WO2006014731A2 - Methodes et dispositifs permettant de maintenir la permeabilite de canaux crees par intervention chirurgicale dans un organe du corps - Google Patents

Methodes et dispositifs permettant de maintenir la permeabilite de canaux crees par intervention chirurgicale dans un organe du corps Download PDF

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Publication number
WO2006014731A2
WO2006014731A2 PCT/US2005/025738 US2005025738W WO2006014731A2 WO 2006014731 A2 WO2006014731 A2 WO 2006014731A2 US 2005025738 W US2005025738 W US 2005025738W WO 2006014731 A2 WO2006014731 A2 WO 2006014731A2
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WO
WIPO (PCT)
Prior art keywords
implant
support member
paclitaxel
use according
composition
Prior art date
Application number
PCT/US2005/025738
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English (en)
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WO2006014731A3 (fr
Inventor
Loc X. Phan
Edmund J. Roschak
Original Assignee
Broncus Technologies, Inc.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from US10/235,240 external-priority patent/US20030070676A1/en
Priority claimed from US10/458,085 external-priority patent/US20040073155A1/en
Priority claimed from US10/894,647 external-priority patent/US7708712B2/en
Priority claimed from US10/895,258 external-priority patent/US20050060041A1/en
Priority claimed from US10/895,010 external-priority patent/US7462162B2/en
Priority claimed from US10/895,273 external-priority patent/US20050060042A1/en
Priority to JP2007522700A priority Critical patent/JP2008506507A/ja
Priority to CA002577792A priority patent/CA2577792A1/fr
Application filed by Broncus Technologies, Inc. filed Critical Broncus Technologies, Inc.
Priority to AU2005269718A priority patent/AU2005269718A1/en
Priority to EP05791123A priority patent/EP1802365A4/fr
Publication of WO2006014731A2 publication Critical patent/WO2006014731A2/fr
Publication of WO2006014731A3 publication Critical patent/WO2006014731A3/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/064—Surgical staples, i.e. penetrating the tissue
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/08—Wound clamps or clips, i.e. not or only partly penetrating the tissue ; Devices for bringing together the edges of a wound
    • A61B17/083—Clips, e.g. resilient
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/10—Surgical instruments, devices or methods, e.g. tourniquets for applying or removing wound clamps, e.g. containing only one clamp or staple; Wound clamp magazines
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
    • A61B17/12099—Occluding by internal devices, e.g. balloons or releasable wires characterised by the location of the occluder
    • A61B17/12104—Occluding by internal devices, e.g. balloons or releasable wires characterised by the location of the occluder in an air passage
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00491—Surgical glue applicators
    • 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
    • A61B2017/00252—Making holes in the wall of the heart, e.g. laser Myocardial revascularization for by-pass connections, i.e. connections from heart chamber to blood vessel or from blood vessel to blood vessel
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00743—Type of operation; Specification of treatment sites
    • A61B2017/00809—Lung operations
    • 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
    • A61B2018/00541—Lung or bronchi
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/04—Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
    • A61F2/06—Blood vessels
    • A61F2002/068—Modifying the blood flow model, e.g. by diffuser or deflector

Definitions

  • ALA American Lung Association
  • COPD chronic obstructive pulmonary disease
  • COPD chronic obstructive pulmonary disease
  • the ALA estimated that COPD was the fourth-ranking cause of death in the U.S.
  • the ALA estimates that about 14 million and 2 million Americans suffer from emphysema and chronic bronchitis respectively.
  • the primary function of the lungs is to permit the exchange of two gasses by removing carbon dioxide from arterial blood and replacing it with oxygen.
  • the lungs provide a blood gas interface.
  • the oxygen and carbon dioxide move between the gas (air) and blood by diffusion. This diffusion is possible since the blood is delivered to one side of the blood-gas interface via small blood vessels (capillaries).
  • the capillaries are wrapped around numerous air sacs called alveoli which function as the blood-gas interface.
  • a typical human lung contains about 300 million alveoli.
  • a natural respiratory airway hereafter referred to as a natural airway or airway, consisting of branching tubes which become narrower, shorter, and more numerous as they penetrate deeper into the lung.
  • the airway begins with the trachea which branches into the left and right bronchi which divide into lobar, then segmental bronchi.
  • the branching continues down to the terminal bronchioles which lead to the alveoli. Plates of cartilage may be found as part of the walls throughout most of the airway from the trachea to the bronchi. The cartilage plates become less prevalent as the airways branch.
  • the bronchi and bronchioles may be distinguished as the bronchi lie proximal to the last plate of cartilage found along the airway, while the bronchiole lies distal to the last plate of cartilage.
  • the bronchioles are the smallest airways that do not contain alveoli.
  • the function of the bronchi and bronchioles is to provide conducting airways that lead air to and from the gas-blood interface. However, these conducting airways do not take part in gas exchange because they do not contain alveoli. Rather, the gas exchange takes place in the alveoli which are found in the distal most end of the airways.
  • the mechanics of breathing include the lungs, the rib cage, the diaphragm and abdominal wall.
  • inspiratory muscles contract increasing the volume of the chest cavity.
  • the pleural pressure the pressure within the chest cavity, becomes sub-atmospheric. Consequently, air flows into the lungs and the lungs expand.
  • the inspiratory muscles relax and the lungs begin to recoil and reduce in size.
  • the lungs recoil because they contain elastic fibers that allow for expansion, as the lungs inflate, and relaxation, as the lungs deflate, with each breath. This characteristic is called elastic recoil.
  • the recoil of the lungs causes alveolar pressure to exceed atmospheric pressure causing air to flow out of the lungs and deflate the lungs. If the lungs' ability to recoil is damaged, the lungs cannot contract and reduce in size from their inflated state. As a result, the lungs cannot evacuate all of the inspired air. [0007]
  • the lung's elastic fibers also assist in keeping small airways open during the exhalation cycle. This effect is also known as "tethering" of the airways. Tethering is desirable since small airways do not contain cartilage that would otherwise provide structural rigidity for these airways. Without tethering, and in the absence of structural rigidity, the small airways collapse during exhalation and prevent air from exiting thereby trapping air within the lung.
  • Emphysema is characterized by irreversible biochemical destruction of the alveolar walls that contain the elastic fibers, called elastin, described above.
  • the destruction of the alveolar walls results in a dual problem of reduction of elastic recoil and the loss of tethering of the airways.
  • these two problems combine to result in extreme hyperinflation (air trapping) of the lung and an inability of the person to exhale. In this situation, the individual will be debilitated since the lungs are unable to perform gas exchange at a satisfactory rate.
  • alveolar wall destruction is that the airflow between neighboring air sacs, known as collateral ventilation or collateral air flow, is markedly increased as when compared to a healthy lung. While alveolar wall destruction decreases resistance to collateral ventilation, the resulting increased collateral ventilation does not benefit the individual since air is still unable to flow into and out of the lungs. Hence, because this trapped air is rich in CO 2 , it is of little or no benefit to the individual.
  • Chronic bronchitis is characterized by excessive mucus production in the bronchial tree. Usually there is a general increase in bulk (hypertrophy) of the large bronchi and chronic inflammatory changes in the small airways. Excessive amounts of mucus are found in the airways and semisolid plugs of this mucus may occlude some small bronchi. Also, the small airways are usually narrowed and show inflammatory changes.
  • bronchodilator drugs relax and widen the air passages thereby reducing the residual volume and increasing gas flow permitting more oxygen to enter the lungs.
  • bronchodilator drugs are only effective for a short period of time and require repeated application.
  • the bronchodilator drugs are only effective in a certain percentage of the population of those diagnosed with COPD.
  • patients suffering from COPD are given supplemental oxygen to assist in breathing.
  • the oxygen is only partially functional and does not eliminate the effects of the COPD.
  • patients requiring a supplemental source of oxygen are usually never able to return to functioning without the oxygen.
  • Lung volume reduction surgery is a procedure which removes portions of the lung that are over-inflated.
  • the portion of the lung that remains has relatively better elastic recoil, providing reduced airway obstruction.
  • the reduced lung volume also improves the efficiency of the respiratory muscles.
  • lung reduction surgery is an extremely traumatic procedure which involves opening the chest and thoracic cavity to remove a portion of the lung. As such, the procedure involves an extended recovery period. Hence, the long term benefits of this surgery are still being evaluated. In any case, it is thought that lung reduction surgery is sought in those cases of emphysema where only a portion of the lung is emphysematous as opposed to the case where the entire lung is emphysematous.
  • the implant may become encapsulated or filled with tissue thereby occluding the channel.
  • Drug eluting coronary-type stents are not known to overcome the above mentioned events because these stents are often substantially cylindrical (or otherwise have a shape that conforms to the shape of a tubular blood vessel). Hence, they may slide and eject from surgically created openings in an airway wall leading to rapid closure of any channel.
  • the design and structure of the coronary-type stents reflect the fact that these stents operate in an environment that contains different tissues when compared to the airways not to mention an environment where there is a constant flow of blood against the stent. Moreover, the design of coronary stents also acknowledges the need to place the stent within a tubular vessel and avoid partial restenosis of the vessel after stent placement so that blood may continue to flow . In view of the above, implants suited for placement in the coronary are often designed to account for factors that may be insignificant when considering a device for the airways.
  • the healing response in both the coronary and the lungs may be divided into approximately four stages as measured relative to the time of the injury: 1) acute phase; 2) sub-chronic phase; 3) chronic phase; and 4) late phase.
  • the healing process begins in the acute phase with thrombus and acute inflammation.
  • thrombus During the sub-chronic phase, there is an organization of the thrombus, an acute/chronic inflammation and early neointima hyperplasia.
  • chronic phase In the following chronic phase, there is a proliferation of smooth muscle cells along with chronic inflammation and adventitial thickening.
  • neointimal remodeling In the late stage of the healing process there is chronic inflammation, neointimal remodeling, medial hypertrophy and adventitial thickening.
  • the healing response in the airway begins with a fibrinous clot, edema hemorrhage, and fibrin deposition.
  • the sub-chronic phase there is re-epithelialization, mucosal hypertrophy, squamous metaplasia, fibroplasias and fibrosis.
  • the chronic phase while the epithelium is intact and there is less mucosal hypertrophy, there is still fibroplasia and fibrosis.
  • the respiratory epithelium In the late stage the respiratory epithelium is intact and there is evidence of a scar.
  • the unique requirements of the airways and collateral channels calls for specific features for any implant used in collateral channels.
  • these implants/conduits are often placed across three different tissue zones; namely the parenchyma, the newly sectioned airway wall, and the interior of the airway surface.
  • Each different zone may have a different reaction to the presence of the implant/conduit.
  • the parenchyma may build up a layer of scar tissue around the conduit, which may eventually eject the implant or block the air path on the parenchyma side of the conduit.
  • the airway wall may undergo a healing response as a result of the trauma of the procedure. This healing response and associated tissue growth may restrict air-flow through the implant.
  • mucus from the airways may deposit in to the conduit thereby further occluding the conduit.
  • placement of an implant or conduit within the collateral channel may present additional structure requirements for the devices.
  • surgeons often use radiological imaging to place coronary stents within the vasculature. In most cases, placement of coronary stents is critical so that the ends of the coronary stent straddle the vascular obstruction.
  • a surgeon placing an implant in collateral channels is often using a remote access device such as a bronchoscope or endoscope that allows for direct observation of the device during placement.
  • a remote access device such as a bronchoscope or endoscope that allows for direct observation of the device during placement.
  • the devices and methods described herein serve to maintain the patency of a channel surgically created in an organ such as an airway wall.
  • the devices and methods are suited for placement within a channel created within the airway wall and prevent closure of the channel such that air may flow through the channel and into the airway.
  • Implants of the present invention may include a support member having a structure that is adapted for placement within a wall of a body organ, especially an airway wall.
  • implants of the present invention modify the healing response of the lung tissue (e.g., at the site of newly created hole/channel) for a sufficient time until the healing response of the lung tissue subsides or reduces such that the hole/channel becomes a persistent air path.
  • the implant and bioactive substance will modify the healing response for a sufficient time until the healing response is reduced and, from a visual observation, the body treats the opening essentially as a natural airway passage rather than as an injury to the airway wall.
  • Variations of the invention include implants having compositions comprising a polymer which either serves as a carrier for the agent or as a delivery barrier for the agent.
  • the composition may provide a steady release rate of bio-active substance as well as have a sufficient amount of available bio-active substance to modify the healing response of the lung tissue.
  • a delivery system takes advantage of the tissue environment surrounding the airways.
  • the antiproliferative agent of the present invention is one that modifies a healing response.
  • a microtubule stabilizing agent such as taxol or paclitaxel
  • a microtubule destabilizing agent such as vincristine, vinblastine, podophylotoxin, estramustine, noscapine, griseofulvin, dicoumarol, a vinca alkaloid, or a combination thereof.
  • the agent may include steroids, non-steroidal antiinflammatories, rapamycin, dactinomycin, sirolimus, everolimus, Abt-578, tacrolimus, and a combination thereof.
  • composition or implant may also include additional substance as required by the location of the implant.
  • additional substance may affect/suppress mucus production, provide protection against bacteria, or maintain sterility of the implant site or surrounding tissue.
  • bio-active substances listed herein includes all forms of the substances (e.g., analogs, derivatives, salt forms and crystalline forms.)
  • Variations of the invention also may include visualization features which provide assistance when attempting to place the implant from within an organ and having no or little direct visibility outside of the organ.
  • the invention may also include additional features such as valves within the implant to regulate flow or provide a protective barrier.
  • the invention includes a combination of support member and bioactive substance, it is noted that the structural configurations of several, if not all, of the support members provide unique advantages that lend themselves to use in securing the implant about a wall of an organ. Therefore, it is further contemplated that the structural configurations may also provide inventive embodiments without the bioactive substance.
  • Figures 1A-1C illustrate various states of the natural airways and the blood-gas interface.
  • Figure ID illustrates a schematic of a lung demonstrating a principle of the invention described herein.
  • Figures 2A-2B illustrates deployment of an implant of the present invention.
  • Figures 3A-3C provide various views of a variation of an implant of the present invention.
  • Figures 4A-4C are views of an additional variation of the invention.
  • Figures 5A-5C and 6A-6B illustrate a variation of the invention having control members in an alternating fashion about the implant and additional control members at an end of the implant.
  • Figures 7A-7C illustrate a variation of the invention where the proximal portion and the distal portion are of differing sizes.
  • Figures 8A-8B illustrate additional variations of delivering an bioactive agent with the present invention.
  • Figures 9A-9C illustrate variations of the present invention having visualization marks or features.
  • Figure 10A-10B illustrate variations of the invention having valves and barriers within the device.
  • Figure 1 IA-I IB illustrate histology samples comparing conventional devices and an implant of the present invention.
  • Figure 12 illustrates pre-clinical data of an animal model comparing conventional devices, coronary drug eluting stents, and implants of the present invention.
  • Described herein are devices (and methods) for improving the gas exchange in the lung.
  • methods and devices are described that serve to maintain and extend the patency of collateral openings or channels through an airway wall so that air is able to pass directly out of the lung tissue and into the airways. This facilitates exchange of oxygen into the blood and decompresses hyper inflated lungs.
  • channel it is meant to include, but not be limited to, any opening, hole, slit, channel or passage created in the tissue wall (e.g., airway wall).
  • the channel may be created in tissue having a discrete wall thickness and the channel may extend all the way through the wall. Also, a channel may extend through lung tissue which does not have well defined boundaries such as, for example, parenchymal tissue.
  • Figures 1A-1C are simplified illustrations of various states of a natural airway and a blood gas interface found at a distal end of those airways.
  • Figure IA shows a natural airway 100 which eventually branches to a blood gas interface 102.
  • the airway comprises an internal layer of epithelial pseudostratified columnar or cuboidal cells. Mucous secreting goblet cells are also found in this layer and cilia may be present on the free surface of the epithelial lining of the upper respiratory airways. Supporting the epithelium is a loose fibrous, glandular, vascular lamina basement including mobile fibroblasts. Deep in this connective tissue layer is supportive cartilage for the bronchi and smooth muscle for the bronchi and bronchioles.
  • Figure IB illustrates an airway 100 and blood gas interface 102 in an individual having COPD. The obstructions 104 impair the passage of gas between the airways 100 and the interface 102.
  • Figure 1C illustrates a portion of an emphysematous lung where the blood gas interface 102 expands due to the loss of the interface walls 106 which have deteriorated due to a bio-chemical breakdown of the walls 106. Also depicted is a constriction 108 of the airway 100. It is generally understood that there is usually a combination of the phenomena depicted in Figures lA-lC. Often, the states of the lung depicted in Figures IB and 1C may be found in the same lung. [0053] Figure ID illustrates airflow in a lung 118 when implants 200 are placed in collateral channels 112.
  • collateral channels 112 place lung tissue parenchyma 116 in fluid communication with airways 100 allowing air to pass directly out of the airways 100 whereas constricted airways 108 may ordinarily prevent air from exiting the lung tissue parenchyma 116.
  • the invention is not limited to the number of collateral channels which may be created, it is to be understood that 1 or 2 channels may be placed per lobe of the lung and perhaps, 2-12 channels per individual patient.
  • the invention includes the creation of any number of collateral channels in the lung. This number may vary on a case by case basis. For instance, in some cases in an emphysematous lung, it may be desirable to place 3 or more collateral channels in one or more lobes of the lung.
  • FIGs 2A-2B illustrate deployment of a variation of an implant 200 of the present invention.
  • the implant 200 is well suited for maintaining an opening in a wall of a body organ.
  • the illustration depicts the implant 200 as deployed into a collateral channel 112 formed in a wall of an airway 100.
  • a delivery device 300 carrying the implant 200 is advanced to the site and inserted into the channel 112.
  • the delivery device 300 may optionally be constructed to also form the channel 112.
  • the delivery device 300 may extend from an access device such as an endoscope or bronchoscope 302, or it may be directly advanced to the site.
  • Figure 2B illustrates deployment of the implant 200 in the airway wall 100.
  • an expandable member such as a balloon 304 expands the implant 200 into a non-cylindrical shape that is able to sandwich or capture the tissue 100 between the expanded portions of the implant 200.
  • the implant 200 forms a non-cylindrical (e.g., a "grommet" or "hour-glass") shape that is suited, when used in the airways, for limiting movement of the implant 200 within the tissue opening and securing the implant 200 about the perimeter of the tissue opening in the airway wall.
  • the implant 200 expands in the mid portion and flares at the ends to retain itself within the opening in the airway wall.
  • the grommet shape of the implant 200 extends only minimally into the airway.
  • the implant is suited for placement about an opening in the wall of an organ.
  • the implant is suited to placement in an organ having a thin wall.
  • airway wall thickness is fairly proportional to the diameter of the airway lumen by approximately a factor of 1/6.
  • the invention is not limited to use in any particular sized airway, on average the implant is placed in airways ranging from 3 mm to 15 mm in diameter with respective airway wall thicknesses of 0.5mm to 2.5 mm. Therefore, in many variations of the invention, the grommet or hour-glass shape will be suitable to retain itself on the relatively thin airway wall tissue.
  • a variation of the implant 200 shrinks in axial length as it secures itself within the channel.
  • Shrinking in axial length may also provide additional benefit as it reduces the length of the implant 200 that extends into the airway. This reduction in length may prevent unwanted tissue damage to the airway wall and/or occlusion of the airway.
  • the implant 200 must not only capture relatively thin tissue, but must also maintain a minimum internal diameter to allow sufficient air flow. For example, a fewer number of implants may be used given a sufficiently large diameter. In such cases it is undesirable for the implant 200 to constrict in internal diameter as it forms the non-cylindrical shape.
  • the entire implant is expandable, but a portion of the implant 200 expands to a greater amount as compared to a remainder of the implant. Such a configuration allows for the entire implant 200 to expand while still forming a non-cylindrical shape.
  • the implants of the present invention include a support member and a composition that maintain patency of the channel.
  • Variations of the invention include support members selected from a mesh or woven structure either of which are comprised of a metal alloy(e.g., stainless steel, titanium, a shape-memory alloy, etc.), a polymer, a ceramic, or a combination thereof.
  • the support member provides a structure that mechanically maintains patency of the channel as well as provides a delivery means for the composition or other substances as described herein. It is specifically noted that while the variations of the present invention are suited for use in the airways, the invention is not limited to such applications. Rather, the variations of the present invention may be used in various applications as appropriate.
  • Figure 3 A illustrates a planar view of a variation of an implant 200 where the support member 202 is in the unexpanded shape.
  • the support member 202 comprises a plurality of struts or members and has a proximal portion 204, a distal portion 206, and a mid-portion 208 therebetween.
  • a composition 212 is located on the implant.
  • the composition 212 may encapsulate the support member 202, or it may be located on an exterior or interior surface. Alternatively, it may be located between or within the intensities of the support member 202.
  • Figure 3A also illustrates the struts or members (i.e., the extension member) on the proximal and distal portions 204, 206 as being tapered. Because the proximal and distal portions 204, 206 expand significantly, there is a propensity for the composition to tear at these locations. The tapering configuration is helpful to prevent tearing of the composition 212 during expansion as it allows for more material between adjacent struts.
  • the variation of the support member 202 illustrated in FIG. 3A includes control segments 210 which permit the support member 200 to assume a desired shape upon deployment. As will be described herein, the control segments 210 limit expansion of a portion of the implant (in this case the mid portion 208) as well as enable the implant to expand in a uniform manner. Although figure 3A illustrates the entire implant 200 as being covered by the composition 212, it is noted that the composition 212 may alternatively extend over portions of the support member 202. [0062] Figure 3B illustrates a side view of the implant 200 after expansion. In this variation, the control segments 210 restrain expansion at the mid portion 208.
  • Figure 3C illustrates a front view of an expanded implant 200.
  • Figure 3C shows the passageway having a hexagonal cross section.
  • the cross-section is not limited to such a shape.
  • the cross section may be circular, oval, rectangular, elliptical, or any other multi-faceted or curved shape.
  • the implant 200 will have a variable diameter.
  • ) of the center section will be a minimum expanded diameter and the diameter of the implant at the expanded ends (D2) will be a maximum expanded diameter.
  • the inner diameter (Dl) when deployed, may range from 1 to 10 mm and perhaps, from 2 to 5 mm.
  • implants 200 have a sufficiently small delivery state diameter so that they are delivered to the channel having a sufficiently small diameter profile but a relatively large axial length.
  • the implant's 200 minimum (internal) diameter is greater than or equal to its axial expanded length.
  • FIGS 4A-4C illustrate additional variations of implants 200 of the present invention. It is noted that in Figure 4A, as in many additional figures below, the composition is not illustrated for sake of clarity. Figure 4A shows a side view of a implant 200 in an un-deployed state. The variation shown in Figure 4A is similar to that shown in Figure 3 with the exception of that the proximal and distal portions 204, 206 are not tapered.
  • Figure 4B illustrates a side view of the implant 200 of Figure 4A when expanded.
  • the opposing ends of the implant 200 may have a V, U, or similar shape.
  • the angles Al, A2 may vary and may range from, for example, 30 to 150 degrees, 45 to 135 degrees and perhaps from 30 to 90 degrees.
  • the angle Al may be different than angle A2.
  • the angle corresponding to each proximal extension member may be different or identical to that of another proximal extension member.
  • the angle corresponding to each distal extension member may be different or identical to that of another distal extension member.
  • Figure 4B also illustrates the implant 200 having a length L that decreases upon expansion of the implant 200.
  • the length of the implants of the present invention will depend upon their intended site of implantation. Variations of implants may have lengths ranging from between 2 - 20 mm. Furthermore, although the figures illustrate the proximal and distal portions of the implant as being symmetric about its center, the implant is not limited to such a configuration.
  • the implant of the present invention may have any number of extension members on each end device.
  • the number of extension members on each end may range from 2-10.
  • the number of proximal extension members may differ from the number of distal extension members for a particular implant.
  • the extension members may be symmetrical or non-symmetrical about the center section.
  • the proximal and distal extension members may also be arranged in an in-line pattern or an alternating pattern.
  • the extension members or the center section may also contain barbs or other similar configurations to increase adhesion between the implant and the tissue.
  • the extension members may also have openings to permit tissue in-growth for improved retention.
  • Variations of the implant 200 also includes diametric-control segments, tethers, or leashes 210 to control and limit the expansion of the a portion of the implant 200 when expanded.
  • the shape of the center-control segment 210 typically bends, when the implant radially expands, until it is substantially straight or unfolded.
  • Such a center-control segment 210 may be circular or annular shaped in its folded or unexpanded shape. However, its shape may vary widely and it may have, for example, an arcuate, semi-circular, v-shape, u-shape, s-shape, sinusoidal shape, or other type of shape which limits the expansion of the implant upon unfolding.
  • the control members 210 assist the implant 200 in assuming a uniform non- cylindrical expanded shape.
  • the implant 200 there will be variation in the amounts of expansion of various cells (i.e., where a cell is typically defined by an area surrounded by a number of joined struts - as an example refer to Figure 4C, the shaded portion representing the cell 216) of the implant 200. If one cell expands at an increased amount relative to the remaining cells, once the control member 210 fully unfolds, the cell will be unable to further expand. Thus, the expansion force, as applied by the balloon, is re-directed to a remaining part of the implant 200. It should be noted that while the control members substantially straighten, there may be a residual bend or "kink" in the control member when expanded.
  • one end of the control segment 210 is attached or joined to one location (e.g., a first rib) and the other end of the center-control segment is connected to a second location (e.g., a rib adjacent or opposite to the first rib).
  • the center-control segments may have other constructs.
  • the center-control segments may connect adjacent or non-adjacent center section members.
  • each center-control segment may connect one or more ribs together.
  • the center-control segments may further be doubled up or reinforced with ancillary control segments to provide added control over the expansion of the center section.
  • the ancillary control segments may be different or identical to the primary control segments.
  • the center-control segments 210 may bend, unfold, straighten, or otherwise deform until they maximize their length (i.e., unfold to become substantially straight) such as the center-control segments 210 shown in Figure 3B.
  • the invention is not so limited and other types of center-control segments may be employed.
  • control segments 210 may also be used to join and limit the expansion of various portions of the implant 200.
  • control segments may be placed elsewhere on the implant 200.
  • Figure. 5A illustrates control segments 210 located in an alternating pattern at the mid portion 208 of the implant 200.
  • the implant 200 also includes additional control segments 214 located on an end of the implant 200.
  • the end control segments 214 upon expansion of the implant 200 the end control segments 214 cause the respective end portion to form an angle A2 that is different from an angle Al at the opposite unrestrained end.
  • Figure 6A illustrates an implant 200 similar to that of Figure 3 with additional control segments 214 located at both ends of the implant 200.
  • Figure 6B illustrates the implant 200 of 6A in an expanded state.
  • control segments are illustrated to have equal lengths, any length may be selected.
  • adjacent control segments may have different lengths, or opposing control segments (e.g., those located on opposing ends) may have different lengths.
  • Figure 7 A illustrates another variation of the invention.
  • the support member 202 may comprise a plurality of members forming a number of cells 216 where each cell 216 is joined to an adjacent cell at the mid portion 208 and the proximal and distal portions are unconnected.
  • the cells 216 are located in a circumferential manner about an axis of the implant and further include at least one control member 210 having a serpentine configuration. Upon expansion of the cell, the control member 210 straightens or unfolds to limit expansion of the cell 216.
  • the composition is not illustrated in Figures 7A and 7B.
  • Figures 7A and 7B differ from previously described implants as the proximal 204 and distal 206 portions are of different sizes.
  • the larger sized portion 206 may be useful in separating parenchymal tissue or providing a larger anchoring structure when implanted (as shown in Figure 7B.)
  • Figure 7C illustrates the implant 200 of Figures 7A and 7B having a composition 218 as described herein. As illustrated, variations of the invention include composition 218 that are only placed over a portion of the implant 200.
  • control segments may be added or mounted to the implant or alternatively, they may be integral with the implant. That is, the control segments may be part of the implant rather than separately joined to the implant with adhesives or welding, for example.
  • the control segments may also be mounted exteriorly or interiorly to the members to be linked. Additionally, sections of the implant may be removed to allow areas of the implant to deform more readily. These weakened areas provide another approach to control the final shape of the deployed implant. Details for creating and utilizing weakened sections to control the final shape of the deployed implant may be found in U.S. Pat. No. 09/947,144 filed on September 4, 2001 which is hereby incorporated by reference in its entirety.
  • the implant described herein may be manufactured by a variety of manufacturing processes including but not limited to laser cutting, chemical etching, punching, stamping, etc.
  • the implant may be formed from a tube that is slit to form extension members and a center section between the members.
  • One variation of the implant may be constructed from a metal tube, such as stainless steel, 316L stainless steel, titanium, tantalum, titanium alloy, nitinol, MP35N (a nickel-cobalt-chromium- molybdenum alloy), etc.
  • the implant may be formed from a rigid or elastomeric material that is formable into the configurations described herein.
  • the implant may be formed from a cylinder with the passageway being formed through the implant.
  • the implant may also be formed from a sheet of material in which a specific pattern is cut. The cut sheet may then be rolled and formed into a tube.
  • the materials used for the implant can be those described above as well as a polymeric material, a biostable or implantable material, a material with rigid properties, a material with elastomeric properties, or a combination thereof. If the implant is a polymeric elastic tube (e.g. a thermoplastic elastomer), the implant may be -extruded and cut to size, injection molded, or otherwise formed.
  • the implants described herein may be comprised of a shape memory alloy, a super-elastic alloy (e.g., a NiTi alloy), a shape memory polymer, or a shape memory composite material.
  • the implant may be constructed to have a natural self- assuming deployed configuration, but is restrained in a pre-deployed configuration. As such, removal of the restraints (e.g., a sheath) causes the implant to assume the deployed configuration.
  • a implant of this type could be, but is not limited to being, comprised from an elastic polymeric material, or shape memory material such as a shape memory alloy. It is also contemplated that the implant could comprise a shape memory alloy such that, upon reaching a particular temperature (e.g., 98.5 0 F), it assumes a deployed configuration. ⁇
  • the implant described herein may be formed of a plastically deformable material such that the implant is expanded and plastically deforms into a deployed configuration.
  • the implant may be expanded into its expanded state by a variety of devices such as, for example, a balloon catheter.
  • the implant's surface may be modified to affect tissue growth or adhesion.
  • an implant may comprise a smooth surface finish in the range of 0.1 micrometer to 0.01 micrometer. Such a finish may serve to prevent the implant from being ejected or occluded by tissue overgrowth.
  • the surface may be roughened or porous.
  • the implant may also comprise various coatings and polymeric layers as discussed below.
  • COMPOSITION As discussed above, the implants of the present invention may include a composition or polymeric layer that includes a bio-active substance or combination of bioactive substances. One purpose of the composition is to assist in modifying the healing response as a result of the trauma to lung tissue resulting from creation of the collateral channel.
  • the composition may also serve other purposes as well. For example, the composition may assist in controlling of bacteria, prevent irritation of the tissue near the implant, or may carry additional bio-active substances.
  • lung tissue is intended to include the tissue lining the airway, the tissue beneath the lining, and the tissue within the lung but exterior to the airway (e.g., lung parenchyma.)
  • the composition may comprise a polymeric layer which acts as a carrier for various bioactive or other agents as described herein.
  • the polymeric layer may function as a tissue barrier to inhibit growth of tissue into the conduit/implant.
  • the support member may be fabricated from a polymeric material having the bio-active substance incorporated directly therein.
  • the composition 212 prevents tissue in-growth from occluding the collateral channel or passage of the implant 200.
  • the polymeric layer 212 may coaxially cover the center section from one end to the other or it may only cover one or more regions of the implant 200.
  • the composition 212 may completely or partially cover the implant 200.
  • the composition 212 may be located about an exterior of the implant's surface, about an interior of the implant's surface.
  • the composition 212 may be located within an opening or pocket 220 in the support structure 202 of the implant.
  • the pocket 220 will have a barrier (e.g., polymeric or other porous material) that either degrades to allow the composition or bioactive substance to be delivered from the implant, or acts as a diffusible barrier to deliver the composition or bioactive substance.
  • a barrier e.g., polymeric or other porous material
  • composition should be selected to accommodate the significant expansion of the implant.
  • polymers include, but are not limited to, thermoplastic polymers , thermoset polymers, acrylate polymers, a blend of acrylate-methacrylate polymers, silicone elastomers, urethane elastomers, ethylene vinyl acetate polymers, polyethylene, polypropylene, PLA-PGA, PLA, PGA, polyortho-ester, polycapralactone, polyester, hydrogels, polystyrene, co-polymers of styrene-isobutylene-styrene, and combinations or blends thereof.
  • bioabsorbable polymers include but are not limited to poly(L-lactic acid), polycaprolactone, poly(lactide-co-glycolide), poly(hydroxybutyrate), poly(hydroxybutyrate-co-valerate), polydioxanone, polyorthoester, polyanhydride, poly(glycolic acid), poly(D,L-lactic acid), poly(glycolic acid-co-trimethylene carbonate), polyphosphoester, polyphosphoester urethane, poly(amino acids), cyanoacrylates, poly(trimethylene carbonate), poly(iminocarbonate), copoly(ether-esters) (e.g., PEO/PLA), polyalkylene oxalates, polyphosphazenes and biomolecules such as fibrin, fibrinogen, cellulose, starch, collagen and hyaluronic acid.
  • PEO/PLA polyalkylene oxalates
  • biomolecules such as fibrin, fibrinogen, cellulose
  • biostable polymers with a relatively low chronic tissue response such as polyurethanes, silicones, fluorosilicones, and polyesters could be used.
  • hydrogels may be used to carry the drug.
  • examples of other types of polymers that may be useful include but are not limited to polyolefins, polyisobutylene and ethylene-alphaolefin copolymers; acrylic polymers and copolymers, vinyl halide polymers and copolymers, such as polyvinyl chloride; polyvinyl ethers, such as polyvinyl methyl ether; polyvinylidene halides, such as polyvinylidene fluoride and polyvinylidene chloride; polyacrylonitrile, polyvinyl ketones; polyvinyl aromatics, such as polystyrene, polyvinyl esters, such as polyvinyl acetate; copolymers of vinyl monomers with each other and olefins, such as ethylene-methyl methacrylate
  • the coatings may be applied, for example, by either painting, dip coating, molding, spin-coating, transfer molding or liquid injection molding.
  • the polymeric layer may be a tube of a material and the tube is placed either over and/or within the implant. The polymeric layer may then be bonded, crimped, heated, melted, shrink fitted or fused to the implant.
  • the polymeric layer may also be tied to the implant with a filament of, for example, a suture material.
  • Still other techniques for attaching the polymeric layer include: solvent swelling applications and extrusion processes; wrapping a sheet of material about the implant, or placing a tube of the material about the implant and securing the tube to the implant.
  • the polymeric layer may be secured on the interior of the implant by positioning a sheet or tube of material on the inside of the center section and securing the material therein.
  • the composition may also be formed of a fine mesh with a porosity or treatment such that tissue may not penetrate the pores.
  • a ChronoFlexTM DACRON® or TEFLON® mesh having a pore size of 100-300 microns may be saturated with collagen or another biocompatible substance.
  • This construct may form a suitable polymeric layer.
  • the mesh may be coaxially attached to a frame such as the open frame structures disclosed above. Still other suitable frames include a continuous spiral metallic or polymeric element.
  • the bio-active substance or combination of bioactive substances is selected to assists in modifying the healing response as a result of the trauma to the lung tissue resulting from creation of the collateral channel.
  • lung tissue is intended to include the tissue lining the airway, the tissue beneath the lining, and the tissue within the lung but exterior to the airway (e.g., lung parenchyma.)
  • the purpose of modifying the healing response is to further extend the patency of the channel or implant to increase the duration which trapped gasses may exit through the implant into the airways.
  • antiproliferative agent is intended to include those bioactive substances that directly modify the healing response described herein.
  • the bioactive substances are intended to interact with the tissue of the surgically created channels and in particular, lung tissue. These substances may interact with the tissue in a number of ways. They may, for example, 1.) accelerate cell proliferation or wound healing to epithelialize or scar the walls of the surgically-created channel to maintain its patent shape or 2.) the substances may inhibit or halt tissue growth when a channel is surgically created through an airway wall such that occlusion of the channel due to tissue overgrowth is prevented.
  • bioactive agents may inhibit wound healing such that the injury site (e.g., the channel or opening) does not heal leaving the injury site open and/or inhibit infection (e.g., reduce bacteria) such that excessive wound healing does not occur which may lead to excessive tissue growth at the channel thereby blocking the passageway.
  • infection e.g., reduce bacteria
  • bioactive substances may be used alone or in combination with the devices described herein.
  • bioactive substances include, but are not limited to, antimetabolites, antithrobotics, anticoagulants, antiplatelet agents, thorombolytics, antiproliferatives, antinflammatories, agents that inhibit hyperplasia and in particular restenosis, smooth muscle cell inhibitors, growth factors, growth factor inhibitors, cell adhesion inhibitors, cell adhesion promoters and drugs that may enhance the formation of healthy neointimal tissue, including endothelial cell regeneration.
  • the positive action may come from inhibiting particular cells (e.g., smooth muscle cells) or tissue formation (e.g., fibromuscular tissue) while encouraging different cell migration (e.g., endothelium, epithelium) and tissue formation (neointimal tissue).
  • particular cells e.g., smooth muscle cells
  • tissue formation e.g., fibromuscular tissue
  • cell migration e.g., endothelium, epithelium
  • tissue formation e.g., fibromuscular tissue
  • bioactive agents include but are not limited to analgesics, anticonvulsives, anti-infectives (e.g., antibiotics, antimicrobials), antineoplastics, H2 antagonists (Histamine 2 antagonists), steroids, non-steroidal anti-inflammatories, hormones, immunomodulators, mast cell stabilizers, nucleoside analogues, respiratory agents, antihypertensives, antihistamines, ACE inhibitors, cell growth factors, nerve growth factors, anti-angiogenic agents or angiogenesis inhibitors (e.g., endostatins or angiostatins), tissue irritants (e.g., a compound comprising talc), poisons (e.g., arsenic), cytotoxic agents (e.g., a compound that can cause cell death), various metals (silver, aluminum, zinc, platinum, arsenic, etc.), epithelial growth factors or a combination of any of the agents disclosed herein.
  • analgesics e
  • agents include pyrolitic carbon, titanium-nitride-oxide, taxanes, fibrinogen, collagen, thrombin, phosphorylcholine, heparin, rapamycin, radioactive 188Re and 32P, silver nitrate, dactinomycin, sirolimus, everolimus, Abt-578, tacrolimus, camptothecin, etoposide, vincristine, mitomycin, fluorouracil, or cell adhesion peptides.
  • Taxanes include, for example, paclitaxel, 10-deacetyltaxol, 7-epi-10- deacetyltaxol, 7-xylosyl-lO-deacetyltaxol, 7-epi-taxol, cephalomannine, baccatin III, baccatin V, lO-deacetylbaccatin III, 7-epi-l O-deacetylbaccatin III,docetaxel.
  • an antiproliferative agent such as methotrexate will inhibit over-proliferation of smooth muscle cells and thus inhibit restenosis.
  • the antiproliferative is desirably supplied for this purpose until the tissue has properly healed. Additionally, localized delivery of an antiproliferative agent is also useful for the treatment of a variety of malignant conditions characterized by highly vascular growth.
  • an implant such as a implant could be placed in the surgically created channel to provide a means of delivering a relatively high dose of the antiproliferative agent directly to the target area.
  • a vasodilator such as a calcium channel blocker or a nitrate may also be delivered to the target site.
  • the agent may further be a curative, a pre-operative debulker reducing the size of the growth, or a palliative which eases the symptoms of the disease.
  • tamoxifen citrate, Taxol ® or derivatives thereof Proscar ® , Hytrin ® , or Eulexin ® may be applied to the target site as described herein.
  • Variations of the invention may also include fibrinolytics such as tPA, streptokinase, or urokinase, etc.
  • fibrinolytics prevent or reduce the accumulation of fibrin within the opening. Accumulation of fibrin in the opening may result from inflammation of the tissue.
  • the fibrin may form a structure which makes it easier for tissue to grow into the opening using the fibrin structure as a framework.
  • Use of fibrinolytics either topically, locally, or on the implant, serves to remove or hinder the network of fibrin from forming within the opening (or implant) and therefore aids in modifying the healing response.
  • the poisonous and toxic compounds should be controlled so that inadvertent death of tissue does not occur.
  • the poisonous agent should be delivered locally or only be effective locally.
  • One method for delivering the bioactive agent locally is to associate the bioactive agent with an implant.
  • the implants described herein may include a bioactive substance or medicine deposited onto the interior, the exterior, or both the interior and exterior surfaces of the implant. The bioactive substance may remain on the implant so that it does not leach. Cells that grow into the surgically created channel contact the poison and die.
  • the bioactive agent may be configured to gradually elute as discussed below.
  • the implant modifies the healing response of the lung tissue (e.g., at the site of newly created hole/channel) for a sufficient time until the healing response of the lung tissue subsides or reduces such that the hole/channel becomes a persistent air path.
  • the implant and bioactive substance will modify the healing response for a sufficient time until the healing response is reduced and, from a visual observation, the body treats the opening essentially as a natural airway passage rather than as an injury to the airway wall.
  • Figures 1 IA-I IB show histology from animal models.
  • the histology is a cross sectional slice of the airway wall 110 and lung parenchyma 116.
  • the collateral channel 112 was created in the airway wall 110 and extended into the lung parenchyma 116.
  • the implant (which was removed for histology and is not shown) was placed in the channel 112 so as to create an airflow path (as demonstrated by the arrows 114) from the lung parenchyma 116 through the airway wall 110.
  • Figure 1 IA illustrates a histology sample from a site two weeks subsequent to the creation of a channel and implantation with a device.
  • the device included a polymeric coating but no bio-active substance.
  • This site was also given a single local treatment of a bioactfve substance (mitomycin) subsequent to creation of the channel 112.
  • mitomycin a bioactfve substance
  • the healing process of the lung tissue already caused a considerable amount of fibrosis 120 between the channel 112 and lung parenchyma 116. From the figure, the fibrosis appears as a darker tissue that is adjacent to the lung parenchyma 116. The presence of this fibrosis 120 strongly suggests that air would not be able to flow from the lung parenchyma 116 through the channel 112.
  • Figure 1 IB illustrates a histology sample from a site 18weeks subsequent to the creation of a channel and implantation with an implant of the present invention (an example of which is discussed below.) As evident from the figure, the channel 112 remained significantly unobstructed with only a minimal discontinuous layer of fibrosis 120.
  • the implant provides a steady release rate of bio-active substance as well as has a sufficient amount of available bio-active substance to modify the healing response of the lung tissue.
  • lung tissue is intended to include the tissue lining the airway, the tissue beneath the lining, and the tissue within the lung but exterior to the airway (e.g., lung parenchyma.) Such a delivery profile allows for a concentration gradient of drug to build in these tissues adjacent to the delivery site of the implant.
  • forming the concentration gradient affects the healing response of the lung tissue so that the implant does not become occluded as a result of the healing response.
  • the implant is often placed in the airway wall it is exposed to the healing process of the multiple tissues. Providing a sufficient amount of bio-active substance allows for the formation of a concentration of the bio-active substance across these various tissues.
  • the fluids from these tissues enter into the composition layer of the device. The fluids then combine with the bio-active substances and migrate out of the composition layer to settle into the lung tissue.
  • a concentration gradient forms when the drug 'saturates' local tissue and migrates beyond the saturated tissues.
  • the healing response may be affected or suppressed during the critical time immediately after the wounding caused by creation of the collateral channel when the healing response is greatest.
  • the solubility parameter of the polymer must be matched with the bio-active substance to provide an acceptable slow elution rate from the polymer.
  • the polymer itself must be selected to have the proper attributes, such as a proper diffusion coefficient (to slow fluid entering and departing from the implant), and proper mechanical expansion properties (to allow for the significant expansion of the polymer to accommodate formation of the grommet shape.)
  • the solubility parameter is defined as the square root of the cohesive energy of the molecules in a compound.
  • the level of control that a polymer has over the elution of a drug is the difference between the solubility parameters of the polymer and the solubility parameter of the drug.
  • paclitaxel is a taxane that is regarded as a microtubule stabilizer.
  • the benefits of a microtubule stabilizing substance for use in vascular drug eluting stents is discussed, for example, in U.S. Patent No. 5,616,608 to Kinsella et al. This type of drug operates to enhance microtubule polymerization which inhibits cell replication by stabilizing microtubules in spindles which block cell division.
  • the implant for use in the present invention may use microtubule stabilizing substances such as taxanes (e.g., paclitaxel) as well as those microtubule destabilizing substances that are believed to promote microtubule disassembly in preventing cell replication.
  • destabilizing substances include, but are not limited to vincristine, vinblastine, podophylotoxin, estramustine, noscapine, griseofulvin, dicoumarol, a vinca alkaloid, and a combination thereof.
  • the exterior surface of the implant may be treated via etching processes or with electrical charge to encourage binding of the bioactive substances to the implant.
  • the exterior surface may also be roughened to enhance binding of the medicine to the surface as discussed in U.S. Patent Application Publication No. 2002/0098278. See also U.S. Patent Application Publication Nos. 2002/0071902, 2002/0127327 and U.S. Patent No. 5,824,048 which discuss various techniques for coating medical implants.
  • the implant may comprise a frame or body with a bioactive matrix disposed or otherwise associated therewith, the invention is not so limited.
  • the support member is formed from a polymer and the composition is joined to the polymeric support member.
  • the bioactive substances may be placed directly onto the polymeric support member.
  • Adverse reactions include, but are not limited to, granulation, swelling, and mucus overproduction. These substance may also be inhaled, injected, orally applied, topically applied, or carried by the implant. These substances may include anti- inflammatory, infection-fighting substances, steroids, mucalytics, enzymes, and wound healing-accelerating substances. Examples of these substances include but are not limited to, acetylcysteine, albuterol sulfate, ipratropium bromide, dornase alfa, and corticosteroids.
  • FIG. 12 illustrates data from a pre-clinical animal model evaluating the wound healing response, under pre-clinical protocol (QT-305), using an implant w/o any antiproliferative substance, a paclitaxel coronary Stent (manufactured by Boston Scientific under the name Taxus®), and a sirolimus coronary stent (manufactured by Johnson & Johnson under the name Cypher®).
  • patency of the devices in these trials would have extended well beyond the respective 12 and 18 weeks.
  • patency of the implants were determined visually using a bronchoscope advanced to the implant site.
  • the implant of the present invention when placed into an airway wall, is usually placed using a bronchoscope under direct visualization.
  • the direct visualization only permits viewing of the interior of the airway and care must be taken to place the implant such that during expansion, the implant properly deploys about the airway wall.
  • care must be taken not to advance the implant/balloon catheter too far into the opening into the airway wall. Improper advancing of the implant/balloon could potentially result in a pneumothorax or pneumomediastinum.
  • the implant 200 may also include a visualization mark 218.
  • the visualization marker 218 is visually apparent during a procedure and gives the medical practitioner an indication when the implant/balloon is advanced to the proper location. In this manner, the visualization mark 218 facilitates alignment and deployment of the implants into collateral channels.
  • the visualization mark 218 may be a ring of biocompatible polymer and may be selected to provide contrast so that it may be identified as the medical practitioner views the device through a endoscope or bronchoscope.
  • the bronchoscope will usually contain a light-source that illuminates the target area. Therefore, the visualization mark may be something that reflects or refracts the light in a different manner from the remainder of the implant.
  • the visualization mark may be the same color as the remainder of the device, or partially transparent, or entirely transparent, but is identifiable because the mark reflects or refracts light differently than the remainder of the device.
  • the visualization feature may protrude from the center section or it may be an indentation(s).
  • the visualization mark may also be a ring, groove or any other physical feature on the implant. Moreover, the visualization feature may be continuous or comprise discrete segments (e.g., dots or line segments). [0123]
  • the visualization feature may be made using a number of techniques.
  • the mark is a ring formed of silicone and is white.
  • the polymeric ring may be spun onto the polymeric layer.
  • a clear silicone barrier may be coated onto the implant such that it coaxially covers the implant.
  • a thin ring of white material such as a metal oxide suspended in clear silicone may be spun onto the silicone coating.
  • another coating of clear silicone may be applied to coat the white layer.
  • the implant thus may include upwards of 1-3 layers including a polymeric layer, a visualization mark layer, and a clear outer covering.
  • the mark is a ring formed of silicone and is black.
  • the mark is a ring formed by suspending gold particulates in the polymer as shown in Figure 9A.
  • the shape of the visualization mark is not limited to a thin ring.
  • the visualization mark may be large, for example, and cover an entire half of the implant as shown in Figure 9B.
  • the visualization mark may, for example, be a white coating disposed on the proximal or distal half of the implant.
  • the visualization mark thus may extend from an end of the extension members to the center section of the implant.
  • the physician may observe when one-half of the implant extends into the channel. This allows the physician to properly actuate or deploy the implant to secure the implant in the tissue wall.
  • the visualization mark is made to stand out when viewed with, for example, an endoscope.
  • the implants may also have additional imaging enhancing additives to increase non-direct imaging, such as fluoroscopic or radioscopic viewinglt is also contemplated that other elements of the implant can include visualization features such as but not limited to the extension members, polymeric layer, control segments, etc.
  • composition layer e.g., the polymer turns white
  • This coloration obscures the support member structure in the layer making it difficult to identify the edges and center of the support member or implant.
  • placement of the implant may depend upon positioning the center of the implant within the opening in tissue. If the support member structure is identifiable, then one is able to visually identify the center of the implant.
  • the composition colors obscures the support member or renders the implant otherwise opaque, it may become difficult to properly place the device. This may be especially true when the composition layer extends continuously over the support member.
  • a variation of the invention includes a delivery device for delivering an expandable implant (such as those described herein and in the cases referenced herein), where the delivery device includes an expandable member having an expandable implant located about the expandable member. Where the implant and the expandable member are of different visually identifiable colors or shades such that the distinction is easy to identify under endoscopic or bronchoscopic viewing.
  • a balloon catheter has a colored sleeve 306 located about the balloon.
  • the sleeve 306 comprises a visually identifiable color where selection of the colors should ease identification of the implant in an endoscopic visualization system (e.g., blue or a similar color that is not naturally occurring within the body.)
  • the implant is placed about the sleeve 306 where the proximal and distal areas of the implant would be identifiable by the difference in color.
  • the sleeve 306 may be fashioned from any expandable material, such as a polymer.
  • the sleeve 306 may also provide an elastic force to return the balloon to a reduced profile after expansion of the balloon. Such a system allows for identification without affecting the properties of the implant.
  • the visualization mark may comprise providing a contrast between the implant and a delivery catheter.
  • the implant appears mostly white and while mounted on a contrasting color inflation balloon.
  • the implant would be placed over a blue deflated balloon catheter.
  • the proximal and distal areas of the implant would be flanked by the deflated blue balloon, thus giving the appearance of a distinct distal and proximal end of the implant. This would allow a physician to place the implant properly by using the blue flanks as a guide for placing the central white portion in the tissue wall.
  • a colored flexible sheath covering the balloon would also suffice.
  • the implants may further comprise various structures deposited within the passageway.
  • an implant may include a valve 224.
  • the valve 224 may be positioned such that it permits expiration of gas from lung tissue but prevents gas from entering the tissue.
  • the valve 224 may be placed anywhere within the passageway of the implant.
  • the valve 224 may also be used as bacterial in-flow protection for the lungs.
  • the valve 224 may also be used in combination with a bioactive or biostable polymeric layer/matrix and the polymeric layer may be disposed coaxially about the implant.
  • Various types of one way valves may be used as is known to those of skill in the art.
  • One example of the one-way valve 224 is a valve as shown in Figure 1OA.
  • the geometry of the valve is such that when air is passed through the valve 224 the bill members deflect. When air places pressure on the closed side the geometry of the bills place a force onto the opening preventing air from flowing through.
  • a valve could be used to prevent fluid such as mucus from flowing into the passage and into the parenchyma.
  • a valve could be configured and could operate similarly to the one described above for gas flow.
  • Figure 1OB illustrates another variation of the invention 200 having a barrier which may serve as an anti-bacterial barrier, or to preserve sterility of the parenchymal tissue adjacent to the implant.
  • Implants comprising stainless steel mesh frame fully encapsulated with a composition comprising silicone (as described below) and paclitaxel were implanted in several canine models.
  • the composition comprised approximately a 9% paclitaxel to silicone ratio with approximately 400 micrograms of paclitaxel per implant. Measurements found that approximately 30% of the paclitaxel released after 60 days. In general, for implants with the paclitaxel/silicone composition, observations of chronic inflammation, epithelial metaplasia and fibrosis were all very mild.
  • the polymer used in the example device has good diffusivity for lipophilic drug (such as paclitaxel) because the side methyl group on the silicone may be substituted with more lipophilic hydrocarbon molecules containing vinyl group or groups for polymerization by platinum catalyst.
  • lipophilic drug such as paclitaxel
  • Some variations of the invention include an active analog and/or derivative of paclitaxel in addition to the paclitaxel.
  • Such variation may have a ratio of the first amount of paclitaxel to the second amount of the active derivative or analog of paclitaxel comprises of at least 2 to 1 , 3 to 1 , or other ranges as found necessary to assist in maintaining patency of the implant passageway.
  • the amounts of paclitaxel may be as provided herein or include additional ranges.
  • a variation of the invention includes an implant with a composition located on the support member and comprising an antiproliferative agent, where the agent comprises a first amount of paclitaxel and a second amount of an active derivative or analog of paclitaxel.
  • an active derivative or analog of paclitaxel may be 7-epitaxol. It is believed that existence of the active derivative or analog of paclitaxel (e.g., 7-epitaxol) aids in maintaining the patency of the implant passageway.
  • 7-epitaxol from paclitaxel Some combinations or some key components and time are all that are required to produce 7-epitaxol from PTX. To understand the exact parameters to produce 7-epitaxol from PTX requires more careful studies.
  • the bound-fraction i.e., the portion of unaccounted drug discussed above
  • Bound-fractions are typical occurrences in matrix-drug-delivery devices.
  • the amount of bound-fraction varies depending upon chemistry of the polymerization reaction, stoichiometry, and the characteristics of the drug.
  • the ratio as well as the total load may be adjusted as the application requires to modify the release characteristics.
  • an implant coated with polymer loaded with relatively high percentage of paclitaxel can have a relatively low total drug load by decreasing the amount of polymer/drug coating.
  • the composition for the example may be as follow: polymer part: polydimethylsiloxane, vinyldimethyl terminated, any viscosity; and/or polydimethylsiloxane, vinylmonomethyl terminated, any viscosity.
  • the cross- linker part polydimethylsiloxane, any viscosity; and/or polymonomethylsiloxane, any viscosity.
  • Platinum catalyst part and/or cross-linker part platinum; and/or platinum- divinyltetramethyldisiloxane complex in xylene, 2-3% Pt; and/or platinum- divinyltetramethyldisiloxane complex in vinyl terminated polydimethylsiloxane, 2-3% Pt; and/or platinum- divinyltetramethyldisiloxane complex in vinyl terminated polydimethylsiloxane, ⁇ 1% Pt; platinum-Cyclovinylmethylsiloxane complex, 2-3% Pt in cyclic vinyl methyl siloxane.
  • polydimethylsiloxanes such as: trimethylsiloxy terminated polydimethylsiloxane in various viscosities, (48-96%) dimethyl (4-52%) diphenylsiloxane copolymer in various viscosities, dimethylsiloxane- ethylene oxide copolymer, dimethyl diphenylsiloxane copolymer, polymethylhydrosiloxane, trimethylsilyl terminated at various viscosities, (30-55%) methyldro- (45-70%) dimethylsiloxane copolymer at various viscosities, polymethylphenylsiloxane, polydimethylsiloxane silanol terminated at various viscosities, polydimethylsiloxane aminopropyldimethyl terminated at various viscosities.
  • paclitaxel a release profile was found to be acceptable with a polymer system consisting of polydimethylsiloxane vinyl terminated at various viscosity and a range of platinum- mono, di, tri and/or tetramethyldisiloxane complex.

Abstract

L'invention concerne des méthodes et des dispositifs adaptés pour maintenir une ouverture dans une paroi d'un organe du corps pour une durée prolongée. Cette invention concerne plus particulièrement des dispositifs et des méthodes permettant de maintenir la perméabilité de canaux qui modifient le flux gazeux dans un poumon de manière à améliorer le cycle d'expiration, par exemple, d'un individu atteint d'une maladie pulmonaire obstructive chronique.
PCT/US2005/025738 2001-09-04 2005-07-19 Methodes et dispositifs permettant de maintenir la permeabilite de canaux crees par intervention chirurgicale dans un organe du corps WO2006014731A2 (fr)

Priority Applications (4)

Application Number Priority Date Filing Date Title
EP05791123A EP1802365A4 (fr) 2004-07-19 2005-07-19 Methodes et dispositifs permettant de maintenir la permeabilite de canaux crees par intervention chirurgicale dans un organe du corps
AU2005269718A AU2005269718A1 (en) 2004-07-19 2005-07-19 Methods and devices for maintaining surgically created channels in a body organ
JP2007522700A JP2008506507A (ja) 2004-07-19 2005-07-19 体器官に外科的に作製されたチャネルを維持するための方法および器具
CA002577792A CA2577792A1 (fr) 2004-07-19 2005-07-19 Methodes et dispositifs permettant de maintenir la permeabilite de canaux crees par intervention chirurgicale dans un organe du corps

Applications Claiming Priority (13)

Application Number Priority Date Filing Date Title
US31733801P 2001-09-04 2001-09-04
US10/235,240 US20030070676A1 (en) 1999-08-05 2002-09-04 Conduits having distal cage structure for maintaining collateral channels in tissue and related methods
US10/458,085 US20040073155A1 (en) 2000-01-14 2003-06-09 Methods and devices for maintaining patency of surgically created channels in tissue
US10/895,273 US20050060042A1 (en) 2001-09-04 2004-07-19 Methods and devices for maintaining surgically created channels in a body organ
US10/895,010 US7462162B2 (en) 2001-09-04 2004-07-19 Antiproliferative devices for maintaining patency of surgically created channels in a body organ
US10/895,258 US20050060041A1 (en) 2001-09-04 2004-07-19 Methods and devices for maintaining surgically created channels in a body organ
US10/895,258 2004-07-19
US10/895,010 2004-07-19
US10/894,647 2004-07-19
US10/895,273 2004-07-19
US10/894,647 US7708712B2 (en) 2001-09-04 2004-07-19 Methods and devices for maintaining patency of surgically created channels in a body organ
US68684805P 2005-06-01 2005-06-01
US60/686,848 2005-06-01

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Cited By (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US7708712B2 (en) 2001-09-04 2010-05-04 Broncus Technologies, Inc. Methods and devices for maintaining patency of surgically created channels in a body organ
US7985187B2 (en) 2006-06-30 2011-07-26 Broncus Technologies, Inc. Airway bypass site selection and treatment planning
US9913969B2 (en) 2006-10-05 2018-03-13 Broncus Medical Inc. Devices for delivering substances through an extra-anatomic opening created in an airway
US10272260B2 (en) 2011-11-23 2019-04-30 Broncus Medical Inc. Methods and devices for diagnosing, monitoring, or treating medical conditions through an opening through an airway wall
US10631938B2 (en) 2011-05-13 2020-04-28 Broncus Medical Inc. Methods and devices for diagnosing, monitoring, or treating medical conditions through an opening through an airway wall

Families Citing this family (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8308682B2 (en) 2003-07-18 2012-11-13 Broncus Medical Inc. Devices for maintaining patency of surgically created channels in tissue
JP2014521381A (ja) 2011-05-13 2014-08-28 ブロンカス テクノロジーズ， インコーポレイテッド 組織の切除のための方法およびデバイス

Family Cites Families (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US7815590B2 (en) * 1999-08-05 2010-10-19 Broncus Technologies, Inc. Devices for maintaining patency of surgically created channels in tissue
US7803149B2 (en) * 2002-07-12 2010-09-28 Cook Incorporated Coated medical device
US20030153971A1 (en) * 2002-02-14 2003-08-14 Chandru Chandrasekaran Metal reinforced biodegradable intraluminal stents
DE60303705T2 (de) * 2002-05-14 2006-10-19 Terumo K.K. Beschichteter Stent für die Freisetzung aktiver Substanzen

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
See references of EP1802365A4 *

Cited By (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US7708712B2 (en) 2001-09-04 2010-05-04 Broncus Technologies, Inc. Methods and devices for maintaining patency of surgically created channels in a body organ
US10369339B2 (en) 2004-07-19 2019-08-06 Broncus Medical Inc. Devices for delivering substances through an extra-anatomic opening created in an airway
US11357960B2 (en) 2004-07-19 2022-06-14 Broncus Medical Inc. Devices for delivering substances through an extra-anatomic opening created in an airway
US7985187B2 (en) 2006-06-30 2011-07-26 Broncus Technologies, Inc. Airway bypass site selection and treatment planning
US8668652B2 (en) 2006-06-30 2014-03-11 Broncus Medical Inc. Airway bypass site selection and treatment planning
US9913969B2 (en) 2006-10-05 2018-03-13 Broncus Medical Inc. Devices for delivering substances through an extra-anatomic opening created in an airway
US10631938B2 (en) 2011-05-13 2020-04-28 Broncus Medical Inc. Methods and devices for diagnosing, monitoring, or treating medical conditions through an opening through an airway wall
US10272260B2 (en) 2011-11-23 2019-04-30 Broncus Medical Inc. Methods and devices for diagnosing, monitoring, or treating medical conditions through an opening through an airway wall

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