1. Field of the Invention.
The present invention describes methods and apparatus for creating tissue necrosis. More specifically, this invention pertains to the creation of necrotic tissue having the effect of blocking conductive pathways. This invention may be used in the treatment of hypertension, cardiac, neurologic, renal, and various other disorders.
Hypertension affects an estimated one billion patients worldwide. The kidney is directly involved in body fluid homeostasis, and its ability to excrete sodium chloride and maintain sodium balance, extracellular fluid volume, and blood volume are major factors in the regulation of long-term arterial pressure. Both the kidneys and the autonomic nervous system contribute to kidney function, with the two being linked through the renal nerves.
The renal sympathetic nerves play a significant role in the pathophysiology of hypertension, where increased stimulation of these nerves triggers changes in renal vascular resistance, renin release, and retention of water and sodium. The afferent renal nerves monitor pressure changes in the kidney and relay the information to the central nervous system which then influences function of effector organs. Renal receptors influence cardiovascular function via increased activity of the sympathetic nerves to the kidney and other vascular beds and organs. The increase in sympathetic nerve activity and the activation of afferent renal nerves directly contributes to hypertension.
Untreated, hypertension can lead or contribute to cardiovascular (e.g. myocardial infarction, congestive heart failure), neurologic (e.g. stroke, dementia), and renal (e.g. chronic renal failure) disorders all having a direct effect on morbidity and mortality. Current therapies for hypertension primarily consist of lifestyle changes and pharmacological therapy, with varying degrees of success. In a subset of these patients with persistent hypertension, interventional therapy has been tested.
Initial treatment for hypertension is a change in lifestyle, including: diet, exercise, and weight loss, as well as elimination of smoking. Dietary modifications include limiting sodium intake, and consumption of nuts, whole grains, fish, poultry, fruits, and vegetables. In addition, a decrease in the consumption of red meats, sweets, and sugar is recommended. Exercise, weight loss, and non-smoking all contribute to improved cardiovascular function and decreased cardiac demand.
Pharmacologic approaches consist of individual or combinations of antihypertensive drugs, namely: diuretics, which reduce blood volume by eliminating sodium and water; beta blockers, which reduce cardiac workload and dilate blood vessels; angiotensin-converting enzyme inhibitors; Angiotensin II receptor blockers; and calcium channels blockers, all of which dilate blood vessels and may reduce heart rate; and renin inhibitors which decrease the production of renin, an enzyme in the chain that increases blood pressure. In addition to these medications, in certain cases these drugs are administered: alpha blockers, to reduce vasoconstrictive chemicals; alpha-beta blockers, which also reduce cardiac output; central nervous system agents to reduce vasoconstriction; and vasodilators, used to increase vessel diameter and reduce pressure. Combinations of all these medications are administered in light of their different effects on patients of varying race, gender, and age.
Patients taking multiple simultaneous medications without relief of hypertension are considered to have resistant hypertension. In the case of resistant hypertension, an invasive approach wherein the functionality of the renal nerves or sympathetic nervous elements is decreased or eliminated is proposed. This approach may also be applicable as a therapy for controlled hypertension.
While existing therapies may have demonstrated a limited effect in treating these disorders, improved systems and methods for creating necrotic tissue and effecting nerve activity are needed. Furthermore, it would be desirable for such systems to have an increased control in, for example: position, profile, and morphology of the generated necrotic tissue, while also offering greater patient safety and ultimately greater efficacy.
2. Background Art.
Other devices based on ultrasound energy to create lesions are described in U.S. Pat. Nos. 6,997,925; 6,966,908; 6,964,660; 6,954,977; 6,953,460; 6,652,515; 6,547,788; and 6,514,249 to Maguire et al.; U.S. Pat. Nos. 6,955,173; 6,052,576; 6,305,378; 6,164,283; and 6,012,457 to Lesh; U.S. Pat. Nos. 6,872,205; 6,416,511; 6,254,599; 6,245,064; and 6,024,740; to Lesh et al.; U.S. Pat. Nos. 6,383,151; 6,117,101; and WO 99/02096 to Diederich et al.; U.S. Pat. No. 6,635,054 to Fjield et al.; U.S. Pat. No. 6,780,183 to Jimenez et al.; U.S. Pat. No. 6,605,084 to Acker et al.; U.S. Pat. No. 5,295,484 to Marcus et al.; and WO 2005/117734 to Wong et al. Other related patents and patent publications include: U.S. Pat. Nos. 6,978,174; 7,162,303; 7,617,005; 7,620,451; 7,647,115; 7,653,438; 7,717,948; 7,756,583; 7,853,333; 7,873,417; 7,937,143; US20060212078; US20070173899; US20100137952; US20110060324; US20060212076; US20070265687; US20100168731; US20110112400; US20060265014; US20080213331; US20100168739; US20110166499; US20060265015; US20080255642; US20100174282; US20110178570; US20060271111; US20090036948; US20100191112; US20110200171; US20060276852; US20090062873; US20100222851; US20110202098; US20060025821; US20090076409; US20100222854; US20110208096; US20070129720; US20100137860; US20100249773; US20110257564; US20050234523; US20060041277; US20100268307; US20110264011; US20100010567; US20110264075.
The present invention provides medical systems and methods to create tissue necrosis, and more specifically to medical systems and methods used to deliver energy to tissue in the treatment of hypertension, cardiac, neurologic, renal, and other medical conditions.
One aspect of the invention pertains to a method for creating tissue necrosis, the method comprising the steps of: providing a catheter that carries an energy delivery apparatus, positioning the energy delivery apparatus adjacent a vessel without contact therebetween, delivering collimated energy from the energy delivery apparatus to the vessel, and creating sufficient damage to the tissue with the collimated energy to cause tissue necrosis. In some embodiments of the invention delivering collimated energy comprises delivering ultrasound energy. Some embodiments may also include the step of cooling the energy delivery apparatus.
Additionally, some embodiments of the invention comprise irrigating the energy delivery apparatus with a fluid.
In some embodiments, creating sufficient damage may comprise creating one or more linear tissue necrosis regions. The one or more linear necrosis regions may further comprise lesions selected from the group consisting of arc, spiral, helix, straight, dashed, freeform line, or variations or combinations thereof.
In some embodiments causing tissue necrosis is conducted at least in part by semi-automated control. Causing tissue necrosis may also be conducted at least in part by automated control.
In some embodiments delivering collimated energy comprises delivering the energy to the tissue in a substantially radial direction. In some embodiments, delivering collimated energy comprises delivering the energy to the tissue in a substantially longitudinal direction.
Some embodiments of invention feature a controller which controls the energy delivery.
The method of creating tissue necrosis may further comprise deflecting a shaft of the catheter thereby facilitating positioning of the catheter at a target location. Some embodiments further comprise sensing or measuring a position and/or an orientation of an element of the catheter, and adjusting a control feature in response to the sensed or measured information obtained.
Some embodiments of the invention also comprise the step of delivering energy to the tissue in order to determine information pertaining to one or more of the following: tissue structures, morphology, physiology, nerves, calcified regions, vessel wall thickness, distance from the energy delivery apparatus to a structure, and progression of lesion formation. Such embodiments may further comprise adjusting parameters of the energy delivered and/or adjusting movement of an element of the catheter in response to the information received.
Some embodiment also comprise the step of delivering a pain reduction medicament. The delivered energy mentioned above may also enhance delivery of the pain reduction medicament to a tissue through one or more of the following: acoustic pressure or streaming, sonoporation, bursting or altering encapsulated drug delivery vehicles, or thermal stimulation.
In exemplary embodiments of the invention the vessel comprises a renal vessel, and tissue necrosis comprises necrosis of a nerve. Necrosis of the nerve may alleviate hypertension in a patient.
Another embodiment of the method for creating tissue necrosis comprises: directing an energy delivery apparatus percutaneously to a target vessel, positioning the energy delivery apparatus in a desired location within the target vessel, initiating energy delivery, and moving the energy delivery apparatus while deliverying energy to create a desired region of tissue necrosis.
Some embodiments of the invention further comprise turning power on and off to the energy delivery apparatus while moving the energy delivery apparatus or in between movement of the energy delivery apparatus.
Some embodiments of the invention further comprise imaging during or interleaved with the creation of tissue necrosis.
Another aspect of the present invention entails, a system for creating necrotic tissue in a patient comprising a catheter (also referred to as energy delivery catheter) suitable for delivering energy sufficient to create tissue necrosis. The catheter may be constructed to enable radial and/or longitudinal movement of the energy delivery apparatus with respect to other components or structures of the catheter, or other devices (e.g. sheath or guiding catheter). The energy delivery apparatus comprising one or more elements capable of delivering and/or receiving energy, such as one or more ultrasound transducers. The catheter may be connected to a component (e.g. controller and/or generator) which receives and/or sends information from/to the catheter and/or has some level of control over functions of the catheter. The catheter may have one or more deflectable sections in the distal region of the catheter, the deflectable section(s) being delectable in one or more than one plane. The deflectable sections may be on the same shaft or on relatively independent shafts (e.g. coaxial shafts).
In another aspect of the present invention, movement of the deflecting section or sections may be facilitated by pull and/or push element or elements (e.g. wires, fibers, combinations thereof, etc.) This element or elements may function with a supporting element or elements (e.g. surrounded at least in part by a coil or element with fixed or varying compressive strength). In addition, the supporting element or elements may be stationary, movable, or capable of being temporarily or permanently fixed in a given position.
In another aspect of the present invention, the energy delivery apparatus may be for example; side-, distal-, and/or radial-firing. The energy may be direct or reflected to the target tissue.
In another aspect of the present invention, components or elements of the catheter may be straight, preshaped, or deflectable to one or more desired configurations.
In another aspect of the present invention, the catheter may be configured to be used over a guide wire or have an integral guide wire or guide member.
In another aspect of the present invention, the catheter may have an atraumatic distal region or tip.
In another aspect of the present invention, a handle may be connected to the catheter which enhances manipulation of the catheter. The handle may have a drive mechanism or mechanisms for movement of the energy delivery apparatus with respect to other components or structures of the catheter, or other devices. The handle may provide feedback or receive information from the controller and or generator and/or catheter.
In another aspect of the present invention, the generator and controller may be combined in an integrated unit.
In another aspect of the present invention, the generator and/or controller may be integrated with the handle.
In another aspect of the present invention, movement and/or actuation of the energy delivery apparatus may be at least in part controlled by the controller and/or generator. These movements may be for example: pre-programmed, auto or semi-automated, input manually, or any combination thereof.
In another aspect of the present invention, the catheter and/or component and/or components which receives and/or sends information from/to the catheter and/or has some level of control over functions of the catheter may provide the ability to determine or limit use of the catheter or component or components.
In another aspect of the present invention, the energy delivered to create the necrotic tissue may be ultrasound.
In another aspect of the present invention, the energy delivered to create the necrotic tissue may be ultrasound in a relatively collimated beam. This energy may be delivered from one or more ultrasound elements.
In another aspect of the present invention, the energy delivery apparatus may be positioned within a structure. The structure may be designed to maintain a blood barrier of fluid between a certain component(s) and/or element(s).
In another aspect of the present invention, the energy delivery apparatus may be directly or indirectly cooled. The effect of cooling the element of elements may aide in the overall performance of the system, including but not limited to efficiency, safety, and therapeutic effect.
In another aspect of the present invention, the energy delivery apparatus may be not in contact with the target tissue during energy delivery.
In another aspect of the present invention, the energy may be delivered to create greater tissue necrosis within the target tissue than at the surface of the target tissue.
In another aspect of the present invention, the energy may be delivered to form tissue necrosis in various shapes, including but not limited to individual or combinations of continuous and/or intermittent lines (e.g. open, closed, crossing, etc), shapes, spots, patterns (e.g. spiral, helix, dashed lines, etc). Any of these may be created by computer and/or mechanical control and/or assist and/or by or with or without operator input.
In another aspect of the present invention, the catheter may be designed to provide acoustic pressure induced flow (e.g. blood, cooling fluid, etc) in the region of energy delivery. The induced flow may remove heat from the surface of the target tissue allowing less or no damage at the tissue surface, preserving the endothelium and/or intimal layer and increasing safety (reduction in thrombus, charring, stenosis, etc.)
In another aspect of the present invention, an element or elements of the system may be used for imaging and/or analysis of tissue. This element or elements may be the same or different from the element or elements used to deliver energy to create necrotic tissue. Information from the element or elements may be used to determine distance from the element to a structure, to gather information about the structure or structures (e.g. thickness, morphology, physiology, multiple structures, structure recognition, calcified tissue, nerve location and depth, etc.), and other uses. In addition, the information gathered may be used to affect the energy delivered, including but not limited to intensity, duration, power, frequency, speed, etc, as well position of energy delivery. Examples include measuring wall thickness to determine energy dose parameters and identifying structures to determine energy delivery position and intensity. The structure in the region of the energy delivery apparatus (e.g. ultrasound transducer or transducers) may be constructed to improve the signal to noise ratio of the system. In addition, software may be used in or by the system to improve the signal to noise ratio.
In another aspect of the invention, the energy delivery apparatus may be composed of a one- or multi-dimensional array of elements.
In another aspect of the present invention, the imaging and/or therapeutic information may be wholly or partly used in a display image (e.g. 2 dimensional, 3 dimensional, layered, integrated) that may be static, dynamic, interactive, etc.
In another aspect of the present invention, the catheter and/or system may be constructed as to be visualized and/or recognized by and/or interface with additional equipment, including but not limited to fluoroscopy, pumps (e.g. fluid), anatomical mapping, respiration, computed tomography, magnetic resonance imaging, etc.
In another aspect of the invention the catheter, may comprise one or more elements to accommodate varying degrees of stiffness. For instance a proximal segment of the catheter may be relatively stiffer when compared to a distal portion of a catheter.
In another aspect of the invention, the catheter may be sized to pass through a guiding sheath or guiding catheter. The catheter of this or any other embodiment of the invention may comprise an inner shaft and an outer shaft, wherein the inner shaft is translatable and/or rotatable with respect to the outer shaft. When used with a guiding catheter, the guiding catheter (or sheath) may be selectively clamped or tightened down on the outer shaft of the catheter used for energy delivery. This leaves the inner shaft slidable and/or rotatable with respect to the outer shaft and guiding catheter. The inner shaft may then used to guide the energy delivery element. The inner shaft may comprise one or more elements to accommodate varying degrees of stiffness. For example, the inner shaft may be constructed to be stiffer in its proximal portions relative to its distal portions. Such elements may comprise coils, springs, support members, or sections of varying materials and geometries aimed towards altering local stiffness.
In another aspect of the present invention, the catheter has the ability to affect a decrease in the pain associated with delivery of energy and/or creating tissue necrosis, especially necrosis of nerves. This may be accomplished for example, by localized drug delivery through or around the catheter. A suitable pain reduction medicament may be combined with the cooling fluid and delivered directly to the region of energy delivery. Additionally, an agent may be delivered via a component or components on, within, about, and/or passed through the catheter (e.g. port, needle(s), retractable needle(s), etc) to affect the nerves and/or surrounding tissue and decrease the pain of creating tissue necrosis. Further, the ultrasound may also be used to stimulate the drug delivery through sonoporation, bursting or altering encapsulated drug delivery vehicles, and/or thermal stimulated drug delivery.
Descriptions of the embodiments presented herein are understood to be non-limiting. It is understood that features and elements described in the different embodiments above and below may combined with each other.
These and other embodiments are described in further detail in the following description related to the appended drawing figures.
All publications, patents, and patent applications mentioned in this specification are herein incorporated by reference to the same extent as if each individual publication, patent, or patent application was specifically and individually indicated to be incorporated by reference.
The novel features of the invention are set forth with particularity in the appended claims. A better understanding of the features and advantages of the present invention will be obtained by reference to the following detailed description that sets forth illustrative embodiments, in which the principles of the invention are utilized, and the accompanying drawings of which:
The invention described herein describes a system and methods for creating tissue necrosis. The catheter 100 of the invention includes an elongate member 200. The elongate member includes a distal assembly 400 encompassing an energy delivery apparatus and supporting structure for directing energy to tissue. Uses of the invention include but are not limited to creating tissue necrosis, and more specifically for the treatment hypertension, cardiac, neurologic, renal, and various other disorders.
One aspect of a first embodiment of the invention is shown in
The distal assembly 400 can house an energy delivery apparatus 410, for example, one or more ultrasound transducers (described in more detail in
Although the system described herein includes a distal assembly 400 having an ultrasound transducer as a source of energy, it is envisioned than any of a number of energy sources can be used with various implementations of the invention. Suitable sources of energy include but are not limited to, radio frequency (RF) energy, microwaves, photonic energy, and thermal energy. It is envisioned that the energy source to create necrotic tissue could alternatively be achieved using cooled fluids (e.g., cryogenic fluid). Additionally, although use of a single ultrasound transducer is described herein as an exemplary energy delivery source, it is envisioned that a plurality of energy delivery structures can be included in the distal assembly 400 and that the energy may be delivered in a direct and/or reflected and/or refracted manner.
The outer shaft 300 of the catheter 100 can include a deflectable region 310 as shown in
The outer shaft 300 and/or handle 500 can include a bending mechanism or mechanisms for bending the deflectable region 310 of the outer shaft 300 which may include a deflection element 320. The bending mechanism may include but is not limited to lengths of wires, ribbons, cables, lines, fibers, filament, combinations thereof, or any other actuating or force transmitting member. In one implementation the bending mechanism includes one deflection element 320 comprised of two materials, for example, a distal Nitinol region and a proximal. Kevlar filament region. A variety of attachment elements and positions for connecting the bending mechanism and the elongate member are envisioned.
The deflection element 320 may be connected in the distal portion of the deflectable region 310 to a radial band 330 to serve as an anchor. The radial band 330 may be radiopaque to provide visualization under fluoroscopy. Similarly, attachment of the deflection element 320 may include but is not limited to using: adhesive, welding, pins, and/or screws or the like. Proximally, the deflection element 320 may be terminated in the region of the handle and be actuated by one or more ways of moving the deflection element 320, for example screw(s), slider(s), gear(s), pulley (s), motor(s), electrical coil(s), and the like or combinations thereof. Position of the deflection element 320 or a portion of the catheter 100 may be desired. The use of a sensor or sensors may be used to accomplish this. Examples of sensors include but are not limited to optical, electrical, mechanical, magnetic, hydraulic, wireless, etc. Information from the sensors may be used to inform and/or modify system parameters and/or control features (e.g. intensity, speed, position, pull wire position or tension, motor position, etc).
The elongate member 200 and outer shaft 300 may rotate and/or translate with respect to each other.
Control of the movement of any component of the catheter 100 may be accomplished by physical inputs and/or by use of a controller 600. These movements may be for example: pre-programmed, auto or semi-automated, input manually, or a combination thereof. Control of the energy delivery may also be in part controlled by the controller 600. The controller 600 may incorporate an integral or separate display 610 which may have touch screen inputs and/or soft keys. The controller 600 and/or display 610 may have various inputs and/or outputs, for example: power in, alarms, visual display(s) (e.g. display 610), energy control, position of catheter 100 element or elements (e.g. distal assembly 400—longitudinal and/or rotational), sensor input/output, power out, control of actuating elements, tissue necrosis shape or pattern, energy delivery ON/OFF, time of use, energy setting, energy delivered, tissue structure depth(s), nerve(s) location, calcified tissue, progression of lesion formation, indicator of lesion completion, external and/or additional equipment control (e.g. pumps), safety stops and limits, etc.
The ability to regulate the use of the system and/or catheter 100 may be accomplished in, for example, the controller 600 or handle 100 where software and/or hardware monitors the use of the catheter 100 and only allows it to be functional for a determined amount of time and/or uses and/or energy delivery and the like. For example, once the catheter 100 delivers energy for the first time, there is a 4-hour clock which is started which after that has expired, the catheter 100 is no longer recognized by the controller 600 as being usable.
Information from an element or elements of the system (e.g. energy delivery apparatus 410) may be used for imaging and/or analysis of tissue (further referred to as “imaging”) in or by the controller 600 and/or a separate component or instrument (not shown). This element or elements may be the same or different from the element or elements used to deliver energy to create necrotic tissue. Information from the element or elements may be used to determine distance from the element to a structure, to gather information about the structure or structures (e.g. thickness, morphology, physiology, multiple structures, structure recognition, tissue type, etc.), and other uses. Further this element or elements may be used to monitor the progression of a lesion while the lesion is created to titrate the energy delivered and/or stop energy delivery when the targeted lesion dimensions are achieved. In addition, the information gathered may be used to affect the energy delivered, including but not limited to intensity, duration, power, frequency, speed, etc, as well position of energy delivery. Examples include measuring wall thickness to determine energy dose parameters and identifying structures (e.g. nerve tissue) to determine energy delivery position. Imaging may be used to identify received echoes that are indicative of calcified regions where reflections are stronger than non-calcified tissue. Therapy power and intensity levels may be increased in these regions to insure effective therapy. Additional manual or automated guidance from the controller 600 and display 610 may direct the therapy to regions without substantial calcification as to insure effective therapy.
Imaging may be accomplished independently or interleaved with the delivery of therapeutic energy. It is intended that the imaging energy level or time of energy delivery is such that an insufficient amount of energy is deposited in the tissue to damage the tissue (e.g. create thermal damage and/or tissue necrosis) from the imaging. With respect to wall thickness, an ultrasound wave may be delivered to the tissue by an energy deliver element 410, in this case an ultrasound transducer or transducers. The varying tissues and tissue interfaces reflect back energy, which is then received by the ultrasound transducer(s) or other transducers, and the delay time is used to calculate the relative tissue positions (e.g. blood vessel inner and outer wall). From this, the wall thickness can be calculated and the energy delivery parameters can be adjusted, for example by the controller 600 and/or by the operator or a combination thereof, to ensure the appropriate depth of tissue necrosis is created from both an efficacy and a safety perspective. The energy delivery parameters can be adjusted prior to therapeutic energy delivery and/or during therapeutic energy, while the energy delivery apparatus is held in a specific position or is being moved with respect to the tissue (e.g. creating a line of tissue necrosis).
Imaging can be used to determine the properties of tissues. As tissue necrosis is being created, the acoustic properties of the tissue changes. This can be evaluated to determine among other things, for example if the tissue is healthy, necrotic, the depth of necrotic tissue, and the like. As different structures have different acoustic properties such as nerve tissue compared to the blood vessel wall, these structures can be differentiated using similar imaging techniques. In this manner for example, nerve tissue can be identified and specifically targeted with therapeutic energy. It is envisioned that combinations of energy delivery and imaging can be combined to produce the desired results.
The imaging and/or therapeutic information may be wholly or partly used in an image (e.g. 2 dimensional, 3 dimensional, layered, integrated) that may be static, dynamic, interactive, etc and shown on the display 610.
The imaging may further incorporate coded excitation and reception for improving the signal-to-noise (SNR) ratio and/or improve the spatial resolution.
In another aspect of the present invention, the catheter and/or system may be constructed as to be visualized and/or recognized by and/or interface and/or integrated with additional equipment, including but not limited to fluoroscopy, pumps (e.g. fluid), computed tomography, magnetic resonance imaging, anatomical mapping, electrocardiogram, respiration, pumps, imaging, etc. Control of a pump(s) may be used to deliver fluids (e.g. cooling, drugs, etc) along or through elements of the catheter 100, for example: cooling fluid through the elongate member 200, saline through the outer shaft 300, etc. A pump or pumps may be integrated with the controller.
The outer shaft 300 may be free to be moved at least in part rotationally and/or translationally with respect to the elongate member 200 by the proximal end of the outer shaft 300 terminating distal to the proximal end of the elongate member 200. Fixing the position between the two elements may be accomplished by using a seal, valve, locking mechanism, friction device or component or fit, etc and the like on one or more components.
Various details, features and uses of this embodiment include those as described herein regarding other embodiments.
During energy delivery, heat may be generated by the transducer. It is envisioned that the temperature can be controlled or affected by cooling the transducer. In one or more implementations cooling of the transducer can be accomplished by contacting the transducer subassembly with a fluid, for example; saline. In some implementations the transducer can be cooled using a fluid having a lower temperature relative to the temperature of the transducer. In one implementation a fluid for cooling the transducer is flushed past the transducer subassembly from a lumen in the catheter 100. Accordingly, as shown in
As shown in e.g.
As further shown in e.g.
In various embodiments, recessing the energy delivery apparatus 410 may be advantageous to cooling the energy delivery apparatus 410, as well for providing a fluid and/or cooling fluid barrier between the energy delivery apparatus 410 and the blood. Features of the reflector 420 and/or the housing 480 and/or other additional elements may be used to create various patterns of energy as will be described in more detail elsewhere.
In various embodiments, the aperture 430 or apertures can be in part or completely covered and/or filled with an energy transparent and/or semi-transparent material. Additionally, components of the catheter 100 may be in part or entirely coated. The coating may be for example but not limited to: lubricious, anti-thrombogenic, biocompatible, and the like.
Intensity levels from the beam of
As shown, the energy delivery apparatus 410 is not in contact with the target tissue. By generating an ultrasound beam with a given length of usable energy (as shown in
One or more elements of the catheter 100 (e.g. distal assembly 400, housing 480, aperture 430, reflector 420) maybe be constructed to affect acoustic pressure induced flow 910, such as focusing the acoustic pressure induced flow 910 into a more narrow region or diverging it to cover a greater area.
Various details, features, and uses of this embodiment include those as described herein regarding other embodiments.
Blood flow within the vessel 1000 as well as acoustic pressure induced flow 910 increase the thermal transfer at the vessel surface 1010 from the vessel surface 1010 to the blood and/or fluid delivered by the catheter. This increased rate of heat removal reduces the thermal damage at the vessel surface 1010. This can be affected by, for example: the flow rate, velocity, and temperature of the fluid passed through the catheter 100 as well as the power, frequency, pulse rate, duration, etc of the energy delivered among other factors. If desired, these parameters can be tailored such that the endothelial layer of the vessel 1000 is not permanently damaged.
Tissue necrosis occurs when the tissue is heated above a temperature of 55 degrees Celsius. By adjusting the energy parameters the region of tissue necrosis 1100, particularly depth of the region, can be controlled. For specific applications, it may be desirable to cause necrosis through the entire tissue or wall of the vessel 1000, or only through a portion of the tissue. Accurate control of tissue necrosis and depth are particularly important when there is a tissue or structure on the far side of the target tissue that it is undesirable to cause damage to.
The ability to accurately control width and depth of the region of tissue necrosis 1100 provides for a safe and efficacious treatment. Being able to monitor changes within the tissue using imaging is an additional enhancement. Monitoring reflected amplitudes and the rate of change of these amplitudes can be used to monitor the progression of a thermal lesion. Changes in density and changes in the speed of sound can all be used to monitor treatment.
As described above, the distal assembly 400 is retracted, similarly it can be advanced or advanced and retracted and rotated if necessary to form the desired shape or shapes. The invention provides a system that is capable of creating regions of tissue necrosis 1100 that may be composed of one of more spots; lines of varying shapes, for example a spiral or helix; continuous or intermittent lines, circles, narrow or wide lines, and the like as well as combinations thereof
The handle 500 and/or controller 600, for example, can be used to affect manual (e.g. operator input), semi-automatic, and/or fully-automatic control over various functions of the system, including but not limited to catheter 100 or catheter component movement, energy parameters, energy delivery, and imaging among others. Control in this manner allows for accurate placement and shape of the tissue necrosis pattern. By not having to manually reposition the energy delivery apparatus 410, the desired region(s) of tissue necrosis can be created in a more expeditious manner. Similarly, by having an energy beam the does not require tissue contact, the procedure can be conducted more quickly than if contact and/or a range of contact pressures is required.
Accurate tissue necrosis patterns with controlled width and depth, provides the operator with an easy-to-use system capable of quickly delivering an efficacious and safe therapy to the patient.
A reduction in pain associated with creating tissue necrosis may be accomplished by delivering a pain reduction medicament or anesthetic or other fluid/gel/solid near the region of energy delivery or to a region that will affect the sensation of pain from the delivery of energy. The delivery of the pain reduction medicament or anesthetic or other fluid/gel/solid can take place prior to and/or during and/or after the delivery of energy. As seen in
Other features on the catheter 100 can be constructed for localized fluid/gel/solid delivery, for example, components of the catheter 100 such as the elongate member 200, outer shaft 300, and distal assembly 400 may have one or more openings or ports or features (e.g. barbs, sharp elements) to deliver the fluid/gel/solid at a point or points along the length of the catheter 100. As shown in
Further, the ultrasound from the energy delivery apparatus may also be used to stimulate the efficiency of the drug delivery through sonoporation, bursting or altering encapsulated drug delivery vehicles, and thermal stimulated drug delivery. Injecting the drug directly into the fluid path 520 can avoid a separate needle delivery vehicle and may be most efficiently directed to the intimal layer of interest.
While preferred embodiments of the present invention have been shown and described herein, it will be obvious to those skilled in the art that such embodiments are provided by way of example only. Numerous variations, changes, and substitutions will now occur to those skilled in the art without departing from the invention. It should be understood that various alternatives to the embodiments of the invention described herein may be employed in practicing the invention. It is intended that the following claims define the scope of the invention and that methods and structures within the scope of these claims and their equivalents be covered thereby.
This application claims the benefit of priority of Provisional U.S. Patent Application Ser. No. 61/592,392, entitled “Tissue Necrosis Methods and Apparatus”, filed on Jan. 30, 2012, which is fully incorporated by reference herein for all purposes. This application is related to the following U.S. Pat. Nos. 7,950,397; 7,942,871; and also related to the following U.S. patent application Ser. Nos. 13/092,747; 12/480,929; 12/480,256; 12/483,174; 12/482,640; 12/505,326; 12/505,335; 12/620,287; 12/695,857; 12/609,759; 12/609,274; 12/609,705; 12/909,642; and also related to U.S. Provisional Patent Application No. 61/475,130; the entire contents of each of which is incorporated herein by reference.
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