US20050021063A1 - Magnetically Guided Atherectomy - Google Patents

Abstract

Atherectomy devices are guided by and manipulated by externally applied magnetic fields to treat total or partial occlusions of a patient's vasculature.

Description

CROSS-REFERENCE TO RELATED CASES
• This application is a continuation patent application of U.S. patent application Ser. No. 09/352,161, filed Jul. 12, 1999, which is a continuation-in-part of U.S. patent application Ser. No. 09/281,241, filed Mar. 30, 1999, the disclosures of which are incorporated by reference.
FIELD OF THE INVENTION
• The present invention relates generally to the removal of occlusive material from body lumens, and more particularly both methods and devices for magnetically guided atherectomy of totally occluded arterial vasculature. Catheters which employ thermal as well as other energy sources are disclosed along with complementary equipment for carrying out the procedures.
DESCRIPTION OF THE PRIOR ART
• Arteriolosclerosis is a progressive disease marked by deposits within the lumen of arterial vessels. Removal of these deposits restores blood flow and is a preferred treatment for this disease. In instances where the vessel cannot be salvaged, bypass grafts may be used to treat the disorder.
• A wide range of recannalization techniques have been developed over time. The primary technique in clinical use today is balloon angioplasty. This is a “mechanical” treatment where a balloon at the treatment site is inflated to compress obstructive material against the vessel wall. In most treatment protocols the recannalization device is navigated to the treatment site through the patent's vasculature. The so-called “Seldinger” technique is used most often to gain access to and navigate through the blood vessels. In this technique the catheter enters the body in the groin area and is moved through the vasculature to the heart with the assistance of both guide wire and occasionally guide catheters or sheaths.
• Although balloon angioplasty is probably the most common procedure, there are several drawbacks to this type of device. One problem is that the vascular occlusion must first be crossed with a guide wire to position the balloon. The balloon device follows the guide wire through the lesion and the wire biases the balloon against the walls of the vessel. If the vessel is totally occluded the wire cannot cross the lesion and therefore cannot be used to guide the balloon.
• Other energy sources for recannalization have been proposed and studied as well. For example, U.S. Pat. No. 5,318,014 to Carter, teaches a device to treat occlusions with ultrasound. The Drasler U.S. Pat. No. 5,370,609 teaches the use of a high-energy rearward facing water jet to remove occlusive material. The art teaches the use of rotating mechanical burrs or blades for removing material. See for example Pannek, U.S. Pat. No. 5,224,945. Also the use of heat to reform and remodel a vessel is known from Eggers U.S. Pat. No. 4,998,933 among others.
SUMMARY
• The atherectomy devices according to the invention include a magnetic element that allows for the remote manipulation of the distal end of working tip of the catheter by a magnetic surgery system (MSS) or other magnetic field generator operated outside of the patient.
• The application of external fields and gradients allows the physician to control the orientation and location of the distal tip of the catheter in the vessel at the treatment site. This permits the use of small and potentially single size catheters to treat either partial or total occlusions in the vasculature. In operation the device is moved to various treatment sites or locations in a vessel under the guidance of the MSS. The methods of the invention may be partially automated in the sense that the physician can image the current location of the device and program a desired location
• with the MSS and designate a location or orientation of the device in a vessel. The MSS system can provide feedback to the physician to help the physician direct the device as “planned” with the MSS workstation. Robotic control of the device is also contemplated wherein the motion of the device in the vessel is entirely under software control. In this instance physician observation and transducer feedback manages the procedure.
• Any of a variety of energy sources can be used to carry out the recannalization process of the invention, although thermal energy is preferred and is used as an illustrative but limiting energy source. The source of heat may include optical or radio frequency energy sources. However, the device is also useful with hydraulic energy, direct laser sources or ultrasonic energy sources. Physician supplied energy is contemplated as well in the sense that a doddering wire may manipulated by the physician and guided magnetically to treat the occlusion.
• Devices which rely on heat or which generate heat in the body may include fluid cooling to manage the distribution of heat, several device with adjunctive fluid delivery are shown as illustrative of the invention.
• Additional “delivery” structures are present in some embodiments of the device and may be used to accommodate various medical techniques and methods. For example lumens for “over the wire” and “rapid exchange” delivery of the catheters are shown. Also these lumens may be used with imaging and localization devices to carry out the methods of the invention. These lumens may also be used to introduce contrast agent into the treatment site.
• Localization structures are disclosed for use in the procedure. Preoperative Magnetic Resonance Imaging (MRI), Computed Tomography (CT) or Ultrasound scans provide a “roadmap” for the procedure while X-ray, Doppler ultrasound, or other localization techniques are used to display the current real time position of the device in the lumen.
• It is also contemplated that the “open” lumens of the device can be used with ultrasonic or laser based imaging systems to characterize the nature of the occlusion.
BRIEF DESCRIPTION OF THE DRAWINGS
• Throughout the various figures of the drawing like reference enumerates refer to identical structure. A typical and exemplary set of embodiments of the invention are shown in the drawing but various changes to the devices may be made without departing from the scope of the invention wherein:
• FIG. 1 is schematic diagram of a thermal catheter in a vessel;
• FIG. 2 is a schematic diagram of a bipolar thermal catheter;
• FIG. 3 is a schematic diagram of a resistance heated thermal catheter;
• FIG. 4 is a schematic of a laser-heated catheter;
• FIG. 5 is a schematic of a thermal catheter having an additional lumen;
• FIG. 6 is a RF heated catheter with a rapid exchange lumen;
• FIG. 7 is an ultrasound atherectomy device driven by an external horn;
• FIG. 8 is a hydraulic catheter;
• FIG. 9 is an optically heated catheter in a sheath;
• FIG. 10 is an optically heated device with an auxiliary lumen;
• FIG. 11 is an optically heated device with multiple lumens;
• FIG. 12 is an optically heated device with a distal port; and
• FIG. 13 is a schematic overview of the automated workstation.
DETAILED DESCRIPTION THE INVENTION
• FIG. 1 shows athermal catheter10 in avessel12. Thedistal tip section14 of the device is shown in a vessel while theproximal section15 is illustrated as a fragment located outside of thevessel12. In general, the construction of the proximal end of the device and configuration and power couplings are within the ordinary skill of this art and are illustrated schematically inFIG. 1. For clarity the detailed disclosure is directed to the distal tip structures. However it should be recognized that the devices are intended for use in coronary vessels, the overall length of devices in accordance with this invention are30 or more inches long and typical are between 2 and 12 French in diameter. It should be understood that coronary use is merely illustrative and other vessels and body lumens may be addressed therapeutically using the invention. The proximal end will carry suitable hubs and connections for the wires and lumens discussed in connection with the distal tip.
• InFIG. 1 thedistal tip14 of thecatheter10 abuts atotal occlusion16. Aguide wire18 shown in phantom, andsheath20 may be used together to deliver thecatheter10 to the treatment site near theocclusion16. Either or both of the guide wire or sheath may have amagnetic element22 included in its design to assist in access to the treatment site. For instance theguide wire18 may have amagnet22 located at its distal tip. Similarly the sheath may have amagnetic tube24 located at its distal tip. However, for the purpose of this disclosure the magnetic elements on the guide wire or sheath permit the applied field or gradient to orient the distal tip. InFIG. 1 the forces generated on the tip by an external magnet are shown by vectors indicated byreference numeral9. The physician can advance the guide wire or sheath by pushing on the proximal end of end of the device with the distal tip direction determined in part by the magnetic forces represented at9. The magnetic orientation of the tip coupled with physical motion applied to the proximal end of the device positions the device. The physical motion can be supplied by either the physician or a robotic element.
• The thermal catheter embodiment ofFIG. 1 has aheated tip26. Preferably this tip is formed from Hiperco or other magnetically active metallic material. In this context iron containing alloys of steel which are attracted to magnets are suitable choices for the tip material. Although the distal tips are shown in hemispheric in shape for consistency of explanation it should be understood that other forms and shapes are operable so the shape should be understood as illustrative and not limiting. In use heat is delivered by thetip26. The lines located byreference numeral38 represent heat transfer to theocclusion16, which allows thetip26 to move through theocclusion16. In this embodiment thetip26 is heated with RF energy from anRF source28. The RF source is coupled to the tip by awire32. Apatch electrode34 having a large area may be placed on the patient to complete the circuit to theRF source28 throughwire36. This configuration may be called “monopolar” in contrast to the “bipolar configuration shown inFIG. 2.Acoating27 may be applied to the surface of the distal tip to prevent sticking or adhesions. Thecoating27 may also increase bio compatibility or improve heat transfer through the device. Both polymeric materials such as Teflon and metallic materials such as titanium nickel alloy are suitable for this application. Therefore the illustrative embodiments of the invention should be considered to be “composite” constructions where individual elements may be made of more than one material as indicated by coating29.
• FIG. 2 shows a distal tip embodiment for athermal catheter10, which includes two metal structures that are insulated from each other. The first structure is thedistal tip40 which is metal and may be magnetically active. Thewire32 couples this tip to theRF source28. The second element is thereturn electrode42. Preferably this function is served by metallic ring orbank42 which is coupled to theRF source28 through thewire36. In this embodiment one or both of the metallic elements may be magnetically active. Also partial rings which surround only part of the catheter are contemplated within the scope of the invention although they are not preferred. In general the exact shape of the distal rings will not be critical to the operation of the invention.
• FIG. 3 shows a resistance heated embodiment of athermal catheter10 where thedistal tip44 is magnetically active metal. Thetip44 is electrically isolated from, but in thermal contact with theresistance wire heater46 located near the tip.Wire48 andwire50 couple theheater46 to theelectrical power source52 which may be an AC or DC source which may be modulated to control the energy delivery to the tip.
• FIG. 4 shows a laser heated embodiment of thethermal catheter device10. In this embodiment thetip60 absorbs radiation from the optical wave guide62 coupled to thelaser source64. In operation the laser energy source may operate continuously or intermittently to deliver energy to thetip60. In operation the laser light impinges on the tip structure and it is absorbed and converted to heat. Thedistal tip60 may be magnetic or may be made from a magnetically active material. In general, and depending on detail design issues the surface of the tip may or may not be electrically conductive. In this particular embodiment it should be clear that the thermal requirements of the tip are significant in contrast to other embodiments where electrical conductivity is critical. It is contemplated that the distal tip may be made of ceramic or “glassy” material.
• FIG. 5 shows an embodiment of the invention whereinthermal catheter10 has adistal tip70 which has atube71 that has anopen lumen72 which communicates to the proximal end of the device. Thislumen72 can be used for several purposes. For example, the lumen can accommodate either animaging wire76, ultrasonic or laser imaging, or aguide wire74. In operation the preferred ultrasonic imaging wire can be used to visualize and locate the occlusion. Once the occlusion has been located and characterized, the correct amount of power can be delivered to thedistal tip70. Typically the ultrasound imaging wire would be withdrawn and parked in thelumen72 proximally to prevent heat damage to the transducer of the imaging wire. During device placement the lumen can be used withguide wire74 to access the treatment site.
• The lumen can also be used with an optical fiber to perform laser induced florescence spectroscopy or optical low coherence reflectometry. These procedures can be used to “look at” and evaluate the obstruction during treatment.
• FIG. 6 is an example of a “rapid exchange” delivery configuration for thethermal catheter10. Thedistal tip80 as anopen lumen82 which is relatively short and exits the side of thecatheter body84 at a location distal of the proximal end of thedevice10. This opening can receive a guide wire which can be used to position the device near the occlusion.
• FIG. 7 represents an ultrasoundenergy source catheter92. Theultrasonic horn94 is coupled to thewaveguide96 which in turn terminates in adistal tip90. The waveguide may extend beyond the tip. In operation the delivery of ultrasound energy to the distal tip results in the formation of very small bubbles which dislodge the nearby plaque or other obstructing material. In this embodiment thedistal tip90 may be formed of Hiperco or other magnetically active material.
• FIG. 8 represents ahydraulic catheter91 which uses the force of a jet of fluid emerging fromnozzle93 to disrupt the occlusive material. In this device the distal tip100 may be made from Hiperco or another magnetically active material.
• FIG. 9 shows thedevice10 ofFIG. 5 located in asheath120. The space between the sheath and thecatheter body122 can be flooded with contrast agent to reveal the location of the catheter with respect to the occlusion. At some power levels the space can be used to conduct cooling fluid to the tip to help regulate the temperature and temperature distribution of thedevice124. Saline injection can also be used to prevent implosion of vapors in the blood at the treatment site.
• FIG. 10 shows the device78 ofFIG. 5 in a sheath that limits the movement of thedistal tip70. In this version of the device thesheath130 positions thedistal tip70 near theguide magnets134. This allows the physician to move the tip with the MSS and to control the exit of fluid from the sheath.
• FIG. 11 represents a multilumen construction where afluid supply lumen140 is provided to irrigate thetip144 of thecatheter146. An offsetguide wire lumen1485 is provided for used with imaging and locating devices.
• FIG. 12 shows an embodiment of the catheter where the fluid exiting the tip through aport150 serves to cool thecatheter body152. In this device the exterior wall of the catheter forms a central lumen which may be filled with a cooling solution. In general this volume may be too large to use for contrast injection. The fluid pressure in this sheath could also be reversed to create a vacuum on the occlusive material and remove it from the body during ablation.
• FIG. 13 is a schematic diagram of a MSS system for using the catheters in a patient. In operation the physician user interacts with thepatient302 and theworkstation console300. The software used by the workstation coordinates several separate sources of data and control certain hardware as well. For example information from apreoperative scan305 is loaded into theworkstation300 to provide a template of the treatment site. This preoperative data may be collected from MRI, CT, ultrasound, or other diagnostic imaging scans. Real time biplane x-ray data is supplied by anx-ray machine303 and304 to the workstation as well for display against the template and for interaction with the physician. As an alternativeorthogonal coils301 and302 may be used with an RF location system to localize the position of the catheter.
• In general a fiducial marker on the catheter allows the preoperative scan and the real time scans to be appropriately merged. In operation the user can define a location on theMSS workstation300 with a mouse or other pointing device which identifies the desired location of the therapy. Next the MSS workstation computes the forces and required fields and gradients required to navigate the catheter to the new location. This information controls themagnet system308. An appropriate set ofcatheter actuators306 may be provided to allow the MSS to move the catheter as well.

Claims (26)

1. A catheter for treating an occluded vessel comprising:

a catheter body having a proximal end and a distal end, said distal end terminating in a distal tip;

an energy source coupled to said distal tip for supplying energy to the distal tip for treating an occlusion;

a magnetically active element located proximate said distal tip responsive to externally applied magnetic fields whereby said externally applied magnetic fields direct and orient said distal tip.

2. The catheter ofclaim 1 wherein said magnetically active element forms at least a portion of said distal tip.

3. The catheter ofclaim 1 further including a lumen positioned in said catheter body extending form said proximal end to said distal end.

4. The catheter ofclaim 1 further including one or more electrical coils located proximate said distal tip for cooperation with a localization device.

5. A sheath for use with a catheter ofclaim 1 for treating a vessel occlusion comprising:

a sheath body having a proximal end and having a distal end;

a lumen extending from said proximal end to said distal end;

a magnetically active element located proximate said distal tip.

6. A system for treating a vessel occlusion comprising:

a sheath, having a sheath body, said sheath body having a proximal end and having a distal end;

a lumen extending through said sheath body from said proximal end to said distal end;

a catheter having a catheter body having a proximal end and a distal end terminating in distal tip;

an energy source coupled to said distal tip;

a magnetically active element located proximate said distal tip of said catheter body.

7. A system for treating a vessel occlusion comprising:

a sheath, having a sheath body, said sheath body having a proximal end and having a distal end;

a lumen extending through said sheath body from said proximal end to said distal end;

a catheter having a catheter body having a proximal end and a distal end;

an energy source coupled to said distal tip for delivering therapeutic energy to a vessel occlusion;

a magnetically active element forming a portion of said distal tip of said sheath body.

8. The catheter ofclaim 1 including a first metallic element located proximate said distal tip adapted for coupling to a remote radio frequency energy source whereby RF energy coupled to said metallic element heats said metallic element.

9. The catheter ofclaim 8 wherein said metallic element forms one pole of a monopolar energy distribution system.

10. The catheter ofclaim 9 further comprising a second metallic element proximate said distal tip forming a pole of a bipolar energy distribution system.

11. The catheter ofclaim 1 including a thermally conductive element located proximate said distal tip adapted for coupling to a remote optical laser energy source whereby optical energy coupled to said thermally conductive element heats said thermally conductive element.

12. The catheter ofclaim 11 wherein said thermally conductive element is metallic.

13. The catheter ofclaim 1 further including an ultrasonic waveguide element located proximate said distal tip adapted for coupling to a remote ultrasonic frequency energy source.

14. The catheter ofclaim 1 further including a resistance heating element located proximate said distal tip adapted for coupling to a remote electrical energy source.

15. The catheter ofclaim 14 further including a resistance heating element located proximate said distal tip adapted for coupling to a remote AC elect5rical energy source.

16. The catheter ofclaim 14 further including a resistance heating element located proximate said distal tip adapted for coupling to a remote DC electrical energy source.

17. The catheter ofclaim 1 further including a fluid directing element located proximate said distal tip adapted for coupling to a remote hydraulic energy source, whereby fluid coupled to said device extracts occlusive material from locations near the distal tip.

18. The catheter ofclaim 3 further including a laser imaging device located in said lumen for observing an occlusion.

19. The catheter ofclaim 3 further including an ultrasonic imaging device located in said lumen for observing an occlusion.

20. A system for treating total occlusions of a patient's vasculature comprising:

a catheter having an elongate body and a distal tip;

a heated element located proximate the distal tip of the catheter;

a magnetic element located proximate distal tip;

a magnetic surgery system for interacting with said magnetic element; said magnetic surgery system including a localization device to determine the location of the catheter distal tip within the body;

said magnetic surgery system including an occlusion visualization device for presenting an image to a user which depicts the location of the catheter tip.

21. The system ofclaim 20 wherein said visualization device is an ultrasonic imaging wire.

22. The system ofclaim 20 wherein said visualization device is a laser imaging wire.

23. A system for treating occlusions of a patient's vasculature comprising:

a catheter having an elongate body and a distal tip;

a heated element located proximate the distal tip of the catheter;

a magnetic element located proximate the distal tip;

a magnetic surgery system for interacting with said magnetic element;

said magnetic surgery system including a localization device to determine the location of the catheter distal tip within the body;

said magnetic surgery system including a catheter location visualization device for presenting an image to a user which depicts the location of the catheter tip.

24. The system ofclaim 23 wherein said catheter location visualization device is a preoperative CT image.

25. The system ofclaim 23 wherein said catheter location visualization device is a preoperative MRI image.

26. A method of treating a total vascular occlusion comprising the steps of:

inserting a catheter having a magnetic tip into the body;

directing the catheter to the location of the total occlusion;

imaging the catheter tip to confirm and direct therapy;

energizing said catheter to heat said distal tip;

manipulating said distal tip by the application of external magnetic fields, directing said catheter tip into said occlusion.

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