method for fabricating an implantable medical device such as a stent from a tube or sheet in a deformed state. In one embodiment, the method may include radially expanding a tube about a cylindrical axis of the tube from a first diameter to a second diameter. The method may further include forming a pattern on at least a portion of the expanded tube.
An additional embodiment of the invention may include stretching a sheet along an axis of stretching from a first length to a second length. The method may further include forming a pattern on at least a portion of the stretched sheet. A tube may then be formed from the stretched sheet with the pattern. In another embodiment, a tube may be formed from the stretched sheet prior to forming a pattern. The method may further include forming a pattern on at least a portion of the tube.
For the purposes of the present invention, the following terms and definitions apply:
“Delivery diameter” refers to a diameter at which a cylindrical or substantially cylindrical implantable medical device, such as a stent, is introduced into and transported through a bodily lumen.
“Deployment diameter” refers to a diameter which a cylindrical or substantially cylindrical implantable medical device, such as a stent, is expanded to within a bodily lumen.
The “glass transition temperature,” Tg, is the temperature at which the amorphous domains of a polymer change from a brittle vitreous state to a solid deformable state at atmospheric pressure. In other words, the Tg corresponds to the temperature where the onset of segmental motion in the chains of the polymer occurs. When an amorphous or semicrystalline polymer is exposed to an increasing temperature, the coefficient of expansion and the heat capacity of the polymer both increase as the temperature is raised, indicating increased molecular motion. As the temperature is raised the actual molecular volume in the sample remains constant, and so a higher coefficient of expansion points to an increase in free volume associated with the system and therefore increased freedom for the molecules to move. The increasing heat capacity corresponds to an increase in heat dissipation through movement. Tg of a given polymer can be dependent on the heating rate and can be influenced by the thermal history of the polymer. Furthermore, the chemical structure of the polymer heavily influences the glass transition by affecting mobility.
The “melting temperature”, Tm, of a polymer is the highest temperature at which a crystal lattice in the polymer is stable. The Tm of a polymer is also known as the fusion temperature (Tf). The Tm is always greater than the Tg for a given polymer.
The term “elastic deformation” refers to deformation of a body in which the applied stress is small enough so that the object retains, substantially retains, or moves towards its original dimensions once the stress is released. However, an elastically deformed polymer material may be prevented from returning to or moving towards an undeformed state if the material is cooled below the Tg of the polymer. Below the Tg, energy barriers may inhibit or prevent molecular movement that allows deformation or bulk relaxation.
The term “plastic deformation” refers to permanent deformation that occurs in a material under stress after elastic limits have been exceeded.
The term “implantable medical device” is intended to include self-expandable stents, balloon-expandable stents, stent-grafts, and grafts. The structural pattern of the device can be of virtually any design. The device can also be made partially or completely from a biodegradable, bioabsorbable, or biostable polymer. The polymer may also be purified.
Polymers can be biostable, bioabsorbable, biodegradable, or bioerodable. Biostable refers to polymers that are not biodegradable. The terms biodegradable, bioabsorbable, and bioerodable are used interchangeably and refer to polymers that are capable of being completely degraded, absorbed, and/or eroded when exposed to bodily fluids such as blood and can be gradually resorbed, absorbed and/or eliminated by the body. The processes of breaking down and eventual absorption and elimination of the polymer can be caused by, for example, hydrolysis, metabolic processes, bulk or surface erosion, and the like. For stents made from a biodegradable polymer, the stent is intended to remain in the body for a duration of time until its intended function of, for example, maintaining vascular patency, and/or drug delivery is accomplished.
Representative examples of polymers that may be used to fabricate an implantable medical device using the methods disclosed herein include, but are not limited to, poly(N-acetylglucosamine) (Chitin), Chitoson, poly(hydroxyvalerate), poly(lactide-co-glycolide), poly(hydroxybutyrate), poly(hydroxybutyrate-co-valerate), polyorthoester, polyanhydride, poly(glycolic acid), poly(glycolide), poly(L-lactic acid), poly(L-lactide), poly(D,L-lactic acid), poly(D,L-lactide), poly(caprolactone), poly(trimethylene carbonate), polyester amide, poly(glycolic acid-co-trimethylene carbonate), co-poly(ether-esters) (e.g. PEO/PLA), polyphosphazenes, biomolecules (such as fibrin, fibrinogen, cellulose, starch, collagen and hyaluronic acid), polyurethanes, silicones, polyesters, polyolefins, polyisobutylene and ethylene-alphaolefin copolymers, acrylic polymers and copolymers other than polyacrylates, vinyl halide polymers and copolymers (such as polyvinyl chloride), polyvinyl ethers (such as polyvinyl methyl ether), polyvinylidene halides (such as polyvinylidene chloride), polyacrylonitrile, polyvinyl ketones, polyvinyl aromatics (such as polystyrene), polyvinyl esters (such as polyvinyl acetate), acrylonitrile-styrene copolymers, ABS resins, polyamides (such as Nylon 66 and polycaprolactam), polycarbonates, polyoxymethylenes, polyimides, polyethers, polyurethanes, rayon, rayon-triacetate, cellulose, cellulose acetate, cellulose butyrate, cellulose acetate butyrate, cellophane, cellulose nitrate, cellulose propionate, cellulose ethers, and carboxymethyl cellulose. Additional representative examples of polymers that may be especially well suited for use in fabricating an implantable medical device according to the methods disclosed herein include ethylene vinyl alcohol copolymer (commonly known by the generic name EVOH or by the trade name EVAL), poly(butyl methacrylate), poly(vinylidene fluoride-co-hexafluororpropene) (e.g., SOLEF 21508, available from Solvay Solexis PVDF, Thorofare, N.J.), polyvinylidene fluoride (otherwise known as KYNAR, available from ATOFINA Chemicals, Philadelphia, Pa.), ethylene-vinyl acetate copolymers, and polyethylene glycol.
In some embodiments, an implantable medical device may be fabricated from a conduit or tube. The tube may be cylindrical or substantially cylindrical in shape. For example,
Typically, stent patterns as shown in
The difficulty faced in forming fine, intricate patterns may be addressed by forming a stent pattern on a tube in an expanded or deformed state. The tube may then be reduced to a size less than its expanded state or to a size the same as or generally equivalent to the initial state. Certain embodiments of fabricating an implantable medical device may include radially expanding a tube about a cylindrical axis of the tube from a first diameter to a second diameter. The tube may be expanded radially by application of a radial pressure. The first diameter may correspond to a diameter of the tube prior to fabrication of the implantable medical device. In addition, the second diameter may refer to a diameter of the tube in an expanded state. In certain embodiments, expanding the tube may facilitate forming a desired pattern in the tube. The method may further include forming a pattern on at least a portion of the expanded tube. During formation of the pattern, it may be desirable to maintain the tube at or near the expanded state. In some embodiments, expansion, forming the pattern, and/or allowing the tube to reduce to a smaller size may be performed in a temperature range equal to or above the Tg and below the melting temperature of a polymer of the tube. In other embodiments, the temperature range may be less than the Tg of the polymer. It may be advantageous to expand the tube elastically to facilitate the return of the expanded tube to or approximately to its original dimensions. In other embodiments, expansion may include plastic deformation of the tube.
In some embodiments, the first diameter may be equal to or less than a deployment diameter of the implantable medical device and equal to or greater than a delivery diameter of the implantable medical device. In other embodiments, the first diameter may be less or equal to a delivery diameter of the implantable medical device. In an embodiment, the second diameter may be equal to or greater than the deployment diameter of the implantable medical device. In other embodiments, second diameter may be equal to or greater than the delivery diameter and equal to or less than the deployment diameter. In some embodiments, the second diameter may be up to 500% of the first diameter, such as from 101% of the first diameter to 200% of the first diameter. In other embodiments, the second diameter may be between about 150% and about 300% of the first diameter.
Additionally, expansion of the tube may be facilitated by applying heat. Increasing the temperature of a polymer tends to allow a polymer to be deformed more easily. For instance, it may be desirable to increase the temperature to at or above the Tg, but below the melting temperature of the polymer, Tm. In various embodiments, the application of heat may be prior to, contemporaneous with, and/or subsequent to expansion. In some embodiments, heat may be applied by contacting the tube with a fluid above ambient temperature. An ambient temperature may be about 25° C. For example, the tube may be immersed in a liquid and/or contacted with a stream of gas. The tube may be translated through the liquid and/or the stream of gas. In addition, the tube may be heated through contact and/or close proximity to a heated object. In another embodiment, heat may be applied by using an oven. In other embodiments, the expansion of the tube may be performed satisfactorily without application of heat. For example, a polymer with a Tg below an ambient temperature may deform adequately to a desired expanded state without application of heat.
In some embodiments, radial pressure may be applied to the polymer tube by positioning the polymer tube within an annular member and conveying a gas at a selected pressure into a proximate end of the polymer tube. A distal end of the polymer tube may be closed. Subsequent processing steps may be used to open the distal end. The annular member may act to control the diameter of the expanded polymer tube by limiting the expansion to the inside diameter of the annular member. The inside diameter of the annular member may correspond to a desired diameter of the polymer tube. Alternatively, the pressure of the conveyed gas may be used to control the expansion of the polymer tube to a desired diameter.
Furthermore, due to heating of the tube, the temperature of the tube during and/or after expansion may be higher than an ambient temperature. Heating may be from applying heat to the tube and/or from the forming the pattern. As indicated above, an elastically deformed polymer material above the Tg of the material tends to relax towards its undeformed state when stress is removed. Several embodiments of the method may include inhibiting or preventing relaxation of the expanded tube prior to and during forming the pattern onto the expanded tube. The tendency to relax may increase as the temperature increases. In one embodiment, radial pressure may be applied or maintained during the forming of the pattern. Applying radial pressure may include conveying a gas into the expanded tube. Additionally, applying radial pressure may include supporting the expanded tube, for example, by positioning the expanded tube over an annular member, such as a mandrel, to inhibit or prevent relaxation of the expanded tube. Some embodiments may include applying heat to the tube during the forming of the pattern.
In some embodiments, it may be desirable to cool the expanded tube. In certain embodiments, it may be desirable to inhibit or prevent relaxation of the expanded tube towards its unexpanded state. Cooling the expanded tube may stabilize the tube in an expanded state. During or after expansion, the tube may be at a first temperature, which may be above the Tg of the polymer. As indicated above, below the Tg energy barriers preventing movement of polymer molecules may inhibit or prevent even an elastically deformed material from returning to its unstressed state. Therefore, cooling the tube to a temperature below Tg may stabilize the tube in an expanded state. In some embodiments, a method may include decreasing the temperature of the tube from a first temperature to a second temperature prior to, contemporaneous with, and/or subsequent to forming the pattern. In some embodiments, the second temperature may be below the Tg of the polymer. In other embodiments, the second temperature may be above Tg, but low enough that the polymer does not relax significantly during the time frame of the forming process.
Some embodiments of the method may include decreasing the temperature of the tube relatively slowly in a temperature range at or near an ambient temperature. One embodiment may include contacting the tube with a fluid, for example, a stream of an inert gas such as air, nitrogen, etc. If the tube is cooled prior to forming the pattern, it may be necessary to apply radial pressure to the tube to inhibit relaxation during the cooling process.
Alternatively, if the tube is cooled subsequent to forming the pattern, it may be desirable to allow relaxation of the tube towards it original diameter. If such is the case, then the tube may be cooled without applying radial pressure. However, the tube may stabilize at or less than or equal to Tg prior to reaching its original unexpanded state.
In other embodiments, the tube may be cooled relatively quickly or by a fast quench from a first temperature to a second temperature. In an embodiment, the expanded tube may be contacted with a fluid below an ambient temperature and/or below the Tg of the polymer. For example, refrigerated air cooled by liquid nitrogen or by some other means may be blown onto the expanded tube. Radial pressure may be applied to inhibit or prevent relaxation of the polymer.
Additionally, after forming a pattern, a tube may be stable in an expanded state at a diameter greater than a desired diameter. It may be desirable to decrease the diameter of the expanded tube close to a delivery or crimped diameter. The tube may have been stabilized in an expanded state by cooling the tube, as described above. Alternatively, the expanded tube may be above Tg, and it may be desirable to speed up the relaxation towards the unexpanded, relaxed state. Relaxation of the expanded tube may be facilitated by heat shrinking the tube. Increasing a temperature of an elastically deformed material facilitates relaxation to an unstressed state. Some embodiments of the method may include increasing a temperature of the expanded tube to a temperature in a manner that decreases a diameter of the tube to a third diameter. In one embodiment, the third diameter may be approximately equal to the first diameter or original diameter. Alternatively, the third diameter may be less the second diameter and greater than the first diameter. In some embodiments, the third diameter may be less than the first diameter.
Additionally, various embodiments may be distinguished by the relative size of the third diameter relative to the delivery diameter of the medical device. In some embodiments, the third diameter may be greater than or equal to the delivery diameter. In other embodiments, the third diameter may be less than the delivery diameter. When the third diameter is greater than a delivery diameter, a method of fabricating an implantable medical device may further include decreasing the diameter of the tube to a delivery diameter. Decreasing the diameter of the tube may be accomplished by crimping the tube.
Further embodiments of addressing the difficulty of forming fine, intricate patterns may include forming a stent pattern on a stretched or deformed sheet from which a stent may be formed. A stent pattern may also be formed on a tube formed from a stretched or deformed sheet. A stretched sheet or tube formed from a stretched sheet may be relaxed at least partially from a stretched or deformed state.
Certain embodiments of fabricating an implantable medical device may include stretching a sheet along an axis of stretching from a first length to a second length. The sheet may be stretched by application of a tensile force. The first length may correspond to an initial state of the sheet prior to fabrication of the device. In addition, the second length may be the length of the sheet in a stretched or deformed state. In some embodiments, the second length may be up to 500% of the first length, such as from 101% of the first length to 200% of the first length. In other embodiments, the second length may be between about 150% and about 300% of the first length. Stretching the sheet may facilitate forming a desired pattern on the sheet or a tube formed from a stretched sheet.
In certain embodiments, the method may include forming a pattern on at least a portion of the stretched sheet after stretching the sheet. The method may further include forming a tube from the stretched sheet. A cylindrical axis of the tube may be parallel, perpendicular, or at an angle between parallel and perpendicular to the axis of stretching. In an embodiment, the method may include forming a pattern on the formed tube. The formed tube may then be allowed to relax or reduce to a smaller diameter. The stretched sheet with the pattern may also be allowed to relax prior to forming the tube.
In other embodiments, the method may include forming the tube from the stretched sheet prior to forming a pattern. A pattern may then be formed on at least a portion of the tube that is in an expanded or stretched state due to stretching of the sheet. The formed tube may then be allowed to reduce or relax to a smaller size. The pattern on a stretched sheet or formed tube may be formed using a laser cutting technique or chemical etching.
Certain embodiments may include stretching the sheet along a second axis of stretching. A cylindrical axis of the tube may be parallel, perpendicular, or at an angle between parallel and perpendicular to the second axis of stretching.
In certain embodiments, a tube may be formed from a sheet by rolling a sheet into a cylindrical shape. The sheet may then be bonded with a suitable adhesive at the opposing edges of the sheet that are parallel or substantially parallel to a cylindrical axis. The sheet may be cut so that the formed tube is a desired diameter.
During formation of the pattern on a formed tube or stretched sheet, it may be desirable to maintain the formed tube or the stretched sheet at or near the expanded or stretched state. In some embodiments, stretching, forming the pattern, and/or allowing the formed tube or stretched sheet to relax or reduce to a smaller size may be performed in a temperature range equal to or above the Tg and below the melting temperature of a polymer of the sheet or tube. It may be advantageous to stretch the sheet elastically to facilitate the relaxation of the stretched sheet or tube formed from a stretched sheet towards an undeformed state. In other embodiments, the sheet may be expanded plastically.
Additionally, as in expansion of a tube, stretching may be facilitated by applying heat. In various embodiments, the application of heat may be prior to, contemporaneous with, and/or subsequent to stretching. Heat may be applied in ways similar to that described above.
In one embodiment, a sheet may be stretched along at least one an axis using a tenter. In a tenter, stretching is performed inside of a box that may be temperature-controlled. Inside of the box, a sheet may be grasped on either side by tenterhooks that exert a tensile force or drawing tension along at least one axis.
In addition, the temperature of the sheet during and/or after expansion and the tube after it is formed may be higher than an ambient temperature due to heating and/or forming the pattern. Several embodiments of the method may include inhibiting or preventing relaxation of the stretched sheet or formed tube prior to and during forming the pattern onto the stretched sheet or formed tube. In an embodiment, a tensile force may be applied to or maintained on the sheet during the forming of the pattern. Radial pressure may be applied to the formed tube as describe above. Some embodiments may include applying heat to the stretched sheet or formed tube during the forming of the pattern.
Furthermore, it may be desirable to cool the stretched sheet or the formed tube to inhibit or prevent relaxation of the stretched sheet or formed tube prior to and during forming a pattern on the stretched sheet or formed tube. Cooling the stretched sheet or the formed tube may stabilize the stretched sheet or formed tube in a stretched state or expanded state. The stretched sheet or formed tube may be cooled in manners similar to that described above.
If the stretched sheet or the formed tube is cooled prior to forming the pattern, it may be necessary to apply a tensile force or radial pressure, respectively, to inhibit relaxation during the cooling process. Alternatively, if the stretched sheet or the formed tube is cooled subsequent to forming the pattern, it may be desirable to allow relaxation of the stretched sheet or the formed tube. If such is the case, then the stretched tube or formed tube may be cooled without applying tensile force or radial pressure, respectively. However, the stretched sheet or the formed tube may stabilize at or less than or equal to Tg of the polymer prior to reaching an undeformed state. In other embodiments, the stretched sheet or the formed tube may be cooled relatively quickly or by a fast quench from a first temperature to a second temperature.
Additionally, after forming a pattern, a stretched sheet or formed tube may be stabilized in a deformed state. It may be desirable to relax the stretched sheet with a pattern to inhibit or prevent undesirable changes in dimensions of a tube formed from the stretched tube with a pattern during any subsequent processing steps of the device or during use of the device. As described above, relaxation may be facilitated by heat shrinking the stretched sheet with a pattern or the formed tube with a pattern. In some embodiments, the stretched sheet may be relaxed to a third length by increasing a temperature of the stretched tube. In one embodiment, the third length may be less than or equal to the first length. Alternatively, the third length may be less the second length and greater than the first length. A tube with a pattern, or stent, with a desired diameter may then be formed from a stretched sheet with a pattern after heat shrinking. A desired diameter may be greater than a deployment diameter; less than or equal to a deployment diameter and greater than or equal to a delivery diameter; or less than a delivery diameter.
Alternatively, a tube may be formed from a stretched sheet with a pattern while still in a stretched or deformed state. As discussed above, it may be desirable to relax the formed tube to decrease its diameter close to a delivery or crimped diameter. The formed tube may be subjected to heat shrinking as described above. The diameter of the formed tube may be decreased, for example, to greater than or equal to a deployment diameter; to less than or equal to a deployment diameter and greater than or equal to a delivery diameter; or to less than or equal to a delivery diameter. For a tube that has a diameter greater than a delivery diameter, a method of fabricating an implantable medical device may further include decreasing the diameter of the formed tube to a delivery diameter. Decreasing the diameter of the tube may be accomplished by crimping the tube.
Furthermore, forming a pattern in an expanded state may result in a desired fine, intricate pattern on a stent. The diameter of the stent may close to the crimped state. It may not be possible to form such a pattern with laser cutting. Furthermore, crimping tends to result in a nonuniform change in the geometry of a stent pattern. However, heat shrinking an expanded tube with a pattern, a tube with a pattern formed from a stretched sheet, or a stretched sheet with a pattern may result in a relatively uniform change in the geometry of the stent. Therefore, forming a pattern on tubes or sheets in expanded or stretched states may allow better control over the geometry of a stent pattern.
While particular embodiments of the present invention have been shown and described, it will be obvious to those skilled in the art that changes and modifications can be made without departing from this invention in its broader aspects. Therefore, the appended claims are to encompass within their scope all such changes and modifications as fall within the true spirit and scope of this invention.
Number | Name | Date | Kind |
---|---|---|---|
3687135 | Stroganov et al. | Aug 1972 | A |
3839743 | Schwarcz | Oct 1974 | A |
3900632 | Robinson | Aug 1975 | A |
4104410 | Malecki | Aug 1978 | A |
4110497 | Hoel | Aug 1978 | A |
4321711 | Mano | Mar 1982 | A |
4346028 | Griffith | Aug 1982 | A |
4596574 | Urist | Jun 1986 | A |
4599085 | Riess et al. | Jul 1986 | A |
4612009 | Drobnik et al. | Sep 1986 | A |
4633873 | Dumican et al. | Jan 1987 | A |
4656083 | Hoffman et al. | Apr 1987 | A |
4718907 | Karwoski et al. | Jan 1988 | A |
4722335 | Vilasi | Feb 1988 | A |
4723549 | Wholey et al. | Feb 1988 | A |
4732152 | Wallstén et al. | Mar 1988 | A |
4733665 | Palmaz | Mar 1988 | A |
4739762 | Palmaz | Apr 1988 | A |
4740207 | Kreamer | Apr 1988 | A |
4743252 | Martin, Jr. et al. | May 1988 | A |
4768507 | Fischell et al. | Sep 1988 | A |
4776337 | Palmaz | Oct 1988 | A |
4776337 | Palmaz | Oct 1988 | A |
4800882 | Gianturco | Jan 1989 | A |
4816339 | Tu et al. | Mar 1989 | A |
4818559 | Hama et al. | Apr 1989 | A |
4850999 | Planck | Jul 1989 | A |
4877030 | Beck et al. | Oct 1989 | A |
4878906 | Lindemann et al. | Nov 1989 | A |
4879135 | Greco et al. | Nov 1989 | A |
4886062 | Wiktor | Dec 1989 | A |
4902289 | Yannas | Feb 1990 | A |
4957687 | Akman et al. | Sep 1990 | A |
4977901 | Ofstead | Dec 1990 | A |
4994298 | Yasuda | Feb 1991 | A |
5019090 | Pinchuk | May 1991 | A |
5028597 | Kodama et al. | Jul 1991 | A |
5059211 | Stack et al. | Oct 1991 | A |
5062829 | Pryor et al. | Nov 1991 | A |
5084065 | Weldon et al. | Jan 1992 | A |
5085629 | Goldberg et al. | Feb 1992 | A |
5100429 | Sinofsky et al. | Mar 1992 | A |
5104410 | Chowdhary | Apr 1992 | A |
5108417 | Sawyer | Apr 1992 | A |
5108755 | Daniels et al. | Apr 1992 | A |
5112457 | Marchant | May 1992 | A |
5123917 | Lee | Jun 1992 | A |
5156623 | Hakamatsuka et al. | Oct 1992 | A |
5163951 | Pinchuk et al. | Nov 1992 | A |
5163952 | Froix | Nov 1992 | A |
5163958 | Pinchuk | Nov 1992 | A |
5167614 | Tessmann et al. | Dec 1992 | A |
5192311 | King et al. | Mar 1993 | A |
5197977 | Hoffman, Jr. et al. | Mar 1993 | A |
5234456 | Silvestrini | Aug 1993 | A |
5234457 | Andersen | Aug 1993 | A |
5236447 | Kubo et al. | Aug 1993 | A |
5279594 | Jackson | Jan 1994 | A |
5282860 | Matsuno et al. | Feb 1994 | A |
5289831 | Bosley | Mar 1994 | A |
5290271 | Jernberg | Mar 1994 | A |
5306286 | Stack et al. | Apr 1994 | A |
5306294 | Winston et al. | Apr 1994 | A |
5328471 | Slepian | Jul 1994 | A |
5330500 | Song | Jul 1994 | A |
5342348 | Kaplan | Aug 1994 | A |
5342395 | Jarrett et al. | Aug 1994 | A |
5342621 | Eury | Aug 1994 | A |
5356433 | Rowland et al. | Oct 1994 | A |
5383925 | Schmitt | Jan 1995 | A |
5385580 | Schmitt | Jan 1995 | A |
5389106 | Tower | Feb 1995 | A |
5399666 | Ford | Mar 1995 | A |
5423885 | Williams | Jun 1995 | A |
5441515 | Khosravi et al. | Aug 1995 | A |
5443458 | Eury et al. | Aug 1995 | A |
5443500 | Sigwart | Aug 1995 | A |
5455040 | Marchant | Oct 1995 | A |
5464650 | Berg et al. | Nov 1995 | A |
5500013 | Buscemi et al. | Mar 1996 | A |
5502158 | Sinclair et al. | Mar 1996 | A |
5514379 | Weissleder et al. | May 1996 | A |
5527337 | Stack et al. | Jun 1996 | A |
5545408 | Trigg et al. | Aug 1996 | A |
5554120 | Chen et al. | Sep 1996 | A |
5556413 | Lam | Sep 1996 | A |
5578046 | Liu et al. | Nov 1996 | A |
5578073 | Haimovich et al. | Nov 1996 | A |
5591199 | Porter et al. | Jan 1997 | A |
5591607 | Gryaznov et al. | Jan 1997 | A |
5593403 | Buscemi | Jan 1997 | A |
5593434 | Williams | Jan 1997 | A |
5599301 | Jacobs et al. | Feb 1997 | A |
5599922 | Gryaznov et al. | Feb 1997 | A |
5605696 | Eury et al. | Feb 1997 | A |
5607442 | Fischell et al. | Mar 1997 | A |
5607467 | Froix | Mar 1997 | A |
5618299 | Khosravi et al. | Apr 1997 | A |
5629077 | Turnlund et al. | May 1997 | A |
5631135 | Gryaznov et al. | May 1997 | A |
5632771 | Boatman et al. | May 1997 | A |
5632840 | Campbell | May 1997 | A |
5637113 | Tartaglia et al. | Jun 1997 | A |
5649977 | Campbell | Jul 1997 | A |
5667767 | Greff et al. | Sep 1997 | A |
5667796 | Otten | Sep 1997 | A |
5670558 | Onishi et al. | Sep 1997 | A |
5693085 | Buirge et al. | Dec 1997 | A |
5700286 | Tartaglia et al. | Dec 1997 | A |
5707385 | Williams | Jan 1998 | A |
5711763 | Nonami et al. | Jan 1998 | A |
5716981 | Hunter et al. | Feb 1998 | A |
5725549 | Lam | Mar 1998 | A |
5726297 | Gryaznov et al. | Mar 1998 | A |
5728751 | Patnaik | Mar 1998 | A |
5733326 | Tomonto et al. | Mar 1998 | A |
5733330 | Cox | Mar 1998 | A |
5733564 | Lehtinen | Mar 1998 | A |
5733925 | Kunz et al. | Mar 1998 | A |
5741881 | Patnaik | Apr 1998 | A |
5756457 | Wang et al. | May 1998 | A |
5756476 | Epstein et al. | May 1998 | A |
5765682 | Bley et al. | Jun 1998 | A |
5766204 | Porter et al. | Jun 1998 | A |
5766239 | Cox | Jun 1998 | A |
5766710 | Turnlund et al. | Jun 1998 | A |
5769883 | Buscemi et al. | Jun 1998 | A |
5780807 | Saunders | Jul 1998 | A |
5800516 | Fine et al. | Sep 1998 | A |
5811447 | Kunz et al. | Sep 1998 | A |
5824049 | Ragheb et al. | Oct 1998 | A |
5830178 | Jones et al. | Nov 1998 | A |
5830461 | Billiar | Nov 1998 | A |
5830879 | Isner | Nov 1998 | A |
5833651 | Donovan et al. | Nov 1998 | A |
5834582 | Sinclair et al. | Nov 1998 | A |
5836962 | Gianotti | Nov 1998 | A |
5837313 | Ding et al. | Nov 1998 | A |
5837835 | Gryaznov et al. | Nov 1998 | A |
5840083 | Braach-Maksvytis | Nov 1998 | A |
5851508 | Greff et al. | Dec 1998 | A |
5853408 | Muni | Dec 1998 | A |
5854207 | Lee et al. | Dec 1998 | A |
5855612 | Ohthuki et al. | Jan 1999 | A |
5855618 | Patnaik et al. | Jan 1999 | A |
5858746 | Hubbell et al. | Jan 1999 | A |
5865814 | Tuch | Feb 1999 | A |
5868781 | Killion | Feb 1999 | A |
5873904 | Ragheb et al. | Feb 1999 | A |
5874101 | Zhong et al. | Feb 1999 | A |
5874109 | Ducheyne et al. | Feb 1999 | A |
5874165 | Drumheller | Feb 1999 | A |
5876743 | Ibsen et al. | Mar 1999 | A |
5877263 | Patnaik et al. | Mar 1999 | A |
5879713 | Roth et al. | Mar 1999 | A |
5888533 | Dunn | Mar 1999 | A |
5891192 | Murayama et al. | Apr 1999 | A |
5891386 | Deitermann et al. | Apr 1999 | A |
5897955 | Drumheller | Apr 1999 | A |
5906759 | Richter | May 1999 | A |
5914182 | Drumheller | Jun 1999 | A |
5916870 | Lee et al. | Jun 1999 | A |
5922005 | Richter et al. | Jul 1999 | A |
5942209 | Leavitt et al. | Aug 1999 | A |
5948428 | Lee et al. | Sep 1999 | A |
5954744 | Phan et al. | Sep 1999 | A |
5957975 | Lafont et al. | Sep 1999 | A |
5965720 | Gryaznov et al. | Oct 1999 | A |
5971954 | Conway et al. | Oct 1999 | A |
5976182 | Cox | Nov 1999 | A |
5980564 | Stinson | Nov 1999 | A |
5980928 | Terry | Nov 1999 | A |
5980972 | Ding | Nov 1999 | A |
5981568 | Kunz et al. | Nov 1999 | A |
5986169 | Gjunter | Nov 1999 | A |
5997468 | Wolff et al. | Dec 1999 | A |
6010445 | Armini et al. | Jan 2000 | A |
6015541 | Greff et al. | Jan 2000 | A |
6042875 | Ding et al. | Mar 2000 | A |
6048964 | Lee et al. | Apr 2000 | A |
6051648 | Rhee et al. | Apr 2000 | A |
6056993 | Leidner et al. | May 2000 | A |
6060451 | DiMaio et al. | May 2000 | A |
6066156 | Yan | May 2000 | A |
6071266 | Kelley | Jun 2000 | A |
6074659 | Kunz et al. | Jun 2000 | A |
6080177 | Igaki et al. | Jun 2000 | A |
6080488 | Hostettler et al. | Jun 2000 | A |
6083258 | Yadav | Jul 2000 | A |
6093463 | Thakrar | Jul 2000 | A |
6096070 | Ragheb et al. | Aug 2000 | A |
6096525 | Patnaik | Aug 2000 | A |
6099562 | Ding et al. | Aug 2000 | A |
6103230 | Billiar et al. | Aug 2000 | A |
6107416 | Patnaik et al. | Aug 2000 | A |
6110188 | Narciso, Jr. | Aug 2000 | A |
6113629 | Ken | Sep 2000 | A |
6117979 | Hendriks et al. | Sep 2000 | A |
6120536 | Ding et al. | Sep 2000 | A |
6120904 | Hostettler et al. | Sep 2000 | A |
6121027 | Clapper et al. | Sep 2000 | A |
6125523 | Brown et al. | Oct 2000 | A |
6127173 | Eckstein et al. | Oct 2000 | A |
6129761 | Hubbell | Oct 2000 | A |
6129928 | Sarangapani et al. | Oct 2000 | A |
6150630 | Perry et al. | Nov 2000 | A |
6153252 | Hossainy et al. | Nov 2000 | A |
6159951 | Karpeisky et al. | Dec 2000 | A |
6160084 | Langer et al. | Dec 2000 | A |
6165212 | Dereume et al. | Dec 2000 | A |
6166130 | Rhee et al. | Dec 2000 | A |
6169170 | Gryaznov et al. | Jan 2001 | B1 |
6171609 | Kunz | Jan 2001 | B1 |
6174330 | Stinson | Jan 2001 | B1 |
6177523 | Reich et al. | Jan 2001 | B1 |
6183505 | Mohn, Jr. et al. | Feb 2001 | B1 |
6187045 | Fehring et al. | Feb 2001 | B1 |
6210715 | Starling et al. | Apr 2001 | B1 |
6224626 | Steinke | May 2001 | B1 |
6228845 | Donovan et al. | May 2001 | B1 |
6240616 | Yan | Jun 2001 | B1 |
6245076 | Yan | Jun 2001 | B1 |
6245103 | Stinson | Jun 2001 | B1 |
6248344 | Ylanen et al. | Jun 2001 | B1 |
6251135 | Stinson et al. | Jun 2001 | B1 |
6251142 | Bernacca et al. | Jun 2001 | B1 |
6273913 | Wright et al. | Aug 2001 | B1 |
6281262 | Shikinami | Aug 2001 | B1 |
6284333 | Wang et al. | Sep 2001 | B1 |
6287332 | Bolz et al. | Sep 2001 | B1 |
6290721 | Heath | Sep 2001 | B1 |
6293966 | Frantzen | Sep 2001 | B1 |
6303901 | Perry et al. | Oct 2001 | B1 |
6312459 | Huang et al. | Nov 2001 | B1 |
6327772 | Zadno-Azizi et al. | Dec 2001 | B1 |
6375826 | Wang et al. | Apr 2002 | B1 |
6379381 | Hossainy et al. | Apr 2002 | B1 |
6387121 | Alt | May 2002 | B1 |
6388043 | Langer et al. | May 2002 | B1 |
6395326 | Castro et al. | May 2002 | B1 |
6409761 | Jang | Jun 2002 | B1 |
6423092 | Datta et al. | Jul 2002 | B2 |
6461632 | Gogolewski | Oct 2002 | B1 |
6464720 | Boatman et al. | Oct 2002 | B2 |
6479565 | Stanley | Nov 2002 | B1 |
6485512 | Cheng | Nov 2002 | B1 |
6492615 | Flanagan | Dec 2002 | B1 |
6494908 | Huxel et al. | Dec 2002 | B1 |
6495156 | Wenz et al. | Dec 2002 | B2 |
6511748 | Barrows | Jan 2003 | B1 |
6517888 | Weber | Feb 2003 | B1 |
6527801 | Dutta | Mar 2003 | B1 |
6537589 | Chae et al. | Mar 2003 | B1 |
6539607 | Fehring et al. | Apr 2003 | B1 |
6540777 | Stenzel | Apr 2003 | B2 |
6554854 | Flanagan | Apr 2003 | B1 |
6565599 | Hong et al. | May 2003 | B1 |
6569191 | Hogan | May 2003 | B1 |
6569193 | Cox et al. | May 2003 | B1 |
6572672 | Yadav et al. | Jun 2003 | B2 |
6574851 | Mirizzi | Jun 2003 | B1 |
6585755 | Jackson et al. | Jul 2003 | B2 |
6592614 | Lenker et al. | Jul 2003 | B2 |
6592617 | Thompson | Jul 2003 | B2 |
6613072 | Lau et al. | Sep 2003 | B2 |
6626939 | Burnside et al. | Sep 2003 | B1 |
6635269 | Jennissen | Oct 2003 | B1 |
6645243 | Vallana et al. | Nov 2003 | B2 |
6656162 | Santini, Jr. et al. | Dec 2003 | B2 |
6664335 | Krishnan | Dec 2003 | B2 |
6666214 | Canham | Dec 2003 | B2 |
6667049 | Janas et al. | Dec 2003 | B2 |
6669723 | Killion et al. | Dec 2003 | B2 |
6676697 | Richter | Jan 2004 | B1 |
6679980 | Andreacchi | Jan 2004 | B1 |
6689375 | Wahlig et al. | Feb 2004 | B1 |
6695920 | Pacetti et al. | Feb 2004 | B1 |
6706273 | Roessler | Mar 2004 | B1 |
6709379 | Brandau et al. | Mar 2004 | B1 |
6719934 | Stinson | Apr 2004 | B2 |
6719989 | Matsushima et al. | Apr 2004 | B1 |
6720402 | Langer et al. | Apr 2004 | B2 |
6746773 | Llanos et al. | Jun 2004 | B2 |
6752826 | Holloway et al. | Jun 2004 | B2 |
6753007 | Haggard et al. | Jun 2004 | B2 |
6764505 | Hossainy et al. | Jul 2004 | B1 |
6818063 | Kerrigan | Nov 2004 | B1 |
6846323 | Yip et al. | Jan 2005 | B2 |
20010044652 | Moore | Nov 2001 | A1 |
20020002399 | Huxel et al. | Jan 2002 | A1 |
20020004060 | Heublein et al. | Jan 2002 | A1 |
20020004101 | Ding et al. | Jan 2002 | A1 |
20020062148 | Hart | May 2002 | A1 |
20020065553 | Weber | May 2002 | A1 |
20020111590 | Davila et al. | Aug 2002 | A1 |
20020116050 | Kocur | Aug 2002 | A1 |
20020138133 | Lenz et al. | Sep 2002 | A1 |
20020161114 | Gunatillake et al. | Oct 2002 | A1 |
20030028241 | Stinson | Feb 2003 | A1 |
20030033001 | Igaki | Feb 2003 | A1 |
20030083732 | Stinson | May 2003 | A1 |
20030093107 | Parsonage et al. | May 2003 | A1 |
20030100865 | Santini, Jr. et al. | May 2003 | A1 |
20030105518 | Dutta | Jun 2003 | A1 |
20030105530 | Pirhonen | Jun 2003 | A1 |
20030171053 | Sanders | Sep 2003 | A1 |
20030187495 | Cully et al. | Oct 2003 | A1 |
20030208259 | Penhasi | Nov 2003 | A1 |
20030209835 | Chun et al. | Nov 2003 | A1 |
20030226833 | Shapovalov et al. | Dec 2003 | A1 |
20030236565 | Fifer | Dec 2003 | A1 |
20040000361 | Trozera | Jan 2004 | A1 |
20040093077 | White et al. | May 2004 | A1 |
20040098095 | Burnside et al. | May 2004 | A1 |
20040111149 | Stinson | Jun 2004 | A1 |
20040127970 | Weber | Jul 2004 | A1 |
20040143317 | Stinson et al. | Jul 2004 | A1 |
20040167610 | Fleming, III | Aug 2004 | A1 |
Number | Date | Country |
---|---|---|
44 07 079 | Sep 1994 | DE |
197 31 021 | Jan 1999 | DE |
198 56 983 | Dec 1999 | DE |
0 108 171 | May 1984 | EP |
0 144 534 | Jun 1985 | EP |
0 364 787 | Apr 1990 | EP |
0 397 500 | Nov 1990 | EP |
0 464 755 | Jan 1992 | EP |
0 493 788 | Jul 1992 | EP |
0 554 082 | Aug 1993 | EP |
0 578 998 | Jan 1994 | EP |
0 604 022 | Jun 1994 | EP |
0 621 017 | Oct 1994 | EP |
0 623 354 | Nov 1994 | EP |
0 665 023 | Aug 1995 | EP |
0 709 068 | May 1996 | EP |
0 970 711 | Jan 2000 | EP |
2 247 696 | Mar 1992 | GB |
WO 8903232 | Apr 1989 | WO |
WO 9001969 | Mar 1990 | WO |
WO 9004982 | May 1990 | WO |
WO 9006094 | Jun 1990 | WO |
WO 9117744 | Nov 1991 | WO |
WO 9117789 | Nov 1991 | WO |
WO 9210218 | Jun 1992 | WO |
WO 9306792 | Apr 1993 | WO |
WO 9421196 | Sep 1994 | WO |
WO 9529647 | Nov 1995 | WO |
WO 9804415 | Feb 1998 | WO |
WO 9903515 | Jan 1999 | WO |
WO 9916386 | Apr 1999 | WO |
WO 9942147 | Aug 1999 | WO |
WO 0012147 | Mar 2000 | WO |
WO 0064506 | Nov 2000 | WO |
WO 0101890 | Jan 2001 | WO |
WO 2004023985 | Mar 2004 | WO |