CA2392207A1 - Systems and methods for clot disruption and retrieval - Google Patents

Systems and methods for clot disruption and retrieval Download PDF

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Publication number
CA2392207A1
CA2392207A1 CA002392207A CA2392207A CA2392207A1 CA 2392207 A1 CA2392207 A1 CA 2392207A1 CA 002392207 A CA002392207 A CA 002392207A CA 2392207 A CA2392207 A CA 2392207A CA 2392207 A1 CA2392207 A1 CA 2392207A1
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CA
Canada
Prior art keywords
macerator
catheter
lumen
distal end
wire
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Granted
Application number
CA002392207A
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French (fr)
Other versions
CA2392207C (en
Inventor
Denise Demarais
Michael A. Evans
Stephen A. Leeflang
Christian S. Eversull
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Covidien LP
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Individual
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Filing date
Publication date
Application filed by Individual filed Critical Individual
Priority to CA2690259A priority Critical patent/CA2690259A1/en
Publication of CA2392207A1 publication Critical patent/CA2392207A1/en
Application granted granted Critical
Publication of CA2392207C publication Critical patent/CA2392207C/en
Anticipated expiration legal-status Critical
Expired - Fee Related legal-status Critical Current

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
    • A61B17/320725—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions with radially expandable cutting or abrading elements
    • 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
    • A61M25/0021—Catheters; Hollow probes characterised by the form of the tubing
    • A61M25/0023—Catheters; Hollow probes characterised by the form of the tubing by the form of the lumen, e.g. cross-section, variable diameter
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00681—Aspects not otherwise provided for
    • A61B2017/00685—Archimedes screw
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B17/221—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions
    • A61B2017/2212—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions having a closed distal end, e.g. a loop
    • 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
    • A61B2017/320775—Morcellators, impeller or propeller like means
    • 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
    • A61F2/01—Filters implantable into blood vessels
    • A61F2002/016—Filters implantable into blood vessels made from wire-like elements
    • 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
    • A61F2/01—Filters implantable into blood vessels
    • A61F2002/018—Filters implantable into blood vessels made from tubes or sheets of material, e.g. by etching or laser-cutting
    • 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
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0063—Three-dimensional shapes
    • A61F2230/0067—Three-dimensional shapes conical
    • 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
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0063—Three-dimensional shapes
    • A61F2230/0073—Quadric-shaped
    • A61F2230/0076—Quadric-shaped ellipsoidal or ovoid
    • 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
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0063—Three-dimensional shapes
    • A61F2230/0093—Umbrella-shaped, e.g. mushroom-shaped

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • Veterinary Medicine (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Public Health (AREA)
  • Engineering & Computer Science (AREA)
  • General Health & Medical Sciences (AREA)
  • Vascular Medicine (AREA)
  • Hematology (AREA)
  • Anesthesiology (AREA)
  • Surgery (AREA)
  • Biophysics (AREA)
  • Pulmonology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Surgical Instruments (AREA)

Abstract

Occlusive material, notably thrombus or clot, can block body cavities.
Treatment requires disrupting, collecting and removing the material. A catheter for removing occlusive material from a body lumen is provided that has a catheter body having a proximal end, a distal end, and a lumen therethrough, a radially expansible positioning cage near the distal end of the catheter body, and a radially expansible macerator configured to break up occlusive material within the cage and draw the material into the catheter body lumen.
The macerator includes a shaped wire having a spiral geometry.

Claims (36)

1. A catheter for removing occlusive material from a body lumen, said catheter comprising:
a catheter body having a proximal end, a distal end, and a lumen therethrough;
a radially expansible positioning cage near the distal end of the catheter body; and a macerator configured to break up occlusive material within the cage and draw the material into the catheter body lumen.
2. A catheter as in claim 1, further comprising a mechanical pump component disposed within the catheter body lumen.
3. A catheter as in claim 2, wherein the mechanical pump component is adapted to rotate such that it moves occlusive material from the distal end to the proximal end of the catheter body within the lumen.
4. A catheter as in claim 1, further comprising means for selectively adjusting the diameter of the radially expansible positioning cage.
5. A catheter as in claim 1, wherein the radially expansible cage is self-expanding and has a predetermined unconstrained diameter.
6. A catheter as in any of claims 1 to 5, wherein the macerator is radially expansible.
7. A catheter as in claim 6, further comprising means for selectively adjusting the diameter of the macerator.
8. A catheter as in claim 6, wherein the macerator is self-expanding and has a predetermined unconstrained diameter.
9. A catheter as in claim 6, wherein the cage is expansible from an initial width in the range from 1 mm to 4 mm to an expanded width in the range from 2 mm to 40 mm and the macerator has an initial width in the range from 1 mm to 4 mm and an expanded width in the range from 2 mm to 40 mm.
10. A catheter as in claim 6, wherein adjustment of the radial dimension of the macerator is not coupled to expansion of the positioning cage.
11. A catheter as in claim 6, wherein the macerator is rotatable.
12. A catheter as in claim 11, further comprising a drive unit at the proximal end of the catheter body, wherein the drive unit is mechanically coupled to the macerator.
13. A macerator comprising:
a tubular shaft having a proximal end, a distal end, and at least one lumen therethrough;
a wire having a distal section terminating in a distal tip and proximal shank;
wherein the distal tip of the wire is attached to an exterior location near the distal end of the tubular shaft and wherein the proximal shank is slidably received in the lumen of the shaft so that the distal section of the wire can be radially expanded and contracted by axially translating the shank within the shaft.
14. A macerator as in claim 13, wherein the tubular shaft includes only a single lumen which extends the entire length of the shaft and wherein the wire passes into the lumen through a port in a side of the shaft.
15. A macerator as in claim 14, wherein the lumen has an internal diameter of at least 0.25 mm to accommodate both the wire and a guidewire.
16. A macerator as in claim 15, wherein the wire has a maximum diameter in the range from 0.05 mm to 1.3 mm.
17. A macerator as in claim 13, wherein the tubular shaft has at least two lumens, wherein the capture wire is received in a proximal portion of one lumen and the other lumen is configured to receive a guidewire.
18. A macerator as in claim 17, wherein the lumen which receives the capture wire terminates proximally of the distal end of the tubular shaft and wherein the lumen which receives the guidewire extends to the distal end of the shaft.
19. A macerator as in claim 18, wherein the lumen which receives the guidewire extends the entire length of the shaft.
20. A macerator as in claim 13, further comprising a helical rotor disposed over at least a portion of the tubular shaft, wherein said rotor is configured to act as a mechanical pump when the macerator is rotated about its axis.
21. A macerator comprising:
a tubular shaft assembly including:
(a) an outer tube having a proximal end, a distal end, and a lumen therethrough; and (b) an inner tube having a proximal end, a distal end, and a lumen therethrough, wherein the outer tube is slidably and/or rotatably received over the inner tube; and a wire capture coil having one end attached to the proximal end of the inner tube and another end attached to the proximal end of the outer tube, wherein the coil can be radially expanded and collapsed by rotating and/or axially translating the inner tube relative to the outer tube.
22. A macerator as in claim 19, further comprising a helical rotor disposed over at least a portion of the tubular shaft, wherein said rotor is configured to act as a mechanical pump when the macerator is rotated about its axis.
23. A method for removing occlusive material from a body lumen, said method comprising:
positioning a macerator so that it is spaced inwardly from a surrounding wall of the body lumen;
rotating the macerator to engage and disrupt clot without significant shearing; and withdrawing the disrupted clot from the body lumen.
24. A method as in claim 23, further comprising adjusting a width of the macerator.
25. A method as in claim 24, wherein the macerator is a shaped wire.
26. A method as in claim 25, wherein the width is adjusted by relative rotation of a pair of spaced-apart points on the wire.
27. A method as in claim 25, wherein the width is adjusted by relative axial adjustment of a pair of spaced-apart points on the wire.
28. A method as in claim 23, wherein positioning comprises expanding a positioning cage with the body lumen, wherein the macerator is located within the positioning cage.
29. A method as in claim 28, further comprising axially translating the rotating macerator within the positioning cage.
30. A method as in claim 28, wherein the macerator is rotated without axial movement.
31. A kit comprising:
a catheter having a rotatable macerator near a distal end thereof; and instructions for use according to the method of claim 23.
32. A catheter for removing occlusive material from a body lumen, said catheter comprising:
a catheter body having a proximal end, a distal end, and a lumen therethrough;
means for breaking-up occlusive material;
means for positioning said breaking-up means, said positioning means expansible over said breaking-up means near the distal end; and means for drawing said material proximally in the catheter body lumen.
33. A catheter as in claim 32, wherein said catheter body is axially flexible and wherein said drawing means comprises a pump component extending along said flexible catheter body lumen.
34. A catheter as in claim 32, further comprising a guidewire lumen extending proximally from adjacent the distal end.
35. A catheter as in claim 32, further comprising means for filtering luminal flow to inhibit movement of the material axially within the body lumen, the filtering means radially expansible and disposed near the distal end.
36. A catheter as in claim 32, further comprising means for blocking lumenal flow, the blocking means radially expansible and disposed near the distal end.
CA2392207A 1999-12-06 2000-11-28 Systems and methods for clot disruption and retrieval Expired - Fee Related CA2392207C (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
CA2690259A CA2690259A1 (en) 1999-12-06 2000-11-28 Systems and methods for clot disruption and retrieval

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
US09/454,517 1999-12-06
US09/454,517 US6454775B1 (en) 1999-12-06 1999-12-06 Systems and methods for clot disruption and retrieval
PCT/US2000/032412 WO2001039673A1 (en) 1999-12-06 2000-11-28 Systems and methods for clot disruption and retrieval

Related Child Applications (1)

Application Number Title Priority Date Filing Date
CA2690259A Division CA2690259A1 (en) 1999-12-06 2000-11-28 Systems and methods for clot disruption and retrieval

Publications (2)

Publication Number Publication Date
CA2392207A1 true CA2392207A1 (en) 2001-06-07
CA2392207C CA2392207C (en) 2010-04-13

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CA2392207A Expired - Fee Related CA2392207C (en) 1999-12-06 2000-11-28 Systems and methods for clot disruption and retrieval
CA2690259A Abandoned CA2690259A1 (en) 1999-12-06 2000-11-28 Systems and methods for clot disruption and retrieval

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US (3) US6454775B1 (en)
EP (1) EP1237488A4 (en)
JP (1) JP2004500171A (en)
AU (1) AU781613B2 (en)
CA (2) CA2392207C (en)
WO (1) WO2001039673A1 (en)

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US6945977B2 (en) 2005-09-20

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