US20030216769A1 - Removable anchored lung volume reduction devices and methods - Google Patents

Abstract

An intra-bronchial device placed and anchored in an air passageway of a patient to collapse a lung portion associated with the air passageway. The device includes a support structure, an obstructing member carried by the support structure that reduces ventilation to the lung portion by preventing air from being inhaled into the lung portion, and at least one anchor carried by the support structure that anchors the obstruction device within the air passageway. The anchor may engage the air passageway wall by piercing or friction, include a stop dimensioned for limiting the piercing of the air passageway wall, and may be releasable from the air passageway for removal of the intra-bronchial device. The anchors may be carried by a peripheral portion of the support structure, or by a central portion of the support structure. The obstructing member may be a one-way valve.

Description

BACKGROUND
• The present invention is generally directed to a removable anchored device, system, and method for treating Chronic Obstructive Pulmonary Disease (COPD). The present invention is more particularly directed to providing an anchored intra-bronchial obstruction that may be removable.[0001]
• COPD has become a major cause of morbidity and mortality in the United States over the last three decades. COPD is characterized by the presence of airflow obstruction due to chronic bronchitis or emphysema. The airflow obstruction in COPD is due largely to structural abnormalities in the smaller airways. Important causes are inflammation, fibrosis, goblet cell metaplasia, and smooth muscle hypertrophy in terminal bronchioles.[0002]
• The incidence, prevalence, and health-related costs of COPD are on the rise. Mortality due to COPD is also on the rise. In 1991, COPD was the fourth leading cause of death in the United States and had increased 33% since 1979. COPD affects the patient's whole life. It has three main symptoms: cough; breathlessness; and wheeze. At first, breathlessness may be noticed when running for a bus, digging in the garden, or walking uphill. Later, it may be noticed when simply walking in the kitchen. Over time, it may occur with less and less effort until it is present all of the time. COPD is a progressive disease and currently has no cure. Current treatments for COPD include the prevention of further respiratory damage, pharmacotherapy, and surgery. Each is discussed below.[0003]
• The prevention of further respiratory damage entails the adoption of a healthy lifestyle. Smoking cessation is believed to be the single most important therapeutic intervention. However, regular exercise and weight control are also important. Patients whose symptoms restrict their daily activities or who otherwise have an impaired quality of life may require a pulmonary rehabilitation program including ventilatory muscle training and breathing retraining. Long-term oxygen therapy may also become necessary.[0004]
• Pharmacotherapy may include bronchodilator therapy to open up the airways as much as possible or inhaled beta-agonists. For those patients who respond poorly to the foregoing or who have persistent symptoms, ipratropium bromide may be indicated. Further, courses of steroids, such as corticosteroids, may be required. Lastly, antibiotics may be required to prevent infections and influenza and pneumococcal vaccines may be routinely administered. Unfortunately, there is no evidence that early, regular use of pharmacotherapy will alter the progression of COPD.[0005]
• About 40 years ago, it was first postulated that the tethering force that tends to keep the intrathoracic airways open was lost in emphysema and that by surgically removing the most affected parts of the lungs, the force could be partially restored. Although the surgery was deemed promising, the lung volume reduction surgery (LVRS) procedure was abandoned. LVRS was later revived. In the early 1990's, hundreds of patients underwent the procedure. However, the procedure fell out of favor when Medicare stopped reimbursing for LVRS. Unfortunately, data is relatively scarce and many factors conspire to make what data exists difficult to interpret. The procedure is currently under review in a controlled clinical trial. However, what data does exist tends to indicate that patients benefited from the procedure in terms of an increase in forced expiratory volume, a decrease in total lung capacity, and a significant improvement in lung function, dyspnea, and quality of life. Improvements in pulmonary function after LVRS have been attributed to at least four possible mechanisms. These include enhanced elastic recoil, correction of ventilation/perfusion mismatch, improved efficiency of respiratory musculature, and improved right ventricular filling.[0006]
• Lastly, lung transplantation is also an option. Today, COPD is the most common diagnosis for which lung transplantation is considered. Unfortunately, this consideration is given for only those with advanced COPD. Given the limited availability of donor organs, lung transplant is far from being available to all patients.[0007]
• There is a need for additional non-surgical options for permanently treating COPD. A promising new therapy includes non-surgical apparatus and procedures for lung volume reduction by permanently obstructing the air passageway that communicates with the portion of the lung to be collapsed. The therapy includes placing an obstruction in the air passageway that prevents inhaled air from flowing into the portion of the lung to be collapsed. Lung volume reduction with concomitant improved pulmonary function may be obtained without the need for surgery. The effectiveness of obstructions may be enhanced if it is anchored in place. The effectiveness may also be enhanced if the obstruction is removable. However, no readily available apparatus and method exists for anchoring the obstruction, and for removal if required.[0008]
• In view of the foregoing, there is a need in the art for a new and improved apparatus and method for permanently obstructing an air passageway that is anchored in place, and that may be removed if required. The present invention is directed to a device, system, and method that provide such an improved apparatus and method for treating COPD.[0009]
SUMMARY
• The present invention provides an anchored intra-bronchial device for placement in an air passageway of a patient to collapse a lung portion associated with the air passageway. The device includes a support structure, an obstructing member carried by the support structure that prevents air from being inhaled into the lung portion to collapse the lung portion, and at least one anchor carried by the support structure that anchors the obstruction device within the air passageway when the anchor is deployed. The support structure, or a portion thereof, may be collapsible. The obstructing member and at least one anchor may be simultaneously deployable. The support structure may be configured to urge at least one anchor to engage the air passageway wall. The obstructing member may be a one-way valve. The obstructing member may be releasable from the support structure and removable from the air passageway.[0010]
• In accordance with the present invention, alternative embodiments are provided for the anchors. An anchor may have an anchoring end that engages the air passageway wall, and that may pierce into the air passageway wall. An anchor may include a stop dimensioned for limiting the piercing of the air passageway wall. An anchor may include a resilient material for imparting a force against the air passageway to deform the air passageway to more positively anchor the obstructing member. An anchor may be releasable from the air passageway for removal of the intra-bronchial device. An anchor may include a pad that frictionally engages the air passageway. Further, an anchor may be configured to move from a first configuration to a second configuration to engage the air passageway. An anchor may be configured to move from a first configuration to a second configuration to engage the air passageway, and to move from the second configuration to the first configuration to disengage the air passageway. Alternatively, an anchor may be configured to move from a first configuration to a second configuration to engage the air passageway, and to move from the second configuration to a third configuration to disengage the air passageway.[0011]
• In accordance with the present invention, alternative embodiments provide for the anchors to be carried on different portions of the device. An anchor may be carried by a peripheral portion of the support structure, and/or by a central portion of the support structure. An anchor may be carried distal to the obstructing member, and/or proximal to the obstructing member.[0012]
• The present invention further provides a method of reducing the size of a lung, or reducing ventilation to a portion of a lung, by collapsing at least a portion of the lung. The method includes the step of providing an intra-bronchial device that includes a support structure, an obstructing member carried by the support structure which is so dimensioned when deployed in an air passageway communicating with the portion of the lung to be collapsed to preclude air from being inhaled, and at least one anchor carried by the support structure that anchors the obstructing member when the anchor is deployed. The method further includes the steps of placing the obstructing member in the air passageway, and deploying at least one anchor. An anchor may be releasable for removal of the intra-bronchial device. The obstructing member may form a one-way valve. The support structure may be collapsible.[0013]
• The present invention yet further provides a method of reducing the size of a lung, or reducing ventilation to a portion of a lung, by collapsing a portion of the lung with a removable device. The method includes the step of providing an intra-bronchial device comprising a support structure, an obstructing member carried by the support structure which is so dimensioned when deployed in an air passageway communicating with the portion of the lung to be collapsed to preclude air from being inhaled, and at least one anchor carried by the support structure that anchors the obstructing member when the anchor is deployed. The method further includes the steps of placing the obstructing member in the air passageway, and deploying at least one anchor. The method further includes the step of removing at least the obstructing member. At least one anchor may be releasable from the air passageway for removal of at least the obstructing device, and the step of removing at least the obstructing device includes releasing at least one anchor. At least a portion of the obstructing member is releasable from the support structure, and the step of removing at least the obstructing member includes releasing the obstructing member from the support structure. The obstructing member may form a one-way valve. At least a portion of the support structure may be collapsible.[0014]
• The present invention additionally provides an air passageway obstructing device. The device includes frame means for forming a support structure, flexible membrane means for obstructing air flow within the air passageway and carried by the support structure, and anchoring means to anchor the air passageway obstructing device, carried by the support structure. The frame means is expandable to an expanded state within an air passageway to support the membrane means and the anchoring means. The anchoring means is releasable for removal of the device from the air passageway.[0015]
• These and various other features as well as advantages which characterize the present invention will be apparent from a reading of the following detailed description and a review of the associated drawings.[0016]
BRIEF DESCRIPTION OF THE DRAWINGS
• The features of the present invention which are believed to be novel are set forth with particularity in the appended claims. The invention, together with further objects and advantages thereof, may best be understood by making reference to the following description taken in conjunction with the accompanying drawings, in the several figures of which like referenced numerals identify like elements, and wherein:[0017]
• FIG. 1 is a simplified sectional view of a thorax illustrating a healthy respiratory system;[0018]
• FIG. 2 is a sectional view similar to FIG. 1, but illustrating a respiratory system suffering from COPD and the execution of a first step in treating the COPD condition by reducing the size of a lung portion in accordance with the present invention;[0019]
• FIG. 3 is perspective view, partially in section, and to an enlarged scale, illustrating an intermediate step in the treatment;[0020]
• FIG. 4 is a perspective view of a conduit that may be utilized in practicing the present invention;[0021]
• FIG. 5 is a perspective view of an intra-bronchial device, with anchors located proximally on peripheral portions of the support members, as the device would appear when fully deployed in an air passageway in accordance with the present invention;[0022]
• FIG. 6 is a partial section view of the device of FIG. 5 showing additional details of the support structure;[0023]
• FIG. 7 is a perspective view of the intra-bronchial device of FIG. 5 anchored in an air passageway;[0024]
• FIG. 8 illustrates an intra-bronchial device, with anchors carried distally on the central support structure, fully deployed in an air passageway in accordance with an alternative embodiment of the invention;[0025]
• FIG. 9 is a perspective view of an intra-bronchial device, with proximal anchors carried on the central support structure, in accordance with an alternative embodiment of the invention;[0026]
• FIG. 10 is a side view of an intra-bronchial device, with proximal anchors carried on the central support structure, in accordance with an alternative embodiment of the invention;[0027]
• FIG. 11 is an end view of an intra-bronchial device, with proximal anchors carried on the central support structure, in accordance with an alternative embodiment of the invention;[0028]
• FIG. 12 is a perspective view of an intra-bronchial device, with distal friction anchors carried on the central support structure, in accordance with an alternative embodiment of the invention;[0029]
• FIG. 13 is a side view of an intra-bronchial device, with distal friction anchors carried on the central support structure, in accordance with an alternative embodiment of the invention;[0030]
• FIG. 14 is an end view of an intra-bronchial device, with distal friction anchors carried on the central support structure, in accordance with an alternative embodiment of the invention;[0031]
• FIG. 15 is a perspective view of an intra-bronchial device similar to that of FIGS.[0032]12-14 anchored in an air passageway;
• FIG. 16 is a perspective view illustrating an alternative embodiment of a removable intra-bronchial device with proximal anchors carried on a peripheral portion of a plurality of support structure members in accord with the present invention;[0033]
• FIG. 17 is a side view of the device of FIG. 16;[0034]
• FIG. 18 is a perspective view illustrating an alternative embodiment of a removable intra-bronchial device with both distal and proximal anchors carried on corresponding peripheral portions of the central support structure in accord with the present invention; and[0035]
• FIG. 19 is a side view of the device of FIG. 18.[0036]
DETAILED DESCRIPTION
• In the following detailed description of exemplary embodiments of the invention, reference is made to the accompanying drawings that form a part hereof. The detailed description and the drawings illustrate how specific exemplary embodiments by which the invention may be practiced. These embodiments are described in sufficient detail to enable those skilled in the art to practice the invention. It is understood that other embodiments may be utilized, and other changes may be made, without departing from the spirit or scope of the present invention. The following detailed description is therefore not to be taken in a limiting sense, and the scope of the present invention is defined by the appended claims.[0037]
• Throughout the specification and claims, the following terms take the meanings explicitly associated herein unless the context clearly dictates otherwise. The meaning of “a”, “an”, and “the” include plural references. The meaning of “in” includes “in” and “on.” Referring to the drawings, like numbers indicate like parts throughout the views. Additionally, a reference to the singular includes a reference to the plural unless otherwise stated or inconsistent with the disclosure herein.[0038]
• Additionally, throughout the specification, claims, and drawings, the term “proximal” means nearest the trachea, and “distal” means nearest the bronchioles.[0039]
• Briefly stated, an aspect of the invention provides an anchored intra-bronchial device for placement in an air passageway of a patient. The intra-bronchial device obstructs the air passageway, reducing the ventilation to a portion of the lung and/or collapsing the lung portion associated with the air passageway. A further aspect of the invention provides removability of the intra-bronchial device, either by releasing the anchors for removal of the entire device or by separating the obstructing member and removing it.[0040]
• FIG. 1 is a sectional view of a healthy respiratory system. The[0041]respiratory system20 resides within thethorax22 that occupies a space defined by thechest wall24 and thediaphragm26.
• The[0042]respiratory system20 includes thetrachea28, theleft mainstem bronchus30, theright mainstem bronchus32, thebronchial branches34,36,38,40, and42 andsub-branches44,46,48, and50. Therespiratory system20 further includesleft lung lobes52 and54 andright lung lobes56,58, and60. Each bronchial branch and sub-branch communicates with a respective different portion of a lung lobe, either the entire lung lobe or a portion thereof. As used herein, the term “air passageway” is meant to denote either a bronchi or bronchiole, and typically means a bronchial branch or sub-branch which communicates with a corresponding individual lung lobe or lung lobe portion to provide inhaled air thereto or conduct exhaled air therefrom.
• Characteristic of a healthy respiratory system is the arched or inwardly[0043]arcuate diaphragm26. As the individual inhales, thediaphragm26 straightens to increase the volume of thethorax22. This causes a negative pressure within the thorax. The negative pressure within the thorax in turn causes the lung lobes to fill with air. When the individual exhales, the diaphragm returns to its original arched condition to decrease the volume of the thorax. The decreased volume of the thorax causes a positive pressure within the thorax which in turn causes exhalation of the lung lobes.
• In contrast to the healthy respiratory system of FIG. 1, FIG. 2 illustrates a respiratory system suffering from COPD. Here it may be seen that the[0044]lung lobes52,54,56,58, and60 are enlarged and that thediaphragm26 is not arched but substantially straight. Hence, this individual is incapable of breathing normally by movingdiaphragm26. Instead, in order to create the negative pressure inthorax22 required for breathing, this individual must move the chest wall outwardly to increase the volume of the thorax. This results in inefficient breathing causing these individuals to breathe rapidly with shallow breaths.
• It has been found that the[0045]apex portions62 and66 of theupper lung lobes52 and56, respectively, are most affected by COPD. Hence, bronchial sub-branch obstructing devices are generally employed for treating the apex66 of the right,upper lung lobe56. However, as will be appreciated by those skilled in the art, the present invention may be applied to any lung portion without departing from the present invention. As will be further appreciated by those skilled the in art, the present invention may be used with any type of obstructing member to provide an anchored obstructing device, which may be removed. The inventions disclosed and claimed in U.S. Pat. Nos. 6,258,100 and 6,293,951, both of which are incorporated herein by reference, provide an improved therapy for treating COPD by obstructing an air passageway using an intra-bronchial valve or plug. The present invention may be used with the apparatus, system, and methods of these patents as will be briefly described in conjunction with the disclosure of the preferred embodiments of the present invention.
• The insertion of an obstructing member treats COPD by deriving the benefits of lung volume reduction surgery without the need of performing the surgery. The treatment contemplates permanent collapse of a lung portion. This leaves extra volume within the thorax for the diaphragm to assume its arched state for acting upon the remaining healthier lung tissue. As previously mentioned, this should result in improved pulmonary function due to enhanced elastic recoil, correction of ventilation/perfusion mismatch, improved efficiency of respiratory musculature, and improved right ventricle filling., The present invention supports the use of intra-bronchial obstructions to treat COPD by anchoring the obstruction device in the air passageway. The present invention further supports the use of intra-bronchial obstructions by providing for their removal if necessary. Use of anchors can allow the obstructing member to be relatively loosely fitted against the air passageway wall, which may preserve mucociliary transport of mucus and debris out of the collapsed lung portion and allow distal mucus to be coughed.[0046]
• FIG. 2 also illustrates a step in COPD treatment using an obstructing member. Treatment is initiated by feeding a conduit or[0047]catheter70 down thetrachea28, into theright mainstem bronchus32, into thebronchial branch42 and into and terminating within the sub-branch50. The sub-branch50 is the air passageway that communicates with thelung portion66 to be treated, and is also referred to herein asair passageway50. Thecatheter70 is preferably formed of flexible material such as polyethylene. Also, thecatheter70 is preferably preformed with abend72 to assist the feeding of the catheter from theright mainstem bronchus32 into thebronchial branch42.
• FIG. 3 illustrates a further step in a method for placing an obstructing[0048]member90 in a bronchial sub-branch using a catheter. The invention disclosed herein is not limited to use with the particular method illustrated herein.Catheter70 includes an optionalinflatable sealing member74 for use with a vacuum to collapselung portion66 prior to insertion of obstructingmember90. The obstructingmember90 may be formed of resilient or collapsible material to enable the obstructingmember90 to be fed through theconduit70 in a collapsed state. Thestylet92 is used to push the obstructingmember90 to theend77 of thecatheter70 for placing the obstructingmember90 within theair passageway50 adjacent to thelung portion66 to be permanently collapsed. Optional sealingmember74 is withdrawn after obstructingmember90 is inserted.
• Another step in placing an obstructing[0049]member90 may include sizing the air passageway location where the obstructingmember90 will be positioned.
• A function of the intra-bronchial device disclosed and claimed in this specification, including the detailed description and the claims, is described in terms of collapsing a lung portion associated with an air passageway. In some lungs, a portion of a lung may receive air from collateral air passageways. Obstructing one of the collateral air passageways may reduce the volume of the lung portion associated with the air passageway, but not completely collapse the lung portion, as that term may be generally understood. As used herein, the meaning of “collapse” includes both a complete collapse of a lung portion, and a partial collapse resulting in a marked decrease in the volume of a lung portion.[0050]
• Once deployed, the obstructing member precludes inhaled air from entering the lung portion to be collapsed. In accordance with the present invention, it is preferable that the obstructing member takes the form of a one-way valve. In addition to precluding inhaled air from entering the lung portion, the member further allows air within the lung portion to be exhaled. This results in more rapid collapse of the lung portion. In addition, anchoring obstructing members that preclude both inhaled and exhaled airflow are contemplated as within the scope of the invention.[0051]
• FIG. 4 illustrates the obstructing device in place within[0052]air passageway50. Obstructingmember90 has expanded upon placement in theair passageway50 to seal theair passageway50. This causes thelung portion66 to be maintained in a permanently collapsed state. The obstructingmember90 may be any shape suitable for accomplishing its purpose, and may be a solid material or a membrane.
• More specifically, the obstructing[0053]member90 has anouter dimension91, and when expanded, enables a contact zone with the air passageway inner dimension51. This seals the air passageway upon placement of the obstructingmember90 in theair passageway50 for maintaining thelung portion66 in the collapsed state.
• Alternatively, the[0054]lung portion66 may be collapsed using vacuum prior to placement of obstructingmember90, or sealing theair passageway50 with obstructingmember90 may collapse it. The air within thelung portion66 will be absorbed by the body over time, reducing the volume of and/or collapsing thelung portion66. Alternatively, obstructingmember90 may include the function of a one-way valve that allows air to escape fromlung portion66.Lung portion66 will then collapse, and the valve will prevent air from being inhaled.
• FIG. 5 is a perspective view of an intra-bronchial device, with anchors located proximally on peripheral portions of the support members, as the device would appear when fully deployed in an air passageway in accordance with the present invention.[0055]Intra-bronchial device100 includes asupport structure101, acentral support structure109;support members102,104,106, and108;anchors112,114,116, and118; anchor ends122,124,126, and128; and an obstructingmember110.
• The[0056]support structure101 of intra-bronchial device includescentral support structure109, andsupport members102,104,106, and108. Thesupport members102,104,106, and108, carryanchors112,114,116, and118; and anchor ends122,124,126, and128, respectively.Central support structure109 is a tubular member, preferably hypodermic needle tubing.Support members102,104,106, and108, are coupled mechanically tocentral support structure109, such as by crimping, or by other methods such as adhesive or welding.Support members102,104,106, and108 are generally similar to each other. The support members are preferably formed of stainless steel, Nitinol, or other suitable material having a memory of its original shape, and resiliency to return the material to that shape.
• [0057]Anchors112,114,116, and118 are extensions ofsupport members102,104,106, and108. The anchors are formed by bending the support members to an angle that will result in a deployed anchor engaging the air passageway wall by piercing it approximately perpendicularly. In this preferred embodiment, the bend angle is approximately a right angle. Anchor ends122,124,126, and128 may be shaped to promote piercing the air passageway wall. In an alternative embodiment, the elements ofsupport structure101 may be formed by laser cutting a single piece of hypodermic needle tubing.
• Obstructing[0058]member110 is carried on thesupport structure101, and includes a flexible membrane open in the proximal direction and which may be formed of silicone or polyurethane, for example. The obstructingmember110 is secured to thecentral support structure109, and may be additionally secured to the support members at itslarger diameter91. It may be secured by adhesive, or other manner known in the art. Obstructingmember110 may be loosely carried onsupport members102,104,106, and108, such that it expands on inhalation to form a seal against a wall of the air passageway, and contracts on exhalation to allow air and mucociliary transport from the collapsed lung. This provides a one-way valve function.
• FIG. 6 is a partial section view of the device of FIG. 5 showing additional detail of the support structure. The linear cross-section view of FIG. 6 exposes the arrangement of[0059]support members106 and108 in their deployed configuration. The details ofsupport members102 and104 are omitted from FIG. 6 for clarity, but are the same assupport members106 and108. The distal end of obstructingmember110 is carried oncentral support structure109.Support members106 and108 are shown emanating fromcentral support structure109, and arranged to loosely support to obstructingmember110 at itslarger diameter91. This allows obstructingmember110 to expand on inhalation and seal at the contact zone (element129 of FIG. 7), and to partially contract on exhalation to allow exhalation of air and mucociliary transport. In an alternative embodiment,support members106 and108 do not actively support obstructingmember110, and the expansion and contraction of obstructingmember110 is governed by its elasticity.
• FIG. 7 is a perspective view of the intra-bronchial device of FIG. 5 anchored in an air passageway.[0060]Intra-bronchial device100 is illustrated withanchors112 and116 piercing into theair passageway wall130 ofair passageway50. This anchors theintra-bronchial device100 in place.
• [0061]Intra-bronchial device100 is collapsible for insertion into an internal lumen of a catheter. At least thesupport members102,104,106, and108, and the obstructingmember110, may be collapsed.Intra-bronchial device100 is inserted into the catheter lumen, which is typically already placed in theair passageway50 as generally illustrated in FIG. 3. Using the stylet,intra-bronchial device100 is advanced down the catheter lumen into theair passageway50 to where the device is to be deployed. Once the point of deployment is reached,intra-bronchial device100 is expelled from the catheter and assumes its deployed shape as illustrated in FIG. 5. Upon deployment, obstructingmember110 forms acontact zone129 with thewall130 of theair passageway50 to prevent air from being inhaled into the lung portion to collapse the lung portion. Simultaneously upon deployment, the memory and resiliency of thesupport members102,104,106, and108 impart a force on the anchor ends122,124,126, and128, and urge theanchors112,114,116, and118 to engageair passageway wall130 by piercing. The anchors pierce into and become embedded in thewall130 of theair passageway50, preferably without projecting through thewall130. Stops may be incorporated into the anchors to limit piercing of thewall130. For example, the bend between the support member and the anchor may form a stop.
• The preclusion of air from being inhaled into the lung portion may be terminated by eliminating the obstructing effect of[0062]intra-bronchial device100. The preclusion of air by the embodiment illustrated in FIGS.5-7 may be eliminated by releasinganchors112,114,116, and118 from theair passageway wail130. The anchors may be released by inserting a catheter intoair passageway50 in proximity tointra-bronchial device100. A retractor device, such as biopsy forceps, capable of gripping a portion ofintra-bronchial device100 is inserted in the catheter. The forceps are used to engage a portion of thesupport structure101 ofintra-bronchial device100, such as a support member or an anchor, or the obstructingmember110, and draw it toward the catheter. The drawing action releases anchors112,114,116, and118 fromair passageway wall130. Theintra-bronchial device110 is then drawn into the catheter with the forceps, causing thesupport structure101 and obstructingmember110 to collapse. Thecollapsed device100 now fully enters the catheter lumen for removal from the patient. Alternatively, the obstructing effect may be eliminated by grabbing the obstructingmember110, releasing it from thesupport structure101, and removing obstructingmember110 from the patient.
• FIG. 8 illustrates an intra-bronchial device, with anchors carried distally on the central support structure, fully deployed in an air passageway in accordance with an alternative embodiment of the invention. The[0063]anchors112,114,116, and118 ofintra-bronchial device140 are carried on portions ofsupport members102,104,106, and108 distal of thecentral support structure109. The support members are gathered together and carried by thecentral support structure109. Other than theanchors112,114,116, and118 being formed and carried on distal portions ofsupport members102,104,106, and108,intra-bronchial device140 is substantially similar in construction, operation, and removal as theintra-bronchial device100 of FIG. 5.
• When[0064]intra-bronchial device140 is compressed for insertion into the catheter lumen for placement in the air passageway, theanchors112,114,116, and118 are collapsed into a first configuration. In the first configuration, the anchor ends122,124,126, and128 are moved toward obstructingmember110, and anchors112,114,116, and118 thereby folded toward obstructingmember110. In an alternative embodiment, the anchor ends122,124,126, and128 are moved away from obstructingmember110, and anchors112,114,116, and118 thereby folded away from obstructingmember110.
• When[0065]intra-bronchial device100 is deployed from the catheter lumen, the memory and resiliency of theanchors112,114,116, and118 impart a force that moves the anchor ends122,124,126, and128 into a second configuration to engageair passageway wall130. This is the deployed configuration illustrated in FIG. 8. For removal, drawingintra-bronchial device140 toward the catheter causes the anchor ends122,124,126, and128 to move away from obstructingmember110 to a third configuration.Anchors112,114,116, and118 are thereby folded away from obstructingmember110 and are released from engagement withair passageway wall130 for removal of theintra-bronchial device140. In an alternative embodiment, theanchors112,114,116, and118 may be formed on additional support members carried bycentral support structure109, instead of being formed from distal portions ofsupport members102,104,106, and108.
• FIGS.[0066]9-11 illustrate an intra-bronchial device, with proximal anchors carried on the central support structure, in accordance with an alternative embodiment of the invention. FIG. 9 is a perspective view, FIG. 10 is a side view, and FIG. 11 is an end view of the device.Intra-bronchial device150 is generally similar in construction, operation, placement, and removal to theintra-bronchial device100 of FIG. 5. Its structure has six support members and three anchors, with anchor stops.Anchors112,114, and116 includestops152,154, and156 respectively.Intra-bronchial device150 also includes ananchor base161, ananchor base aperture165,anchor base angle163, and twoadditional support members103 and105.
• [0067]Central support structure109 extends both proximal and distal of obstructingmember110, and carriesanchor base161 proximal of obstructingmember110, carriesanchors112,114, and116, and includesanchor base aperture165. The linear plane ofanchors112,114, and116 intersectanchor base161 atanchor base angle163.Anchor base angle163 is selected to optimize anchor deployment force and anchor release.Stops152,154, and156 include a flat area to limit the piercing of the air passageway wall by anchor ends122,124, and126. In alternative embodiments, the stops can be any configuration or shape known to those skilled in the art to limit the piercing.
• In operation, when[0068]intra-bronchial device150 is compressed for insertion into the catheter lumen for placement in the air passageway, anchors112,114, and116 are collapsed into a first configuration. In the first configuration, the anchor ends122,124, and126 are moved toward obstructingmember110, thereby decreasinganchor base angle163 and folding anchors112,114, and116 toward obstructingmember110. The anchor ends and the anchors may be moved by sliding a catheter or hollow member overanchor base161 and toward obstructingmember110. Whenintra-bronchial device150 is deployed from the catheter lumen, the memory and resiliency of theanchors112,114, and116,anchor angle163, andanchor base161 impart a force that moves the anchor members into a second configuration, which is the deployed configuration, to engageair passageway wall130. The second or deployed configuration is illustrated in FIGS.9-11.Stops152,154, and156 limit the piercing of the air passageway wall by anchor ends122,124, and126.
• For removal, a retractor device is deployed from a catheter to engage[0069]anchor base161 and restrainintra-bronchial device150.Anchor base aperture165 is arranged for being gripped by a retractor device. The retractor device may be a biopsy forceps to engageanchor base161, or a hooked device to engageanchor base aperture165. The retractor device is then used to drawintra-bronchial device150 proximal, releasing theanchors112,114, and116 from the air passageway wall. This collapses the anchors into to the first configuration for removal.
• In an alternative step to collapse the anchors, after[0070]anchor base161 oraperture165 is engaged, a catheter may then moved distally overanchor base161, and in contact withanchors112,114, and116. The catheter is further moved againstanchors112,114, and116, whileintra-bronchial device150 is restrained atanchor base161. This releases theanchors112,114, and116 from the air passageway wall. This collapses the anchors into to the first configuration for removal.
• Continuing with the removal steps,[0071]intra-bronchial device150 is then further drawn into the catheter by pulling on the retractor device used to engageanchor base161. This collapsessupport structure101 and obstructingmember110 so that they may be fully drawn into the catheter. Once drawn into the catheter,intra-bronchial device160 may be removed from the air passageway and the patient.
• FIGS.[0072]12-14 illustrate an intra-bronchial device, with distal friction anchors carried on the central support structure, in accordance with an alternative embodiment of the invention. FIG. 12 is a perspective view, FIG. 13 is a side view, and FIG. 14 is an end view.Intra-bronchial device160 is generally similar in construction, placement, and operation to theintra-bronchial device150 of FIGS.9-11.Intra-bronchial device160 is removed in the manner described in conjunction with FIG. 7. However,Intra-bronchial device160 differs fromintra-bronchial device150 in that the structure includes four distal anchors with anchor ends122,124,126, and128 shaped into pads that deform and frictionally engage the air passageway wall to more positively anchorintra-bronchial device160 without piercing. The structure also includes an obstructingmember support base170.
• [0073]Central support structure109 extends distal of obstructingmember110, and carriesanchor base161 distal of obstructingmember110.Anchor base161 carriesanchors112,114,116, and118. The linear plane ofanchors112,114,116, and118 intersectsanchor base161 atanchor angle163.Anchor angle163 is selected to optimize anchor deployment force and anchor release. Theanchors112,114,116, and118, andanchor base161 may be constructed by laser cutting a single piece of hypodermic tubing lengthwise to form theanchors112,114,116, and118, and then bending the anchors to formanchor angle163.Anchor base161 is secured tocentral support structure109.Support members102,103,104,105,106, and108, and the obstructing membersupport member base170 may be constructed in a like manner. Obstructingmember110 is secured to the obstructingmember support base170, and alternatively to supportmembers102,103,104,105,106, and108. The assembly of obstructingmember110 andsupport base170 is secured tocentral support structure109.Central support structure109 may extend proximal ofsupport member base170 to provide a surface for gripping theintra-bronchial device160 for removal, and may include an aperture to be engaged by a hooked device.
• FIG. 15 is a perspective view of an intra-bronchial device similar to that of FIGS.[0074]12-14 anchored in an air passageway. It illustrates pad-shaped anchor ends122-128 ofintra-bronchial device180 deforming and frictionally engagingair passageway wall130.
• FIGS. 16 and 17 illustrate a removable intra-bronchial device with proximal anchors carried on a peripheral portion of a plurality of support structure members in accord with the present invention. FIG. 16 is a perspective view, as the device would appear when fully deployed in an air passageway. FIG. 17 is a side view of FIG. 16. In a preferred embodiment, the[0075]support structure101 ofintra-bronchial device190 includes six support members, with two opposing pairs of support members carrying anchors and each member of a pair being joined together by a retracting member.Intra-bronchial device190 includes asupport structure101 having acentral support structure109 andsupport members102,103,104,105,106, and108; fouranchors113,114,116, and118 having anchor ends123,124,126, and128 respectively; two “U” shaped retractingmembers192 and194 having an apex193 and195 respectively; and obstructingmember110.
• [0076]Intra-bronchial device190 is generally similar in construction, operation, placement, and removal to theintra-bronchial device150 of FIG. 9.Support structure101 is a tubular member, preferably hypodermic needle tubing, or stainless steel, Nitinol, or other suitable material having a memory of its original shape and resiliency to return the material to that shape.Support members102,103,104,105,106, and108, andcentral support structure109 may be formed by laser cutting a single piece of hypodermic needle tubing lengthwise, and bending the support members to a required shape.Support members102,103,104,105,106, and108 are generally similar to each other.Anchors113,114,116, and118 are disposed onsupport members103,104,106, and108, respectively, in any manner available in the art. Anchors113-118 are disposed onsupport members103,104,106, and108 to be located proximally of obstructingmember110, and to engage an air passageway wall whenintra-bronchial device190 is deployed.
• “U” shaped retracting[0077]member192 is coupled to supportmembers103 and104, and “U” shaped retractingmember194 is coupled to supportmembers106 and108. “U” shaped retractingmembers192 and194 may be constructed of any material suitable for use within a patient, and may or may not be resilient as required by the particular embodiment. Whenintra-bronchial device190 is fully deployed in an air passageway, the “U” shaped retractingmembers192 and194 are arranged opposite each other, and they partially overlap, with the apex of one lying within a space bounded by the “U” shape of the other member. In the deployed configuration, increasing the distance betweenapex193 and apex195 moves support member pairs103-104 and106-108 centrally.
• In operation, when[0078]intra-bronchial device190 is compressed for insertion into a catheter lumen and placement in an air passageway,support members102,103,104,105,106, and108 are collapsed centrally into a first configuration. This causes the anchor ends123,124,126 and128 to move centrally.
• When[0079]intra-bronchial device190 is deployed from the catheter lumen, the memory and resiliency of the support member pairs103,104 and106,108 impart a force that moves theanchors113 and114, and116 and118, and their anchor ends123 and124, and126 and128 into a second configuration, which is the deployed configuration to engage air passageway wall. In addition, deployment ofintra-bronchial device190 may include a step of forcibly decreasing the distance betweenapexes193 and195 to forcibly move theanchors113 and114, and116 and118 into engagement with the wall of the air passageway. While theanchors113 and114, and116 and118 of this embodiment do not include stops, the expansive or peripheral movement of the anchors will be limited by the interior surface of obstructingmember110. This may limit the piercing of the air passageway wall byanchors113 and114, and116 and118.
• In an alternative embodiment, support member pairs[0080]103,104 and106,108 may be compressed for insertion into a catheter lumen by a device that increases the distance betweenapex193 and apex195. Such a device could be a tool with spreading jaws, or a tapered member inserted between the apexes. The device could be left in engagement after insertion into the catheter, and then withdrawn to allow support member pairs103-104 and106-108 to move apart and engage their anchors into the wail of the air passageway.
• For removal, a retractor device is deployed from a catheter lumen to engage apex[0081]193 and195, and restrainintra-bronchial device190. The retractor device may be any device that fits into the space defined byapexes193 and195 when theintra-bronchial device190 is in its fully deployed configuration. The retractor device is used to increase the distance betweenapexes193 and195 untilanchors113,114,116, and118, and anchor ends123,124,126, and128 are released from the air passageway wall. This collapses the anchors into to the first configuration for removal.Intra-bronchial device190 is then further collapsed, and drawn into the catheter by pulling on the retractor device. This additionally collapsessupport structure101 and obstructingmember110 into the first position so that they may be fully drawn into the catheter. Once drawn into the catheter,intra-bronchial device190 may be removed from the air passageway and the patient.
• FIG. 18 is a perspective view illustrating an alternative embodiment of a removable intra-bronchial device[0082]200 with both distal and proximal anchors carried on corresponding peripheral portions ofcentral support structure109 in accord with the present invention. FIG. 19 is a side view of the device200 of FIG. 18. Intra-bronchial device200 is generally similar in construction, placement, and operation tointra-bronchial device150 of FIGS.9-11. Intra-bronchial device200 is removed in the manner described in conjunction with FIG. 7. Intra-bronchial device200 differs fromintra-bronchial device150 in that thecentral support structure109 carries distal anchors in addition to the proximal anchors ofdevice150. Intra-bronchial device200 includesdistal anchors212,213,214,216, and218; anchor ends222,223,224,226, and228; and stops252,253,254,256, and258. Intra-bronchial device200 also include two more proximal anchors thandevice150, which areproximal anchors113 and118; anchor ends123 and128, and stops153 and158.
• The[0083]central support structure109 ofsupport structure101 extends both distally and proximally of obstructingmember110, and carries both theproximal anchors112,113,114,116, and118 anddistal anchors212,213,214,216, and218. Thesupport structure101 also includessupport members102,103,104,106, and108. Because of the perspective of FIGS. 18 and 19, several of the anchor members and several of the support members are not visible. Intra-bronchial device200 is expected to provide additional anchoring force compared to the other embodiments disclosed herein.
• Although the present invention has been described in considerable detail with reference to certain preferred embodiments, other embodiments are possible. Therefore, the spirit or scope of the appended claims should not be limited to the description of the embodiments contained herein. It is intended that the invention resides in the claims hereinafter appended.[0084]

Claims (31)

What is claimed is:

1. An intra-bronchial device for placement in an air passageway of a patient to collapse a lung portion associated with the air passageway, the device comprising:

a support structure;

an obstructing member carried by the support structure that prevents air from being inhaled into the lung portion to collapse the lung portion; and

at least one anchor carried by the support structure that anchors the obstruction device within the air passageway when the anchor is deployed.

2. The intra-bronchial device ofclaim 1, wherein at least one anchor has an anchoring end that engages the air passageway wall.

3. The intra-bronchial device ofclaim 1, wherein the obstructing member and at least one anchor are simultaneously deployable.

4. The intra-bronchial device ofclaim 1, wherein at least one anchor is releasable from the air passageway for removal of the intra-bronchial device.

5. The intra-bronchial device ofclaim 1, wherein at least one anchor pierces into the air passageway wall.

6. The intra-bronchial device ofclaim 1, wherein at least a portion of the support structure is collapsible.

7. The intra-bronchial device ofclaim 1, wherein at least one anchor includes a stop dimensioned for limiting the piercing of the air passageway wall.

8. The intra-bronchial device ofclaim 1, wherein at least one anchor is configured to move from a first configuration to a second configuration to engage the air passageway.

9. The intra-bronchial device ofclaim 1, wherein at least one anchor is configured to move from a first configuration to a second configuration to engage the air passageway, and to move from the second configuration to the first configuration to disengage the air passageway.

10. The intra-bronchial device ofclaim 1, wherein at least one anchor is configured to move from a first configuration to a second configuration to engage the air passageway, and to move from the second configuration to a third configuration to disengage the air passageway.

11. The intra-bronchial device ofclaim 1, wherein the support structure is configured to urge at least one anchor to engage the air passageway wall.

12. The intra-bronchial device ofclaim 1, wherein the anchor includes a resilient material for imparting a force against the air passageway to deform the air passageway to more positively anchor the obstructing member.

13. The intra-bronchial device ofclaim 1, wherein the anchor includes at least one pad that frictionally engages the air passageway.

14. The intra-bronchial device ofclaim 1, wherein the obstructing member is a one-way valve.

15. The intra-bronchial device ofclaim 1, wherein at least one anchor is carried by a peripheral portion of the support structure.

16. The intra-bronchial device ofclaim 1, wherein at least one anchor is carried by a central portion of the support structure.

17. The intra-bronchial device ofclaim 1, wherein the obstructing member is releasable from the support structure and removable from the air passageway.

18. The intra-bronchial device ofclaim 1, wherein at least one anchor is carried distal to the obstructing member.

19. The intra-bronchial device ofclaim 1, wherein at least one anchor is carried proximal to the obstructing member.

20. The intra-bronchial device ofclaim 1, wherein at least one anchor is carried distal to the obstructing member and at least one anchor is carried proximal to the obstructing member.

21. A method of reducing the size of a lung by collapsing a portion of the lung, the method including the steps of:

providing an intra-bronchial device comprising a support structure, an obstructing member carried by the support structure which is so dimensioned when deployed in an air passageway communicating with the portion of the lung to be collapsed to preclude air from being inhaled, and at least one anchor carried by the support structure that anchors the obstructing member when the anchor is deployed;

placing the obstructing member in the air passageway; and

deploying at least one anchor.

22. The method ofclaim 21, wherein at least one anchor is releasable for removal of the intra-bronchial device.

23. The method ofclaim 21, wherein the obstructing member forms a one-way valve.

24. The method ofclaim 21, wherein at least a portion of the support structure is collapsible.

25. A method of reducing the size of a lung by collapsing a portion of the lung with a removable device, the method including the steps of:

providing an intra-bronchial device comprising a support structure, an obstructing member carried by the support structure which is so dimensioned when deployed in an air passageway communicating with the portion of the lung to be collapsed to preclude air from being inhaled, and at least one anchor carried by the support structure that anchors the obstructing member when the anchor is deployed;

placing the obstructing member in the air passageway;

deploying at least one anchor; and

removing at least the obstructing member.

26. The method ofclaim 25, wherein at least one anchor is releasable from the air passageway for removal of the intra-bronchial device, and the step of removing at least the obstructing member includes releasing at least one anchor.

27. The method ofclaim 25, wherein at least a portion of the obstructing member is releasable from the support structure, and the step of removing at least the obstructing member includes releasing the obstructing member from the support structure.

28. The method ofclaim 25, wherein the obstructing member forms a one-way valve.

29. The method ofclaim 25, wherein at least a portion of the support structure is collapsible.

30. An air passageway obstructing device comprising:

frame means for forming a support structure;

flexible membrane means for obstructing air flow within the air passageway, carried by the support structure; and

anchoring means to anchor the air passageway obstructing device, carried by the support structure,

the frame means being expandable to an expanded state within an air passageway to support the membrane means and the anchoring means, the anchoring means being releasable for removal of the device from the air passageway.

31. The intra-bronchial device ofclaim 1, wherein the support structure comprises material having memory of an original shape, and resiliency to return the material to that shape.

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