US20130184656A1 - Method of Treating the Heart - Google Patents
Method of Treating the Heart Download PDFInfo
- Publication number
- US20130184656A1 US20130184656A1 US13/785,886 US201313785886A US2013184656A1 US 20130184656 A1 US20130184656 A1 US 20130184656A1 US 201313785886 A US201313785886 A US 201313785886A US 2013184656 A1 US2013184656 A1 US 2013184656A1
- Authority
- US
- United States
- Prior art keywords
- reservoir
- drug delivery
- implantable
- heart
- catheter
- 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.)
- Abandoned
Links
Images
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES 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
- A61M25/00—Catheters; Hollow probes
- A61M25/0067—Catheters; Hollow probes characterised by the distal end, e.g. tips
- A61M25/0082—Catheter tip comprising a tool
- A61M25/0084—Catheter tip comprising a tool being one or more injection needles
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES 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
- A61M5/00—Devices for bringing media into the body in a subcutaneous, intra-vascular or intramuscular way; Accessories therefor, e.g. filling or cleaning devices, arm-rests
- A61M5/14—Infusion devices, e.g. infusing by gravity; Blood infusion; Accessories therefor
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES 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
- A61M25/00—Catheters; Hollow probes
- A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
- A61M25/06—Body-piercing guide needles or the like
- A61M25/0662—Guide tubes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES 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
- A61M25/00—Catheters; Hollow probes
- A61M25/0067—Catheters; Hollow probes characterised by the distal end, e.g. tips
- A61M25/0082—Catheter tip comprising a tool
- A61M25/0084—Catheter tip comprising a tool being one or more injection needles
- A61M2025/0089—Single injection needle protruding axially, i.e. along the longitudinal axis of the catheter, from the distal tip
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES 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
- A61M25/00—Catheters; Hollow probes
- A61M25/10—Balloon catheters
- A61M2025/1043—Balloon catheters with special features or adapted for special applications
- A61M2025/1052—Balloon catheters with special features or adapted for special applications for temporarily occluding a vessel for isolating a sector
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES 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
- A61M2210/00—Anatomical parts of the body
- A61M2210/12—Blood circulatory system
- A61M2210/125—Heart
Definitions
- the inventions described below relate to site specific delivery of therapeutic agents, structures and catheter systems to achieve site specific delivery of therapeutic agents, and means for implanting and using these systems to enable delivery of therapeutic agents to the body.
- the devices and methods described in this application provide for safer and better treatment of various forms of heart disease.
- the forms of heart disease which may be treated with these devices and methods include angina pectoris and related causes such as ischemia, arrhythmia, stenosis and restenosis.
- Other conditions such as chronic heart failure, heart transplant infection and rejection can be treated.
- Each of these conditions involves regions of tissue which are diseased, and these diseased regions of the heart may be treated with various therapeutic agents.
- Ischemia and myocardial infarct are two important cardiac disease states. Symptoms are those included in the constellation of symptoms referred to as angina pectoris, and include constricting pain in the chest and radiating pain in the arms. Ischemic tissue is tissue which is starved of oxygen and nutrients, usually because the tissue is not receiving adequate blood supply. It is characterized by limited metabolic processes which causes poor functionality, and may lead to fibrillation and death. In turn this hinders the normal functioning of the heart cells or myocytes in an ischemic region. Ischemia is reversible, such that cells may return to normal function once they receive the proper nutrients.
- an ischemic, or damaged, region of the heart does not receive enough nutrients to sustain the myocytes they are said to die, and the tissue is said to become infarcted. Infarcted tissue may also lead to fibrillation and death, and infarction is irreversible. The onset of ischemia and infarction are often referred to as a heart attack.
- a number of methods have been developed to treat ischemic regions in the heart.
- Systemic delivery of anti-ischemic agents such as nitrates or vasodilators reduces vascular resistance, thereby reducing the amount of work the heart must perform, which in turn allows the heart function properly even with reduced blood flow.
- These drugs are taken orally or by injection, and affect the entire body as well as the ischemic tissue.
- Ischemic tissue caused by clogged arteries or vascular obstructions are treated by removal of the vascular obstruction. This can be done with the systemic delivery of pharmacological agents such as TPA, urokinase, or antithrombolytics which can break up the obstruction. It can also be done with catheter based techniques intended to open clogged arteries and remove the vascular obstructions.
- catheter-based techniques include percutaneous transluminal coronary angioplasty (PTCA), atherectomy, and stent placement. These techniques can increase myocardial blood flow (perfusion), thereby providing the heart with sufficient oxygen and nutrients. More drastic but very reliable procedures such as coronary artery bypass surgery can also be performed.
- PTCA percutaneous transluminal coronary angioplasty
- atherectomy atherectomy
- stent placement a technique that can increase myocardial blood flow (perfusion), thereby providing the heart with sufficient oxygen and nutrients.
- More drastic but very reliable procedures such as coronary artery bypass surgery can also be performed.
- Cardiac arrhythmias are abnormal rhythmic contractions of the myocardial muscle, often introduced by electrical abnormalities, or irregularities in the heart tissue. Arrhythmias arise from arrhythmogenic tissue, sometimes including a focal point referred to as the focus of the arrhythmia.
- Arrhythmogenic tissue is sometimes caused by ischemia and infarct, and is sometimes causes by other conditions such as an inherent defect in the heart. Arrhythmogenic tissue may also be treated by injection of therapeutic agents, injected in the same manner as is used to treat ischemia and infarct.
- Local drug delivery provides many advantages. Approaches for local delivery of agents at a depth within a tissue enables the delivery of drugs to sites where they are most needed, reduces the amount of drugs required, increases the therapeutic index of the particular dosing regime, and increases the control over the time course of agent delivery. These, in turn, improve the viability of the drugs, lower the amount (and cost) of agents, reduce systemic effects, reduce the chance of drug-drug interactions, lower the risk to patients, and allow the physician to more precisely control the effects induced. Such local delivery may mimic endogenous modes of release, and address the issues of agent toxicity and short half lives. March, U.S. Pat. No.
- 5,840,059 describes a means of delivering therapeutic agents into a channel within the heart, but suffers the serious limitation in that the material will likely not be retained in the channels.
- the viscous carrier suggested by March to help retain the material within the channels poses substantial risk as embolic material should it escape from the channels and be released into the endocardial chamber.
- Our own applications have provided devices, methods, and formulations of therapeutic agents for use in treating various cardiac diseases. These applications have disclosed percutaneous delivery of therapeutic agents to the heart through the arterial system and the left heart, with devices and methods to enhance the retention of therapeutic agents within the heart wall.
- the devices and methods described below provide for delivery of therapeutic substances to a depth within the heart muscle via the venous side of the heart, with a primary focus on delivery through the coronary sinus and through the right ventricular apex and septum.
- the devices and methods may be combined with percutaneous access catheters in order to provide for right heart delivery of therapeutic agents.
- the devices and methods may be combined with permanently implantable devices with and without the electrical sensing and stimulation capabilities, and they provide either sustained delivery of therapeutic agents locally over time via a fluid pathway, or may deliver fluid agents upon demand as a result of an event sensed by a patient are described.
- Devices and techniques for delivering drug microformulations such as microspheres and liposomes, and drug delivery structures from an acute use catheter system are also described.
- FIG. 1 is an illustration of the method of treating the human heart.
- FIG. 2 is an illustration of the system for treating the human heart according to the method illustrated in FIG. 1 .
- FIG. 3 is an illustration of the method of treating the human heart.
- FIG. 1 illustrates the method of treating the human heart.
- the heart 1 of the patient is illustrated in a posterior view.
- the heart comprises the four chambers, the right atrium 3 , the left atrium 4 , the right ventricle 5 (hidden behind the pulmonary veins in this view) and the left ventricle 6 .
- the left ventricle is the chamber that pumps blood out of the heart to the rest of the body through the aorta 7 .
- the right atrium collects venous blood from that superior vena cava 8 and the inferior vena cava 9 , and also from the coronary sinus 10 .
- the coronary sinus in turn collects blood from the great cardiac vein 11 , the posterior vein of the left ventricle 12 , the middle cardiac vein 13 , and the anterior cardiac vein 14 (shown in phantom).
- the coronary sinus is joined to the right atrium through an aperture called the coronary ostium 15 .
- the ostium is covered by a valve which is not shown.
- Catheter based procedures for treating the heart may be directed toward any chamber of the heart.
- catheters When catheters are placed in the left ventricle and foreign materials are injected into the left ventricle, two detrimental effects may occur: first, due to the high blood flow in the left ventricular chamber, the therapeutic agents injected are quickly washed away into the blood stream and delivered to the rest of the body, raising systemic levels of the therapeutic agents and increasing the dosage required to create the desired local effect in the ventricle wall; and second, releasing or creating potentially embolic or thrombogenic material into the blood stream and creating a risk of stroke should emboli reach the brain.
- catheters When catheters are placed in the right ventricle 5 or right atrium 3 , or foreign materials are injected into these chambers, any emboli created is pumped with the blood into the lungs to be filtered or lodged in the lungs with little effect.
- a guide catheter 26 has been used to guide the drug delivery catheter, and extend until the distal tip 27 extends into the vena cava and the coronary sinus.
- the catheter distal tip 24 includes a penetrating element 28 , for example a curved or helical needle, which is selectively extended from the distal tip and is forced through the wall of the vein, and into the myocardium. Therapeutic agents are then injected into the myocardium through the catheter and needle.
- the venous flow path is shut off by occluding the coronary ostium 10 with the guide catheter which has occluding mechanism 29 (visible in FIG. 2 ) located near its distal end.
- the occluding mechanism may be a flange, a collar or other circumferential projection on a portion of the guide catheter 26 just proximal to the distal tip 27 of the guide catheter, and may be formed with a circumferential balloon which is inflated once the catheter is in place, or it may be formed merely of a low durometer annular projection which is soft enough to be deformed during passage through the ostium.
- the occluding mechanism could also be the guide catheter distal tip itself, if it of sufficient diameter to substantially occlude the ostium, as may be the case with very small patients).
- the drug delivery catheter and the guide catheter are longitudinally slidable relative to each other, so that the flange may be moved longitudinally relative to the distal tip 23 and penetrating element of the drug delivery catheter, so that the collar may occlude the ostium while the drug delivery catheter can reach various points within the coronary sinus and cardiac veins.
- FIG. 2 shows the intra-cardiac portion 30 of the drug delivery catheter 22 and the associated cardiac structures including the atrial ostial wall 31 , the atrial ostium (the hole indicated by item 15 ) and the valve 32 .
- the catheter distal tip 24 of the drug delivery catheter 22 lies within the cardiac venous system, for example the anterior section of the great cardiac vein 11 feed into the coronary sinus 10 .
- the penetrating element is proximate the target site 33 , which is the area of tissue which the surgeon intends to treat.
- the guide catheter disposed coaxially over the drug delivery catheter, is advanced so that the distal tip of the guide catheter protrudes into the coronary sinus and the flange lies just distal (relative to the catheter) to the coronary ostium.
- the relationship need not be strictly coaxial; it is sufficient that the two parts may slide along the same longitudinal axis, and they need not be centered on the same axis).
- the flange is provided in the form of an expandable balloon, the balloon is expanded to occlude the coronary ostium and block the flow of venous blood from the coronary sinus into the right atrium.
- the flange is provided in the form of a resilient flange, it merely compresses to slip through the ostium in either direction.
- the longitudinal distance between the distal end of the drug delivery catheter and the proximal face 34 of the occluding mechanism 29 approximates the expected length coronary venous pathway between the ostium and the target site 33 of cardiac tissue.
- the drug delivery catheter is slidably disposed within the guide catheter so that it may be moved longitudinally within the guide catheter to reach various target sites within the coronary venous system while the occluding mechanism of the guide catheter remains in its occluding position relative to the ostium.
- Venous blood flow is in the direction of arrow 35 , which would tend to resist injection of fluid in the retrograde direction.
- the guide catheter and drug delivery catheter are inserted into the patient's venous system and navigated to the superior or inferior vena cava.
- the distal end of the catheter system is then passed retrograde through the coronary ostium and into the coronary sinus, and the drug delivery catheter distal tip is navigated to the target site within the coronary venous system.
- the delivery can be accomplished percutaneously for acute applications or operating room procedures, such as supply of a small number of injections in short order, as in response to a heart attack or other acute condition, or in-hospital treatment of chronic conditions.
- Placement of the drug delivery catheter can also be accomplished surgically (open or minimally invasive surgery) along with internal placement of a drug reservoir and pump, for automatic or chronic supply of therapeutic agents to the heart on an ongoing basis.
- drug delivery can be initiated.
- the occluding mechanism is placed over the ostium (and expanded) to occlude the ostium, and drug delivery is initiated.
- Drug delivery is accomplished by injection therapeutic agents through a lumen extending from the proximal end of the drug delivery catheter to the penetration element.
- the occluding mechanism may be removed or contracted, and the penetrating element may be left in place or moved, depending on the desired course of injections.
- the penetrating element may be comprised of, or coated with, therapeutic agents, so that therapeutic agents are delivered upon penetration and/or bio-erosion of the penetrating element, and in this case, fluid injection through the drug delivery catheter will be unnecessary.
- therapeutic agents such as VEGF-121, VEGF-165, VEDF-145, VEGF-189, aFGF, bFGF (or gene therapy preparations of these agents) may be used, either in freely available formulations or time-release formulations.
- therapeutic agents such as Natrecor® (nesiritide), the recombinant form of B-type natriuretic peptide (BNP).
- Natrecor® the recombinant form of B-type natriuretic peptide
- the needle may be left in place for several seconds, and the therapeutic agents slowly injected at a rate of about 0.1 milliliters per minute.
- the devices and methods described below provide for delivery of therapeutic substances to a depth within the heart muscle via the venous side of the heart.
- the devices and methods may be combined with percutaneous access catheters in order to provide for right heart delivery of therapeutic agents.
- the devices and methods may be combined with permanently implantable devices with and without the electrical sensing and stimulation capabilities, and they provide either sustained delivery of therapeutic agents locally over time via a fluid pathway, or they may deliver fluid agents upon demand as a result of an event sensed by a patient are described.
- the devices and techniques may be used for delivering drug microformulations such as microspheres and liposomes, and drug delivery structures from an acute use catheter.
- Controlled release matrices proposed for use elsewhere in the body include polymeric matrices, hydro gels, fibrin glues, and the like to provide for sustained release of a drug over time to the body.
- Microsphere structures such as those provided as Alkermes Prolease system are one example of polymeric matrices. Implantation of these controlled release structures creates a high potential to for embolic events, as they can aggregate and migrate from the heart and travel to the brain and other organs. When microspheres are delivered in to the body at sited where they can enter arteries supplying the brain, doses of microspheres in the size range of 10 to 50 um are limited to 50,000 microspheres.
- FIG. 3 illustrates another method of right heart access for treatment of the apex region of the heart. This may be used to deliver therapeutic agents to the apex of the right ventricle, the apex of the left ventricle, or to the coronary septum.
- a drug delivery catheter 22 is shown in use to deliver therapeutic agents to the coronary septum and the apex of the heart, in particular the apical section of the right ventricle.
- the catheter distal tip 24 of the drug delivery catheter 22 is shown in the proximity of the apex 36 of the heart, and the penetrating element has penetrated the myocardium from the inside of the right ventricular chamber 37 .
- the drug delivery catheter has been navigated through the patient's venous system, into the superior vena cava (approach may also be made through the inferior vena cava), through the right atrium and finally into the right ventricle.
- an ostium occlusion catheter 38 is also inserted percutaneously and navigated through the venous system so that the distal tip 39 of the occlusion catheter is passed through the coronary ostium, and the occluding mechanism is in occluding relationship with the coronary ostium.
- the occlusion catheter may be routed through a common guide catheter with the drug delivery catheter (and hence inserted through the same percutaneous access point) or it may be delivered through a separation guide catheter, as shown, which is routed through the inferior vena cava to reach the right atrium.
- the surgeon operates the occluding mechanism to cause it to expand and occlude coronary ostium. (With the ostium occluded, venous flow within the entire heart in impeded.) With the ostium occluded, the surgeon injects a therapeutic agent through the drug delivery catheter into the myocardium. Therapeutic agents may be injected slowly and over an intra-operative time frame of several minutes to several hours.
- the approach illustrated in FIG. 3 can be used for injections elsewhere in the heart, either through endocardial approaches, open epicardial approaches, or minimally invasive epicardial approaches.
- the ostium occlusion can also be used in conjunction with injections of therapeutic agents through the coronary arteries.
- the drug delivery catheter may be delivered percutaneously into the left ventricle chamber 40 .
- intramyocardial delivery to the ventricles is performed by either an endocardial intra-ventricular approach or other routes, much of the washout is identified in the venous outflow of the heart. Obstructing this venous outflow forces agents to be retained for greater periods of time within the heart.
- an increased residence time in the tissue should increases their retention in the tissue over even longer times. Obstructing their egress from the injection site by occluding the coronary sinus for the first one to five minutes after injection will increase their residence time for binding, and increase their longer-term retention well after the obstruction is removed. This may be combined with any approach for cardiac delivery, but is preferred for intramyocardial (through coronary sinus, trans-endocardial, or trans-epicardial routes) delivery and intracoronary delivery.
- the devices and methods described above also enable treatment of the left ventricle by placing agents in the right ventricular walls.
- Intramyocardial placement of delivery systems in the right side of the heart may be performed such that the left side of the heart is exposed to the therapeutic agents delivered.
- Such systems may be implanted into the shared ventricular septum or the right ventricular apex to optimize their effects on the left heart.
- Appropriate therapies to be delivered to the apex or the septum may include angiogenic agents, anti-restenosis agents, and agents for the treatment of chronic heart failure. These may be provided in a controlled release form without fear of embolic events. This is particularly useful for implantable transient on-demand delivery systems (for acute treatments) which deliver small molecule therapeutics as well as sustained release systems as described above.
- Implantable systems for on-demand delivery for the ventricular septum may include the matrices or reservoirs of antiarrhythmic agents for the termination of ventricular tachyarrhythmias.
Landscapes
- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Hematology (AREA)
- Animal Behavior & Ethology (AREA)
- Engineering & Computer Science (AREA)
- Anesthesiology (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Veterinary Medicine (AREA)
- Public Health (AREA)
- General Health & Medical Sciences (AREA)
- Pulmonology (AREA)
- Biophysics (AREA)
- Vascular Medicine (AREA)
- Media Introduction/Drainage Providing Device (AREA)
- Materials For Medical Uses (AREA)
Abstract
Description
- This application is a continuation of U.S. application Ser. No. 10/610,012, filed Jun. 30, 2003, now U.S. Pat. No. 8,388,581, which is a continuation of U.S. application Ser. No. 09/543,388, filed on Apr. 5, 2000, now U.S. Pat. No. 6,585,716.
- The inventions described below relate to site specific delivery of therapeutic agents, structures and catheter systems to achieve site specific delivery of therapeutic agents, and means for implanting and using these systems to enable delivery of therapeutic agents to the body.
- The devices and methods described in this application provide for safer and better treatment of various forms of heart disease. The forms of heart disease which may be treated with these devices and methods include angina pectoris and related causes such as ischemia, arrhythmia, stenosis and restenosis. Other conditions such as chronic heart failure, heart transplant infection and rejection can be treated. Each of these conditions involves regions of tissue which are diseased, and these diseased regions of the heart may be treated with various therapeutic agents.
- Ischemia and myocardial infarct are two important cardiac disease states. Symptoms are those included in the constellation of symptoms referred to as angina pectoris, and include constricting pain in the chest and radiating pain in the arms. Ischemic tissue is tissue which is starved of oxygen and nutrients, usually because the tissue is not receiving adequate blood supply. It is characterized by limited metabolic processes which causes poor functionality, and may lead to fibrillation and death. In turn this hinders the normal functioning of the heart cells or myocytes in an ischemic region. Ischemia is reversible, such that cells may return to normal function once they receive the proper nutrients. If an ischemic, or damaged, region of the heart does not receive enough nutrients to sustain the myocytes they are said to die, and the tissue is said to become infarcted. Infarcted tissue may also lead to fibrillation and death, and infarction is irreversible. The onset of ischemia and infarction are often referred to as a heart attack.
- A number of methods have been developed to treat ischemic regions in the heart. Systemic delivery of anti-ischemic agents such as nitrates or vasodilators reduces vascular resistance, thereby reducing the amount of work the heart must perform, which in turn allows the heart function properly even with reduced blood flow. These drugs are taken orally or by injection, and affect the entire body as well as the ischemic tissue. Ischemic tissue caused by clogged arteries or vascular obstructions are treated by removal of the vascular obstruction. This can be done with the systemic delivery of pharmacological agents such as TPA, urokinase, or antithrombolytics which can break up the obstruction. It can also be done with catheter based techniques intended to open clogged arteries and remove the vascular obstructions. These catheter-based techniques include percutaneous transluminal coronary angioplasty (PTCA), atherectomy, and stent placement. These techniques can increase myocardial blood flow (perfusion), thereby providing the heart with sufficient oxygen and nutrients. More drastic but very reliable procedures such as coronary artery bypass surgery can also be performed.
- Recently, some references have proposed injection of therapeutic agents into myocardium through the coronary arteries. Unger, et al., Method To Foster Myocardial Blood Vessel Growth And Improve Blood Flow To The Heart, U.S. Pat. No. 5,244,460 (Sep. 14, 1993) proposed injection of angiogenic growth factors into the coronary arteries through a catheter, with the intention that the growth factors be perfused along with the blood flow into the myocardium. This approach is problematic because (1) all the tissue served by the coronary artery is supplied with angiogenic agent, even though only the region of artery including the occlusion and downstream regions requires the angiogenic agent and (2) to ensure adequate supply to the ischemic area, substantially more angiogenic growth factor than is needed to treat the ischemic area must be delivered to the coronary artery. This may be substantially more tissue than is in need of local drug delivery therapy. The growth factors will act in the tissue which the coronary arteries successfully perfuse. The excess growth factors may cause unwanted angiogenesis in tissue elsewhere in the body. The cornea is described by Unger as such a location, but perhaps more critical is inappropriate delivery of these factors to the brain. Additionally, placement of delivery devices within the coronary arteries as Unger describes will tend to obstruct these arteries and may augment occlusive thrombosis formation. There is a significant need for a means and method of minimizing the amount of growth factors for introducing angiogenesis by delivering these agents only to the site where they are most needed.
- Several other cardiac disease states are related to the diseases already discussed. After stent placement, and after opening vessels using balloon angioplasty (PTCA), the vessels often lose patency over time. This loss of patency due to restenosis may be reduced by appropriate pharmacological therapy in the region of the artery. These problems have not been resolved, and current proposals included irradiating the blood vessel in the region of the balloon angioplasty or stent. Cardiac arrhythmias are abnormal rhythmic contractions of the myocardial muscle, often introduced by electrical abnormalities, or irregularities in the heart tissue. Arrhythmias arise from arrhythmogenic tissue, sometimes including a focal point referred to as the focus of the arrhythmia. Arrhythmogenic tissue is sometimes caused by ischemia and infarct, and is sometimes causes by other conditions such as an inherent defect in the heart. Arrhythmogenic tissue may also be treated by injection of therapeutic agents, injected in the same manner as is used to treat ischemia and infarct.
- Local drug delivery provides many advantages. Approaches for local delivery of agents at a depth within a tissue enables the delivery of drugs to sites where they are most needed, reduces the amount of drugs required, increases the therapeutic index of the particular dosing regime, and increases the control over the time course of agent delivery. These, in turn, improve the viability of the drugs, lower the amount (and cost) of agents, reduce systemic effects, reduce the chance of drug-drug interactions, lower the risk to patients, and allow the physician to more precisely control the effects induced. Such local delivery may mimic endogenous modes of release, and address the issues of agent toxicity and short half lives. March, U.S. Pat. No. 5,840,059 describes a means of delivering therapeutic agents into a channel within the heart, but suffers the serious limitation in that the material will likely not be retained in the channels. The viscous carrier suggested by March to help retain the material within the channels poses substantial risk as embolic material should it escape from the channels and be released into the endocardial chamber. Our own applications have provided devices, methods, and formulations of therapeutic agents for use in treating various cardiac diseases. These applications have disclosed percutaneous delivery of therapeutic agents to the heart through the arterial system and the left heart, with devices and methods to enhance the retention of therapeutic agents within the heart wall.
- The devices and methods described below provide for delivery of therapeutic substances to a depth within the heart muscle via the venous side of the heart, with a primary focus on delivery through the coronary sinus and through the right ventricular apex and septum. The devices and methods may be combined with percutaneous access catheters in order to provide for right heart delivery of therapeutic agents. The devices and methods may be combined with permanently implantable devices with and without the electrical sensing and stimulation capabilities, and they provide either sustained delivery of therapeutic agents locally over time via a fluid pathway, or may deliver fluid agents upon demand as a result of an event sensed by a patient are described. Devices and techniques for delivering drug microformulations such as microspheres and liposomes, and drug delivery structures from an acute use catheter system are also described.
-
FIG. 1 is an illustration of the method of treating the human heart. -
FIG. 2 is an illustration of the system for treating the human heart according to the method illustrated inFIG. 1 . -
FIG. 3 is an illustration of the method of treating the human heart. -
FIG. 1 illustrates the method of treating the human heart. Theheart 1 of the patient is illustrated in a posterior view. The heart comprises the four chambers, theright atrium 3, theleft atrium 4, the right ventricle 5 (hidden behind the pulmonary veins in this view) and theleft ventricle 6. The left ventricle is the chamber that pumps blood out of the heart to the rest of the body through theaorta 7. The right atrium collects venous blood from thatsuperior vena cava 8 and theinferior vena cava 9, and also from thecoronary sinus 10. The coronary sinus in turn collects blood from the greatcardiac vein 11, the posterior vein of theleft ventricle 12, the middlecardiac vein 13, and the anterior cardiac vein 14 (shown in phantom). The coronary sinus is joined to the right atrium through an aperture called thecoronary ostium 15. The ostium is covered by a valve which is not shown. - Catheter based procedures for treating the heart, in which therapeutic agents are injected into the heart, may be directed toward any chamber of the heart. When catheters are placed in the left ventricle and foreign materials are injected into the left ventricle, two detrimental effects may occur: first, due to the high blood flow in the left ventricular chamber, the therapeutic agents injected are quickly washed away into the blood stream and delivered to the rest of the body, raising systemic levels of the therapeutic agents and increasing the dosage required to create the desired local effect in the ventricle wall; and second, releasing or creating potentially embolic or thrombogenic material into the blood stream and creating a risk of stroke should emboli reach the brain. When catheters are placed in the
right ventricle 5 orright atrium 3, or foreign materials are injected into these chambers, any emboli created is pumped with the blood into the lungs to be filtered or lodged in the lungs with little effect. - Our co-pending U.S. application Ser. No. 09/407,461 filed Sep. 28, 1999 describes several therapeutic agents useful for local delivery into the heart, including macromolecule and microsphere formulations of anti-restenosis agents and angiogenic agents into the heart wall. Each of these therapeutic agents (and others) can be delivered through the right heart delivery pathway described here. Referring again to
FIG. 1 , thedrug delivery catheter 22 has been inserted into the venous portion of the patient's vasculature so that thedistal end 23 of the catheter enters into either the inferior vena cava, as shown, or the superior vena cava and thedistal tip 24 of the catheter enters the greatcardiac vein 11 and, as shown, extends into the posterior vein of the left ventricle (item 12). Aguide catheter 26 has been used to guide the drug delivery catheter, and extend until thedistal tip 27 extends into the vena cava and the coronary sinus. The catheterdistal tip 24 includes a penetratingelement 28, for example a curved or helical needle, which is selectively extended from the distal tip and is forced through the wall of the vein, and into the myocardium. Therapeutic agents are then injected into the myocardium through the catheter and needle. - To enhance the retention of the therapeutic agents in the needle track and/or within the myocardium in the face of natural fluid flow from the myocardium into the vein, the venous flow path is shut off by occluding the
coronary ostium 10 with the guide catheter which has occluding mechanism 29 (visible inFIG. 2 ) located near its distal end. The occluding mechanism may be a flange, a collar or other circumferential projection on a portion of theguide catheter 26 just proximal to thedistal tip 27 of the guide catheter, and may be formed with a circumferential balloon which is inflated once the catheter is in place, or it may be formed merely of a low durometer annular projection which is soft enough to be deformed during passage through the ostium. (The occluding mechanism could also be the guide catheter distal tip itself, if it of sufficient diameter to substantially occlude the ostium, as may be the case with very small patients). The drug delivery catheter and the guide catheter are longitudinally slidable relative to each other, so that the flange may be moved longitudinally relative to thedistal tip 23 and penetrating element of the drug delivery catheter, so that the collar may occlude the ostium while the drug delivery catheter can reach various points within the coronary sinus and cardiac veins. With the collar placed in occluding position relative to the coronary ostium, venous flow into the cardiac vein is temporarily stopped, so that therapeutic agents injected through the cardiac vein and into the myocardium is not flushed backwardly by the normal flow of venous blood. - The relationship of the collar to the ostium is more clearly illustrated in
FIG. 2 , which shows theintra-cardiac portion 30 of thedrug delivery catheter 22 and the associated cardiac structures including the atrial ostial wall 31, the atrial ostium (the hole indicated by item 15) and thevalve 32. The catheterdistal tip 24 of thedrug delivery catheter 22 lies within the cardiac venous system, for example the anterior section of the greatcardiac vein 11 feed into thecoronary sinus 10. The penetrating element is proximate thetarget site 33, which is the area of tissue which the surgeon intends to treat. The guide catheter, disposed coaxially over the drug delivery catheter, is advanced so that the distal tip of the guide catheter protrudes into the coronary sinus and the flange lies just distal (relative to the catheter) to the coronary ostium. (The relationship need not be strictly coaxial; it is sufficient that the two parts may slide along the same longitudinal axis, and they need not be centered on the same axis). Where the flange is provided in the form of an expandable balloon, the balloon is expanded to occlude the coronary ostium and block the flow of venous blood from the coronary sinus into the right atrium. Where the flange is provided in the form of a resilient flange, it merely compresses to slip through the ostium in either direction. The longitudinal distance between the distal end of the drug delivery catheter and theproximal face 34 of theoccluding mechanism 29 approximates the expected length coronary venous pathway between the ostium and thetarget site 33 of cardiac tissue. Preferably, the drug delivery catheter is slidably disposed within the guide catheter so that it may be moved longitudinally within the guide catheter to reach various target sites within the coronary venous system while the occluding mechanism of the guide catheter remains in its occluding position relative to the ostium. Venous blood flow is in the direction ofarrow 35, which would tend to resist injection of fluid in the retrograde direction. - To use the drug delivery catheter system, the guide catheter and drug delivery catheter are inserted into the patient's venous system and navigated to the superior or inferior vena cava. The distal end of the catheter system is then passed retrograde through the coronary ostium and into the coronary sinus, and the drug delivery catheter distal tip is navigated to the target site within the coronary venous system. The delivery can be accomplished percutaneously for acute applications or operating room procedures, such as supply of a small number of injections in short order, as in response to a heart attack or other acute condition, or in-hospital treatment of chronic conditions. Placement of the drug delivery catheter can also be accomplished surgically (open or minimally invasive surgery) along with internal placement of a drug reservoir and pump, for automatic or chronic supply of therapeutic agents to the heart on an ongoing basis. In any case, once the penetrating element is forced through the wall of the vein and into the myocardium, drug delivery can be initiated. The occluding mechanism is placed over the ostium (and expanded) to occlude the ostium, and drug delivery is initiated. Drug delivery is accomplished by injection therapeutic agents through a lumen extending from the proximal end of the drug delivery catheter to the penetration element. The occluding mechanism may be removed or contracted, and the penetrating element may be left in place or moved, depending on the desired course of injections. Additionally, the penetrating element may be comprised of, or coated with, therapeutic agents, so that therapeutic agents are delivered upon penetration and/or bio-erosion of the penetrating element, and in this case, fluid injection through the drug delivery catheter will be unnecessary.
- Many drugs and other therapeutic agents may be used in the procedure. For treatment of ischemic heart disease, therapeutic agents such as VEGF-121, VEGF-165, VEDF-145, VEGF-189, aFGF, bFGF (or gene therapy preparations of these agents) may be used, either in freely available formulations or time-release formulations. To treat congestive heart failure, therapeutic agents such as Natrecor® (nesiritide), the recombinant form of B-type natriuretic peptide (BNP). To enhance retention of the therapeutic agents in the needle track and/or within the myocardium, the needle may be left in place for several seconds, and the therapeutic agents slowly injected at a rate of about 0.1 milliliters per minute. The devices and methods described below provide for delivery of therapeutic substances to a depth within the heart muscle via the venous side of the heart. The devices and methods may be combined with percutaneous access catheters in order to provide for right heart delivery of therapeutic agents. The devices and methods may be combined with permanently implantable devices with and without the electrical sensing and stimulation capabilities, and they provide either sustained delivery of therapeutic agents locally over time via a fluid pathway, or they may deliver fluid agents upon demand as a result of an event sensed by a patient are described. The devices and techniques may be used for delivering drug microformulations such as microspheres and liposomes, and drug delivery structures from an acute use catheter.
- Controlled release matrices proposed for use elsewhere in the body include polymeric matrices, hydro gels, fibrin glues, and the like to provide for sustained release of a drug over time to the body. Microsphere structures such as those provided as Alkermes Prolease system are one example of polymeric matrices. Implantation of these controlled release structures creates a high potential to for embolic events, as they can aggregate and migrate from the heart and travel to the brain and other organs. When microspheres are delivered in to the body at sited where they can enter arteries supplying the brain, doses of microspheres in the size range of 10 to 50 um are limited to 50,000 microspheres. Similar doses of 99TC labeled macro aggregated albumin particles are used to assay right to left shunting in pediatric cardiology. These 99TC spheres provide extremely small volumes for drug delivery, but increasing the diameter of the spheres or their number may cause embolisms should they be delivered into the left heart chambers inadvertently. Similar problems exist for gel based controlled release systems. The solution to date has been limitation of the size of molecules and particles in the therapeutic agent, and limitation of the dose or total amount injected at any one time. Intramyocardial access for such controlled release systems through the venous side of the heart eliminates the possibility that embolic events could occur in the arteries of the body. Thus, even if a large portion of the injected microspheres wash out of the delivery site during and after injection due to poor techniques or poor formulation of the microspheres, there would be little chance of embolic events. This approach also makes a great deal of sense if placing an indwelling implant for infusing the left ventricle myocardium through a fluidic pathway with potentially embolic therapeutic agents.
-
FIG. 3 illustrates another method of right heart access for treatment of the apex region of the heart. This may be used to deliver therapeutic agents to the apex of the right ventricle, the apex of the left ventricle, or to the coronary septum. Adrug delivery catheter 22 is shown in use to deliver therapeutic agents to the coronary septum and the apex of the heart, in particular the apical section of the right ventricle. The catheterdistal tip 24 of thedrug delivery catheter 22 is shown in the proximity of the apex 36 of the heart, and the penetrating element has penetrated the myocardium from the inside of theright ventricular chamber 37. The drug delivery catheter has been navigated through the patient's venous system, into the superior vena cava (approach may also be made through the inferior vena cava), through the right atrium and finally into the right ventricle. With thedelivery catheter 22 in place, anostium occlusion catheter 38 is also inserted percutaneously and navigated through the venous system so that thedistal tip 39 of the occlusion catheter is passed through the coronary ostium, and the occluding mechanism is in occluding relationship with the coronary ostium. The occlusion catheter may be routed through a common guide catheter with the drug delivery catheter (and hence inserted through the same percutaneous access point) or it may be delivered through a separation guide catheter, as shown, which is routed through the inferior vena cava to reach the right atrium. The surgeon operates the occluding mechanism to cause it to expand and occlude coronary ostium. (With the ostium occluded, venous flow within the entire heart in impeded.) With the ostium occluded, the surgeon injects a therapeutic agent through the drug delivery catheter into the myocardium. Therapeutic agents may be injected slowly and over an intra-operative time frame of several minutes to several hours. - The approach illustrated in
FIG. 3 can be used for injections elsewhere in the heart, either through endocardial approaches, open epicardial approaches, or minimally invasive epicardial approaches. The ostium occlusion can also be used in conjunction with injections of therapeutic agents through the coronary arteries. For example, the drug delivery catheter may be delivered percutaneously into the left ventricle chamber 40. When intramyocardial delivery to the ventricles is performed by either an endocardial intra-ventricular approach or other routes, much of the washout is identified in the venous outflow of the heart. Obstructing this venous outflow forces agents to be retained for greater periods of time within the heart. Particularly for heparin binding agents such as bFGF and VEGF-165 which bind to heparin sulfate proteoglycans, an increased residence time in the tissue should increases their retention in the tissue over even longer times. Obstructing their egress from the injection site by occluding the coronary sinus for the first one to five minutes after injection will increase their residence time for binding, and increase their longer-term retention well after the obstruction is removed. This may be combined with any approach for cardiac delivery, but is preferred for intramyocardial (through coronary sinus, trans-endocardial, or trans-epicardial routes) delivery and intracoronary delivery. - The devices and methods described above also enable treatment of the left ventricle by placing agents in the right ventricular walls. Intramyocardial placement of delivery systems in the right side of the heart may be performed such that the left side of the heart is exposed to the therapeutic agents delivered. Such systems may be implanted into the shared ventricular septum or the right ventricular apex to optimize their effects on the left heart. Appropriate therapies to be delivered to the apex or the septum may include angiogenic agents, anti-restenosis agents, and agents for the treatment of chronic heart failure. These may be provided in a controlled release form without fear of embolic events. This is particularly useful for implantable transient on-demand delivery systems (for acute treatments) which deliver small molecule therapeutics as well as sustained release systems as described above. Implantable systems for on-demand delivery for the ventricular septum may include the matrices or reservoirs of antiarrhythmic agents for the termination of ventricular tachyarrhythmias.
- While the preferred embodiments of the devices and methods have been described in reference to the environment in which they were developed, they are merely illustrative of the principles of the inventions. Other embodiments and configurations may be devised without departing from the spirit of the inventions and the scope of the appended claims.
Claims (16)
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US13/785,886 US20130184656A1 (en) | 2000-04-05 | 2013-03-05 | Method of Treating the Heart |
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US09/543,388 US6585716B2 (en) | 2000-04-05 | 2000-04-05 | Method of treating the heart |
US10/610,012 US8388581B2 (en) | 2000-04-05 | 2003-06-30 | System for treating the heart with potentially embolic agents through a right heart approach |
US13/785,886 US20130184656A1 (en) | 2000-04-05 | 2013-03-05 | Method of Treating the Heart |
Related Parent Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US10/610,012 Continuation US8388581B2 (en) | 2000-04-05 | 2003-06-30 | System for treating the heart with potentially embolic agents through a right heart approach |
Publications (1)
Publication Number | Publication Date |
---|---|
US20130184656A1 true US20130184656A1 (en) | 2013-07-18 |
Family
ID=24167807
Family Applications (3)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US09/543,388 Expired - Lifetime US6585716B2 (en) | 2000-04-05 | 2000-04-05 | Method of treating the heart |
US10/610,012 Expired - Lifetime US8388581B2 (en) | 2000-04-05 | 2003-06-30 | System for treating the heart with potentially embolic agents through a right heart approach |
US13/785,886 Abandoned US20130184656A1 (en) | 2000-04-05 | 2013-03-05 | Method of Treating the Heart |
Family Applications Before (2)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US09/543,388 Expired - Lifetime US6585716B2 (en) | 2000-04-05 | 2000-04-05 | Method of treating the heart |
US10/610,012 Expired - Lifetime US8388581B2 (en) | 2000-04-05 | 2003-06-30 | System for treating the heart with potentially embolic agents through a right heart approach |
Country Status (3)
Country | Link |
---|---|
US (3) | US6585716B2 (en) |
AU (1) | AU2001249881A1 (en) |
WO (1) | WO2001076679A1 (en) |
Families Citing this family (65)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US6585716B2 (en) * | 2000-04-05 | 2003-07-01 | Biocardia, Inc. | Method of treating the heart |
WO2004043303A2 (en) * | 2002-11-12 | 2004-05-27 | Regenex Ltd. | Expandable devices and methods for tissue expansion, regenerationand fixation |
US6656221B2 (en) * | 2001-02-05 | 2003-12-02 | Viacor, Inc. | Method and apparatus for improving mitral valve function |
AU2002243851A1 (en) * | 2001-02-05 | 2002-08-19 | Viacor, Inc. | Apparatus and method for reducing mitral regurgitation |
CA2437820C (en) * | 2001-02-09 | 2008-09-23 | Endoluminal Therapeutics, Inc. | Endomural therapy |
CA2441370C (en) * | 2001-03-05 | 2011-05-24 | Viacor, Incorporated | Apparatus and method for reducing mitral regurgitation |
US6890353B2 (en) * | 2001-03-23 | 2005-05-10 | Viacor, Inc. | Method and apparatus for reducing mitral regurgitation |
US7186264B2 (en) * | 2001-03-29 | 2007-03-06 | Viacor, Inc. | Method and apparatus for improving mitral valve function |
US20030078654A1 (en) * | 2001-08-14 | 2003-04-24 | Taylor Daniel C. | Method and apparatus for improving mitral valve function |
US6702835B2 (en) | 2001-09-07 | 2004-03-09 | Core Medical, Inc. | Needle apparatus for closing septal defects and methods for using such apparatus |
US20060052821A1 (en) | 2001-09-06 | 2006-03-09 | Ovalis, Inc. | Systems and methods for treating septal defects |
US6776784B2 (en) | 2001-09-06 | 2004-08-17 | Core Medical, Inc. | Clip apparatus for closing septal defects and methods of use |
US7052487B2 (en) * | 2001-10-26 | 2006-05-30 | Cohn William E | Method and apparatus for reducing mitral regurgitation |
US7125420B2 (en) * | 2002-02-05 | 2006-10-24 | Viacor, Inc. | Method and apparatus for improving mitral valve function |
US7400931B2 (en) * | 2002-09-18 | 2008-07-15 | Cardiac Pacemakers, Inc. | Devices and methods to stimulate therapeutic angiogenesis for ischemia and heart failure |
US20060136053A1 (en) * | 2003-05-27 | 2006-06-22 | Rourke Jonathan M | Method and apparatus for improving mitral valve function |
WO2005009286A2 (en) * | 2003-07-23 | 2005-02-03 | Viacor, Inc. | Method and apparatus for improving mitral valve function |
ITRM20030376A1 (en) | 2003-07-31 | 2005-02-01 | Univ Roma | PROCEDURE FOR THE ISOLATION AND EXPANSION OF CARDIOC STAMIN CELLS FROM BIOPSIA. |
US20050101968A1 (en) * | 2003-11-12 | 2005-05-12 | Dadourian Daniel G. | Ostial locator device and methods for transluminal interventions |
US7245973B2 (en) * | 2003-12-23 | 2007-07-17 | Cardiac Pacemakers, Inc. | His bundle mapping, pacing, and injection lead |
US20070038283A1 (en) * | 2004-02-06 | 2007-02-15 | Mustapha Jihad A | Ostial stent and balloon |
US7722596B2 (en) * | 2004-02-26 | 2010-05-25 | Osprey Medical, Inc. | Regional cardiac tissue treatment |
US20070203445A1 (en) * | 2004-02-26 | 2007-08-30 | V-Kardia Pty Ltd | Isolating cardiac circulation |
US11660317B2 (en) | 2004-11-08 | 2023-05-30 | The Johns Hopkins University | Compositions comprising cardiosphere-derived cells for use in cell therapy |
US8326423B2 (en) * | 2004-12-20 | 2012-12-04 | Cardiac Pacemakers, Inc. | Devices and methods for steering electrical stimulation in cardiac rhythm management |
US8423139B2 (en) | 2004-12-20 | 2013-04-16 | Cardiac Pacemakers, Inc. | Methods, devices and systems for cardiac rhythm management using an electrode arrangement |
US8010192B2 (en) | 2004-12-20 | 2011-08-30 | Cardiac Pacemakers, Inc. | Endocardial pacing relating to conduction abnormalities |
AR047851A1 (en) | 2004-12-20 | 2006-03-01 | Giniger Alberto German | A NEW MARCAPASOS THAT RESTORES OR PRESERVES THE PHYSIOLOGICAL ELECTRIC DRIVING OF THE HEART AND A METHOD OF APPLICATION |
US8010191B2 (en) | 2004-12-20 | 2011-08-30 | Cardiac Pacemakers, Inc. | Systems, devices and methods for monitoring efficiency of pacing |
US8005544B2 (en) | 2004-12-20 | 2011-08-23 | Cardiac Pacemakers, Inc. | Endocardial pacing devices and methods useful for resynchronization and defibrillation |
US8290586B2 (en) * | 2004-12-20 | 2012-10-16 | Cardiac Pacemakers, Inc. | Methods, devices and systems for single-chamber pacing using a dual-chamber pacing device |
US7226440B2 (en) * | 2005-01-31 | 2007-06-05 | G & L Consulting, Llc | Method and device for accessing a pericardial space |
US20070021819A1 (en) * | 2005-05-23 | 2007-01-25 | Jeff Krolik | Apparatus and Methods for Locating an Ostium of a Vessel |
US8579936B2 (en) | 2005-07-05 | 2013-11-12 | ProMed, Inc. | Centering of delivery devices with respect to a septal defect |
US7846179B2 (en) | 2005-09-01 | 2010-12-07 | Ovalis, Inc. | Suture-based systems and methods for treating septal defects |
WO2007038774A2 (en) * | 2005-09-30 | 2007-04-05 | Incept, Llc | Apparatus for locating an ostium of a vessel |
EP1948043A1 (en) * | 2005-10-13 | 2008-07-30 | Endoluminal Therapeutics, Inc. | Channeled endomural therapy |
US8658210B2 (en) | 2006-04-17 | 2014-02-25 | Advanced Cardiovascular Systems, Inc. | Polyesteramide platform for site specific drug delivery |
US20080125746A1 (en) * | 2006-08-18 | 2008-05-29 | James Edward Shapland | Collection catheter and method |
US8936780B2 (en) * | 2006-08-30 | 2015-01-20 | Advanced Cardiovascular Systems, Inc. | Stimuli responsive polyester amide particles |
US20080108950A1 (en) * | 2006-11-03 | 2008-05-08 | Rioux Robert F | Corkscrew helical inserter port |
US8152786B2 (en) * | 2006-11-07 | 2012-04-10 | Osprey Medical, Inc. | Collection catheter and kit |
JP2010523264A (en) * | 2007-04-11 | 2010-07-15 | ヘンリー フォード ヘルス システム | Heart repair, resizing, and reshaping using the venous system of the heart |
US8496926B2 (en) | 2007-04-16 | 2013-07-30 | Biocardia, Inc. | Treatment for chronic myocardial infarction |
US20090259210A1 (en) * | 2008-04-10 | 2009-10-15 | Sabbah Hani N | Method, apparatus and kits for forming structural members within the cardiac venous system |
US8801665B2 (en) * | 2008-04-10 | 2014-08-12 | Henry Ford Health System | Apparatus and method for controlled depth of injection into myocardial tissue |
US8486022B2 (en) * | 2008-07-03 | 2013-07-16 | Abbott Cardiovascular Systems Inc. | Needle catheter with an angled distal tip lumen |
US20100041984A1 (en) * | 2008-08-12 | 2010-02-18 | James Edward Shapland | Impedance sensing device and catheter system |
US9050400B2 (en) * | 2008-08-12 | 2015-06-09 | Osprey Medical, Inc. | Remote sensing catheter system and methods |
US8688234B2 (en) | 2008-12-19 | 2014-04-01 | Cardiac Pacemakers, Inc. | Devices, methods, and systems including cardiac pacing |
US9295816B2 (en) * | 2009-12-09 | 2016-03-29 | Osprey Medical, Inc. | Catheter with distal and proximal ports |
WO2011139691A1 (en) | 2010-04-27 | 2011-11-10 | Cardiac Pacemakers, Inc. | His-bundle capture verification and monitoring |
US9249392B2 (en) | 2010-04-30 | 2016-02-02 | Cedars-Sinai Medical Center | Methods and compositions for maintaining genomic stability in cultured stem cells |
US9845457B2 (en) | 2010-04-30 | 2017-12-19 | Cedars-Sinai Medical Center | Maintenance of genomic stability in cultured stem cells |
WO2011140535A1 (en) | 2010-05-07 | 2011-11-10 | Entellus Medical, Inc. | Sinus balloon dilation catheters and sinus surgury tools |
WO2012125273A2 (en) | 2011-03-14 | 2012-09-20 | Cardiac Pacemakers, Inc. | His capture verification using electro-mechanical delay |
EP2741804B1 (en) | 2011-08-11 | 2017-04-26 | Osprey Medical Inc. | Systems and methods for limb treatment |
WO2013184527A1 (en) | 2012-06-05 | 2013-12-12 | Capricor, Inc. | Optimized methods for generation of cardiac stem cells from cardiac tissue and their use in cardiac therapy |
JP6433896B2 (en) | 2012-08-13 | 2018-12-05 | シーダーズ−サイナイ・メディカル・センターCedars−Sinai Medical Center | Exosomes and microribonucleic acids for tissue regeneration |
JP6878274B2 (en) | 2014-10-03 | 2021-05-26 | シーダーズ−サイナイ・メディカル・センターCedars−Sinai Medical Center | Myocardial cell-derived cells and exosomes secreted by such cells in the treatment of muscular dystrophy |
US11253551B2 (en) | 2016-01-11 | 2022-02-22 | Cedars-Sinai Medical Center | Cardiosphere-derived cells and exosomes secreted by such cells in the treatment of heart failure with preserved ejection fraction |
US11351200B2 (en) | 2016-06-03 | 2022-06-07 | Cedars-Sinai Medical Center | CDC-derived exosomes for treatment of ventricular tachyarrythmias |
EP3515459A4 (en) | 2016-09-20 | 2020-08-05 | Cedars-Sinai Medical Center | Cardiosphere-derived cells and their extracellular vesicles to retard or reverse aging and age-related disorders |
WO2018195210A1 (en) | 2017-04-19 | 2018-10-25 | Cedars-Sinai Medical Center | Methods and compositions for treating skeletal muscular dystrophy |
US11660355B2 (en) | 2017-12-20 | 2023-05-30 | Cedars-Sinai Medical Center | Engineered extracellular vesicles for enhanced tissue delivery |
Citations (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US8388581B2 (en) * | 2000-04-05 | 2013-03-05 | Biocardia, Inc. | System for treating the heart with potentially embolic agents through a right heart approach |
Family Cites Families (39)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US3995623A (en) | 1974-12-23 | 1976-12-07 | American Hospital Supply Corporation | Multipurpose flow-directed catheter |
US4900303A (en) | 1978-03-10 | 1990-02-13 | Lemelson Jerome H | Dispensing catheter and method |
US4689041A (en) | 1984-01-20 | 1987-08-25 | Eliot Corday | Retrograde delivery of pharmacologic and diagnostic agents via venous circulation |
US5558644A (en) | 1991-07-16 | 1996-09-24 | Heartport, Inc. | Retrograde delivery catheter and method for inducing cardioplegic arrest |
US5244460A (en) | 1991-11-27 | 1993-09-14 | The United States Of America As Represented By The Department Of Health And Human Services | Method to foster myocardial blood vessel growth and improve blood flow to the heart |
US5699796A (en) | 1993-01-29 | 1997-12-23 | Cardima, Inc. | High resolution intravascular signal detection |
US5962316A (en) * | 1992-10-16 | 1999-10-05 | Cold Spring Harbor Laboratory | Cell-cycle regulatory proteins, and uses related thereto |
DE4235506A1 (en) | 1992-10-21 | 1994-04-28 | Bavaria Med Tech | Drug injection catheter |
US6001085A (en) | 1993-08-13 | 1999-12-14 | Daig Corporation | Coronary sinus catheter |
US5807395A (en) | 1993-08-27 | 1998-09-15 | Medtronic, Inc. | Method and apparatus for RF ablation and hyperthermia |
US5464395A (en) | 1994-04-05 | 1995-11-07 | Faxon; David P. | Catheter for delivering therapeutic and/or diagnostic agents to the tissue surrounding a bodily passageway |
US6152141A (en) * | 1994-07-28 | 2000-11-28 | Heartport, Inc. | Method for delivery of therapeutic agents to the heart |
FR2729152A1 (en) * | 1995-01-06 | 1996-07-12 | Alcatel Cable | UV CROSSLINKING DEVICE |
US5551427A (en) | 1995-02-13 | 1996-09-03 | Altman; Peter A. | Implantable device for the effective elimination of cardiac arrhythmogenic sites |
US5681347A (en) | 1995-05-23 | 1997-10-28 | Boston Scientific Corporation | Vena cava filter delivery system |
CA2223990C (en) | 1995-06-07 | 2007-01-30 | Cardima, Inc. | Guiding catheter for coronary sinus |
US5840059A (en) | 1995-06-07 | 1998-11-24 | Cardiogenesis Corporation | Therapeutic and diagnostic agent delivery |
US6283983B1 (en) * | 1995-10-13 | 2001-09-04 | Transvascular, Inc. | Percutaneous in-situ coronary bypass method and apparatus |
US6190353B1 (en) * | 1995-10-13 | 2001-02-20 | Transvascular, Inc. | Methods and apparatus for bypassing arterial obstructions and/or performing other transvascular procedures |
US6283951B1 (en) * | 1996-10-11 | 2001-09-04 | Transvascular, Inc. | Systems and methods for delivering drugs to selected locations within the body |
IL124037A (en) * | 1995-10-13 | 2003-01-12 | Transvascular Inc | Device and system for interstitial transvascular intervention |
US5766152A (en) | 1996-08-15 | 1998-06-16 | Cardima, Inc. | Intraluminal delivery of tissue lysing medium |
US5655548A (en) * | 1996-09-16 | 1997-08-12 | Circulation, Inc. | Method for treatment of ischemic heart disease by providing transvenous myocardial perfusion |
US6186972B1 (en) * | 1996-09-16 | 2001-02-13 | James A. Nelson | Methods and apparatus for treating ischemic heart disease by providing transvenous myocardial perfusion |
US6447539B1 (en) * | 1996-09-16 | 2002-09-10 | Transvascular, Inc. | Method and apparatus for treating ischemic heart disease by providing transvenous myocardial perfusion |
US5935160A (en) | 1997-01-24 | 1999-08-10 | Cardiac Pacemakers, Inc. | Left ventricular access lead for heart failure pacing |
US6086582A (en) | 1997-03-13 | 2000-07-11 | Altman; Peter A. | Cardiac drug delivery system |
CA2241615A1 (en) | 1997-06-26 | 1998-12-26 | An-Go-Gen Inc. | Catheters |
US6071292A (en) * | 1997-06-28 | 2000-06-06 | Transvascular, Inc. | Transluminal methods and devices for closing, forming attachments to, and/or forming anastomotic junctions in, luminal anatomical structures |
US5895404A (en) | 1997-09-29 | 1999-04-20 | Ruiz; Carlos E. | Apparatus and methods for percutaneously forming a passageway between adjacent vessels or portions of a vessel |
US6159196A (en) * | 1998-03-09 | 2000-12-12 | Ruiz; Carlos | Methods and apparatus for transvascular muscular revascularization and drug delivery |
US6102887A (en) | 1998-08-11 | 2000-08-15 | Biocardia, Inc. | Catheter drug delivery system and method for use |
US20030078212A1 (en) * | 1998-10-30 | 2003-04-24 | Jia-He Li | Pharmaceutical compositions containing poly(adp-ribose) glycohydrolase inhibitors and methods of using the same |
US6193763B1 (en) * | 1998-12-17 | 2001-02-27 | Robert A. Mackin | Apparatus and method for contemporaneous treatment and fluoroscopic mapping of body tissue |
US6217554B1 (en) * | 1999-02-12 | 2001-04-17 | Pharmaspec Corporation | Methods and apparatus for delivering substances into extravascular tissue |
US5971968A (en) | 1999-04-08 | 1999-10-26 | Irvine Biomedical, Inc. | Catheter probe having contrast media delivery means |
US20030007954A1 (en) * | 1999-04-12 | 2003-01-09 | Gail K. Naughton | Methods for using a three-dimensional stromal tissue to promote angiogenesis |
US6977080B1 (en) * | 1999-08-10 | 2005-12-20 | Allergan, Inc. | Intrapericardial botulinum toxin treatment for bradycardia |
US6346098B1 (en) * | 2000-03-07 | 2002-02-12 | The Board Of Trustees Of The Leland Stanford Junior University | Methods and kits for locally administering an active agent to an interstitial space of a host |
-
2000
- 2000-04-05 US US09/543,388 patent/US6585716B2/en not_active Expired - Lifetime
-
2001
- 2001-04-05 AU AU2001249881A patent/AU2001249881A1/en not_active Abandoned
- 2001-04-05 WO PCT/US2001/011074 patent/WO2001076679A1/en active Application Filing
-
2003
- 2003-06-30 US US10/610,012 patent/US8388581B2/en not_active Expired - Lifetime
-
2013
- 2013-03-05 US US13/785,886 patent/US20130184656A1/en not_active Abandoned
Patent Citations (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US8388581B2 (en) * | 2000-04-05 | 2013-03-05 | Biocardia, Inc. | System for treating the heart with potentially embolic agents through a right heart approach |
Also Published As
Publication number | Publication date |
---|---|
AU2001249881A1 (en) | 2001-10-23 |
WO2001076679A1 (en) | 2001-10-18 |
US6585716B2 (en) | 2003-07-01 |
US20030032938A1 (en) | 2003-02-13 |
US20040030286A1 (en) | 2004-02-12 |
US8388581B2 (en) | 2013-03-05 |
Similar Documents
Publication | Publication Date | Title |
---|---|---|
US8388581B2 (en) | System for treating the heart with potentially embolic agents through a right heart approach | |
US6152141A (en) | Method for delivery of therapeutic agents to the heart | |
US7736346B2 (en) | Bio-interventional therapeutic treatments for cardiovascular diseases | |
US8262612B1 (en) | Apparatus to prevent reperfusion injury | |
US7547301B2 (en) | Device and method to slow or stop the heart temporarily | |
JP4653918B2 (en) | Drug delivery catheter attached to tissue and method of use thereof | |
US6689121B1 (en) | Systems and methods for treating ischemia | |
JP4224608B2 (en) | Infusion therapy equipment | |
JP2004149533A (en) | Homing of donor cell to specified target zone in tissue by active therapeutic agent or substance | |
JP2004149532A (en) | Homing of autologous cell to specified target zone in tissue by active therapeutic method or substance | |
WO1996039830A1 (en) | Pericardial therapeutic and diagnostic agent delivery | |
JP2004149534A (en) | Homing of embryonic stem cell to specified target zone in tissue by active therapeutic agent or substance | |
US20190298983A1 (en) | Injection Port for Therapeutic Delivery | |
JP2003521275A (en) | High efficiency local drug delivery | |
WO1999049926A2 (en) | Delivery of an angiogenic substance | |
US20030216678A1 (en) | Methods for inducing vascular remodeling and related methods for treating diseased vascular structures | |
EP1188417A2 (en) | Method and apparatus for delivery of therapeutic agents to the heart | |
US8172783B1 (en) | Conduit system for isolation of fluids in biological tissues | |
US11400263B1 (en) | System and method for selective pressure-controlled therapeutic delivery | |
US20080175916A1 (en) | Vessel enlargement by arteriogenic factor delivery |
Legal Events
Date | Code | Title | Description |
---|---|---|---|
AS | Assignment |
Owner name: BIOCARDIA DEVICECO, INC., CALIFORNIA Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:BIOCARDIA, INC.;REEL/FRAME:030578/0857 Effective date: 20020302 Owner name: BIOCARDIA, INC., CALIFORNIA Free format text: CHANGE OF NAME;ASSIGNOR:BIOCARDIA DEVICECO, INC.;REEL/FRAME:030586/0202 Effective date: 20020809 Owner name: BIOCARDIA, INC., CALIFORNIA Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:ALTMAN, PETER A.;REEL/FRAME:030578/0797 Effective date: 20020706 |
|
AS | Assignment |
Owner name: BIOCARDIA, INC., CALIFORNIA Free format text: CORRECTIVE ASSIGNMENT TO CORRECT THE ASSIGNOR'S SIGNATURE DATE PREVIOUSLY RECORDED ON REEL 030578 FRAME 0797. ASSIGNOR(S) HEREBY CONFIRMS THE ASSIGNMENT;ASSIGNOR:ALTMAN, PETER A.;REEL/FRAME:030629/0463 Effective date: 20000706 |
|
STCB | Information on status: application discontinuation |
Free format text: ABANDONED -- FAILURE TO RESPOND TO AN OFFICE ACTION |