US20170340346A1 - Expandable lead jacket - Google Patents

Expandable lead jacket Download PDF

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US20170340346A1
US20170340346A1 US15621728 US201715621728A US2017340346A1 US 20170340346 A1 US20170340346 A1 US 20170340346A1 US 15621728 US15621728 US 15621728 US 201715621728 A US201715621728 A US 201715621728A US 2017340346 A1 US2017340346 A1 US 2017340346A1
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lead
tissue
expandable member
method
jacket
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US15621728
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Brandon Thomas HENDRICK
Michael Craig Anderson
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Spectranetics Corp
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Spectranetics Corp
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    • A61B17/32075Pullback cutting; combined forward and pullback cutting, e.g. with cutters at both sides of the plaque
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    • A61B17/320725Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions with radially expandable cutting or abrading elements
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    • A61B17/3211Surgical scalpels, knives; Accessories therefor
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    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/20Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
    • A61B18/22Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor
    • A61B18/24Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor with a catheter
    • A61B18/245Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor with a catheter for removing obstructions in blood vessels or calculi
    • AHUMAN NECESSITIES
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    • GPHYSICS
    • G10MUSICAL INSTRUMENTS; ACOUSTICS
    • G10LSPEECH ANALYSIS OR SYNTHESIS; SPEECH RECOGNITION; SPEECH OR VOICE PROCESSING; SPEECH OR AUDIO CODING OR DECODING
    • G10L21/00Processing of the speech or voice signal to produce another audible or non-audible signal, e.g. visual or tactile, in order to modify its quality or its intelligibility
    • HELECTRICITY
    • H04ELECTRIC COMMUNICATION TECHNIQUE
    • H04LTRANSMISSION OF DIGITAL INFORMATION, e.g. TELEGRAPHIC COMMUNICATION
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    • A61N2001/0578Anchoring means; Means for fixing the head inside the heart having means for removal or extraction
    • FMECHANICAL ENGINEERING; LIGHTING; HEATING; WEAPONS; BLASTING
    • F04POSITIVE DISPLACEMENT MACHINES FOR LIQUIDS; PUMPS FOR LIQUIDS OR ELASTIC FLUIDS
    • F04CROTARY-PISTON, OR OSCILLATING-PISTON, POSITIVE-DISPLACEMENT MACHINES FOR LIQUIDS; ROTARY-PISTON, OR OSCILLATING-PISTON, POSITIVE-DISPLACEMENT PUMPS
    • F04C2270/00Control; Monitoring or safety arrangements
    • F04C2270/04Force
    • F04C2270/041Controlled or regulated

Abstract

Methods, devices and systems for separating an implanted object, such as a lead attached to a cardiac conduction device, from formed tissue within a blood vessel are provided. The methods, devices and systems for separating a lead from the tissue relate to dilating the tissue surrounding the lead from underneath the tissue and/or between the lead and the tissue.

Description

    CROSS REFERENCE TO RELATED APPLICATIONS
  • The present application is a divisional of U.S. application Ser. No. 13/828,536, filed Mar. 14, 2013, entitled “EXPANDABLE LEAD JACKET,” which claims the benefit of and priority, under 35 U.S.C. §119(e), to U.S. Provisional Application Ser. No. 61/701,521, filed Sep. 14, 2012, entitled “TISSUE SEPARATING METHODS AND SYSTEMS,” which is hereby incorporated herein by reference in its entirety for all that it teaches and for all purposes.
  • This application is also related to U.S. patent application Ser. No. 13/828,231, filed on Mar. 14, 2013, entitled, “Tissue Slitting Methods and Systems”; Ser. No. 13/828,310, filed on Mar. 14, 2013, entitled, “Tissue Slitting Methods and Systems”; Ser. No. 13/828,383, filed on Mar. 14, 2013, entitled, “Tissue Slitting Methods and Systems”; Ser. No. 13/828,441, filed on Mar. 14, 2013, entitled, “Tissue Slitting Methods and Systems”; and Ser. No. 13/828,638, filed on Mar. 14, 2013, entitled, “Lead Removal Sleeve”. The entire disclosures of the applications listed above are hereby incorporated herein by reference, in their entirety, for all that they teach and for all purposes.
  • FIELD OF THE DISCLOSURE
  • The present disclosure relates generally to devices, methods and systems for removing implanted objects, such as leads, from tissue within a blood vessel of a patient.
  • BACKGROUND
  • Although there may be more, there are generally at least two primary types of cardiac conduction devices (CCDs). Those two primary types of CCDs are mechanical pacemakers and implantable cardioverter defibrillators. A mechanical pacemaker is an electronic device that produces small bursts of electrical energy to the heart, when needed, to increase the heart beat during period(s) when the heart's natural electrical activity is slower than desirable. Alternatively, implantable cardioverter-defibrillators stop dangerously rapid heart rhythms by delivering a large electric shock to the heart to prevent cardiac arrest.
  • The mechanical pacemaker typically includes a power source and circuitry configured to send timed electrical pulses to the lead. The lead carries the electrical pulse to the heart to initiate a heartbeat, and transmits information about the heart's electrical activity to the pacemaker. The lead can include a fixation mechanism that holds the lead to the cardiac tissue. In some cases, a lead is inserted through a vein or artery (collectively vasculature) and guided to the heart where it is attached. In other instances, a lead is attached to the outside of the heart.
  • Implantable cardioverter-defibrillators typically include particular types of coils that provide the electric shock. The leads are generally placed within the region of the brachiocephalic vein—superior vena cava junction and in the right ventricle positioned so that the shock coils are located in the region of the brachiocephalic vein—superior vena cava junction and in the right ventricle. An implantable cardioverter-defibrillator is capable of sensing the heart's rhythm, and in the event it senses a particular type of rhythm, such as tachyarrhythmia, the implantable cardioverter-defibrillators sends a relatively large shock to the heart.
  • For the mechanical pacemakers and CCDs to work effectively, the leads are preferably in contact with heart tissue. For example, a lead for a CCD typically passes through a vein under the collarbone to the innominate vein, past the superior vena cava (“SVC”), and into the right atrium of the heart. The distal portion of the lead then enters the right ventricle and attaches to the heart via a fixation mechanism, such as a small screw and/or hooks at the end. In certain instances, a lead may be attached to the outside of the heart.
  • Within a relatively short time after a lead is implanted into the body, the body's natural healing process may cause tissue to form around the lead, thereby encasing it. Although leads are designed to be implanted permanently in the body, occasionally these leads must be removed, or extracted. Leads may be removed from patients for numerous reasons, including but not limited to, infections, lead age, and lead malfunction. Accordingly, removal or extraction of the lead may present associated complications.
  • A variety of tools have been developed to make lead extraction safer and more successful. Current lead extraction techniques include mechanical traction, mechanical cutting devices, and laser devices. Mechanical traction may be accomplished by inserting a locking stylet into the hollow portion of the lead and then pulling the lead to remove it. The mechanical cutting devices and laser devices generally include a coring technique, which includes cutting or ablating the tissue from and/or around the lead.
  • Further complicating lead removal is the fact that in some cases, the leads may be located in, and/or attached to, the body of a patient in a structurally-weak portion of the vasculature. For instance, typical leads in a human may pass through the innominate vein, past the SVC, and into the right atrium of the heart. A majority of tissue growth can occur along the SVC and other locations along the innominate vein where the leads make contact with the vein walls. However, tissue growth can also occur at locations within a patient where the leads make contact with arterials or other areas of the vasculature. Certain veins and arteries, and certain areas of vein and arterial walls, can be thin which can make lead removal a complicated and delicate process.
  • SUMMARY
  • Traditional approaches for removing tissue from implanted leads are based on the presumption that tissue growths adhere directly to the surfaces of the implanted leads. As such, methods, devices and systems have been designed to dislocate the connection between the tissue attached to the implanted device and the body of a patient. Although some tissue may remain on the lead, current methods focus on removing most of the tissue surrounding a circumference of the lead. In other words, while tissue may remain attached around the lead, current approaches and techniques essentially core around this tissue surrounding the circumference of a lead to free the lead along with a section of the cored tissue to create slack for removing the lead from a patient.
  • Surprisingly and unexpectedly, it has been discovered that tissue growth may not adhere directly to the implanted lead but actually form a substantially cylindrical “tube” around the implanted substantially cylindrical lead at a given contact area. Contrary to conventional wisdom, the tissue growth typically does not physically adhere to the lead. For example, this tissue growth, once formed completely around a lead, forms a tubular-shaped member that essentially holds the lead and resists lead removal. The tubular-shaped section of formed tissue around an implanted device may impart a combination of restrictive forces that prevent the removal of the device from a patient. For example, the tubular-shaped section of formed tissue, or tissue growth, may constrict, capture, and/or surround implanted leads. In some cases, the tissue growth may constrict a lead, especially if a force is applied to one end of the lead during a removal operation. In other cases, the tissue growth may capture the lead and prevent removal, by, among other things, being attached to the patient and the lead simultaneously. Additionally or alternatively, the tissue growth, during attempted lead removal, may at least partially adhere to the lead in one or more sections while completely forming around the lead.
  • Based upon the surprising and unexpected discovery that tissue growth may not be directly adhered to the implanted lead, alternative devices and methods may be used to extract an object from such tissue. In other words, methods and devices are disclosed herein, that are capable of exploiting the growth nature of the tissue around a lead to efficiently extract the lead from tissue that acts to hold the lead with some type of restrictive force. The tissue growth may form around the lead such that the lead is contained from free movement within a patient. For instance, the tissue growth may impart a restrictive force around the circumference of the lead that can prevent movement of the lead within this constrictive tissue growth. Due to the taught and constrictive nature of the tissue around a portion or the entire lead, the lead may be able to be removed without mechanically removing or laser ablating the tissue region surrounding the lead, either partially (i.e., less than 360 degrees) or totally in 360 degree, or circumferential, fashion.
  • Accordingly, there is a need for a device, method and/or system that has the capability to dilate the tissue surrounding the lead in a manner that the tissue is dilated from within and/or from underneath the tissue. Stated differently, the tissue is dilated by the lead itself, or a portion thereof, rather than with a separate device, thereby creating a separation or void between the lead and the tissue. Such lead may include a means for radially expanding the lead and/or an expandable member attached to and/or incorporated in the lead. The lead may also include a means for contracting the lead, particularly the jacket of the lead.
  • The method may include the step of radially expanding an expandable member attached to at least an exterior portion of a lead and/or within the lead, which is at least partially surrounded by tissue within a blood vessel, such that upon expansion of the expandable member from an unexpanded state and subsequent contraction, the expandable member creates a void between the lead and the tissue, thereby facilitating the removal of the lead from the tissue. The method may also include the step of collapsing the jacket after removal of the wire.
  • The lead for performing such methods may comprise a wire, a jacket surrounding at least a portion of the wire; and an expandable member capable of radially expanding 360 degrees from the longitudinal axis of the jacket. The expandable member may comprise a balloon and/or a bladder located on and/or within the jacket.
  • As mentioned above, the device, method and/or system of the present disclosure dilates the tissue by expanding the lead itself, or a portion thereof. To the extent that existing dilation techniques could be used to dilate, separate and/or push away tissue from implanted objects, such techniques require the use of a separate device. Utilizing a separate device may be difficult, particularly when the lead has a tortuous path or curvature. Additionally traditional dilating techniques using separate device typically require longitudinal forces to extract the tissue from the lead, and the longitudinal forces may require heavy counter forces on the lead, which may result in lead breakage. Accordingly, the device, method and/or system of the present disclosure used to dilate tissue via the lead itself, or a portion thereof, rather than with a separate device is advantageous.
  • The phrases “at least one”, “one or more”, and “and/or” are open-ended expressions that are both conjunctive and disjunctive in operation. For example, each of the expressions “at least one of A, B and C”, “at least one of A, B, or C”, “one or more of A, B, and C”, “one or more of A, B, or C” and “A, B, and/or C” means A alone, B alone, C alone, A and B together, A and C together, B and C together, or A, B and C together. When each one of A, B, and C in the above expressions refers to an element, such as X, Y, and Z, or class of elements, such as X1-Xn, Y1-Ym, and Z1-Zo, the phrase is intended to refer to a single element selected from X, Y, and Z, a combination of elements selected from the same class (e.g., X1 and X2) as well as a combination of elements selected from two or more classes (e.g., Y1 and Zo).
  • The term “a” or “an” entity refers to one or more of that entity. As such, the terms “a” (or “an”), “one or more” and “at least one” can be used interchangeably herein. It is also to be noted that the terms “comprising”, “including”, and “having” can be used interchangeably.
  • A “lead” is a conductive structure, typically an electrically insulated coiled wire. The electrically conductive material can be any conductive material, with metals and intermetallic alloys common. The outer sheath or jacket of insulative material is biocompatible and biostable (e.g., non-dissolving in the body) and generally includes organic materials such as polyurethane and polyimide. Lead types include, by way of non-limiting example, epicardial and endocardial leads. Leads may have different configurations, such as solid or coiled configurations. Leads are commonly implanted into a body percutaneously or surgically.
  • The term “means” as used herein shall be given its broadest possible interpretation in accordance with 35 U.S.C., Section 112, Paragraph 6. Accordingly, a claim incorporating the term “means” shall cover all structures, materials, or acts set forth herein, and all of the equivalents thereof. Further, the structures, materials or acts and the equivalents thereof shall include all those described in the summary of the invention, brief description of the drawings, detailed description, abstract, and claims themselves.
  • A “restrictive force” shall mean a clamping force or a constrictive force or a shear force or a compression force or any other type of force that resists a traction force applied to a lead by tissue.
  • A “surgical implant” is a medical device manufactured to replace a missing biological structure, support, stimulate, or treat a damaged biological structure, or enhance, stimulate, or treat an existing biological structure. Medical implants are man-made devices, in contrast to a transplant, which is a transplanted biomedical tissue. In some cases implants contain electronics, including, without limitation, artificial pacemaker, defibrillator, electrodes, and cochlear implants. Some implants are bioactive, including, without limitation, subcutaneous drug delivery devices in the form of implantable pills or drug-eluting stents.
  • A “traction force” shall mean an external force applied to lead to extract it from a patient's vasculature.
  • It should be understood that every maximum numerical limitation given throughout this disclosure is deemed to include each and every lower numerical limitation as an alternative, as if such lower numerical limitations were expressly written herein. Every minimum numerical limitation given throughout this disclosure is deemed to include each and every higher numerical limitation as an alternative, as if such higher numerical limitations were expressly written herein. Every numerical range given throughout this disclosure is deemed to include each and every narrower numerical range that falls within such broader numerical range, as if such narrower numerical ranges were all expressly written herein.
  • The preceding is a simplified summary of the disclosure to provide an understanding of some aspects of the disclosure. This summary is neither an extensive nor exhaustive overview of the disclosure and its various aspects, embodiments, and configurations. It is intended neither to identify key or critical elements of the disclosure nor to delineate the scope of the disclosure but to present selected concepts of the disclosure in a simplified form as an introduction to the more detailed description presented below. As will be appreciated, other aspects, embodiments, and configurations of the disclosure are possible utilizing, alone or in combination, one or more of the features set forth above or described in detail below.
  • BRIEF DESCRIPTION OF THE DRAWINGS
  • The accompanying drawings are incorporated into and form a part of the specification to illustrate several examples of the present disclosure. These drawings, together with the description, explain the principles of the disclosure. The drawings simply illustrate preferred and alternative examples of how the disclosure can be made and used and are not to be construed as limiting the disclosure to only the illustrated and described examples. Further features and advantages will become apparent from the following, more detailed, description of the various aspects, embodiments, and configurations of the disclosure, as illustrated by the drawings referenced below.
  • FIG. 1 shows an exemplary patient vasculature in section with implanted lead and multiple locations of tissue growth in accordance with some embodiments of the present disclosure;
  • FIG. 2 shows a detail section view of a patient vasculature and implanted lead subjected to a restrictive force and a traction force in a path in accordance with some embodiments of the present disclosure;
  • FIG. 3 shows a section view of a curved area of vasculature with tissue growth formed around an implanted lead;
  • FIG. 4 shows a cross-sectional view of the curved area of vasculature of FIG. 3 taken along line A-A;
  • FIG. 5 is a flow diagram depicting a lead removal method in accordance with embodiments of the present disclosure;
  • FIG. 6A shows a cross-sectional view of a lead surrounded by un-dilated tissue growth within a subject's vasculature, wherein the lead is in an unexpanded state, in accordance with embodiments of the present disclosure;
  • FIG. 6B shows a cross-sectional view of a lead surrounded by dilated tissue growth within a subject's vasculature, wherein the lead is in an expanded state, in accordance with embodiments of the present disclosure;
  • FIG. 6C shows a cross-sectional view of a lead surrounded by dilated tissue growth within a subject's dilated vasculature, wherein the lead is in an unexpanded state in accordance with embodiments of the present disclosure;
  • FIG. 7A is a cross-sectional view of a portion of a unexpanded lead in accordance with an embodiment of the present disclosure;
  • FIG. 7B is a cross-sectional view of a portion of an expanded lead in accordance with an embodiment of the present disclosure;
  • FIG. 8A is a cross-sectional view of a portion of a unexpanded lead in accordance with an alternative embodiment of the present disclosure;
  • FIG. 8B is a cross-sectional view of a portion of an expanded lead in accordance with an alternative embodiment of the present disclosure;
  • FIG. 9 is a flow diagram depicting an alternative lead removal method in accordance with embodiments of the present disclosure;
  • FIG. 10 is a flow diagram depicting an alternative lead removal method in accordance with embodiments of the present disclosure;
  • FIG. 11A shows a cross-sectional view of a lead surrounded by un-dilated tissue growth within a subject's vasculature, wherein the lead is in an normal state, in accordance with embodiments of the present disclosure; and
  • FIG. 11B shows a cross-sectional view of a lead surrounded by dilated tissue growth within a subject's vasculature, wherein the lead is in a collapsed state, in accordance with embodiments of the present disclosure.
  • It should be understood that the drawings are not necessarily to scale. In certain instances, details that are not necessary for an understanding of the disclosure or that render other details difficult to perceive may have been omitted. It should be understood, of course, that the disclosure is not necessarily limited to the particular embodiments illustrated herein.
  • DETAILED DESCRIPTION
  • Before any embodiments of the disclosure are explained in detail, it is to be understood that the disclosure is not limited in its application to the details of construction and the arrangement of components set forth in the following description or illustrated in the following drawings. The disclosure is capable of other embodiments and of being practiced or of being carried out in various ways. Also, it is to be understood that the phraseology and terminology used herein is for the purpose of description and should not be regarded as limiting. The use of “including,” “comprising,” or “having” and variations thereof herein is meant to encompass the items listed thereafter and equivalents thereof as well as additional items.
  • Embodiments of the present disclosure are directed to devices and methods to dilate tissue formed around and encapsulating an implanted lead to assist and improve the ease with which the implanted lead is removed from within the vascular system of a patient. Among other things, the method of removing an implanted lead from formed tissue may include expanding the lead and dilating the tissue that lies along an axial length of the implanted lead. In some embodiments, the lead may include an expandable member that radially expands from the longitudinal axis of the lead (or its components, such as the jacket) and dilates the tissue growth to enable removal of the implanted lead. In other embodiments, the lead may be collapsed along a section of the tissue growth to allow an implanted lead to be removed from a patient.
  • FIG. 1 depicts an exemplary patient 102 with an implanted lead 104 running along the left innominate vein 112 past the superior vena cava and connected into, or about, the right ventricle of the heart 106. Along the length of the lead 104 at least one formed tissue growth 108 is shown where the tissue 108 may completely surround a section of the lead 104. In a typical lead 104 explant procedure, the one or more of the tissue growths 108 may act to contain the lead 104. For example, the tissue 108 may impart one or more restrictive forces on the lead 104 that may act to prevent successful removal of the lead 104 when subjected to a traction force 120 applied in the direction indicated by arrow (→).
  • FIG. 2 shows a detailed view of a heart 106 having an implanted lead 104 subjected to a traction force in a patient's vasculature. In some embodiments, a lead 104 explant procedure may involve removing the lead 104 from a patient 102 via one or more paths. For example, a lead-locking device (not shown), or other type of traction device may be engaged with the lead 104 and then used by a clinician to pull the lead 104 from a patient 102. However, in some cases the lead 104 may be contained by a formed tissue growth 108 that imparts restrictive force(s) which may potentially offset the fraction force 120 applied to the lead 104 and increase the difficulty in removing the lead 104. As can be appreciated, subjecting the lead 104 to excessive traction forces 120 may cause a tear to the vasculature inside the patient 102 where the tissue is attached to the vasculature. In one example, a tissue growth 108 may form along a critical area of the vasculature, such as the superior vena cava curve 116, of a patient. If this critical area is torn during a lead 104 explant procedure, the result may be fatal to the patient 102.
  • Complicating the lead 104 removal process is the fact that the tissue growth 108 surrounding a lead 104 may attach to a vessel in a curved portion of the vasculature. Removal of the lead 104 from such a curved portion of vasculature can present a challenge when introducing tissue removal devices alone or in conjunction with traction devices. In some cases, the tissue removal devices include sharp edges, aggressive tips, or imprecise actuation mechanisms that can puncture the thin walls of a patient 102 vasculature.
  • FIG. 3 shows a section view of a curved area of vasculature with tissue growth 108 formed around an implanted lead 104 in accordance with embodiments of the present disclosure. The tissue growth 108 may completely surround a section of the lead 104 and even be attached to a vessel wall at a tissue connected side 128 of the vasculature. In some cases, the tissue growth 108 may not be adhered to at least one free side 124 of a vessel, such that a vessel opening 126 exists where bodily fluid may pass through the vessel unobstructed. Surprisingly and unexpectedly, it has been discovered that the tissue growth 108 is at least substantially free of and even more completely free of attachment to the lead 104.
  • FIG. 4 shows a cross-sectional view of the curved area of vasculature of FIG. 3 taken along line A-A. In some embodiments, reference may be made to the tissue growth 108 forming a tube 132 (or cylindrical or sock-like structure) around the implanted lead 104. As mentioned above, the tissue growth 108 imparts restrictive forces on the lead 104. It is believed that these restrictive forces may compress upon the lead 104, thereby creating a tube-like structure around the lead 104, rather than the tissue becoming engrained into the lead. FIG. 4 depicts a tube 32 for the purpose of illustrative purposes only. That is, the tube-like configuration 32 attempts to illustrate where the restrictive forces are potentially at least being applied around and to the lead 104. It is an aspect of the present disclosure to provide one or more methods and devices to effectively dilate the tissue 108, particularly the tube 32 portion of the tissue 108, around the lead 104 to create a separation between the lead 104 and the tissue growth 108 along a length of the lead 104 that is encapsulated by the tissue growth 108 (or portion thereof) in order to release the lead 104 from the restrictive forces of the tissue growth 108. In some embodiments, the tissue growth 108 may be dilated by radially expanding the lead 104, such that after dilation, the lead contracts and can be pulled from the dilated tissue 108.
  • FIG. 5 is a flow diagram depicting a method that may be performed by a clinician to remove a lead from tissue surrounding and encapsulating the lead in accordance with embodiments of the present disclosure. The method 500 may include step 504, step 508 and step 512. Step 504 includes radially expanding the lead 504 encapsulated by the tissue growth, thereby dilating the surrounding tissue. It may be preferable that the lead 504 expand in a 360 degree fashion about its longitudinal axis. Step 508 includes contracting the lead after the lead has expanded and dilated the tissue. Step 512 includes removing the lead from the dilated and surrounding tissue.
  • FIGS. 6A, 6B and 6C are cross-sectional views of a lead 604 surrounded by tissue growth 608 within a blood vessel 612 of a subject's vascular system at different states during implementation of the method of FIG. 5. Specifically, FIG. 6A depicts the lead 604 in an unexpanded state and the tissue growth 608 encapsulating the lead 604 in an un-dilated state prior to implementing step 504 of FIG. 5. Upon radially expanding the lead 604, in accordance with step 504 of FIG. 5, the expanded lead 604′ dilates the surrounding tissue growth 608′ as depicted in FIG. 6B, wherein the lead 604′ is shown in an expanded state and the surrounding tissue growth 608′ is shown in a dilated state. FIG. 6C illustrates that after dilating the tissue growth 608′, the lead 604″ contracts to its initial configuration, size and state in accordance with step 508 of FIG. 5. As shown in FIG. 6C, upon contracting the lead 604″ the tissue growth 608′ remains dilated and a separation or void is created between the contracted lead 604″ and the dilated tissue growth 608′. At this point, the clinician may remove the lead 604″ from the dilated tissue growth 608′ by applying a traction force to the lead, such as by pulling on the lead with or without the assistance of a medical device.
  • There are various means to expand a lead, particularly means to radially expand a lead in a 360 degree fashion. Such means may include an expandable member on the surface or outer jacket of the lead, an expandable member within the outer jacket of the lead, and an expandable member between the outer jacket and the inner wire of the lead. The expandable member may be of different sizes, shapes, and configurations. For example, the expandable member may be an inflatable balloon located on the surface of the outer jacket or the expandable member may an expandable bladder located within the outer jacket or between the outer jacket and the inner wire. The expandable member need not be a balloon or bladder that is filled with fluid (e.g., air, liquid, etc.), but can also include a mechanical apparatus such as a smooth covered expandable braided structure. Depending upon the desired expansion of the lead and/or its components, those of skill in the art will understand how to make and use the disclosed aspects, embodiments, and/or configurations after understanding the present disclosure to select the appropriate expandable member. Additionally, once one skilled in the art is informed that it has been discovered that tissue growth may not adhere directly to the implanted lead but actually forms a substantially cylindrical “tube” around the implanted lead at a given contact area, those skilled in the art will understand how to incorporate desirably configured expandable members to leads in order to radially expand the lead or jacket thereof. For example, it may be desirable to merely inflate the outer jacket without the use of a balloon or bladder, such as applying fluid pressure within the main lumen of the lead or jacket. All such expandable members, as well as the various sizes, shapes and configurations within the knowledge of one skilled in the art, are considered within the scope of this disclosure.
  • Referring to FIGS. 7A and 7B, there is depicted an example of an expandable member for a lead. The expandable member in these figures includes an inflatable balloon 712. Accordingly, FIG. 7A illustrates a lead 700 having an inner wire 704, an outer jacket (or sleeve) 708, and an inflatable balloon 712 surrounding the outer jacket 708 in a deflated state. The outer jacket 708 also includes an inflation lumen 716. Although the inflation lumen 716 is illustrated within the outer jacket 708, the inflation lumen 716 may be located on the exterior surface of the outer jacket 706, between the inner wire 704 and the outer jacket 708 or elsewhere.
  • Assuming an inflatable balloon 712 is used as a type of expandable member, a clinician may begin the surgical method or procedure of FIG. 5 for removing the lead from the tissue growth by initially detaching the proximal end of the lead 700 from the cardiac conduction device. Once the lead 700 is detached from the cardiac conduction device, the clinician may attach the distal end of an inflation adapter (not shown) to a mating adapter (not shown) at the proximal end of the inflation lumen 716 within the lead 700. The proximal end of the inflation adapter is coupled to an inflation device (not shown) that is capable of supplying a sufficient quantity and pressure of fluid to inflate the balloon 712 to a desirable shape and size in order to dilate the surrounding tissue growth. An example of the balloon 712′ in an inflated state is depicted in FIG. 7B. After inflating the balloon 712′ and holding in it in the inflated state for a predetermined period of time to sufficiently dilate the surrounding tissue growth, the balloon 712′ is deflated and returns to its initial shape and size depicted in FIG. 7A. At this point, the clinician may pull on the proximal end of the lead 700 and remove it via sliding the lead through the void created between the lead 700 and the tissue growth via the dilation method. The clinician may be able to easily slide the lead 700 from the surrounding tissue growth because the restrictive forces created by the tissue will no longer impart upon the lead and the traction forces are substantially greater than any potentially remaining restrictive forces.
  • Although FIGS. 7A and 7B depict a single inflatable balloon 712 surrounding only a portion of the outer jacket 708, multiple inflatable balloons having similar or different shapes and sizes attached to various and strategically located portions of the outer jacket are considered within the scope of this disclosure. And if so, it may be preferable to have multiple inflation lumens included within the lead. For example, it may be preferable to have a series of inflatable balloons wherein the balloon(s) located proximally on the lead to inflate the balloon(s) to a diameter greater than those balloon(s) located more distally on the lead. Additionally, it may be preferable to have a single inflatable balloon surrounding the entire or substantially entire outer jacket.
  • Referring to FIGS. 8A and 8B, there is depicted an example of an alternative embodiment of an expandable member for a lead. The expandable member in these figures includes an inflatable bladder 812. Accordingly, FIG. 8A illustrates a lead 800 having an inner wire 804, an outer jacket (or sleeve) 808, and an inflatable bladder 812 in a deflated state located between inner wire 804 and outer jacket 808.
  • Assuming an inflatable bladder 812 is used as a type of expandable member, a clinician may begin the surgical method or procedure of FIG. 5 for removing the lead from the tissue growth by initially detaching the proximal end of the lead 800 from the cardiac conduction device. Once the lead 800 is detached from the cardiac conduction device, the clinician may attach the distal end of an inflation adapter (not shown) to and mating adapter (not shown) coupled to the proximal end of inflatable bladder 812. The proximal end of the inflation adapter is coupled to an inflation device (not shown) that is capable of supplying a sufficient quantity and pressure of fluid to inflate the bladder 812 to a desirable shape and size in order to dilate the surrounding tissue growth. An example of the bladder 812′ in an inflated state is depicted in FIG. 8B. After inflating the bladder 812′ and holding in it in the inflated state for a predetermined period of time to sufficiently dilate the surrounding tissue growth, the bladder 812′ is deflated and returns to its initial shape and size depicted in FIG. 8A. At this point, the clinician may pull on the proximal end of the lead 800 and remove it via sliding the lead through the void created between the lead 800 and the tissue growth via the dilation method.
  • The method discussed above with reference to FIG. 5 may begin with the expandable member being substantially in a contracted state (unexpanded state). That is, upon implantation of the lead within the patient's vasculature, the expandable member may not be expanded and remains contracted during usage. It is, however, also within the scope of this disclosure that upon implantation of the lead within the patient's vasculature, the expandable member may be expanded or partially expanded so that it remains in such state during usage. If so, when a clinician desires to remove the lead from the patient's vasculature, the clinician may contract the lead 904, particularly its expandable member, and the lead may be removed from the surrounding tissue 908 as depicted in the method 900 of FIG. 9. Stated differently, upon contraction of the lead and/or its expandable member, a separation (or void) is created between the lead and the surrounding tissue, such that the lead may be removed from the surrounding tissue because the restrictive forces created by the tissue will no longer impart upon the lead.
  • This disclosure also contemplates contracting the lead, the outer jacket of the lead, and/or the expandable member of the lead, to create a separation between the tissue and the contracted lead. For example, FIG. 10 depicts a flow diagram illustrating such an alternative lead removal method. The method of FIG. 10 includes step 1004, step 1008, and step 1012. Step 1004 includes removing the inner wire from the outer jacket of the lead 1004. Step 1008 includes contracting the outer jacket of the lead. Step 1012 includes removing the lead from the surrounding tissue.
  • FIGS. 11A and 11B and 6C are cross-sectional views of a lead 1104 surrounded by tissue growth 1108 within a blood vessel 1112 of a subject's vascular system at different states during implementation of the method of FIG. 10. Specifically, FIG. 6A depicts the lead 1104 in a normal state and the tissue growth 1108 encapsulating the lead 1104 prior to implementing step 1004 of FIG. 10. The inner wire (not shown) of the lead 1104 is then removed from outer jacket (not shown) in accordance with step 1004 of FIG. 10. The outer jacket of the lead is then contracted in accordance with step 1008 of FIG. 10. There are many ways in which one of skill in the art may contract the outer jacket. For example, the proximal end of the hollow jacket may be connected to a vacuum source, and the vacuum source causes the jacket to collapse as depicted in FIG. 11B. Once the outer jacket is a contracted state, particularly a collapsed state, a void 1116 is created between the lead 1104′ and the surrounding tissue 1108. At this point, the lead 1104′ may be removed from the surrounding tissue 1108.
  • In the appended figures, similar components and/or features may have the same reference label. Further, various components of the same type may be distinguished by following the reference label by a letter that distinguishes among the similar components. If only the first reference label is used in the specification, the description is applicable to any one of the similar components having the same first reference label irrespective of the second reference label.
  • Presented herein are embodiments of a tissue separating device, system, and method. As described herein, the device(s) may be electrical, mechanical, electro-mechanical, and/or combinations thereof
  • Also, while the flowcharts have been discussed and illustrated in relation to a particular sequence of events, it should be appreciated that changes, additions, and omissions to this sequence can occur without materially affecting the operation of the disclosed embodiments, configuration, and aspects. Specifically, two or more of the flow charts in FIG. 5 and FIG. 9 and FIG. 10 may be combined and the order of such steps may be re-arranged. For example, combining the methods depicted in FIGS. 5 and 9 would allow the clinician to utilize an expandable member and collapse the lead, particularly the outer sheath, thereby potentially increasing the ease with which the lead may be extracted from the tissue growth.
  • A number of variations and modifications of the disclosure can be used. It would be possible to provide for some features of the disclosure without providing others. By way of illustration, any methodology or modality of cutting tissue may be employed as described herein to effect lead removal from an encased tissue growth.
  • The present disclosure, in various aspects, embodiments, and/or configurations, includes components, methods, processes, systems and/or apparatus substantially as depicted and described herein, including various aspects, embodiments, configurations embodiments, sub-combinations, and/or subsets thereof. Those of skill in the art will understand how to make and use the disclosed aspects, embodiments, and/or configurations after understanding the present disclosure. The present disclosure, in various aspects, embodiments, and/or configurations, includes providing devices and processes in the absence of items not depicted and/or described herein or in various aspects, embodiments, and/or configurations hereof, including in the absence of such items as may have been used in previous devices or processes, e.g., for improving performance, achieving ease and/or reducing cost of implementation.
  • The foregoing discussion has been presented for purposes of illustration and description. The foregoing is not intended to limit the disclosure to the form or forms disclosed herein. In the foregoing Summary for example, various features of the disclosure are grouped together in one or more aspects, embodiments, and/or configurations for the purpose of streamlining the disclosure. The features of the aspects, embodiments, and/or configurations of the disclosure may be combined in alternate aspects, embodiments, and/or configurations other than those discussed above. This method of disclosure is not to be interpreted as reflecting an intention that the claims require more features than are expressly recited in each claim. Rather, as the following claims reflect, inventive aspects lie in less than all features of a single foregoing disclosed aspect, embodiment, and/or configuration. Thus, the following claims are hereby incorporated into this Summary, with each claim standing on its own as a separate preferred embodiment of the disclosure.
  • Moreover, though the description has included description of one or more aspects, embodiments, and/or configurations and certain variations and modifications, other variations, combinations, and modifications are within the scope of the disclosure, e.g., as may be within the skill and knowledge of those in the art, after understanding the present disclosure. It is intended to obtain rights which include alternative aspects, embodiments, and/or configurations to the extent permitted, including alternate, interchangeable and/or equivalent structures, functions, ranges or steps to those claimed, whether or not such alternate, interchangeable and/or equivalent structures, functions, ranges or steps are disclosed herein, and without intending to publicly dedicate any patentable subject matter.

Claims (16)

  1. 1-11. (canceled)
  2. 12. A method of performing a surgical procedure, the method comprising:
    radially expanding an expandable member located within a portion of a lead, wherein the lead is at least partially surrounded by tissue within a blood vessel, wherein the expandable member is initially in an unexpanded state;
    contracting the expandable member and creating a void between the expandable member and the tissue; and
    removing the lead from the tissue.
  3. 13. The method of claim 11, wherein the expandable member is an inflatable bladder.
  4. 14-20. (canceled)
  5. 21. The method of claim 11, wherein the lead comprises:
    a wire; and
    a jacket surrounding at least a portion of the wire;
    wherein the expandable member is located between the wire and the jacket.
  6. 22. The method of claim 21, wherein radially expanding the expandable member comprises radially expanding the jacket 360 degrees from the longitudinal axis.
  7. 23. The method of claim 21, wherein contracting the expandable member and creating the void between the expandable member and the tissue comprises creating the void between the jacket and the tissue.
  8. 24. The method of claim 21, wherein radially expanding the expandable member comprises applying forces radially outwardly to the jacket and radially inwardly to the wire via the expandable member.
  9. 25. The method of claim 11, wherein radially expanding the expandable member comprises delivering a fluid to the expandable member.
  10. 26. The method of claim 13, wherein the lead comprises:
    a wire; and
    a jacket surrounding at least a portion of the wire;
    wherein the inflatable bladder is located between the wire and the jacket.
  11. 27. The method of claim 26, wherein radially expanding the inflatable bladder comprises radially expanding the jacket 360 degrees from the longitudinal axis.
  12. 28. The method of claim 26, wherein contracting the inflatable bladder and creating the void between the inflatable bladder and the tissue comprises creating the void between the jacket and the tissue.
  13. 29. The method of claim 26, wherein radially expanding the inflatable bladder comprises applying forces radially outwardly to the jacket and radially inwardly to the wire via the inflatable bladder.
  14. 30. The method of claim 11, wherein removing the lead from the tissue comprises applying a traction force to the lead.
  15. 31. The method of claim 11, wherein removing the lead from the tissue comprises sliding the lead through the void.
  16. 32. The method of claim 11, wherein the blood vessel is a curved portion of the vasculature.
US15621728 2012-09-14 2017-06-13 Expandable lead jacket Pending US20170340346A1 (en)

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US13828638 Abandoned US20140081289A1 (en) 2012-09-14 2013-03-14 Lead removal sleeve
US13828310 Active 2034-06-22 US9413896B2 (en) 2012-09-14 2013-03-14 Tissue slitting methods and systems
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US14877683 Pending US20160022303A1 (en) 2012-09-14 2015-10-07 Lead removal sleeve
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US13828638 Abandoned US20140081289A1 (en) 2012-09-14 2013-03-14 Lead removal sleeve
US13828310 Active 2034-06-22 US9413896B2 (en) 2012-09-14 2013-03-14 Tissue slitting methods and systems
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Owner name: THE SPECTRANETICS CORPORATION, COLORADO

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Effective date: 20130411