WO1999049926A2 - Apport d'une substance angiogene - Google Patents

Apport d'une substance angiogene Download PDF

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Publication number
WO1999049926A2
WO1999049926A2 PCT/US1999/007081 US9907081W WO9949926A2 WO 1999049926 A2 WO1999049926 A2 WO 1999049926A2 US 9907081 W US9907081 W US 9907081W WO 9949926 A2 WO9949926 A2 WO 9949926A2
Authority
WO
WIPO (PCT)
Prior art keywords
tissue
distal end
heart
distal
substance
Prior art date
Application number
PCT/US1999/007081
Other languages
English (en)
Other versions
WO1999049926A3 (fr
Inventor
Sam G. Payne
Randy J. Kesten
Michael Aita
Stewart Kume
Stephen B. Pearce
Manuel A. Javier, Jr.
Original Assignee
Cardiogenesis Corporation
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Cardiogenesis Corporation filed Critical Cardiogenesis Corporation
Priority to AU33747/99A priority Critical patent/AU3374799A/en
Publication of WO1999049926A2 publication Critical patent/WO1999049926A2/fr
Publication of WO1999049926A3 publication Critical patent/WO1999049926A3/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
    • A61B18/22—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor
    • A61B18/24—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor with a catheter
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00238—Type of minimally invasive operation
    • A61B2017/00243—Type of minimally invasive operation cardiac
    • A61B2017/00247—Making holes in the wall of the heart, e.g. laser Myocardial revascularization
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00681—Aspects not otherwise provided for
    • A61B2017/00694—Aspects not otherwise provided for with means correcting for movement of or for synchronisation with the body
    • A61B2017/00703—Aspects not otherwise provided for with means correcting for movement of or for synchronisation with the body correcting for movement of heart, e.g. ECG-triggered
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22082—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for after introduction of a substance
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00345—Vascular system
    • A61B2018/00351—Heart
    • A61B2018/00392—Transmyocardial revascularisation
    • 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
    • A61M2025/0085—Multiple injection needles protruding axially, i.e. along the longitudinal axis of the catheter, from the distal tip
    • A61M2025/0086—Multiple injection needles protruding axially, i.e. along the longitudinal axis of the catheter, from the distal tip the needles having bent tips, i.e. the needle distal tips are angled in relation to the longitudinal axis of the catheter
    • 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
    • A61M2025/0087—Multiple injection needles protruding laterally 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
    • A61M25/0067—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
    • A61M25/0067—Catheters; Hollow probes characterised by the distal end, e.g. tips
    • A61M25/0082—Catheter tip comprising a tool
    • A61M2025/0096—Catheter tip comprising a tool being laterally outward extensions or tools, e.g. hooks or fibres

Definitions

  • the present invention relates to methods and apparatus for the delivery
  • TMR transmyocardial revascularization
  • Coronary artery disease affects the lives of millions of patients
  • CABG coronary artery by-pass graft surgery
  • PTCA percutaneous transluminal coronary angioplasty
  • pharmacological therapies are of limited value. Ideally, a non-invasive
  • WO 9723256 discloses the percutaneous delivery of an angiogenic factor to a
  • indwelling catheter for localized delivery of a substance into a "tissue conduit"
  • fibroblast growth factor to induce neoangiogeneisis in ischemic myocardium.
  • the FGF-I was administered during a CABG procedure by injection into the
  • FGF-I administration was made by direct injection during surgery which is less
  • At least one fibroblast growth factor has been delivered by using a
  • microparticle carrier that is delivered to an artery via a catheter in a non-
  • TMR transmyocardial revascularization
  • This focal injury is often in the form of a "channel" formed by the laser
  • the amount of tissue ablated to form the channel may also vary. It has been
  • focal injury acts to stimulate subsequent neovasculogenesis.
  • ventricle an area where revascularization is often indicated.
  • the apparatus delivers a substance, such as an
  • angiogenic agent to a desired tissue region.
  • an elongated device has a handpiece for delivering a metered
  • the elongated device may be either
  • a reservoir containing the substance in a deliverable state, such as an
  • the device comprises a metered dispensing
  • apparatus for injecting one or more appropriate doses includes a
  • dispensing control system such as a switch disposed on the handpiece or a
  • the dispensing control system is
  • a signal generated by the heart is provided to a heart
  • the apparatus may be synchronized to the cardiac cycle.
  • the apparatus may be synchronized to the cardiac cycle.
  • the delivery device has a distal end which is
  • needle-like distal end and has at least one orifice in fluid communication with
  • the distal end has one or more radially oriented lumens to direct the substance to be delivered
  • the of the present invention relates to contacting the tissue to be treated with the
  • elongated elements such as bristles or barbs may be
  • the elongated elements are aligned with a longitudinal axis of the
  • the distal end can have an
  • enlarged or bulbous section which may or may not be expandable.
  • a depth stop is the construction of a section of the distal end smaller in
  • the depth stop can be one or more mechanical
  • visualization of the dose is accomplished by the administration
  • multiple lumen catheters or probes are provided with one of the
  • plurality of lumens being used to deliver the substance such as an angiogenic
  • the present invention may also be provided
  • the myocardium to perform a procedure that dissects, disturbs, disrupts or
  • the distal tissue contact device can be a
  • mechanical device affixed to the distal end or it can be a device such as a
  • contact device can be a lumen in a device connected to a source of fluid at a
  • the distal tissue contact device is preferably introduced using a
  • lumen separate from a lumen carrying the therapeutic or diagnostic substance
  • conduit with a least one lumen connected on a proximal end to an injection
  • a controlled amount of a substance to be delivered is dispensed when the
  • solenoid is pulsed by a signal related to the cardiac cycle.
  • the solenoid is pulsed by a signal related to the cardiac cycle.
  • solenoid advances the same amount after each of one or more pulses, so that
  • Another additional aspect of the present invention is the provision of an
  • agent is in a fluidic or thixotropic state to facilitate delivery.
  • the delivery lumen contains at least an angiogenic
  • intraoperative versions of the present invention may differ markedly in
  • each device may have one or more of a number of features addressed below. The discussion of these features of a substance delivery
  • angiogenic agent includes any material or
  • the methods and apparatus of the present invention may
  • vascular physiology such as nitric oxide agents that effect the
  • non-specific protease inhibitors postaglandins, inhibitors of prostaglandin
  • FGF growth factors
  • aFGF acidic growth factor
  • FGF-II basic fibroblast growth factor
  • bFGF vascular endothelial growth factors
  • VEGF vascular endothelial growth factors
  • angiogenin transforming growth factor alpha
  • transforming growth factor beta transforming growth factor beta
  • angiogenic agents useful with the present invention may comprise
  • conditioned serum or conditioned cell culture media such as conditioned serum or conditioned cell culture media.
  • Such diagnostic agents or markers may be delivered before, after or during
  • tissue or tissues e.g., dyes, stains, diagnostic challenge agents and agents
  • radiopaque agents used to enhance contrast during diagnostic or
  • FIG. 1 is a perspective view of one preferred embodiment of an
  • FIG. 2 is a perspective view of one preferred embodiment of a
  • percutaneous system for administering a therapeutic substance.
  • FIG. 3 is a diagrammatic illustration of a control system useful with the
  • FIGS. 1 -2 embodiments of the present invention illustrated in FIGS. 1 -2;
  • FIG. 4 is a partial side elevation view of the distal tip of a device
  • FIG. 5 is a partial side elevation view of the an alternative construction
  • FIG. 6 is a partial side elevation view of the an alternative construction
  • FIG. 7 is a partial side elevation view, partially in cross-section
  • FIG. 6 illustrating the embodiment of FIG. 6 within the lumen of a catheter or guide.
  • FIG. 8 is a partial side elevation view of the an alternative construction
  • FIG. 9 is a partial side elevation view of the an alternative construction
  • FIG. 1 0 is a partial side elevation view of the an alternative
  • FIG. 1 1 is a partial side elevation view of the an alternative
  • FIG. 1 2 is a partial side elevation view, partially in cross-section, of the
  • FIG. 1 3 is a partial side elevation view of an alternative construction of
  • FIGS. 1 4-1 5 are cross-sectional views of alternative multiple lumen
  • FIG. 1 6A is a partial side elevation view of the distal tip of a device
  • FIG. 1 6B depicts the apparatus of FIG. 1 6A after deeper penetration
  • FIG. 1 7 is a partial cross-sectional elevation view of a conduit carrying
  • FIG 1 depicts a basic system for the
  • distal reservoir 10 for the substance to be delivered is in fluid communication
  • 1 6 of the administration device 1 2 includes a specialized distal tip
  • a valve 1 8 is
  • present invention may be stored either proximally or distally.
  • the fluid conduit 14 will comprise a hypodermic tube
  • the conduit 14 may serve as a carrier and reservoir for the
  • the conduit 14 will be formed into a coil to
  • a reservoir can be
  • FIG. 2 illustrates a percutaneous system similar to FIG. 1 which has a
  • the substance reservoir 10 and connecting fluid conduit 14 may not necessarily be present in each
  • invention will be to place the distal tip in contact with, or at least in close
  • the surface of the tissue to be treated such as in the patient's
  • the surface may be the endocardium, epicardium, or the
  • angiogenic agent preferably by injection, after the distal tip has penetrated
  • FIG. 3 In preferred embodiments, the penetration of tissue of the heart 30
  • the substance injection is
  • ADMIN automated and an automatic administration device 34
  • foot switch (not shown), handpiece switch (not shown).
  • the automated system as shown in FIG. 3 has
  • ECG electrocardiograph
  • the ECG 38 in turn is
  • the ECG signal can be coupled to a device controller and can be
  • an injector that is synchronized to
  • the heartbeat is provided by connecting a syringe or similar administration
  • a solenoid plunger (not
  • a DC solenoid can be pulsed with a voltage much higher than
  • a variable delay circuit can be added to adjust the
  • circuits can be devised to carry out the same function.
  • the proximal controller 30 may include one or more switches or activation
  • preferably controlled is the advancement of the distal end 34 into the
  • the sharp end of the device will be
  • advancement of the sharp end is preferably controlled and linked to the
  • the injector tip is in contact with the endocardial surface arises.
  • an indication of tip contact is preferred to ensure that the
  • a tip contact signal is interconnected with the administration device 34.
  • administration is preferably inhibited when there is no tip contact.
  • the cost per dose of the substance delivered may be a determinative factor as
  • angiogenic agent may be related to the viscosity
  • a gas may be a gas, a colloidal suspension, a gel and further encompasses
  • the pharmocokenetics of the angiogenetic agent are also be a
  • angiogenic agent may require a change in the velocity and pressure by which
  • the substance travels within the delivery lumen in the device to the distal end
  • angiogenic agent in, for example, embodiments where it is important to reduce or eliminate waste or accidental discharge of excess material into the
  • the present invention provides methods and apparatus to localize the
  • injection of angiogenic agents For example, the injection site and the growth
  • FIGS. 1 -3 there are a number of useful embodiments for the
  • distal end of a device is configured to readily penetrate at least a few layers
  • a radiopaque band 44 is also preferably provided. The distal end
  • the dosimetry of the substance is 1 00 ⁇ l per injection at 1 0
  • injection sites and the inner diameter of the delivery tube is about 0.01 8
  • injection sites would take up a significant length of the delivery tube and
  • the distal end 50 can be modified by introducing
  • the central lumen may remain open, or may be closed.
  • memory and/or are comprised of stainless steel, NITINOL, or other materials
  • a radiopaque band 56 may be provided as
  • FIG. 6 another embodiment of an apparatus made in
  • the distal end 60 has one or more sharps 62 and 64 in the form of "bristles" or
  • bristles may be hollow to provide conduits for the delivery of the angiogenic
  • the sharps 62 and 64 are solid and serve as fixation elements for a larger
  • FIG. 7 illustrates a preferred delivery of the distal end 60
  • the bristles 62 and 64 are preferably collapsed
  • FIG. 8 Another embodiment of the present invention illustrated in FIG. 8.
  • a distal end 80 with a sharp 82 that is helically shaped includes a distal end 80 with a sharp 82 that is helically shaped.
  • distal feature will aid in the retention of the distal end 80 in the tissue during
  • diffusion ports 84 along the sharp 82 includes either diffusion ports 84 along the sharp 82, or diffusion ports 86
  • radiopaque marker 86 may also be provided.
  • fixation devices Referring now to FIG. 9 an additional embodiment of fixation devices
  • the barbs 92 are preferably
  • the barbs 92 help to keep the
  • distal end 90 engaged in the myocardium during substance delivery.
  • the barbs 92 are retractable so that they are covered when the
  • barbs 92 include a back cut "sawtooth” or “rasp” structure lying longitudinally
  • angiogenic agent or other fluid can additionally be useful to help ensure retention of the sharp and aid in dissection and diffusion. As shown in FIG.
  • the distal end 1 00 has angled orifices 1 02 which
  • FIG. 1 1 the distal tip 1 10
  • the expansion and contraction of the bulge can be
  • 1 1 1 2 may be permanently formed near the distal tip will also be effective.
  • a radiopaque marker 1 1 6 may also be
  • multiple lumens or the space between multiple catheters or probes will have a
  • extendible/retractable elongated elements such as barbs, bristles, teeth or
  • the multi-component tip can also be used as tissue engaging elongated elements.
  • the multi-component tip can also be used as tissue engaging elongated elements.
  • the multi-component tip can also be used as tissue engaging elongated elements.
  • FIG. 1 One basic type of depth stop is illustrated in FIG. 1 2.
  • the depth stop is illustrated in FIG. 1 2.
  • distal end 1 20 may be of any construction, and a maximum depth of
  • penetration d is defined from the distal tip back to a depth stop.
  • stop is a shoulder 1 22 formed by the juncture between the distal end 1 20 and
  • the larger diameter section 1 24 will in some embodiments be an outgrowth of
  • distal end configurations can include mechanical
  • end 1 30 may be provided with wire loop "petals" 1 32 which provide a depth
  • radiopaque markers can be placed on a catheter or probe, and
  • markers are well known in the art. The relative position of the markers will be described.
  • administered can provide a force useful in the administration procedure.
  • the catheter 140 has a lumen
  • a catheter 1 50 has a single central lumen 1 52 and additional
  • lumens 1 54 and 1 56 within the walls of the catheter defining the lumen 1 52.
  • certain of the multiple lumens can be selected to carry sensors or
  • active components such as laser fibers, lead wires to ultrasonic transducers or
  • FIGS. 1 6A and 1 6B illustrate another embodiment of the present
  • the catheter 1 60 may be a
  • FIGS. 1 6A-B the angiogenic substance or another of the fluids that comprise
  • part of the administered dose is forced out at sufficient velocity and pressure such that an area of disturbance or dissection is created in the myocardium
  • the substance may be a chemical that ablates
  • tissue a chemical denervation agent or a combination of the two with a fluid
  • catheter 1 60 emits a jet of fluid
  • FIG. 1 4 the fluid stream 1 62 that creates the dissection may be
  • catheter 1 60 as shown by the arrows. This embodiment will be particularly
  • the high velocity fluid stream 1 62 impinges on the tissue 1 66,
  • FIGS. 1 6A-B where radial orifices are provided in the distal end
  • lateral fluid flow e.g. liquids or gases like CO 2 can be forced through the
  • tissue can be either ablated or denerved.
  • orifices are disposed at angles such that their discharge axes are inclined
  • end of the delivery device is to heat a portion of the distal end of the device.
  • This heating may be to a temperature sufficient to ablate tissue, but may be
  • Another aspect of the present innovation is the visualization of the
  • a catheter 1 70 has a conduit
  • a carrier fluid 1 74 fills a
  • angiogenic agent 1 78 is preferably filled with the radiopaque marker
  • radiopaque marker substance 1 76 can be the angiogenic substance itself, in
  • marker substance 1 76 that can be expressed prior to delivery of the
  • angiogenic agent to the tissue may be provided.
  • marker substance allows the physician to visualize delivery of the appropriate
  • the radiopaque fluid When the angiogenic agent is delivered, the radiopaque fluid will be flushed
  • angiogenic agent is a semi-solid "pellet" instead of a
  • the pellet itself is preferably radiopaque.
  • angiogenic agent will be to mark the regions of deposition so that a surrounding area of the tissue region may be properly treated with other
  • TMR causes tissue damage in a region
  • TMR magnetic resonance
  • an optical fiber or RF electrode is
  • the physician can leave the first delivery catheter in place and deliver an angiogenic agent through the lumen of the first delivery catheter to
  • FIGS. 1 4-1 5 permit energy and angiogenic agents to be delivered
  • the introduction of energy to a tissue site includes all forms of
  • adjunctive use described herein includes the application of
  • neovasculogenesis may occur due to subtle tissue effects. Such tissue
  • deposition may only serve to disturb or disrupt tissue locally while enhancing
  • This use may be preferable in cases where a simple injection or penetration
  • ultrasound or acousto-optic affects can be used to drive the angiogenic agent
  • adjunctive energy to
  • the present invention also encompasses methods of administering an
  • a delivery device is placed in contact with a heart wall and a dose
  • the delivery device may be timed to the heart cycle, and the step of placing the delivery device in
  • contact with the heart wall can be preceded by piercing the wall.
  • the step of administering the angiogenic agent is
  • step of administering the angiogenic agent follows the step of

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Abstract

La présente invention concerne un procédé, qui est soit de nature percutanée et intraopératoire, soit de nature effractive minimale, et qui consiste à prendre un élément allongé contenant un angiogène et à le guider jusqu'à une paroi cardiaque, puis à le délivrer dans le tissu cardiaque. L'administration de l'angiogène peut se faire en mode automatisé, en synchronisme avec le cycle cardiaque. Le dispositif comporte une extrémité digitale configurée pour disséquer le tissu cardiaque et pénétrer dans le myocarde. Il est possible de dispenser d'autres fluides ou substances en association avec l'angiogène de façon à visualiser le site et le cartographier. Selon certaines réalisations, l'angiogène vient complémenter l'administration d'énergie telle que de l'énergie de rayonnement haute fréquence laser. Cela permet de perturber suffisamment le tissu cardiaque pour renforcer les effets de l'angiogène. L'invention concerne également un dispositif servant à l'administration de l'angiogène. Ce dispositif contient dans un même conduit l'angiogène ainsi que des fluides additionnels tels qu'un marqueur.
PCT/US1999/007081 1998-03-31 1999-03-31 Apport d'une substance angiogene WO1999049926A2 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
AU33747/99A AU3374799A (en) 1998-03-31 1999-03-31 Delivery of an angiogenic substance

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US5314698A 1998-03-31 1998-03-31
US09/053,146 1998-03-31

Publications (2)

Publication Number Publication Date
WO1999049926A2 true WO1999049926A2 (fr) 1999-10-07
WO1999049926A3 WO1999049926A3 (fr) 2000-02-10

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WO (1) WO1999049926A2 (fr)

Cited By (19)

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WO2001010315A1 (fr) * 1999-08-05 2001-02-15 Cornell Research Foundation, Inc. Aiguille butee destinee a une therapie genique et methode d'administration d'une solution therapeutique dans le coeur
WO2001041657A1 (fr) * 1999-12-08 2001-06-14 Boston Scientific Limited Dispositif et procede d'injection laterale sans aiguille
WO2001041656A1 (fr) * 1999-12-08 2001-06-14 Boston Scientific Limited Procede et dispositif d'injection sans aiguille
US6319230B1 (en) 1999-05-07 2001-11-20 Scimed Life Systems, Inc. Lateral needle injection apparatus and method
WO2001045548A3 (fr) * 1999-12-20 2002-01-10 Tricardia Llc Aiguille hypodermique munie d'une pointe poreuse et procede d'utilisation
WO2002000278A3 (fr) * 2000-06-26 2002-04-04 Microheart Inc Procedes et dispositifs pour le traitement de tissus ischemiques
US6464693B1 (en) 2000-03-06 2002-10-15 Plc Medical Systems, Inc. Myocardial revascularization
EP1250103A1 (fr) * 2000-01-29 2002-10-23 PLC Medical Systems, Inc. Marquage percutane de revascularisation myocardique et systeme de distribution d'un agent therapeutique et diagnostique
WO2003043507A3 (fr) * 2001-11-19 2003-11-13 Swaminathan Jayaraman Modification des proprietes et de la geometrie du tissu cardiaque exerçant un effet sur la fonction cardiaque
US6689103B1 (en) 1999-05-07 2004-02-10 Scimed Life System, Inc. Injection array apparatus and method
US6902562B1 (en) 1996-10-21 2005-06-07 Plc Medical Systems, Inc. Percutaneous myocardial revascularization marking and therapeutic or diagnostic agent delivery system
WO2006034357A2 (fr) * 2004-09-21 2006-03-30 Advanced Cardiovascular Systems, Inc. Dispositifs et procedes d'imagerie de vaisseaux
WO2007136491A1 (fr) * 2006-05-16 2007-11-29 Abbott Cardiovascular Systems Inc. Dispositifs d'aiguilles médicales et procédés associés
US7534775B2 (en) 2004-04-08 2009-05-19 Sangamo Biosciences, Inc. Methods and compositions for modulating cardiac contractility
WO2010020404A1 (fr) * 2008-08-20 2010-02-25 Gabriele Krombach Dispositif cathéter
EP2722068A1 (fr) * 2008-04-08 2014-04-23 Karolinska Institutet Innovations AB Dispositif d'accès médical endoluminal
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KR20220131998A (ko) 2020-03-27 2022-09-29 니혼라이프라인 가부시키가이샤 약액 주입침 및 약액 주입침 시스템

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EP1250103A4 (fr) * 2000-01-29 2004-03-17 Plc Medical Systems Inc Marquage percutane de revascularisation myocardique et systeme de distribution d'un agent therapeutique et diagnostique
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WO2002000278A3 (fr) * 2000-06-26 2002-04-04 Microheart Inc Procedes et dispositifs pour le traitement de tissus ischemiques
WO2003043507A3 (fr) * 2001-11-19 2003-11-13 Swaminathan Jayaraman Modification des proprietes et de la geometrie du tissu cardiaque exerçant un effet sur la fonction cardiaque
US7534775B2 (en) 2004-04-08 2009-05-19 Sangamo Biosciences, Inc. Methods and compositions for modulating cardiac contractility
WO2006034357A2 (fr) * 2004-09-21 2006-03-30 Advanced Cardiovascular Systems, Inc. Dispositifs et procedes d'imagerie de vaisseaux
WO2006034357A3 (fr) * 2004-09-21 2006-06-08 Advanced Cardiovascular System Dispositifs et procedes d'imagerie de vaisseaux
WO2007136491A1 (fr) * 2006-05-16 2007-11-29 Abbott Cardiovascular Systems Inc. Dispositifs d'aiguilles médicales et procédés associés
EP2722068A1 (fr) * 2008-04-08 2014-04-23 Karolinska Institutet Innovations AB Dispositif d'accès médical endoluminal
US8876792B2 (en) 2008-04-08 2014-11-04 Karolinska Institutet Innovations Ab Endoluminal medical access device
WO2010020404A1 (fr) * 2008-08-20 2010-02-25 Gabriele Krombach Dispositif cathéter
WO2016049028A1 (fr) * 2014-09-23 2016-03-31 Cordis Corporation Systèmes de cathéter et procédés permettant de ré-entrer dans des vaisseaux corporels avec occlusion totale chronique
US10130384B2 (en) 2014-09-23 2018-11-20 CARDINAL HEALTH SWITZERLAND 515 GmbH Catheter systems and methods for re-entry in body vessels with chronic total occlusion
KR20220131998A (ko) 2020-03-27 2022-09-29 니혼라이프라인 가부시키가이샤 약액 주입침 및 약액 주입침 시스템
DE112020006978T5 (de) 2020-03-27 2023-01-05 Japan Lifeline Co., Ltd. Medikamentenlösungsinjektionsnadel und Medikamentenlösungsinjektionsnadelsystem

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