US20120004544A9 - Delivery of biological compounds to ischemic and/or infarcted tissue - Google Patents

Delivery of biological compounds to ischemic and/or infarcted tissue Download PDF

Info

Publication number
US20120004544A9
US20120004544A9 US11828267 US82826707A US2012004544A9 US 20120004544 A9 US20120004544 A9 US 20120004544A9 US 11828267 US11828267 US 11828267 US 82826707 A US82826707 A US 82826707A US 2012004544 A9 US2012004544 A9 US 2012004544A9
Authority
US
Grant status
Application
Patent type
Prior art keywords
tissue
method
tissue region
comprises
imaging
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Granted
Application number
US11828267
Other versions
US20080033290A1 (en )
US8137333B2 (en )
Inventor
Vahid Saadat
Sekhar Rao
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Intuitive Surgical Operations Inc
Original Assignee
Voyage Medical Inc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date

Links

Images

Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00163Optical arrangements
    • A61B1/00165Optical arrangements with light-conductive means, e.g. fibre optics
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00064Constructional details of the endoscope body
    • A61B1/00071Insertion part of the endoscope body
    • A61B1/0008Insertion part of the endoscope body characterised by distal tip features
    • A61B1/00089Hoods
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00064Constructional details of the endoscope body
    • A61B1/00071Insertion part of the endoscope body
    • A61B1/0008Insertion part of the endoscope body characterised by distal tip features
    • A61B1/00096Optical elements
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00147Holding or positioning arrangements
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/012Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor
    • A61B1/015Control of fluid supply or evacuation
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/04Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor combined with photographic or television appliances
    • A61B1/05Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor combined with photographic or television appliances characterised by the image sensor, e.g. camera, being in the distal end portion
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/12Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor with cooling or rinsing arrangements
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00Detecting, measuring or recording for diagnostic purposes; Identification of persons
    • A61B5/0059Detecting, measuring or recording for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence
    • A61B5/0082Detecting, measuring or recording for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence adapted for particular medical purposes
    • A61B5/0084Detecting, measuring or recording for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence adapted for particular medical purposes for introduction into the body, e.g. by catheters
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00Detecting, measuring or recording for diagnostic purposes; Identification of persons
    • A61B5/68Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient
    • A61B5/6846Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive
    • A61B5/6879Means for maintaining contact with the body
    • A61B5/6882Anchoring means
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00Detecting, measuring or recording for diagnostic purposes; Identification of persons
    • A61B5/72Signal processing specially adapted for physiological signals or for diagnostic purposes
    • A61B5/7271Specific aspects of physiological measurement analysis
    • A61B5/7282Event detection, e.g. detecting unique waveforms indicative of a medical condition
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00Catheters; Hollow probes
    • A61M25/0067Catheters; Hollow probes characterised by the distal end, e.g. tips
    • A61M25/0074Dynamic characteristics of the catheter tip, e.g. openable, closable, expandable or deformable
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00Catheters; Hollow probes
    • A61M25/0067Catheters; Hollow probes characterised by the distal end, e.g. tips
    • A61M25/0082Catheter tip comprising a tool
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00Catheters; Hollow probes
    • A61M25/0067Catheters; Hollow probes characterised by the distal end, e.g. tips
    • A61M25/0082Catheter tip comprising a tool
    • A61M25/0084Catheter tip comprising a tool being one or more injection needles

Abstract

The delivery of biological compounds to ischemic and/or infarcted tissue are described herein where such a system may include a deployment catheter and an attached imaging hood deployable into an expanded configuration. In use, the imaging hood is placed against or adjacent to a region of tissue to be imaged in a body lumen that is normally filled with an opaque bodily fluid such as blood. A translucent or transparent fluid, such as saline, can be pumped into the imaging hood until the fluid displaces any blood, thereby leaving a clear region of tissue to be imaged via an imaging element in the deployment catheter. Additionally, any number of therapeutic tools can also be passed through the deployment catheter and into the imaging hood for performing any number of procedures on the tissue for identifying, locating, and/or accessing ischemic and/or infarcted tissue.

Description

    CROSS-REFERENCE TO RELATED APPLICATIONS
  • This application claims the benefit of priority to U.S. Provisional Patent Application No. 60/821,117 filed Aug. 1, 2006, which is incorporated herein by reference in its entirety.
  • FIELD OF THE INVENTION
  • The present invention relates generally to medical devices used for accessing, visualizing, and/or treating regions of tissue within a body. More particularly, the present invention relates to methods and apparatus for locating and accessing ischemic and/or infracted tissue and for treating the tissue by delivering biologically active compounds within a patient heart.
  • BACKGROUND OF THE INVENTION
  • Conventional devices for accessing and visualizing interior regions of a body lumen are known. For example, ultrasound devices have been used to produce images from within a body in vivo. Ultrasound has been used both with and without contrast agents, which typically enhance ultrasound-derived images.
  • Other conventional methods have utilized catheters or probes having position sensors deployed within the body lumen, such as the interior of a cardiac chamber. These types of positional sensors are typically used to determine the movement of a cardiac tissue surface or the electrical activity within the cardiac tissue. When a sufficient number of points have been sampled by the sensors, a “map” of the cardiac tissue may be generated.
  • Another conventional device utilizes an inflatable balloon which is typically introduced intravascularly in a deflated state and then inflated against the tissue region to be examined. Imaging is typically accomplished by an optical fiber or other apparatus such as electronic chips for viewing the tissue through the membrane(s) of the inflated balloon. Moreover, the balloon must generally be inflated for imaging. Other conventional balloons utilize a cavity or depression formed at a distal end of the inflated balloon. This cavity or depression is pressed against the tissue to be examined and is flushed with a clear fluid to provide a clear pathway through the blood.
  • However, such imaging balloons have many inherent disadvantages. For instance, such balloons generally require that the balloon be inflated to a relatively large size which may undesirably displace surrounding tissue and interfere with fine positioning of the imaging system against the tissue. Moreover, the working area created by such inflatable balloons are generally cramped and limited in size. Furthermore, inflated balloons may be susceptible to pressure changes in the surrounding fluid. For example, if the environment surrounding the inflated balloon undergoes pressure changes, e.g., during systolic and diastolic pressure cycles in a beating heart, the constant pressure change may affect the inflated balloon volume and its positioning to produce unsteady or undesirable conditions for optimal tissue imaging.
  • Accordingly, these types of imaging modalities are generally unable to provide desirable images useful for sufficient diagnosis and therapy of the endoluminal structure, due in part to factors such as dynamic forces generated by the natural movement of the heart. Moreover, anatomic structures within the body can occlude or obstruct the image acquisition process. Also, the presence and movement of opaque bodily fluids such as blood generally make in vivo imaging of tissue regions within the heart difficult.
  • Other external imaging modalities are also conventionally utilized. For example, computed tomography (CT) and magnetic resonance imaging (MRI) are typical modalities which are widely used to obtain images of body lumens such as the interior chambers of the heart. However, such imaging modalities fail to provide real-time imaging for intra-operative therapeutic procedures. Fluoroscopic imaging, for instance, is widely used to identify anatomic landmarks within the heart and other regions of the body. However, fluoroscopy fails to provide an accurate image of the tissue quality or surface and also fails to provide for instrumentation for performing tissue manipulation or other therapeutic procedures upon the visualized tissue regions. In addition, fluoroscopy provides a shadow of the intervening tissue onto a plate or sensor when it may be desirable to view the intraluminal surface of the tissue to diagnose pathologies or to perform some form of therapy on it.
  • Thus, a tissue imaging system which is able to provide real-time in vivo access to and images of tissue regions within body lumens such as the heart through opaque media such as blood and which also provide instruments for therapeutic procedures upon the visualized tissue are desirable.
  • SUMMARY OF THE INVENTION
  • A tissue imaging and manipulation apparatus that may be utilized for procedures within a body lumen, such as the heart, in which visualization of the surrounding tissue is made difficult, if not impossible, by medium contained within the lumen such as blood, is described below. Generally, such a tissue imaging and manipulation apparatus comprises an optional delivery catheter or sheath through which a deployment catheter and imaging hood may be advanced for placement against or adjacent to the tissue to be imaged.
  • The deployment catheter may define a fluid delivery lumen therethrough as well as an imaging lumen within which an optical imaging fiber or assembly may be disposed for imaging tissue. When deployed, the imaging hood may be expanded into any number of shapes, e.g., cylindrical, conical as shown, semi-spherical, etc., provided that an open area or field is defined by the imaging hood. The open area is the area within which the tissue region of interest may be imaged. The imaging hood may also define an a traumatic contact lip or edge for placement or abutment against the tissue region of interest. Moreover, the distal end of the deployment catheter or separate manipulatable catheters may be articulated through various controlling mechanisms such as push-pull wires manually or via computer control
  • In operation, after the imaging hood has been deployed, fluid may be pumped at a positive pressure through the fluid delivery lumen until the fluid fills the open area completely and displaces any blood from within the open area. The fluid may comprise any biocompatible fluid, e.g., saline, water, plasma, Fluorinert™, etc., which is sufficiently transparent to allow for relatively undistorted visualization through the fluid. The fluid may be pumped continuously or intermittently to allow for image capture by an optional processor which may be in communication with the assembly.
  • One particular application for the tissue visualization system includes utilizing the system for detecting the presence and/or location of ischemic and/or infarcted tissue by visual inspection and/or measurement of one or more parameter of the tissue. Any number of physiologic parameters can be utilized to obtain measurements of the visualized tissue to detect the certain parameters, e.g., partial pressure values of oxygen (PO2) and carbon dioxide (PCO2); temperature differences between tissue regions; biomarkers indicative of injured tissue; electrical current and/or electrical potential differences through the tissue; variations in tissue surface hardness and deflection between tissue regions; etc.
  • Once the injured tissue region has been identified, a number of treatments may be utilized for injecting or infusing bioactive agents into or upon the tissue. Accordingly, a number of systems and methods for utilizing instruments to locate and/or access ischemic and/or infarcted tissue and to treat the tissue by delivering biologically active compounds may be utilized.
  • BRIEF DESCRIPTION OF THE DRAWING
  • FIG. 1A shows a side view of one variation of a tissue imaging apparatus during deployment from a sheath or delivery catheter.
  • FIG. 1B shows the deployed tissue imaging apparatus of FIG. 1A having an optionally expandable hood or sheath attached to an imaging and/or diagnostic catheter.
  • FIG. 1C shows an end view of a deployed imaging apparatus.
  • FIGS. 1D to 1F show the apparatus of FIGS. 1A to 1C with an additional lumen, e.g., for passage of a guidewire therethrough.
  • FIGS. 2A and 2B show one example of a deployed tissue imager positioned against or adjacent to the tissue to be imaged and a flow of fluid, such as saline, displacing blood from within the expandable hood.
  • FIG. 3A shows an articulatable imaging assembly which may be manipulated via push-pull wires or by computer control.
  • FIGS. 3B and 3C show steerable instruments, respectively, where an articulatable delivery catheter may be steered within the imaging hood or a distal portion of the deployment catheter itself may be steered.
  • FIGS. 4A to 4C show side and cross-sectional end views, respectively, of another variation having an off-axis imaging capability.
  • FIGS. 5A and 5B show examples of various visualization imagers which may be utilized within or along the imaging hood.
  • FIGS. 6A to 6C illustrate deployment catheters having one or more optional inflatable balloons or anchors for stabilizing the device during a procedure.
  • FIGS. 7A and 7B illustrate a variation of an anchoring mechanism such as a helical tissue piercing device for temporarily stabilizing the imaging hood relative to a tissue surface.
  • FIG. 7C shows another variation for anchoring the imaging hood having one or more tubular support members integrated with the imaging hood; each support members may define a lumen therethrough for advancing a helical tissue anchor within.
  • FIG. 8A shows an illustrative example of one variation of how a tissue imager may be utilized with an imaging device.
  • FIG. 8B shows a further illustration of a hand-held variation of the fluid delivery and tissue manipulation system.
  • FIGS. 9A to 9C illustrate an example of capturing several images of the tissue at multiple regions.
  • FIG. 10 shows a perspective view of the tissue visualization catheter visualizing the underlying tissue for the presence of ischemic and/or infarcted tissue.
  • FIGS. 11A and 11B show side and perspective views, respectively, of a variation of the tissue visualization catheter having a needle catheter for injecting a fluorescent dye into the underlying tissue to determine whether ischemic and/or infarcted tissue is present.
  • FIG. 12 shows a perspective view of a variation of the tissue visualization catheter having a single probe configured to obtain measurements of a variety of physiologic parameters for determining the presence and/or location of ischemic and/or infarcted tissue.
  • FIG. 13 shows a perspective view of another variation of the tissue visualization catheter having a multi-probe configuration to obtain measurements of a variety of physiologic parameters for determining presence and location of ischenmic and/or infarcted tissue.
  • FIG. 14A shows a perspective view of a helical needle having a plurality of holes or openings along a surface of the needle body for delivery of bioactive substances into tissue
  • FIG. 14B shows a perspective view of the helical delivery needle to be advanced into the underlying tissue while under direct visualization.
  • FIG. 15 shows a perspective view of another variation of the visualization catheter having multiple helical delivery needles positioned circumferentially around a periphery of the hood.
  • FIGS. 16A and 16B illustrate perspective views of another variation where a laser probe, e.g., an optical fiber bundle coupled to a laser generator, may be inserted through the work channel of the tissue visualization catheter and activated for ablation treatment prior to delivery of bioactive substances into the ablated tissue.
  • FIG. 17 shows a cross sectional view of the heart illustrating the implantation of a deposited delivery of a bioactive substance, e.g., in the anterolateral myocardium of the left ventricle.
  • DETAILED DESCRIPTION OF THE INVENTION
  • A tissue-imaging and manipulation apparatus described below is able to provide real-time images in vivo of tissue regions within a body lumen such as a heart, which is filled with blood flowing dynamically therethrough and is also able to provide intravascular tools and instruments for performing various procedures upon the imaged tissue regions. Such an apparatus may be utilized for many procedures, e.g., facilitating trans-septal access to the left atrium, cannulating the coronary sinus, diagnosis of valve regurgitation/stenosis, valvuloplasty, atrial appendage closure, arrhythmogenic focus ablation, among other procedures. Details of tissue imaging and manipulation systems and methods which may be utilized with apparatus and methods described herein are described in U.S. patent application Ser. No. 11/259,498 filed Oct. 25, 2005 (U.S. Pat. Pub. No. 2006/0184048 A1), which is incorporated herein by reference in its entirety.
  • One variation of a tissue access and imaging apparatus is shown in the detail perspective views of FIGS. 1A to 1C. As shown in FIG. 1A, tissue imaging and manipulation assembly 10 may be delivered intravascularly through the patient's body in a low-profile configuration via a delivery catheter or sheath 14. In the case of treating tissue, such as the mitral valve located at the outflow tract of the left atrium of the heart, it is generally desirable to enter or access the left atrium while minimizing trauma to the patient. To non-operatively effect such access, one conventional approach involves puncturing the intra-atrial septum from the right atrial chamber to the left atrial chamber in a procedure commonly called a trans-septal procedure or septostomy. For procedures such as percutaneous valve repair and replacement, trans-septal access to the left atrial chamber of the heart may allow for larger devices to be introduced into the venous system than can generally be introduced percutaneously into the arterial system.
  • When the imaging and manipulation assembly 10 is ready to be utilized for imaging tissue, imaging hood 12 may be advanced relative to catheter 14 and deployed from a distal opening of catheter 14, as shown by the arrow. Upon deployment, imaging hood 12 may be unconstrained to expand or open into a deployed imaging configuration, as shown in FIG. 1B. Imaging hood 12 may be fabricated from a variety of pliable or conformable biocompatible material including but not limited to, e.g., polymeric, plastic, or woven materials. One example of a woven material is Kevlar® (E. I. du Pont de Nemours, Wilmington, Del.), which is an aramid and which can be made into thin, e.g., less than 0.001 in., materials which maintain enough integrity for such applications described herein. Moreover, the imaging hood 12 may be fabricated from a translucent or opaque material and in a variety of different colors to optimize or attenuate any reflected lighting from surrounding fluids or structures, i.e., anatomical or mechanical structures or instruments. In either case, imaging hood 12 may be fabricated into a uniform structure or a scaffold-supported structure, in which case a scaffold made of a shape memory alloy, such as Nitinol, or a spring steel, or plastic, etc., may be fabricated and covered with the polymeric, plastic, or woven material.
  • Imaging hood 12 may be attached at interface 24 to a deployment catheter 16 which may be translated independently of deployment catheter or sheath 14. Attachment of interface 24 may be accomplished through any number of conventional methods. Deployment catheter 16 may define a fluid delivery lumen 18 as well as an imaging lumen 20 within which an optical imaging fiber or assembly may be disposed for imaging tissue. When deployed, imaging hood 12 may expand into any number of shapes, e.g., cylindrical, conical as shown, semi-spherical, etc., provided that an open area or field 26 is defined by imaging hood 12. The open area 26 is the area within which the tissue region of interest may be imaged. Imaging hood 12 may also define an atraumatic contact lip or edge 22 for placement or abutment against the tissue region of interest. Moreover, the diameter of imaging hood 12 at its maximum fully deployed diameter, e.g., at contact lip or edge 22, is typically greater relative to a diameter of the deployment catheter 16 (although a diameter of contact lip or edge 22 may be made to have a smaller or equal diameter of deployment catheter 16). For instance, the contact edge diameter may range anywhere from 1 to 5 times (or even greater, as practicable) a diameter of deployment catheter 16. FIG. 1C shows an end view of the imaging hood 12 in its deployed configuration. Also shown are the contact lip or edge 22 and fluid delivery lumen 18 and imaging lumen 20.
  • The imaging and manipulation assembly 10 may additionally define a guidewire lumen therethrough, e.g., a concentric or eccentric lumen, as shown in the side and end views, respectively, of FIGS. 1D to 1F. The deployment catheter 16 may define guidewire lumen 19 for facilitating the passage of the system over or along a guidewire 17, which may be advanced intravascularly within a body lumen. The deployment catheter 16 may then be advanced over the guidewire 17, as generally known in the art.
  • In operation, after imaging hood 12 has been deployed, as in FIG. 1B, and desirably positioned against the tissue region to be imaged along contact edge 22, the displacing fluid may be pumped at positive pressure through fluid delivery lumen 18 until the fluid fills open area 26 completely and displaces any fluid 28 from within open area 26. The displacing fluid flow may be laminarized to improve its clearing effect and to help prevent blood from re-entering the imaging hood 12. Alternatively, fluid flow may be started before the deployment takes place. The displacing fluid, also described herein as imaging fluid, may comprise any biocompatible fluid, e.g., saline, water, plasma, etc., which is sufficiently transparent to allow for relatively undistorted visualization through the fluid. Alternatively or additionally, any number of therapeutic drugs may be suspended within the fluid or may comprise the fluid itself which is pumped into open area 26 and which is subsequently passed into and through the heart and the patient body.
  • As seen in the example of FIGS. 2A and 2B, deployment catheter 16 may be manipulated to position deployed imaging hood 12 against or near the underlying tissue region of interest to be imaged, in this example a portion of annulus A of mitral valve MV within the left atrial chamber. As the surrounding blood 30 flows around imaging hood 12 and within open area 26 defined within imaging hood 12, as seen in FIG. 2A, the underlying annulus A is obstructed by the opaque blood 30 and is difficult to view through the imaging lumen 20. The translucent fluid 28, such as saline, may then be pumped through fluid delivery lumen 18, intermittently or continuously, until the blood 30 is at least partially, and preferably completely, displaced from within open area 26 by fluid 28, as shown in FIG. 2B.
  • Although contact edge 22 need not directly contact the underlying tissue, it is at least preferably brought into close proximity to the tissue such that the flow of clear fluid 28 from open area 26 may be maintained to inhibit significant backflow of blood 30 back into open area 26. Contact edge 22 may also be made of a soft elastomeric material such as certain soft grades of silicone or polyurethane, as typically known, to help contact edge 22 conform to an uneven or rough underlying anatomical tissue surface. Once the blood 30 has been displaced from imaging hood 12, an image may then be viewed of the underlying tissue through the clear fluid 30. This image may then be recorded or available for real-time viewing for performing a therapeutic procedure. The positive flow of fluid 28 may be maintained continuously to provide for clear viewing of the underlying tissue. Alternatively, the fluid 28 may be pumped temporarily or sporadically only until a clear view of the tissue is available to be imaged and recorded, at which point the fluid flow 28 may cease and blood 30 may be allowed to seep or flow back into imaging hood 12. This process may be repeated a number of times at the same tissue region or at multiple tissue regions.
  • In desirably positioning the assembly at various regions within the patient body, a number of articulation and manipulation controls may be utilized. For example, as shown in the articulatable imaging assembly 40 in FIG. 3A, one or more push-pull wires 42 may be routed through deployment catheter 16 for steering the distal end portion of the device in various directions 46 to desirably position the imaging hood 12 adjacent to a region of tissue to be visualized. Depending upon the positioning and the number of push-pull wires 42 utilized, deployment catheter 16 and imaging hood 12 may be articulated into any number of configurations 44. The push-pull wire or wires 42 may be articulated via their proximal ends from outside the patient body manually utilizing one or more controls. Alternatively, deployment catheter 16 may be articulated by computer control, as further described below.
  • Additionally or alternatively, an articulatable delivery catheter 48, which may be articulated via one or more push-pull wires and having an imaging lumen and one or more working lumens, may be delivered through the deployment catheter 16 and into imaging hood 12. With a distal portion of articulatable delivery catheter 48 within imaging hood 12, the clear displacing fluid may be pumped through delivery catheter 48 or deployment catheter 16 to clear the field within imaging hood 12. As shown in FIG. 3B, the articulatable delivery catheter 48 may be articulated within the imaging hood to obtain a better image of tissue adjacent to the imaging hood 12. Moreover, articulatable delivery catheter 48 may be articulated to direct an instrument or tool passed through the catheter 48, as described in detail below, to specific areas of tissue imaged through imaging hood 12 without having to reposition deployment catheter 16 and re-clear the imaging field within hood 12.
  • Alternatively, rather than passing an articulatable delivery catheter 48 through the deployment catheter 16, a distal portion of the deployment catheter 16 itself may comprise a distal end 49 which is articulatable within imaging hood 12, as shown in FIG. 3C. Directed imaging, instrument delivery, etc., may be accomplished directly through one or more lumens within deployment catheter 16 to specific regions of the underlying tissue imaged within imaging hood 12.
  • Visualization within the imaging hood 12 may be accomplished through an imaging lumen 20 defined through deployment catheter 16, as described above. In such a configuration, visualization is available in a straight-line manner, i.e., images are generated from the field distally along a longitudinal axis defined by the deployment catheter 16. Alternatively or additionally, an articulatable imaging assembly having a pivotable support member 50 may be connected to, mounted to, or otherwise passed through deployment catheter 16 to provide for visualization off-axis relative to the longitudinal axis defined by deployment catheter 16, as shown in FIG. 4A. Support member 50 may have an imaging element 52, e.g., a CCD or CMOS imager or optical fiber, attached at its distal end with its proximal end connected to deployment catheter 16 via a pivoting connection 54.
  • If one or more optical fibers are utilized for imaging, the optical fibers 58 may be passed through deployment catheter 16, as shown in the cross-section of FIG. 4B, and routed through the support member 50. The use of optical fibers 58 may provide for increased diameter sizes of the one or several lumens 56 through deployment catheter 16 for the passage of diagnostic and/or therapeutic tools therethrough. Alternatively, electronic chips, such as a charge coupled device (CCD) or a CMOS imager, which are typically known, may be utilized in place of the optical fibers 58, in which case the electronic imager may be positioned in the distal portion of the deployment catheter 16 with electric wires being routed proximally through the deployment catheter 16. Alternatively, the electronic imagers may be wirelessly coupled to a receiver for the wireless transmission of images. Additional optical fibers or light emitting diodes (LEDs) can be used to provide lighting for the image or operative theater, as described below in farther detail. Support member 50 may be pivoted via connection 54 such that the member 50 can be positioned in a low-profile configuration within channel or groove 60 defined in a distal portion of catheter 16, as shown in the cross-section of FIG. 4C. During intravascular delivery of deployment catheter 16 through the patient body, support member 50 can be positioned within channel or groove 60 with imaging hood 12 also in its low-profile configuration. During visualization, imaging hood 12 may be expanded into its deployed configuration and support member 50 may be deployed into its off-axis configuration for imaging the tissue adjacent to hood 12, as in FIG. 4A. Other configurations for support member 50 for off-axis visualization may be utilized, as desired.
  • FIG. 5A shows a partial cross-sectional view of an example where one or more optical fiber-bundles 62 may be positioned within the catheter and within imaging hood 12 to provide direct in-line imaging of the open area within hood 12. FIG. 5B shows another example where an imaging element 64 (e.g., CCD or CMOS electronic imager) may be placed along an interior surface of imaging hood 12 to provide imaging of the open area such that the imaging element 64 is off-axis relative to a longitudinal axis of the hood 12. The off-axis position of element 64 may provide for direct visualization and uninhibited access by instruments from the catheter to the underlying tissue during treatment.
  • To facilitate stabilization of the deployment catheter 16 during a procedure, one or more inflatable balloons or anchors 76 may be positioned along the length of catheter 16, as shown in FIG. 6A. For example, when utilizing a trans-septal approach across the atrial septum AS into the left atrium LA, the inflatable balloons 76 may be inflated from a low-profile into their expanded configuration to temporarily anchor or stabilize the catheter 16 position relative to the heart H. FIG. 6B shows a first balloon 78 inflated while FIG. 6C also shows a second balloon 80 inflated proximal to the first balloon 78. In such a configuration, the septal wall AS may be wedged or sandwiched between the balloons 78, 80 to temporarily stabilize the catheter 16 and imaging hood 12. A single balloon 78 or both balloons 78, 80 may be used. Other alternatives may utilize expandable mesh members, malecots, or any other temporary expandable structure. After a procedure has been accomplished, the balloon assembly 76 may be deflated or re-configured into a low-profile for removal of the deployment catheter 16.
  • To further stabilize a position of the imaging hood 12 relative to a tissue surface to be imaged, various anchoring mechanisms may be optionally employed for temporarily holding the imaging hood 12 against the tissue. Such anchoring mechanisms may be particularly useful for imaging tissue which is subject to movement, e.g., when imaging tissue within the chambers of a beating heart. A tool delivery catheter 82 having at least one instrument lumen and an optional visualization lumen may be delivered through deployment catheter 16 and into an expanded imaging hood 12. As the imaging hood 12 is brought into contact against a tissue surface T to be examined, an anchoring mechanisms such as a helical tissue piercing device 84 may be passed through the tool delivery catheter 82, as shown in FIG. 7A, and into imaging hood 12.
  • The helical tissue engaging device 84 may be torqued from its proximal end outside the patient body to temporarily anchor itself into the underlying tissue surface T. Once embedded within the tissue T, the helical tissue engaging device 84 may be pulled proximally relative to deployment catheter 16 while the deployment catheter 16 and imaging hood 12 are pushed distally, as indicated by the arrows in FIG. 7B, to gently force the contact edge or lip 22 of imaging hood against the tissue T. The positioning of the tissue engaging device 84 may be locked temporarily relative to the deployment catheter 16 to ensure secure positioning of the imaging hood 12 during a diagnostic or therapeutic procedure within the imaging hood 12. After a procedure, tissue engaging device 84 may be disengaged from the tissue by torquing its proximal end in the opposite direction to remove the anchor form the tissue T and the deployment catheter 16 may be repositioned to another region of tissue where the anchoring process may be repeated or removed from the patient body. The tissue engaging device 84 may also be constructed from other known tissue engaging devices such as vacuum-assisted engagement or grasper-assisted engagement tools, among others.
  • Although a helical anchor 84 is shown, this is intended to be illustrative and other types of temporary anchors may be utilized, e.g., hooked or barbed anchors, graspers, etc. Moreover, the tool delivery catheter 82 may be omitted entirely and the anchoring device may be delivered directly through a lumen defined through the deployment catheter 16.
  • In another variation where the tool delivery catheter 82 may be omitted entirely to temporarily anchor imaging hood 12, FIG. 7C shows an imaging hood 12 having one or more tubular support members 86, e.g., four support members 86 as shown, integrated with the imaging hood 12. The tubular support members 86 may define lumens therethrough each having helical tissue engaging devices 88 positioned within. When an expanded imaging hood 12 is to be temporarily anchored to the tissue, the helical tissue engaging devices 88 may be urged distally to extend from imaging hood 12 and each may be torqued from its proximal end to engage the underlying tissue T. Each of the helical tissue engaging devices 88 may be advanced through the length of deployment catheter 16 or they may be positioned within tubular support members 86 during the delivery and deployment of imaging hood 12. Once the procedure within imaging hood 12 is finished, each of the tissue engaging devices 88 may be disengaged from the tissue and the imaging hood 12 may be repositioned to another region of tissue or removed from the patient body.
  • An illustrative example is shown in FIG. 8A of a tissue imaging assembly connected to a fluid delivery system 90 and to an optional processor 98 and image recorder and/or viewer 100. The fluid delivery system 90 may generally comprise a pump 92 and an optional valve 94 for controlling the flow rate of the fluid into the system. A fluid reservoir 96, fluidly connected to pump 92, may hold the fluid to be pumped through imaging hood 12. An optional central processing unit or processor 98 may be in electrical communication with fluid delivery system 90 for controlling flow parameters such as the flow rate and/or velocity of the pumped fluid. The processor 98 may also be in electrical communication with an image recorder and/or viewer 100 for directly viewing the images of tissue received from within imaging hood 12. Imager recorder and/or viewer 100 may also be used not only to record the image but also the location of the viewed tissue region, if so desired.
  • Optionally, processor 98 may also be utilized to coordinate the fluid flow and the image capture. For instance, processor 98 may be programmed to provide for fluid flow from reservoir 96 until the tissue area has been displaced of blood to obtain a clear image. Once the image has been determined to be sufficiently clear, either visually by a practitioner or by computer, an image of the tissue may be captured automatically by recorder 100 and pump 92 may be automatically stopped or slowed by processor 98 to cease the fluid flow into the patient. Other variations for fluid delivery and image capture are, of course, possible and the aforementioned configuration is intended only to be illustrative and not limiting.
  • FIG. 8B shows a further illustration of a hand-held variation of the fluid delivery and tissue manipulation system 110. In this variation, system 110 may have a housing or handle assembly 112 which can be held or manipulated by the physician from outside the patient body. The fluid reservoir 114, shown in this variation as a syringe, can be fluidly coupled to the handle assembly 112 and actuated via a pumping mechanism 116, e.g., lead screw. Fluid reservoir 114 may be a simple reservoir separated from the handle assembly 112 and fluidly coupled to handle assembly 112 via one or more tubes. The fluid flow rate and other mechanisms may be metered by the electronic controller 118.
  • Deployment of imaging hood 12 may be actuated by a hood deployment switch 120 located on the handle assembly 112 while dispensation of the fluid from reservoir 114 may be actuated by a fluid deployment switch 122, which can be electrically coupled to the controller 118. Controller 118 may also be electrically coupled to a wired or wireless antenna 124 optionally integrated with the handle assembly 112, as shown in the figure. The wireless antenna 124 can be used to wirelessly transmit images captured from the imaging hood 12 to a receiver, e.g., via Bluetooth® wireless technology (Bluetooth SIG, Inc., Bellevue, Wash.), RF, etc., for viewing on a monitor 128 or for recording for later viewing.
  • Articulation control of the deployment catheter 16, or a delivery catheter or sheath 14 through which the deployment catheter 16 may be delivered, may be accomplished by computer control, as described above, in which case an additional controller may be utilized with handle assembly 112. In the case of manual articulation, handle assembly 112 may incorporate one or more articulation controls 126 for manual manipulation of the position of deployment catheter 16. Handle assembly 112 may also define one or more instrument ports 130 through which a number of intravascular tools may be passed for tissue manipulation and treatment within imaging hood 12, as described further below. Furthermore, in certain procedures, fluid or debris may be sucked into imaging hood 12 for evacuation from the patient body by optionally fluidly coupling a suction pump 132 to handle assembly 112 or directly to deployment catheter 16.
  • As described above, fluid may be pumped continuously into imaging hood 12 to provide for clear viewing of the underlying tissue. Alternatively, fluid may be pumped temporarily or sporadically only until a clear view of the tissue is available to be imaged and recorded, at which point the fluid flow may cease and the blood may be allowed to seep or flow back into imaging hood 12. FIGS. 9A to 9C illustrate an example of capturing several images of the tissue at multiple regions. Deployment catheter 16 may be desirably positioned and imaging hood 12 deployed and brought into position against a region of tissue to be imaged, in this example the tissue surrounding a mitral valve MV within the left atrium of a patient's heart. The imaging hood 12 may be optionally anchored to the tissue, as described above, and then cleared by pumping the imaging fluid into the hood 12. Once sufficiently clear, the tissue may be visualized and the image captured by control electronics 118. The first captured image 140 may be stored and/or transmitted wirelessly 124 to a monitor 128 for viewing by the physician, as shown in FIG. 9A.
  • The deployment catheter 16 may be then repositioned to an adjacent portion of mitral valve MV, as shown in FIG. 9B, where the process may be repeated to capture a second image 142 for viewing and/or recording. The deployment catheter 16 may again be repositioned to another region of tissue, as shown in FIG. 9C, where a third image 144 may be captured for viewing and/or recording. This procedure may be repeated as many times as necessary for capturing a comprehensive image of the tissue surrounding mitral valve MV, or any other tissue region. When the deployment catheter 16 and imaging hood 12 is repositioned from tissue region to tissue region, the pump may be stopped during positioning and blood or surrounding fluid may be allowed to enter within imaging hood 12 until the tissue is to be imaged, where the imaging hood 12 may be cleared, as above.
  • As mentioned above, when the imaging hood 12 is cleared by pumping the imaging fluid within for clearing the blood or other bodily fluid, the fluid may be pumped continuously to maintain the imaging fluid within the hood 12 at a positive pressure or it may be pumped under computer control for slowing or stopping the fluid flow into the hood 12 upon detection of various parameters or until a clear image of the underlying tissue is obtained. The control electronics 118 may also be programmed to coordinate the fluid flow into the imaging hood 12 with various physical parameters to maintain a clear image within imaging hood 12.
  • Detail examples and descriptions of a visualization catheter device and system which may be utilized herein are shown and described in further detail in U.S. patent application Ser. No. 11/259,498 filed Oct. 25, 2005, which has been incorporated herein above in its entirety.
  • One particular application for the tissue visualization system includes utilizing the system for detecting the presence and/or location of ischemic and/or infarcted tissue by visual inspection and/or measurement of one or more parameter of the tissue. Any number of physiologic parameters can be utilized to obtain measurements of the visualized tissue to detect the certain parameters, e.g., partial pressure values of oxygen (PO2) and carbon dioxide (PCO2); temperature differences between tissue regions; biomarkers indicative of injured tissue; electrical current and/or electrical potential differences through the tissue; variations in tissue surface hardness and deflection between tissue regions; etc.
  • One method for detecting the ischemic and/or infarcted tissue is by visual inspection alone. As shown in the perspective view of FIG. 10, with hood 12 placed over a tissue region T to be inspected, transparent displacement fluid 150 may be infused into the hood 12 and the underlying tissue may be visually inspected via imaging element 64. In determining the presence and/or location of the affected tissue, the user may directly visualize the tissue surface via the visualization catheter and ascertain, e.g., the colors, intensities, and patterns of appearance. Accordingly, regions of healthy and diseased tissue may be identified. Such physical parameters are generally known to one of skill in the art as indicated in various clinical-pathologic correlation studies.
  • Another method for detecting certain tissue conditions may incorporate the use of fluorescent compounds injected into the tissue being visually inspected to enhance any contrasts in the tissue appearance. As shown in the respective side and perspective views of FIGS. 11A and 11B, with hood 12 placed against the tissue region T to be inspected and the hood open area purged of blood, hollow piercing needle 160 may be advanced through deployment catheter 16 and into the underlying tissue T to penetrate at least partially into the tissue to directly administer a fluorescent chemical dye, e.g., indocyanin green. Alternatively, piercing needle 160 may be advanced against the tissue surface and simply drip the fluorescent dye onto or over the tissue surface. In yet another alternative, the fluorescent chemical dye may be systemically administered to the patient via an intravenous route. When the fluorescent dye has been absorbed by the tissue region T to be inspected, the tissue may exhibit a visual appearance which is indicative of certain physiological characteristics. For instance, the dyed tissue region may exhibit different patterns of variously fluorescing regions of tissue which may be indicative of tissue health, e.g., healthy, perfused tissue; ischemic tissue; infarcted tissue, necrotic tissue, etc.
  • The intensity and pattern of fluorescence may be observed directly by the user without image processing. Alternatively, imaging element 64 (which may be optionally filtered) may be in communication with signal processor 162 which may take the images and process them for analysis of the emitted wavelength distribution. The emitted wavelength distribution may be correlated to determine the physiologic characteristics of the tissue and the resulting image may be displayed upon a monitor 164 for user evaluation.
  • Another variation for determining tissue condition may include the use of a sensor probe 170 advanced into contact against the tissue surface T while under visualization from imaging element 64, as shown in FIG. 12. Sensor probe 170 may be used to measure physiologic data such as local tissue concentrations of the partial pressure values of oxygen (PO2) and/or carbon dioxide (PCO2) within the tissue region T. This data may be analyzed by processor 162 to extrapolate the locations of tissue having relatively higher PO2 values and/or lower PCO2 values which are indicative of well-perfused (and healthy) tissue. Conversely, regions with relatively lower PO2 and/or higher PCO2 values may indicate poorly-perfused and presumably ischemic and/or infarcted tissue. The measured concentration values of PO2 and/or PCO2 may be processed 162 for visual representation 164 to and evaluation by the user, as illustrated by the concentration profile 172 as measured by probe 170.
  • Aside from PO2 and PCO2 concentration measurement, sensor probe 170 may be additionally or alternatively configured to detect tissue temperature values as well. From local measured tissue temperatures as well as from the known temperature of the local perfusate, the user may extrapolate regions of the tissue T having relatively higher temperature values, which may be indicative of tissue having higher perfusion and metabolic activity (and presumably increased viability). Conversely, regions of tissue with relatively lower temperature values may be indicative of tissue having lower perfusion and metabolic activity (and presumably lowered viability), thus possibly indicating ischemic and/or infarcted tissue regions. The temperature measurements may also be processed 162 for visual representation 164, as illustrated by the temperature profile 174 as measured by probe 170.
  • FIG. 13 illustrates a perspective view of a variation of hood 12 having one or more sensor probes 180 which are located circumferentially about the periphery of hood 12. Several sensor probes 180 may be uniformly (or non-uniformly) placed around the hood 12 circumference such that when hood 12 contacts the tissue region T to be inspected, multiple measurements or a greater region of the tissue may be interrogated. Each of the sensor probes 180 may be configured for measuring PO2/PCO2 and/or temperature as well. Moreover, the measured data may be processed 162 to generate a concentration profile 182 and/or temperature profile 184, as above.
  • The sensor probe(s) in FIG. 12 and/or FIG. 13 may also be configured to detect other tissue parameters besides concentration and temperature. For instance, yet another variation includes utilizing the sensor probes for detecting the presence of certain biomarkers which are typically indicative of tissue injury, and presumably the presence of ischemic and/or infarcted tissue. In such a variation, one or more biochemical sensor probe(s) may be utilized to measure the presence of certain chemical substances. Typically, damaged tissues release unique chemical substances. In the case of myocardial tissue, damaged cardiac muscles release troponin T, I, and C; creatine phosphokinase; MB fraction (CKMB); myoglobin; and lactate dehydrogenase (LDH). By quantitatively measuring the concentrations of one or more of these biochemical markers, processor 162 may be used to map the location and degree of injury within the tissue.
  • In yet another variation of FIG. 12 and/or FIG. 13, sensor probe(s) may be configured to measure electrical current in the interrogated tissue region T. The pathologic physiologic changes induced by ischemia and infarction may be evident in the current level measured within injured tissue. For example, several weeks after myocardial tissue experiences infarction, the cardiac muscle undergoes liquefactive necrosis, remodeling, and ultimately scar formation. Scar tissue, comprised primarily of fibroblasts and collagen, demonstrates diminished electrical conductivity secondary to increased impedance (relative to healthy myocardium). By electrically sampling levels of tissue impedance at several points across the region of interest, one may generate a map delineating regions of tissue ischemia, infarct in evolution, acute infarct, subacute infarct, and old infarct (scar).
  • In another variation of FIG. 12 and/or FIG. 13, sensor probe(s) may be configured to measure electrical potential differences in the interrogated tissue region T. As such, one or more electrical probe(s) or electrodes may be utilized for measurement of electrical potential difference. The presence of pathologic physiologic changes induced by ischemia and/or infarction may be evidenced in the voltages measured, e.g., via an electrocardiogram (ECG) within injured tissues. An ECG is a graphical representation of cardiac electrical activity depicting voltage (ordinate) as a function of time (abcissa). ECG measurements have long been utilized to diagnose cardiac pathology including ischemia (S-T segment elevation) and infarction (S-T segment depression, Q waves). Presumably, intracardiac voltage measurements may demonstrate findings correlating to traditional transcutaneous ECG data. By mapping voltage differences throughout the tissue of interest, one may generate a map delineating regions of tissue ischemia, acute infarct, subacute infarct, and old infarct.
  • In yet another variation of FIG. 12 and/or FIG. 13, sensor probe(s) may be configured to detect tissue hardness and deflection differences in the interrogated tissue region T. As such, one or more probe(s) may be configured as pressure-sensitive probes for measuring hardness (e.g., Rockwell, Vickers, durometer type, etc.) or force required to produce a given deflection in the tissue of interest. Several weeks after infarction, myocardial tissue becomes weakened secondary to coagulative necrosis. In fact, the patient may be at risk for ventricular rupture. After several more weeks, the necrotic tissue is replaced with fibroblasts (scar tissue) which, although non-contractile, provides relatively stable structural support for the moving ventricle. It is theorized that the complete but unscarred infarct may demonstrate increased compliance and decreased hardness relative to normal myocardial tissue. Similarly, the healed (scarred) old infarct is thought to demonstrate decreased compliance and increased hardness relative to normal myocardial tissue. By acquiring multiple measurements from the tissue surface of interest, a map delineating the hardness and extrapolated infarct ages and locations may be generated.
  • Once a region of ischemic and/or infarcted tissue has been identified using any of the modalities described above, the injured tissue may be repaired or improved, in one variation, by administering one or more bioactive substances into the affected tissue. One method for treating the injured tissue may utilize a hollow needle, such as piercing needle 160 shown above in FIG. 11A, advanced into the tissue through hood 12 while under direct visualization. Another variation may utilize helical delivery needle 190, as shown in the perspective view of FIG. 14A. A hollow helical delivery needle 190 may be positioned upon elongate member 192 and it may also define a plurality of openings 194 along its surface through which one or more bioactive substances may be infused. In use, as shown in the perspective view of FIG. 14B, once the tissue region T of interest is identified, the helical delivery needle 190 may be gently twisted and advanced into the tissue. Once partially or fully embedded, bioactive chemicals may be infused within the tissue via the openings 194 in the needle 190. In another variation, rather than utilizing a single helical delivery needle, multiple delivery needles 190 may be positioned to extend along support struts/elongate members 200 along hood 12 and extend distally past the hood 12 for advancement into the underlying tissue, as shown in the perspective view of FIG. 15.
  • In yet another alternative for treating tissue regions identified as potentially ischemic and/or infarcted, a laser catheter may be utilized while under direct visualization of the tissue region of interest. FIGS. 16A and 16B illustrate perspective views where a laser probe or fiber 210, e.g., an optical fiber bundle coupled to a laser generator, may be inserted through the work channel of the tissue visualization catheter. When actuated, laser energy 212 may be channeled through probe 210 and applied to the underlying tissue at different angles to form a variety of lesion patterns. Further examples of laser or ablation probes are described in detail in U.S. patent application Ser. No. 11/775,819 filed Jul. 10, 2007, which is incorporated herein by reference in its entirety.
  • As the laser energy 212 is highly focused with intense energy to precisely ablate small quantities of tissue, the laser probe 210 may be used to perforate the tissue surface and/or deeper layers. Various bioactive chemicals may then be infused through hood 12 or through a catheter and directly into the tissue via the perforations. Alternatively, the tissue may be perforated during or after the various bioactive chemicals have been infused into the tissue. In yet another alternative, the tissue may be simply revascularized with the laser treatment and the infusion of bioactive chemicals may be omitted entirely, if so desired.
  • In yet another variation, a bioactive substance may be implanted into or near the injured tissue region. As shown in the partial cross-sectional view of the heart H, a bioactive substance 220 may be delivered and deposited directly into the tissue wall, e.g., in the anterolateral myocardium of the left ventricle, as shown in FIG. 17. The bioactive substance 220 may be delivered utilizing any number of delivery devices through hood 12 while under direct visualization, e.g., via a needle as described above. As shown, the deposited administration of a bioactive substance 220 within the tissue of interest may or may not be encapsulated for controlled release over time.
  • In treating the tissue with bioactive substances, any number of suitable materials may be delivered utilizing the devices and methods herein. For instance, bioactive substances for healing and/or regenerating functional tissue may include the use of stem cells, which are protean cells from which other specialized cell lines are formed. Most damaged tissues undergo a natural process of death, resorption, and scar formation. If the stem cells, e.g., from a patient's bone marrow, can be identified and isolated these may be transplanted into the damaged tissue of interest. Ideally, the specific stem cell line responsible for generating the tissue of interest is identified and transplanted. Preclinical studies have established that implantation of bone marrow mononuclear into ischemic limbs increased collateral vessel formation. Direct myocardial injection of, e.g., bone marrow cells, into the infarct border zone produced improved LV function and infarct tissue perfusion (Tse, et al. Lancet 2003, Jan. 4; 361 (9357): 47-9), which is incorporated herein by reference in its entirety. It follows that by utilizing any of the previously described devices for direct visualization to identify the location of damaged tissue (e.g. infracted myocardium) and any of the delivery systems to deposit the bioactive substances, one may deliver bone marrow cells (e.g. vascular progenitor cells) to stimulate angiogenesis for improved tissue perfusion and function as well as new intrinsic tissue formation (e.g. myogenesis).
  • Another example of a bioactive substance which may be infused into the identified injured tissue may include biologic substances which promote angiogenesis and subsequently improve local tissue perfusion and function. Vascular endothelial growth factor (VEGF) is an angiogenic factor regulating vascular endothelial cell migration, proliferation, and permeability. Fibroblast growth factor (FGF) induces microvascular endothelial cell growth and neovascularization. Similarly, pro-angiogenic cytokines including tumor necrosis factor alpha (TNF) and interleukin 8 (IL8), as well as the peptides SIKVAV (derived from laminin 1) and neuropeptide Y (NPY) have been shown to demonstrate similar effects.
  • Aside from administering bioactive agents, chemical irritants may also be delivered to tissue utilizing any of the methods and systems described herein to promote angiogenesis and improved tissue perfusion and function.
  • The applications of the disclosed invention discussed above are not limited to certain treatments or regions of the body, but may include any number of other treatments and areas of the body. Modification of the above-described methods and devices for carrying out the invention, and variations of aspects of the invention that are obvious to those of skill in the arts are intended to be within the scope of this disclosure. Moreover, various combinations of aspects between examples are also contemplated and are considered to be within the scope of this disclosure as well.

Claims (50)

  1. 1. A method of identifying a tissue region of interest for treatment, comprising:
    positioning an expanded barrier or membrane defining an open area and projecting distally from a deployment catheter against the tissue region of interest;
    urging a transparent fluid into the open area such that an opaque fluid is displaced therefrom;
    visualizing the tissue region of interest through the transparent fluid; and
    assessing at least one parameter of the tissue region for an indication of injured tissue.
  2. 2. The method of claim 1 wherein positioning comprises intravascularly advancing the deployment catheter into a chamber of a patient heart.
  3. 3. The method of claim 1 wherein positioning comprises deploying the barrier or membrane from a low-profile delivery configuration into an expanded deployed configuration.
  4. 4. The method of claim 1 wherein urging a transparent fluid comprises pumping the transparent fluid into the open area through a fluid delivery lumen defined through the deployment catheter.
  5. 5. The method of claim 4 wherein pumping the transparent fluid comprises urging saline, plasma, water, or perfluorinated liquid into the open area such that blood is displaced.
  6. 6. The method of claim 1 wherein visualizing comprises imaging the tissue region via an imaging element off-axis relative to the deployment catheter.
  7. 7. The method of claim 1 wherein assessing comprises visually inspecting the tissue region for indications of ischemic and/or infarcted regions of tissue.
  8. 8. The method of claim 7 further comprising administering a fluorescent compound upon or into the tissue region prior to visually inspecting the tissue region.
  9. 9. The method of claim 8 wherein the fluorescent compound comprises indocyanin green.
  10. 10. The method of claim 1 wherein assessing comprises measuring a partial pressure of oxygen and/or carbon dioxide present in the tissue region.
  11. 11. The method of claim 1 wherein assessing comprises measuring a temperature of the tissue region.
  12. 12. The method of claim 1 wherein assessing comprises measuring for a presence of a biomarker indicative of tissue injury.
  13. 13. The method of claim 12 wherein the biomarker is selected from the group consisting of troponin T, troponin I, troponin C; creatine phosphokinase, MB fraction (CKMB), myoglobin, lactate dehydrogenase (LDH), and combinations thereof.
  14. 14. The method of claim 1 wherein assessing comprises detecting differences in electrical current and/or electrical potential in the tissue region.
  15. 15. The method of claim 1 wherein assessing comprises measuring relative tissue hardness and/or deflection over the tissue region.
  16. 16. The method of claim 1 further comprising identifying the injured tissue based upon an assessment of the at least one parameter.
  17. 17. The method of claim 16 further comprising treating the injured tissue with a bioactive agent.
  18. 18. The method of claim 17 wherein treating comprises injecting or infusing the bioactive agent upon or into the injured tissue.
  19. 19. The method of claim 17 wherein the bioactive agent is selected from the group consisting of stem cells, vascular endothelial growth factor, fibroblast growth factor, pro-angiogenic cytokines, tumor necrosis factor alpha, interleukin 8, SIKVAV, and neuropeptide Y.
  20. 20. The method of claim 16 further comprising treating the injured tissue with a chemical irritant.
  21. 21. A method of treating a tissue region of interest, comprising:
    positioning an expanded barrier or membrane defining an open area and projecting distally from a deployment catheter against the tissue region of interest;
    urging a transparent fluid into the open area such that an opaque fluid is displaced therefrom;
    visualizing the tissue region of interest through the transparent fluid;
    piercing at least partially into the tissue region with a delivery instrument; and
    delivering an agent through the instrument into the tissue region.
  22. 22. The method of claim 21 further comprising assessing at least one parameter of the tissue region for an indication of injured tissue.
  23. 23. The method of claim 22 wherein assessing comprises visually inspecting the tissue region for indications of ischemic and/or infarcted regions of tissue.
  24. 24. The method of claim 21 wherein positioning comprises deploying the barrier or membrane from a low-profile delivery configuration into an expanded deployed configuration.
  25. 25. The method of claim 21 wherein urging a transparent fluid comprises pumping the transparent fluid into the open area through a fluid delivery lumen defined through the deployment catheter.
  26. 26. The method of claim 25 wherein pumping the transparent fluid comprises urging saline, plasma, water, or perfluorinated liquid into the open area such that blood is displaced.
  27. 27. The method of claim 21 wherein visualizing comprises imaging the tissue region via an imaging element off-axis relative to the deployment catheter.
  28. 28. The method of claim 21 wherein the delivery instrument comprises a needle defining a lumen through which the agent is delivered.
  29. 29. The method of claim 21 wherein the delivery instrument comprises a helical needle having a plurality of openings therealong through which the agent may be delivered.
  30. 30. The method of claim 21 wherein delivering an agent comprises administering a fluorescent compound into the tissue region.
  31. 31. The method of claim 30 further comprising further visualizing the tissue region for an indication of injured tissue.
  32. 32. The method of claim 21 wherein delivering an agent comprises administering a bioactive agent into the tissue region.
  33. 33. The method of claim 32 wherein the bioactive agent is selected from the group consisting of stem cells, vascular endothelial growth factor, fibroblast growth factor, pro-angiogenic cytokines, tumor necrosis factor alpha, interleukin 8, SIKVAV, and neuropeptide Y.
  34. 34. The method of claim 21 wherein delivering an agent comprises administering a chemical irritant.
  35. 35. The method of claim 21 wherein delivering an agent comprises implanting an encapsulated bioactive substance.
  36. 36. A system for identifying a tissue region of interest, comprising:
    a deployment catheter defining at least one lumen therethrough;
    a barrier or membrane projecting distally from the deployment catheter and defining an open area therein, wherein the open area is in fluid communication with the at least one lumen;
    a visualization element disposed within or along the barrier or membrane for visualizing tissue adjacent to the open area; and
    a sensor probe configured to assess at least one parameter of the tissue region for an indication of injured tissue.
  37. 37. The system of claim 36 wherein the barrier is comprised of a compliant material.
  38. 38. The system of claim 36 wherein the barrier or membrane is adapted to be reconfigured from a low-profile delivery configuration to an expanded deployed configuration.
  39. 39. The system of claim 36 wherein the barrier or membrane is conically shaped.
  40. 40. The system of claim 36 wherein the visualization element comprises at least one optical fiber, CCD imager, or CMOS imager.
  41. 41. The system of claim 36 further comprising a fluorescent compound for injection or infusion upon or into the tissue region for facilitating imaging via the visualization element.
  42. 42. The system of claim 41 wherein the fluorescent compound comprises indocyanin green.
  43. 43. The system of claim 36 wherein the sensor probe is configured to measure a partial pressure of oxygen and/or carbon dioxide present in the tissue region.
  44. 44. The system of claim 36 wherein the sensor probe is configured to measure a temperature of the tissue region.
  45. 45. The system of claim 36 wherein the sensor probe is configured to measure for a presence of a biomarker indicative of tissue injury.
  46. 46. The system of claim 45 wherein the biomarker is selected from the group consisting of troponin T, troponin I, troponin C; creatine phosphokinase, MB fraction (CKMB), myoglobin, lactate dehydrogenase (LDH), and combinations thereof.
  47. 47. The system of claim 36 wherein the sensor probe is configured to detect differences in electrical current and/or electrical potential in the tissue region.
  48. 48. The system of claim 36 wherein the sensor probe is configured to measure relative tissue hardness and/or deflection over the tissue region.
  49. 49. The system of claim 36 further comprising a bioactive agent for injection or infusion upon or into the tissue region.
  50. 50. The system of claim 49 wherein the bioactive agent is selected from the group consisting of stem cells, vascular endothelial growth factor, fibroblast growth factor, pro-angiogenic cytokines, tumor necrosis factor alpha, interleukin 8, SIKVAV, and neuropeptide Y.
US11828267 2005-02-02 2007-07-25 Delivery of biological compounds to ischemic and/or infarcted tissue Active 2026-07-29 US8137333B2 (en)

Priority Applications (3)

Application Number Priority Date Filing Date Title
US11259498 US7860555B2 (en) 2005-02-02 2005-10-25 Tissue visualization and manipulation system
US82111706 true 2006-08-01 2006-08-01
US11828267 US8137333B2 (en) 2005-10-25 2007-07-25 Delivery of biological compounds to ischemic and/or infarcted tissue

Applications Claiming Priority (4)

Application Number Priority Date Filing Date Title
US11828267 US8137333B2 (en) 2005-10-25 2007-07-25 Delivery of biological compounds to ischemic and/or infarcted tissue
US13365914 US8814845B2 (en) 2005-02-02 2012-02-03 Delivery of biological compounds to ischemic and/or infarcted tissue
US14452268 US9332893B2 (en) 2005-02-02 2014-08-05 Delivery of biological compounds to ischemic and/or infarcted tissue
US15130416 US20160227989A1 (en) 2005-02-02 2016-04-15 Delivery Of Biological Compounds To Ischemic And/Or Infarcted Tissue

Related Parent Applications (2)

Application Number Title Priority Date Filing Date
US11259498 Continuation-In-Part US7860555B2 (en) 2005-02-02 2005-10-25 Tissue visualization and manipulation system
US12259498 Continuation-In-Part US7757373B2 (en) 2004-01-19 2008-10-28 Method and tool head for machining optically active surfaces, particularly surfaces of progressive spectacle lenses, which are symmetrical in pairs

Related Child Applications (1)

Application Number Title Priority Date Filing Date
US13365914 Continuation US8814845B2 (en) 2005-02-02 2012-02-03 Delivery of biological compounds to ischemic and/or infarcted tissue

Publications (3)

Publication Number Publication Date
US20080033290A1 true US20080033290A1 (en) 2008-02-07
US20120004544A9 true true US20120004544A9 (en) 2012-01-05
US8137333B2 US8137333B2 (en) 2012-03-20

Family

ID=39030124

Family Applications (4)

Application Number Title Priority Date Filing Date
US11828267 Active 2026-07-29 US8137333B2 (en) 2005-02-02 2007-07-25 Delivery of biological compounds to ischemic and/or infarcted tissue
US13365914 Active 2026-02-14 US8814845B2 (en) 2005-02-02 2012-02-03 Delivery of biological compounds to ischemic and/or infarcted tissue
US14452268 Active US9332893B2 (en) 2005-02-02 2014-08-05 Delivery of biological compounds to ischemic and/or infarcted tissue
US15130416 Pending US20160227989A1 (en) 2005-02-02 2016-04-15 Delivery Of Biological Compounds To Ischemic And/Or Infarcted Tissue

Family Applications After (3)

Application Number Title Priority Date Filing Date
US13365914 Active 2026-02-14 US8814845B2 (en) 2005-02-02 2012-02-03 Delivery of biological compounds to ischemic and/or infarcted tissue
US14452268 Active US9332893B2 (en) 2005-02-02 2014-08-05 Delivery of biological compounds to ischemic and/or infarcted tissue
US15130416 Pending US20160227989A1 (en) 2005-02-02 2016-04-15 Delivery Of Biological Compounds To Ischemic And/Or Infarcted Tissue

Country Status (1)

Country Link
US (4) US8137333B2 (en)

Cited By (9)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20080009747A1 (en) * 2005-02-02 2008-01-10 Voyage Medical, Inc. Transmural subsurface interrogation and ablation
US20080015569A1 (en) * 2005-02-02 2008-01-17 Voyage Medical, Inc. Methods and apparatus for treatment of atrial fibrillation
US20080033241A1 (en) * 2006-08-01 2008-02-07 Ruey-Feng Peh Left atrial appendage closure
US20100292558A1 (en) * 2006-06-14 2010-11-18 Voyage Medical, Inc. In-vivo visualization systems
US20120172664A1 (en) * 2010-12-29 2012-07-05 Nellcor Puritan Bennett Llc Multi-lumen tracheal tube with visualization device
US8694071B2 (en) 2010-02-12 2014-04-08 Intuitive Surgical Operations, Inc. Image stabilization techniques and methods
US8814845B2 (en) 2005-02-02 2014-08-26 Intuitive Surgical Operations, Inc. Delivery of biological compounds to ischemic and/or infarcted tissue
US8934962B2 (en) 2005-02-02 2015-01-13 Intuitive Surgical Operations, Inc. Electrophysiology mapping and visualization system
US9526401B2 (en) 2005-02-02 2016-12-27 Intuitive Surgical Operations, Inc. Flow reduction hood systems

Families Citing this family (44)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5665062A (en) * 1995-01-23 1997-09-09 Houser; Russell A. Atherectomy catheter and RF cutting method
US7338441B2 (en) * 2001-09-06 2008-03-04 Houser Russell A Superelastic/shape memory tissue stabilizers and surgical instruments
US7930016B1 (en) 2005-02-02 2011-04-19 Voyage Medical, Inc. Tissue closure system
US7918787B2 (en) 2005-02-02 2011-04-05 Voyage Medical, Inc. Tissue visualization and manipulation systems
US10064540B2 (en) * 2005-02-02 2018-09-04 Intuitive Surgical Operations, Inc. Visualization apparatus for transseptal access
US7860555B2 (en) * 2005-02-02 2010-12-28 Voyage Medical, Inc. Tissue visualization and manipulation system
US7860556B2 (en) * 2005-02-02 2010-12-28 Voyage Medical, Inc. Tissue imaging and extraction systems
US9510732B2 (en) * 2005-10-25 2016-12-06 Intuitive Surgical Operations, Inc. Methods and apparatus for efficient purging
US8050746B2 (en) * 2005-02-02 2011-11-01 Voyage Medical, Inc. Tissue visualization device and method variations
US8221310B2 (en) * 2005-10-25 2012-07-17 Voyage Medical, Inc. Tissue visualization device and method variations
WO2006133193A1 (en) * 2005-06-07 2006-12-14 American Medical Systems Research Corporation Injection guidance system and method
US10004388B2 (en) * 2006-09-01 2018-06-26 Intuitive Surgical Operations, Inc. Coronary sinus cannulation
US20080097476A1 (en) * 2006-09-01 2008-04-24 Voyage Medical, Inc. Precision control systems for tissue visualization and manipulation assemblies
US20080214889A1 (en) * 2006-10-23 2008-09-04 Voyage Medical, Inc. Methods and apparatus for preventing tissue migration
US20080183036A1 (en) * 2006-12-18 2008-07-31 Voyage Medical, Inc. Systems and methods for unobstructed visualization and ablation
US8131350B2 (en) * 2006-12-21 2012-03-06 Voyage Medical, Inc. Stabilization of visualization catheters
US8758229B2 (en) * 2006-12-21 2014-06-24 Intuitive Surgical Operations, Inc. Axial visualization systems
JP2010524651A (en) * 2007-04-27 2010-07-22 ボエッジ メディカル, インコーポレイテッド Steerable tissue visualization and manipulation the catheter with a complex shape
US8657805B2 (en) * 2007-05-08 2014-02-25 Intuitive Surgical Operations, Inc. Complex shape steerable tissue visualization and manipulation catheter
EP2155036B1 (en) * 2007-05-11 2016-02-24 Intuitive Surgical Operations, Inc. Visual electrode ablation systems
US8235985B2 (en) * 2007-08-31 2012-08-07 Voyage Medical, Inc. Visualization and ablation system variations
WO2009045265A1 (en) 2007-10-05 2009-04-09 Maquet Cardiovascular, Llc Devices and methods for minimally-invasive surgical procedures
US20090143640A1 (en) * 2007-11-26 2009-06-04 Voyage Medical, Inc. Combination imaging and treatment assemblies
US20090192485A1 (en) * 2008-01-28 2009-07-30 Heuser Richard R Snare device
US8858609B2 (en) * 2008-02-07 2014-10-14 Intuitive Surgical Operations, Inc. Stent delivery under direct visualization
US20090326572A1 (en) * 2008-06-27 2009-12-31 Ruey-Feng Peh Apparatus and methods for rapid tissue crossing
US9101735B2 (en) * 2008-07-07 2015-08-11 Intuitive Surgical Operations, Inc. Catheter control systems
JP2011528955A (en) * 2008-07-23 2011-12-01 セント ジュード メディカル インコーポレイテッド Wireless transmission catheter radio frequency adapter
US20100056904A1 (en) * 2008-09-02 2010-03-04 Saunders John K Image guided intervention
US8333012B2 (en) * 2008-10-10 2012-12-18 Voyage Medical, Inc. Method of forming electrode placement and connection systems
US8894643B2 (en) * 2008-10-10 2014-11-25 Intuitive Surgical Operations, Inc. Integral electrode placement and connection systems
US9468364B2 (en) * 2008-11-14 2016-10-18 Intuitive Surgical Operations, Inc. Intravascular catheter with hood and image processing systems
US20100204561A1 (en) * 2009-02-11 2010-08-12 Voyage Medical, Inc. Imaging catheters having irrigation
US20100256629A1 (en) * 2009-04-06 2010-10-07 Voyage Medical, Inc. Methods and devices for treatment of the ostium
US8380294B2 (en) * 2009-10-06 2013-02-19 Medtronic, Inc. Cardiac risk stratification
US9907962B2 (en) * 2009-10-29 2018-03-06 Medtronic, Inc. Arrhythmia prediction based on heart rate turbulence
US9814522B2 (en) 2010-04-06 2017-11-14 Intuitive Surgical Operations, Inc. Apparatus and methods for ablation efficacy
US8940008B2 (en) 2010-04-23 2015-01-27 Assist Medical Llc Transseptal access device and method of use
CA2815580A1 (en) * 2010-11-08 2012-05-18 Colibri Technologies Inc. Systems and methods for improved visualization during minimally invasive procedures
US9084611B2 (en) 2011-09-22 2015-07-21 The George Washington University Systems and methods for visualizing ablated tissue
EP2757933A4 (en) 2011-09-22 2015-07-01 Univ George Washington Systems and methods for visualizing ablated tissue
US9101449B2 (en) * 2012-07-27 2015-08-11 Cook Medical Technologies Llc Filter removal device
JP2017513645A (en) * 2014-04-28 2017-06-01 カーディオフォーカス,インコーポレーテッド System and method for visualizing tissue using icg dye composition upon ablation procedures
US20160089172A1 (en) * 2014-09-30 2016-03-31 Boston Scientific Scimed, Inc. Devices and methods for applying suction

Family Cites Families (483)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US623022A (en) 1899-04-11 johnson
US2305462A (en) 1940-06-20 1942-12-15 Wolf Richard Cystoscopic instrument
US2453862A (en) 1947-06-02 1948-11-16 Salisbury Peter Frederic Gastroscope
US3559651A (en) 1968-10-14 1971-02-02 David H Moss Body-worn all disposable urinal
US3903877A (en) 1973-06-13 1975-09-09 Olympus Optical Co Endoscope
US3831587A (en) 1973-02-08 1974-08-27 Mc Anally R Multipurpose vaginal and cervical device
US3874388A (en) * 1973-02-12 1975-04-01 Ochsner Med Found Alton Shunt defect closure system
US4175545A (en) 1977-03-10 1979-11-27 Zafmedico Corp. Method and apparatus for fiber-optic cardiovascular endoscopy
US4326529A (en) 1978-05-26 1982-04-27 The United States Of America As Represented By The United States Department Of Energy Corneal-shaping electrode
JPS5869527A (en) 1981-10-20 1983-04-25 Fuji Photo Film Co Ltd High frequency knife and endoscope using same
US4470407A (en) 1982-03-11 1984-09-11 Laserscope, Inc. Endoscopic device
US4445892A (en) * 1982-05-06 1984-05-01 Laserscope, Inc. Dual balloon catheter device
JPS5993413A (en) 1982-11-18 1984-05-29 Olympus Optical Co Ltd Endoscope
DE3370132D1 (en) * 1982-12-13 1987-04-16 Sumitomo Electric Industries Endoscope
CA1255757C (en) * 1983-01-24 1989-06-13
JPH0583886B2 (en) * 1983-03-22 1993-11-30 Sumitomo Electric Industries
US4619247A (en) * 1983-03-31 1986-10-28 Sumitomo Electric Industries, Ltd. Catheter
JPS59181315A (en) 1983-03-31 1984-10-15 Kiyoshi Inoue Fiber scope
US4569335A (en) * 1983-04-12 1986-02-11 Sumitomo Electric Industries, Ltd. Fiberscope
JPH0355943Y2 (en) 1984-02-03 1991-12-13
US4960411A (en) 1984-09-18 1990-10-02 Medtronic Versaflex, Inc. Low profile sterrable soft-tip catheter
JPH0573110B2 (en) * 1985-07-02 1993-10-13 Olympus Optical Co
US4917084A (en) 1985-07-31 1990-04-17 C. R. Bard, Inc. Infrared laser catheter system
DE3686621D1 (en) 1985-07-31 1992-10-08 Bard Inc C R Infrared laser kathetergeraet.
US4710192A (en) 1985-12-30 1987-12-01 Liotta Domingo S Diaphragm and method for occlusion of the descending thoracic aorta
US4772260A (en) 1986-05-02 1988-09-20 Heyden Eugene L Rectal catheter
US4709698A (en) 1986-05-14 1987-12-01 Thomas J. Fogarty Heatable dilation catheter
US4838246A (en) 1986-08-13 1989-06-13 Messerschmitt-Bolkow-Blohm Gmbh Application part for an endoscope
US4784133A (en) 1987-01-28 1988-11-15 Mackin Robert A Working well balloon angioscope and method
US4976710A (en) 1987-01-28 1990-12-11 Mackin Robert A Working well balloon method
US4961738A (en) 1987-01-28 1990-10-09 Mackin Robert A Angioplasty catheter with illumination and visualization within angioplasty balloon
NL8700329A (en) * 1987-02-11 1988-09-01 Hoed Daniel Stichting Apparatus and method for examining and / or illuminating a cavity in a body.
US5090959A (en) * 1987-04-30 1992-02-25 Advanced Cardiovascular Systems, Inc. Imaging balloon dilatation catheter
US4943290A (en) 1987-06-23 1990-07-24 Concept Inc. Electrolyte purging electrode tip
US5372138A (en) * 1988-03-21 1994-12-13 Boston Scientific Corporation Acousting imaging catheters and the like
US4998972A (en) 1988-04-28 1991-03-12 Thomas J. Fogarty Real time angioscopy imaging system
EP0415997A4 (en) 1988-05-18 1992-04-08 Kasevich Associates, Inc. Microwave balloon angioplasty
US6120437A (en) 1988-07-22 2000-09-19 Inbae Yoon Methods for creating spaces at obstructed sites endoscopically and methods therefor
US4957484A (en) 1988-07-26 1990-09-18 Automedix Sciences, Inc. Lymph access catheters and methods of administration
US5115626A (en) * 1988-09-30 1992-05-26 Rapak, Inc. Apparatus for filling flexible plastic bags carried in a continuous web and supplies therefore
US5123428A (en) 1988-10-11 1992-06-23 Schwarz Gerald R Laparoscopically implanting bladder control apparatus
US4994069A (en) 1988-11-02 1991-02-19 Target Therapeutics Vaso-occlusion coil and method
US4998916A (en) * 1989-01-09 1991-03-12 Hammerslag Julius G Steerable medical device
US4914521A (en) 1989-02-03 1990-04-03 Adair Edwin Lloyd Sterilizable video camera cover
USRE34002E (en) 1989-02-03 1992-07-21 Sterilizable video camera cover
US4911148A (en) * 1989-03-14 1990-03-27 Intramed Laboratories, Inc. Deflectable-end endoscope with detachable flexible shaft assembly
US4991578A (en) * 1989-04-04 1991-02-12 Siemens-Pacesetter, Inc. Method and system for implanting self-anchoring epicardial defibrillation electrodes
DE3915636C1 (en) 1989-05-12 1990-04-26 Sass, Wolfgang, Dr.
NL8901350A (en) 1989-05-29 1990-12-17 Wouter Matthijs Muijs Van De M Closure assembly.
US4950285A (en) 1989-11-27 1990-08-21 Wilk Peter J Suture device
US5345927A (en) 1990-03-02 1994-09-13 Bonutti Peter M Arthroscopic retractors
US5514153A (en) 1990-03-02 1996-05-07 General Surgical Innovations, Inc. Method of dissecting tissue layers
JP2893833B2 (en) 1990-03-30 1999-05-24 東レ株式会社 Endoscopic balloon catheter
CA2057018C (en) 1990-04-02 1997-12-09 Kanji Inoue Device for nonoperatively occluding a defect
US5236413B1 (en) 1990-05-07 1996-06-18 Andrew J Feiring Method and apparatus for inducing the permeation of medication into internal tissue
US5197457A (en) * 1990-09-12 1993-03-30 Adair Edwin Lloyd Deformable and removable sheath for optical catheter
US5370647A (en) 1991-01-23 1994-12-06 Surgical Innovations, Inc. Tissue and organ extractor
US5156141A (en) 1991-03-11 1992-10-20 Helmut Krebs Connector for coupling an endoscope to a video camera
JP3065702B2 (en) 1991-04-23 2000-07-17 オリンパス光学工業株式会社 The endoscope system
US5330496A (en) * 1991-05-06 1994-07-19 Alferness Clifton A Vascular catheter assembly for tissue penetration and for cardiac stimulation and methods thereof
DE69226375D1 (en) 1991-05-29 1998-08-27 Origin Medsystems Inc Retractor apparatus for endoscopic surgery
US5697281A (en) 1991-10-09 1997-12-16 Arthrocare Corporation System and method for electrosurgical cutting and ablation
US5697882A (en) 1992-01-07 1997-12-16 Arthrocare Corporation System and method for electrosurgical cutting and ablation
US6190381B1 (en) 1995-06-07 2001-02-20 Arthrocare Corporation Methods for tissue resection, ablation and aspiration
JPH05103746A (en) 1991-10-18 1993-04-27 Olympus Optical Co Ltd Metabolism information measuring device
US5282827A (en) 1991-11-08 1994-02-01 Kensey Nash Corporation Hemostatic puncture closure system and method of use
US5281238A (en) 1991-11-22 1994-01-25 Chin Albert K Endoscopic ligation instrument
CA2089999A1 (en) 1992-02-24 1993-08-25 H. Jonathan Tovey Resilient arm mesh deployer
US5334159A (en) 1992-03-30 1994-08-02 Symbiosis Corporation Thoracentesis needle assembly utilizing check valve
FR2689388B1 (en) 1992-04-07 1999-07-16 Celsa Lg blood filter perfects possibly resorbable.
DE4214283A1 (en) 1992-04-30 1993-11-04 Schneider Co Optische Werke Contactless length measuring camera - contains semiconducting transducer moved axially within camera body during focussing
US5336252A (en) 1992-06-22 1994-08-09 Cohen Donald M System and method for implanting cardiac electrical leads
US5435805A (en) * 1992-08-12 1995-07-25 Vidamed, Inc. Medical probe device with optical viewing capability
US5672153A (en) 1992-08-12 1997-09-30 Vidamed, Inc. Medical probe device and method
US5527338A (en) 1992-09-02 1996-06-18 Board Of Regents, The University Of Texas System Intravascular device
US5339800A (en) 1992-09-10 1994-08-23 Devmed Group Inc. Lens cleaning means for invasive viewing medical instruments with anti-contamination means
US5313934A (en) 1992-09-10 1994-05-24 Deumed Group Inc. Lens cleaning means for invasive viewing medical instruments
US5313943A (en) 1992-09-25 1994-05-24 Ep Technologies, Inc. Catheters and methods for performing cardiac diagnosis and treatment
US5373840A (en) 1992-10-02 1994-12-20 Knighton; David R. Endoscope and method for vein removal
US5575756A (en) 1993-08-16 1996-11-19 Olympus Optical Co., Ltd. Endoscope apparatus
US6068653A (en) 1992-11-13 2000-05-30 Scimed Life Systems, Inc. Electrophysiology catheter device
DE4338758C2 (en) * 1992-11-13 2001-08-09 Scimed Life Systems Inc A catheter assembly
US6923805B1 (en) 1992-11-13 2005-08-02 Scimed Life Systems, Inc. Electrophysiology energy treatment devices and methods of use
US5334193A (en) 1992-11-13 1994-08-02 American Cardiac Ablation Co., Inc. Fluid cooled ablation catheter
US5676693A (en) 1992-11-13 1997-10-14 Scimed Life Systems, Inc. Electrophysiology device
US5348554A (en) 1992-12-01 1994-09-20 Cardiac Pathways Corporation Catheter for RF ablation with cooled electrode
US5417699A (en) 1992-12-10 1995-05-23 Perclose Incorporated Device and method for the percutaneous suturing of a vascular puncture site
US5403326A (en) 1993-02-01 1995-04-04 The Regents Of The University Of California Method for performing a gastric wrap of the esophagus for use in the treatment of esophageal reflux
US6346074B1 (en) * 1993-02-22 2002-02-12 Heartport, Inc. Devices for less invasive intracardiac interventions
US5797960A (en) * 1993-02-22 1998-08-25 Stevens; John H. Method and apparatus for thoracoscopic intracardiac procedures
US6161543A (en) 1993-02-22 2000-12-19 Epicor, Inc. Methods of epicardial ablation for creating a lesion around the pulmonary veins
US6719755B2 (en) 1996-10-22 2004-04-13 Epicor Medical, Inc. Methods and devices for ablation
US6311692B1 (en) 1996-10-22 2001-11-06 Epicor, Inc. Apparatus and method for diagnosis and therapy of electrophysiological disease
US7052493B2 (en) 1996-10-22 2006-05-30 Epicor Medical, Inc. Methods and devices for ablation
US6840936B2 (en) 1996-10-22 2005-01-11 Epicor Medical, Inc. Methods and devices for ablation
US6805128B1 (en) 1996-10-22 2004-10-19 Epicor Medical, Inc. Apparatus and method for ablating tissue
US6237605B1 (en) 1996-10-22 2001-05-29 Epicor, Inc. Methods of epicardial ablation
US5306234A (en) 1993-03-23 1994-04-26 Johnson W Dudley Method for closing an atrial appendage
US5985307A (en) 1993-04-14 1999-11-16 Emory University Device and method for non-occlusive localized drug delivery
US5860974A (en) 1993-07-01 1999-01-19 Boston Scientific Corporation Heart ablation catheter with expandable electrode and method of coupling energy to an electrode on a catheter shaft
US5571088A (en) 1993-07-01 1996-11-05 Boston Scientific Corporation Ablation catheters
DE69432148D1 (en) 1993-07-01 2003-03-27 Boston Scient Ltd Catheter for image display, for displaying electrical signals and for ablation
US5391199A (en) * 1993-07-20 1995-02-21 Biosense, Inc. Apparatus and method for treating cardiac arrhythmias
US6285898B1 (en) * 1993-07-20 2001-09-04 Biosense, Inc. Cardiac electromechanics
WO1995003843A1 (en) 1993-07-30 1995-02-09 The Regents Of The University Of California Endocardial infusion catheter
US5385148A (en) * 1993-07-30 1995-01-31 The Regents Of The University Of California Cardiac imaging and ablation catheter
US5391182A (en) 1993-08-03 1995-02-21 Origin Medsystems, Inc. Apparatus and method for closing puncture wounds
US5431649A (en) 1993-08-27 1995-07-11 Medtronic, Inc. Method and apparatus for R-F ablation
US5405376A (en) * 1993-08-27 1995-04-11 Medtronic, Inc. Method and apparatus for ablation
US6129724A (en) 1993-10-14 2000-10-10 Ep Technologies, Inc. Systems and methods for forming elongated lesion patterns in body tissue using straight or curvilinear electrode elements
US5575810A (en) 1993-10-15 1996-11-19 Ep Technologies, Inc. Composite structures and methods for ablating tissue to form complex lesion patterns in the treatment of cardiac conditions and the like
US5462521A (en) 1993-12-21 1995-10-31 Angeion Corporation Fluid cooled and perfused tip for a catheter
US5471515A (en) 1994-01-28 1995-11-28 California Institute Of Technology Active pixel sensor with intra-pixel charge transfer
US5746747A (en) 1994-05-13 1998-05-05 Mckeating; John A. Polypectomy instrument
US5842973A (en) 1994-05-17 1998-12-01 Bullard; James Roger Nasal intubation apparatus
US5505730A (en) 1994-06-24 1996-04-09 Stuart D. Edwards Thin layer ablation apparatus
US6423058B1 (en) 1998-02-19 2002-07-23 Curon Medical, Inc. Assemblies to visualize and treat sphincters and adjoining tissue regions
US5575788A (en) 1994-06-24 1996-11-19 Stuart D. Edwards Thin layer ablation apparatus
US6464697B1 (en) 1998-02-19 2002-10-15 Curon Medical, Inc. Stomach and adjoining tissue regions in the esophagus
US5681308A (en) 1994-06-24 1997-10-28 Stuart D. Edwards Ablation apparatus for cardiac chambers
US6056744A (en) 1994-06-24 2000-05-02 Conway Stuart Medical, Inc. Sphincter treatment apparatus
US5593405A (en) * 1994-07-16 1997-01-14 Osypka; Peter Fiber optic endoscope
US5593424A (en) 1994-08-10 1997-01-14 Segmed, Inc. Apparatus and method for reducing and stabilizing the circumference of a vascular structure
US6690963B2 (en) 1995-01-24 2004-02-10 Biosense, Inc. System for determining the location and orientation of an invasive medical instrument
US5643282A (en) 1994-08-22 1997-07-01 Kieturakis; Maciej J. Surgical instrument and method for removing tissue from an endoscopic workspace
JP2802244B2 (en) 1994-08-29 1998-09-24 オリンパス光学工業株式会社 Endoscopic sheath
US8540704B2 (en) 1999-07-14 2013-09-24 Cardiofocus, Inc. Guided cardiac ablation catheters
US20050222558A1 (en) 1999-07-14 2005-10-06 Cardiofocus, Inc. Methods of cardiac ablation employing a deflectable sheath catheter
US7935108B2 (en) 1999-07-14 2011-05-03 Cardiofocus, Inc. Deflectable sheath catheters
US20040147913A1 (en) 1999-08-25 2004-07-29 Cardiofocus, Inc. Surgical ablation instruments with irrigation features
US20050234436A1 (en) 1999-07-14 2005-10-20 Cardiofocus, Inc. Methods of cardiac ablation in the vicinity of the right inferior pulmonary vein
US20040167503A1 (en) 1999-08-25 2004-08-26 Cardiofocus, Inc. Malleable surgical ablation instruments
US20050234437A1 (en) 1999-07-14 2005-10-20 Cardiofocus, Inc. Deflectable sheath catheters with out-of-plane bent tip
US8025661B2 (en) 1994-09-09 2011-09-27 Cardiofocus, Inc. Coaxial catheter instruments for ablation with radiant energy
US6168591B1 (en) 1994-09-09 2001-01-02 Cardiofocus, Inc. Guide for penetrating phototherapy
US6676656B2 (en) 1994-09-09 2004-01-13 Cardiofocus, Inc. Surgical ablation with radiant energy
US6102905A (en) 1994-09-09 2000-08-15 Cardiofocus, Inc. Phototherapy device including housing for an optical element and method of making
US6270492B1 (en) 1994-09-09 2001-08-07 Cardiofocus, Inc. Phototherapeutic apparatus with diffusive tip assembly
US6579285B2 (en) 1994-09-09 2003-06-17 Cardiofocus, Inc. Photoablation with infrared radiation
US5498230A (en) 1994-10-03 1996-03-12 Adair; Edwin L. Sterile connector and video camera cover for sterile endoscope
US5792045A (en) 1994-10-03 1998-08-11 Adair; Edwin L. Sterile surgical coupler and drape
US5591119A (en) 1994-12-07 1997-01-07 Adair; Edwin L. Sterile surgical coupler and drape
US6063081A (en) 1995-02-22 2000-05-16 Medtronic, Inc. Fluid-assisted electrocautery device
US5515853A (en) * 1995-03-28 1996-05-14 Sonometrics Corporation Three-dimensional digital ultrasound tracking system
US5709224A (en) 1995-06-07 1998-01-20 Radiotherapeutics Corporation Method and device for permanent vessel occlusion
US6132438A (en) 1995-06-07 2000-10-17 Ep Technologies, Inc. Devices for installing stasis reducing means in body tissue
CA2224975A1 (en) 1995-06-23 1997-01-09 Gyrus Medical Limited An electrosurgical instrument
US5713907A (en) 1995-07-20 1998-02-03 Endotex Interventional Systems, Inc. Apparatus and method for dilating a lumen and for inserting an intraluminal graft
JP3134726B2 (en) 1995-08-14 2001-02-13 富士写真光機株式会社 The ultrasonic diagnostic apparatus
JP3151153B2 (en) * 1995-09-20 2001-04-03 定夫 尾股 Frequency deviation detecting circuit and the measuring device using the same
US5716321A (en) * 1995-10-10 1998-02-10 Conceptus, Inc. Method for maintaining separation between a falloposcope and a tubal wall
US6726677B1 (en) 1995-10-13 2004-04-27 Transvascular, Inc. Stabilized tissue penetrating catheters
US5897553A (en) 1995-11-02 1999-04-27 Medtronic, Inc. Ball point fluid-assisted electrocautery device
US5860953A (en) * 1995-11-21 1999-01-19 Catheter Imaging Systems, Inc. Steerable catheter having disposable module and sterilizable handle and method of connecting same
US5925038A (en) 1996-01-19 1999-07-20 Ep Technologies, Inc. Expandable-collapsible electrode structures for capacitive coupling to tissue
US5895417A (en) * 1996-03-06 1999-04-20 Cardiac Pathways Corporation Deflectable loop design for a linear lesion ablation apparatus
US6258083B1 (en) * 1996-03-29 2001-07-10 Eclipse Surgical Technologies, Inc. Viewing surgical scope for minimally invasive procedures
US5725523A (en) 1996-03-29 1998-03-10 Mueller; Richard L. Lateral-and posterior-aspect method and apparatus for laser-assisted transmyocardial revascularization and other surgical applications
US6063077A (en) 1996-04-08 2000-05-16 Cardima, Inc. Linear ablation device and assembly
US5797903A (en) 1996-04-12 1998-08-25 Ep Technologies, Inc. Tissue heating and ablation systems and methods using porous electrode structures with electrically conductive surfaces
US5713867A (en) 1996-04-29 1998-02-03 Medtronic, Inc. Introducer system having kink resistant splittable sheath
US20020026145A1 (en) * 1997-03-06 2002-02-28 Bagaoisan Celso J. Method and apparatus for emboli containment
US6270477B1 (en) 1996-05-20 2001-08-07 Percusurge, Inc. Catheter for emboli containment
US5662671A (en) 1996-07-17 1997-09-02 Embol-X, Inc. Atherectomy device having trapping and excising means for removal of plaque from the aorta and other arteries
US5754313A (en) 1996-07-17 1998-05-19 Welch Allyn, Inc. Imager assembly
US6905505B2 (en) 1996-07-26 2005-06-14 Kensey Nash Corporation System and method of use for agent delivery and revascularizing of grafts and vessels
US6830577B2 (en) 1996-07-26 2004-12-14 Kensey Nash Corporation System and method of use for treating occluded vessels and diseased tissue
US5826576A (en) 1996-08-08 1998-10-27 Medtronic, Inc. Electrophysiology catheter with multifunction wire and method for making
US6126682A (en) 1996-08-13 2000-10-03 Oratec Interventions, Inc. Method for treating annular fissures in intervertebral discs
US5752518A (en) 1996-10-28 1998-05-19 Ep Technologies, Inc. Systems and methods for visualizing interior regions of the body
US5904651A (en) 1996-10-28 1999-05-18 Ep Technologies, Inc. Systems and methods for visualizing tissue during diagnostic or therapeutic procedures
US5908445A (en) * 1996-10-28 1999-06-01 Ep Technologies, Inc. Systems for visualizing interior tissue regions including an actuator to move imaging element
US5722403A (en) 1996-10-28 1998-03-03 Ep Technologies, Inc. Systems and methods using a porous electrode for ablating and visualizing interior tissue regions
US5848969A (en) 1996-10-28 1998-12-15 Ep Technologies, Inc. Systems and methods for visualizing interior tissue regions using expandable imaging structures
US5827268A (en) 1996-10-30 1998-10-27 Hearten Medical, Inc. Device for the treatment of patent ductus arteriosus and method of using the device
US6002955A (en) 1996-11-08 1999-12-14 Medtronic, Inc. Stabilized electrophysiology catheter and method for use
US5749890A (en) * 1996-12-03 1998-05-12 Shaknovich; Alexander Method and system for stent placement in ostial lesions
US6071279A (en) 1996-12-19 2000-06-06 Ep Technologies, Inc. Branched structures for supporting multiple electrode elements
US5879366A (en) 1996-12-20 1999-03-09 W.L. Gore & Associates, Inc. Self-expanding defect closure device and method of making and using
US6007521A (en) 1997-01-07 1999-12-28 Bidwell; Robert E. Drainage catheter system
US6013024A (en) 1997-01-20 2000-01-11 Suzuki Motor Corporation Hybrid operation system
JP3134287B2 (en) 1997-01-30 2001-02-13 株式会社ニッショー Intracardiac suture surgery for catheter assembly
US5968053A (en) 1997-01-31 1999-10-19 Cardiac Assist Technologies, Inc. Method and apparatus for implanting a graft in a vessel of a patient
US6295989B1 (en) 1997-02-06 2001-10-02 Arteria Medical Science, Inc. ICA angioplasty with cerebral protection
US6086534A (en) * 1997-03-07 2000-07-11 Cardiogenesis Corporation Apparatus and method of myocardial revascularization using ultrasonic pulse-echo distance ranging
US6086582A (en) 1997-03-13 2000-07-11 Altman; Peter A. Cardiac drug delivery system
US5944690A (en) 1997-03-17 1999-08-31 C.R. Bard, Inc. Slidable control mechanism for steerable catheter
US5897487A (en) 1997-04-15 1999-04-27 Asahi Kogaku Kogyo Kabushiki Kaisha Front end hood for endoscope
US6081740A (en) 1997-04-23 2000-06-27 Accumed International, Inc. Method and apparatus for imaging and sampling diseased tissue
US5971983A (en) 1997-05-09 1999-10-26 The Regents Of The University Of California Tissue ablation device and method of use
US6251109B1 (en) 1997-06-27 2001-06-26 Daig Corporation Process and device for the treatment of atrial arrhythmia
US6514249B1 (en) 1997-07-08 2003-02-04 Atrionix, Inc. Positioning system and method for orienting an ablation element within a pulmonary vein ostium
US6500174B1 (en) 1997-07-08 2002-12-31 Atrionix, Inc. Circumferential ablation device assembly and methods of use and manufacture providing an ablative circumferential band along an expandable member
US6012457A (en) 1997-07-08 2000-01-11 The Regents Of The University Of California Device and method for forming a circumferential conduction block in a pulmonary vein
US6164283A (en) 1997-07-08 2000-12-26 The Regents Of The University Of California Device and method for forming a circumferential conduction block in a pulmonary vein
US6997925B2 (en) * 1997-07-08 2006-02-14 Atrionx, Inc. Tissue ablation device assembly and method for electrically isolating a pulmonary vein ostium from an atrial wall
US6024740A (en) 1997-07-08 2000-02-15 The Regents Of The University Of California Circumferential ablation device assembly
DE69822713D1 (en) 1997-07-22 2004-05-06 Terumo Corp Indwelling catheter and Herstellungsmetode
JP4255208B2 (en) 1997-07-24 2009-04-15 レックス メディカル リミテッド パートナーシップ Apparatus for ablating a subcutaneous target tissue mass was
US5902299A (en) 1997-07-29 1999-05-11 Jayaraman; Swaminathan Cryotherapy method for reducing tissue injury after balloon angioplasty or stent implantation
US5941845A (en) 1997-08-05 1999-08-24 Irvine Biomedical, Inc. Catheter having multiple-needle electrode and methods thereof
US6459919B1 (en) 1997-08-26 2002-10-01 Color Kinetics, Incorporated Precision illumination methods and systems
US6015414A (en) 1997-08-29 2000-01-18 Stereotaxis, Inc. Method and apparatus for magnetically controlling motion direction of a mechanically pushed catheter
US6179832B1 (en) * 1997-09-11 2001-01-30 Vnus Medical Technologies, Inc. Expandable catheter having two sets of electrodes
US6211904B1 (en) 1997-09-11 2001-04-03 Edwin L. Adair Surgical devices incorporating reduced area imaging devices
US6086528A (en) 1997-09-11 2000-07-11 Adair; Edwin L. Surgical devices with removable imaging capability and methods of employing same
US6401719B1 (en) 1997-09-11 2002-06-11 Vnus Medical Technologies, Inc. Method of ligating hollow anatomical structures
US5916147A (en) 1997-09-22 1999-06-29 Boury; Harb N. Selectively manipulable catheter
US6043839A (en) 1997-10-06 2000-03-28 Adair; Edwin L. Reduced area imaging devices
US7030904B2 (en) 1997-10-06 2006-04-18 Micro-Medical Devices, Inc. Reduced area imaging device incorporated within wireless endoscopic devices
US5986693A (en) 1997-10-06 1999-11-16 Adair; Edwin L. Reduced area imaging devices incorporated within surgical instruments
US5929901A (en) 1997-10-06 1999-07-27 Adair; Edwin L. Reduced area imaging devices incorporated within surgical instruments
US6982740B2 (en) 1997-11-24 2006-01-03 Micro-Medical Devices, Inc. Reduced area imaging devices utilizing selected charge integration periods
US6310642B1 (en) 1997-11-24 2001-10-30 Micro-Medical Devices, Inc. Reduced area imaging devices incorporated within surgical instruments
US6240312B1 (en) 1997-10-23 2001-05-29 Robert R. Alfano Remote-controllable, micro-scale device for use in in vivo medical diagnosis and/or treatment
US5997571A (en) 1997-12-17 1999-12-07 Cardiofocus, Inc. Non-occluding phototherapy probe stabilizers
US6071302A (en) 1997-12-31 2000-06-06 Cardiofocus, Inc. Phototherapeutic apparatus for wide-angle diffusion
US7090683B2 (en) * 1998-02-24 2006-08-15 Hansen Medical, Inc. Flexible instrument
US7214230B2 (en) * 1998-02-24 2007-05-08 Hansen Medical, Inc. Flexible instrument
US6142993A (en) 1998-02-27 2000-11-07 Ep Technologies, Inc. Collapsible spline structure using a balloon as an expanding actuator
US5997509A (en) 1998-03-06 1999-12-07 Cornell Research Foundation, Inc. Minimally invasive gene therapy delivery device and method
US6115626A (en) 1998-03-26 2000-09-05 Scimed Life Systems, Inc. Systems and methods using annotated images for controlling the use of diagnostic or therapeutic instruments in instruments in interior body regions
US6383195B1 (en) 1998-04-13 2002-05-07 Endoline, Inc. Laparoscopic specimen removal apparatus
JPH11299725A (en) 1998-04-21 1999-11-02 Olympus Optical Co Ltd Hood for endoscope
US6522930B1 (en) 1998-05-06 2003-02-18 Atrionix, Inc. Irrigated ablation device assembly
US7263397B2 (en) 1998-06-30 2007-08-28 St. Jude Medical, Atrial Fibrillation Division, Inc. Method and apparatus for catheter navigation and location and mapping in the heart
US6409722B1 (en) 1998-07-07 2002-06-25 Medtronic, Inc. Apparatus and method for creating, maintaining, and controlling a virtual electrode used for the ablation of tissue
US6537272B2 (en) 1998-07-07 2003-03-25 Medtronic, Inc. Apparatus and method for creating, maintaining, and controlling a virtual electrode used for the ablation of tissue
US6315777B1 (en) 1998-07-07 2001-11-13 Medtronic, Inc. Method and apparatus for creating a virtual electrode used for the ablation of tissue
US6706039B2 (en) 1998-07-07 2004-03-16 Medtronic, Inc. Method and apparatus for creating a bi-polar virtual electrode used for the ablation of tissue
US6494902B2 (en) 1998-07-07 2002-12-17 Medtronic, Inc. Method for creating a virtual electrode for the ablation of tissue and for selected protection of tissue during an ablation
US6238393B1 (en) 1998-07-07 2001-05-29 Medtronic, Inc. Method and apparatus for creating a bi-polar virtual electrode used for the ablation of tissue
US6394096B1 (en) 1998-07-15 2002-05-28 Corazon Technologies, Inc. Method and apparatus for treatment of cardiovascular tissue mineralization
WO2000003651A1 (en) 1998-07-15 2000-01-27 Corazon Technologies, Inc. Methods and devices for reducing the mineral content of vascular calcified lesions
US6562020B1 (en) 1998-07-15 2003-05-13 Corazon Technologies, Inc. Kits for use in the treatment of vascular calcified lesions
US6112123A (en) 1998-07-28 2000-08-29 Endonetics, Inc. Device and method for ablation of tissue
JP2003524443A (en) 1998-08-02 2003-08-19 スーパー ディメンション リミテッド Medical body guidance system
US6139508A (en) 1998-08-04 2000-10-31 Endonetics, Inc. Articulated medical device
US6461327B1 (en) 1998-08-07 2002-10-08 Embol-X, Inc. Atrial isolator and method of use
US6099498A (en) 1998-09-02 2000-08-08 Embol-X, Inc Cardioplegia access view probe and methods of use
US6123703A (en) 1998-09-19 2000-09-26 Tu; Lily Chen Ablation catheter and methods for treating tissues
US6178346B1 (en) 1998-10-23 2001-01-23 David C. Amundson Infrared endoscopic imaging in a liquid with suspended particles: method and apparatus
US6123718A (en) 1998-11-02 2000-09-26 Polymerex Medical Corp. Balloon catheter
US7128073B1 (en) 1998-11-06 2006-10-31 Ev3 Endovascular, Inc. Method and device for left atrial appendage occlusion
US6152144A (en) 1998-11-06 2000-11-28 Appriva Medical, Inc. Method and device for left atrial appendage occlusion
US6234995B1 (en) 1998-11-12 2001-05-22 Advanced Interventional Technologies, Inc. Apparatus and method for selectively isolating a proximal anastomosis site from blood in an aorta
US6162179A (en) 1998-12-08 2000-12-19 Scimed Life Systems, Inc. Loop imaging catheter
US6896690B1 (en) * 2000-01-27 2005-05-24 Viacor, Inc. Cardiac valve procedure methods and devices
US6396873B1 (en) * 1999-02-25 2002-05-28 Envision Advanced Medical Systems Optical device
US6325797B1 (en) 1999-04-05 2001-12-04 Medtronic, Inc. Ablation catheter and method for isolating a pulmonary vein
US20040044350A1 (en) 1999-04-09 2004-03-04 Evalve, Inc. Steerable access sheath and methods of use
US6167297A (en) 1999-05-05 2000-12-26 Benaron; David A. Detecting, localizing, and targeting internal sites in vivo using optical contrast agents
JP3490933B2 (en) 1999-06-07 2004-01-26 ペンタックス株式会社 Swallowable endoscope apparatus
US6890329B2 (en) 1999-06-15 2005-05-10 Cryocath Technologies Inc. Defined deflection structure
US6306132B1 (en) 1999-06-17 2001-10-23 Vivant Medical Modular biopsy and microwave ablation needle delivery apparatus adapted to in situ assembly and method of use
US6626899B2 (en) 1999-06-25 2003-09-30 Nidus Medical, Llc Apparatus and methods for treating tissue
US20040249367A1 (en) 2003-01-15 2004-12-09 Usgi Medical Corp. Endoluminal tool deployment system
US6572609B1 (en) * 1999-07-14 2003-06-03 Cardiofocus, Inc. Phototherapeutic waveguide apparatus
US6423055B1 (en) 1999-07-14 2002-07-23 Cardiofocus, Inc. Phototherapeutic wave guide apparatus
EP1866019B1 (en) 2005-02-22 2017-10-25 Cardiofocus, Inc. Deflectable sheath catheters
US6235044B1 (en) * 1999-08-04 2001-05-22 Scimed Life Systems, Inc. Percutaneous catheter and guidewire for filtering during ablation of mycardial or vascular tissue
US6755811B1 (en) * 1999-08-25 2004-06-29 Corazon Technologies, Inc. Methods and devices for reducing the mineral content of a region of non-intimal vascular tissue
US6527979B2 (en) 1999-08-27 2003-03-04 Corazon Technologies, Inc. Catheter systems and methods for their use in the treatment of calcified vascular occlusions
US6702780B1 (en) 1999-09-08 2004-03-09 Super Dimension Ltd. Steering configuration for catheter with rigid distal device
US6458151B1 (en) 1999-09-10 2002-10-01 Frank S. Saltiel Ostial stent positioning device and method
US6315778B1 (en) 1999-09-10 2001-11-13 C. R. Bard, Inc. Apparatus for creating a continuous annular lesion
US6423051B1 (en) 1999-09-16 2002-07-23 Aaron V. Kaplan Methods and apparatus for pericardial access
US6231561B1 (en) 1999-09-20 2001-05-15 Appriva Medical, Inc. Method and apparatus for closing a body lumen
US6385476B1 (en) * 1999-09-21 2002-05-07 Biosense, Inc. Method and apparatus for intracardially surveying a condition of a chamber of a heart
US6915154B1 (en) 1999-09-24 2005-07-05 National Research Council Of Canada Method and apparatus for performing intra-operative angiography
US6485489B2 (en) 1999-10-02 2002-11-26 Quantum Cor, Inc. Catheter system for repairing a mitral valve annulus
US6533767B2 (en) 2000-03-20 2003-03-18 Corazon Technologies, Inc. Methods for enhancing fluid flow through an obstructed vascular site, and systems and kits for use in practicing the same
US6488671B1 (en) 1999-10-22 2002-12-03 Corazon Technologies, Inc. Methods for enhancing fluid flow through an obstructed vascular site, and systems and kits for use in practicing the same
US6290689B1 (en) 1999-10-22 2001-09-18 Corazón Technologies, Inc. Catheter devices and methods for their use in the treatment of calcified vascular occlusions
US6780151B2 (en) 1999-10-26 2004-08-24 Acmi Corporation Flexible ureteropyeloscope
US6613062B1 (en) 1999-10-29 2003-09-02 Medtronic, Inc. Method and apparatus for providing intra-pericardial access
US7758521B2 (en) * 1999-10-29 2010-07-20 Medtronic, Inc. Methods and systems for accessing the pericardial space
US6529756B1 (en) * 1999-11-22 2003-03-04 Scimed Life Systems, Inc. Apparatus for mapping and coagulating soft tissue in or around body orifices
US6711444B2 (en) * 1999-11-22 2004-03-23 Scimed Life Systems, Inc. Methods of deploying helical diagnostic and therapeutic element supporting structures within the body
US6626855B1 (en) 1999-11-26 2003-09-30 Therus Corpoation Controlled high efficiency lesion formation using high intensity ultrasound
US6156350A (en) 1999-12-02 2000-12-05 Corazon Technologies, Inc. Methods and kits for use in preventing restenosis
WO2001049356A1 (en) 2000-01-06 2001-07-12 Bedell Raymond L Steerable fiberoptic epidural balloon catheter and scope
WO2001053871A3 (en) 2000-01-21 2002-01-24 Ampersand Medical Corp In-vivo tissue inspection and sampling
US6892091B1 (en) 2000-02-18 2005-05-10 Biosense, Inc. Catheter, method and apparatus for generating an electrical map of a chamber of the heart
US6478769B1 (en) 2000-02-22 2002-11-12 The Board Of Trustees Of The University Of Arkansas Anatomical fluid evacuation apparatus and method
US6436118B1 (en) 2000-02-25 2002-08-20 General Surgical Innovations, Inc. IMA dissection device
US6544195B2 (en) 2000-03-04 2003-04-08 Joseph F. Wilson Tissue of foreign body extractor
JP2001258822A (en) 2000-03-14 2001-09-25 Olympus Optical Co Ltd Endoscope
US6770070B1 (en) * 2000-03-17 2004-08-03 Rita Medical Systems, Inc. Lung treatment apparatus and method
US6440061B1 (en) 2000-03-24 2002-08-27 Donald E. Wenner Laparoscopic instrument system for real-time biliary exploration and stone removal
EP1267986B1 (en) 2000-03-31 2006-05-10 Medtronic, Inc. Deflection Mechanism
US6858005B2 (en) * 2000-04-03 2005-02-22 Neo Guide Systems, Inc. Tendon-driven endoscope and methods of insertion
US6692430B2 (en) 2000-04-10 2004-02-17 C2Cure Inc. Intra vascular imaging apparatus
US6650923B1 (en) 2000-04-13 2003-11-18 Ev3 Sunnyvale, Inc. Method for accessing the left atrium of the heart by locating the fossa ovalis
US7056294B2 (en) 2000-04-13 2006-06-06 Ev3 Sunnyvale, Inc Method and apparatus for accessing the left atrial appendage
US6558382B2 (en) 2000-04-27 2003-05-06 Medtronic, Inc. Suction stabilized epicardial ablation devices
US6375654B1 (en) 2000-05-19 2002-04-23 Cardiofocus, Inc. Catheter system with working portion radially expandable upon rotation
US6532380B1 (en) * 2000-06-30 2003-03-11 Cedars Sinai Medical Center Image guidance for coronary stent deployment
US6558375B1 (en) 2000-07-14 2003-05-06 Cardiofocus, Inc. Cardiac ablation instrument
US6811562B1 (en) 2000-07-31 2004-11-02 Epicor, Inc. Procedures for photodynamic cardiac ablation therapy and devices for those procedures
US6773402B2 (en) 2001-07-10 2004-08-10 Biosense, Inc. Location sensing with real-time ultrasound imaging
JP2002058642A (en) 2000-08-21 2002-02-26 Asahi Optical Co Ltd Imaging element for electronic endoscope
US6605055B1 (en) 2000-09-13 2003-08-12 Cardiofocus, Inc. Balloon catheter with irrigation sheath
JP2002177198A (en) * 2000-10-02 2002-06-25 Olympus Optical Co Ltd Endoscope
US6926669B1 (en) 2000-10-10 2005-08-09 Medtronic, Inc. Heart wall ablation/mapping catheter and method
US6540733B2 (en) 2000-12-29 2003-04-01 Corazon Technologies, Inc. Proton generating catheters and methods for their use in enhancing fluid flow through a vascular site occupied by a calcified vascular occlusion
US6958069B2 (en) 2001-01-17 2005-10-25 Mark LoGuidice Instruments and methods for use in laparoscopic surgery
DE10115341A1 (en) * 2001-03-28 2002-10-02 Philips Corp Intellectual Pty A method and system for imaging ultrasound Besim Mung the position of a catheter
US6837901B2 (en) 2001-04-27 2005-01-04 Intek Technology L.L.C. Methods for delivering, repositioning and/or retrieving self-expanding stents
US7422579B2 (en) 2001-05-01 2008-09-09 St. Jude Medical Cardiology Divison, Inc. Emboli protection devices and related methods of use
WO2002089686A1 (en) 2001-05-10 2002-11-14 Rita Medical Systems, Inc. Rf tissue ablation apparatus and method
US6635070B2 (en) 2001-05-21 2003-10-21 Bacchus Vascular, Inc. Apparatus and methods for capturing particulate material within blood vessels
US6771996B2 (en) 2001-05-24 2004-08-03 Cardiac Pacemakers, Inc. Ablation and high-resolution mapping catheter system for pulmonary vein foci elimination
JP3722729B2 (en) 2001-06-04 2005-11-30 オリンパス株式会社 Endoscopic treatment equipment
US6693821B2 (en) 2001-06-28 2004-02-17 Sharp Laboratories Of America, Inc. Low cross-talk electrically programmable resistance cross point memory
US6916286B2 (en) 2001-08-09 2005-07-12 Smith & Nephew, Inc. Endoscope with imaging probe
US7218344B2 (en) 2001-08-15 2007-05-15 Sony Corporation System and method for efficiently performing a white balance operation
US20030036698A1 (en) 2001-08-16 2003-02-20 Robert Kohler Interventional diagnostic catheter and a method for using a catheter to access artificial cardiac shunts
US7125421B2 (en) 2001-08-31 2006-10-24 Mitral Interventions, Inc. Method and apparatus for valve repair
US7101395B2 (en) 2002-06-12 2006-09-05 Mitral Interventions, Inc. Method and apparatus for tissue connection
WO2003028571A3 (en) 2001-09-28 2003-10-30 Marc Dubuc Method for identification and visualization of atrial tissue
JP2005505385A (en) * 2001-10-12 2005-02-24 アプライド メディカル リソーシーズ コーポレイション High flow low pressure irrigation system
US20050020914A1 (en) 2002-11-12 2005-01-27 David Amundson Coronary sinus access catheter with forward-imaging
WO2003039350A3 (en) 2001-11-09 2004-02-19 David Amundson Direct, real-time imaging guidance of cardiac catheterization
WO2003073942A3 (en) 2002-02-28 2005-01-13 Medtronic Inc Improved system and method of positioning implantable medical devices
EP1450715A4 (en) 2001-11-14 2006-03-08 Latis Inc Improved catheters for clot removal
US7588535B2 (en) 2001-12-11 2009-09-15 C2Cure Inc. Apparatus, method and system for intravascular photographic imaging
WO2003057272A3 (en) * 2001-12-26 2004-01-29 Michael Tal Vascular access device
US7019610B2 (en) * 2002-01-23 2006-03-28 Stereotaxis, Inc. Magnetic navigation system
US7717899B2 (en) 2002-01-28 2010-05-18 Cardiac Pacemakers, Inc. Inner and outer telescoping catheter delivery system
JP3826045B2 (en) 2002-02-07 2006-09-27 オリンパス株式会社 Food for an endoscope
US6974464B2 (en) 2002-02-28 2005-12-13 3F Therapeutics, Inc. Supportless atrioventricular heart valve and minimally invasive delivery systems thereof
US20060146172A1 (en) 2002-03-18 2006-07-06 Jacobsen Stephen C Miniaturized utility device having integrated optical capabilities
US7591780B2 (en) 2002-03-18 2009-09-22 Sterling Lc Miniaturized imaging device with integrated circuit connector system
US6712798B2 (en) 2002-03-18 2004-03-30 Corazon Technologies, Inc. Multilumen catheters and methods for their use
US7787939B2 (en) 2002-03-18 2010-08-31 Sterling Lc Miniaturized imaging device including utility aperture and SSID
US6866651B2 (en) 2002-03-20 2005-03-15 Corazon Technologies, Inc. Methods and devices for the in situ dissolution of renal calculi
US6932809B2 (en) 2002-05-14 2005-08-23 Cardiofocus, Inc. Safety shut-off device for laser surgical instruments employing blackbody emitters
DE10392670T5 (en) 2002-05-16 2005-07-28 C2Cure Inc., Wilmington Miniature camera head
US7118566B2 (en) 2002-05-16 2006-10-10 Medtronic, Inc. Device and method for needle-less interstitial injection of fluid for ablation of cardiac tissue
US8956280B2 (en) 2002-05-30 2015-02-17 Intuitive Surgical Operations, Inc. Apparatus and methods for placing leads using direct visualization
EP1870018A3 (en) 2002-05-30 2008-08-06 The Board of Trustees of The Leland Stanford Junior University Apparatus and methods for coronary sinus access
US6783491B2 (en) 2002-06-13 2004-08-31 Vahid Saadat Shape lockable apparatus and method for advancing an instrument through unsupported anatomy
US6986775B2 (en) * 2002-06-13 2006-01-17 Guided Delivery Systems, Inc. Devices and methods for heart valve repair
US6679836B2 (en) 2002-06-21 2004-01-20 Scimed Life Systems, Inc. Universal programmable guide catheter
US7421295B2 (en) * 2002-07-19 2008-09-02 Oscor Inc. Implantable cardiac lead having removable fluid delivery port
US6887237B2 (en) 2002-07-22 2005-05-03 Medtronic, Inc. Method for treating tissue with a wet electrode and apparatus for using same
US6701581B2 (en) 2002-08-10 2004-03-09 Epicor Industries, Inc. Clamp retention device
US6863668B2 (en) * 2002-08-16 2005-03-08 Edwards Lifesciences Corporation Articulation mechanism for medical devices
WO2004026134B1 (en) 2002-08-24 2004-05-13 Subramaniam C Krishnan Method and apparatus for locating the fossa ovalis and performing transseptal puncture
US6755790B2 (en) 2002-10-14 2004-06-29 Medtronic, Inc. Transseptal access tissue thickness sensing dilator devices and methods for fabricating and using same
US6899672B2 (en) 2002-11-08 2005-05-31 Scimed Life Systems, Inc. Endoscopic imaging system including removable deflection device
US20040158289A1 (en) * 2002-11-30 2004-08-12 Girouard Steven D. Method and apparatus for cell and electrical therapy of living tissue
US20040138707A1 (en) * 2003-01-14 2004-07-15 Greenhalgh E. Skott Anchor removable from a substrate
US6984232B2 (en) 2003-01-17 2006-01-10 St. Jude Medical, Daig Division, Inc. Ablation catheter assembly having a virtual electrode comprising portholes
US7323001B2 (en) 2003-01-30 2008-01-29 Ev3 Inc. Embolic filters with controlled pore size
US8021359B2 (en) 2003-02-13 2011-09-20 Coaptus Medical Corporation Transseptal closure of a patent foramen ovale and other cardiac defects
CA2516559C (en) 2003-02-21 2016-09-27 Electro-Cat, Llc System and method for measuring cross-sectional areas and pressure gradients in luminal organs
US7658747B2 (en) 2003-03-12 2010-02-09 Nmt Medical, Inc. Medical device for manipulation of a medical implant
US20050015048A1 (en) * 2003-03-12 2005-01-20 Chiu Jessica G. Infusion treatment agents, catheters, filter devices, and occlusion devices, and use thereof
US20070055142A1 (en) 2003-03-14 2007-03-08 Webler William E Method and apparatus for image guided position tracking during percutaneous procedures
US7300429B2 (en) * 2003-03-18 2007-11-27 Catharos Medical Systems, Inc. Methods and devices for retrieval of a medical agent from a physiological efferent fluid collection site
JP2006520649A (en) 2003-03-18 2006-09-14 ダイヤレックス メディカル インコーポレーティッド Method and apparatus for recovering the drug from efferent physiological fluid collection site
US6939348B2 (en) 2003-03-27 2005-09-06 Cierra, Inc. Energy based devices and methods for treatment of patent foramen ovale
US7293562B2 (en) * 2003-03-27 2007-11-13 Cierra, Inc. Energy based devices and methods for treatment of anatomic tissue defects
US20040199052A1 (en) 2003-04-01 2004-10-07 Scimed Life Systems, Inc. Endoscopic imaging system
US7569952B1 (en) 2003-04-18 2009-08-04 Ferro Solutions, Inc. High efficiency, inductive vibration energy harvester
US20040215180A1 (en) 2003-04-25 2004-10-28 Medtronic, Inc. Ablation of stomach lining to treat obesity
US6994094B2 (en) 2003-04-29 2006-02-07 Biosense, Inc. Method and device for transseptal facilitation based on injury patterns
US20040220471A1 (en) 2003-04-29 2004-11-04 Yitzhack Schwartz Method and device for transseptal facilitation using location system
JP4414682B2 (en) 2003-06-06 2010-02-10 オリンパス株式会社 Ultrasonic endoscopic apparatus
US20040260182A1 (en) 2003-06-23 2004-12-23 Zuluaga Andres F. Intraluminal spectroscope with wall contacting probe
JP4599353B2 (en) 2003-07-17 2010-12-15 コラゾン テクノロジーズ インコーポレーティッド Percutaneously treat apparatus aortic valve stenosis
US20050027163A1 (en) 2003-07-29 2005-02-03 Scimed Life Systems, Inc. Vision catheter
US7534204B2 (en) * 2003-09-03 2009-05-19 Guided Delivery Systems, Inc. Cardiac visualization devices and methods
JP2007504885A (en) 2003-09-11 2007-03-08 エヌエムティー メディカル, インコーポレイティッド Device for suturing tissue, system and method
US7569052B2 (en) 2003-09-12 2009-08-04 Boston Scientific Scimed, Inc. Ablation catheter with tissue protecting assembly
US20050059862A1 (en) 2003-09-12 2005-03-17 Scimed Life Systems, Inc. Cannula with integrated imaging and optical capability
US7736362B2 (en) 2003-09-15 2010-06-15 Boston Scientific Scimed, Inc. Catheter balloons
US8172747B2 (en) 2003-09-25 2012-05-08 Hansen Medical, Inc. Balloon visualization for traversing a tissue wall
US7435248B2 (en) 2003-09-26 2008-10-14 Boston Scientific Scimed, Inc. Medical probes for creating and diagnosing circumferential lesions within or around the ostium of a vessel
US7875049B2 (en) 2004-10-04 2011-01-25 Medtronic, Inc. Expandable guide sheath with steerable backbone and methods for making and using them
US7207989B2 (en) 2003-10-27 2007-04-24 Biosense Webster, Inc. Method for ablating with needle electrode
US20050096502A1 (en) 2003-10-29 2005-05-05 Khalili Theodore M. Robotic surgical device
US7267674B2 (en) 2003-10-30 2007-09-11 Medical Cv, Inc. Apparatus and method for laser treatment
US7666203B2 (en) 2003-11-06 2010-02-23 Nmt Medical, Inc. Transseptal puncture apparatus
US20050215895A1 (en) 2003-11-12 2005-09-29 Popp Richard L Devices and methods for obtaining three-dimensional images of an internal body site
WO2006126979A3 (en) 2003-12-04 2007-05-03 Ev3 Inc System and method for delivering a left atrial appendage containment device
US20050165456A1 (en) * 2003-12-19 2005-07-28 Brian Mann Digital electrode for cardiac rhythm management
JP3823321B2 (en) * 2003-12-25 2006-09-20 フジノン株式会社 Balloon control device
US7399271B2 (en) 2004-01-09 2008-07-15 Cardiokinetix, Inc. Ventricular partitioning device
US8652089B2 (en) 2004-01-19 2014-02-18 Arthrex, Inc. System for distending body tissue cavities by continuous flow irrigation
US20050228452A1 (en) 2004-02-11 2005-10-13 Mourlas Nicholas J Steerable catheters and methods for using them
US7186214B2 (en) * 2004-02-12 2007-03-06 Medtronic, Inc. Instruments and methods for accessing an anatomic space
US20050197623A1 (en) 2004-02-17 2005-09-08 Leeflang Stephen A. Variable steerable catheters and methods for using them
US8052636B2 (en) 2004-03-05 2011-11-08 Hansen Medical, Inc. Robotic catheter system and methods
US8021326B2 (en) * 2004-03-05 2011-09-20 Hansen Medical, Inc. Instrument driver for robotic catheter system
US7972298B2 (en) * 2004-03-05 2011-07-05 Hansen Medical, Inc. Robotic catheter system
US7585308B2 (en) 2005-03-30 2009-09-08 Ethicon Endo-Surgery, Inc. Handle system and method for use in anastomotic procedures
US7632265B2 (en) 2004-05-28 2009-12-15 St. Jude Medical, Atrial Fibrillation Division, Inc. Radio frequency ablation servo catheter and method
US7678081B2 (en) 2004-07-12 2010-03-16 Pacesetter, Inc. Methods and devices for transseptal access
US7242832B2 (en) 2004-07-27 2007-07-10 Medeikon Corporation Device for tissue characterization
US7300397B2 (en) 2004-07-29 2007-11-27 C2C Cure, Inc. Endoscope electronics assembly
US7527625B2 (en) * 2004-08-04 2009-05-05 Olympus Corporation Transparent electrode for the radiofrequency ablation of tissue
EP2272420B1 (en) 2004-08-24 2013-06-19 The General Hospital Corporation Apparatus for imaging of vessel segments
US7919610B2 (en) 2004-08-31 2011-04-05 Fox Chase Cancer Center Yeast bacterial two-hybrid system and methods of use thereof
US8029470B2 (en) 2004-09-30 2011-10-04 Pacesetter, Inc. Transmembrane access systems and methods
US20060069303A1 (en) * 2004-09-30 2006-03-30 Couvillon Lucien A Jr Endoscopic apparatus with integrated hemostasis device
US20060089637A1 (en) * 2004-10-14 2006-04-27 Werneth Randell L Ablation catheter
JP2008520364A (en) 2004-11-17 2008-06-19 バイオセンス・ウェブスター・インコーポレイテッドBiosense Webster, Inc. Real-time evaluation apparatus of the tissue ablation
US7883503B2 (en) 2005-01-26 2011-02-08 Kalser Gary Illuminating balloon catheter and method for using the catheter
US8221310B2 (en) 2005-10-25 2012-07-17 Voyage Medical, Inc. Tissue visualization device and method variations
US9055906B2 (en) 2006-06-14 2015-06-16 Intuitive Surgical Operations, Inc. In-vivo visualization systems
US8137333B2 (en) 2005-10-25 2012-03-20 Voyage Medical, Inc. Delivery of biological compounds to ischemic and/or infarcted tissue
US7930016B1 (en) 2005-02-02 2011-04-19 Voyage Medical, Inc. Tissue closure system
US7918787B2 (en) 2005-02-02 2011-04-05 Voyage Medical, Inc. Tissue visualization and manipulation systems
US20080015569A1 (en) * 2005-02-02 2008-01-17 Voyage Medical, Inc. Methods and apparatus for treatment of atrial fibrillation
US10064540B2 (en) 2005-02-02 2018-09-04 Intuitive Surgical Operations, Inc. Visualization apparatus for transseptal access
US9510732B2 (en) 2005-10-25 2016-12-06 Intuitive Surgical Operations, Inc. Methods and apparatus for efficient purging
US8050746B2 (en) * 2005-02-02 2011-11-01 Voyage Medical, Inc. Tissue visualization device and method variations
US7860556B2 (en) * 2005-02-02 2010-12-28 Voyage Medical, Inc. Tissue imaging and extraction systems
US7860555B2 (en) 2005-02-02 2010-12-28 Voyage Medical, Inc. Tissue visualization and manipulation system
US8078266B2 (en) 2005-10-25 2011-12-13 Voyage Medical, Inc. Flow reduction hood systems
US20080009747A1 (en) * 2005-02-02 2008-01-10 Voyage Medical, Inc. Transmural subsurface interrogation and ablation
US20060258909A1 (en) 2005-04-08 2006-11-16 Usgi Medical, Inc. Methods and apparatus for maintaining sterility during transluminal procedures
WO2006122061A1 (en) 2005-05-06 2006-11-16 Acumen Medical, Inc. Complexly shaped steerable catheters and methods for making and using them
US20060271032A1 (en) 2005-05-26 2006-11-30 Chin Albert K Ablation instruments and methods for performing abalation
JP2007000463A (en) 2005-06-24 2007-01-11 Terumo Corp Catheter assembly
US7765014B2 (en) 2005-08-16 2010-07-27 Medtronic, Inc. Apparatus and methods for delivering transvenous leads
US7575569B2 (en) 2005-08-16 2009-08-18 Medtronic, Inc. Apparatus and methods for delivering stem cells and other agents into cardiac tissue
US7416552B2 (en) 2005-08-22 2008-08-26 St. Jude Medical, Atrial Fibrillation Division, Inc. Multipolar, multi-lumen, virtual-electrode catheter with at least one surface electrode and method for ablation
US8355801B2 (en) * 2005-09-26 2013-01-15 Biosense Webster, Inc. System and method for measuring esophagus proximity
US20070100324A1 (en) 2005-10-17 2007-05-03 Coaptus Medical Corporation Systems and methods for applying vacuum to a patient, including via a disposable liquid collection unit
US7918793B2 (en) * 2005-10-28 2011-04-05 Biosense Webster, Inc. Synchronization of ultrasound imaging data with electrical mapping
US20070135826A1 (en) 2005-12-01 2007-06-14 Steve Zaver Method and apparatus for delivering an implant without bias to a left atrial appendage
US8303505B2 (en) 2005-12-02 2012-11-06 Abbott Cardiovascular Systems Inc. Methods and apparatuses for image guided medical procedures
EP1971285B1 (en) 2005-12-30 2012-01-18 C.R.Bard, Inc. Apparatus for ablation of cardiac tissue
EP2015821B1 (en) 2006-03-20 2015-05-27 Medtronic, Inc. Removable valves and methods for making them
US20070270686A1 (en) 2006-05-03 2007-11-22 Ritter Rogers C Apparatus and methods for using inertial sensing to navigate a medical device
JP5410962B2 (en) 2006-05-12 2014-02-05 ビトロンユーエス, インコーポレイテッド Device for ablating body tissue
US7615067B2 (en) 2006-06-05 2009-11-10 Cambridge Endoscopic Devices, Inc. Surgical instrument
US9220402B2 (en) 2006-06-07 2015-12-29 Intuitive Surgical Operations, Inc. Visualization and treatment via percutaneous methods and devices
EP2037828A2 (en) 2006-07-12 2009-03-25 Les Hôpitaux Universitaires De Geneve Medical device for tissue ablation
US20080027464A1 (en) 2006-07-26 2008-01-31 Moll Frederic H Systems and methods for performing minimally invasive surgical operations
US20080033241A1 (en) 2006-08-01 2008-02-07 Ruey-Feng Peh Left atrial appendage closure
CN101542525B (en) 2006-08-02 2012-12-05 皇家飞利浦电子股份有限公司 3D segmentation by voxel classification based on intensity histogram thresholding initialized by K-means clustering
EP2046227A2 (en) 2006-08-03 2009-04-15 Hansen Medical, Inc. Systems for performing minimally invasive procedures
WO2008024261A3 (en) 2006-08-23 2008-11-20 David C Amundson Image-guided therapy of the fossa ovalis and septal defects
US20080057106A1 (en) 2006-08-29 2008-03-06 Erickson Signe R Low profile bioactive agent delivery device
WO2008028022A3 (en) * 2006-09-01 2008-07-10 Nidus Medical Llc Tissue visualization device having multi-segmented frame
US20080097476A1 (en) * 2006-09-01 2008-04-24 Voyage Medical, Inc. Precision control systems for tissue visualization and manipulation assemblies
US10004388B2 (en) 2006-09-01 2018-06-26 Intuitive Surgical Operations, Inc. Coronary sinus cannulation
JP2010502313A (en) * 2006-09-01 2010-01-28 ボエッジ メディカル, インコーポレイテッド Method and apparatus for the treatment of atrial fibrillation
US20080214889A1 (en) 2006-10-23 2008-09-04 Voyage Medical, Inc. Methods and apparatus for preventing tissue migration
WO2008079828A3 (en) 2006-12-20 2008-08-14 Onset Medical Corp Expandable trans-septal sheath
US8758229B2 (en) 2006-12-21 2014-06-24 Intuitive Surgical Operations, Inc. Axial visualization systems
US8131350B2 (en) 2006-12-21 2012-03-06 Voyage Medical, Inc. Stabilization of visualization catheters
JP2010524651A (en) 2007-04-27 2010-07-22 ボエッジ メディカル, インコーポレイテッド Steerable tissue visualization and manipulation the catheter with a complex shape
US8657805B2 (en) 2007-05-08 2014-02-25 Intuitive Surgical Operations, Inc. Complex shape steerable tissue visualization and manipulation catheter
EP2155036B1 (en) * 2007-05-11 2016-02-24 Intuitive Surgical Operations, Inc. Visual electrode ablation systems
US8527032B2 (en) 2007-05-16 2013-09-03 General Electric Company Imaging system and method of delivery of an instrument to an imaged subject
US20080287805A1 (en) 2007-05-16 2008-11-20 General Electric Company System and method to guide an instrument through an imaged subject
KR20100029235A (en) 2007-06-08 2010-03-16 싸이노슈어, 인코포레이티드 Surgical waveguide
US20090030276A1 (en) 2007-07-27 2009-01-29 Voyage Medical, Inc. Tissue visualization catheter with imaging systems integration
US20090048480A1 (en) 2007-08-13 2009-02-19 Paracor Medical, Inc. Cardiac harness delivery device
US20090062790A1 (en) * 2007-08-31 2009-03-05 Voyage Medical, Inc. Direct visualization bipolar ablation systems
US8235985B2 (en) * 2007-08-31 2012-08-07 Voyage Medical, Inc. Visualization and ablation system variations
US20090125022A1 (en) 2007-11-12 2009-05-14 Voyage Medical, Inc. Tissue visualization and ablation systems
US20090143640A1 (en) * 2007-11-26 2009-06-04 Voyage Medical, Inc. Combination imaging and treatment assemblies
US8460181B2 (en) 2008-01-17 2013-06-11 Nidus Medical, Llc Epicardial access and treatment systems
US8858609B2 (en) 2008-02-07 2014-10-14 Intuitive Surgical Operations, Inc. Stent delivery under direct visualization
EP2252228B1 (en) 2008-03-12 2016-11-02 AFreeze GmbH Handle for an ablation device
US7534294B1 (en) 2008-04-14 2009-05-19 Xerox Corporation Quinacridone nanoscale pigment particles and methods of making same
US8532734B2 (en) 2008-04-18 2013-09-10 Regents Of The University Of Minnesota Method and apparatus for mapping a structure
US8494608B2 (en) 2008-04-18 2013-07-23 Medtronic, Inc. Method and apparatus for mapping a structure
US20090326572A1 (en) 2008-06-27 2009-12-31 Ruey-Feng Peh Apparatus and methods for rapid tissue crossing
US9101735B2 (en) 2008-07-07 2015-08-11 Intuitive Surgical Operations, Inc. Catheter control systems
US8333012B2 (en) 2008-10-10 2012-12-18 Voyage Medical, Inc. Method of forming electrode placement and connection systems
US9468364B2 (en) 2008-11-14 2016-10-18 Intuitive Surgical Operations, Inc. Intravascular catheter with hood and image processing systems
US20110144576A1 (en) * 2009-12-14 2011-06-16 Voyage Medical, Inc. Catheter orientation control system mechanisms
US8694071B2 (en) 2010-02-12 2014-04-08 Intuitive Surgical Operations, Inc. Image stabilization techniques and methods
US9814522B2 (en) 2010-04-06 2017-11-14 Intuitive Surgical Operations, Inc. Apparatus and methods for ablation efficacy
US9254090B2 (en) 2010-10-22 2016-02-09 Intuitive Surgical Operations, Inc. Tissue contrast imaging systems

Cited By (11)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20080009747A1 (en) * 2005-02-02 2008-01-10 Voyage Medical, Inc. Transmural subsurface interrogation and ablation
US20080015569A1 (en) * 2005-02-02 2008-01-17 Voyage Medical, Inc. Methods and apparatus for treatment of atrial fibrillation
US9526401B2 (en) 2005-02-02 2016-12-27 Intuitive Surgical Operations, Inc. Flow reduction hood systems
US8814845B2 (en) 2005-02-02 2014-08-26 Intuitive Surgical Operations, Inc. Delivery of biological compounds to ischemic and/or infarcted tissue
US8934962B2 (en) 2005-02-02 2015-01-13 Intuitive Surgical Operations, Inc. Electrophysiology mapping and visualization system
US20100292558A1 (en) * 2006-06-14 2010-11-18 Voyage Medical, Inc. In-vivo visualization systems
US9055906B2 (en) 2006-06-14 2015-06-16 Intuitive Surgical Operations, Inc. In-vivo visualization systems
US20080033241A1 (en) * 2006-08-01 2008-02-07 Ruey-Feng Peh Left atrial appendage closure
US8694071B2 (en) 2010-02-12 2014-04-08 Intuitive Surgical Operations, Inc. Image stabilization techniques and methods
US8998798B2 (en) * 2010-12-29 2015-04-07 Covidien Lp Multi-lumen tracheal tube with visualization device
US20120172664A1 (en) * 2010-12-29 2012-07-05 Nellcor Puritan Bennett Llc Multi-lumen tracheal tube with visualization device

Also Published As

Publication number Publication date Type
US20080033290A1 (en) 2008-02-07 application
US20140350412A1 (en) 2014-11-27 application
US9332893B2 (en) 2016-05-10 grant
US8814845B2 (en) 2014-08-26 grant
US8137333B2 (en) 2012-03-20 grant
US20120226166A1 (en) 2012-09-06 application
US20160227989A1 (en) 2016-08-11 application

Similar Documents

Publication Publication Date Title
SAKAKIBARA et al. Endomyocardial biopsy
US6832111B2 (en) Device for tumor diagnosis and methods thereof
US7232437B2 (en) Assessment of lesion transmurality
US7542807B2 (en) Conduction block verification probe and method of use
US7371215B2 (en) Endoscopic instrument for engaging a device
US6095987A (en) Apparatus and methods of bioelectrical impedance analysis of blood flow
US8046052B2 (en) Navigation system for cardiac therapies
US6322536B1 (en) Minimally invasive gene therapy delivery and method
US20050267381A1 (en) Portable device for monitoring electrocardiographic signals and indices of blood flow
US7702392B2 (en) Methods and apparatus for determining cardiac stimulation sites using hemodynamic data
US5396897A (en) Method for locating tumors prior to needle biopsy
US20040186368A1 (en) Systems and methods for internal tissue penetration
US6600941B1 (en) Systems and methods of pH tissue monitoring
US6685666B1 (en) Catheters for breast surgery
US20020077687A1 (en) Catheter assembly for treating ischemic tissue
US20120265296A1 (en) Atrial pressure regulation with control, sensing, monitoring and therapy delivery
US8172757B2 (en) Methods and devices for image-guided manipulation or sensing or anatomic structures
US20090299363A1 (en) Off-axis visualization systems
US6254573B1 (en) Intracardiac drug delivery device utilizing spring-loaded mechanism
US20090209950A1 (en) Electrophysiology catheter system
US20090182287A1 (en) Localization of body lumen junctions
US20050113760A1 (en) Diagnostic and injection catheter, in particular for an application in cardiology
US6231518B1 (en) Intrapericardial electrophysiological procedures
US20050245788A1 (en) Esophageal delivery system and method with position indexing
US20100168557A1 (en) Multi-electrode ablation sensing catheter and system

Legal Events

Date Code Title Description
AS Assignment

Owner name: VOYAGE MEDICAL, INC., CALIFORNIA

Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:SAADAT, VAHID;RAO, SEKHAR S.;REEL/FRAME:019942/0731;SIGNING DATES FROM 20070801 TO 20070813

Owner name: VOYAGE MEDICAL, INC., CALIFORNIA

Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:SAADAT, VAHID;RAO, SEKHAR S.;SIGNING DATES FROM 20070801TO 20070813;REEL/FRAME:019942/0731

AS Assignment

Owner name: TRIPLEPOINT CAPITAL LLC, CALIFORNIA

Free format text: SECURITY AGREEMENT;ASSIGNOR:VOYAGE MEDICAL, INC.;REEL/FRAME:029011/0077

Effective date: 20120921

AS Assignment

Owner name: INTUITIVE SURGICAL OPERATIONS, INC., CALIFORNIA

Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:VOYAGE MEDICAL, INC.;REEL/FRAME:031030/0061

Effective date: 20130816

Owner name: VOYAGE MEDICAL, INC., CALIFORNIA

Free format text: RELEASE BY SECURED PARTY;ASSIGNOR:TRIPLEPOINT CAPITAL LLC;REEL/FRAME:031029/0949

Effective date: 20130816

FPAY Fee payment

Year of fee payment: 4