WO1999005979A1 - Cryotherapy method for reducing tissue injury after balloon angioplasty or stent implantation - Google Patents

Cryotherapy method for reducing tissue injury after balloon angioplasty or stent implantation Download PDF

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Publication number
WO1999005979A1
WO1999005979A1 PCT/US1998/015329 US9815329W WO9905979A1 WO 1999005979 A1 WO1999005979 A1 WO 1999005979A1 US 9815329 W US9815329 W US 9815329W WO 9905979 A1 WO9905979 A1 WO 9905979A1
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WO
WIPO (PCT)
Prior art keywords
catheter
holes
medium
site
cryo
Prior art date
Application number
PCT/US1998/015329
Other languages
French (fr)
Inventor
Swaminathan Jayaraman
Original Assignee
Swaminathan Jayaraman
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Swaminathan Jayaraman filed Critical Swaminathan Jayaraman
Priority to AU86619/98A priority Critical patent/AU8661998A/en
Publication of WO1999005979A1 publication Critical patent/WO1999005979A1/en

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Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/02Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by cooling, e.g. cryogenic techniques
    • A61B18/0218Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by cooling, e.g. cryogenic techniques with open-end cryogenic probe, e.g. for spraying fluid directly on tissue or via a tissue-contacting porous tip
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00017Electrical control of surgical instruments
    • A61B2017/00022Sensing or detecting at the treatment site
    • A61B2017/00084Temperature
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00238Type of minimally invasive operation
    • A61B2017/00243Type of minimally invasive operation cardiac
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22001Angioplasty, e.g. PCTA
    • A61B2017/22002Angioplasty, e.g. PCTA preventing restenosis
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22051Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with an inflatable part, e.g. balloon, for positioning, blocking, or immobilisation
    • A61B2017/22054Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with an inflatable part, e.g. balloon, for positioning, blocking, or immobilisation with two balloons
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22082Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for after introduction of a substance
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00053Mechanical features of the instrument of device
    • A61B2018/00214Expandable means emitting energy, e.g. by elements carried thereon
    • A61B2018/0022Balloons
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/02Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by cooling, e.g. cryogenic techniques
    • A61B2018/0212Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by cooling, e.g. cryogenic techniques using an instrument inserted into a body lumen, e.g. catheter
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/02Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by cooling, e.g. cryogenic techniques
    • A61B2018/0231Characteristics of handpieces or probes
    • A61B2018/0262Characteristics of handpieces or probes using a circulating cryogenic fluid
    • A61B2018/0268Characteristics of handpieces or probes using a circulating cryogenic fluid with restriction of flow
    • A61B2018/0275Characteristics of handpieces or probes using a circulating cryogenic fluid with restriction of flow using porous elements
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00Catheters; Hollow probes
    • A61M25/10Balloon catheters
    • A61M25/104Balloon catheters used for angioplasty

Definitions

  • the present invention relates to a cryotherapy method for reducing tissue injury after balloon angioplasty or stent implantation.
  • angioplasty use of a balloon inflated within an artery to compress occluding materials against the inner arterial wall
  • stent implantation is the mechanism of restenosis. Restenosis is evidenced when the artery re—occludes due to tissue ingrowth and/or elastic recoil of the arterial wall at the site of the prior occlusion.
  • cryotherapy is a known technique for preserving tissues at reduced temperatures for short periods of time. Cryotherapy has been decisively shown to be effective in tissue preservation, maintenance of tissue function and facilitation of tissue healing processes.
  • cryotherapy Some of the well- defined applications of cryotherapy include the following: (1) Tissues collected from bovine, pigs and sheep are preserved at reduced temperature so that the elastic membranes or elastin present in the tissues is protected for subsequent applications. Without the use of such temperature reduction, the tissues dry out and lose their original mechanical, physical and chemical properties. (2) During open heart surgery, when the heart is opened to either replace a valve or an underlying diseased coronary artery, the myocardium or the tissues surrounding the heart are exposed to reduced temperature by dipping them in ice or sub—cooled water while the surgery is underway to preserve them.
  • United States Patent 5,213,561 to Weinstein et al . also discloses the use of radioactive material to reduce the incidence of restenosis.
  • United States Patent 5,092,81 to Spears discloses the bonding of a bioprotective material to the arterial wall where angioplasty has been conducted.
  • United States Patent 5,140,012 to McGovern et al discloses a method for preventing onset of restenosis after angioplasty which involves administration of pravastatin in combination with an ACE inhibitor.
  • United States Patent 5,242,397 to Barath et al discloses prevention or reduction of the incidence of late restenosis through the administration of protein kinase C and tyrosine protein kinase inhibitors.
  • United States Patent 5,284,869 to Bisaccia et al discloses a method for preventing restenosis following angioplasty that includes the use of a photophoresis treatment method.
  • United States Patent 5,298,018 to Narciso, Jr. discloses administration of a photosensitizer prior to surgical or interventional procedure which is then re— dministered after the procedure to maintain the photosensitizer concentration level in the atheromatous plaque and smooth muscle cells in the vicinity of the lesion for a period of about 5-18 days.
  • a handheld valve is incorporated into the conduit to allow the surgeon to closely control the flow of the cryo-medium to the point of use.
  • the conduit extends downstream of the valve and is fluidly connected to the catheter that is positioned at the point of the lesion in the body.
  • antibiotics, anticoagulants, antiproliferative agents, gene materials, etc. may also be dispersed along with the cryo-medium intraluminally .
  • additional substances may be mixed with the cryo-medium in the storage chamber before introduction into the catheter or concurrently with introduction into the catheter.
  • cryo-medium and other substance can be applied to all intraluminal, intercranial and endovascular procedures regardless of the size of the lumen of the artery or the vein and regardless of the site on the body where it is located.
  • catheter structures are the following:
  • the catheter may be provided with two lumens, one for introduction over a guide wire and a second lumen having a plurality of holes at the distal end thereof that act as the point of delivery for the cryo-medium and other substance (s) . These holes may be provided over an area prescribed based upon the length of the lesion and the diameter of the artery involved.
  • the catheter may have a triple lumen where one lumen is provided for the guide wire, the second lumen is provided for balloon inflation to center the catheter, and the third lumen is used for delivery of the cryo-medium and other substance (s) .
  • the catheter may have four lumens where three of the lumens perform the functions described in subparagraph (b) above, and the fourth lumen provides an
  • Figure 1 shows a schematic representation of the overall system of the present invention.
  • Figure 2 shows a longitudinal cross—sectional view through a first embodiment of catheter including two lumens.
  • Figure 3 shows a further side view, partially in cross— section, of the embodiment illustrated in Figure 2.
  • Figure 4 shows a second embodiment of catheter including three lumens .
  • Figure 5 shows a third embodiment of catheter including the use of four lumens .
  • Figure 6 shows a fourth embodiment of catheter including a two layered balloon having an inner layer with pores to deliver cryo— medium.
  • Figure 7 shows a fifth embodiment of catheter having a two layered balloon with the outer layer having pores to deliver cryo— medium.
  • Figure 8 shows a sixth embodiment of catheter devoid of a balloon but having a series of holes to deliver cryo-medium.
  • Figure 9 shows the catheter of Figure 8 with a flexible sheath covering the delivery holes, which sheath may be withdrawn to expose the holes and allow cryo-medium delivery.
  • the overall system of the present invention is generally designated by the reference numeral 10 and is seen to include a cryo-generator 11, a cryo—storage tank 13, a conduit 15 interconnecting the cryo-generator 11 with the cryo-storage tank 13, and an outlet conduit 17 allowing flow of cryo-medium from the storage tank 13 to a handheld controller 19 consisting of an inlet port 21, an outlet port 23, and a valve 25 having a valve actuator 27 that may be manipulated by the user to allow metering of a flow path through the valve 25 to allow control of flow rate of cryo-medium into the catheter 30.
  • the valve 25 may be of any desired type including one having a spring 26 biasing the valve head to a position of closure so that when the actuator 27 is released, the valve 25 is restored to the closed position.
  • Any suitable valve that will firmly and repeatedly seat to block flow in the contemplated environment, to—wit, that of a cryo-medium having a temperature between —10°C and 4°C may be employed. Such valves are well known to those skilled in the art .
  • the storage tank includes two gauges, a temperature read—out gauge 14 and a volume or a pressure display 16.
  • the volume display 16 may display rate of flow of cryo-medium in any manner well known to those skilled in the art.
  • the flow path of cryo-medium may include a conduit with a restricted orifice and with sensor lines just upstream and downstream of the restricted orifice.
  • the pressure differential on either side of the restricted orifice relates to flow rate in a manner well known to those skilled in the art.
  • Figure 2 shows more details of the catheter 30 also shown in Figure 1.
  • the catheter 30 includes two lumens, a first lumen 31 provided for insertion therethrough of a guide wire 33 designed to guide movement of the catheter 30 to its desired location.
  • the second lumen 35 includes balloon 37 and a plurality of ports 39 in a prescribed pattern and extent designed to dispense cryo-medium to the desired location for the reasons explained herein.
  • the catheter 30 also includes a hub 38 to which the hand held monitor is connected.
  • Figures 3 and 4 show a second embodiment of catheter generally designated by the reference numeral 40 and including three lumens.
  • One lumen 41 includes a port 42 designed to allow insertion of a guide wire (not shown) .
  • a second lumen 43 is provided to allow inflation of the balloon 44.
  • a third lumen includes a plurality of holes 45 therein rt TJ co TJ tr s: ⁇ ⁇ P rt ⁇ - ⁇ - ⁇ ⁇ - P ⁇ p. tr h- 1 3 ⁇ - tr tr rt tr TJ 0 rt O ⁇ P. ⁇ - tr P o ⁇ 0 P ⁇ - tr ⁇ ⁇ P ⁇ hi -> ⁇ - ⁇ P ⁇ ⁇ P ⁇ tr P P TJ o 0 hh P ⁇ -
  • P o TJ s co s: ⁇ rt p co P.

Abstract

A cryotherapy method for reducing tissue injury after balloon angioplasty, or stent implantation, contemplates use of a well insulated, low profile catheter (30) designed to transport a low temperature medium such as gas, fluid, or a mixture thereof at a particular temperature over a guide wire (33) to the site of a lesion. The lesion may, or may not have undergone previous procedure for balloon angioplasty, or stent implantation. The cryo-medium is introduced from a well insulated storage chamber (13) having a small nozzle to which a conduit (15) may be attached to allow conveyance of the fluid to a point of use. A hand held valve (25) is incorporated into the conduit to allow the surgeon to closely control the flow of the cryo-medium to the point of use. The conduit extends downstream of the valve, and is fluidly connected to the catheter that is positioned at the point of the lesion in the body. If desired, antibiotics, anticoagulants, anti-proliferative agents, gene materials, etc. may also be dispersed along the cryo-medium intraluminously. Such additional substances may be mixed with the cryo-medium in the storage chamber before introduction into the catheter. Several alternative catheter structures are contemplated in accordance with the teachings of the present invention.

Description

CRYOTHERAPY METHOD FOR REDUCING TISSUE INJURY AFTER BALLOON ANGIOPLASTY OR STENT IMPLANTATION
BACKGROUND OF THE INVENTION
The present invention relates to a cryotherapy method for reducing tissue injury after balloon angioplasty or stent implantation. One of the well known and well documented causes of failure of angioplasty (use of a balloon inflated within an artery to compress occluding materials against the inner arterial wall) or stent implantation is the mechanism of restenosis. Restenosis is evidenced when the artery re—occludes due to tissue ingrowth and/or elastic recoil of the arterial wall at the site of the prior occlusion.
After a balloon angioplasty procedure or stent implantation procedure has been completed, the arterial wall often exhibits damage or inflammation due to the required use of force from inflation of a balloon catheter against the cellular layers of the arterial wall. This ingrowth phenomenon, namely, restenosis, affects the long term success of balloon angioplasties and stent implantations. In the prior art, cryotherapy is a known technique for preserving tissues at reduced temperatures for short periods of time. Cryotherapy has been decisively shown to be effective in tissue preservation, maintenance of tissue function and facilitation of tissue healing processes. Some of the well- defined applications of cryotherapy include the following: (1) Tissues collected from bovine, pigs and sheep are preserved at reduced temperature so that the elastic membranes or elastin present in the tissues is protected for subsequent applications. Without the use of such temperature reduction, the tissues dry out and lose their original mechanical, physical and chemical properties. (2) During open heart surgery, when the heart is opened to either replace a valve or an underlying diseased coronary artery, the myocardium or the tissues surrounding the heart are exposed to reduced temperature by dipping them in ice or sub—cooled water while the surgery is underway to preserve them.
(3) During open heart surgery, when the aorta is cross— clamped and blood from the heart is directed into a heart- lung machine, the blood is mixed with cold cardioplegia solution to preserve the cells and other essential components in the blood, an especially critical procedure where surgery is lengthy. (4) Bovine and other homograft valves that have been preserved in cryo—based solutions and reduced temperature environment have been shown to have superior performance during long term follow-up studies when compared with mechanical bileaflet or single leaflet valves. (5) In many pain management therapeutic situations, the area or region of acute pain is exposed to reduced temperature fluids or "cold packs" to reduce nerve damage and relieve pain.
The prior art teaches several techniques designed to reduce or eliminate the onset of restenosis. However,
Applicant is unaware of any such technique that involves the use of application of reduced temperature within an artery. One of the most common causes of recurrence of luminal narrowing after balloon angioplasty or stent implantation is the ingrowth of tissue at the site of the previous blockage. When a balloon is inflated at the site of a lesion where the artery is occluded, the lesion is mechanically pushed up by force acting thereon due to inflation of the balloon. Pathology of experiments in pigs and sheep reveals that the balloon inflation causes endothelial injury as well as tissue dislodgement at the site of the lesion. Such an injury is characterized by inner lumen wall cracks that are filled up with blood and some thrombus (clotting material) . These cracks may infiltrate into the second and third layers of the vessel wall that are termed adventitia and media primarily composed of collagen, smooth muscle cells and elastic cells that contribute to the compliance of the artery. When these layers are disrupted due to balloon inflation or stent implantation, compliance response is lost. This results in proliferation of cells as a function of time. Although the proliferation starts immediately after the injury to the arterial wall, maximum proliferation may be observed 6 to 18 months after the initial injury.
Applicant is aware of the following prior art:
United States Patent 5,059,166 to Fischell et al . discloses a technique for reducing the onset of intimal hyperplasia which technique involves the use of irradiation from a radioisotope .
United States Patent 5,213,561 to Weinstein et al . also discloses the use of radioactive material to reduce the incidence of restenosis. United States Patent 5,092,81 to Spears discloses the bonding of a bioprotective material to the arterial wall where angioplasty has been conducted.
United States Patent 5,140,012 to McGovern et al . discloses a method for preventing onset of restenosis after angioplasty which involves administration of pravastatin in combination with an ACE inhibitor.
United States Patent 5,242,397 to Barath et al . discloses prevention or reduction of the incidence of late restenosis through the administration of protein kinase C and tyrosine protein kinase inhibitors.
United States Patent 5,284,869 to Bisaccia et al . discloses a method for preventing restenosis following angioplasty that includes the use of a photophoresis treatment method. United States Patent 5,298,018 to Narciso, Jr. discloses administration of a photosensitizer prior to surgical or interventional procedure which is then re— dministered after the procedure to maintain the photosensitizer concentration level in the atheromatous plaque and smooth muscle cells in the vicinity of the lesion for a period of about 5-18 days.
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fluid to a point of use. A handheld valve is incorporated into the conduit to allow the surgeon to closely control the flow of the cryo-medium to the point of use. The conduit extends downstream of the valve and is fluidly connected to the catheter that is positioned at the point of the lesion in the body.
(3) Additionally, antibiotics, anticoagulants, antiproliferative agents, gene materials, etc. may also be dispersed along with the cryo-medium intraluminally . Such additional substances may be mixed with the cryo-medium in the storage chamber before introduction into the catheter or concurrently with introduction into the catheter.
(4) These additional substances may also be introduced prior to introduction of the cryo-medium or thereafter. (5) The procedure for introduction of the cryo-medium and other substance (s) can be applied to all intraluminal, intercranial and endovascular procedures regardless of the size of the lumen of the artery or the vein and regardless of the site on the body where it is located. (6) Several alternative catheter structures are contemplated in accordance with the teachings of the present invention. These catheter structures are the following:
(a) The catheter may be provided with two lumens, one for introduction over a guide wire and a second lumen having a plurality of holes at the distal end thereof that act as the point of delivery for the cryo-medium and other substance (s) . These holes may be provided over an area prescribed based upon the length of the lesion and the diameter of the artery involved. (b) The catheter may have a triple lumen where one lumen is provided for the guide wire, the second lumen is provided for balloon inflation to center the catheter, and the third lumen is used for delivery of the cryo-medium and other substance (s) . (c) The catheter may have four lumens where three of the lumens perform the functions described in subparagraph (b) above, and the fourth lumen provides an
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following detailed description of the preferred embodiments when read in conjunction with the appended drawing figures.
BRIEF DESCRIPTION OF THE DRAWINGS Figure 1 shows a schematic representation of the overall system of the present invention.
Figure 2 shows a longitudinal cross—sectional view through a first embodiment of catheter including two lumens. Figure 3 shows a further side view, partially in cross— section, of the embodiment illustrated in Figure 2.
Figure 4 shows a second embodiment of catheter including three lumens .
Figure 5 shows a third embodiment of catheter including the use of four lumens . Figure 6 shows a fourth embodiment of catheter including a two layered balloon having an inner layer with pores to deliver cryo— medium.
Figure 7 shows a fifth embodiment of catheter having a two layered balloon with the outer layer having pores to deliver cryo— medium.
Figure 8 shows a sixth embodiment of catheter devoid of a balloon but having a series of holes to deliver cryo-medium.
Figure 9 shows the catheter of Figure 8 with a flexible sheath covering the delivery holes, which sheath may be withdrawn to expose the holes and allow cryo-medium delivery.
SPECIFIC DESCRIPTION OF THE PREFERRED EMBODIMENTS With reference, first, to Figure 1, the overall system of the present invention is generally designated by the reference numeral 10 and is seen to include a cryo-generator 11, a cryo—storage tank 13, a conduit 15 interconnecting the cryo-generator 11 with the cryo-storage tank 13, and an outlet conduit 17 allowing flow of cryo-medium from the storage tank 13 to a handheld controller 19 consisting of an inlet port 21, an outlet port 23, and a valve 25 having a valve actuator 27 that may be manipulated by the user to allow metering of a flow path through the valve 25 to allow control of flow rate of cryo-medium into the catheter 30. The valve 25 may be of any desired type including one having a spring 26 biasing the valve head to a position of closure so that when the actuator 27 is released, the valve 25 is restored to the closed position. Any suitable valve that will firmly and repeatedly seat to block flow in the contemplated environment, to—wit, that of a cryo-medium having a temperature between —10°C and 4°C may be employed. Such valves are well known to those skilled in the art .
As further seen in Figure 1, the storage tank includes two gauges, a temperature read—out gauge 14 and a volume or a pressure display 16. The volume display 16 may display rate of flow of cryo-medium in any manner well known to those skilled in the art. For example, the flow path of cryo-medium may include a conduit with a restricted orifice and with sensor lines just upstream and downstream of the restricted orifice. The pressure differential on either side of the restricted orifice relates to flow rate in a manner well known to those skilled in the art. Figure 2 shows more details of the catheter 30 also shown in Figure 1. With reference to Figure 2, the catheter 30 includes two lumens, a first lumen 31 provided for insertion therethrough of a guide wire 33 designed to guide movement of the catheter 30 to its desired location. The second lumen 35 includes balloon 37 and a plurality of ports 39 in a prescribed pattern and extent designed to dispense cryo-medium to the desired location for the reasons explained herein. The catheter 30 also includes a hub 38 to which the hand held monitor is connected.
Figures 3 and 4 show a second embodiment of catheter generally designated by the reference numeral 40 and including three lumens. One lumen 41 includes a port 42 designed to allow insertion of a guide wire (not shown) . A second lumen 43 is provided to allow inflation of the balloon 44. A third lumen includes a plurality of holes 45 therein
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injury after balloon angioplasty or stent implantation of great novelty and utility.
Of course, various changes, modifications and alterations in the teachings of the present invention may be contemplated by those skilled in the art without departing from the intended spirit and scope thereof.
As such, it is intended that the present invention only be limited by the terms of the appended claims .

Claims

1. A method of reducing tissue injury, or proliferation within a cardiovascular system after a surgical procedure or an interventional procedure or endovascular procedure at a site therein, including the steps of: a) providing a quantity of a cryo-medium maintained at a temperature below normal human body temperature in a refillable storage container; b) fluidly connecting said storage container with a catheter; c) inserting said catheter within a cardiovascular system and conveying said catheter to said site; d) controllably dispensing fluid, gaseous medium, or a mixture thereof from said storage chamber through said catheter and into a cardiovascular system at said site.
2. The method of Claim 1, wherein said providing step includes the step of maintaining said cryo-medium at a temperature between 14 ┬░C and -l╬╕┬░C.
3. The method of Claim 1, wherein said fluidly connecting step includes the step of interposing a valve between said storage container and catheter.
4. The method of Claim 1, wherein said inserting step further includes the step opening an orifice in a cardiovascular system.
5. The method of Claim 1, wherein said conveying step includes the step of guiding said catheter with a guide wire.
6. The method of Claim 3, wherein said dispensing step includes the step of controllably operating said valve.
7. The method of Claim 5, wherein said catheter has two lumens, one receiving said guide wire and another conveying said fluid medium.
8. The method of Claim 7, wherein said catheter includes an inflatable balloon for securing said catheter at said site.
9. The method of Claim 7, wherein said catheter has two spaced balloons, inflatable upstream and downstream of said site.
10. The method of Claim 8, wherein said balloon has two walls, an outer impervious wall and an inner wall with holes therein, said method including the step of conveying said fluid between said walls and out said holes.
11. The method of Claim 8, wherein said balloon has two walls, an inner impervious wall and an outer wall with holes therein, said method including the step of conveying said fluid between said walls and out said holes.
12. The method of Claim 1, wherein said catheter has an inner passageway with a closed distal end and a peripheral wall with holes therein, said method including the step of dispensing said fluid medium through said holes.
13. A method of reducing tissue injury within a cardiovascular system after a surgical procedure at a site therein, including the steps of: a) providing a quantity of a cryo-fluid medium maintained in a storage container at a temperature between 14 ┬░C and -10 ┬░C; b) fluidly connecting said storage container with a catheter via a control valve; c) inserting said catheter within a cardiovascular system and conveying said catheter to said site while guiding with a guide wire; d) controllably dispensing fluid medium from said storage chamber through said catheter by operating said control valve and into a cardiovascular system at said site.
14. The method of Claim 13, wherein said inserting step further includes the step opening an orifice in a cardiovascular system.
15. The method of Claim 13, wherein said catheter includes an inflatable balloon for securing said catheter at said site.
16. The method of Claim 13, wherein said catheter has two spaced balloons, inflatable upstream and downstream of said site.
17. The method of Claim 15, wherein said balloon has two walls, an outer impervious wall and an inner wall with holes therein, said method including the step of conveying said fluid between said walls and out said holes.
18. The method of Claim 15, wherein said balloon has two walls, an inner impervious wall and an outer wall with holes therein, said method including the step of conveying said fluid between said walls and out said holes.
19. The method of Claim 13, wherein said catheter has an inner passageway with a closed distal end and a peripheral wall with holes therein, said method including the step of dispensing said fluid medium through said holes.
PCT/US1998/015329 1997-07-29 1998-07-28 Cryotherapy method for reducing tissue injury after balloon angioplasty or stent implantation WO1999005979A1 (en)

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US9241752B2 (en) 2012-04-27 2016-01-26 Medtronic Ardian Luxembourg S.A.R.L. Shafts with pressure relief in cryotherapeutic catheters and associated devices, systems, and methods
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