WO2015013590A1 - Devices, systems and methods for performing atherectomy and subsequent balloon angioplasty without exchanging devices - Google Patents
Devices, systems and methods for performing atherectomy and subsequent balloon angioplasty without exchanging devices Download PDFInfo
- Publication number
- WO2015013590A1 WO2015013590A1 PCT/US2014/048153 US2014048153W WO2015013590A1 WO 2015013590 A1 WO2015013590 A1 WO 2015013590A1 US 2014048153 W US2014048153 W US 2014048153W WO 2015013590 A1 WO2015013590 A1 WO 2015013590A1
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- inflatable balloon
- drive shaft
- lumen
- inflated
- catheter
- Prior art date
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/3205—Excision instruments
- A61B17/3207—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions
- A61B17/320758—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions with a rotating cutting instrument, e.g. motor driven
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B2017/320004—Surgical cutting instruments abrasive
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/10—Balloon catheters
- A61M2025/1043—Balloon catheters with special features or adapted for special applications
- A61M2025/105—Balloon catheters with special features or adapted for special applications having a balloon suitable for drug delivery, e.g. by using holes for delivery, drug coating or membranes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/10—Balloon catheters
- A61M2025/1043—Balloon catheters with special features or adapted for special applications
- A61M2025/1068—Balloon catheters with special features or adapted for special applications having means for varying the length or diameter of the deployed balloon, this variations could be caused by excess pressure
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/10—Balloon catheters
- A61M25/104—Balloon catheters used for angioplasty
-
- 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
- A61M29/00—Dilators with or without means for introducing media, e.g. remedies
- A61M29/02—Dilators made of swellable material
Definitions
- the present disclosure generally relates to methods, devices and systems relating to removing occlusions from vessels. More specifically, the present invention comprises providing a balloon
- a variety of techniques and instruments have been developed for use in the removal or repair of tissue in arteries and similar body passageways, e.g., biological conduits.
- a frequent objective of such techniques and instruments is the removal of atherosclerotic plaques in a patient's arteries.
- Atherosclerosis is characterized by the buildup of fatty deposits (atheromas) in the intimal layer (under the endothelium) of a patient's blood vessels. Very often over time, what initially is deposited as relatively soft, cholesterol-rich atheromatous material hardens into a calcified atherosclerotic plaque.
- Such atheromas restrict the flow of blood, and therefore often are referred to as stenotic lesions or stenoses, the blocking material being referred to as stenotic material. If left untreated, such stenoses can cause angina, hypertension, myocardial infarction, strokes and the like.
- the present invention is directed in various methods, devices and systems relating to providing a balloon on a sheath in combination with orbital atherectomy in order reduce the number of steps in the procedure.
- the balloon comprises adjunctive low pressure balloon for prevention of vessel trauma during dilatation.
- FIG. 1 illustrates a perspective view of one embodiment of the present invention
- FIG. 2 illustrates a front view of one embodiment of the present invention
- FIG. 3 illustrates a side view of one embodiment of the present invention
- FIG. 4 illustrates a cutaway side view of one embodiment of the present invention
- FIG. 5 illustrates a side view of one embodiment of the present invention.
- FIG. 6 illustrates a front view of one embodiment of the present invention.
- FIG. 1 illustrates an exemplary rotational atherectomy device of the invention.
- the device includes a handle portion 10, an elongated, flexible drive shaft 20 having an abrasive section 28, as will be readily understood by the skilled artisan, and an elongated catheter 13 extending distally from the handle portion 10.
- the abrasive section 28 is disposed on the drive shaft 20.
- the catheter 13 has a lumen in which the length of the drive shaft 20 may be disposed, including, in certain embodiments, the abrasive section 28 and, when present, a short section distal to the abrasive section 28.
- the drive shaft 20 also contains an inner lumen, permitting the drive shaft 20 to be advanced and rotated over a guide wire 15.
- a fluid supply line 17 may be provided for introducing a cooling and lubricating solution (typically saline or another biocompatible fluid) into the catheter 13 from a cooling and lubrication solution reservoir (not shown but as well understood by the skilled artisan).
- a separate inflation media reservoir 19 may be included for providing inflation media, preferably saline, to an inflatable balloon 100 on the tip of the catheter 13.
- the handle 10 desirably contains an electric motor (or similar rotational drive mechanism, e.g., a turbine) for rotating the drive shaft 20 at low or high speeds.
- the handle 10 typically may be connected to a power source, such as compressed air delivered through a tube 16.
- a pair of fiber optic cables 25 may also be provided for monitoring the speed of rotation of the turbine and drive shaft 20. Details regarding such handles and associated instrumentation are well known in the industry.
- the handle 10 also desirably includes a control knob 11 for advancing and retracting the electric motor, or equivalent, and the drive shaft 20 with respect to the catheter 13 and the body of the handle.
- the inflatable balloon 100 mounted on the tip of catheter 13 allows for rotational atherectomy to proceed with abrasive section 28, followed by advancement of the catheter 13 such that the inflatable balloon is within the treatment region of the vessel.
- Balloon 100 is illustrated in the various Figures as attached to outer surface of catheter 13 and as completely surrounding the outer surface of catheter 13 and this is the preferred embodiment. However, the skilled artisan will recognize that alternate embodiments may be provided to achieve the requisite dilatation. Inflation of the balloon 100 by introduction of the inflation media from inflation reservoir 19 is accomplished as is well understood by the skilled artisan to achieve dilatation of the treatment region post-afherectomy procedure. Such an arrangement eliminates the need to withdraw the atherectomy device and, subsequently, advance a balloon device back to the treatment site for dilatation. Thus, embodiments of the present invention eliminates the need for the extra time to remove the atherectomy device and insert and position a balloon. In addition, radiopaque dye and subsequent radiation exposure will be reduced.
- catheter 13 may comprise two lumens such as illustrated in Figure 2.
- Catheter 13 of Figure 2 comprises a drive shaft lumen 102 wherein the drive shaft 20 is rotatable and translatable.
- Catheter 13 also comprises an inflation medium lumen 104.
- Inflation medium lumen 104 is in fluid communication with inflation medium reservoir 19 and inflatable balloon 100, serving as the conduit for inflation medium, e.g., saline, to be controllably moved through lumen 104 from the reservoir 19 to the inflatable balloon 100 by means that are well known to the skilled artisan.
- a system according to Figures 1 and 2 may comprise:
- a rotatable drive shaft having an abrasive section and means for rotating and translating the drive shaft;
- a drive shaft lumen wherein the drive shaft is rotatable and translatable; and an inflation lumen separated from the drive shaft lumen;
- an inflation media reservoir comprising an inflation medium, wherein the inflation lumen is in fluid communication with the inflation lumen and the inflatable balloon, and wherein a portion of the inflatable balloon may be pulled proximally within the drive shaft lumen to adjust the length of the inflated balloon exposed outside of the drive shaft lumen.
- Figure 3 provides an alternative embodiment wherein the device of Figures 1 and 2 further comprises sheath 200 having a lumen therethrough 202.
- Catheter 13 with balloon 100 disposed on or near catheter's distal tip, is rotatably and translatably disposed within lumen 202.
- Catheter 13 further comprises drive shaft lumen 102 and inflation media lumen 104, which is in fluid communication with inflation media reservoir 19 and inflation balloon 100 as shown and discussed in connection with Figures 1 and 2.
- Drive shaft 20 is, as also discussed above, rotatably and translatably disposed within drive shaft lumen 102.
- sheath 200 with both drive shaft 20 and catheter 13 drawn proximally into lumen 202, both being collinear, may be advanced to a point proximal of the treatment region, e.g., occlusion.
- Distal advancement of the drive shaft 20 allows distal translation of the drive shaft 20 and the abrasive section 28 (shown in Figure 3 as an exemplary eccentric abrasive crown) out of lumen 202 and, in certain embodiments, out of the drive shaft lumen 102 of catheter 13. This allows the operator to initiate and complete the rotational atherectomy procedure using the exemplary eccentric abrasive crown.
- the operator may simply advance catheter 13 so that the inflatable balloon 100 is positioned within the treatment region and initiate dilatation of same.
- the drive shaft 20 and exemplary abrasive crown may be left in place during dilatation or, alternatively, may be proximally translated into the drive shaft lumen 102.
- the balloon 100 is deflated and catheter 13 and drive shaft 20 are once again moved proximally into the lumen 202 of sheath 200 for removal.
- a further use of lumen 202 may comprise dye or drug injection into the lumen at the localized treatment region, thereby eliminating the need for long introducers or settling for diffuse dye coverage or drug uptake.
- Figure 4 provides a variation of the collinear device illustrated in Figure 3, wherein sheath 200 may be used to adjust the inflated length of the inflatable balloon 100.
- catheter 13 is drawn proximally into lumen 202 so that at least a portion of the inflated balloon 100 is pulled within lumen 202, thereby shortening the overall length of exposure of inflated balloon 100 to the vessel wall.
- sheath 200 may be advanced distally to enable movement of at least a portion of the balloon to enter lumen 202.
- the length that the inflated balloon is shortened by the process of Figure 4 is equal to the length of the balloon that is pulled within the lumen 202.
- Lumen 202 may also be used to deploy self-expanding stents, stent graphs or distal filters.
- a system according to the embodiment of Figure 4 may comprise:
- a system for atherectomy and subsequent dilatation comprising:
- a rotatable drive shaft having an abrasive section and means for rotating and translating the drive shaft;
- a drive shaft lumen wherein the drive shaft is rotatable and translatable; and an inflation lumen separated from the drive shaft lumen;
- an inflation media reservoir comprising an inflation medium, wherein the inflation lumen is in fluid communication with the inflation lumen and the inflatable balloon;
- a sheath having a lumen therethrough, wherein the catheter and drive shaft are collinear with the sheath and wherein the catheter is rotatable and translatable within the sheath, wherein a portion of the inflatable balloon may be pulled proximally within the lumen of the sheath to adjust the length of the inflated balloon exposed outside of the lumen of the sheath.
- FIG. 5 provides another embodiment wherein the inflatable balloon 100 and drive shaft 20 are not collinear.
- sheath 200 comprises at least two separate lumens as illustrated in Figure 6: a drive shaft lumen 602 wherein the drive shaft and abrasive section 28 (illustrated as exemplary eccentric abrasive crown) are rotatably and translatably disposed; and an inflatable balloon lumen 610 wherein the balloon catheter and inflatable balloon affixed to the distal end of the balloon catheter, are rotatably and translatably disposed.
- sheath 200 is positioned proximal to the treatment region, e.g., the occlusion, with balloon catheter and balloon 100 and drive shaft 20 and abrasive crown disposed within lumens 610 and 602, respectively.
- the operator may extend the drive shaft 20 distally and out of the drive shaft lumen 602 to accomplish the rotational
- the drive shaft 20 and exemplary abrasive crown may be proximally pulled back into drive shaft lumen 602.
- the operator may extend the balloon catheter and balloon 100 distally and out of the balloon lumen 610 to the treatment region to inflate balloon 100 as described above and accomplish the required dilatation.
- dilatation the operator deflates the balloon and withdraws the now-deflated balloon proximally into the balloon lumen 610 for removal.
- Figure 5 illustrates the distal portion of the sheath 200 as comprising a partial cutaway section. Other embodiments of sheath 200 do not include this partially cutaway section and comprise sheath 200 as illustrated in Figures 3 and 4.
- the balloon 100 may be micro-porous to enable delivery of a therapeutic agent to the vessel wall, e.g., an anti-restinosis agent.
- the balloon may also be coated with a drug for delivery of the therapeutic agent to the vessel wall.
- the balloon 100 of the present invention when used for low-pressure dilatation comprises an acceptable fluid loss during the inflation cycle. Stent deployment may be an option in all embodiments described herein relating to balloon inflation.
- Atherectomy procedures are followed up with a balloon procedure to remodel the artery and to provide a larger lumen internal diameter (ID).
- ID lumen internal diameter
- Rotational atherectomy allows for subsequent low-pressure balloon dilatations.
- Low- pressure balloon dilatations of, e.g., 2 to 4 atmospheres of pressure are much less traumatic to the vessel wall than the more typical 10 to 13 atmospheres of pressure.
- a preferred low- pressure balloon range using the devices and methods of the present invention comprises 1 to 8 atmospheres, a more preferred range comprises 2 to 6 atmospheres, and a still more preferred range comprises 2 to 4 atmospheres of pressure.
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- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Surgery (AREA)
- Heart & Thoracic Surgery (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Biomedical Technology (AREA)
- Veterinary Medicine (AREA)
- Engineering & Computer Science (AREA)
- Public Health (AREA)
- Vascular Medicine (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Surgical Instruments (AREA)
- Child & Adolescent Psychology (AREA)
- Biophysics (AREA)
- Pulmonology (AREA)
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Abstract
Description
Claims
Priority Applications (5)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
CN201480042326.9A CN105407818A (en) | 2013-07-26 | 2014-07-25 | Devices, systems and methods for performing atherectomy and subsequent balloon angioplasty without exchanging devices |
EP14829772.4A EP3024402A4 (en) | 2013-07-26 | 2014-07-25 | Devices, systems and methods for performing atherectomy and subsequent balloon angioplasty without exchanging devices |
JP2016530065A JP2016529968A (en) | 2013-07-26 | 2014-07-25 | Apparatus, system and method for performing atherectomy and subsequent balloon angioplasty without replacing the apparatus |
AU2014292933A AU2014292933A1 (en) | 2013-07-26 | 2014-07-25 | Devices, systems and methods for performing atherectomy and subsequent balloon angioplasty without exchanging devices |
CA2918432A CA2918432A1 (en) | 2013-07-26 | 2014-07-25 | Devices, systems and methods for performing atherectomy and subsequent balloon angioplasty without exchanging devices |
Applications Claiming Priority (6)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US201361858881P | 2013-07-26 | 2013-07-26 | |
US61/858,881 | 2013-07-26 | ||
US201361861041P | 2013-08-01 | 2013-08-01 | |
US61/861,041 | 2013-08-01 | ||
US14/339,933 | 2014-07-24 | ||
US14/339,933 US20150080795A1 (en) | 2013-07-26 | 2014-07-24 | Devices, systems and methods for performing atherectomy and subsequent balloon angioplasty without exchanging devices |
Publications (1)
Publication Number | Publication Date |
---|---|
WO2015013590A1 true WO2015013590A1 (en) | 2015-01-29 |
Family
ID=52393861
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/US2014/048153 WO2015013590A1 (en) | 2013-07-26 | 2014-07-25 | Devices, systems and methods for performing atherectomy and subsequent balloon angioplasty without exchanging devices |
Country Status (7)
Country | Link |
---|---|
US (1) | US20150080795A1 (en) |
EP (1) | EP3024402A4 (en) |
JP (1) | JP2016529968A (en) |
CN (1) | CN105407818A (en) |
AU (1) | AU2014292933A1 (en) |
CA (1) | CA2918432A1 (en) |
WO (1) | WO2015013590A1 (en) |
Cited By (4)
Publication number | Priority date | Publication date | Assignee | Title |
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US10869689B2 (en) | 2017-05-03 | 2020-12-22 | Medtronic Vascular, Inc. | Tissue-removing catheter |
US11690645B2 (en) | 2017-05-03 | 2023-07-04 | Medtronic Vascular, Inc. | Tissue-removing catheter |
US11819236B2 (en) | 2019-05-17 | 2023-11-21 | Medtronic Vascular, Inc. | Tissue-removing catheter |
US12114887B2 (en) | 2021-07-02 | 2024-10-15 | Medtronic Vascular, Inc. | Tissue-removing catheter with guidewire isolation liner |
Families Citing this family (10)
Publication number | Priority date | Publication date | Assignee | Title |
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US9788853B2 (en) | 2014-01-15 | 2017-10-17 | Cardio Flow, Inc. | Atherectomy devices and methods |
EP3957259B1 (en) | 2014-03-12 | 2023-09-27 | Boston Scientific Limited | Infusion lubricated atherectomy catheter |
US10405879B2 (en) | 2014-12-04 | 2019-09-10 | Boston Scientific Scimed, Inc. | Rotatable medical device |
US10639062B2 (en) | 2016-04-06 | 2020-05-05 | Cardio Flow, Inc. | Atherectomy devices and methods |
US10441312B2 (en) | 2017-02-23 | 2019-10-15 | Cardio Flow, Inc. | Atherectomy devices and methods |
US10463390B1 (en) | 2018-05-24 | 2019-11-05 | Cardio Flow, Inc. | Atherectomy devices and methods |
US11147582B2 (en) | 2018-06-14 | 2021-10-19 | Cardio Flow, Inc. | Atherectomy devices and methods |
WO2020033260A1 (en) | 2018-08-07 | 2020-02-13 | Cardio Flow, Inc. | Atherectomy devices and methods |
EP4434477A2 (en) | 2018-11-16 | 2024-09-25 | Medtronic Vascular Inc. | Tissue-removing catheter |
US12004771B1 (en) | 2023-06-27 | 2024-06-11 | Cardio Flow, Inc. | Rotational atherectomy devices and methods |
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- 2014-07-24 US US14/339,933 patent/US20150080795A1/en not_active Abandoned
- 2014-07-25 JP JP2016530065A patent/JP2016529968A/en active Pending
- 2014-07-25 WO PCT/US2014/048153 patent/WO2015013590A1/en active Application Filing
- 2014-07-25 CN CN201480042326.9A patent/CN105407818A/en active Pending
- 2014-07-25 CA CA2918432A patent/CA2918432A1/en not_active Abandoned
- 2014-07-25 AU AU2014292933A patent/AU2014292933A1/en not_active Abandoned
- 2014-07-25 EP EP14829772.4A patent/EP3024402A4/en not_active Withdrawn
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Also Published As
Publication number | Publication date |
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CA2918432A1 (en) | 2015-01-29 |
EP3024402A4 (en) | 2017-03-01 |
AU2014292933A1 (en) | 2016-02-11 |
CN105407818A (en) | 2016-03-16 |
JP2016529968A (en) | 2016-09-29 |
US20150080795A1 (en) | 2015-03-19 |
EP3024402A1 (en) | 2016-06-01 |
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