Patent Grant
11672960
The invention is generally related to expandable implants, devices for delivering and/or crimping implants, and methods of using them.
There is a movement toward using minimally-invasive approaches to treat conditions or diseases associated with bodily structures such as the nasal passageways, sinus cavities, or the like. For example, individuals suffering from nasal polyposis may have obstructed airways or sinus ostia, and may experience symptoms such as difficulty breathing, headaches, sneezing, snoring, and general discomfort. Expandable implants may be useful in maintaining, opening, or dilating bodily structures such as nasal passageways, paranasal sinus cavities, or the like. Given the variety of benefits that these devices may provide, additional expandable devices may be desirable, as well as systems for crimping and/or delivering such implants.
Described here are devices, systems, and methods for treating one or more sinus or nasal conditions. Also described here are devices and methods for crimping an implant. In some variations, the devices may comprise an expandable implant comprising a hub and plurality of filaments. The hub may comprise a plurality of apertures extending through the hub, and each filament of the plurality of filaments may be positioned in a corresponding aperture to extend through the hub. In these variations, placement of a filament in a corresponding aperture may define a first leg on a first side of the hub and a second leg on the second side of the hub. In some variations, the filament may comprise a first straight segment, a second straight segment, and a curved segment positioned between the first straight segment and the second straight segment. In some of these variations, the curved segment of each filament may be positioned in the corresponding aperture to position the first straight segment on the first side of the hub and the second straight segment on the second side of the hub. In some variations, each filament may be an extruded polymer filament. In some variations, the hub and the plurality of filaments may be formed from one or more biodegradable materials. In some variations, the implant may comprise a drug-releasing coating. The implants described here may be delivered to any suitable location, such as a sinus or nasal cavity. In some variations, the methods described here may comprise advancing an implant to a location in a sinus cavity, sinus ostium, or nasal passageway, delivering the implant, and expanding the implant from a low-profile configuration to an expanded configuration.
Described here are methods for crimping an implant. In some variations, the device may comprise a housing and a crimping member. The crimping member may comprise a plurality of arms radially extending from a stem portion, and the housing may comprise a recess, such that movement of the stem portion into the recess may rotate the plurality of arms relative to the stem portion. In some variations, the recess may comprise a central recess and a plurality of channels radially extending from the central recess. In some of these variations, each arm of the plurality of arms may be at least partially positioned within a corresponding channel of the plurality of channels. In some variations, the device may further comprise a spring positioned between the stem portion and the recess. Additionally or alternatively, each arm of the plurality of arms may comprise at least one holder having a channel. In some variations the stem portion may comprise a recess configured to receive a portion of the implant.
Also described here are systems for treating a patient comprising an implant and a crimping device. The implant may comprise a plurality of legs, and in some instances may further comprise a hub attaching the plurality of legs. The crimping device may comprise a crimping member, which may be configured to engage the plurality of legs and move the implant to a low-profile configuration. In some instances, each leg of an implant may be engaged by a correspond arm of a crimping member of the crimping device. The crimping member may be moved into a recess of a housing of the crimping member to rotate the plurality of arms relative to a stem portion of the crimping device. This rotation of the arms may rotate the corresponding legs of the implant to move the implant to a low-profile configuration. In some variations, a delivery device may be used to push the crimping member into the recess of the housing. In some of these variations, a portion of the delivery device may be advanced to hold the implant in a low-profile configuration.
In some variations, a crimping device may comprise a housing, the housing defining a crimping chamber having a proximal end and distal end, the crimping chamber having a proximal opening at the proximal end of the crimping chamber. The crimping device may further comprise a plurality of ribs located within the crimping chamber, wherein the plurality of ribs defines a plurality of channels between adjacent ribs of the plurality of ribs. The crimping chamber may comprise a first segment and a second segment, wherein the first segment extends from the proximal opening to a proximal end of the second segment. In some of these variations, the first segment may have an outer diameter which tapers from a first diameter at a proximal end of the first segment to a second diameter at a distal end of the first segment, wherein the first diameter is larger than the second diameter. In some of these variations, the second segment may have an outer diameter equal to the second diameter.
In some variations, the crimping chamber may further comprise a third segment, wherein the second segment extends distally from a distal end of the second segment. In some of these variations, the third segment may have an outer diameter equal to an outer diameter of the second segment. Additionally or alternatively, the inner diameter of the second segment is equal to an outer diameter of the second segment. Additionally or alternatively, the third segment has an inner diameter smaller than an inner diameter of the second segment. In some variations the system may further comprise a delivery device having an inner shaft and an outer sheath. In some of these variations, an outer diameter of a distal end of the outer sheath may be less than or equal to the inner diameter of the second segment and greater than the inner diameter of the third segment.
In some variations, the plurality of ribs and plurality of channels extend at least partially through each of the first, second, and third segments. In other variations, the plurality of ribs and the plurality of channels may comprise a first plurality of ribs and a first plurality of channels extending at least partially through first segment and a second plurality of ribs extends and a second plurality of channels extending at least partially along the third segment. In some variations, the system may further comprise an implant, wherein the implant comprises a hub and a plurality of legs extending from the hub and wherein the implant is moveable from an expanded configuration to a low-profile configuration. The first segment and second segment may be sized such that advancement of the hub from the first segment into the second segment crimps the implant from the expanded configuration to the low-profile configuration. In some variations the crimping device may further comprise a cap removably connected to the housing. In some variations, the housing may further comprise a base.
Described here are devices, systems, and methods for treating one or more sinus or nasal conditions with an implant. Also described here are devices and methods for crimping an implant. Generally, the systems comprise an implant sized and configured for placement in one or more portions of the paranasal sinus or nasal cavities. The implant may be delivered in a low-profile configuration, and may be expanded in the paranasal sinus or nasal cavity to dilate, separate, or otherwise press against tissue, which in some instances may assist in opening an airway of a patient. The implant may be configured to deliver or release one or more drugs (e.g., to surrounding tissue). In some variations, the systems may comprise a delivery device for delivering the implant into the body. Additionally or alternatively, the systems may comprise a crimping device configured to place the implant in a low-profile configuration.
Generally, the hub (102) may act as a junction to join the plurality of legs (103). In some instances the hub (102) may help facilitate advancement of the implant (100) through tissue (e.g., by separating tissue as the hub (102) is advanced therethrough), and/or may be configured to pierce tissue and/or at least partially anchor the implant (100) relative to tissue, as will be discussed in more detail below.
Additionally, while the hub (102) is shown in
Generally, the plurality of legs (103) of the implant may be formed from a plurality of filaments (104) that are attached to the hub (102).
To attach the filaments (104) to the hub (102), each filament (104) may be advanced through a respective aperture (112) and positioned such that a portion of the filament (104) extends through the hub (102). For example,
The filament (104) may be positioned such that any suitable portion of the filament extends through the hub (102). For example, in the variation shown in
The implant (100) may comprise any number of filaments (104). When the filaments (104) are positioned to extend through a hub (102), the filaments (104) may in turn define twice as many legs (103). For example, in some variations the implant (100) may comprise two filaments (104), which may define four legs (103) when the filaments (104) are positioned to extend through the hub (102). In other variations, the implant (100) may comprise three filaments (104), which may define six legs (103) when the filaments (104) are positioned to extend through the hub (102). In yet other variations, such as the variation shown in
Generally, each leg (103) of the implant (100) may have any suitable length between the proximal and distal end of the leg. In some variations all of the legs (103) may have the same length. This length may be any suitable value, for example, about between about 15 mm and about 30 mm. In some of these variations, each leg (103) may have a length between about 20 mm and about 25 mm. In some of these variations, each leg (103) may have a length of about 20 mm. In others of these variations, each leg (103) may have a length of about 25 mm. In other variations, different legs (103) of the implant may have different lengths between proximal and distal ends of the respective legs. In some of these variations, the implant may comprise a first plurality of legs having a first length between proximal and distal ends of each leg of the first plurality of legs and the a second plurality of legs having a second length between proximal and distal ends of each leg of the second plurality of legs, wherein the second length is longer than the first length. For example, in some variations the first length may be about 20 mm and the second length may be about 25 mm. In some variations where the implant (100) comprises a first plurality of legs having a first length and a second plurality of legs having a second length, the first and second plurality of legs are rotationally oriented such that the legs (103) of the implant alternate between legs of the first plurality of legs and the second plurality of legs (e.g., each leg of the first plurality of legs may be rotationally positioned between two legs of the second plurality of legs). While the number of legs in the first plurality of legs may be equal to the number of legs in the second plurality of legs, it should be appreciated that the first plurality of legs may have more legs than the second plurality of legs, or may have fewer legs than the second plurality of legs.
Generally, the filaments (104) may have any suitable cross-sectional shape. For example, in the variation shown in
The implants (100) described above may be formed in any suitable manner. Generally, forming the implant may comprise forming a hub comprising a plurality of apertures extending therethrough, forming a plurality of filaments, and advancing each filament through a respective aperture such that a portion of the filament extends through the hub. The hub and filaments may be formed in any suitable manner (e.g., extrusion, injection-molding, blow-molding, vacuum-formation, casting, or the like), and the hub and filaments may be formed using the same processing techniques or different processing techniques. In some variations, forming the plurality of filaments may comprise extruding the plurality of polymer filaments. In some of these variations, forming the hub may comprise forming the hub using injection molding. In others of these variations, forming the hub may comprise extruding the hub. In others of these variations, the hub may be formed from a laser-cut tube.
Additionally, in some variations, forming the plurality of filaments may include shaping each filament such that the filament comprises one or more straight and/or curved segments, such as discussed above. For example, in some of these variations, some or all of the filaments may be shaped such that the filaments have a first straight portion, a second straight portion, and a curved segment between the first and second straight portions. In some of these variations, advancing each filament through a respective aperture in the hub may include positioning a filament in the aperture such that the curved segment extends through the hub. In some variations, once the filaments have been advanced through the hub, the filaments may be fixed relative to the hub to prevent the filament from sliding relative to the hub. This may be done, for example, by bonding (e.g., thermal bonding, adhesive bonding) or welding (e.g., ultrasonic welding) the filaments to the hub.
Generally, the implant may be formed from any suitable material or combinations of materials. In some variations, the hub and/or the filaments may be formed from one or more materials that are biodegradable, bioerodable, or otherwise erodible. In some variations, the plurality of filaments may be biodegradable, but the hub may not be (or vice versa). In other variations, both the hub and the filaments may be biodegradable. In still other variations, neither the hub nor the filaments may be biodegradable. While in some instances the hub and the plurality of filaments may be formed from the same material or materials, in other variations the hub may be formed from a different material or materials than the material or materials of the plurality of filaments.
In some variations, the hub and/or the plurality of filaments may be formed from one or more polymers. When both the hub and the plurality of filaments are formed from one or more polymers, the hub may be formed from the same polymer (or polymers) as the filaments or may be formed from different polymers than the filaments. The polymers may be biodegradable, but need not be. Examples of biodegradable polymers that may be suitable for use with the implants describe here include, but are not limited to, aliginate, cellulose and ester, dextran, elastin, fibrin, hyaluronic acid, polyacetals, polyarylates (L-tyrosine-derived or free acid), poly(α-hydroxy-esters), poly(ß-hydroxy-esters), polyamides, poly(amino acid), polyalkanotes, polyalkylene alkylates, polyalkylene oxylates, polyalkylene succinates, polyanhydrides, polyanhydride esters, polyaspartimic acid, polybutylene diglycolate, poly(caprolactone), poly(caprolactone)/poly(ethylene glycol) copolymers, poly(carbonate), L-tyrosine-derived polycarbonates, polycyanoacrylates, polydihidropyrans, poly(dioxanone), poly-p-dioxanone, poly(epsilon-caprolactone), poly(epsilon-caprolactone-dimethyltrimethylene carbonate), poly(esteramide), poly(esters), aliphatic polyesters, poly(etherester), poly(ethylene glycol)/poly(orthoester) copolymers, poly(glutarunic acid), poly(glycolic acid), poly(glycolide), poly(glycolide)/poly(ethylene glycol) copolymers, poly(glycolide-trimethylene carbonate), poly(hydroxyalkanoates), poly(hydroxybutyrate), poly(hydroxybutyrate-co-valerate), poly(imino carbonates), polyketals, poly(lactic acid), poly(lactic acid-co-glycolic acid), poly(lactic acid-co-glycolic acid)/poly(ethylene glycol) copolymers, poly(lactide), poly(lactide-co-caprolactone), poly(DL-lactide-co-glycolide), poly(lactide-co-glycolide)/poly(ethylene glycol) copolymers, poly(lactide)/poly(ethylene glycol) copolymers, poly(lactide)/poly(glycolide) copolymers, polyorthoesters, poly(oxyethylene)/poly(oxypropylene) copolymers, polypeptides, polyphosphazenes, polyphosphoesters, polyphosphoester urethanes, poly(propylene fumarate-co-ethylene glycol), poly(trimethylene carbonate), polytyrosine carbonate, polyurethane, PorLastin or silk-ealastin polymers, spider silk, tephaflex, terpolymer (copolymers of glycolide, lactide or dimethyltrimethylene carbonate), and combinations, mixtures or copolymers thereof. Examples of nonbiodegradable polymers suitable for use with the methods and devices described herein include, but are not limited to poly(ethylene vinyl acetate), poly(vinyl acetate), silicone polymers, polyurethanes, polysaccharides such as a cellulosic polymers and cellulose derivatives, acyl substituted cellulose acetates and derivatives thereof, copolymers of poly(ethylene glycol) and poly(butylene terephthalate), polystyrenes, polyvinyl chloride, polyvinyl fluoride, poly(vinyl imidazole), chorosulphonated polyolefins, polyethylene oxide, and copolymers and blends thereof. In variations where the implant comprises poly(lactic-co-glycolic acid), the molar percent of lactide or the molar percent of glycolide may be any suitable amount, for example, between about 0% and about 100%, between about 30% and about 100%, between about 50% and about 100%, between about 70% and about 100%, between about 0% and about 70%, between about 30% and about 70%, between about 50% and about 70%, between about 0% and about 50%, between about 30% and about 50%, between about 0% and about 50% and the like. In some variations, the molar ratio of lactide to glycolide is about 10:90, about 85:15, about 15:85, or the like. In variations where the implant comprises a poly(lactic-co-glycolic acid)/poly(ethylene glycol) copolymer, the copolymer may include any suitable amounts of poly(lactic-co-glycolic acid) and poly(ethylene glycol). For example, in some variations the copolymer may comprise about 90% poly(lactic-co-glycolic acid) and about 10% poly(ethylene glycol). It should be further appreciated that the poly(lactic-co-glycolic acid) may have any suitable molar percentages of lactide and glycolide, as described above. Examples of other suitable materials may be found in U.S. patent application Ser. No. 12/779,240, filed on May 13, 2010 and titled “Expandable Devices and Methods Therefor,” the content of which is hereby incorporated by reference in its entirety.
In some variations, the implant may be configured to release one or more drugs therefrom. The implant may be configured to release any suitable drugs or agents, such as those described in U.S. patent application Ser. No. 12/779,240, which was previously incorporated by reference. For example, in some variations the implant may be configured to release one or more steroids, such as mometasone furoate. The implant may be configured to release one or more drugs in any suitable manner. In some variations, the implant may comprise one or more drug-releasing coatings, such as those described in U.S. patent application Ser. No. 12/779,240, which was previously incorporated by reference. In other variations, the hub and/or one or more of the filaments may be configured to elute or otherwise release one or more drugs therefrom. The selection of drugs, the timing of delivery, and the overall amount of drug or drugs released may be determined by the intended treatment plan, and may be further fine-tuned to the meet the specific needs of an individual patient.
The implants described here may be delivered using any suitable delivery device, such as, for example, the delivery device (200) shown in
Generally, the inner shaft (204) may be positioned at least partially within the outer sheath (206), and the inner shaft (204) may be moveable relative to the outer sheath (206). The handle (202) may be configured to move the inner shaft (204) relative to the outer sheath (206). For example, in the variation of the delivery device (100) shown in
To load an implant (such as implant (100) depicted in
While the inner shaft (204) is shown in
In variations of the delivery devices (200) described here where the inner shaft (204) comprises an engagement sleeve (208), the engagement sleeve (208) may be configured to grip or otherwise increase a frictional force between the inner shaft (204) and one or more legs (103) of the implant (100). Specifically, when the legs (103) of the implant are moved to a low-profile configuration around the inner shaft (204), one or more portions of the legs (103) (e.g., a straight segment of the leg) may contact the engagement sleeve (208). In some variations, the engagement sleeve (208) may comprise a flexible material (e.g., a foam, silicon, or the like), such that contact between the legs (103) and the engagement sleeve (208) may temporarily form a depression in the engagement sleeve (208), which may help to hold the leg (103) relative to the engagement sleeve (208). Additionally or alternatively, the engagement sleeve (208) may be roughened, patterned, or otherwise have a higher coefficient of friction than the inner shaft (204), which may reduce the ability of the legs (103) to slip relative to the engagement sleeve (208) (and thus the delivery device (200). It should be appreciated that the implants described here may be delivered using any suitable implant, such as those described in U.S. patent application Ser. No. 12/779,240, which was previously incorporated by reference.
Also described here are devices for crimping expandable devices. Generally the crimping devices described here may be configured to crimp an implant having a plurality of legs. While the crimping devices are described here as being used to crimp the implant (100) described above with respect to
Returning to
As mentioned above, the crimping member (304) may interact with the inner housing (308) to crimp an implant. To illustrate this,
Specifically, the recess (320) may comprise a central recess (322) and a plurality of channels (324) extending radially from the central recess (322). The crimping member (304) may be positioned at least partially in the recess (320) to position the stem portion (310) at least partially within the central recess (322), and may be moved between an open configuration (as shown in
In some variations, the crimping device (300) may comprise a spring (330) positioned between the stem portion (310) of the crimping member (304) and the bottom surface (328) of the central recess (322). The spring (330) may bias the crimping member (304) towards the open configuration shown in
In some variations, the crimping device (300) may be configured such that the crimping member (304) may not be completely released from the recess (320) of the inner housing (308). For example, in some variations (such as shown in
The arms (312) may be configured to rotate relative to stem portion (310) in any suitable manner. In some variations, the joint (314) may comprise a pin joint that connects the arm (312) to the stem portion (310). In other variations, the arm (312) may be configured to rotate via deformation of a portion of the arm. For example, in some variations, such as that shown in
Each leg of an implant may be engaged by a respective arm (312) of the crimping member (304), such that rotation of the arms (312) toward the longitudinal axis (316) of the crimping member (304) also may rotate the legs of the implant relative to a low-profile configuration. To engage a leg of an implant, an arm (312) of the crimping member (304) may comprise one or more holders (317). Generally, a holder (317) may extend from a corresponding arm (312) and may comprise a channel (318) sized and configured to receive a portion of the leg of the implant. When the implant is initially positioned relative to the crimping member (304), each leg may be positioned in the channels (318) of the one or more holders (317) of a corresponding arm (312). When positioned in the channels (318) of one or more holders (317), each leg may be moved with a corresponding arm (312) as that arm (312) rotates relative to the stem portion (310). Each arm (312) of the crimping member (304) may comprise any suitable number of holders (e.g., one, two, three, or four or more holders). For example, the arms (312) are shown in
In some variations, the height of one or more arms (312) of the crimping member (304) may vary along the length of the arm. For example, in the variation of the crimping device shown in
In some variations, the stem portion (310) may also comprise one or more structures configured to engage a portion of the implant. For example, in the variation of the crimping device (300) shown in
With each leg (103) of the implant engaged by a corresponding arm (312) of the crimping member (304), the crimping member may be moved into the recess (320) of the inner housing (308) (which is not shown in
In some variations, a delivery device may assist in the operation of the crimping device. For example,
With the inner shaft (204) pressed against the hub (102), the delivery device (200) may be advanced to push the crimping member (304) into the recess (320) of the inner housing (308). In some variations, the outer sheath (206) and distal cup (210) may be retracted relative to the inner shaft (204) prior to or during the movement of the crimping member (304) into the recess (320). As the crimping member (304) is pushed into the recess (320), the crimping member (304) may move from an open configuration to the crimping configuration, which may rotate the legs (103) relative to the hub (102) into a low-profile configuration, as discussed above. Rotation of the legs (103) to the low-profile configuration may position the legs (103) into contact with or substantially parallel to the inner shaft (204) of the delivery device, such as shown in
With the delivery device (200) coupled to the implant (100), the delivery device (200) may then be withdrawn relative to the crimping member (304). This may cause the crimping member (304) to return to the open configuration (e.g., due to the biasing force provided by a spring (330) as discussed above), which release the engagement between the crimping member (304) and the implant (100). The delivery device (200) may then be used to deliver the implant to a target location within a patient's body. To deliver the implant (100), the distal cup (210) may be withdrawn (e.g., by retracting the outer sheath (206) relative to the inner shaft (204)) to expose the legs (103) of the implant (100). The implant (100) may then be expanded (either by self-expansion or via a device such as a balloon) in the patient to press against, dilate, or otherwise hold tissue in the patient.
The housing (502) may comprise a plurality of ribs (516) positioned in the crimping chamber (504). The plurality of ribs (516) may define a plurality of channels (518) in the crimping chamber (504), with each channel (518) defined between adjacent ribs (516). The ribs (516) may extend through some or all of the segments of the crimping chamber (504). For example, in the variation shown in
In some variations, one or more of the first segment (506), second segment (508), and third segment (510) may not have any ribs (516) positioned in that segment. For example, in some variations the first segment (506) may not include any ribs (516). In some of these variations, the housing (502) may comprise a plurality of ribs (516) which may extend at least partially through the second segment (508) and at least partially through the third segment (510). In other variations, the second segment (508) may not include any ribs (516). In some of these variations, the first segment (506) may comprise a first plurality of ribs (516) and the third segment (510) may comprise a second plurality of ribs. In some variations, the first plurality of ribs (516) may have the same number of ribs (516) as the second plurality of ribs (516), and in some of these variations, each rib of the first plurality of ribs (516) may be aligned with a corresponding rib of the second plurality of ribs (516).
It should be appreciated that in some instances, different ribs (516) of the plurality of ribs (516) may extend through different segments or combinations of segments, such that different segments of the crimping chamber (504) may have differing numbers of ribs (and thus differing number of channels) positioned therein. For example, in some variations, the plurality of ribs (516) positioned in the crimping chamber (504) may comprise a first plurality of ribs (516) which may extend at least partially along each of the first segment, second segment, and third segment, and a second plurality of ribs (516) which may extend at least partially along the first segment. In these variations, the first segment (506) may include a first number of ribs and the second segment (508) and third segment (510) may include a second number of ribs less than the first number of ribs.
Generally, each segment of the crimping chamber (504) may have an inner diameter and an outer diameter. Generally the outer diameter may represent the outermost profile of the crimping chamber (504), while the inner diameter may represent a profile of the crimping chamber (504) that represents unobstructed space within the crimping chamber (504). The wall of the housing (502) may define the outer diameter of the crimping chamber (504). In portions of the crimping chamber (504) that do not include ribs (516), the inner diameter may be equal to the outer the diameter. In portions of the crimping chamber that do include a plurality of ribs (516) extending inwardly from wall of the housing (502), the tips of the ribs (516) may define the inner diameter of the crimping chamber (504). In these variations, the channels (518) defined between adjacent ribs (516) may extend from the inner diameter to the outer diameter. Accordingly, the depth of each channel (518) may be defined by the height of the adjacent ribs (516).
Each segment of the crimping chamber (504) may have any suitable inner and outer diameters. For example, when the crimping chamber (504) is used to crimp an implant having a plurality of legs moveable between a low-profile and an expanded configuration (such as implant 100 described above), the first segment (506) may be configured to house the implant in its expanded (e.g., uncrimped) configuration. In these variations, at least a portion of the first segment (506) may have an outer diameter greater than or equal to the largest diameter of implant. For example, in variations where the crimping device (500) is configured to crimp a variation of the implant (100) described above with respect to
In some variations, such as that shown in
In variations in which the first segment (506) comprises a plurality of ribs (516) and channels (518) extending at least partially along the first segment (506), the legs of the implant may be at least partially positioned within the plurality of channels (518) when the implant is positioned in the first segment (506), which may align the implant relative to the crimping chamber (504). In some variations, each leg may be positioned in a separate channel (518). In these variations, first segment (506) of the crimping chamber (504) may have at least as many channels (518) as legs of the implant. In other variations, multiple legs (e.g., two, three, or more legs) may be positioned in individual channels (518) of the first segment (506). In these variations, the first segment (506) may have fewer channels (518) than the number of legs of the implant. While the first segment (506) is shown in
In some variations, the housing (502) may comprise a lip (520) located at the proximal end of the crimping chamber (504). The lip (520) may extend inward from the housing (502) to define an opening smaller than may be smaller than the outer diameter of the proximal end of the first segment (506). The opening of the lip (520) may define the proximal opening (512) of the crimping chamber (504). Accordingly, the diameter of the proximal opening (512) may be smaller than the outer diameter of the proximal end of the first segment (506). In some of these variations, having a proximal opening (512) with a diameter smaller than the outer diameter of the proximal end of the first segment (506) may help to temporarily hold the implant within the crimping chamber (504). For example, the diameter of the opening of the lip (520) may be smaller than the largest diameter of an implant in when in an expanded configuration (e.g., the diameter defined by the proximal ends of the legs (103) of implant (100) in the expanded configuration). Accordingly, when the implant is placed in the first segment (506) in an expanded configuration, the implant may be temporarily prevented from exiting the crimping chamber (504) through the proximal opening (512). To remove the implant from the crimping chamber (504), the implant may be moved from an expanded configuration to a low-profile configuration, as discussed in more detail below.
In some instances, the lip (520) may be formed integrally with the housing (502). In other variations, such as shown in
When an implant is positioned in the first segment (506) of the crimping chamber (504), the implant may be moved from the first segment (506) to the second segment (508) to crimp or partially crimp the implant. Generally, the second segment (508) may have an outer diameter that corresponds to a desired outer profile of the implant. For example, in variations where it may be desirable to reduce the implant to a diameter of about 8 mm, the outer diameter of the second segment (508) may be about 8 mm. It should also be appreciated that in some variations where the outer diameter of the first segment (506) tapers from a first diameter at a proximal end of the first segment (506) and a second diameter at a distal end of the first segment (506), the second diameter of the first segment (506) may be equal to the outer diameter of the second segment (508). For example, in variations where the outer diameter of the first segment (506) is tapered from a first diameter at a proximal end of the first segment (506) to about 8 mm at the distal end of the first segment (506), the second segment (508) may have an outer diameter of about 8 mm.
As a portion of implant is moved into the second segment (508) of the crimping chamber, the outer diameter of that portion of the implant may be crimped to the outer diameter of the second segment (508) to allow that portion of the implant to fit within the second segment (508), as will be discussed in more detail below. As mentioned above, in some variations, the second segment (508) may not have any ribs (516) positioned therein. In variations that do include a plurality of ribs (516) defining a plurality of channels (518), the legs of the implants may be at least partially housed in the plurality of channels (518) as the implant is advanced into the second segment (508). As discussed above with respect to the first segment (506), in some variations, each leg may be positioned in a separate channel (518) of the second segment (508). In these variations, second segment (508) of the crimping chamber (504) may have at least as many channels (518) as legs of the implant. In other variations, multiple legs (e.g., two, three, or more legs) may be positioned in individual channels (518) of the second segment (508). In these variations, the second segment (508) may have fewer channels (518) than the number of legs of the implant. While the second segment (508) is shown in
Additionally, in some variations, the second segment (508) of the crimping chamber may be sized to receive an outer sheath of a delivery device (e.g., the outer sheath (206) of the delivery device (200) described above with respect to
The third segment (510) may be configured to receive a portion of the implant as the implant is moved from the second segment (508). In some variations, such as shown in
In variations where the second segment (508) is sized to receive an outer sheath of a delivery device (e.g., where the second segment (508) has an inner diameter greater than an outer diameter of the outer sheath), the third segment (510) may be sized to prevent the outer sheath from being advanced from the second segment (508) into the third segment (510). In some of these variations, the inner diameter of the third segment (510) may be smaller than an outer diameter of the outer sheath of the delivery device. For example, in instances where the outer sheath of the delivery device has an outer diameter or about 6 mm, the inner diameter of the third segment (510) may be less than about 6 mm (e.g., about 3.5 mm, between about 3.5 mm and about 4 mm). In variations where the third segment (510) comprises a plurality of ribs (516), the plurality of ribs (516) may define the inner diameter such that the outer sheath of the delivery device catches on or otherwise engages the ribs (516) of the third segment (510) during advancement of the outer sheath, which may prevent the outer sheath from being advanced into the third segment (510), as discussed in more detail below.
In variations where the crimping device (500) is used to crimp an implant having a hub and a plurality of legs extending from the hub, the third segment (510) may be configured to accommodate the hub of the implant. For example, the inner diameter of the third segment (510) may be greater than or equal to the outer diameter of the hub. In variations where the hub of the implant has an outer diameter of about 3.5 mm, the inner diameter of the third segment (510) may be at least about 3.5 mm (e.g., about 3.5 mm). In some instances, it may be desirable to size the inner diameter of the third segment (510) to be equal to or slightly larger (e.g., less than 1 mm larger) than the outer diameter, which may help to center the hub within the inner diameter of the third segment (510) during advancement of the implant. In some variations, the inner diameter of the third segment (510) may greater than or equal to an outer diameter of a hub of the implant and may be less than the outer diameter of an outer sheath of a delivery device.
In some variations, the height of the third segment (510) may be sized such only a portion of the implant may be received in the third segment (510). For example, in these variations the height of the third segment (510) may be less than the height of the implant when the implant is crimped. Accordingly, when the implant is advanced into the third segment (510) at least a portion of the implant (e.g., a proximal portion of the legs of the implant) may extend out of the third segment (510) (e.g., into the second segment (508)). In variations where the inner diameter of the third segment (510) is smaller than the outer diameter of an outer sheath (e.g., which may prevent the outer sheath from entering the third segment (510)), the height of the third segment (510) may facilitate placement of the outer sheath of the delivery device at a predetermined position along the implant.
As mentioned above, in some variations the third segment (510) may include a plurality of ribs (516) positioned therein and defining a plurality of channels (518). In these variations, the legs of the implants may be at least partially housed in the plurality of channels (518) as the implant is advanced into the third segment (510). As discussed above with respect to the second segment (508), in some variations, each leg may be positioned in a separate channel (518) of the third segment (510). In these variations, third segment (510) of the crimping chamber (504) may have at least as many channels (518) as legs of the implant. In other variations, multiple legs (e.g., two, three, or more legs) may be positioned in individual channels (518) of the third segment (510). In these variations, the third segment (508) may have fewer channels (518) than the number of legs of the implant. While the third segment (510) is shown in
In variations where the second segment comprises a plurality of ribs (516) positioned therein, some or all of the ribs (516) of the second segment (508) may extend from the second segment (508) into the third segment (510), the ribs (516) and channels (518) may help maintain alignment of the implant relative to the crimping chamber (504) as the implant is advanced into the third segment (510). In some of these variations, the number of ribs and channels in the third segment (510) may be equal to the number of ribs and channels in the second segment (508), although it should be appreciated that in some instances the third segment (510) may have more or fewer ribs and channels than the second segment (508). As mentioned above, the inner diameter of the second segment (508) may be larger than the inner diameter of the third segment (510), while the outer diameter of the second segment (508) may be the same as the outer diameter of the third segment (510). In some of these variations, each of the second and third segments may comprise a plurality of ribs defining a plurality of channels, and the channels (518) may in the second segment (508) may be shallower than the channels (518) in the third segment (510).
In some variations, such as the variation shown in
When the implant (100) is placed in the first segment (506) of the crimping chamber (504), the hub (102) of the implant (100) may be located distally relative to the legs (103) (i.e., toward the third segment (510)). One or more portions of the legs (103) (e.g., the proximal ends of the legs) may rest on the inner surface of the housing (502) within the first segment (506) when the implant (100) is positioned in the first segment (506), such as shown in
With the implant (100) positioned in the first segment (506), the delivery device (200) described above with respect to
As portions of the legs (103) enter the second segment (508), the outer diameter of that portion of the implant (100) may be limited by the outer diameter of the second segment (508). In variations where the second segment (508) includes a plurality of ribs (516) defining a plurality of channels (518), a portion of each of the legs (103) may be positioned in one of the channels (518) (e.g., each leg (103) of the implant (100) may be positioned in a different channel (518) or multiple legs (103) may be positioned in individual channels (518)), which may help guide and align the implant (100).
Further advancement of the inner shaft (204) toward the third segment (510) may advance the hub (102) of the implant into the third segment (510), such as shown in
In variations where the delivery device (200) comprises and outer sheath (206), the inner shaft (204) may advance the hub (102) into the third segment (as discussed immediately above) with the outer sheath (206) retracted relative to the inner shaft (204). As the delivery device (200) and implant (100) are pushed toward the third segment (510), the legs (103) of the implant (100) may rotate relative to the hub (102) toward a low-profile (i.e., crimped) configuration, which in some instances may position a portion of each of the legs (103) into contact with or substantially parallel to the inner shaft (204) of the delivery device (200) (e.g., in some instances the legs may contact an engagement sleeve of the inner shaft). With the implant (100) positioned in a low-profile configuration, the outer sheath (206) may be advanced relative to the inner shaft (204) to cover at least a portion of the legs (103) with a portion of the outer sheath (206) (e.g., the distal cup (210) of the outer sheath (206)). This may act to hold the legs (103) of the implant (100) between the distal cup (210) and the inner shaft (204) of the delivery device (200), and thus may couple the implant (100) thereto, such as shown in
With the delivery device (200) coupled to the implant (100), the delivery device (200) and implant (100) may be withdrawn relative to the crimping device (500). The delivery device (200) may then be used to deliver the implant (100) to a target location within a patient's body. To deliver the implant (100), the outer sheath (206) may be withdrawn (e.g., by retracting the outer sheath (206) relative to the inner shaft (204)) to expose the legs (103) of the implant. The implant (100) may then be expanded (either by self-expansion or via a device such as a balloon) in the patient to press against, dilate, or otherwise hold tissue in the patient.
The implants described here may be delivered to any suitable portion of the anatomy in any suitable manner. In some variations, the implant may be delivered to a sinus cavity or sinus ostium. In other variations, the implant may be delivered to a nasal cavity. In some variations, the implant may deliver, elute, or otherwise release one or more drugs therefrom when implanted.
The implants may be delivered and deployed in any suitable manner. In some variations, the implants are deployed in an open surgical fashion. In other variations, the implants are deployed in a less invasive fashion (for example, laparoscopically, endoscopically, or intravascularly through the use of catheters). In instances where the implants are delivered in a generally minimally invasive fashion, the implants may be delivered in their low-profile configurations. The implants may be preloaded in or on a delivery device, but need not be. For example, in instances where the implant has a limited ability to fully expand after remaining in its compressed state for extended periods of time (i.e., relaxation of the implant may occur over time, resulting in a loss of shape memory, for example), it may be more desirable to crimp and load the implant into or onto a delivery device just prior to delivery and deployment.
Generally, at least a portion of a delivery device is introduced into the body. In some variations, the delivery device may be introduced into a natural opening in the body, such as an ear canal or a nostril. In other variations, the delivery device may be introduced into an opening in formed in the body via one or more procedures (e.g., a surgically-formed opening). In some of these variations, the artificially-created opening may be pre-formed using one or more tools that are separate from the delivery device. In some variations, one or more portions of the delivery device may be used to create the opening. In still other variations, one or more portions of the expandable device may be used to create the opening.
Once the delivery device is introduced into the body, at least a portion of the delivery device may then be advanced to a target location. In some variations, this advancement occurs under direct visualization. The direct visualization may be achieved by a device external to the delivery device, such as an endoscope, or may be achieved by one or more visualization devices attached to the delivery device or disposed within one or more portions (i.e., a lumen of a cannula) of the delivery device. In other variations, the advancement occurs under indirect visualization, such as fluoroscopy, ultrasound, or computer image guidance.
Once the delivery device is introduced into the body, at least a portion of the delivery device may then be advanced to a target location. In some variations, this advancement occurs under direct visualization. The direct visualization may be achieved by a device external to the delivery device, such as an endoscope, or may be achieved by one or more visualization devices attached to the delivery device or disposed within one or more portions (i.e., a lumen of a cannula) of the delivery device. In other variations, the advancement occurs under indirect visualization, such as fluoroscopy, ultrasound, or computer image guidance.
Once the delivery device has reached the target location, the expandable implant may be released from the delivery device. In variations where the implant is self-expandable, the implant may self-expand into an expanded configuration. In variations where the implant is expandable in response to one or more forces or stimuli, one or more appropriate forces or stimuli may be applied to the implant to expand the implant into an expanded configuration. In some instances, expansion of the implant may act to anchor the implant against or into tissue. The implant may be left in place for any suitable amount of time (e.g., one week, two weeks, one month, two months, or more). In variations where the implant is biodegradable, the implant may be removed prior to complete degradation of the implant, or may be left in place until the implant is absorbed or otherwise cleared by the body. When the implant is removed, it may be removed using a grasping device, pull-string structure, or the like.
When used to treat nasal polyposis or other polypoid edema one or more of the implant described here may be delivered into either a nasal passage or one or more sinus cavities. Once expanded, each leg of the implant may either sit against one or more nasal polyps, puncture one or more nasal polyps, push between two or more nasal polyps to contact the base of one or more nasal polyps, or do a combination thereof. When the implant is configured to deliver one or more drugs, it may be especially beneficial to deliver one or more drugs to the base of one or more of the nasal polyps. When one or more legs presses against one or more nasal polyps, the one or more legs may dilate or otherwise move the nasal polyps. This may, in turn, open one or more blocked nasal passageways or sinus ostia. It should be appreciated that the implants described here may be delivered using any of the methods described in U.S. patent application Ser. No. 12/779,240, which was previously incorporated by reference.
Although the foregoing invention has, for the purposes of clarity and understanding been described in some detail by way of illustration and example, it will be apparent that certain changes and modifications may be practiced, and are intended to fall within the scope of the appended claims.
This application is a continuation of U.S. application Ser. No. 14/210,078, filed on Mar. 13, 2014, which claims priority to U.S. Provisional Application Ser. No. 61/785,939, filed on Mar. 14, 2013, and titled “SYSTEMS, DEVICES, AND METHOD FOR TREATING A SINUS CONDITION,” each of which is hereby incorporated by reference in its entirety.
| Number | Name | Date | Kind |
|---|---|---|---|
| 374026 | Williams | Nov 1887 | A |
| 1381829 | Hartman | Jun 1921 | A |
| 1485126 | Schumacher | Feb 1924 | A |
| 1520908 | Meyer | Dec 1924 | A |
| 1658801 | Condren | Feb 1928 | A |
| 2009393 | Failla | Jul 1935 | A |
| 2096162 | Daley | Oct 1937 | A |
| 2691985 | Newsom | Oct 1954 | A |
| 3049125 | Kriwkowitsch | Aug 1962 | A |
| 3473165 | Gran et al. | Oct 1969 | A |
| 3502078 | Hill et al. | Mar 1970 | A |
| 3570494 | Gottschalk | Mar 1971 | A |
| 3583391 | Cox et al. | Jun 1971 | A |
| 3766924 | Pidgeon | Oct 1973 | A |
| 3800788 | White | Apr 1974 | A |
| 3894539 | Tallent | Jul 1975 | A |
| 3903893 | Scheer | Sep 1975 | A |
| 3913584 | Walchle et al. | Oct 1975 | A |
| 4094303 | Johnston | Jun 1978 | A |
| 4245652 | Kelly et al. | Jan 1981 | A |
| 4389208 | LeVeen et al. | Jun 1983 | A |
| 4419095 | Nebergall et al. | Dec 1983 | A |
| D276937 | Griggs | Dec 1984 | S |
| 4534761 | Raible | Aug 1985 | A |
| 4580568 | Gianturco | Apr 1986 | A |
| 4604920 | Dupke | Aug 1986 | A |
| 4627971 | Ayer | Dec 1986 | A |
| 4650488 | Bays et al. | Mar 1987 | A |
| 4655771 | Wallsten | Apr 1987 | A |
| 4704126 | Baswell et al. | Nov 1987 | A |
| 4737141 | Spits | Apr 1988 | A |
| 4744792 | Sander et al. | May 1988 | A |
| 4753636 | Free | Jun 1988 | A |
| 4793351 | Landman et al. | Dec 1988 | A |
| 4886493 | Yee | Dec 1989 | A |
| 4941881 | Masters et al. | Jul 1990 | A |
| 4964850 | Bouton et al. | Oct 1990 | A |
| 5000957 | Eckenhoff et al. | Mar 1991 | A |
| 5011474 | Brennan | Apr 1991 | A |
| 5035706 | Giantureo et al. | Jul 1991 | A |
| 5062829 | Pryor et al. | Nov 1991 | A |
| 5116311 | Lofstedt | May 1992 | A |
| 5139502 | Berg et al. | Aug 1992 | A |
| 5139510 | Goldsmith et al. | Aug 1992 | A |
| 5139832 | Hayashi et al. | Aug 1992 | A |
| 5167614 | Tessmann et al. | Dec 1992 | A |
| 5189110 | Ikematu et al. | Feb 1993 | A |
| 5217484 | Marks | Jun 1993 | A |
| 5246455 | Shikani | Sep 1993 | A |
| 5256146 | Ensminger et al. | Oct 1993 | A |
| 5300119 | Blom | Apr 1994 | A |
| 5312813 | Costerton et al. | May 1994 | A |
| 5336163 | DeMane et al. | Aug 1994 | A |
| 5342296 | Persson et al. | Aug 1994 | A |
| 5348553 | Whitney | Sep 1994 | A |
| 5350580 | Muchow et al. | Sep 1994 | A |
| 5391179 | Mezzoli | Feb 1995 | A |
| 5443498 | Fontaine | Aug 1995 | A |
| 5501700 | Hirata | Mar 1996 | A |
| 5507210 | Paramest | Apr 1996 | A |
| 5507807 | Shippert | Apr 1996 | A |
| 5512055 | Domb et al. | Apr 1996 | A |
| 5538738 | Ritter et al. | Jul 1996 | A |
| 5540712 | Kleshinski et al. | Jul 1996 | A |
| 5556413 | Lam | Sep 1996 | A |
| 5632762 | Myler | May 1997 | A |
| 5645584 | Suyama | Jul 1997 | A |
| 5664567 | Linder | Sep 1997 | A |
| 5672179 | Garth et al. | Sep 1997 | A |
| 5693065 | Rains, III | Dec 1997 | A |
| 5713855 | Shippert | Feb 1998 | A |
| 5746224 | Edwards | May 1998 | A |
| 5749921 | Lenker et al. | May 1998 | A |
| 5792100 | Shantha | Aug 1998 | A |
| 5800379 | Edwards | Sep 1998 | A |
| 5800429 | Edwards | Sep 1998 | A |
| 5827224 | Shippert | Oct 1998 | A |
| 5895408 | Pagan | Apr 1999 | A |
| 5899878 | Glassman | May 1999 | A |
| 5928190 | Davis | Jul 1999 | A |
| 5992000 | Humphrey et al. | Nov 1999 | A |
| 6033436 | Steinke et al. | Mar 2000 | A |
| 6054122 | MacPhee et al. | Apr 2000 | A |
| 6063102 | Morales | May 2000 | A |
| 6074381 | Dinh et al. | Jun 2000 | A |
| 6082990 | Jackson et al. | Jul 2000 | A |
| 6092273 | Villareal | Jul 2000 | A |
| 6092528 | Edwards | Jul 2000 | A |
| 6108886 | Kimes et al. | Aug 2000 | A |
| 6113641 | Leroy et al. | Sep 2000 | A |
| 6123697 | Shippert | Sep 2000 | A |
| 6149681 | Houser et al. | Nov 2000 | A |
| 6149944 | Jeong et al. | Nov 2000 | A |
| 6152946 | Broome et al. | Nov 2000 | A |
| 6180848 | Flament et al. | Jan 2001 | B1 |
| 6190353 | Makower et al. | Feb 2001 | B1 |
| 6195225 | Komatsu et al. | Feb 2001 | B1 |
| 6200335 | Igaki | Mar 2001 | B1 |
| 6224626 | Steinke | May 2001 | B1 |
| 6228111 | Tormala et al. | May 2001 | B1 |
| 6280413 | Clark et al. | Aug 2001 | B1 |
| 6290728 | Phelps et al. | Sep 2001 | B1 |
| 6297227 | Johnson | Oct 2001 | B1 |
| 6302875 | Makower et al. | Oct 2001 | B1 |
| 6306084 | Pinczower | Oct 2001 | B1 |
| 6329386 | Mollison | Dec 2001 | B1 |
| 6342068 | Thompson | Jan 2002 | B1 |
| 6347241 | Burbank et al. | Feb 2002 | B2 |
| 6350465 | Jonnalagadda et al. | Feb 2002 | B1 |
| 6352547 | Brown et al. | Mar 2002 | B1 |
| 6355032 | Hovda et al. | Mar 2002 | B1 |
| 6375615 | Flaherty et al. | Apr 2002 | B1 |
| 6386197 | Miller | May 2002 | B1 |
| 6398758 | Jacobsen et al. | Jun 2002 | B1 |
| 6409750 | Hyodoh et al. | Jun 2002 | B1 |
| 6447539 | Nelson et al. | Sep 2002 | B1 |
| 6491940 | Levin | Dec 2002 | B1 |
| 6524608 | Ottoboni et al. | Feb 2003 | B2 |
| 6537294 | Boyle et al. | Mar 2003 | B1 |
| 6543452 | Lavigne | Apr 2003 | B1 |
| 6544230 | Flaherty et al. | Apr 2003 | B1 |
| 6555566 | Ponikau | Apr 2003 | B2 |
| 6562058 | Seguin et al. | May 2003 | B2 |
| 6565597 | Fearnot et al. | May 2003 | B1 |
| 6589286 | Litner | Jul 2003 | B1 |
| 6605294 | Sawhney | Aug 2003 | B2 |
| 6606995 | Sadek et al. | Aug 2003 | B1 |
| 6618921 | Thornton | Sep 2003 | B1 |
| 6685648 | Flaherty et al. | Feb 2004 | B2 |
| 6692455 | Goode et al. | Feb 2004 | B2 |
| 6695856 | Kieturakis et al. | Feb 2004 | B2 |
| 6709465 | Mitchell et al. | Mar 2004 | B2 |
| 6712859 | Rousseau et al. | Mar 2004 | B2 |
| 6715485 | Djupesland et al. | Apr 2004 | B1 |
| 6719934 | Stinson | Apr 2004 | B2 |
| 6746426 | Flaherty et al. | Jun 2004 | B1 |
| 6749617 | Palasis et al. | Jun 2004 | B1 |
| 6884260 | Kugler et al. | Apr 2005 | B2 |
| 6942690 | Pollock et al. | Sep 2005 | B1 |
| 6945992 | Goodson, IV et al. | Sep 2005 | B2 |
| 6951053 | Padilla et al. | Oct 2005 | B2 |
| 6966923 | Gittings | Nov 2005 | B2 |
| 7018401 | Hyodoh et al. | Mar 2006 | B1 |
| 7072720 | Puskas | Jul 2006 | B2 |
| 7074426 | Kochinke | Jul 2006 | B2 |
| 7108706 | Hogle | Sep 2006 | B2 |
| RE39321 | MacPhee et al. | Oct 2006 | E |
| 7195016 | Loyd et al. | Mar 2007 | B2 |
| 7225518 | Eidenschink et al. | Jun 2007 | B2 |
| 7235099 | Duncavage et al. | Jun 2007 | B1 |
| 7249390 | Yale et al. | Jul 2007 | B2 |
| RE39923 | Blom | Nov 2007 | E |
| 7314484 | Deem et al. | Jan 2008 | B2 |
| 7316147 | Perreault et al. | Jan 2008 | B2 |
| 7361168 | Makower et al. | Apr 2008 | B2 |
| 7410480 | Muni et al. | Aug 2008 | B2 |
| 7419497 | Muni et al. | Sep 2008 | B2 |
| 7451765 | Adler | Nov 2008 | B2 |
| 7462175 | Chang et al. | Dec 2008 | B2 |
| 7500971 | Chang et al. | Mar 2009 | B2 |
| 7520876 | Ressemann et al. | Apr 2009 | B2 |
| 7544192 | Eaton et al. | Jun 2009 | B2 |
| 7559925 | Goldfarb et al. | Jul 2009 | B2 |
| 7641644 | Chang et al. | Jan 2010 | B2 |
| 7641688 | Lesh | Jan 2010 | B2 |
| 7645272 | Chang et al. | Jan 2010 | B2 |
| 7651696 | Bates | Jan 2010 | B2 |
| 7654997 | Makower et al. | Feb 2010 | B2 |
| 7658758 | Diaz et al. | Feb 2010 | B2 |
| 7658764 | Reitan et al. | Feb 2010 | B2 |
| 7662141 | Eaton et al. | Feb 2010 | B2 |
| 7662142 | Eaton et al. | Feb 2010 | B2 |
| 7686798 | Eaton et al. | Mar 2010 | B2 |
| 7691094 | Eaton et al. | Apr 2010 | B2 |
| 7713255 | Eaton et al. | May 2010 | B2 |
| 7717933 | Becker | May 2010 | B2 |
| 7740642 | Becker | Jun 2010 | B2 |
| 7753929 | Becker | Jul 2010 | B2 |
| 7771482 | Karmon | Aug 2010 | B1 |
| 7951130 | Eaton et al. | May 2011 | B2 |
| 7951131 | Eaton et al. | May 2011 | B2 |
| 7951132 | Eaton et al. | May 2011 | B2 |
| 7951133 | Eaton et al. | May 2011 | B2 |
| 7951134 | Eaton et al. | May 2011 | B2 |
| 7951135 | Eaton et al. | May 2011 | B2 |
| 8025635 | Eaton et al. | Sep 2011 | B2 |
| 8088120 | Worsoff | Jan 2012 | B2 |
| 8109918 | Eaton et al. | Feb 2012 | B2 |
| 8192450 | Gonzales et al. | Jun 2012 | B2 |
| 8197433 | Cohen | Jun 2012 | B2 |
| 8303640 | Hepworth et al. | Nov 2012 | B2 |
| 8337454 | Eaton et al. | Dec 2012 | B2 |
| 8500776 | Ebner | Aug 2013 | B2 |
| 8535707 | Arensdorf et al. | Sep 2013 | B2 |
| 8585730 | Eaton et al. | Nov 2013 | B2 |
| 8585731 | Abbate et al. | Nov 2013 | B2 |
| 8585753 | Scanlon et al. | Nov 2013 | B2 |
| 8721591 | Chang et al. | May 2014 | B2 |
| 8740029 | Barnoski et al. | Jun 2014 | B2 |
| 8740839 | Eaton et al. | Jun 2014 | B2 |
| 8740929 | Gopferich et al. | Jun 2014 | B2 |
| 8763222 | Abbate et al. | Jul 2014 | B2 |
| 8802131 | Arensdorf et al. | Aug 2014 | B2 |
| 8858974 | Eaton et al. | Oct 2014 | B2 |
| 8986341 | Abbate et al. | Mar 2015 | B2 |
| 9585681 | Eaton et al. | Mar 2017 | B2 |
| 9782283 | Abbate et al. | Oct 2017 | B2 |
| 10010651 | Eaton et al. | Jul 2018 | B2 |
| 10357640 | Abbate | Jul 2019 | B2 |
| 10471185 | Eaton et al. | Nov 2019 | B2 |
| 20010021871 | Stinson | Sep 2001 | A1 |
| 20020022048 | Bromberg et al. | Feb 2002 | A1 |
| 20020051793 | Drabick | May 2002 | A1 |
| 20020051845 | Mehta et al. | May 2002 | A1 |
| 20020077693 | Barclay et al. | Jun 2002 | A1 |
| 20020111603 | Cheikh | Aug 2002 | A1 |
| 20020143387 | Soetikno et al. | Oct 2002 | A1 |
| 20020188344 | Bolea et al. | Dec 2002 | A1 |
| 20020198586 | Inoue | Dec 2002 | A1 |
| 20030033001 | Igaki | Feb 2003 | A1 |
| 20030040790 | Furst | Feb 2003 | A1 |
| 20030055488 | Igaki | Mar 2003 | A1 |
| 20030065346 | Evens et al. | Apr 2003 | A1 |
| 20030070682 | Wilson et al. | Apr 2003 | A1 |
| 20030105469 | Karmon | Jun 2003 | A1 |
| 20030109837 | McBride-Sakal | Jun 2003 | A1 |
| 20030125774 | Salo | Jul 2003 | A1 |
| 20030133877 | Levin | Jul 2003 | A1 |
| 20030135266 | Chew et al. | Jul 2003 | A1 |
| 20030135268 | Desai | Jul 2003 | A1 |
| 20030135970 | Thornton | Jul 2003 | A1 |
| 20030147954 | Yang et al. | Aug 2003 | A1 |
| 20030158598 | Ashton | Aug 2003 | A1 |
| 20030195459 | Shippert | Oct 2003 | A1 |
| 20030203030 | Ashton et al. | Oct 2003 | A1 |
| 20030209835 | Chun et al. | Nov 2003 | A1 |
| 20030236570 | Cook et al. | Dec 2003 | A1 |
| 20040043052 | Hunter et al. | Mar 2004 | A1 |
| 20040064083 | Becker | Apr 2004 | A1 |
| 20040064150 | Becker | Apr 2004 | A1 |
| 20040093062 | Glastra | May 2004 | A1 |
| 20040116958 | Gopferich et al. | Jun 2004 | A1 |
| 20040117004 | Osborne et al. | Jun 2004 | A1 |
| 20040133270 | Grandt | Jul 2004 | A1 |
| 20040176827 | Jacobson et al. | Sep 2004 | A1 |
| 20040236415 | Thomas | Nov 2004 | A1 |
| 20050038497 | Neuendorf et al. | Feb 2005 | A1 |
| 20050043706 | Eaton et al. | Feb 2005 | A1 |
| 20050043783 | Amis et al. | Feb 2005 | A1 |
| 20050119725 | Wang et al. | Jun 2005 | A1 |
| 20050124560 | Sung et al. | Jun 2005 | A1 |
| 20050131460 | Gifford et al. | Jun 2005 | A1 |
| 20050131514 | Hijlkema et al. | Jun 2005 | A1 |
| 20050131524 | Majercak et al. | Jun 2005 | A1 |
| 20050131525 | Hartley | Jun 2005 | A1 |
| 20050143817 | Hunter et al. | Jun 2005 | A1 |
| 20050163821 | Sung et al. | Jul 2005 | A1 |
| 20050165347 | Bardy | Jul 2005 | A1 |
| 20050203605 | Dolan | Sep 2005 | A1 |
| 20050229670 | Perreault | Oct 2005 | A1 |
| 20050240147 | Makower et al. | Oct 2005 | A1 |
| 20050245906 | Makower et al. | Nov 2005 | A1 |
| 20060004286 | Chang et al. | Jan 2006 | A1 |
| 20060004323 | Chang et al. | Jan 2006 | A1 |
| 20060025849 | Kaplan | Feb 2006 | A1 |
| 20060063973 | Makower et al. | Mar 2006 | A1 |
| 20060095066 | Chang et al. | May 2006 | A1 |
| 20060106361 | Muni et al. | May 2006 | A1 |
| 20060106417 | Tessmer | May 2006 | A1 |
| 20060135981 | Lenker et al. | Jun 2006 | A1 |
| 20060142736 | Hissink et al. | Jun 2006 | A1 |
| 20060162722 | Boehm et al. | Jul 2006 | A1 |
| 20060167540 | Masters et al. | Jul 2006 | A1 |
| 20060210605 | Chang et al. | Sep 2006 | A1 |
| 20060247499 | Butler et al. | Nov 2006 | A1 |
| 20060265042 | Catanese, III et al. | Nov 2006 | A1 |
| 20060276871 | Lamson et al. | Dec 2006 | A1 |
| 20070005094 | Eaton et al. | Jan 2007 | A1 |
| 20070055346 | Pryor | Mar 2007 | A1 |
| 20070055348 | Pryor | Mar 2007 | A1 |
| 20070079494 | Serrano | Apr 2007 | A1 |
| 20070100435 | Case et al. | May 2007 | A1 |
| 20070106366 | Delaloye et al. | May 2007 | A1 |
| 20070129751 | Muni et al. | Jun 2007 | A1 |
| 20070135789 | Chang et al. | Jun 2007 | A1 |
| 20070156211 | Ferren et al. | Jul 2007 | A1 |
| 20070156229 | Park | Jul 2007 | A1 |
| 20070162100 | Gabbay | Jul 2007 | A1 |
| 20070167682 | Goldfarb et al. | Jul 2007 | A1 |
| 20070179599 | Brodbeck et al. | Aug 2007 | A1 |
| 20070191922 | Hartley | Aug 2007 | A1 |
| 20070207186 | Scanlon et al. | Sep 2007 | A1 |
| 20070208252 | Makower | Sep 2007 | A1 |
| 20070208301 | Evard et al. | Sep 2007 | A1 |
| 20070227544 | Betsy et al. | Oct 2007 | A1 |
| 20070233225 | Rapacki et al. | Oct 2007 | A1 |
| 20070249896 | Goldfarb et al. | Oct 2007 | A1 |
| 20070250105 | Ressemann et al. | Oct 2007 | A1 |
| 20070269385 | Yun et al. | Nov 2007 | A1 |
| 20070270941 | Headley et al. | Nov 2007 | A1 |
| 20070282305 | Goldfarb et al. | Dec 2007 | A1 |
| 20070289677 | Ma et al. | Dec 2007 | A1 |
| 20070293726 | Goldfarb et al. | Dec 2007 | A1 |
| 20070293727 | Goldfarb et al. | Dec 2007 | A1 |
| 20070293946 | Gonzales et al. | Dec 2007 | A1 |
| 20070297186 | Hoover et al. | Dec 2007 | A1 |
| 20070299043 | Hunter et al. | Dec 2007 | A1 |
| 20080015540 | Muni et al. | Jan 2008 | A1 |
| 20080058295 | Chaudry | Mar 2008 | A1 |
| 20080058296 | Chaudry | Mar 2008 | A1 |
| 20080069858 | Weber | Mar 2008 | A1 |
| 20080077226 | Ouellette et al. | Mar 2008 | A1 |
| 20080077230 | Heaney et al. | Mar 2008 | A1 |
| 20080082162 | Boismier et al. | Apr 2008 | A1 |
| 20080085293 | Yang | Apr 2008 | A1 |
| 20080087239 | Chang et al. | Apr 2008 | A1 |
| 20080087295 | Makower et al. | Apr 2008 | A1 |
| 20080089952 | Hunter et al. | Apr 2008 | A1 |
| 20080097154 | Makower et al. | Apr 2008 | A1 |
| 20080097239 | Chang et al. | Apr 2008 | A1 |
| 20080097295 | Makower et al. | Apr 2008 | A1 |
| 20080097400 | Chang et al. | Apr 2008 | A1 |
| 20080097514 | Chang et al. | Apr 2008 | A1 |
| 20080097515 | Chang et al. | Apr 2008 | A1 |
| 20080097516 | Chang et al. | Apr 2008 | A1 |
| 20080097568 | Savage et al. | Apr 2008 | A1 |
| 20080097575 | Cottone | Apr 2008 | A1 |
| 20080097576 | Cottone et al. | Apr 2008 | A1 |
| 20080097580 | Dave | Apr 2008 | A1 |
| 20080097581 | Shanley | Apr 2008 | A1 |
| 20080097591 | Savage et al. | Apr 2008 | A1 |
| 20080103361 | Makower et al. | May 2008 | A1 |
| 20080103521 | Makower et al. | May 2008 | A1 |
| 20080103584 | Su et al. | May 2008 | A1 |
| 20080113000 | Hunter et al. | May 2008 | A1 |
| 20080119693 | Makower et al. | May 2008 | A1 |
| 20080125626 | Chang et al. | May 2008 | A1 |
| 20080125720 | Kim et al. | May 2008 | A1 |
| 20080132938 | Chang et al. | Jun 2008 | A1 |
| 20080145514 | Hunter et al. | Jun 2008 | A1 |
| 20080154237 | Chang et al. | Jun 2008 | A1 |
| 20080154250 | Makower et al. | Jun 2008 | A1 |
| 20080183128 | Morriss et al. | Jul 2008 | A1 |
| 20080195041 | Goldfarb et al. | Aug 2008 | A1 |
| 20080228085 | Jenkins et al. | Sep 2008 | A1 |
| 20080234720 | Chang et al. | Sep 2008 | A1 |
| 20080243140 | Gopferich et al. | Oct 2008 | A1 |
| 20080262468 | Clifford et al. | Oct 2008 | A1 |
| 20080262505 | Shahoian | Oct 2008 | A1 |
| 20080262508 | Clifford et al. | Oct 2008 | A1 |
| 20080262509 | Clifford et al. | Oct 2008 | A1 |
| 20080262510 | Clifford | Oct 2008 | A1 |
| 20080262593 | Ryan et al. | Oct 2008 | A1 |
| 20080275483 | Makower et al. | Nov 2008 | A1 |
| 20080281156 | Makower et al. | Nov 2008 | A1 |
| 20080287908 | Muni et al. | Nov 2008 | A1 |
| 20080306579 | Dolan et al. | Dec 2008 | A1 |
| 20080319424 | Muni et al. | Dec 2008 | A1 |
| 20090004272 | Gibson et al. | Jan 2009 | A1 |
| 20090004273 | Gibson et al. | Jan 2009 | A1 |
| 20090005763 | Makower et al. | Jan 2009 | A1 |
| 20090017090 | Arensdorf et al. | Jan 2009 | A1 |
| 20090028923 | Muni et al. | Jan 2009 | A1 |
| 20090030274 | Goldfarb et al. | Jan 2009 | A1 |
| 20090035351 | Berglund et al. | Feb 2009 | A1 |
| 20090036968 | Hepworth et al. | Feb 2009 | A1 |
| 20090036974 | Penn et al. | Feb 2009 | A1 |
| 20090041824 | Zugates et al. | Feb 2009 | A1 |
| 20090047326 | Eaton et al. | Feb 2009 | A1 |
| 20090047327 | Eaton et al. | Feb 2009 | A1 |
| 20090056709 | Worsoff | Mar 2009 | A1 |
| 20090093823 | Chang et al. | Apr 2009 | A1 |
| 20090156980 | Eaton et al. | Jun 2009 | A1 |
| 20090177272 | Abbate et al. | Jul 2009 | A1 |
| 20090187098 | Makower et al. | Jul 2009 | A1 |
| 20090192488 | Eaton et al. | Jul 2009 | A1 |
| 20090192489 | Eaton et al. | Jul 2009 | A1 |
| 20090192490 | Eaton et al. | Jul 2009 | A1 |
| 20090192491 | Eaton et al. | Jul 2009 | A1 |
| 20090192492 | Eaton et al. | Jul 2009 | A1 |
| 20090198179 | Abbate et al. | Aug 2009 | A1 |
| 20090198216 | Muni et al. | Aug 2009 | A1 |
| 20090220571 | Eaton et al. | Sep 2009 | A1 |
| 20090227945 | Eaton et al. | Sep 2009 | A1 |
| 20090238859 | Eaton et al. | Sep 2009 | A1 |
| 20090240112 | Goldfarb et al. | Sep 2009 | A1 |
| 20090306624 | Arensdorf et al. | Dec 2009 | A1 |
| 20090312745 | Goldfarb et al. | Dec 2009 | A1 |
| 20100043197 | Abbate et al. | Feb 2010 | A1 |
| 20110004192 | Eaton et al. | Jan 2011 | A1 |
| 20110004193 | Eaton et al. | Jan 2011 | A1 |
| 20110004194 | Eaton et al. | Jan 2011 | A1 |
| 20110004195 | Eaton et al. | Jan 2011 | A1 |
| 20110004196 | Eaton et al. | Jan 2011 | A1 |
| 20110021986 | Zamboni | Jan 2011 | A1 |
| 20110066135 | Eaton et al. | Mar 2011 | A1 |
| 20110167964 | Price | Jul 2011 | A1 |
| 20120101429 | Eaton et al. | Apr 2012 | A1 |
| 20120143054 | Eaton et al. | Jun 2012 | A1 |
| 20130041463 | Ressemann | Feb 2013 | A1 |
| 20130066358 | Nalluri et al. | Mar 2013 | A1 |
| 20130231693 | Edgren et al. | Sep 2013 | A1 |
| 20130245608 | Muni et al. | Sep 2013 | A1 |
| 20130253567 | Edgren et al. | Sep 2013 | A1 |
| 20130281982 | Makower et al. | Oct 2013 | A1 |
| 20130304232 | Gries | Nov 2013 | A1 |
| 20140018839 | Renner et al. | Jan 2014 | A1 |
| 20140046255 | Hakimimehr et al. | Feb 2014 | A1 |
| 20140074065 | Muni et al. | Mar 2014 | A1 |
| 20140074238 | Abbate et al. | Mar 2014 | A1 |
| 20140079755 | Eaton et al. | Mar 2014 | A1 |
| 20140107615 | Doshi et al. | Apr 2014 | A1 |
| 20140283349 | Abbate et al. | Sep 2014 | A1 |
| 20140324025 | Arensdorf et al. | Oct 2014 | A1 |
| 20150081017 | Abbate et al. | Mar 2015 | A1 |
| 20160287854 | Eaton et al. | Oct 2016 | A1 |
| 20170128093 | Eaton et al. | May 2017 | A1 |
| 20190125935 | Eaton et al. | May 2019 | A1 |
| 20190143087 | Eaton et al. | May 2019 | A1 |
| Number | Date | Country | |
|---|---|---|---|
| 20190336737 A1 | Nov 2019 | US |
| Number | Date | Country | |
|---|---|---|---|
| 61785939 | Mar 2013 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 14210078 | Mar 2014 | US |
| Child | 16514334 | US |
