1. Technical Field
This application relates to a rotational thrombectomy wire for clearing thrombus from native vessels.
2. Background of Related Art
There have been various attempts to break up clots and other obstructing material in grafts or native vessels. One approach is through injection of thrombolytic agents such as urokinase or streptokinase. These agents, however, are expensive, require lengthy hospital procedures and create risks of drug toxicity and bleeding complications as the clots are broken.
Other approaches to breaking up clots involve mechanical thrombectomy devices. For example, U.S. Pat. No. 5,766,191 discloses a cage or basket composed of six memory wires that expand to press against the inner lumen to conform to the size and shape of the lumen. This multiple wire device is expensive and can be traumatic to the graft, possibly causing damage, since as the basket rotates, the graft is contacted multiple times by the spinning wires. Other risks associated with the basket include the possibility of catching onto the graft itself and tearing the graft as well as catching and tearing the suture at the anastomotic site. Additionally, the basket can become filled with a clot which would then require time consuming withdrawal of the basket, cleaning the basket and reinserting it into the lumen. This device could be traumatic if used in the vessel, could denude endothelium, create vessel spasms and has the potential for basket and drive shaft fracture.
U.S. Pat. No. 6,090,118, incorporated herein by reference in its entirety, discloses a wire rotated to create a standing wave to break-up or macerate thrombus. The single wire is less traumatic than the aforedescribed basket device since it minimizes contact with the graft wall while still effectively mechanically removing thrombotic material.
U.S. Pat. No. 7,037,316 discloses another example of a rotational thrombectomy wire for breaking up clots in grafts. The thrombectomy wire has a sinuous shape at its distal end and is contained within a sheath in a substantially straight non-deployed position. When the sheath is retracted, the distal portion of the wire is exposed to enable the wire to return to its non-linear sinuous configuration. The wire is composed of two stainless steel wires wound side by side with an elastomeric tip at the distalmost end. Actuation of the motor causes rotational movement of the wire, creating a wave pattern, to macerate thrombus. Thus, it provides the additional advantages of increased reliability and consistency in creating the wave pattern since the wave pattern created by the standing wave of the '118 patent will depend more on the rotational speed and the stiffness of the wire. Additionally, the sinuous configuration enables creation of a wave pattern at a lower rotational speed.
Although the sinuous wire of the '316 patent is effective in proper clinical use to macerate thrombus in dialysis grafts, it is not best suited for use in native vessels. U.S. Pat. No. 7,819,887, the entire contents of which are incorporated herein by reference, discloses a thrombectomy wire better suited for use in native vessels (and can also be used for deep vein thrombosis and pulmonary embolisms).
In neurovascular thrombectomy procedures, the thrombectomy wire needs to navigate tortuous vessels. That is, the wire is inserted through femoral artery and then must navigate small and tortuous vessels as it is advanced to the smaller cerebral arteries of the brain. Within the brain, the carotid and vertebrobasilar arteries meet to form the circle of Willis. From this circle, other arteries, e.g., the anterior cerebral artery, the middle cerebral artery and the posterior cerebral artery, arise and travel to various parts of the brain. Clots formed in these cerebral arteries can cause stroke and in certain instances death of the patient.
Due to the size and curves of the vessels en route to the cerebral arteries from the femoral artery, as well as the size and structure of cerebral arteries themselves, access is difficult. If the thrombectomy device is too large then navigation through the small vessels, which can be as small as 1 mm, would be difficult. Also, if the device is too stiff, then it can damage the vessel walls during insertion. On the other hand, if the device is too flexible, it will lack sufficient rigidity to be advanced around the vessel curves and can be caught in the vessel. Consequently, it would be advantageous to provide a thrombectomy device for breaking cerebral clots that strikes the optimal balance of flexibility and stiffness, thus effectively having the insertability of a tracking guidewire while enabling high speed rotation to effectively macerate clots without damaging vessels.
The present invention advantageously provides in one aspect a rotational thrombectomy wire for breaking up vascular thrombus or other obstructive material. The wire comprises a core having a proximal region and a distal region and being rotatable by a motor, the distal region having a smaller diameter than the proximal region. A cable is coupled to the distal region of the core and extends distally thereof. A torque tube is positioned over the cable and a coil is positioned over a distal portion of the cable. The distal portion of the cable has a non-linear configuration. A first covering material is positioned over the coil.
In some embodiments, a hypotube couples a distal end of the core to a proximal end of the cable. A second covering material can cover the torque tube. A heat shrink can cover the first covering material. In some embodiments, the second covering material overlies a portion of the core and extends to a region proximal of the first covering material.
In some embodiments, the non-linear distal region of the cable is sinuous in configuration. In other embodiments, the non-linear distal end of the cable is J-shaped in configuration.
In some embodiments, the wire is removably coupled at a proximal end to a motor drive shaft. The wire can be movable within a lumen of a housing, the housing having a suction port extending therefrom and communicating with the lumen.
In another aspect, the present invention provides an assembly for breaking up vascular thrombus or other obstructive material comprising an introducer sheath having a lumen, a rotational thrombectomy wire slidable within the lumen of the introducer sheath, and a connector having a distal portion connectable to the introducer sheath and a proximal portion connectable to a motor housing, the wire operably connectable to a motor positioned within the motor housing.
The wire can comprise a core having a distal region with a smaller diameter than the proximal region. The wire can further include a cable extending distally of the core, a coil attached to a distal portion of the cable and a first covering material positioned over the coil. In some embodiments, a portion of the cable assumes a non-linear shape when exposed.
A housing having a first lumen can be provided, with the introducer sheath connectable to the housing and insertable through the first lumen. In some embodiments, the housing can include a suction arm having a second lumen, with the second lumen configured to remove particles removed by rotation of the wire. The assembly can further include a catheter extending distally of the housing wherein exposure of the wire from the catheter enables a distal portion of the wire to assume a non-linear configuration. The assembly can further include a motor housing.
In another aspect, the present invention provides a method for removing thrombus in a cerebral artery of a patient comprising the steps of:
introducing a guidewire and a first catheter into the femoral artery;
advancing the first catheter through the vascular system;
removing the guidewire;
providing a housing and a second catheter extending distally from the housing;
providing an introducer sheath;
connecting the introducer sheath to the housing;
inserting a rotational thrombectomy wire through the introducer sheath and through the second catheter;
advancing the thrombectomy wire within the catheter to access the cerebral artery;
subsequently operably coupling a motor to the proximal end of the thrombectomy wire; and
activating the motor to rotate the thrombectomy wire to macerate thrombus in the cerebral artery.
In some embodiments, the step of advancing the thrombectomy wire to the cerebral artery includes the step of inserting the thrombectomy wire into the circle of Willis. The method may further include the step of providing a connector tube and attaching a proximal end of the connector tube to a motor housing and a distal end of the connector tube to the introducer sheath. The method may also include the step of providing a vacuum to remove particles from the artery.
Preferred embodiment(s) of the present disclosure are described herein with reference to the drawings wherein:
Referring now in detail to the drawings where like reference numerals identify similar or like components throughout the several views,
The thrombectomy apparatus of
The thrombectomy apparatus or assembly 10 disclosed herein provides a rotational thrombectomy wire as a separate unit from a catheter. That is, the thrombectomy wire 30 is provided as a separate unit insertable through the RHV 40. The RHV 40 has a distal end 52 connected to a proximal end of the introducer catheter 100 to access the surgical site. The introducer sheath 60 aids insertion of the thrombectomy wire into the RHV 40 and through the introducer catheter, with the walls of the introducer sheath 60 maintaining the non-linear distal end of the wire 30 in a substantially straightened (substantially linear) configuration as it enters the RHV 40.
Additionally, the thrombectomy wire 30 of the present invention can be slid within the introducer sheath 60 and introducer catheter 100 prior to connection to the motor, if desired. This can aid introduction and manipulation of the wire 30 since it is less cumbersome and of lighter weight than if the motor housing was attached during manipulation of the wire. However, it is also contemplated that the wire 30 could be attached to the motor housing 12 prior to insertion through the introducer sheath 60, RHV 40 and the introducer catheter 100 and thus the wire 30 would be slidable within the introducer sheath 60 (and introducer catheter 100) with the motor housing 12 attached. Thus, the motor housing 12 can be attached to the wire at a desired time prior to or during the procedure.
Turning to the specific components of the thrombectomy apparatus 10, and with reference to
Motor housing 12 includes a distal tubular portion 22 having a tab in the form of a ring 24 which fits within a groove in the tube connector 80, best shown in
Switch 19 extends though recess 21 in housing half 13a and in a corresponding recess in housing half 13b. A potentiometer (not shown) can optionally be wired to the motor to enable dialing the motor speed up or down to adjust the rotational speed of the thrombectomy wire 30 to adjust for various procedures and/or clot locations and sizes. In a preferred embodiment, the potentiometer is used as a two terminal variable resistor, i.e. a rheostat, by not connecting the third terminal. In this manner, in the initial position, the motor speed is at the desired minimum and rotation of a knob (or in alternate embodiments sliding of a knob) progressively increases the motor speed. Thus, the on/off switch 19 extending from the housing 12 is electrically connected to the motor 14 to turn on the motor 14 to activate the apparatus, i.e. rotate the wire 30.
Turning to the other components illustrated in
Side arm 56 extends from the tubular portion 46 of RHV 40 and has a port 57 for introduction of fluids and/or application of vacuum as described below. Luer lock is provided at the distal end 52 of RHV 40 to connect to the introducer catheter 100 as internal threads 51a of rotation knob 51 threadingly engage external proximal threads of the introducer catheter 100. Tube extension 48 fits within the lumen of the introducer catheter 100 when attached. Washers 49a, 49b help to provide a seal against fluid flow.
Tubular portion 46 of RHV 40 includes a lumen 55 extending therethrough to slidably receive the tubular portion 62 of the introducer sheath 60. Proximal cap 58 at proximal end 54 has internal threads 59 to threadingly attach to external proximal threads 47 of RHV 40 for attachment of the cap 58 to the RHV 40. Further, a crush ring 43 and distal ring 44 are seated within the internal lumen 55 of the tubular portion 46. Thus, as cap 58 is tightened on RHV 40 by rotation, it compresses rings 43 and 44 against the tubular portion 62 of introducer sheath 60 extending therethrough to connect the introducer sheath 60 to the RHV 40. A proximal seal 45 can also be provided. Flange 46a on the proximal end 54 of RHV 40 interacts with lip 58a of cap 58 to allow loosening of cap 58 to release introducer sheath 60 without cap 58 detaching from RHV 40.
Side arm 56 of RHV 40 has a lumen 53 (
The side arm 56 can also be used for vacuum to suction particles detached from the vessel by the rotational wire 30. The particles would flow into the distal opening 103 of the introducer catheter 100 and through the space between the wire 30 and the inner wall of the introducer catheter 100, continuing through lumen 55 and then exiting through lumen 53 and port 57 into a suction tube (not shown).
It should also be appreciated that the guide catheter 150 discussed in conjunction with the method of use below can also have a side arm for injection of fluid (see e.g. side arm 152 of
In the alternate embodiment of
The tubular portion 62 of introducer sheath 60, as noted above, extends through the lumen 55 of RHV 40 and terminates either within RHV 40 or at a proximal portion of the lumen of the introducer catheter 100. The tubular portion 62 preferably has a stiffness greater than the stiffness of the thrombectomy wire 30 to maintain the wire 30 in a straightened position during passage of wire 30 into the RHV 40 for subsequent passage through the lumen of the introducer catheter 100 to the surgical site.
Proximal end 65 of introducer sheath 60 is attachable to connector tube 80. Preferably, the enlarged proximal end 65 has a threaded flange 67 as shown in
Note the tube 80 and introducer sheath 60 can alternatively be provided as one unit, attached together and positioned over the thrombectomy wire 30 as an attached unit. However, in alternative embodiments, the wire 30 is inserted through the introducer sheath 60 and manipulated through the introducer catheter 100 to the surgical site. Once positioned, the connector tube 80 is then threadingly attached at the distal end 82 to the introducer sheath 60 as noted above and at a proximal end 84 to the motor housing 12. In this version, the connector tube 80 can be positioned over the wire 30 prior to insertion of the wire 30 through introducer sheath 60 or after insertion through the sheath 60. The wire 30 can be packaged with the sheath 60 and the tube 80 positioned thereover, or packaged apart from the sheath 60 and tube 80.
Proximal end 84 of connector tube 80 is configured for attachment to the motor housing 12 by an external ring 24 on tip 22 of motor housing 12. Ring 24 is seated within an internal groove of connector tube 80, as shown in
As can be appreciated, by having a detachable motor housing 12, different handles with different motor speeds and/or different batteries can be utilized by attachment to the wire 30. This can even be achieved during the same surgical procedure.
In some embodiments, the housing can be detached, sterilized and reused after recharging of the battery or replacing the battery.
In some embodiments, as an alternative to direct connection to the motor shaft, the proximal end of wire 30, after insertion to the surgical site or prior to insertion, can be attached at a proximal end to a coupler tube which is connected to a gear reducer. The connection can be a friction fit, a magnetic coupling or a twist connect, e.g. a bayonet connection, by way of example.
In the embodiment of
When the wire 30 is fully retracted within the introducer catheter 100 (as in
Thus, as can be appreciated, the wire 30 is advanced within the introducer catheter 100 which is attached at its proximal end to the distal end of the RHV 40. When at the desired site, the wire 30 and introducer catheter 100 are relatively moved to expose the wire 30 to assume its non-linear shape for motorized rotational movement to break up thrombotic material on the vessel wall. If a J-tip wire, such as wire 130 of
The flexible tubular portion 62 of the introducer sheath 60 can optionally contain one or more braided wires embedded in the wall to increase the stiffness. Such braided wires would preferably extend the length of the sheath 60.
In an embodiment of the coiled tip being composed of shape memory material, the memorized configuration is sinuous or s-shape as in
Details of the wire 30 will now be described with reference to
Wire 30 has a core 32 having a proximal portion 34 (see
The core 32 is connected to a cable 90. The cable 90 can be formed of a plurality of wires twisted together such as a 1×19 wire for example. The twisted wires can be surrounded by additional wires or a sheath. The core 32 is tapered to accommodate connection to cable 90. Hypotube 92 is placed over the distalmost end of the core 32 (the uniform diameter portion 37a) and the proximalmost end of the cable 90 and is attached thereto by a number of methods, including but not limited to, laser welding, soldering or crimping. The hypotube 92 thereby forms a coupler for joining the core 32 and cable 90 as these components are positioned within the hypotube 92. The hypotube can have a diameter of about 0.010 inches, although other dimensions are contemplated.
The cable 90 in one embodiment has a variable stiffness such that the proximal portion 94 is stiffer, e.g. has a tighter braid, than a distal portion 96 to increase the flexibility of the distal portion 96. In other embodiments, the cable 90 is of uniform stiffness. The cable 90 can be of substantially uniform diameter. Various covering materials, e.g. coating, jackets and/or shrink wraps, can be used as an alternative or in addition to vary the stiffness of the cable 90.
A torque tube 97 is positioned over the cable 90. The torque tube 97 extends distally from a tapered region of the core 32, terminating at the distal coil 91. The torque tube 97 can be soldered at (proximal) end 97a to the core 32 and at a distal region 97b (e.g. at a distal end) to the cable 90. The torque tube 97 can also be attached, e.g. soldered or laser welded, to a proximal end of the coil.
A polymer coating(s) and/or jacket(s) can be placed over the torque tube 97 to cover the interstices in the cable 90 and provide a smooth surface. In one embodiment, a PTFE shrink wrap tubing 98 is placed over the torque tube 97 and over a portion of the core 32, preferably extending over the tapered transition region 38 of core 32 to terminate at a proximal end adjacent the uniform diameter region of the core 32. At a distal end, the shrink wrap 98 terminates at the end where the torque tube 97 terminates.
Coiled tip 91 is positioned over a distal portion of the cable 90, and preferably over the distal tip. The coil 91 in one embodiment is composed of a soft and malleable material such as platinum and has a uniform pitch and diameter. The distalmost tip of the cable 90 can have a laser welded ball to which the coil 91 is welded to enhance retention of the coil 91 and cable 90. The coiled tip region has a substantially sinuous configuration. In an alternate embodiment, the coiled tip region has a J-tip configuration, as shown for example in
By way of example only, the components of wire 30 can have the approximate dimensions set forth in the table below. It should be understood that these dimensions are being provided by way of example as other dimensions are also contemplated. These are also approximate values.
The covering material, e.g. coating, jackets, and or shrink wraps, helps to prevent bending or knotting of the wire which could otherwise occur in native vessels. The covering also increases the torsional strength of the wire and also strengthens the wire to accommodate spasms occurring in the vessel. The coating also blocks the interstices of the coil 91 to provide a less abrasive surface. The various coating and/or jackets and/or shrink wrap can be made of PET, Teflon, Pebax, polyurethane or other polymeric materials. The material helps to prevent the native vessel from being caught in the coil 90 and reduces vessel spasms.
The use of the thrombectomy apparatus 10 will now be described. The use, by way of example is shown and described with respect to the embodiment of
An access sheath (not shown) is inserted into the vessel and then a guidewire e.g. 0.035 or 0.038 inches in diameter, and a guide catheter 150 are inserted through the sheath and advanced through the vasculature. The guidewire is removed and a smaller diameter guidewire G, e.g. 0.014 inch diameter, and the introducer catheter 100 are inserted through the guide catheter 150 and access sheath with the guidewire G in the femoral artery F and located via imaging. The introducer catheter 100 is advanced to the desired site through the vascular system into the cerebral arteries A, for example through the Circle of Willis C (see
Note in an alternate embodiment, instead of the RHV 40 attached prior to introduction of the introducer catheter 100 through the guide catheter 150, it can be attached after introduction of catheter 100 through guide catheter 150.
The introducer sheath 60 is inserted through the RHV 40, and attached to the RHV 40 by rotation of cap 58 as shown in
With the wire 30 exposed from the introducer catheter 100, switch 19 on housing 12 is actuated to turn on the motor 14 thereby causing wire 30 to rotate about its longitudinal axis to break up/macerate thrombus.
The macerated particles can be removed by suction through side arm 56 of RHV 40 as the particles travel in the space between wire 30 and introducer catheter 100 and RHV 40. The introducer catheter 100 can optionally have a side port(s) and/or the guide catheter 150 can optionally have a side port(s) such as side port 152 for aspirating the small macerated particles in addition to or alternative to side arm 56 of RHV 40.
The delivery (access) sheath or delivery catheter 100 can include a balloon (not shown) to block blood flow and allow aspiration in the blocked space.
While the above description contains many specifics, those specifics should not be construed as limitations on the scope of the disclosure, but merely as exemplifications of preferred embodiments thereof. Those skilled in the art will envision many other possible variations that are within the scope and spirit of the disclosure as defined by the claims appended hereto.
This application is a divisional of Ser. No. 13/303,339, filed Nov. 23, 2011 which claims the benefit of provisional application Ser. No. 61/431,169, filed Jan. 10, 2011, and is a continuation in part of Ser. No. 13/095,329, filed Apr. 27, 2011, now U.S. Pat. No. 8,663,259, which claims the benefit of provisional application Ser. No. 61/334,412, filed May 13, 2010. The entire contents each of these applications are incorporated herein by reference.
Number | Name | Date | Kind |
---|---|---|---|
3612058 | Ackerman | Oct 1971 | A |
3749085 | Wilson et al. | Jul 1973 | A |
4038985 | Chiulli | Aug 1977 | A |
4579127 | Haacke | Apr 1986 | A |
4745919 | Bundy | May 1988 | A |
4765332 | Fischell et al. | Aug 1988 | A |
4784636 | Rydell | Nov 1988 | A |
4842579 | Shiber | Jun 1989 | A |
4883460 | Zanetti | Nov 1989 | A |
4895560 | Papantonakos | Jan 1990 | A |
4906244 | Pinchuk et al. | Mar 1990 | A |
4950277 | Farr | Aug 1990 | A |
4979951 | Simpson | Dec 1990 | A |
4984581 | Stice et al. | Jan 1991 | A |
4990134 | Auth | Feb 1991 | A |
5009659 | Hamlin et al. | Apr 1991 | A |
5025799 | Wilson | Jun 1991 | A |
5026384 | Farr et al. | Jun 1991 | A |
5030201 | Palestrant | Jul 1991 | A |
5041082 | Shiber | Aug 1991 | A |
5067489 | Lind et al. | Nov 1991 | A |
5067957 | Jervis | Nov 1991 | A |
5097849 | Kensey | Mar 1992 | A |
5131406 | Kaltenbach | Jul 1992 | A |
5192268 | Shiber | Mar 1993 | A |
5192290 | Hilal | Mar 1993 | A |
5203772 | Hammerslag et al. | Apr 1993 | A |
5211183 | Wilson | May 1993 | A |
5213111 | Cook | May 1993 | A |
5217026 | Stoy | Jun 1993 | A |
5251640 | Osborne | Oct 1993 | A |
5253653 | Daigle | Oct 1993 | A |
5261877 | Fine et al. | Nov 1993 | A |
5273526 | Dance | Dec 1993 | A |
5299580 | Atkinson | Apr 1994 | A |
5312427 | Shturman | May 1994 | A |
5313967 | Lieber | May 1994 | A |
5314407 | Auth et al. | May 1994 | A |
5314438 | Shturman | May 1994 | A |
5333620 | Moutafis et al. | Aug 1994 | A |
5341818 | Abrams | Aug 1994 | A |
5345945 | Hodgson | Sep 1994 | A |
5356418 | Shturman | Oct 1994 | A |
5372144 | Martier | Dec 1994 | A |
5376100 | Lefebvre | Dec 1994 | A |
5383460 | Jang et al. | Jan 1995 | A |
5395311 | Andrews | Mar 1995 | A |
5395384 | Duthoit | Mar 1995 | A |
5429136 | Milo et al. | Jul 1995 | A |
5431673 | Summers et al. | Jul 1995 | A |
5452726 | Burmeister | Sep 1995 | A |
5490859 | Mische | Feb 1996 | A |
5501694 | Ressemann et al. | Mar 1996 | A |
5514128 | Hillsmon | May 1996 | A |
5529580 | Kusunoki et al. | Jun 1996 | A |
5536242 | Willard et al. | Jul 1996 | A |
5540707 | Resseman et al. | Jul 1996 | A |
5551443 | Sepetka | Sep 1996 | A |
5556408 | Farhat | Sep 1996 | A |
5562275 | Weissenfluh | Oct 1996 | A |
5569179 | Adrian et al. | Oct 1996 | A |
5569275 | Kotula et al. | Oct 1996 | A |
5584843 | Wulfman | Dec 1996 | A |
5605162 | Mirzaee | Feb 1997 | A |
5609602 | Machemer et al. | Mar 1997 | A |
5611807 | O'Boyle | Mar 1997 | A |
5634897 | Dance | Jun 1997 | A |
5653722 | Kieturakis | Aug 1997 | A |
5695506 | Pike et al. | Dec 1997 | A |
5712543 | Sjostrom | Jan 1998 | A |
5746701 | Noone | May 1998 | A |
5749885 | Sjostrom et al. | May 1998 | A |
5762637 | Berg et al. | Jun 1998 | A |
5766191 | Trerotola | Jun 1998 | A |
5797856 | Frisbie et al. | Aug 1998 | A |
5833631 | Nguyen | Nov 1998 | A |
5836868 | Ressemann et al. | Nov 1998 | A |
5836893 | Urick | Nov 1998 | A |
5840046 | Deem | Nov 1998 | A |
5843103 | Wulfman | Dec 1998 | A |
5879361 | Nash | Mar 1999 | A |
5885227 | Finlayson | Mar 1999 | A |
5895399 | Barbut | Apr 1999 | A |
5897567 | Ressemann et al. | Apr 1999 | A |
5902263 | Patterson | May 1999 | A |
5902268 | Saab | May 1999 | A |
5906627 | Spaulding | May 1999 | A |
5910364 | Miyata | Jun 1999 | A |
5916166 | Reiss | Jun 1999 | A |
5924998 | Cornelius | Jul 1999 | A |
5938623 | Quiachon | Aug 1999 | A |
5938645 | Gordon | Aug 1999 | A |
5957941 | Ream | Sep 1999 | A |
5971991 | Sunderland | Oct 1999 | A |
5984877 | Fleischhacker, Jr. | Nov 1999 | A |
6004279 | Crowley | Dec 1999 | A |
6007533 | Casscells et al. | Dec 1999 | A |
6019736 | Avellanet | Feb 2000 | A |
6022363 | Walker | Feb 2000 | A |
6024749 | Shturman et al. | Feb 2000 | A |
6059745 | Gelbfish | May 2000 | A |
6077282 | Shturman et al. | Jun 2000 | A |
6080117 | Cornelius | Jun 2000 | A |
6080170 | Nash et al. | Jun 2000 | A |
6083198 | Afzal | Jul 2000 | A |
6090118 | McGuckin, Jr. | Jul 2000 | A |
6090123 | Culp et al. | Jul 2000 | A |
6096001 | Drasler et al. | Aug 2000 | A |
6106485 | McMahan | Aug 2000 | A |
6113614 | Mears | Sep 2000 | A |
6120515 | Rogers et al. | Sep 2000 | A |
6126635 | Simpson | Oct 2000 | A |
6143009 | Shiber | Nov 2000 | A |
6165140 | Ferrera et al. | Dec 2000 | A |
6168570 | Ferrera et al. | Jan 2001 | B1 |
6185449 | Berg | Feb 2001 | B1 |
6206898 | Honeycutt et al. | Mar 2001 | B1 |
6217589 | McAlister | Apr 2001 | B1 |
6217595 | Shturman | Apr 2001 | B1 |
6251085 | Tezuka | Jun 2001 | B1 |
6251086 | Cornelius | Jun 2001 | B1 |
6251121 | Saadat | Jun 2001 | B1 |
6254550 | McNamara | Jul 2001 | B1 |
6309399 | Barbut et al. | Oct 2001 | B1 |
6319242 | Patterson et al. | Nov 2001 | B1 |
6319262 | Bates et al. | Nov 2001 | B1 |
6322572 | Lee | Nov 2001 | B1 |
6328752 | Sjostrom et al. | Dec 2001 | B1 |
6371928 | Mcfann | Apr 2002 | B1 |
6398773 | Bagaoisan et al. | Jun 2002 | B1 |
6413222 | Pantages et al. | Jul 2002 | B1 |
6432066 | Ferrera et al. | Aug 2002 | B1 |
6451036 | Heitzmann et al. | Sep 2002 | B1 |
6454717 | Pantages et al. | Sep 2002 | B1 |
6454775 | Demarais et al. | Sep 2002 | B1 |
6454779 | Taylor | Sep 2002 | B1 |
6458127 | Truckai et al. | Oct 2002 | B1 |
6475222 | Berg et al. | Nov 2002 | B1 |
6475224 | Pantages et al. | Nov 2002 | B1 |
6475226 | Belef | Nov 2002 | B1 |
6482215 | Shiber | Nov 2002 | B1 |
6482217 | Pintor et al. | Nov 2002 | B1 |
6485482 | Belef | Nov 2002 | B1 |
6491660 | Guo et al. | Dec 2002 | B2 |
6494890 | Shturman | Dec 2002 | B1 |
6508782 | Evans | Jan 2003 | B1 |
6508825 | Selmon et al. | Jan 2003 | B1 |
6517528 | Pantages et al. | Feb 2003 | B1 |
6517560 | Toth et al. | Feb 2003 | B1 |
6565588 | Clement et al. | May 2003 | B1 |
6569147 | Evans et al. | May 2003 | B1 |
6572630 | McGuckin | Jun 2003 | B1 |
6579246 | Jacobson | Jun 2003 | B2 |
6579299 | McGuckin | Jun 2003 | B2 |
6602207 | Mam | Aug 2003 | B1 |
6602262 | Griego et al. | Aug 2003 | B2 |
6602264 | McGuckin | Aug 2003 | B1 |
6620114 | Urba | Sep 2003 | B2 |
6620179 | Boock | Sep 2003 | B2 |
6632230 | Barry | Oct 2003 | B2 |
6648337 | Baehl | Nov 2003 | B1 |
6652480 | Imran et al. | Nov 2003 | B1 |
6652546 | Nash | Nov 2003 | B1 |
6660014 | Demarais | Dec 2003 | B2 |
6663613 | Evans et al. | Dec 2003 | B1 |
6666874 | Heitzmann et al. | Dec 2003 | B2 |
6669652 | Anderson | Dec 2003 | B2 |
6673025 | Richardson | Jan 2004 | B1 |
6685718 | Wyzgala et al. | Feb 2004 | B1 |
6689089 | Tiedtke et al. | Feb 2004 | B1 |
6702830 | Demarais et al. | Mar 2004 | B1 |
6719717 | Johnson et al. | Apr 2004 | B1 |
6746462 | Selmon et al. | Jun 2004 | B1 |
6767353 | Shiber | Jul 2004 | B1 |
6790215 | Findlay | Sep 2004 | B2 |
6805676 | Klint | Oct 2004 | B2 |
6805684 | Bonnette et al. | Oct 2004 | B2 |
6818001 | Wulfman et al. | Nov 2004 | B2 |
6824545 | Sepetka et al. | Nov 2004 | B2 |
6830577 | Nash et al. | Dec 2004 | B2 |
6881194 | Miyata et al. | Apr 2005 | B2 |
6911016 | Balzum et al. | Jun 2005 | B2 |
6926725 | Cooke et al. | Aug 2005 | B2 |
6929633 | Evans et al. | Aug 2005 | B2 |
7037316 | McGuckin, Jr. et al. | May 2006 | B2 |
7074197 | Reynolds et al. | Jul 2006 | B2 |
7115101 | Cornelius et al. | Oct 2006 | B2 |
7150756 | Levinson et al. | Dec 2006 | B2 |
7169118 | Reynolds | Jan 2007 | B2 |
7172610 | Heitzmann et al. | Feb 2007 | B2 |
7179269 | Welch et al. | Feb 2007 | B2 |
7220269 | Ansel et al. | May 2007 | B1 |
7309318 | Cassell et al. | Dec 2007 | B2 |
7399307 | Evans et al. | Jul 2008 | B2 |
7407506 | Makower | Aug 2008 | B2 |
7434437 | Kato | Oct 2008 | B2 |
7462187 | Johnston et al. | Dec 2008 | B2 |
7470239 | Rooney et al. | Dec 2008 | B1 |
7473263 | Johnston et al. | Jan 2009 | B2 |
7488322 | Brunnett | Feb 2009 | B2 |
7494468 | Rabiner et al. | Feb 2009 | B2 |
7494687 | Cox | Feb 2009 | B2 |
7507246 | McGuckin et al. | Mar 2009 | B2 |
7517351 | Culp et al. | Apr 2009 | B2 |
7575585 | Goto et al. | Aug 2009 | B2 |
7621880 | Ryan et al. | Nov 2009 | B2 |
7628763 | Noriega et al. | Dec 2009 | B2 |
7645242 | Jalisi et al. | Jan 2010 | B1 |
7645261 | Hinchliffe | Jan 2010 | B2 |
7655016 | Demarais et al. | Feb 2010 | B2 |
7744545 | Aimi et al. | Jun 2010 | B2 |
7762962 | Mishima | Jul 2010 | B2 |
7763010 | Evans et al. | Jul 2010 | B2 |
7776062 | Besselink et al. | Aug 2010 | B2 |
7780650 | Frassica et al. | Aug 2010 | B2 |
7794414 | Rabiner et al. | Sep 2010 | B2 |
7819887 | McGuckin et al. | Oct 2010 | B2 |
7824345 | Euteneuer et al. | Nov 2010 | B2 |
7862575 | Tal | Jan 2011 | B2 |
7878935 | Lahr | Feb 2011 | B2 |
7878985 | Cornish et al. | Feb 2011 | B2 |
7883474 | Mirigian et al. | Feb 2011 | B1 |
8062317 | McGuckin et al. | Nov 2011 | B2 |
8246641 | Osborne et al. | Aug 2012 | B2 |
8414543 | McGuckin et al. | Apr 2013 | B2 |
20010009980 | Richardson et al. | Jul 2001 | A1 |
20010031981 | Evans | Oct 2001 | A1 |
20020013548 | Hinchliffe | Jan 2002 | A1 |
20020058956 | Honeycutt et al. | May 2002 | A1 |
20020095102 | Winters | Jul 2002 | A1 |
20020143350 | Heitzmann et al. | Oct 2002 | A1 |
20020165567 | Shiber | Nov 2002 | A1 |
20020173812 | McGuckin, Jr. | Nov 2002 | A1 |
20030023190 | Cox | Jan 2003 | A1 |
20030139750 | Shinozuka et al. | Jul 2003 | A1 |
20030181828 | Fujimato | Sep 2003 | A1 |
20030191483 | Cooke et al. | Oct 2003 | A1 |
20030216668 | Howland | Nov 2003 | A1 |
20040030266 | Murayama | Feb 2004 | A1 |
20040073243 | Sepetka | Apr 2004 | A1 |
20040167436 | Reynolds | Aug 2004 | A1 |
20040167442 | Shireman | Aug 2004 | A1 |
20040167443 | Shireman | Aug 2004 | A1 |
20040181175 | Clayman | Sep 2004 | A1 |
20040193073 | DeMello | Sep 2004 | A1 |
20050004517 | Courtney | Jan 2005 | A1 |
20050054951 | Parins | Mar 2005 | A1 |
20050055040 | Tal | Mar 2005 | A1 |
20050137501 | Euteneuer et al. | Jun 2005 | A1 |
20050240146 | Nash et al. | Oct 2005 | A1 |
20060074441 | McGuckin, Jr. et al. | Apr 2006 | A1 |
20060106407 | McGuckin, Jr. et al. | May 2006 | A1 |
20060142793 | Prudnikov et al. | Jun 2006 | A9 |
20060276814 | Omata et al. | Dec 2006 | A1 |
20070060911 | Webster et al. | Mar 2007 | A1 |
20070088323 | Campbell et al. | Apr 2007 | A1 |
20070161963 | Smalling | Jul 2007 | A1 |
20070219484 | Straub | Sep 2007 | A1 |
20070239182 | Glines et al. | Oct 2007 | A1 |
20070250096 | Yamane et al. | Oct 2007 | A1 |
20070282359 | Tal | Dec 2007 | A1 |
20070282539 | Metcalf | Dec 2007 | A1 |
20080091223 | Pokorney et al. | Apr 2008 | A1 |
20080103516 | Wulfman et al. | May 2008 | A1 |
20080188793 | Kozak et al. | Aug 2008 | A1 |
20080208233 | Barnes et al. | Aug 2008 | A1 |
20080228208 | Wulfman et al. | Sep 2008 | A1 |
20080300532 | Bonnette et al. | Dec 2008 | A1 |
20080319462 | Montague et al. | Dec 2008 | A1 |
20090018567 | Escudero et al. | Jan 2009 | A1 |
20090048537 | Lydon et al. | Feb 2009 | A1 |
20090062773 | Cornish | Mar 2009 | A1 |
20090112127 | Keating et al. | Apr 2009 | A1 |
20090138031 | Tsukernik | May 2009 | A1 |
20090143702 | Fleischhacker | Jun 2009 | A1 |
20090209987 | Mathews et al. | Aug 2009 | A1 |
20090227900 | Kim et al. | Sep 2009 | A1 |
20090234378 | Escudero et al. | Sep 2009 | A1 |
20090270791 | Todd | Oct 2009 | A1 |
20090306546 | Knapp | Dec 2009 | A1 |
20090318835 | Ressemann et al. | Dec 2009 | A1 |
20100004561 | Nabeshima | Jan 2010 | A1 |
20100004562 | Jalisi et al. | Jan 2010 | A1 |
20100049225 | To et al. | Feb 2010 | A1 |
20100069794 | Uihlein | Mar 2010 | A1 |
20100094201 | Mallaby | Apr 2010 | A1 |
20100168619 | Elsesser | Jul 2010 | A1 |
20100211087 | Osborne | Aug 2010 | A1 |
20100222786 | Kassab | Sep 2010 | A1 |
20100249655 | Lemon | Sep 2010 | A1 |
20100305592 | McGuckin et al. | Dec 2010 | A1 |
20100312263 | Moberg et al. | Dec 2010 | A1 |
20110004107 | Rosenthal et al. | Jan 2011 | A1 |
20110077673 | Grubac et al. | Mar 2011 | A1 |
20110077674 | Sullivan et al. | Mar 2011 | A1 |
20110087254 | Welty | Apr 2011 | A1 |
20110112563 | To et al. | May 2011 | A1 |
20110125176 | Yates et al. | May 2011 | A1 |
20110230862 | Segner et al. | Sep 2011 | A1 |
20110282370 | Levine et al. | Nov 2011 | A1 |
20120035634 | McGuckin et al. | Feb 2012 | A1 |
20120116429 | Levine et al. | May 2012 | A1 |
20120239066 | Levine et al. | Sep 2012 | A1 |
Number | Date | Country |
---|---|---|
1075903 | Feb 1960 | DE |
3804849 | Sep 1988 | DE |
0358825 | Sep 1988 | EP |
0409372 | Feb 1990 | EP |
56020839 | Feb 1981 | JP |
03-186256 | Aug 1991 | JP |
06-197899 | Jul 1994 | JP |
WO-9505209 | Feb 1995 | WO |
WO-9838926 | Sep 1998 | WO |
WO-9923958 | May 1999 | WO |
WO-9956638 | Nov 1999 | WO |
WO 0032265 | Jun 2000 | WO |
WO 2009029430 | Mar 2009 | WO |
Number | Date | Country | |
---|---|---|---|
20140324081 A1 | Oct 2014 | US |
Number | Date | Country | |
---|---|---|---|
61431169 | Jan 2011 | US | |
61334412 | May 2010 | US |
Number | Date | Country | |
---|---|---|---|
Parent | 13303339 | Nov 2011 | US |
Child | 14292923 | US |
Number | Date | Country | |
---|---|---|---|
Parent | 13095329 | Apr 2011 | US |
Child | 13303339 | US |