|Número de publicación||USRE43300 E1|
|Tipo de publicación||Concesión|
|Número de solicitud||US 10/126,295|
|Fecha de publicación||3 Abr 2012|
|Fecha de presentación||18 Abr 2002|
|Fecha de prioridad||2 Dic 1996|
|También publicado como||US6051008|
|Número de publicación||10126295, 126295, US RE43300 E1, US RE43300E1, US-E1-RE43300, USRE43300 E1, USRE43300E1|
|Inventores||Vahid Saadat, John H. Ream|
|Cesionario original||Abbott Cardiovascular Systems Inc.|
|Exportar cita||BiBTeX, EndNote, RefMan|
|Citas de patentes (223), Otras citas (41), Citada por (24), Clasificaciones (51), Eventos legales (1)|
|Enlaces externos: USPTO, Cesión de USPTO, Espacenet|
The present application is a continuation-in-part application of commonly assigned U.S. patent application Ser. No. 08/863,877, filed May 27, 1997, now U.S. Pat. No. 5,910,150 which claims the benefit of the filing date of U.S. provisional patent application Ser. No. 60/032,196, filed Dec. 2, 1996.
The present invention relates to apparatus and methods for performing surgery on an interior wall of a hollow-body organ such as the heart, or within the brain cavities and the like. More particularly, the present invention provides a device that enables a clinician to perform surgery on an interior wall of an organ or vessel using apparatus for stabilizing an end effector during the surgery.
A leading cause of death in the United States today is coronary artery disease, in which atherosclerotic plaque causes blockages in the coronary arteries, resulting in ischemia of the heart (i.e., inadequate blood flow to the myocardium). The disease manifests itself as chest pain or angina. In 1996, approximately 7 million people suffered from angina in the United States.
Coronary artery bypass grafting (CABG), in which the patient's chest is surgically opened and an obstructed artery replaced with a native artery harvested elsewhere, has been the conventional treatment for coronary artery disease for the last thirty years. Such surgery creates significant trauma to the patient, requires long recuperation times, and causes a great deal of morbidity and mortality. In addition, experience has shown that the graft becomes obstructed with time, requiring further surgery.
More recently, catheter-based therapies such as percutaneous transluminal coronary angioplasty (PTCA) and atherectomy have been developed. In PTCA, a mechanical dilatation device is disposed across an obstruction in the patient's artery and then dilated to compress the plaque lining the artery to restore patency to the vessel. Atherectomy involves using an end effector, such as a mechanical cutting device (or laser) to cut (or ablate) a passage through the blockage. Such methods have drawbacks, however, ranging from re-blockage of dilated vessels with angioplasty to catastrophic rupture or dissection of the vessel during atherectomy. Moreover, these methods may only be used for that fraction of the patient population where the blockages are few and are easily accessible. Neither technique is suitable for the treatment of diffuse atherosclerosis.
A more recent technique, which holds promise of treating a larger percentage of the patient population, including those patients suffering from diffuse atherosclerosis, is referred to as transmyocardial revascularization (TMR). In this method, a series of channels are formed in the left ventricular wall of the heart. Typically, between 15 and 30 channels about 1 mm in diameter and up to 3.0 cm deep are formed with a laser in the wall of the left ventricle to perfuse the heart muscle with blood coming directly from the inside of the left ventricle, rather than traveling through the coronary arteries. Apparatus and methods have been proposed to create those channels both percutaneously and intraoperatively (i.e., with the chest opened).
U.S. Pat. No. 5,389,096 to Aita et al. describes a catheter-based laser apparatus for percutaneously forming channels extending from the endocardium into the myocardium. U.S. Pat. No. 5,380,316 to Aita et al. describes an intraoperative laser-based system for performing TMR. U.S. Pat. No. 5,591,159 to Taheri describes a mechanical apparatus for performing TMR involving a catheter having an end effector formed from a plurality of spring-loaded needles.
Neither the Aita nor Taheri devices describe apparatus wherein the laser-tip or spring-loaded needles are stabilized during the channel-forming process. Because the end effector of such devices may shift position while in use, such previously known devices may not provide the ability to reliably determine the depth of the channels, nor the relative positions between channels if multiple channels are formed.
In view of the shortcomings of previously known TMR devices, it would be desirable to provide apparatus and methods for performing percutaneous surgery, such as TMR, that permit precise control of the end region of the device carrying the end effector.
It also would be desirable to control the location of the end region of the device within the ventricle both with respect to features of the ventricular walls and in relation to other channels formed by the device, and to stabilize the end region of the device within the organ, for example, to counteract reaction forces created by the actuation of the end effector during treatment.
A number of devices are known in the medical arts that provide certain aspects of the desired functionality. For example, U.S. Pat. Nos. 5,389,073 and 5,330,466 to Imran describe steerable catheters; U.S. Pat. No. 5,415,166 to Imran describes a device for endocardial mapping; U.S. Pat. No. 4,813,930 to Elliott describes a radially extendable member for stabilizing an angioplasty catheter within a vessel; U.S. Pat. No. 5,354,310 describes an expandable wire mesh and graft for stabilizing an aneurysm; and U.S. Pat. Nos. 5,358,472 and 5,358,485 to Vance et al. describe atherectomy cutters that provide for aspiration of severed material.
None of the foregoing references overcomes problems associated with locating an end region of a catheter against a position on the inside wall of a heart chamber. Moreover, the prior art is devoid of a comprehensive solution to the above-noted shortcomings of previously-known apparatus for percutaneously performing surgery, and especially for performing TMR.
In view of the foregoing, it is an object of this invention to provide apparatus and methods for performing surgery, such as TMR, that permit precise control of an end effector disposed in an end region of the apparatus.
It is another object of this invention to provide apparatus and methods, suitable for use in performing TMR and surgery of other hollow-body organs, that include the capability to stabilize within the organ an end region of the device carrying an end effector, for example, to counteract reaction forces created by the end effector during treatment.
These and other objects of the present invention are accomplished by providing apparatus having a directable end region carrying an end effector for performing surgery. Apparatus constructed in accordance with the present invention comprises a catheter having a longitudinal axis and an end region movable to a series of positions along the longitudinal axis. The end region may be selectively moved to a position at an angle relative to the longitudinal axis of the catheter, including a substantially orthogonal position. The catheter includes means for stabilizing a distal region of the apparatus within a hollow-body organ, and for counter-acting reaction forces developed during actuation of an end effector.
In a preferred embodiment of the apparatus of the invention, the catheter includes a catheter shaft and a guide member disposed for longitudinal sliding movement within a groove of the catheter shaft. The guide member includes an end region including an end effector maneuverable between a transit position wherein the end region lies parallel to a longitudinal axis of the catheter to a working position wherein the end region and end effector are oriented at an angle relative to the longitudinal axis, including a substantially orthogonal position. The catheter shaft preferably may include adjustable outwardly projecting stabilization members to provide a stable platform to counteract reaction forces generated when the end effector contacts the wall of the hollow-body organ.
Methods of using the apparatus of the present invention to perform surgery, such as transmyocardial revascularization, are also provided.
Further features of the invention, its nature and various advantages will be more apparent from the accompanying drawings and the following detailed description of the preferred embodiments, in which:
The present invention relates generally to apparatus and methods for percutaneously performing surgery within an organ or vessel. The apparatus of the present invention comprises a catheter including a stabilizing catheter shaft which percutaneously may be disposed within an organ. A guide member engaged with the catheter shaft includes an end region that may be selectively articulated to a position at an angle to a longitudinal axis of the catheter, including a position substantially orthogonal to the longitudinal axis. The end region carries an end effector (e.g., an ablative or mechanical cutting device) for treating tissue. Severed or ablated tissue may be aspirated through the catheter to its proximal end for disposal. The catheter shaft, either alone or in conjunction with stabilizing members, and the guide member, provides precise control over the location of the end region, and thus, the end effector.
The present invention therefore offers a device having a directable end region and end effector for performing surgery that provides a degree of control heretofore unattainable. While the invention is described hereinafter as particularly useful in the emerging field of transmyocardial revascularization, apparatus constructed in accordance with the present invention may be advantageously used in performing surgery on other organs or vessels, such as the intestines, blood vessels or the brain cavities. In addition, while the present invention is described herein in the context of a mechanical cutting system, the control and stabilization apparatus of the present invention may be advantageously used with other types of cutting elements, such as lasers, cryogenic cutters or radio-frequency ablation devices.
End region 25 of guide member 22 may be positioned longitudinally with respect to catheter shaft 21 by imparting relative movement between guide member 22 and catheter shaft 21 using handle assembly 26. Catheter shaft 21 preferably includes a plurality of stabilizing members 27 to support and stabilize distal region 23 of the apparatus within the hollow-body organ.
Apparatus 20 is coupled via cable 28 to controller 29. In a preferred embodiment wherein the end effector comprises a rotating cutting head, controller 29 includes a motor and control logic for rotating the cutting head responsive to commands input at handle assembly 26 or a footpedal (not shown) and a vacuum source for aspirating severed tissue from the treatment site. Controller 29 optionally may further include RF circuitry (shown in dotted line) for energizing the cutting head to cauterize tissue as it is cut. Alternatively, controller 29 may include a laser source or radio frequency circuitry for causing laser or RF ablation, respectively, using a suitable end effector.
Referring now to
Guide member 22 includes end region 25 carrying an end effector and flanges 34 and 35 that slidingly engage grooves 31 and 32. End region 25 may be articulated in region 36 using control wires or a temperature actuated shape-memory alloy steering mechanism, such as described in the aforementioned patents to Imran. Guide member 22 may be constructed of a spring material (commonly called a Bowden) with spaces in-between the coils to allow it to bend when it is pulled by a control wire asymmetrically, as previously known in the art. Alternatively, guide member 22 may be constructed of a stiffer material such as polyimide coated over a braided steel tubular structure, such as employed in previously known neuro-navigational endoscope devices. In this case, slits are provided on the inside of the bend in region 36 so that the guide member bends in the direction of the slits. The slits allow a tight bend radius which may not otherwise be achievable.
Guide member 22 preferably includes a lumen, as described hereinafter, through which tissue may be evacuated from a treatment site by suction. Accordingly, guide member 22 may also be formed from a loosely wound spring reinforced with a soft elastomeric coating. The elastomeric coating advantageously serves the following functions: it provides sealing along the length of the guide member required to maintain adequate suction through the lumen; it prevents collapse of the lumen in the presence of applied suction; it resists kinking of the coils of the spring; and it also enables the guide member to be bent to relatively tight radii. Reinforced tubing suitable for use as guide member 22 is available from Adam Spence Corporation, Wall, N.J.
In the above-described embodiments, end region 25 of guide member 22 is movable from a transit position lying parallel to the longitudinal axis of catheter shaft 21 to a working position wherein end region 25 is articulated to a position substantially orthogonal to the longitudinal axis of the catheter shaft. In addition, end region 25 may be constructed to enable it to be locked in position at any angle a that may be desired for a given application.
With respect to
Accordingly, wires 27a-27d may be moved from a retracted position in which they are retracted against distal region 23 of catheter shaft 21 to an expanded position in which they engage a wall of the organ and urge end region 25 into engagement with an opposing wall of the organ, thereby stabilizing catheter shaft 21 against rotation.
Stabilization members 27 may be constructed of any suitable elastic material, including stainless steel, spring steel, nickel-titanium alloys, and a variety of plastics. A nickel-titanium alloy is preferred where wires 27a-27d comprise a continuous coil, as in
Where stabilization members 27 comprise a single coil, as in
The longitudinal position of end region 25 with respect to catheter shaft 21 may be adjusted by sliding guide member 22 in groove 30 of the catheter shaft. Handle assembly 26 preferably includes means, described hereinafter, for moving guide member with respect to catheter shaft 21 so that end region 25 may be positioned at a series of vertical locations. In addition, stabilization members 27 may be adjusted to provide some control over the lateral positioning of the catheter shaft and guide member with respect to the interior wall of the organ or vessel. Thus, apparatus 20 enables a matrix of treatment sites to be accessed without removing and repositioning the apparatus.
Referring now to
Orientation of end region 25 of guide member 22 is accomplished by control wire 46, which is slidingly disposed in lumen 47 of guide member 22. As described hereinabove, guide member 22 preferably comprises a spring material with spaces in-between the coils to allow it to bend when control wire 46 is retracted in a proximal direction. Alternatively, guide member 22 may be constructed of polyimide coated over a braided steel tube and includes slits on the inside of bend region 36 so that end region 25 bends in the direction of the slits when control wire 46 is retracted in a proximal direction.
Cutting head 41 is connected to the motor of controller 29 via drive rod 45. Drive rod 45 may be formed of a flexible tube such as a bowden or a covered coil or may be formed of a plastic having both high torquability and flexibility. Drive rod 45 is disposed in lumen 44 for a limited range of reciprocation, e.g., up to 3.0 cm, to permit extension of cutting head 41 beyond the end of guide member 22. When end region 25 is in its transit position, cutting head 41 is disposed just below distal endface 48 of guide member 22. Drive rod 45 is hollow and preferably includes a covering of a soft plastic or elastomeric material to allow the application of a negative pressure to aspirate the severed tissue.
Applicant expects that high speed rotation of cutting head 41 will generate frictional heating of the tissue surrounding the cutting head, thereby causing coagulation of the tissue with minimal thermal damage to the surrounding tissue. Alternatively, tubular member 42 of cutting head 41 may comprise an electrically conductive material and be electrically coupled to the optional radio-frequency generator circuitry in controller 29 to provide coagulation of the edges of a channel formed in the tissue by cutting head 41. In this embodiment, tubular element 42 serves as the electrode in a monopolar coagulation arrangement. In addition, a second electrode (not shown) may be formed on the working end spaced apart from the cutting head 41, so that tubular member 42 serves as one electrode of a bipolar coagulation arrangement. Applicant expects that the sealing action produced by RF coagulation, if provided, will simulate the lesions produced by a laser.
With respect to
Upper portion 52 includes indicator 57a that may be selectively aligned with indicators 57b, so that the channels formed by end effector 40 are positioned at a series of spaced-apart locations. Cable 28 extends from upper portion 52 and connects the working end of apparatus 20 to controller 29. Upper portion 52 also includes button 58 which may be moved in slot 59 to control the articulation of end region 25 of guide member 22, and depth control lever 60 disposed in slot 61. Depth control lever 60 is moved within slot 61 to control reciprocation of cutting head 41 from end region 25. Slot 61 has a length so that when button 60 is moved to fully extend cutting head 41 from guide member 22, a proximal portion of tubular member 42 remains within guide member 22. In addition, or alternatively, a user-adjustable limit bar (not shown) may be provided in slot 61 to select the maximum extension of cutting head 41 desired for a particular application.
RF button 62 also may be provided to control activation of the optional RF circuitry of controller 29 to coagulate tissue surrounding the channel formed by micromorcellator 40. RF button also could take the form of a microswitch located within slot 61 of handle assembly 50, so as to provide automatic activation of the RF coagulation feature for a short period of time when depth control lever 60 is advanced to contact the user-adjustable limit bar.
It will therefore be seen that handle assembly 50 provides for longitudinal movement of end region 25 with respect to catheter shaft 21 via relative movement between upper portion 52 and lower portion 51 (using knob 53); provides selective deployment of stabilization members 27 via button 55; selective orientation of end region 25 via button 58; control over the depth of the channels formed by end effector 40 via depth control lever 60; and, optionally, activation of an RF coagulation feature via button 62.
Referring now to
Insertion of apparatus 20 into the left ventricle is with guide member 22 in its distal-most position with stabilization members 27 fully retracted and end region 25 in its transit position. As barbs 33 of catheter shaft 21 engage apex 205 of the left ventricle, catheter shaft 21 (and guide member 22) preferentially bends in regions 65 and 66 to form a “dog-leg”, in which distal region 23 becomes urged against a lateral wall of the ventricle. Regions 65 and 66 where the bends take place may be made flexurally weaker than the remainder of the catheter shaft to aid in the bending of the catheter at these locations.
The motor and vacuum source of controller 29 are then actuated to cause cutting head 41 to rotate and to induce negative pressure in lumen 44 of micromorcellator 40. The clinician then pushes depth control lever 60 distally in slot 61, causing cutting head 41 to be advanced beyond distal endface 48 of guide member 22 and engage the endocardium. When micromorcellator 40 engages the endocardium, a reaction force is generated in catheter shaft 21 that tends both to push end region 25 away from the tissue and to cause the catheter shaft to want to rotate. The relatively flat configuration of catheter shaft 21, in conjunction with barbs 33, is expected to adequately counteract the torque induced by operation of the micromorcellator. In addition, stabilization members 27 function to counteract both these outward reaction and torque effects.
As micromorcellator 40 is advanced to form channel 207 in the left ventricular wall, tissue severed by cutting head 41 is suctioned into lumen 44 and aspirated to the proximal end of apparatus 20 via the vacuum source of controller 29. The depth of channel 207, which is proportional to the movement of depth control lever 60 in slot 61, may be predetermined using conventional ultrasound techniques, MRI scanning, or other suitable methods. As channel 207 is formed, tissue severed from the ventricular wall is aspirated through lumen 44 of guide member 22, thereby reducing the risk of embolization of the severed material. In addition, applicant expects that the use of suction through lumen 44 will assist in stabilizing the micromorcellator, and tend to draw tissue into the cutting head.
Once micromorcellator 40 has achieved its maximum predetermined depth, cutting head 41 is withdrawn from channel 207 by retracting depth control lever 60 to its proximal-most position, thereby returning cutting head 41 to a position just below distal endface 48 of end region 25 of guide member 22. It is expected that rotation of cutting head 41 will generate sufficient frictional heat in the tissue contacting the exterior of cutting head 41 to coagulate the tissue defining the channel.
Optionally, RF button 62 may be depressed on handle assembly 50 to apply a burst of RF energy to the edges of channel 207 as micromorcellator 40 achieves its maximum predetermined depth, and while cutting head 41 is stationary, rotating or being withdrawn from the channel. If provided, this burst of RF energy is expected to further coagulate the tissue defining the walls of channel 207 and modify the surface properties of the tissue.
As shown in
The foregoing methods enable a matrix of channels to be formed illustratively in the left ventricular wall. It will of course be understood that the same steps may be performed in mirror image to stabilize the apparatus against the left ventricular wall while actuating the end effector to produce a series of channels in the septal region. In accordance with presently accepted theory, the formation of such channels in the endocardium or septal region enables oxygenated blood in the left ventricle to flow directly into the myocardium and thus nourish and oxygenate the muscle. It is believed that these channels may be drilled anywhere on the walls of the heart chamber, including the septum, apex and left ventricular wall, and the above-described apparatus provides this capability.
Referring now to
Dual-rail embodiment 70 may be used without stabilization members, or alternatively catheter shaft 73 may include the stabilization members of
Wires 71 and 72, in cooperation with a distally-directed axial force exerted on the handle assembly by the clinician, serve to anchor the catheter against a lateral wall of the left ventricle, while catheter shaft 74 and guide member 79 are advanced along the dual-rail. Like apparatus 20, apparatus 70 may include flexurally weaker locations along its length to aid in positioning distal region 74 within the left ventricle.
The dual-rail design of apparatus 70 also may be advantageously employed to determine the location of end region 75 and end effector 81 with respect to the interior of the hollow-body organ or vessel. In this embodiment, wires 71 and 72 are electrically connected within cushion 77 and have a uniform resistance per unit length. Electrodes 80 are positioned in distal end 82 of catheter shaft 73 to measure the resistance of wires 71 and 72 between the electrodes.
The resistance between electrodes 80 may be measured, for example, by ohmmeter circuitry, to determine the distance between the distal end 82 of the catheter shaft and the apex of the left ventricle. In conjunction with the displacement between the upper and lower portions of the handle assembly (see
Referring now to FIGS. 8 and 9A-9C, a first alternative embodiment of the stabilization members of the present invention are described. In
Accordingly, wires 91a-91d of the embodiment of
As illustrated in
Referring now to
As described hereinabove, guide member 102 moves relative to catheter shaft 101 to enable the clinician to form a series of vertically aligned channels in the myocardium. Once a line of channels has been formed, the catheter must be moved laterally to a new location and the procedure repeated until the desired number of channels has been achieved. One expedient for doing so, for example, applicable to the apparatus of
Specifically, when inflated, stabilization members 103 provide a degree of hoop strength that ensures proper contact of the distal face of end region 106 with the wall of the hollow-body organ or vessel at all times. Once a vertical row of channels has been formed, stabilization members 103 are deflated by the clinician and end region 106 is moved to a new lateral position. The stabilization members are fully re-inflated and another vertical row of channels is formed, as discussed hereinabove.
With respect to FIGS. 11 and 12A-12C, another embodiment of the apparatus of the present invention is described in which the stabilization members comprise longitudinally-oriented balloons. Apparatus 110 is otherwise similar to the apparatus of
Referring now to
End region 125 of guide member 122 may be positioned longitudinally with respect to catheter shaft 121 by imparting relative movement between guide member 122 and catheter shaft 121 using handle assembly 126. Catheter shaft 121 includes stabilizing assembly 127 to support and stabilize distal region 123 of the apparatus within an organ or vessel.
Apparatus 120 is coupled via cable 128 to controller 129. In a preferred embodiment, wherein the end effector comprises a flexible wire having a sharpened tip, controller 129 includes a hydraulic or pneumatic piston, valve assembly and control logic for extending and retracting the end effector beyond the distal endface of end region 125 responsive to commands input at handle assembly 126 or a footpedal (not shown). Controller 129 optionally may further contain RF generator circuitry for energizing electrodes disposed on the end effector to cause a controlled degree of necrosis at the treatment site.
Referring now to
End region 125 of guide member 122 is movable from a transit position lying parallel to longitudinal axis 124 of catheter shaft 121 to a working position wherein end region 125 is articulated to a position substantially orthogonal to the longitudinal axis of the catheter shaft. In addition, end region 125 may be constructed to enable it to be locked in position at any angle a that may be desired for a given application.
Stabilization assembly 127 comprises flat band 137 of resilient material, such as stainless steel, that projects outwardly from catheter shaft 121 in distal region 123. Illustratively, stabilization assembly 127 comprises multiple loops 127a-127c of band 137. Band 137 has its distal end affixed to the distal end of catheter shaft 121, and its proximal end connected to handle assembly 126. Band 137 passes through an interior lumen of catheter shaft 121 (see
In the position shown in
The longitudinal position of end region 125 with respect to catheter shaft 121 may be adjusted by sliding guide member 122 in track 130 of the catheter shaft. Handle assembly 126 preferably includes means, described hereinafter, for moving guide member 122 with respect to catheter shaft 121 so that end region 125 may be positioned at a series of longitudinal locations In addition, stabilization assembly 127 may be adjusted to provide some control over the lateral positioning of the catheter shaft and guide member with respect to the interior wall of the organ or vessel. Thus, apparatus 120 enables a matrix of treatment sites to be accessed without removing and repositioning the apparatus.
With respect to
Threaded post 145 is coupled to the proximal end of band 137, and slides in a slot (not visible in
Upper portion 141 includes indicator 147a that may be selectively aligned with indicators 147b, so that the treatment sites are positioned at a series of spaced-apart locations. Cable 128 extends from upper portion 141 and connects the end effector of apparatus 120 to controller 129. Button 148 disposed on the top surface of upper portion 141 may be depressed to command the control logic of controller 129 to reciprocate the end effector from end region 125, and optionally, cause necrosis at the treatment site. Button 149, disposed in a slot in the upper surface of the proximal end of guide tube 122 (not visible in
Handle assembly 126 therefore provides for longitudinal movement of end region 125 with respect to catheter shaft 121 via relative movement between upper portion 141 and lower portion 140 (using knob 142); provides selective deployment of stabilization assembly 127 (using post 145 and thumbwheel 146); selective orientation of end region 125 (using button 149); and control over operation of the end effector (using button 148).
Referring now to
With respect to
Apparatus 170 includes distal region 173 within which guide member 172 has end region 175 that is selectively movable between a transit position parallel to longitudinal axis 174 of catheter shaft 171 and a working position (as shown), substantially orthogonal to longitudinal axis 174. Distal region 173 preferably includes an end effector, as described in detail hereinabove. End region 175 of guide member 172 may be positioned longitudinally with respect to catheter shaft 171 by imparting relative movement between guide member 172 and catheter shaft 171 using handle assembly 176. Catheter shaft 121 includes stabilizing element 177 to support and stabilize distal region 173 of the apparatus within an organ or vessel.
Distal region 173 of apparatus 170 is described in greater detail with respect to
Stabilization element 177 comprises wire or band 186 of resilient material, such as stainless steel, that exits catheter shaft 171 through skive 187, and is fixed to catheter shaft 171 near distal end 188. When deployed within a hollow organ, such as a chamber of the heart, as depicted in
While preferred illustrative embodiments of the invention are described, it will be apparent to one skilled in the art that various changes and modifications may be made without departing from the invention, and the appended claims are intended to cover all such changes and modifications that fall within the true spirit and scope of the invention.
|Patente citada||Fecha de presentación||Fecha de publicación||Solicitante||Título|
|US1162901||8 Oct 1915||7 Dic 1915||Edward B Cantey||Instrument for cutting cores from solid substances.|
|US2710000||19 Feb 1952||7 Jun 1955||Cromer Jeremiah Keith||Cutting instrument|
|US2749909||21 Sep 1954||12 Jun 1956||Biopsy knife|
|US3120845||20 Feb 1961||11 Feb 1964||Horner David B||Self-powered surgical drill|
|US3470876||28 Sep 1966||7 Oct 1969||John Barchilon||Dirigible catheter|
|US3477423||9 Ene 1967||11 Nov 1969||Baxter Laboratories Inc||Biopsy instrument|
|US3557794||30 Jul 1968||26 Ene 1971||Us Air Force||Arterial dilation device|
|US3614953||21 Ene 1969||26 Oct 1971||Nat Res Dev||Drills for clearing obstructions in arteries|
|US3692020||29 Abr 1971||19 Sep 1972||Schied Robert J||Rotary punch for excising uniform diopsy specimens|
|US3780246||22 Ago 1972||18 Dic 1973||Black & Decker Mfg Co||Hand-operated tool with switch actuator having three-position lock-off assembly|
|US4207874||27 Mar 1978||17 Jun 1980||Choy Daniel S J||Laser tunnelling device|
|US4362161||27 Oct 1980||7 Dic 1982||Codman & Shurtleff, Inc.||Cranial drill|
|US4381037||28 Oct 1980||26 Abr 1983||Black & Decker Inc.||Portable electric tool|
|US4461305||4 Sep 1981||24 Jul 1984||Cibley Leonard J||Automated biopsy device|
|US4464738||23 Feb 1981||7 Ago 1984||Sonic Tape Public Limited Company||Sonar distance sensing apparatus|
|US4468224||28 Ene 1982||28 Ago 1984||Advanced Cardiovascular Systems, Inc.||System and method for catheter placement in blood vessels of a human patient|
|US4479896||8 Jul 1983||30 Oct 1984||Antoniades Harry N||Method for extraction localization and direct recovery of platelet derived growth factor|
|US4576162||17 Sep 1984||18 Mar 1986||Mccorkle Charles E||Apparatus and method for separation of scar tissue in venous pathway|
|US4578057||31 Ago 1984||25 Mar 1986||Cordis Corporation||Ventricular right angle connector and system|
|US4582056||17 Sep 1984||15 Abr 1986||Mccorkle Jr Charles E||Endocardial lead extraction apparatus and method|
|US4600014||10 Feb 1984||15 Jul 1986||Dan Beraha||Transrectal prostate biopsy device and method|
|US4640296||10 Dic 1985||3 Feb 1987||Schnepp Pesch Wolfram||Biopsy cannula|
|US4646738||5 Dic 1985||3 Mar 1987||Concept, Inc.||Rotary surgical tool|
|US4702261||3 Jul 1985||27 Oct 1987||Sherwood Medical Company||Biopsy device and method|
|US4729763||6 Jun 1986||8 Mar 1988||Henrie Rodney A||Catheter for removing occlusive material|
|US4788975||5 Nov 1987||6 Dic 1988||Medilase, Inc.||Control system and method for improved laser angioplasty|
|US4790812||15 Nov 1985||13 Dic 1988||Hawkins Jr Irvin F||Apparatus and method for removing a target object from a body passsageway|
|US4792327||16 Oct 1987||20 Dic 1988||Barry Swartz||Lipectomy cannula|
|US4813930||13 Oct 1987||21 Mar 1989||Dimed, Inc.||Angioplasty guiding catheters and methods for performing angioplasty|
|US4850354||13 Ago 1987||25 Jul 1989||Baxter Travenol Laboratories, Inc.||Surgical cutting instrument|
|US4856529||6 Feb 1987||15 Ago 1989||Cardiometrics, Inc.||Ultrasonic pulmonary artery catheter and method|
|US4895156||2 Jul 1986||23 Ene 1990||Schulze John E||Sensor system using fluorometric decay measurements|
|US4895166||23 Nov 1987||23 Ene 1990||Interventional Technologies, Inc.||Rotatable cutter for the lumen of a blood vesel|
|US4898577||28 Sep 1988||6 Feb 1990||Advanced Cardiovascular Systems, Inc.||Guiding cathether with controllable distal tip|
|US4917102 *||14 Sep 1988||17 Abr 1990||Advanced Cardiovascular Systems, Inc.||Guidewire assembly with steerable adjustable tip|
|US4923462||15 Ago 1988||8 May 1990||Cordis Corporation||Catheter system having a small diameter rotatable drive member|
|US4957742||10 Ene 1989||18 Sep 1990||Regents Of The University Of Minnesota||Method for promoting hair growth|
|US4964854||23 Ene 1989||23 Oct 1990||Luther Medical Products, Inc.||Intravascular catheter assembly incorporating needle tip shielding cap|
|US4976710||15 Nov 1988||11 Dic 1990||Mackin Robert A||Working well balloon method|
|US4985028||30 Ago 1989||15 Ene 1991||Angeion Corporation||Catheter|
|US5030201||24 Nov 1989||9 Jul 1991||Aubrey Palestrant||Expandable atherectomy catheter device|
|US5087265 *||24 Jul 1989||11 Feb 1992||American Biomed, Inc.||Distal atherectomy catheter|
|US5093877||30 Oct 1990||3 Mar 1992||Advanced Cardiovascular Systems||Optical fiber lasing apparatus lens|
|US5104393||2 Nov 1990||14 Abr 1992||Angelase, Inc.||Catheter|
|US5106386||2 Nov 1990||21 Abr 1992||Angelase, Inc.||Catheter|
|US5123904||31 Dic 1990||23 Jun 1992||Olympus Optical Co., Ltd.||Surgical resecting instrument|
|US5125924||24 Sep 1990||30 Jun 1992||Laser Engineering, Inc.||Heart-synchronized vacuum-assisted pulsed laser system and method|
|US5125926||24 Sep 1990||30 Jun 1992||Laser Engineering, Inc.||Heart-synchronized pulsed laser system|
|US5133713||30 Mar 1990||28 Jul 1992||Huang Jong Khing||Apparatus of a spinning type of resectoscope for prostatectomy|
|US5135531||27 Mar 1990||4 Ago 1992||Surgical Systems & Instruments, Inc.||Guided atherectomy system|
|US5152744||27 Dic 1990||6 Oct 1992||Smith & Nephew Dyonics||Surgical instrument|
|US5195988||4 Nov 1991||23 Mar 1993||Haaga John R||Medical needle with removable sheath|
|US5197968||14 Ago 1991||30 Mar 1993||Mectra Labs, Inc.||Disposable tissue retrieval assembly|
|US5224951||19 Feb 1991||6 Jul 1993||Dexide, Inc.||Surgical trocar and spike assembly|
|US5242460||25 Oct 1990||7 Sep 1993||Devices For Vascular Intervention, Inc.||Atherectomy catheter having axially-disposed cutting edge|
|US5263959||21 Oct 1991||23 Nov 1993||Cathco, Inc.||Dottering auger catheter system and method|
|US5269785||28 Jun 1990||14 Dic 1993||Bonutti Peter M||Apparatus and method for tissue removal|
|US5273051||16 Mar 1993||28 Dic 1993||Wilk Peter J||Method and associated device for obtaining a biopsy of tissues of an internal organ|
|US5281218||5 Jun 1992||25 Ene 1994||Cardiac Pathways Corporation||Catheter having needle electrode for radiofrequency ablation|
|US5285795||12 Sep 1991||15 Feb 1994||Surgical Dynamics, Inc.||Percutaneous discectomy system having a bendable discectomy probe and a steerable cannula|
|US5287861||30 Oct 1992||22 Feb 1994||Wilk Peter J||Coronary artery by-pass method and associated catheter|
|US5292309||22 Ene 1993||8 Mar 1994||Schneider (Usa) Inc.||Surgical depth measuring instrument and method|
|US5313949 *||1 Feb 1993||24 May 1994||Cardiovascular Imaging Systems Incorporated||Method and apparatus for intravascular two-dimensional ultrasonography|
|US5323781||19 May 1993||28 Jun 1994||Duke University||Methods for the diagnosis and ablation treatment of ventricular tachycardia|
|US5324284||5 Jun 1992||28 Jun 1994||Cardiac Pathways, Inc.||Endocardial mapping and ablation system utilizing a separately controlled ablation catheter and method|
|US5330466||1 Dic 1992||19 Jul 1994||Cardiac Pathways Corporation||Control mechanism and system and method for steering distal extremity of a flexible elongate member|
|US5336237||25 Ago 1993||9 Ago 1994||Devices For Vascular Intervention, Inc.||Removal of tissue from within a body cavity|
|US5339799||17 Abr 1992||23 Ago 1994||Olympus Optical Co., Ltd.||Medical system for reproducing a state of contact of the treatment section in the operation unit|
|US5342300||12 Mar 1993||30 Ago 1994||Stefanadis Christodoulos I||Steerable stent catheter|
|US5342393||27 Ago 1992||30 Ago 1994||Duke University||Method and device for vascular repair|
|US5354310||22 Mar 1993||11 Oct 1994||Cordis Corporation||Expandable temporary graft|
|US5358472||9 Sep 1993||25 Oct 1994||Schneider (Usa) Inc.||Guidewire atherectomy catheter and method of using the same|
|US5358485||16 Ago 1993||25 Oct 1994||Schneider (Usa) Inc.||Cutter for atherectomy catheter|
|US5366468||9 Nov 1993||22 Nov 1994||Linvatec Corporation||Double bladed surgical router having aspiration ports within flutes|
|US5366490 *||22 Dic 1993||22 Nov 1994||Vidamed, Inc.||Medical probe device and method|
|US5370675 *||2 Feb 1993||6 Dic 1994||Vidamed, Inc.||Medical probe device and method|
|US5379772||14 Sep 1993||10 Ene 1995||Intelliwire, Inc.||Flexible elongate device having forward looking ultrasonic imaging|
|US5380316||16 Jun 1993||10 Ene 1995||Advanced Cardiovascular Systems, Inc.||Method for intra-operative myocardial device revascularization|
|US5383884||4 Dic 1992||24 Ene 1995||American Biomed, Inc.||Spinal disc surgical instrument|
|US5389073||12 Oct 1993||14 Feb 1995||Cardiac Pathways Corporation||Steerable catheter with adjustable bend location|
|US5389096||25 Feb 1993||14 Feb 1995||Advanced Cardiovascular Systems||System and method for percutaneous myocardial revascularization|
|US5392917||3 Ago 1993||28 Feb 1995||Ethicon, Inc.||Easy open 1-2-3 instrumentation package|
|US5396897||3 May 1993||14 Mar 1995||The General Hospital Corporation||Method for locating tumors prior to needle biopsy|
|US5403334||1 Oct 1993||4 Abr 1995||Devices For Vascular Intervention, Inc.||Atherectomy device having helical blade and blade guide|
|US5409000||14 Sep 1993||25 Abr 1995||Cardiac Pathways Corporation||Endocardial mapping and ablation system utilizing separately controlled steerable ablation catheter with ultrasonic imaging capabilities and method|
|US5415166||28 Sep 1993||16 May 1995||Cardiac Pathways Corporation||Endocardial mapping apparatus and cylindrical semiconductor device mounting structure for use therewith and method|
|US5419777||2 May 1994||30 May 1995||Bavaria Medizin Technologie Gmbh||Catheter for injecting a fluid or medicine|
|US5425376||8 Sep 1993||20 Jun 1995||Sofamor Danek Properties, Inc.||Method and apparatus for obtaining a biopsy sample|
|US5429144||5 Abr 1994||4 Jul 1995||Wilk; Peter J.||Coronary artery by-pass method|
|US5439474||8 Oct 1993||8 Ago 1995||Li Medical Technologies, Inc.||Morcellator system|
|US5443443||17 Ago 1993||22 Ago 1995||Surgical Systems & Instruments, Inc.||Atherectomy system|
|US5456689||13 Oct 1993||10 Oct 1995||Arnold J. Kresch||Method and device for tissue resection|
|US5464395 *||5 Abr 1994||7 Nov 1995||Faxon; David P.||Catheter for delivering therapeutic and/or diagnostic agents to the tissue surrounding a bodily passageway|
|US5465717||15 Ago 1994||14 Nov 1995||Cardiac Pathways Corporation||Apparatus and Method for ventricular mapping and ablation|
|US5488958||7 Nov 1994||6 Feb 1996||Vance Products Incorporated||Surgical cutting instrument for coring tissue affixed thereto|
|US5492119||22 Dic 1993||20 Feb 1996||Heart Rhythm Technologies, Inc.||Catheter tip stabilizing apparatus|
|US5497784||30 Jun 1994||12 Mar 1996||Intelliwire, Inc.||Flexible elongate device having steerable distal extremity|
|US5505725||27 Ene 1995||9 Abr 1996||Cardiogenesis Corporation||Shapeable optical fiber apparatus|
|US5507802||7 Oct 1994||16 Abr 1996||Cardiac Pathways Corporation||Method of mapping and/or ablation using a catheter having a tip with fixation means|
|US5520634||12 Jul 1994||28 May 1996||Ethicon, Inc.||Mechanical morcellator|
|US5527279||12 May 1994||18 Jun 1996||Cardiac Pathways Corporation||Control mechanism and system and method for steering distal extremity of a flexible elongate member|
|US5531780||30 Jun 1994||2 Jul 1996||Pacesetter, Inc.||Implantable stimulation lead having an advanceable therapeutic drug delivery system|
|US5551427||13 Feb 1995||3 Sep 1996||Altman; Peter A.||Implantable device for the effective elimination of cardiac arrhythmogenic sites|
|US5554152||20 Dic 1994||10 Sep 1996||Cardiogenesis Corporation||Method for intra-operative myocardial revascularization|
|US5562694||11 Oct 1994||8 Oct 1996||Lasersurge, Inc.||Morcellator|
|US5569178||20 Oct 1995||29 Oct 1996||Henley; Julian L.||Power assisted suction lipectomy device|
|US5569254||12 Abr 1995||29 Oct 1996||Midas Rex Pneumatic Tools, Inc.||Surgical resection tool having an irrigation, lighting, suction and vision attachment|
|US5569284||23 Sep 1994||29 Oct 1996||United States Surgical Corporation||Morcellator|
|US5575293||6 Feb 1995||19 Nov 1996||Promex, Inc.||Apparatus for collecting and staging tissue|
|US5575772||15 Feb 1996||19 Nov 1996||Boston Scientific Corporation||Albation catheters|
|US5575787||27 Feb 1995||19 Nov 1996||Abela Laser Systems, Inc.||Cardiac ablation catheters and method|
|US5575810||15 Sep 1995||19 Nov 1996||Ep Technologies, Inc.||Composite structures and methods for ablating tissue to form complex lesion patterns in the treatment of cardiac conditions and the like|
|US5578067||4 Abr 1995||26 Nov 1996||Pacesetter Ab||Medical electrode system having a sleeve body and control element therefor for selectively positioning an exposed conductor area|
|US5584842 *||30 Jun 1994||17 Dic 1996||Intramed Laboratories, Inc.||Valvulotome and method of using|
|US5588432||10 Jul 1995||31 Dic 1996||Boston Scientific Corporation||Catheters for imaging, sensing electrical potentials, and ablating tissue|
|US5591159||9 Nov 1994||7 Ene 1997||Taheri; Syde A.||Transcavitary myocardial perfusion apparatus|
|US5593405 *||9 Ene 1995||14 Ene 1997||Osypka; Peter||Fiber optic endoscope|
|US5601573||15 Mar 1995||11 Feb 1997||Ethicon Endo-Surgery, Inc.||Sterile occlusion fasteners and instruments and method for their placement|
|US5601586||17 Ene 1995||11 Feb 1997||Linvatec Corporation||Variable angle rotating shaver|
|US5601588||27 Sep 1995||11 Feb 1997||Olympus Optical Co., Ltd.||Endoscopic puncture needle|
|US5606974||2 May 1995||4 Mar 1997||Heart Rhythm Technologies, Inc.||Catheter having ultrasonic device|
|US5607421||25 May 1994||4 Mar 1997||The Trustees Of Columbia University In The City Of New York||Myocardial revascularization through the endocardial surface using a laser|
|US5609591||9 Mar 1995||11 Mar 1997||S.L.T. Japan Co., Ltd.||Laser balloon catheter apparatus|
|US5609621||4 Ago 1995||11 Mar 1997||Medtronic, Inc.||Right ventricular outflow tract defibrillation lead|
|US5611803||22 Dic 1994||18 Mar 1997||Urohealth Systems, Inc.||Tissue segmentation device|
|US5613972||13 Sep 1994||25 Mar 1997||The University Of Miami||Surgical cutting heads with curled cutting wings|
|US5640955 *||14 Feb 1995||24 Jun 1997||Daig Corporation||Guiding introducers for use in the treatment of accessory pathways around the mitral valve using a retrograde approach|
|US5643253||6 Jun 1995||1 Jul 1997||Rare Earth Medical, Inc.||Phototherapy apparatus with integral stopper device|
|US5651781||20 Abr 1995||29 Jul 1997||Grace-Wells Technology Partners No. 1, L.P.||Surgical cutting instrument|
|US5658263||18 May 1995||19 Ago 1997||Cordis Corporation||Multisegmented guiding catheter for use in medical catheter systems|
|US5662124||19 Jun 1996||2 Sep 1997||Wilk Patent Development Corp.||Coronary artery by-pass method|
|US5662671||17 Jul 1996||2 Sep 1997||Embol-X, Inc.||Atherectomy device having trapping and excising means for removal of plaque from the aorta and other arteries|
|US5665062 *||23 Ene 1995||9 Sep 1997||Houser; Russell A.||Atherectomy catheter and RF cutting method|
|US5669920||20 Mar 1996||23 Sep 1997||Devices For Vascular Intervention, Inc.||Atherectomy catheter|
|US5680860||31 Oct 1995||28 Oct 1997||Cardiac Pathways Corporation||Mapping and/or ablation catheter with coilable distal extremity and method for using same|
|US5683362||14 May 1996||4 Nov 1997||Rowland; Christopher A.||Apparatus for performing diagnostic and therapeutic modalities in the biliary tree|
|US5688234||26 Ene 1996||18 Nov 1997||Cardiometrics Inc.||Apparatus and method for the treatment of thrombotic occlusions in vessels|
|US5702412||3 Oct 1995||30 Dic 1997||Cedars-Sinai Medical Center||Method and devices for performing vascular anastomosis|
|US5709697||22 Nov 1995||20 Ene 1998||United States Surgical Corporation||Apparatus and method for removing tissue|
|US5722400 *||16 Feb 1995||3 Mar 1998||Daig Corporation||Guiding introducers for use in the treatment of left ventricular tachycardia|
|US5724975||12 Dic 1996||10 Mar 1998||Plc Medical Systems, Inc.||Ultrasonic detection system for transmyocardial revascularization|
|US5725521 *||29 Mar 1996||10 Mar 1998||Eclipse Surgical Technologies, Inc.||Depth stop apparatus and method for laser-assisted transmyocardial revascularization and other surgical applications|
|US5730741 *||7 Feb 1997||24 Mar 1998||Eclipse Surgical Technologies, Inc.||Guided spiral catheter|
|US5743870||6 May 1996||28 Abr 1998||Somnus Medical Technologies, Inc.||Ablation apparatus and system for removal of soft palate tissue|
|US5755714 *||17 Sep 1996||26 May 1998||Eclipse Surgical Technologies, Inc.||Shaped catheter for transmyocardial revascularization|
|US5766163 *||3 Jul 1996||16 Jun 1998||Eclipse Surgical Technologies, Inc.||Controllable trocar for transmyocardial revascularization (TMR) via endocardium method and apparatus|
|US5776092||22 Mar 1995||7 Jul 1998||Erbe Elektromedizin Gmbh||Multifunctional surgical instrument|
|US5782823||5 Abr 1996||21 Jul 1998||Eclipse Surgical Technologies, Inc.||Laser device for transmyocardial revascularization procedures including means for enabling a formation of a pilot hole in the epicardium|
|US5797870||7 Jun 1995||25 Ago 1998||Indiana University Foundation||Pericardial delivery of therapeutic and diagnostic agents|
|US5807384||20 Dic 1996||15 Sep 1998||Eclipse Surgical Technologies, Inc.||Transmyocardial revascularization (TMR) enhanced treatment for coronary artery disease|
|US5807401||2 Nov 1995||15 Sep 1998||Grieshaber & Co. Ag Schaffhausen||Ophthalmic surgical apparatus for pulverizing and removing the lens nucleus from the eye of a living being|
|US5814028||23 Oct 1996||29 Sep 1998||Daig Corporation||Curved guiding introducers for cardiac access|
|US5830210||21 Oct 1996||3 Nov 1998||Plc Medical Systems, Inc.||Catheter navigation apparatus|
|US5830222||11 Oct 1996||3 Nov 1998||Transvascular, Inc.||Device, system and method for intersititial transvascular intervention|
|US5833715||27 Jun 1995||10 Nov 1998||Pacesetter, Inc.||Implantable stimulation lead having an advanceable therapeutic drug delivery system|
|US5834418||20 Mar 1996||10 Nov 1998||Theratechnologies, Inc.||Process for the preparation of platelet growth factors extract|
|US5840059||7 Jun 1995||24 Nov 1998||Cardiogenesis Corporation||Therapeutic and diagnostic agent delivery|
|US5846225||19 Feb 1997||8 Dic 1998||Cornell Research Foundation, Inc.||Gene transfer therapy delivery device and method|
|US5851171 *||4 Nov 1997||22 Dic 1998||Advanced Cardiovascular Systems, Inc.||Catheter assembly for centering a radiation source within a body lumen|
|US5857995||7 Jul 1997||12 Ene 1999||Surgical Dynamics, Inc.||Multiple bladed surgical cutting device removably connected to a rotary drive element|
|US5871495||13 Sep 1996||16 Feb 1999||Eclipse Surgical Technologies, Inc.||Method and apparatus for mechanical transmyocardial revascularization of the heart|
|US5873366||7 Nov 1996||23 Feb 1999||Chim; Nicholas||Method for transmyocardial revascularization|
|US5876373||4 Abr 1997||2 Mar 1999||Eclipse Surgical Technologies, Inc.||Steerable catheter|
|US5878751||20 Oct 1997||9 Mar 1999||Myocardial Stents, Inc.||Method for trans myocardial revascularization (TMR)|
|US5885272||21 Nov 1995||23 Mar 1999||Aita; Michael||System and method for percutaneous myocardial revascularization|
|US5885276||2 Dic 1997||23 Mar 1999||Galil Medical Ltd.||Method and device for transmyocardial cryo revascularization|
|US5893848||24 Oct 1996||13 Abr 1999||Plc Medical Systems, Inc.||Gauging system for monitoring channel depth in percutaneous endocardial revascularization|
|US5899874||30 Abr 1993||4 May 1999||Stiftelsen For Medicinsk-Teknisk Utveckling||Preparation and method for production of platelet concentrates with significantly prolonged viabilty during storage|
|US5906594||8 Ene 1997||25 May 1999||Symbiosis Corporation||Endoscopic infusion needle having dual distal stops|
|US5910150 *||27 May 1997||8 Jun 1999||Angiotrax, Inc.||Apparatus for performing surgery|
|US5916214||28 Mar 1997||29 Jun 1999||Medtronic Cardiorhythm||Dual curve ablation catheter|
|US5921982 *||30 Abr 1997||13 Jul 1999||Lesh; Michael D.||Systems and methods for ablating body tissue|
|US5925012||27 Dic 1996||20 Jul 1999||Eclipse Surgical Technologies, Inc.||Laser assisted drug delivery|
|US5928943||21 Nov 1995||27 Jul 1999||Institut Fur Pflanzengenetik Und Kulturpflanzenforschung||Embryonal cardiac muscle cells, their preparation and their use|
|US5931848 *||27 May 1997||3 Ago 1999||Angiotrax, Inc.||Methods for transluminally performing surgery|
|US5938632||6 Mar 1997||17 Ago 1999||Scimed Life Systems, Inc.||Radiofrequency transmyocardial revascularization apparatus and method|
|US5941868||22 Nov 1996||24 Ago 1999||Localmed, Inc.||Localized intravascular delivery of growth factors for promotion of angiogenesis|
|US5941893 *||27 May 1997||24 Ago 1999||Angiotrax, Inc.||Apparatus for transluminally performing surgery|
|US5944716 *||31 Ene 1997||31 Ago 1999||Scimed Life Systems, Inc.||Radio frequency transmyocardial revascularization corer|
|US5951567||24 Jul 1997||14 Sep 1999||Cardiogenesis Corporation||Introducer for channel forming device|
|US5964754||23 May 1997||12 Oct 1999||Sulzer Osypka Gmbh||Device for perforating the heart wall|
|US5964757||5 Sep 1997||12 Oct 1999||Cordis Webster, Inc.||Steerable direct myocardial revascularization catheter|
|US5968059||6 Mar 1997||19 Oct 1999||Scimed Life Systems, Inc.||Transmyocardial revascularization catheter and method|
|US5971993||16 Dic 1998||26 Oct 1999||Myocardial Stents, Inc.||System for delivery of a trans myocardial device to a heart wall|
|US5980545||13 May 1996||9 Nov 1999||United States Surgical Corporation||Coring device and method|
|US5980548||29 Oct 1997||9 Nov 1999||Kensey Nash Corporation||Transmyocardial revascularization system|
|US5989278||13 Feb 1998||23 Nov 1999||Eclipse Surgical Technologies, Inc.||Method and apparatus for mechanical transmyocardial revascularization of the heart|
|US6030377||21 Oct 1996||29 Feb 2000||Plc Medical Systems, Inc.||Percutaneous transmyocardial revascularization marking system|
|US6036677||28 Jul 1998||14 Mar 2000||Cardiogenesis Corporation||Catheter with flexible intermediate section|
|US6045530||14 Oct 1998||4 Abr 2000||Heyer-Schulte Neurocare Inc.||Adjustable angle catheter|
|US6045565||2 Nov 1998||4 Abr 2000||Scimed Life Systems, Inc.||Percutaneous myocardial revascularization growth factor mediums and method|
|US6051008 *||15 Dic 1998||18 Abr 2000||Angiotrax, Inc.||Apparatus having stabilization members for percutaneously performing surgery and methods of use|
|US6056743 *||5 Mar 1998||2 May 2000||Scimed Life Systems, Inc.||Percutaneous myocardial revascularization device and method|
|US6056760||30 Ene 1998||2 May 2000||Nissho Corporation||Device for intracardiac suture|
|US6066126||18 Dic 1997||23 May 2000||Medtronic, Inc.||Precurved, dual curve cardiac introducer sheath|
|US6093177||7 Mar 1997||25 Jul 2000||Cardiogenesis Corporation||Catheter with flexible intermediate section|
|US6102887||11 Ago 1998||15 Ago 2000||Biocardia, Inc.||Catheter drug delivery system and method for use|
|US6106520||30 Sep 1998||22 Ago 2000||Hearten Medical, Inc.||Endocardial device for producing reversible damage to heart tissue|
|US6126654||24 Feb 1999||3 Oct 2000||Eclipse Surgical Technologies, Inc.||Method of forming revascularization channels in myocardium using a steerable catheter|
|US6165164||29 Mar 1999||26 Dic 2000||Cordis Corporation||Catheter for injecting therapeutic and diagnostic agents|
|US6179809 *||18 Sep 1998||30 Ene 2001||Eclipse Surgical Technologies, Inc.||Drug delivery catheter with tip alignment|
|US6197324||15 Jul 1998||6 Mar 2001||C. R. Bard, Inc.||System and methods for local delivery of an agent|
|US6224584||4 May 1999||1 May 2001||Eclipse Surgical Technologies, Inc.||Therapeutic and diagnostic agent delivery|
|US6238389||30 Sep 1997||29 May 2001||Boston Scientific Corporation||Deflectable interstitial ablation device|
|US6251104||31 Oct 1997||26 Jun 2001||Eclipse Surgical Technologies, Inc.||Guiding catheter system for ablating heart tissue|
|US6270496||1 Mar 2000||7 Ago 2001||Cardiac Pacemakers, Inc.||Steerable catheter with preformed distal shape and method for use|
|US6309370||5 Feb 1998||30 Oct 2001||Biosense, Inc.||Intracardiac drug delivery|
|US6322548||31 Mar 1998||27 Nov 2001||Eclipse Surgical Technologies||Delivery catheter system for heart chamber|
|US6589232||17 Abr 2000||8 Jul 2003||Richard L. Mueller||Selective treatment of endocardial/myocardial boundary|
|US6613062||29 Oct 1999||2 Sep 2003||Medtronic, Inc.||Method and apparatus for providing intra-pericardial access|
|US6620139||11 Nov 1999||16 Sep 2003||Tre Esse Progettazione Biomedica S.R.L.||Catheter system for performing intramyocardiac therapeutic treatment|
|US6638233 *||19 Ago 1999||28 Oct 2003||Fox Hollow Technologies, Inc.||Apparatus and methods for material capture and removal|
|US6905476||13 Ene 2003||14 Jun 2005||Biosense Webster, Inc.||Catheter with injection needle|
|US6994716||15 Sep 2003||7 Feb 2006||Kabushiki Kaisha Toshiba||Medical manipulator|
|US7094201||18 Ago 1999||22 Ago 2006||Medtronic, Inc.||System and method for genetically treating cardiac conduction disturbances|
|US20040010231||13 Jul 2001||15 Ene 2004||Leonhardt Howard J||Deployment system for myocardial cellular material|
|USRE33258||30 Nov 1987||10 Jul 1990||Surgical Dynamics Inc.||Irrigating, cutting and aspirating system for percutaneous surgery|
|EP0807412A1||13 May 1997||19 Nov 1997||United States Surgical Corporation||Coring device and method|
|EP0853921A2||23 Dic 1997||22 Jul 1998||Eclipse Surgical Technologies, Inc.||Laser assisted drug delivery|
|EP0868923A2||26 Mar 1998||7 Oct 1998||Eclipse Surgical Technologies, Inc.||Steerable catheter|
|EP0876796A2||7 May 1998||11 Nov 1998||Eclipse Surgical Technologies, Inc.||Device for use in the treatment of cardiovascular or other tissue|
|EP0895752A1||6 Ago 1998||10 Feb 1999||Eclipse Surgical Technologies, Inc.||Apparatus for sampling heart tissue and/or myocardial revascularization by mechanical cutting|
|WO1992010142A1 *||18 Nov 1991||25 Jun 1992||Howmedica Inc.||A device and method for interstitial laser energy delivery|
|1||A Collection of Abstracts, Society of Thoracic Surgeons, 1999.|
|2||Assmus, Transplantation of Progenitor Cells and Regeneration Enhancement in Acute Myocardial Infarction (TOPCARE-AMI), Clinical Investigation and Reports, Oct. 8, 2002, pp. 3009-3017, Department of Molecular Cardiology and Department of Hematology (H.M., D.H.) University of Frankfurt, Frankfurt, Germany, Circulation available at http://www.circulationha.org DOI: 10.1161/01.CIR.0000043246.74879CD.|
|3||Cooley, Denton A., M.D. et al., "Transmyocardial Laser Revascularization: Anatomic Evidence of Long-Term Channel Patency," Texas heart Institute Journal, vol. 21, No. 3 (1994), pp. 220-224.|
|4||Cooley, Denton A., M.D. et al., "Transmyocardial Laser Revascularization: Clinical Experience with Twelve-Month Follow-Up," The Journal of Thoracic and Cardiovascular Surgery, (Apr. 1996), pp. 791-799.|
|5||Fenton II, John W. et al. "Thrombin and Antithrombotics," Seminars in Thrombosis and Hemostasis, vol. 24, No. 2, 1998, pp. 1987-1991.|
|6||Folkman, Judah, "Angiogenic Therapy of the Human Heart," circulation, 1998, 97:628-629.|
|7||Frazier, O.H., M.D., "Myocardial Revascularization With Laser: Preliminary Findings," Supplement II Circulation, vol. 92, No. 9, (Nov. 1995), pp. II-58-II-65.|
|8||Hardy, Roger Ian, "A Histologic Study of Laser-Induced Transmyocardial Channels," Lasers in Surgery and Medicine, (1987), pp. 6:563-573.|
|9||Henry, Timothy D., Can We Really Grow New Blood Vessels, The Lancet, vol. 351, Jun 20, 1998, pp. 1926-1827.|
|10||Hershey, John E. et al., "Transmyocardial Puncture Revascularization: A Possible Emergency Adjunct to Arterial Implant Surgery," Geriatrics, (Mar. 1969), pp. 101-108.|
|11||Horvath, Keith A., M.D., et al., "Recovery and Viability of an Acute Myocardial Infarct After Transmyocardial Laser Revascularization," Journal of American College of Cardiology, vol. 25, No. 1 (Jan. 1995), pp. 258-263.|
|12||Horvath, Keith A., M.D., et al., "Transmyocardial Laser Revascularization: Operative Techniques and Clinical Results at Two Years," The Journal of Thoracic and Cardiovascular Surgery, (May 1996) pp. 1047-1053.|
|13||Khazei, Hassan A., "A New Method of Myocardial Revasularization," The Annals of Thoracic Surgery, vol. 6, No. 2, (Aug. 1968) pp. 163-171.|
|14||Knighton, David R., et al., "Role of Platelets and Fibrin in the Healing Sequence," Annals of Surgery, vol. 196, No. 4, Oct. 1982, pp. 379-388.|
|15||Kohmoto, Takushi, M.D., "Does Blood Flow Through Holmium: YAG Transmyocardial Laser Channels?," Ann. Thorac. Surg., (1996) pp. 61:861-868.|
|16||Kuzela, Ladislaw, "Experimental Evaluation of Direct Transventricular Revascularization," Journal ofThoracic and Cardiovasuclar Surger, vol. 57, No. 6, (Jun. 1969), pp. 770-773.|
|17||Lee, Garrett, M.D., "Effects of Laser Irradiation Delivered by Flexible Fiberoptic System on the Left Ventricular Internal Myocardium," American Heart Journal, (Sep. 1983), pp. 587-590.|
|18||Losordo, Douglas, W., et al., "Gene Therapy for Myocardial Angiogenesis Initial Clinical Results with Direct Myocardial Injection of phVEGF 165 as Sole Therapy Myocardial Ischemia," Circulation, 1998, 98:2800-2804.|
|19||Maloney, James P. et al., "In Vitro Release of Vascular Endothelial Growth Factor During Platelet Aggregation," American Physiological Society, H1054-H1061, 1998.|
|20||Mandrusov, Membrane-Based Cell Affinity Chromatography to Retrieve Viable Cells, Biotechnol, Prob. 1995, 11, 208-213, Artificial Organs Research Laboratory, Department of Chemical Engineering, Material Science and Metallurgy, Columbia University, New York, New York 10027, and Lousville, Lousville, Kentucky 40292.|
|21||Miyazono, Kohei et al, "Platelet-Derived Endothelial Cell Growth Factor, " Progress in Growth Factor Research, vol. 3, 1991, pp. 207-217.|
|22||NASA's Jet Propulsion Laboratory, "Swivel-Head Sampling Drill Bit," NASA Tech Briefs, Nov. 1998.|
|23||PCT Communication-Supplementary European Search Report, Aug. 3, 2001, 3 pages.|
|24||PCT Communication—Supplementary European Search Report, Aug. 3, 2001, 3 pages.|
|25||PCT International Search Report Mar. 18, 1998, 4 pages.|
|26||PCT Notification of Transmittal of International Preliminary Examination Report, Apr. 15, 1999, 13 pages.|
|27||PCT Written Opinion, Dec. 23, 1998, 4 pages.|
|28||Pipili-Synetos, E. et al., "Evidence That Platelets Promote Tube Formation By Endothelial Cells on Matrigel," British Journal of Pharmacology, vol. 125, 1998, pp. 1252-1257.|
|29||PMR Poduct, Axcis.TM. PMR.TM. System, http://www.cardiogenesis.com/percutaneous/product.html, Jan. 27, 1999.|
|30||PMR Product, Axcis tm PMR. System, http://www.cardiogenesis.com/percutaneous/product.html, Jan. 27, 1999.|
|31||Sen, P.K. et al., "Further Studies in Multiple Transmyocardial Acupuncture as a Method of Myocardial Revascularization," Surgery, vol. 64, No. 5, (Nov. 1968), pp. 861-870.|
|32||Simons, Michael et al. "Food for Starving Hearts," Nature Medicine, vol. 2, No. 5, pp. 519-520 (May 1996).|
|33||Thaning, Otto, "Transmyocardial Laser Revascularisation in South Africa," SAMJ, vol. 85, No. 8 (Aug. 1995) pp. 787-788.|
|34||The PMR.TM. Procedure, http://www.cardiogenesis.com/percutaneous/procedure.html, Jan. 27, 1999.|
|35||Tsopanoglou, Nikos E. et al., "Thrombin Promotes Angiogenesis By a Mechanism Independent of Fibrin Formation," American Physiological Society, 0363-6143/93, C1302-1307, 1993.|
|36||Verheul, Henk M. W., et al., "Platelet: Transporter of Vascular Endothelial Growth Factor," Clinical Cancer Research, vol. 3, Dec. 1997, pp. 2187-2190.|
|37||Von Oppell, Ulrich O., "Transmyocardial Laser Revascularisation," SAMJ, vol. 85, No. 9, (Sep. 1995), p. 930.|
|38||Wakabayashi, Akio, "Myocardial Boring For the Ischemic Heart,"Arch. Surgery, vol. 95, (Nov. 1967), pp. 743-752.|
|39||Wartiovaara, Ulla et al., Peripheral Blood Platelets Express VEGF-C and VEGF Which are Released During Platelet Activation, Thromb Haemost, 9198, 80:171-5, 1999.|
|40||Washington Adventist Hospital, "Washington Area Cardiologist Performs First State-of-the-Art Heart Procedure In U.S.," PR Newswire, Dec. 15, 1999, 2 pages.|
|41||White, Manuel et al., "Multiple Transmyocardial Puncture Revascularization in Refractory Ventricular Fibrillation due to Myocardial Ischemia," The Annals of Thoracic Surgery, vol. 6, No. 6, (Dec. 1968), pp. 557-563.|
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|US9126018||18 Dic 2014||8 Sep 2015||Silk Road Medical, Inc.||Methods and devices for transcarotid access|
|US9241699||10 Nov 2014||26 Ene 2016||Silk Road Medical, Inc.||Methods and devices for transcarotid access|
|US9259215||10 Oct 2014||16 Feb 2016||Silk Road Medical, Inc.||Systems and methods for treating a carotid artery|
|US9265512||12 Dic 2014||23 Feb 2016||Silk Road Medical, Inc.||Transcarotid neurovascular catheter|
|US9283040||13 Mar 2013||15 Mar 2016||The Spectranetics Corporation||Device and method of ablative cutting with helical tip|
|US9289226||5 Ene 2015||22 Mar 2016||The Spectranetics Corporation||Retractable separating systems and methods|
|US9291663||13 Mar 2013||22 Mar 2016||The Spectranetics Corporation||Alarm for lead insulation abnormality|
|US9399118||25 Ene 2016||26 Jul 2016||Silk Road Medical, Inc.||Methods and devices for transcarotid access|
|US9413896||14 Mar 2013||9 Ago 2016||The Spectranetics Corporation||Tissue slitting methods and systems|
|US9456872||13 Mar 2013||4 Oct 2016||The Spectranetics Corporation||Laser ablation catheter|
|US9492637||22 Feb 2016||15 Nov 2016||Silk Road Medical, Inc.||Transcarotid neurovascular catheter|
|US9561345||19 Dic 2014||7 Feb 2017||Route 92 Medical, Inc.||Methods and systems for treatment of acute ischemic stroke|
|US20100204684 *||12 Ene 2010||12 Ago 2010||Garrison Michi E||Methods and systems for performing neurointerventional procedures|
|US20110087147 *||13 Dic 2010||14 Abr 2011||Garrison Michi E||Methods and systems for treatment of acute ischemic stroke|
|US20110166496 *||17 Mar 2011||7 Jul 2011||Enrique Criado||Methods and systems for establishing retrograde carotid arterial blood flow|
|US20110166497 *||17 Mar 2011||7 Jul 2011||Enrique Criado||Methods and systems for establishing retrograde carotid arterial blood flow|
|USD765243||3 Mar 2015||30 Ago 2016||The Spectranetics Corporation||Medical device handle|
|USD770616||3 Mar 2015||1 Nov 2016||The Spectranetics Corporation||Medical device handle|
|Clasificación de EE.UU.||606/159, 606/170, 607/122, 606/15, 606/7|
|Clasificación internacional||A61B19/00, A61M1/00, A61B17/34, A61B18/14, A61B17/00, A61B17/22|
|Clasificación cooperativa||A61B18/00, A61B2017/003, A61B2017/00685, A61B2017/00039, A61B2018/1437, A61B2018/1435, A61B2018/00208, A61B2018/00738, A61B2018/1861, A61B2017/00026, A61B2018/00279, A61B2018/00916, A61B2017/22077, A61B2217/005, A61B2018/00761, A61B2218/002, A61B2017/3488, A61B2218/007, A61B2018/00196, A61B17/3207, A61B2017/00022, A61B2017/00398, A61B2018/00267, A61B18/1492, A61B17/320758, A61M25/0084, A61B2018/00392, A61B2017/00247, A61B2018/00839, A61B2017/306, A61B2018/00291, A61B34/20, A61B2090/034, A61B2090/3782, A61B90/37, A61B2090/0811|
|Clasificación europea||A61B18/14V, A61B18/00, A61B17/3207, A61B17/3207R|