JP2018520795A - 損傷形成及び評価のためのシステム及び方法 - Google Patents
損傷形成及び評価のためのシステム及び方法 Download PDFInfo
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- JP2018520795A JP2018520795A JP2018502383A JP2018502383A JP2018520795A JP 2018520795 A JP2018520795 A JP 2018520795A JP 2018502383 A JP2018502383 A JP 2018502383A JP 2018502383 A JP2018502383 A JP 2018502383A JP 2018520795 A JP2018520795 A JP 2018520795A
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00994—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body combining two or more different kinds of non-mechanical energy or combining one or more non-mechanical energies with ultrasound
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- A—HUMAN NECESSITIES
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- A61B18/02—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by cooling, e.g. cryogenic techniques
- A61B2018/0212—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by cooling, e.g. cryogenic techniques using an instrument inserted into a body lumen, e.g. catheter
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- A—HUMAN NECESSITIES
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- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
- A61B18/1815—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using microwaves
- A61B2018/1861—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using microwaves with an instrument inserted into a body lumen or cavity, e.g. a catheter
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- A61B2218/001—Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body having means for irrigation and/or aspiration of substances to and/or from the surgical site
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Abstract
Description
本出願は、2015年10月21日に出願された米国特許出願第14/919,004号及び2015年7月19日に出願された米国仮出願第62/194,276号の利益及び優先権を主張するものであり、両出願の全体が参照により本明細書に組み込まれる。
本開示は、概してカテーテルに関し、より具体的にはアブレーション及び視覚化カテーテルに関する。
Claims (38)
- アブレーションされた組織を視覚化するカテーテルであって、
カテーテル本体と、
前記カテーテル本体の遠位端部に配置されて照射キャビティを画定する遠位端部材と、
前記照射キャビティ内に配設される光誘導部材と、
を備え、
前記遠位端部材は、前記照射キャビティと組織との間で光エネルギーを交換するための1つ以上の開口部を有し、
前記光誘導部材は、前記遠位端部材の1つ以上の開口部を介して、組織に光エネルギーを誘導するように、かつ、組織から光エネルギーを誘導するように構成されている、
カテーテル。 - 前記照射キャビティ内に至るまで延びて前記照射キャビティに対して光の送受を行う1つ以上の光ファイバを更に備える、請求項1に記載のカテーテル。
- 前記遠位端部材はファイバ位置合わせ部材を更に備え、前記ファイバ位置合わせ部材は、前記1つ以上の光ファイバを前記光誘導部材の中心軸と位置合わせするように構成されている、請求項2に記載のカテーテル。
- 前記光誘導部材及び前記1つ以上の開口部は、前記カテーテルの長手方向軸に対する径方向及び軸方向に組織を照らすことができるように構成されている、請求項1に記載のカテーテル。
- 前記1つ以上の開口部は前記遠位端部材の側壁に沿って配設され、前記光誘導部材は、前記1つ以上の開口部を介して、前記カテーテルの長手方向軸に対するある角度で光エネルギーを誘導するように形成されている、請求項1に記載のカテーテル。
- 前記光誘導部材は1つ以上の貫通孔を備え、前記遠位端部材は、前記遠位端部材の前壁に配設された1つ以上の開口部を備え、光が前記光誘導部材及び前記前壁の1つ以上の開口部を長手方向に通過することができる、請求項5に記載のカテーテル。
- 前記1つ以上の開口部を介してのみ光を反射するように前記光誘導部材が前記1つ以上の開口部と位置合わせされている、請求項5に記載のカテーテル。
- 前記1つ以上の開口部は、前記遠位端部材に沿って周方向に配設されて互いに等距離だけ離間され、前記光誘導部材は、前記1つ以上の開口部と位置合わせされた複数の等間隔のファセットを備える、請求項1に記載のカテーテル。
- 前記遠位端部材は、アブレーションエネルギーを組織に供給するように構成され、前記アブレーションエネルギーは、高周波(RF)エネルギー、マイクロ波エネルギー、電気エネルギー、電磁エネルギー、冷凍エネルギー、レーザーエネルギー、超音波エネルギー、音響エネルギー、化学エネルギー、熱エネルギー及びそれらの組み合わせからなる群から選択される、請求項1〜請求項8のいずれか1つに記載のカテーテル。
- 超音波トランスデューサを更に備える、請求項1〜請求項8のいずれか1つに記載のカテーテル。
- 位置センサ又はナビゲーションセンサを更に備える、請求項1〜請求項8のいずれか1つに記載のカテーテル。
- アブレーションされた組織を視覚化するシステムであって、
カテーテルと、
光源と、
光測定器と、
前記光源及び前記光測定器とつながっている1つ以上の光ファイバと、
を備え、
前記カテーテルは、
カテーテル本体と、
前記カテーテル本体の遠位端部に配置されて照射キャビティを画定する遠位端部材と、
前記照射キャビティ内に配設される光誘導部材と、
を備え、
前記遠位端部材は、前記照射キャビティと組織との間で光エネルギーを交換するための1つ以上の開口部を有し、
前記光誘導部材は、前記遠位端部材の1つ以上の開口部を介して、組織に光エネルギーを誘導するように、かつ、組織から光エネルギーを誘導するように構成され、
前記1つ以上の光ファイバは、前記カテーテル本体を通って前記遠位端部材の前記照射キャビティ内に至るまで延び、
前記1つ以上の光ファイバは、前記遠位端部材の外側の組織を照らすために光エネルギーを前記光源から前記光誘導部材に送るように構成され、
前記1つ以上の光ファイバは、組織から反射された光エネルギーを前記光測定器に中継するように構成されている、
システム。 - 前記1つ以上の光ファイバは、ファイババンドル又は単一のファイバを含む、請求項12に記載のシステム。
- 前記遠位端部材はファイバ位置合わせ部材を更に備え、前記ファイバ位置合わせ部材は、前記1つ以上の光ファイバを前記光誘導部材の中心軸と位置合わせするように構成されている、請求項13に記載のシステム。
- 前記光誘導部材及び前記1つ以上の開口部は、前記カテーテルの長手方向軸に対する径方向及び軸方向に組織を照らすことができるように構成されている、請求項12に記載のシステム。
- 前記1つ以上の開口部は前記遠位端部材の側壁に沿って配設され、前記光誘導部材は、前記1つ以上の開口部を介して、前記カテーテルの長手方向軸に対するある角度で光エネルギーを誘導するように形成されている、請求項12に記載のシステム。
- 前記光誘導部材は1つ以上の貫通孔を備え、前記遠位端部材は、前記遠位端部材の前壁に配設された1つ以上の開口部を備え、光が前記光誘導部材及び前記前壁の1つ以上の開口部を長手方向に通過することができる、請求項16に記載のシステム。
- 前記1つ以上の開口部を介してのみ光を反射するように前記光誘導部材が前記1つ以上の開口部と位置合わせされている、請求項16に記載のシステム。
- 前記1つ以上の開口部は、前記遠位端部材に沿って周方向に配設されて互いに等距離だけ離間され、前記光誘導部材は、前記1つ以上の開口部と位置合わせされた複数の等間隔のファセットを備える、請求項12に記載のシステム。
- 前記遠位端部材は、アブレーションエネルギーを組織に供給するように構成され、前記アブレーションエネルギーは、高周波(RF)エネルギー、マイクロ波エネルギー、電気エネルギー、電磁エネルギー、冷凍エネルギー、レーザーエネルギー、超音波エネルギー、音響エネルギー、化学エネルギー、熱エネルギー及びそれらの組み合わせからなる群から選択される、請求項12〜請求項19のいずれか1つに記載のシステム。
- 前記カテーテルは超音波トランスデューサを更に備える、請求項12〜請求項19のいずれか1つに記載のシステム。
- 前記カテーテルは、位置センサ又はナビゲーションセンサを更に備える、請求項12〜請求項19のいずれか1つに記載のシステム。
- アブレーションされた組織を視覚化する方法であって、
カテーテル本体と、
前記カテーテル本体の遠位端部に配置されて照射キャビティを画定する遠位端部材であって、前記照射キャビティと組織との間で光を交換するための1つ以上の開口部を有する前記遠位端部材と、
前記照射キャビティ内に配設される光誘導部材であって、前記遠位端部材の1つ以上の開口部を介して、組織に光を誘導するように、かつ、組織から光を誘導するように構成されている前記光誘導部材と、
を備えるカテーテルを、アブレーションを必要とする心臓組織へ前進させること、
アブレーションされた心臓組織及びアブレーションされていない心臓組織を含む心臓組織の領域内のニコチンアミドアデニンジヌクレオチド水素(NADH)を励起するために、前記カテーテルの前記遠位端部材の1つ以上の開口部を介して前記光誘導部材に光を誘導させること、
心臓組織から反射された光を前記1つ以上の開口部を介して収集し、この収集された光を光測定器に誘導すること、
心臓組織の前記領域のNADH蛍光を検出するために心臓組織の前記領域を撮像すること、及び、
前記撮像されて照らされた心臓組織の表示を生成すること、
を含み、
前記表示は、前記アブレーションされた心臓組織を、前記アブレーションされていない心臓組織よりも少ない蛍光を呈するものとして示す、
方法。 - 組織を撮像するに先立って、前記遠位端部材により組織をアブレーションすることを更に含む、請求項23に記載の方法。
- 前記アブレーションされた心臓組織と前記アブレーションされていない心臓組織とを前記蛍光の量に基づいて区別することによって識別された別のアブレーションされていない心臓組織をアブレーションすることを更に含む、請求項24に記載の方法。
- 前記光誘導部材及び前記1つ以上の開口部は、前記カテーテルの長手方向軸に対する径方向及び軸方向に心臓組織を照らすことができるように構成されている、請求項23に記載の方法。
- 前記照射キャビティ内に至るまで延びて前記照射キャビティに対して光の送受を行う1つ以上の光ファイバを更に備える、請求項23に記載の方法。
- 前記遠位端部材はファイバ位置合わせ部材を更に備え、前記ファイバ位置合わせ部材は、前記1つ以上の光ファイバを前記光誘導部材の中心軸と位置合わせするように構成されている、請求項27に記載の方法。
- 前記光誘導部材及び前記1つ以上の開口部は、前記カテーテルの長手方向軸に対する径方向及び軸方向に組織を照らすことができるように構成されている、請求項23に記載の方法。
- 前記1つ以上の開口部は前記遠位端部材の側壁に沿って配設され、前記光誘導部材は、前記1つ以上の開口部を介して、前記カテーテルの長手方向軸に対するある角度で光エネルギーを誘導するように形成されている、請求項23に記載の方法。
- 前記光誘導部材は1つ以上の貫通孔を備え、前記遠位端部材は、前記遠位端部材の前壁に配設された1つ以上の開口部を備え、光が前記光誘導部材及び前記前壁の1つ以上の開口部を長手方向に通過することができる、請求項30に記載の方法。
- 前記1つ以上の開口部を介してのみ光を反射するように前記光誘導部材が前記1つ以上の開口部と位置合わせされている、請求項30に記載の方法。
- 前記1つ以上の開口部は、前記遠位端部材に沿って周方向に配設されて互いに等距離だけ離間され、前記光誘導部材は、前記1つ以上の開口部と位置合わせされた複数の等間隔のファセットを備える、請求項23に記載の方法。
- 前記遠位端部材は、アブレーションエネルギーを組織に供給するように構成され、前記アブレーションエネルギーは、高周波(RF)エネルギー、マイクロ波エネルギー、電気エネルギー、電磁エネルギー、冷凍エネルギー、レーザーエネルギー、超音波エネルギー、音響エネルギー、化学エネルギー、熱エネルギー及びそれらの組み合わせからなる群から選択される、請求項23〜請求項33のいずれか1つに記載の方法。
- 超音波トランスデューサを更に備える、請求項23〜請求項33のいずれか1つに記載の方法。
- 位置センサ又はナビゲーションセンサを更に備える、請求項23〜請求項33のいずれか1つに記載の方法。
- アブレーションされた組織を視覚化するためのシステムであって、
カテーテルと、
アブレーション治療システムと、
視覚化システムと、
イリゲーションシステムと、
組織を超音波により評価するための超音波システムと、
前記カテーテルの位置特定及び誘導を行うためのナビゲーションシステムと、
を備え、
前記カテーテルは、
カテーテル本体と、
前記カテーテル本体の遠位端部に配置されて照射キャビティを画定する遠位端部材と、
前記照射キャビティ内に配設される光誘導部材と、
を備え、
前記遠位端部材は、アブレーションエネルギーを組織に供給するように構成され、
前記遠位端部材は、前記照射キャビティと組織との間で光エネルギーを交換するための1つ以上の開口部を有し、
前記光誘導部材は、前記遠位端部材の1つ以上の開口部を介して、組織に光エネルギーを誘導するように、かつ、組織から光エネルギーを誘導するように構成され、
前記カテーテルは、1つ以上の超音波トランスデューサ及び1つ以上の電磁位置センサを更に備え、
前記アブレーション治療システムは、前記アブレーションエネルギーを組織に供給するために前記遠位端部材とつながっており、
前記視覚化システムは、
光源と、
光測定器と、
前記光源及び前記光測定器とつながっている1つ以上の光ファイバと、
を備え、
前記1つ以上の光ファイバは、前記カテーテル本体を通って前記遠位端部材の前記照射キャビティ内に至るまで延び、
前記1つ以上の光ファイバは、前記照射キャビティと光エネルギーをやり取りするように構成され、
前記イリゲーションシステムは、前記1つ以上の開口部の洗浄を行うためのものであり、
前記超音波システムは、前記1つ以上の超音波トランスデューサとつながっており、
前記ナビゲーションシステムは、前記1つ以上の電磁位置センサとつながっている、
システム。 - 前記アブレーションエネルギーは、高周波(RF)エネルギー、マイクロ波エネルギー、電気エネルギー、電磁エネルギー、冷凍エネルギー、レーザーエネルギー、超音波エネルギー、音響エネルギー、化学エネルギー、熱エネルギー及びそれらの組み合わせからなる群から選択される、請求項37に記載のシステム。
Applications Claiming Priority (5)
Application Number | Priority Date | Filing Date | Title |
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US201562194276P | 2015-07-19 | 2015-07-19 | |
US62/194,276 | 2015-07-19 | ||
US14/919,004 US10779904B2 (en) | 2015-07-19 | 2015-10-21 | Systems and methods for lesion formation and assessment |
US14/919,004 | 2015-10-21 | ||
PCT/US2016/042891 WO2017015257A1 (en) | 2015-07-19 | 2016-07-19 | Systems and methods for lesion formation and assessment |
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JP2021072880A (ja) | 2021-05-13 |
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WO2017015257A1 (en) | 2017-01-26 |
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