CA2459002A1 - A catheter positioning device - Google Patents

Abstract

A catheter positioning system comprises a guide catheter extension (24) adapted to co-operate with a guide catheter, a catheter positioning device (21, 22, A) adapted to engage a catheter and guide the catheter within the guide catheter extension (24), wherein the guide catheter extension (24) further comprises a plurality of engagement means (32) for fixing the relative points of the guide catheter extension and the positioning device at any one of a number of positions over its length and a guide catheter extension (24) capable of receiving a catheter, comprising a substantially rigid tubular section (27) capable of sealing engagement within a compression fitting (29) of the guide catheter.

Description

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Field of the lnventivn The present invention relates to medical devices for controlling the positioning of an infra vascular catheter device. In particular, the present invention is concerned with a positioning device forrelative positioning of lumen in a multi-lumen intravascular catheter.
Background to the Invention 1D The human vascular system may suffer from a number of problems. These may broadly be characterised as cardiovascular and peripheral vascular disease.
Among the types of disease, atherosclerosis is a particular problem.
Atheroscierotic plaque can develop in a patient's cardiovascular system. The plaque can be quite extensive and vcGude.a substantial length ofthe vessel. Additionally, the plaque may be inflamed and unstable, such plaque being subject to rupture, erosion or ulce!-ation which can cause the patient to experience a myocardial infarction, thrombosis yr other traumatic and unwanted effects.
Our cv-pending International Application No. PCTIEP01~04401 discloses a vascular catheter apparatus for temperature measurement of vascular tissue.
' z o Imporkantly, it has been reported that unstable and inflamed plaque can cause the temperature of the artery waif to elevate up to 2.5°C proximate the inflamed plaque.
With the vascular catheter apparatus described in PCTIEP01I04401, detection of the temperature at the vascular wall is enabled. 'The temperature information ~ is subsequently transferred via the carrierto a remote device where the wall temperature can be detected arid recarded_ The device is able to locate inflamed plaque by monitoring the vascular wall tar elevated temperatures. This may be achieved by measuring temperature relative to normal segments of a vessel or absolute temperature values.
The tharmography catheter is inserted into the target tissue using usual catheterisation techniques. This usually involves the use of a guide catheter.
Problems associated with systems inGVrporating a guide catheter include its relative positioning with respect to the catheter. For example, where it is desired tp deliver a catheter to the coronary arteries, the guide catheter is maneuvered .to the opening of the coronary arteries by a physician, in order that the catheter may be AMENDED SHEET°
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2 introduced to the coronary arteries. A problem may arise when the catheter is moved in the coronary arteries. As the physician tries to maneuver the catheter in the cardiac tissue, this may cause the guide catheter to be pushed away from the entrance to the coronary artery, consequently causing the catheter to be dragged out of the coronary artery. This problem is exaggerated where mufti-lumen catheters are employed, such as the thermography catheter described in PCT/EP01104401.
In orderto accurately identify regions of unstable plaque, the vascular catheter apparatus described in PCT/EP01104401 is controlled by a positioning device, referred to as a pull-back device. The pull-back device includes a number of lumen mounts that can be selectively connectable to a drive mechanism that can be used to manipulate and maneuver a catheter within a guide catheter and cardiac tissue.
A
guide catheter mount is fixed relative to the patient so that the guide catheter, once in position, does not move relative to the patient.
A problem associated with such a system is that the length of guide catheter remaining outside the patient is dependent on the size of the patient. For example, interventional cardiovascular treatment of a large patient will leave a shorter length of guide catheterand catheteroutside the patient than treatment of the equivalent region in a smaller patient. Furthermore, the relative length of catheter to guide catheter left outside the patient for treatment of different regions, eg. peripheral heart tissue rather 2 o than the main coronary arteries, will differ. This poses a problem as, in use, the guide catheter and catheter must both be fixed to the positioning device in what is a fixed relative separation dictated by the physical dimensions of the positioning device and the lumen mounts.
Summary of the Invention According to a first aspect of the invention, a catheter positioning system comprises a guide catheter extension adapted to co-operate with a guide catheter, a catheter positioning device adapted to engage a catheter and guide the catheter within the guide catheter extension, wherein the guide catheter extension further

3 0 comprises a plurality of engagement means for engaging the positioning device and thereby fixing the relative positions of the guide catheter extension and the positioning device at any one of a number of positions over its length.
The present invention allows the distance between a guide catheter and a positioning device to be manipulated by the user. Thus the guide catheter may be fixed in position relative to both patient and positioning device, while providing the optimum distance between the effective length of the guide catheter (guide catheter and guide catheter extension) and the points at which the catheter is fixed to the positioning device.
The guide catheter extension of the present invention is adapted to receive a catheter used in interventional cardiology. Preferably, the body of the guide catheter extension_is substantially cylindrical in cross section and has a diameter in the range of 1-15 mm. Preferably the diameter is in the range of 2-10 mm, more preferably 3-7 mm. Preferably, the length of the guide catheter extension is in the range of 0.1 m to 1 m. More preferably, the length of the guide catheter extension is 0.15-0.5 m.
The body of the guide catheter extension may be formed from standard guide catheter materials. For example nylon, PTFE, polyurethane, polyethylene and nitinol and mixtures thereof may be used. It may also be made from metals such as aluminium, steel and alloys thereof.
The guide catheter extension preferably has a number of points adapted for engagement with the catheter positioning device. Notches, annular indentations, and any other suitable means may be used. Preferably there are 2-200 fixation points, more preferably 5-100, most preferably 10-50 fixation points. These engagement means enable the guide catheter extension to be fixed in place, at selected positions 2 0 over its length, on the catheter positioning device.
The guide catheter extension comprises a distal and a proximal end.
Preferably, the distal end is adapted for engagementwith the guide catheter, while the proximal end is adapted for engagement with the catheter positioning device.
According to a second aspect of the present invention, there is provided a guide catheter extension for a guide catheter having a proximal end and a distal end, the guide catheter extension being capable of receiving a catheter and comprising a substantially rigid tubular section capable of sealing engagement within a compression fitting of the guide catheter provided at the proximal end of the guide catheter.
3 o Where positioning of the catheter, therefore translationai movementwithin the vascular tissue (therefore also within the guide catheter and guide catheter extension) is required, the arrangement allows the junction between the guide catheter extension and guide catheter to be sealed by tightening the compression fitting, but does not allow the junction to impinge on the catheter within. The seal is preferably achieved

4 by providing a sealing element in the guide catheter extension which forms a low friction, slidable seal with the sheath of the catheter. Thus the catheter is able to be moved and positioned within the apparatus without undue friction being applied to the catheter. This is particularly important as a Y-piece, in addition to being used as the injection point for contrast medium into the patient, is also used as a pressure measurement point during the interventional procedure. In order for the pressure of the patient to_be_celiab(y_measured,~the system-_must._be substantially _closed, otherwise the pressure will vent at a non closed section. ' This will lead to loss of pressure, loss of blood, and unreliable pressure readings. However, the present system maintains the pressure of the system as the guide catheter and guide catheter extension junction is sealed and the diameter of the catheter is generally slightly less than the diameter of the internal lumen of the guide catheter extension.
Alternatively, the pressure is maintained by providing the above mentioned sealing element in the guide catheter which forms a low friction, slidable seal with the sheath of the catheter.
Most preferably, the distal end of the guide catheter extension is adapted for engagement with a standard Y-piece used in interventional cardiology, having a compression fitting. This substantially prevents loss of blood or fluid at the junction between the guide catheter and the guide catheter extension.
In a most preferred embodiment, the distal end of the guide catheter extension 2 0 comprises a substantially rigid tubular section which is fixed to a flexible section, and which is co-axial therewith. The rigid tubular section may be integrally moulded with the flexible section. Alternatively, it is fixed to the flexible section by any suitable means, for example, glue, soldering, welding and the like.
The catheter positioning device is preferably a type for positioning a catheter and comprises a first lumen mount for holding a first lumen of the catheter, a second lumen mount for holding the guide catheter extension, and a drive mechanism, wherein the first lumen mount is selectively connectable to the drive mechanism for relative movement with respect to the second lumen mount.
The second lumen mount preferably includes a bracket, preferably adapted for 3 o engagement with the guide catheter extension. The bracket is usually located at one end of an extension arm, while the other end is connected to the body of the positioning device.
In a preferred embodiment, the positioning device is a pull-back device which is used for positioning and/or controlled withdrawal of a catheter.

5 PCT/EP02/09430 In a particularly preferred embodiment, the present invention is used in concert with a vascular catheter apparatus, especially multi-lumen and/or sheathed catheters;
which require precise positioning and or maneuvering within vascular tissue.
For example, the present invention finds particular utility with catheters used for 5 measurement of a physical parameter and/or treatment of vascular tissue, and which comprise a flexible body, and at least one sensor and/or treatment means.
-Treatment means include those-usuall-y used in inter_venfiional cardiology, such as ablation apparatus (for example electrodes), drug delivery ports, tissue removal apparatus, scents and scent positioning means (for example, balloons or sleeves) and 1 o the like.
In a particularly preferred embodiment, the present invention is used in concert with a vascular catheter apparatus, preferably a catheter apparatus comprising a body, at least one resiliently biased projection depended from the body, a sensor carried by the projection, and an electrical carrier connected to the sensor for l5 . transmitting data from the sensor to a remote device, wherein the electrical carrier is coiled. Such a device is described in our earlier filed European patent application no.
01306599.0 In this embodiment, the electrical connection is coiled to reduce the strain at critical points where it is necessary to maintain a seal, and hence electrical isolation. The design is also especially suitable for use with a vascular thermography .
2 o catheter apparatus of the type described in our earlier filed International patent application no. PCT/EP01/04401.
Preferably, the electrical carrier is coiled around the body of the projection.
Preferably, the pitch of the coil is arranged such that there are 5 to 10 turns per cm.
2 5 Preferably, a heat shrink wrapping is applied over at least a portion of the length of the projection. A heat shrink material is generally a polymeric material capable of being reduced in size upon application of heat. These are generally used in the form of a tube. Suitable materials include polyesters, PVC, polyolefins, PTFE
and the like. The preferred material is a polyester.
3 o Generally, the thermography catheter comprises a plurality of co-axial lumen.
Preferably, the thermography catheter comprises a central lumen adapted to be mounted on a standard angioplasty guide wire suitable for vascular intervention. The apparatus is preferably based on the rapid-exchange orthe monorail system, although over-the-wire techniques are also envisaged. Preferably, outside the central lumen 2 r~0or~ ' ' CA 02459002 2004-02-27 ~~O.ZO~~3~
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6 is located an intermediate lumen. Preferably, outside the intermediate lumen is mounted an external lumen, hereinafter ro(erred to as a sheath. Preferably, at the distal tip of the apparatus is a guide member. Other lumen may be present and all the lumen may house components within themselves or between adjacent lumen. .
The projection is preferably mounted on the central or intermediate lumen but ma_ y be attached to any lumen inside the sheath.
The central lumen may be formed from the standard catheter Lumen materials, for example, nylon, FEP, polyurethane, polyethylene and nitinol and mixtures thereof.
The intermediate lumen and the sheath are generally construcked from, but s o individually selected from, the standard catheter lumen materials discussed above.
The sheath is adapted to fit ever the adjacent lumen housed inside the sheath and should be able to move relative to the adjacent lumen under the control of a remote device.
Preferably, the central and intermediate lumen are bound to one another and 1S are not moveable relative to one another Preferably, the flexible body of the catheter has a longitudinal axis and at least part of the projections are extensible radialty from the longitudinal ~aacis of the body.
Generally, the projection$ have an elongate shape, preferably having dimensions in the range of 2 mm to 15 mm, mare preferably 3 to 7 mm in length. The projections 2 o preferably have a caliper of 0.3 mm to 5 mrn, more preferably 0,5 mm to 3 mn7.
A first end of the projection is preferably attached to the body, preferably the intermediate andlor the central lumen, while a second end comprises one yr more sensors. The second end is preferably free, ie, not attached to any of the lumen, and is adapted to be radially movable away from the central lumen.
~25 Twv or more sensors, preferably 2 to 10 sensors, more preferably 2 to 6 sensors may be utilised in the catheter apparatus. Preferably, each sensor is mounted on a separate projectivn_ In a particularly preferred example, four projections, each having a single sensor mounted thereon, are provided.
The sensors are preferably located on an outer face of the projection, n:lative 3 o the central lumen, ie., facing the vascular tissue in use. Each sensor should preferably be located toward, ar at the distal tip of the projection.
The projections need not be mounted in substantially the same circumferential plane of the catheter body, but this cvnfigurafiivn is preferred.
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7 The projection preferably comprises super-elastic material. Super-elasticity refers to the ability of certain metals to undergo large elastic deformation.
Such compounds favorably exhibit features such as biocompatibility, kink resistance, constancy of stress, physiological compatibility, shape-memory deployment, dynamic interference, and fatigue resistance.
A large number of super-elastic materials may be utilised, particularly binary Ni-Ti with-betweev-50-and-60 atomic--percent nickel: While-many-metals.
exhibit superelastic effects, Ni-Ti-based alloys appear to be best suited for deployment in the human body due to them being chemically and biologically compatible.
1 o Preferably, the projection, when not restrained will adopt a deployed configuration in which a free end of the projection is extended away from the central lumen. In this deployed configuration, the projection is resiliently biased against the vascular wall in use, thus Initiating contact between the sensor and said wall. This achieves an adequate thermal contact with the vascular wall, without substantially compromising blood flow.
In an alternative example, the projection may be mounted to achieve a similar resiliently biased effect. For example, one method of achieving this would be to mount the projection on a spring, preferably a micro-spring, such that when unrestrained, the projection is extended against the vascular wall as discussed above.
2 o The sensors may be any form of temperature sensor and are preferably selected from thermistors, thermocouples, infra red sensors and the like.
Preferably, the sensors are thermistors. These are preferably semi-conductor materials having an electrical impedance in the range of 1-50 Kf~. Such thermistors prove extremely reliable regarding the relation between the temperature changes and resistance 2 5 changes.
Preferably, the catheter comprises a radiopaque marker which aids in the location of the device by fluoroscopy during interventional surgery. More preferably, at least one sensor includes a marker so that it is discernible via fluoroscopy. Most preferably, individual sensors include different markertypes, so thatusing fluoroscopy, 3 o the individual sensors can be identified and their spatial orientation and relative location to a desired part of the vessel wall thus clearly defined.
The distal tip may additionally comprise an ultrasound probe system that can give images of the arterial wall. This may be achieved by the incorporation to the distal catheter tip of a phased array of high-frequency ultrasonic crystals or a

8 mechanical sector ultrasound element. In this way, intravascular ultrasound (IVUS) images may be captured simultaneously with the temperature data. This is extremely useful for morphological data acquisition, correctly recognizing the area of interest and for accurate catheter positioning.
The proximal section of the catheter incorporates a connector for coupling the temperature data signals to a remote device such as a personal computer. These signals-ar-e_transmitted-along_the-wires.fr-om-the--sensors. The_wires-are-pr-eferably housed within the sheath and are preferably electrically isolated from the patient.
Preferably, the wires are housed between the central lumen and the intermediate lumen, within the outer sheath.
When the pull-back device is used in concert with the types of vascular catheter described above, the pull-back device comprises a first lumen mount for holding a first lumen of the catheter, and a second lumen mount for holding a second lumen of the catheter, a third lumen mount for holding a guide catheter extension, and a drive mechanism, wherein each of the first and second lumen mounts is selectively connectable to the drive mechanism for both independent and relative movement with respect to the third lumen mount and to one another to control the configuration of the catheter.
The pull-back device enables a guide catheter and the catheter to be stabily 2 0 mounted. In particular, the pull-back device enables relative movement between the guide catheter and the thermography catheter but, in use, allows the catheter to move relative to the patient and restrains movement of the guide catheter relative to the patient. The pull-back device additionally allows a controlled retraction and positions) retention of the associated sheath, thus ensuring atraumatic . expansion of the 2 5 projections on the catheter.
Preferably, the pull-back device comprises a fixed mount for the guide catheter extension, a mount for the sheath and a mount for the combined inner and intermediate lumen. Hereinafter, the guiding catheter extension mount is referred to as mount A, the sheath mount as mount B, and the inner and intermediate lumen 3 0 mount as mount C.
MountA preferably has a fixed position during pull-back but may be adjustable.
Mount B and C are preferably moveable relative to one another and to mount A.
Mount B and C may be motor driven, in particular stepper motor driven. While mount B and G are moveable, they are preferably adapted to enable selective locking in 1 ~ .~ r~ r~oo3 ' CA 02459002 2004-02-27 e'~PQ~dg,~,~~ j ,,, ,.
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9 place relative to one another and/or to mount A. Mount C is preferably mounted on the drive mechanism although mount B and C may bath be mounted on the drive mechanism. The drive mechanism enables the catheter to be driven towards or away fmm the patient via movement of mounts B andlvr C.
The interlocking of mount B and C prevents the sheath from moving rela4ve to the lumens housed inside the sheath, thereby ensuring the projections remain in the deployed configuration and engaged with the vascular tissue in the area of interest.
The locking mechanism on the pull-back device includes a restraining s o mechanism, preferably a stopper rvd_ This is provided with means far engaging projections within mounts B andlor C_ A similar set of pmjectivns within the.
same mounts are used to selectively cannectthe mounts to the drive~rod. These projections may be actuated by a user who can selecEi~ely control which of the mounts is Ivc(ced and which a~ d 'rnren, and the interaction between the mounts.
The drive mechanism is preferably driven by a motor, and preferably gearing is provided along with control and monitoring means.
It is particularly important that substantial occlusion of the vascular tissue is prevented. This is achieved by the present invention as the apparatus in a deployed configuration does not substantially increase its radial cress sectional area beyond the 2 0 radial cross sectional area of the apparatus in a retracted configuration.
Preferably, the ratio of the area ofthe cross-sections! profiles of the apparatus in the deployed to retracted configurations is in the range 4:1-1:1, preferably 3:1-1 _25:1, mere preferably 2.5:1-2:1. most preferably 1 _75:1-1 _25:1.
The vascular catheter apparatus, subsequent to the identification and measurement of vasculartissue, in particular, atherascleratic plaque, may be used to treat an area identified as being at risk of rupture of said plaque. Treatment rnay be effected by reinserting the catheter to a predetermined area of the vascular tissue.
This reinsertion may be achieved in a controlled manner as the prior temperature measurement scan with the device may be used to produce a temperature map of the 3 0 vascular tissue. This information may be stared in the remote device and can be used to relocate the area of risk. This procedure requires less contrast media to be infused into the patient than would normally be required in similar vascular interventivnal procedures as the position of the catheter is known due to the data stored in the remote device_ The pull-back device may then, under the control AMENDED.-SHEET:-Fm~f _aPi t:18/1~1~003 11:49 ~. .... . ~ ~mp,~ ~hry:71? P.008 of a user, be used to drive the catheter back to, for example, the starting point of the temperature measurement or any point along the path of the temperature data acquisition, for further temperature measurements or alternative treatments of the vascular tissue.
5 For example, the catheter apparatus can then be used to treat the area by any of the usual therapeutic procedures, including localised delivery of a therapeutic agent; delive-ry-of-a scent; br-ashy therapy; ablation of selected-tissue_etc.-.Thus~the thermography catheter may additionally comprise angioplasty balloons or sleeves.

10 Brief Description~of the Drawings Examples of the present invention will now be described in detail with reference to the accompanying drawings, in which:
Figure 1 shows a schematic diagram of a system for conducting vascular catheterisation of a patient;
Figure 2 shows a side view of the distal tip of a thermography catheter device in a temperature sensing (deployed) configuration;
Figure 3 shows a side view of the distal tip of the device in a non-temperature sensing (retracted) configuration;
Figure 4 shows the pull-back device in side view;
2 o Figure 5 shows the pull-back device in plan view;
Figure 6 shows a section of the guide catheter extension distal end; and, Figure 7 is a flow diagram illustrating the steps involved with conducting intravascular catheterisation of a patient and the associated data capture and image processing.
Detailed Description Figure 1 is a schematic diagram of a system for conducting vascular catheterisation of a patient.
The system includes a personal computer (PC) 1 that presents a graphical user 3 0 intertace (GUI) via a number of monitors 2. The user interface system is based on a Microsoft Windows T"' platform. Multiple windows may be used to acquire/project data from/to the user. Although not shown, the PC can accept user inputs via a keyboard and mouse, or other pointing device, in the usual manner. The PC includes a number of data stores 7, which may be external, and a CD ROM reader/writer device 3.

11 The PC is coupled via a data interface 4 to a thermography catheter 5, details of which will be described below. In this example, the thermography catheter 5 transmits four channels (one for each sensor) which are received by the data intertace 4. An analogue temperature data signal on each channel is converted to a digital signal using an A/D converterwithin the data interface 4 at a user configured sampling rate of up to 2.5 KHz. Typically, the sampling rate would be set at around ~5 to 50 Hz ~o_re~luce~he quantity of_data_acq.uir_ed._ ..~_ ~ ,-_. __ _ .__ __ The data interface 4 includes a multiplexer (not shown) that combines the four digital channels into a single time division multiplexed (TDM) signal. This TDM signal 1 o is coupled to the PC over a PCi bus. The data from each channel are written into an area of memory within the data store 7 reserved for that channel where they can subsequently be retrieved for data processing along with the corresponding time sequenced data from other channels and image data from other sources.
The temperature data from the thermography catheter 5 are introduced to the system software running on the PC using function calls. Temperature data are input to the software as the actual voltage at the A/D hardware inputs, and therefore they have to be converted to temperature. A sensor data convert function handles this process.
The system is designed to be used in conjunction with a fluoroscopy x-ray 2 o apparatus and therefore includes a video frame capture interface 6 that couples fluoroscopy video data inputs to the PC via a PCI bus. Similarly, it can be used in conjunction with intravascular ultra-sound (IVUS) image data fed from the thermography catheter 5 (when provided with the appropriate hardware). The system software allocates sufficient memory area to the systems memory for this data, taking into account the current system configuration, for example sampling rate, recording time, and video frame size. A memory handle hDib is used to map video data directly through the PCI bus from the video frame capture interface 6 to this allocated area in memory. hDib memory is divided into i equal chunks, each of a size equal to the frame capture intertace frame-buffer. Optionally, hDib [i] data can also be mapped to 3 0 a memory area of a screen-video buffer, giving capability of live preview during recording. Each time the software records an x group of four (or more) temperature measurements, it prompts for a frame capture at hDib [x]. A user configuration file determines the ratio between temperature data:fluoroscopy video frame capture.

12 Whilst in normal circumstances the thermography catheter 5 is inserted manually, it is intended that when performing vascular measurements the thermography catheter 5 is pulled back relative to a predetermined start position using an electro-mechanical pull-back drive 8 coupled to the body of the catheter.
The pull-s back drive 8 is controlled by the PC via a pull-back drive interface 9. The system software accesses user-defined configuration files to get the necessary information -about controlling-the-systems-automati~pull-back irate-dace-9. -Data ampling rate, recording duration and pre-selected retraction rate are taken into consideration for adjusting the pull-back speed. The software routines control a D/A converter (not 1 o shown) that feeds the input of the pull-back interface 9 with an appropriate control voltage. The controlled pull-back process will be described in more detail below.
Temperature data plotting may be both on-line and/or off-line. In an on-(ine mode, the monitor presents a temperatureltime-distance graph, where temperature is continuously plotted as connected dots. In an off-line mode, temperature data can 15 be loaded from the data store 7 (or other media) and plotted on the screen graph.
The user can scroll to different time/temperature locations, white several automated functions may be provided, for example auto min-max marking, colour coding of temperature on a bullseye graph, colour thermal maps, and 3D temperature coding on a cylinder model. In the latter case, an artificial colour 3D cylinder that represents 2 0 the vessel is divided into splines equal to the temperature channels. The channel temperature is coded on each spline with colours varying from dark-blue (minimum temperature) to flashing-red (maximum temperature). The user can rotate the cylinder as he wishes in a virtual 3D world. The focus is set to the specific time/distance that corresponds to the mouse position on the screen temperature/time graph. 3D
position 2 5 control is performed using multi cubic-bezier lines, where the curvation control points change in relation to the cylinders position in the virtual world. A separate window shows numeric details for the particular time/distance position. Video frame data from simultaneous fluoroscopy/IVUS are plotted as image frames in a separate window.
By moving to a specific time/temperature position, the corresponding video frame is 3 0 automatically projected. In this way, temperature and video frames are accurately synchronised.
The system software is designed to provide basic and advanced image processing functions for the captured fluoroscopy/IVUS video frames, such as filtering and on-screen measurement functions. The user can filter the captured frame to

13 discard unwanted information while focusing on the desired one. There are several auto-filter options as well as manual adjustment of the image curve. In addition, the user can calibrate the system and proceed in performing on-screen measurements of both distances and/or areas. Automatic routines pertorm quantification of the measurements giving significant information on lesion characteristics. The temperature can also be colour coded on the fluoroscopy frame, providing unique --information-about the-correlation~ between temperature and morphology.
By using temperature data and video frame data, the system software uses advanced algorithms based on interpolation and fractal theory to plot a 3D
reconstruction of the vessel under measurement with colour coding of temperature.
The user can freely move the virtual camera inside the reconstructed vessel in 360°, and/or fly-through the vessel. 2D reconstructions are also provided.
Temperature data can be processed on the basis of mean temperature, or on a channel-by-channel basis.
Figures 2 and 3 show an example of the distal tip of a thermography catheter incorporating sensors 10 mounted circumferentially about a central lumen 14.
In this example, four sensors 10 are mounted on resiliently biased projections 11 circumferentially about the central lumen at 90° intervals, although only one sensor is shown here for the sake of clarity. The projections 11 are made of NiTinol.
The sensors 10 are NTC thermistors. Such thermistors prove extremely reliable regarding the relation between the temperature changes and resistance changes. An NTC thermistor having a 30 Kf2 impedance at 25°C typically maintains linearity between 35°C and 45°C, at a resolution of 0.01 °C - 0.1 °C.
The construction of the thermistors .10 are that of two rectangular plates with a semi-conductor material in the centre. The thermistor has dimensions in the range of 0.25mm - 5mm, and a caliper less than 1 mm.
Each thermistor 10 is attached to the end of each projection 11 by bonding with an thermally conducting epoxy glue 12. Each thermistor 10 is connected to an insulated bifilar wire 13. The wire 13 has a low impedence and is constructed from 3 0 nickel and/or copper. This wire provides an electrical connection with the proximal end of the device (not shown).
As shown in the Figures, the wire 13 is coiled around the length of the projection 11. This feature has the effect of substantially eliminating strain when the projection 11 flexes. The pitch of the coil is typically arranged to be such that there

14 are 5 to 10 turns over a length of 10 mm. As will be described below, a heat shrink wrapping 15 is applied over the projection 11 to prevent damage to the wire 13 during retraction and replacement of an outer sheath 16. The heat shrink wrapping also provides an additional degree of electrical isolation.
To assemble a projection, a NiTinol arm is first pretreated by placing it in a bending tool and heating to around 700°C to impart a bend in the arm.
The NiTinol ar_m~s then head_straighf i~a chick-ar~d_a t~termisto~l_bifil_ar.wire assernbl_y_is attached to a free end of the arm using a UV cure adhesive. The wire 13 is then spun around fihe length of the NiTinol arm. Finally, the heat shrink wrapping 15 is placed over the 1 o length of the NiTinol arm to a point just beyond that of the thermistor.
In this example the heat shrink wrapping is supplied as a polyester tube that is cut to length. An epoxy resin is Then injected into the end of the tube. The assembly is subsequently heat treated to shrink the tube and set the epoxy resin. The heat shrink wrapping is then trimmed back to expose at least part of the epoxy resin coated thermistor, while maintaining electrical isolation of the bifilar wires. After heat treatment, the heat shrink has a wall thickness of around l0pm.
As shown in the Figures , the thermography catheter is mounted on an angioplasty guide wire (not shown) which runs through the central lumen 14 and a guide member 17 which defines the tip of the thermography catheter.
2 o In use, the apparatus may be actuated between a non-wall-temperature sensing configuration and a temperature sensing configuration. The non-temperature sensing configuration is hereinafter referred to as the retracted configuration. The temperature sensing configuration is hereinafter referred to as the deployed configuration. An example of the deployed configuration is shown in Figure 2.
An 2 5 example of the retracted configuration is shown in Figure 3.
In the retracted configuration, the sheath 16 encompasses the projections 11 so that they are constrained to lie parallel to the longitudinal axis of the catheter and therefore cannot take up a deployed position. The sheath 16 extends as far as the rear end of the guide member 17 and may or may not overlap the guide member.
3 0 Where there is overlap, a smooth profile of the catheter is maintained.
Any protrusions from the thermography catheter which could lead to damage of the vascular wall, are minimised in the retracted configuration. This is particularly important where a vessel is angulated or there is bifurcation of the vessel.
Such features lead to bending of the thermography catheter and would emphasise any protrusions. Hence, in this example the sheath 16 and the guide member 17 present a smooth profile when adjacent to one another in the retracted configuration.
To adopt the deployed configuration, the sheath 16 is withdrawn away from the extreme distal tip i.e., away from the guide member 17, towards the proximal section, 5 to expose the projections 11: When the sheath 16 is withdrawn to the extent shown in Figure 2, the resiliently biased projections 11 take up the deployed configuration.
-It-should-be-noted-that the-sheath-is-controlled from-the. proximal end of the apparatus and is not shown in its entirety in the Figures.
The projections 11 individually extend a certain distance (r) away from the 1 o longitudinal axis of the catheter. In the deployed configuration, r has a value in the range of 2-4 mm. However, r is not fixed and varies with the diameter of the vascular tissue being measured due to the flexibility of the projections 11.
Different diameter catheters may be used for different diameters of vascular tissue. However, as it is desirable to minimize the diameter of catheters in all

15 interventional vascular treatments, it is desirable to adapt the length of the projections and/or the angle to which the projections may extend away from the central lumen depending on the dimensions of the vascular tissue being measured rather than increasing catheter body dimensions. Thus, the projections for a large blood vessel, for example 8 mm diameter, will generally require a length of projection in the range 2 0 of 5 mm to 10 mm. Smaller diameter vascular tissue, for example 2.5 mm diameter, will generally require a length of projection in the range of 2 mm to 6 mm.
Typically, the ratio of the area of the cross-sectional profiles of the apparatus in the deployed to retracted configurations is up to 4:1.
The thermography catheter includes a valve system (not shown) allowing the annular gap between the sheath and the intermediate lumen to be flushed in an adequate way, thus minimising the possibility of air bubbles or debris within the sheath. Such a valve is constructed to enable engagement by a 2 mm, 5 mm, or mm, 6° luer syringe. The thermography catheter maybe flushed with a suitable fluid such as saline. When flushing the catheter, fluid should exit via the distal tip of the 3 o catheter, indicating proper flushing of the sheath. In addition, the catheter includes a female luer fitting (not shown) attached to the proximal end of the central lumen, to enable the central lumen to be flushed in a similar way to the sheath.
The body of a pull-back device is illustrated in Figures 4 and 5. The proximal section of the thermography catheter described above is constructed to enable r s c E
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16 remote deployment and retraction ofthe projections. This is effected via rnanipulativn of the sheath. A two-lumen telescopic construction 2D is used to manipulate the sheath 21 between the retracted and the deployed configuration. One lumen is connected to, or integral with, the outer sheath and can slide aver an adjacent lumen which comprises or is connected to one of the lumen housed within the sheath.
Rotation of one tube inside the other is prevented by slotting of the lumen or other features on the lumen. Additionally, seating markings {not shown), may be provided to avoid over-retraction of the tubes.
The pull-back device includes a drive module 23 which includes a molar, 1o gearing system, typically a speed reducer, control and monitoring means, and engagement gear far a driving rod 22. The drive module may be formed separately from the body of the pull-back device so that it may be reused. The body of the pull-back device must be kept sterile and may be formed from a material such as polyurethane. This allows the body to be cheaply and easily produced and may be 7.5 disposable. Alternatively, or additionally, the pull-back device may be enclosed in a sterile, flexible plastic sheath when in use, so as to maintain stelllify.
The pull-back device comprises a driving rod 22, adapted for engagementwith an engagement geaC of the drive module 23 and mount G. Mounts G and B are adapted to engage the centralfintermediate lumen 25 and the sheath lumen 27 2 o respectively. A Mount A is provided which is adapted to engage the guide catheter extension 24. Mount A includes a~bracket 31 for connection of mount A to the guide catheter extension trxation paints 32. When engaged, mount B may be moved .~;._....~, ,:. .' towards C to place fine thermograph catheter in the open configuration: ~ C may be selectively driven reversibly over a range of travel (usually about 60 mm) suitable far 2 5 withdrawal of the catheter apparatus over the measured region. The driving rod Z2 is a worm-screw type which interacts with the engagement gear of the drive module 23, fihus providing a smoothly driven apparatus.
The mounts 8 and C may individually be locked in position relative to one another yr may be selectively unlocked in order to allow movement of the lumen 25, 3 o sheath 21 and guide catheter extension 24 relative to one another.
With reference to figures 6 and 7, in use, the sequence of events begins with the insertion of a guiding catheter into the area of general interest (step 100), tar example the cardiac region. Where, for example, the coronary arteries are to be examined, the guiding catheter is inserted so that it is adjacent the opening of the AMEN~DED~.SHEET
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17 coronary arteries (step 110). An angioplasty guide wire is then inserted into the coronary artery, past the paint of speafic interest. The guide wire is usually inserted with the aid of standard fluoroscopic techniques, as is the guide catheter.
The guide catheter, when in place vvetthe entrance to the coronary (or other target) artery wilt protrude a distance from the patient once in place. This is then fixed to,the guide catheter extension 24, The guide catheter extension will be fixed to the guide catheter by inserting the non-compressible tube 27 intv.the Y piece 28.
The gland nut29 and o-ring seal (compression fitting) is tightened to seal the joint between the guide cathetetand guide catheter extension and a securing means 30 is provided Z o which holds the Y piece in place relative to the guide catheter extension.
Alternatively, the outside surface of the non-compressible tube rnay be profiled with shallow circumferential grooves, to ensure that the tube will not pull out when held in the compression fitting of the Y piece (not shown).
A seat element 31 is provided within the guide catheter extension. This is sandwiched between the non-compressible tube and the guide catheter extension body. This provides 3 sealing engagement between the non-compressible tube and the catheter.
Once the guide catheter, guide catheter extension and guide wire are in position, the catheter is maneuvered over the guide wire to a position beyond the z 0 specific area of interest in the coronary artery (step 120) with the aid of tluorascvpy.
The catheter is then fixed in position on the pull-back device by clipping into mounts B and C_ The guide catheter extension is then fixed in position on the mount A, at a ~fucation paint along its length which optimises the distance between mount A
and B ...,.,,..w~~.~.....,..,..t~4;-~.,:
and C_ Thus, the guide catheter extension should be fixed to mount A so that the .
catheter may be mounted on mounts B and C in a closed configuration.
An angivgram is taken (step 13D? to assess the position of the catheter in the vasculartissue. This image is saved and the position of the catheter is rnarised an the image so as to define a starting point for the controlled pull-back step.
The sheath 21 is then retracted to al(vw the projections to adopt the deployed 3 0 configuration. This is achieved by moving mount B towards mount C (usually manually). Mount C at this time is locked relative to mount A. Once the sheath 21 is retracted sufficieptly to allow expansion of the nailiently biased projections, mount B
is locked in position and mount G is pulled back by the drive AMENDEp SHEET' EmP f .ze i t :18l 1 ~1~003 11: 50 ~ ~' ' ' " ' ' tmE~ r W : : 717 P .010

18 mechanism until the projections are housed in the sheath. This is feasible if the sheath 21 is retracted sufficiently (equal or greater than the length of the pull-back distance during which measurement takes place) to allow the intermediate/central lumen 25 to be retracted in the sheath 21 without the sheath impacting on the projections along the length of measurement.
Alternatively, the mount B and C are locked in position once the thermography -catheter-is-in-the-deployed-configuratior-~--and-both-mounts-ar-e-pulled-back-by the-drive mechanism.
The locking mechanism includes a stopper rod 26. This is provided with 0 graduations capable of engaging electrically actuated locking pins (not shown) within mounts B and/or C. A similar set of electrically actuated locking pins (not shown) within the same mounts are used to selectively connect the mounts to the drive rod 22. A set of locking pins on any particular mount may not be connected to both the drive rod 22 and the stopper rod 26 simultaneously. Thus, each mount is either in Z 5 drive or stop mode. Alternatively a ratchet mechanism may be provided as the locking mechanism.
When the mount C is in drive mode, it moves relative to mount A and B. Mount C cannot be moved towards mount B when attached to the pull-back device.
The catheter may be marked to indicate when the sensors are in a deployed 2 0 or in a retracted position. This may be achieved by provision of a telescopic tubing 20 with appropriate indicators or by simply marking the extreme deployed or retracted position on the apparatus.
Controlled pull-back of the catheter then takes place (step 140). The pull-back takes place at a constant speed and is controllable by the user. Pull-back typically 2 5 takes place at speeds of 0.1 to 2 mm in divisions of 0.1 mm or so.
The pull-back takes place over a distance of the vascular tissue being measured. Temperature readings may be taken intermittently or substantially continuously. The data transmitted by the sensors from the vascular wall is captured for data and image processing (step 150) together with a fluoroscopylIVUS
image 3 0 frame.
As the catheter is withdrawn inside the artery, the projections automatically adjust their angle following the wall's morphology without losing the desired thermal contact. The result is that the thermal contact between the sensors and the wall is

19 continuously maintained, even when the catheter is crossing very irregular plaque formations.
Once the pu((-back has been completed, the central/intermediate lumens are retracted such that the projections are withdrawn into the sheath 21 in order to place the sensors in the retracted configuration. This restores the original smooth profile of the catheter. The catheter may then be detached from the pull-back device and wifihdrawn-from the-patient-or-may-be-reinse -rted-into the same or-another-.blood vessel in order to take another reading. Alternatively, the catheter may be reinserted in order to enable a therapeutic or surgical intervention.

Claims (17)

20

1. A catheter positioning system comprising:
a guide catheter adapted to receive a catheter, a catheter positioning device adapted to engage the catheter and maneuver the catheter within the guide catheter, and a guide catheter extension having a distal end and a proximal end, the distal end being adapted for engagement and co-operation with the guide catheter, and the proximal end being adapted for engagement with the catheter positioning device, wherein the guide catheter extension further comprises a plurality of engagement means for engaging the catheter positioning device and thereby fixing the relative positions of the guide catheter extension and the catheter positioning device at any one of a number of positions over its length.

2. A system according to claim 1, in which the guide catheter extension has a number of points adapted for engagement with the catheter positioning device.

3. A system according to claim 2, in which the paints of engagement are formed as notches or annular indentations.

4. A system according to claim 2 or claim 3, wherein the guide catheter extension has between 2 and 240 fixation points, more preferably 5 to 100 fixation points, most preferably 10 to 50 fixation points.

5. A system according to any preceding claim, in which the body of the guide catheter extension is substantially cylindrical in cross-section.

6. A system according to any preceding claim, in which the guide catheter, the guide catheter extension and the catheter positioning device are initially provided as separate components for subsequent assembly.

7. A system according to any preceding claim, in which the distal end of the guide catheter extension comprises a substantially rigid tubular section which is fixed to a flexible section, and which is coaxial therewith.

8. A system according to claim 7, in which the rigid tubular section is integrally molded with the flexible section.

9. A system according to any preceding claim, in which the catheter positioning device comprises a first lumen mount for holding a first lumen of the catheter, a second lumen mount for holding the guide catheter extension, and a drive mechanism, where the first lumen mount is selectively connectable to the drive mechanism for relative movement with respect to the second lumen mount.

10. A system according to claim 9, in which the second lumen mount includes a bracket adapted for engagement with the guide catheter extension.

11. A system according to claim 10, in which the bracket is mounted at one end of an extension arm, and the other end of the extension arm is connected to the body of the positioning device.

12. A system according to any preceding claim, wherein the length of the guide catheter extension is the range of 0.1 meters to one meter, preferably 0.15 to 0.5 meters.

13. A system according to any preceding claim, the guide catheter having a distal and and a proximal end, wherein the proximal end of the guide catheter is provided with a compression fitting, and wherein the guide catheter extension comprises a substantially rigid tubular section, the compression fitting being capable of sealing engagement with the substantially rigid tubular section.

14. A system according to claim 13, in which the guide catheter extension further comprises a sealing element capable of sealing engagement with the catheter.

15. A guide catheter extension for use in the catheter positioning system as claimed in any preceding claim, wherein the guide catheter extension has a distal end and a proximal end, the distal end being adapted for engagement and co-operation with a guide catheter, and the proximal end being adapted far engagement with a catheter positioning device, and wherein the guide catheter extension further comprises a plurality of engagement means for engaging the catheter positioning device and thereby fixing the relative positions of the guide catheter extension and the catheter positioning device at any one of a number of positions over its length.

18. A guide catheter extension according to claim 15, further comprising a substantially rigid tubular section, and wherein the guide catheter has a proximal end and a distal end, the proximal end of the guide catheter being provided with a compression fitting, and the fitting being capable of sealing engagement with the substantially rigid tubular section.

17. A guide catheter extension according to claim 15 or claim 16, in which the guide catheter extension comprises a sealing element capable of sealing engagement with the catheter.