US20070161951A1

Movatterモバイル変換

Info

Publication number: US20070161951A1
Application number: US11/685,643
Authority: US
Inventors: Douglas Hansmann; Peter Rule
Original assignee: Ekos LLC
Current assignee: Boston Scientific Scimed Inc
Priority date: 2004-01-29
Filing date: 2007-03-13
Publication date: 2007-07-12
Also published as: US7201737B2; US20050240151A1

Abstract

A method for providing a therapeutic effect to a treatment site within a patient's vasculature comprises positioning a catheter at the treatment site. The catheter includes a heating element and a fluid delivery lumen that is coupled to an exit port within a distal region of the catheter. The method further comprises passing the therapeutic compound through the delivery lumen and the exit port at a flow rate. The heated therapeutic compound is provided to the treatment site. The method further comprises exposing at least a portion of the treatment site and at least a portion of the delivered heated therapeutic compound to ultrasonic energy generated by the ultrasound radiating member.

Description

PRIORITY APPLICATIONS

This application is a continuation of U.S. patent application Ser. No. 11/046,209 (filed 28 Jan. 2005), which claims the benefit of U.S. Provisional Patent Application 60/540,035 (filed 29 Jan. 2004; Attorney Docket EKOS.169PR) and U.S. Provisional Patent Application 60/564,382 (filed 22 Apr. 2004; Attorney Docket EKOS.169PR2). The entire disclosure of all of these priority applications is hereby incorporated by reference herein.

FIELD OF THE INVENTION

The present invention relates generally to treatment of vascular occlusions, and more specifically to treatment of vascular occlusions with elevated temperatures and a therapeutic compound.

BACKGROUND OF THE INVENTION

As taught in U.S. Pat. No. 6,001,069, catheters can be used to treat human blood vessels that have become partially or completely occluded by plaque, thrombi, emboli or other substances that reduce the blood carrying capacity of the vessel. To remove or reduce the occlusion, the catheter is used to deliver solutions containing therapeutic compounds directly to the occlusion site. In these particular applications, ultrasonic energy generated by the ultrasound assembly is used to enhance the effect of the therapeutic compounds. Such a device can be used in the treatment of diseases such as peripheral arterial occlusion or deep vein thrombosis. In such applications, the ultrasonic energy enhances treatment of the occlusion with therapeutic compounds such as urokinase, tissue plasminogen activator (“tPA”), recombinant tissue plasminogen activator (“rtPA”) and the like. Further information on enhancing the effect of a therapeutic compound using ultrasonic energy is provided in U.S. Pat. Nos. 5,318,014, 5,362,309, 5,474,531, 5,628,728, 6,001,069 and 6,210,356.

The efficacy of therapeutic compounds in reducing or removing a vascular occlusion can also be enhanced by increasing the temperature of the therapeutic compound that is provided at the treatment site. For example, it has been determined that treatment of lower limb ischemia progresses more rapidly when heated rtPA is used, than when room temperature rtPA is used. See Dimitrios K. Tsetis et al., “Potential Benefits From Heating the High-Dose rtPA Boluses Used in Catheter-Directed Thrombolysis for Acute/Subacute Lower Limb lschemia”,J Endovasc Ther10:739-744 (2003), the entire disclosure of which is hereby incorporated herein by reference.

SUMMARY OF THE INVENTION

According to one embodiment of the present invention, a method is provided for treating a vascular obstruction at a treatment site within a patient's vasculature system. In the method, a catheter is advanced to the treatment site. The catheter includes a treatment zone and a fluid delivery lumen that is coupled to an exit port within the treatment zone of the catheter. A therapeutic compound is passed through the fluid delivery lumen and the exit port, such that the therapeutic compound is delivered to the treatment site. The treatment site is heated to an elevated temperature.

According to another embodiment of the present invention, a catheter comprises a tubular body having a drug delivery lumen terminating at a exit port within a treatment zone. A heating element is positioned within the treatment zone. A temperature sensor is in the treatment zone. A control system is configured to maintain the treatment zone at a an elevated temperature for a specified amount of time.

BRIEF DESCRIPTION OF THE DRAWINGS

Exemplary embodiments of the vascular occlusion treatment system are illustrated in the accompanying drawings, which are for illustrative purposes only. The drawings comprise the following figures, in which like numerals indicate like parts.

FIG. 1 is a schematic illustration of an ultrasonic catheter configured for insertion into large vessels of the human body.

FIG. 2 is a cross-sectional view of the ultrasonic catheter ofFIG. 1 taken along line2-2.

FIG. 3 is a schematic illustration of an elongate inner core configured to be positioned within the central lumen of the catheter illustrated inFIG. 2.

FIG. 4 is a cross-sectional view of the elongate inner core ofFIG. 3 taken along line4-4.

FIG. 5 is a schematic wiring diagram illustrating an exemplary technique for electrically connecting five groups of heating members to form an ultrasound assembly.

FIG. 6 illustrates the energy delivery section of the inner core ofFIG. 4 positioned within the energy delivery section of the tubular body ofFIG. 2.

FIG. 7 illustrates a wiring diagram for connecting a plurality of temperature sensors with a common wire.

FIG. 8A is a schematic illustration of an ultrasonic catheter configured for insertion into small vessels of the human body.

FIG. 8B is a cross-sectional view of a distal end of an ultrasonic catheter configured for use within small vessels of a patient's vasculature.

FIG. 8C is a cross-sectional view of the ultrasound catheter taken throughline8C-8C ofFIG. 8B.

FIG. 9 is a side view of the distal end of an ultrasonic catheter positioned at a treatment site.

FIG. 10 is a block diagram of a feedback control system for use with an ultrasonic catheter.

FIG. 11 is a flowchart illustrating an exemplary technique for manipulating the temperature of a therapeutic compound at a treatment site.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

As set forth above, methods and apparatuses have been developed that allow a vascular occlusion at a treatment site to be treated with a combination of a therapeutic compound and thermal energy. Disclosed herein are several exemplary embodiments of catheters that can be used to provide thermal energy and the therapeutic compound to the treatment site. Also disclosed are exemplary methods for using such catheters.

Introduction.

As used herein, the term “therapeutic compound” refers broadly, without limitation, and in addition to its ordinary meaning, to a drug, medicament, dissolution compound, genetic material or any other substance capable of effecting physiological functions. Additionally, a mixture includes substances such as these is also encompassed within this definition of “therapeutic compound”. Examples of therapeutic compounds include thrombolytic compounds, anti-thrombosis compounds, and other compounds used in the treatment of vascular occlusions, including compounds intended to prevent or reduce clot formation. In applications where human blood vessels that have become partially or completely occluded by plaque, thrombi, emboli or other substances that reduce the blood carrying capacity of a vessel, exemplary therapeutic compounds include, but are not limited to, heparin, urokinase, streptokinase, tPA, rtPA and BB-10153 (manufactured by British Biotech, Oxford, UK).

As used herein, the terms “ultrasonic energy”, “ultrasound” and “ultrasonic” refer broadly, without limitation, and in addition to their ordinary meaning, to mechanical energy transferred through longitudinal pressure or compression waves. Ultrasonic energy can be emitted as continuous or pulsed waves, depending on the parameters of a particular application. Additionally, ultrasonic energy can be emitted in waveforms having various shapes, such as sinusoidal waves, triangle waves, square waves, or other wave forms. Ultrasonic energy includes sound waves. In certain embodiments, the ultrasonic energy referred to herein has a frequency between about 20 kHz and about 20 MHz. For example, in one embodiment, the ultrasonic energy has a frequency between about 500 kHz and about 20 MHz. In another embodiment, the ultrasonic energy has a frequency between about 1 MHz and about 3 MHz. In yet another embodiment, the ultrasonic energy has a frequency of about 2 MHz. In certain embodiments described herein, the average acoustic power of the ultrasonic energy is between about 0.01 watts and 300 watts. In one embodiment, the average acoustic power is about 15 watts.

As used herein, the term “heating element” refers broadly, without limitation, and in addition to its ordinary meaning, to any apparatus capable of elevating the temperature of the treatment site. In one embodiment, the heating element comprises an ultrasonic transducer, which converts electrical energy into ultrasonic energy and thermal energy. An exemplary ultrasonic transducer capable of generating ultrasonic energy from electrical energy is a piezoelectric ceramic oscillator. Piezoelectric ceramics typically comprise a crystalline material, such as quartz, that changes shape when an electrical current is applied to the material. This change in shape, made oscillatory by an oscillating driving signal, creates ultrasonic sound waves. With respect to ultrasonic transducer, thermal energy is generated in two ways. First, because the ultrasonic transducer coverts electrical energy to ultrasound energy imperfectly, some portion of the electrical energy is converted to heat. In addition, it is postulated that the ultrasound filed generated by the transducer is absorbed by the surrounding biological material producing a localized elevation of temperature. In another embodiment, the heating element comprises a thermoelectric heater, such as, for example, an electrical resistive heaters. Other embodiments of an heating element include, without limitation, RF emitters, lasers, conductive heaters, convective heaters and/or the delivery of a heated fluid to the treatment site.

Overview of a Large Vessel Catheter.

FIG. 1 schematically illustrates acatheter10 configured for use in the large vessels of a patient's anatomy. For example, thecatheter10 illustrated inFIG. 1 can be used to treat long segment peripheral arterial occlusions, such as those in the vascular system of the leg.

As illustrated inFIG. 1, thecatheter10 generally includes a multi-component, elongate flexibletubular body12 having aproximal region14 and adistal region15. Thetubular body12 includes aflexible treatment zone18 located in thedistal region15. Thetubular body12 and other components of thecatheter10 can be manufactured in accordance with a variety of techniques known to an ordinarily skilled artisan. Suitable materials and dimensions can be readily selected based on the natural and anatomical dimensions of the treatment site and on the desired percutaneous access site.

For example, in an exemplary embodiment, the tubular bodyproximal region14 comprises a material that has sufficient flexibility, kink resistance, rigidity and structural support to push thetreatment zone18 through the patient's vasculature to a treatment site. Examples of such materials include, but are not limited to, extruded polytetrafluoroethylene (“PTFE”), polyethylenes (“PE”), polyamides and other similar materials. In certain embodiments, the tubular bodyproximal region14 is reinforced by braiding, mesh or other constructions to provide increased kink resistance and ability to be pushed. For example, nickel titanium or stainless steel wires can be placed along or incorporated into thetubular body12 to reduce kinking.

For example, in an embodiment configured for treating thrombus in the arteries of the leg, thetubular body12 has an outside diameter between about 0.060 inches and about 0.075 inches. In another embodiment, thetubular body12 has an outside diameter of about 0.071 inches. In certain embodiments, thetubular body12 has an axial length of approximately 105 centimeters, although other lengths can be used in other applications.

In an exemplary embodiment, thetubular body12 is divided into at least three sections of varying stiffness. The first section, which includes theproximal region14, has a relatively higher stiffness. The second section, which is located in an intermediate region between theproximal region14 and thedistal region15, has a relatively lower stiffness. This configuration further facilitates movement and placement of thecatheter10. The third section, which includes thetreatment zone18, has a relatively lower stiffness than the second section in spite of the presence of ultrasound radiating members which can be positioned therein.

FIG. 2 illustrates a cross section of thetubular body12 taken along line2-2 inFIG. 1. In the embodiment illustrated inFIG. 2, threefluid delivery lumens30 are incorporated into thetubular body12. In other embodiments, more or fewer fluid delivery lumens can be incorporated into thetubular body12. In such embodiments, the arrangement of thefluid delivery lumens30 provides a hollowcentral lumen51 passing through thetubular body12. The cross-section of thetubular body12, as illustrated inFIG. 2, is substantially constant along the length of thecatheter10. Thus, in such embodiments, substantially the same cross-section is present in both theproximal region14 and thedistal region15 of thetubular body12, including theenergy delivery section18.

In certain embodiments, thecentral lumen51 has a minimum diameter greater than about 0.030 inches. In another embodiment, thecentral lumen51 has a minimum diameter greater than about 0.037 inches. In an exemplary embodiment, thefluid delivery lumens30 have dimensions of about 0.026 inches wide by about 0.0075 inches high, although other dimensions can be used in other embodiments.

In an exemplary embodiment, thecentral lumen51 extends through the length of thetubular body12. As illustrated inFIG. 1, thecentral lumen51 has adistal exit port29 and aproximal access port31. Theproximal access port31 forms part of thebackend hub33, which is attached to the tubular bodyproximal region14. In such embodiments, the backend hub also includes afluid fitting46, which is hydraulically connected to thecentral lumen51. In such embodiments, thebackend hub33 also includes a therapeuticcompound inlet port32, which is hydraulically coupled to thefluid delivery lumens30, and which can also be hydraulically coupled to a source of therapeutic compound via a hub such as a Luer fitting.

Thecentral lumen51 is configured to receive an elongateinner core34, an exemplary embodiment of which is illustrated inFIG. 3. In such embodiments, the elongateinner core34 includes aproximal region36 and adistal region38. Aproximal hub37 is fitted on one end of the inner coreproximal region36. One ormore heating members40 are positioned within an inner coreenergy delivery section41 that is located within thedistal region38. Theheating members40 form aheating assembly42, which will be described in greater detail below.

As shown in the cross-section illustrated inFIG. 4, which is taken along lines4-4 inFIG. 3, in an exemplary embodiment, theinner core34 has a cylindrical shape, with an outer diameter that permits theinner core34 to be inserted into thecentral lumen51 of thetubular body12 via theproximal access port31. Suitable outer diameters of theinner core34 include, but are not limited to, between about 0.010 inches and about 0.100 inches. In another embodiment, the outer diameter of theinner core34 is between about 0.020 inches and about 0.080 inches. In yet another embodiment, theinner core34 has an outer diameter of about 0.035 inches.

Still referring toFIG. 4, theinner core34 includes a cylindricalouter body35 that houses theheating assembly42. Theheating assembly42 includes wiring andheating members40, described in greater detail in below, such that theheating assembly42 is capable elevating the temperature of the treatment site as described below. For embodiments where the heating assembly is driven by an electrical current, theheating assembly42 is electrically connected to thebackend hub33, where theinner core34 can be connected to acontrol system100 via cable45 (illustrated inFIG. 1). In an exemplary embodiment, an electrically insulatingpotting material43 fills theinner core34, surrounding theheating assembly42, thus reducing or preventing movement of theheating assembly42 with respect to theouter body35. In one embodiment, the thickness of theouter body35 is between about 0.0002 inches and 0.010 inches. In another embodiment, the thickness of theouter body35 is between about 0.0002 inches and 0.005 inches. In yet another embodiment, the thickness of theouter body35 is about 0.0005 inches.

In an exemplary embodiment, theheating assembly42 includes a plurality ofheating members40 that are divided into one or more groups. For example,FIG. 5 is schematic wiring diagram illustrating one technique for connecting five groups ofheating members40, in which the heat source members comprise an ultrasound element or a resistive heater. As illustrated inFIG. 5, theheating assembly42 comprises five groups G1, G2, G3, G4, G5 ofheating members40 that are electrically connected to each other. The five groups are also electrically connected to thecontrol system100.

Still referring toFIG. 5, in an exemplary embodiment, thecontrol circuitry100 includes avoltage source102 having apositive terminal104 and anegative terminal106. Thenegative terminal106 is connected tocommon wire108, which connects the five groups G1-G5 ofheating members40 in series. Thepositive terminal104 is connected to a plurality oflead wires110, which each connect to one of the five groups G1-G5 ofheating members40.

FIG. 6 illustrates theinner core34 positioned within thetubular body12. As described above, theinner core34 can be slid within thecentral lumen51 of thetubular body12, thereby allowing the inner coreenergy delivery section41 to be positioned within the tubular bodyenergy delivery section18. In one embodiment, thetubular body12 is advanced to the treatment site over a guidewire. The guidewire may then be removed and theinner core34 can be an be slid within the central lumen.

FIG. 6 further illustrates placement offluid delivery ports58 within the tubular bodyenergy delivery section18. As illustrated, holes or slits are formed from thefluid delivery lumen30 through thetubular body12, thereby permitting fluid flow from thefluid delivery lumen30 to the treatment site. A plurality offluid delivery ports58 can be positioned axially along thetubular body12. Thus, a source of therapeutic compound coupled to theinlet port32 provides a hydraulic pressure which drives the therapeutic compound through thefluid delivery lumens30 and out thefluid delivery ports58.

By spacing thefluid delivery lumens30 around the circumference of thetubular body12 substantially evenly, as illustrated inFIG. 6, a substantially uniform flow of therapeutic compound around the circumference of thetubular body12 can be achieved. Additionally, the size, location and geometry of thefluid delivery ports58 can be selected to provide uniform fluid flow from thefluid delivery ports30 to the treatment site. For example, in one embodiment, fluid delivery ports closer to the proximal region of theenergy delivery section18 have smaller diameters than fluid delivery ports closer to the distal region of theenergy delivery section18, thereby allowing uniform delivery of therapeutic compound in the energy delivery section.

For example, in one embodiment in which thefluid delivery ports58 have similar sizes along the length of thetubular body12, thefluid delivery ports58 have a diameter between about 0.0005 inches to about 0.0050 inches. In another embodiment in which the size of thefluid delivery ports58 changes along the length of thetubular body12, thefluid delivery ports58 have a diameter between about 0.001 inches to about 0.005 inches in the proximal region of theenergy delivery section18, and between about 0.005 inches to about 0.0020 inches in the distal region of theenergy delivery section18. The increase in size between adjacentfluid delivery ports58 depends on a variety of factors, including the material comprising thetubular body12, and on the size of thefluid delivery lumen30. Thefluid delivery ports58 can be created in thetubular body12 by punching, drilling, burning or ablating (such as with a laser), or by other suitable methods. Therapeutic compound flow along the length of thetubular body12 can also be increased by increasing the density of thefluid delivery ports58 toward the distal region of the energy delivery section.

In certain applications, a spatially nonuniform flow of therapeutic compound from thefluid delivery ports58 to the treatment site is to be provided. In such applications, the size, location and geometry of thefluid delivery ports58 can be selected to provide such nonuniform fluid flow.

Referring still toFIG. 6, placement of theinner core34 within thetubular body12 further definesfluid lumens44.Fluid lumens44 are formed between anouter surface39 of theinner core34 and aninner surface16 of thetubular body12. As explained in more detail below, a cooling or heating fluid can be introduced through theproximal access port31 such that fluid flows through coolingfluid lumens44 and out of thecatheter10 through distal exit port29 (see FIG.1). In an exemplary embodiment, thefluid lumens44 are substantially evenly spaced around the circumference of the tubular body12 (that is, at approximately 120° increments for a three-lumen configuration), thereby providing substantially uniform fluid flow over theinner core34. Such a configuration can advantageously be used to remove or add thermal energy from the treatment site. As will be explained below, the flow rate of the fluid and the power to theheat source assembly42 can be adjusted to maintain the temperature of the inner coreenergy delivery section41, or of the treatment site generally, within a desired range.

In an exemplary embodiment, theinner core34 can be rotated or moved within thetubular body12. Specifically, movement of theinner core34 can be accomplished by maneuvering theproximal hub37 while holding thebackend hub33 stationary. The inner coreouter body35 is at least partially constructed from a material that provides enough structural support to permit movement of theinner core34 within thetubular body12 without kinking of thetubular body12. Additionally, in an exemplary embodiment, the inner coreouter body35 comprises a material having the ability to transmit torque. Suitable materials for the inner coreouter body35 include, but are not limited to, polyimides, polyesters, polyurethanes, thermoplastic elastomers and braided polyimides.

In an exemplary embodiment, thefluid delivery lumens30 and thefluid lumens44 are open at the distal end of thetubular body12, thereby allowing the therapeutic compound and the fluid to pass into the patient's vasculature at thedistal exit port29. In a modified embodiment, thefluid delivery lumens30 can be selectively occluded at the distal end of thetubular body12, thereby providing additional hydraulic pressure to drive the therapeutic compound out of thefluid delivery ports58. In either configuration, theinner core34 can be prevented from passing through thedistal exit port29 by providing theinner core34 with a length that is less than the length of thetubular body12. In other embodiments, a protrusion is formed within thetubular body12 in thedistal region15, thereby preventing theinner core34 from passing through thedistal exit port29.

In other embodiments, thecatheter10 includes an occlusion device positioned at thedistal exit port29. In such embodiments, the occlusion device has a reduced inner diameter that can accommodate a guidewire, but that is less than the inner diameter of thecentral lumen51. Thus, theinner core34 is prevented from extending past the occlusion device and out thedistal exit port29. For example, suitable inner diameters for the occlusion device include, but are not limited to, between about 0.005 inches and about 0.050 inches. In other embodiments, the occlusion device has a closed end, thus preventing cooling fluid from leaving thecatheter10, and instead recirculating to the tubular bodyproximal region14. These and other cooling fluid flow configurations permit the power provided to theultrasound assembly42 to be increased in proportion to the cooling fluid flow rate. Additionally, certain fluid flow configurations can reduce exposure of the patient's body to fluids.

In an exemplary embodiment, such as illustrated inFIG. 6, thetubular body12 includes one ormore temperature sensors20 that are positioned within theenergy delivery section18. In such embodiments, the tubular bodyproximal region14 includes a temperature sensor lead which can be incorporated into cable45 (illustrated inFIG. 1). Suitable temperature sensors include, but are not limited to, temperature sensing diodes, thermistors, thermocouples, resistance temperature detectors (“RTDs”) and fiber optic temperature sensors which use thermalchromic liquid crystals.Suitable temperature sensor20 geometries include, but are not limited to, a point, a patch or a stripe. Thetemperature sensors20 can be positioned within one or more of thefluid delivery lumens30, and/or within one or more of the coolingfluid lumens44. To maintain the axial position of thesensor20 within thecatheter10 they may be attached to one or more elongated rigid members (not shown) that extend through thelumens30.

FIG. 7 illustrates an exemplary embodiment for electrically connecting thetemperature sensors20. In such embodiments, eachtemperature sensor20 is coupled to acommon wire61 and is associated with anindividual return wire62. Accordingly, n+1 wires are passed through thetubular body12 to independently sense the temperature atn temperature sensors20. The temperature at a selectedtemperature sensor20 can be determined by closing aswitch64 to complete a circuit between thereturn wire62 associated with the selected thermocouple and thecommon wire61. In embodiments wherein thetemperature sensors20 are thermocouples, the temperature can be calculated from the voltage in the circuit using, for example, asensing circuit63, which can be located within theexternal control circuitry100.

In other embodiments, thetemperature sensors20 can be independently wired. In such embodiments, 2n wires are passed through thetubular body12 to independently sense the temperature atn temperature sensors20. In still other embodiments, the flexibility of thetubular body12 can be improved by using fiber optic basedtemperature sensors20. In such embodiments, flexibility can be improved because only n fiber optic members are used to sense the temperature at nindependent temperature sensors20.

Overview of a Small Vessel Ultrasonic Catheter.

FIGS. 8A through 8C illustrate anexemplary catheter200 that is specifically configured to effectively navigate the small vessels of a patient's vasculature, such as the main and subsequent branches of the middle cerebral artery.

In a modified embodiment, theouter sheath208 comprises a braided tubing formed of, for example, high or low density polyethylenes, urethanes, nylons, and the like. This configuration enhances the flexibility of thetubular body202. For enhanced maneuverability, especially the ability to be pushed and rotated, theouter sheath208 can be formed with a variable stiffness from the proximal to the distal end. To achieve this, a stiffening member may be included along the proximal end of thetubular body202.

Theinner core210 defines, at least in part, adelivery lumen212, which, in an exemplary embodiment, extends longitudinally along the catheter. Thedelivery lumen212 has adistal exit port214, and is hydraulically connected to aproximal access port216. Similar to the large vessel ultrasonic catheter described herein, the proximal access port can be connected to a source of therapeutic compound or cooling/heating fluid that is to be delivered through thedelivery lumen212.

In an exemplary embodiment, thedelivery lumen212 is configured to receive a guide wire (not shown). In such embodiments, the guidewire has a diameter of between approximately 0.008 and approximately 0.012 inches. In another embodiment, the guidewire has a diameter of about 0.010 inches. In an exemplary embodiment, theinner core210 comprises polyamide or a similar material which can optionally be braided to increase the flexibility of thetubular body202 and reduce kinking and/or binding with the guidewire.

With reference toFIGS. 8B and 8C, the tubular bodydistal region206 includes aheating member224. As mentioned above, theheating element224 may comprise any of a variety of components, such as, for example, thermoelectric devices, ultrasound transducers, and the like. In the illustrated embodiment, theheating element224 is configured as a hollow cylinder or otherwise generally disposed between theinner core210 and theouter sheath208. As such, theinner core210 extends generally through the lumen of theheating member224. Theheating member224 may be secured to theinner core210 in a suitable manner, such as using an adhesive. A potting material can also be used to further secure theheating member224 to theinner core210.

In the illustrated embodiment, thermal energy is generated from electrical power supplied to theheating member224 through

wires

226,228 that extend through thecatheter body202. The

wires

226,228 can be secured to theinner core210, lay along theinner core210 and/or extend freely in theregion238 between theinner core210 and theouter sheath208. In embodiments wherein theheating member224 comprises a transducer formed of a piezoelectric ceramic oscillator or a similar material, thefirst wire226 may be connected to the hollow center of theultrasound radiating member224, while thesecond wire228 is connected to the outer periphery of theultrasound radiating member224.

Still referring to the exemplary embodiment illustrated inFIGS. 8A through 8C, the catheter further includes asleeve230 that is generally positioned about theheating member224. Thesleeve230 is comprises a material that readily transmits thermal energy. Suitable materials for thesleeve230 include, but are not limited to, polyolefins, polyimides, polyester and other materials having a relatively low absorbance of ultrasonic energy. The proximal end of thesleeve230 can be attached to theouter sheath208 with an adhesive232. To improve the bonding of the adhesive232 to theouter sheath208, ashoulder227 or notch can be formed in theouter sheath208 for attachment of the adhesive232 thereto. In an exemplary embodiment, theouter sheath208 and thesleeve230 have substantially the same outer diameter.

Referring now to the exemplary embodiment illustrated inFIG. 8C, the catheter includes at least onetemperature sensor236 in the tubular bodydistal region206. Thetemperature sensor236 can be positioned on or near theheating member224. Suitable temperature sensors include but are not limited to, diodes, thermistors, thermocouples, RTDs and fiber optic temperature sensors that used thermalchromic liquid crystals. In an exemplary embodiment, thetemperature sensor236 is operatively connected to a control system via a control wire that extends through thetubular body202. As described below, the control box includes a feedback control system having the ability to monitor and control the power, voltage, current and phase supplied to theheating member224. Thus, the temperature along the relevant region of the catheter can be monitored and controlled for optimal performance.

As mentioned above, thedistal exit port214 andheating member224 are generally positioned at thedistal end206 of the catheter to form atreatment zone250, which is configured to elevate the temperature of the treatment site and to deliver a therapeutic compound to the treatment site.

Controlled Thermal Effects.

The

catheters

10,200 described above can be used to elevate the temperature of the treatment site. They may also be used to deliver a therapeutic compound to the treatment site. The elevated temperature may enhance the efficacy of certain therapeutic compounds by altering the structure of the therapeutic compound and/or effecting (for example, accelerating) the chemical reactions at the treatment site. As explained below, the elevated temperature may be used alone or in combination with ultrasound energy to enhance the therapeutic effect of a therapeutic compound. In one embodiment, the therapeutic compound is a compound that is used for the treatment of vascular occlusions, such as, for example, heparin, urokinase, streptokinase, tPA, rtPA and BB-10153 (manufactured by British Biotech, Oxford, UK) and/or other thrombolytic compounds or anti-thrombosis compounds. In such an embodiment, the heating element(s) may be used to raise the temperature of the treatment site, which includes the vascular occlusion that is targeted by the therapeutic compound. In this manner, the elevated temperature enhances the treatment and removal of the vascular occlusion. While thermal effects can be beneficial, it should be appreciated excessively high temperatures can cause tissue damage and death. Accordingly, in the preferred embodiments, the elevated temperature is kept within a safe limit, which, in one embodiment, is less than or equal to about 43° C.

As shown inFIG. 9, the

catheter

10,200 ofFIGS. 1 through 7 orFIGS. 8A through 8C may be advanced over aguidewire84 to atreatment site88 that includes a obstruction orclot90. Theguidewire84 is optionally directed through theclot90. The

catheter

10,200 is then advanced until the treatment zone is positioned at that treatment site. In this position, the treatment zone may be positioned partially or wholly within theclot90. In other embodiments, the treatment zone or portions thereof including either the heating elements and/or the drug delivery port(s) (not shown inFIG. 9) may be positioned either upstream or downstream of theclot90. With respect to the embodiments ofFIGS. 1 through 7, it should be understood that theguidewire84 is typically removed before theinner core34 is advanced to thetreatment site88.

With the

catheter

10,200 in place, the heating element(s) may be used to elevate the temperature of the treatment site. The therapeutic compound can be delivered before, after, during or intermittently with the activation of the heating element(s). In one embodiment, the treatment site is maintained at an elevated (as compared to ambient conditions) temperature. In one embodiment, the elevated temperature is at least about 38° C. In another embodiment, the elevated temperature is at least about 40° C. In another embodiment, the treatment site is maintained within elevated temperature range, which in one embodiment is about from about 38° C. to about 43° C. In one embodiment, the treatment site is maintained at the elevated temperature for at least 5 minutes, in another embodiment at least 15 minutes, and in still another embodiment at least 30 minutes. In yet another embodiment, the treatment site is maintained at the elevated temperature until theclot90 is substantially dissolved and/or blood flow through the vessel is substantially reestablished to normal conditions. As mentioned above, the therapeutic compound may be delivered before, during and/or intermittingly during the treatment. Once theclot90 has been sufficiently dissolved, the catheter can be withdrawn from thetreatment site88.

As explained above, the elevated temperature enhances the therapeutic effect of the therapeutic compound. In one embodiment, this results faster dissolution of clot. In another embodiment, the clot can be dissolved with less therapeutic compound as compared to treatment without the elevated temperature. Both embodiments are advantageous in that the therapeutic compound may have adverse side affects.

As mentioned above, the heating element may be any of a variety of components configured to deliver heat to a treatment site within a vascular system. In one embodiment, the heat source comprises an ultrasound transducer. With respect to ultrasonic transducers, thermal energy is generated in two ways. First, because the ultrasonic transducer converts electrical energy to ultrasound energy imperfectly, some portion of the electrical energy is converted to heat. In addition, it is postulated that the ultrasound filed generated by the transducer is absorbed by the biological material surrounding the catheter producing a localized elevation of temperature. In such an embodiment, ultrasound energy can be applied to the treatment site along with the thermal energy. In another embodiment, the heat source comprises an modified ultrasound element that is configured to covert a larger percentage of electrical energy converted to heat as compared to the ultrasound elements optimized for the production of ultrasound energy.

In still another embodiment, the heat source comprises thermoelectric device, such as, a resistant heater through which heat is generated by passing an electrical current therethrough. In another embodiment, a heated solution (for example, the therapeutic compound it self or a fluid passes through thelumen44 ofFIG. 6) can be delivered through the catheter to the treatment zone or the treatment site. In yet another embodiment, a RF element can be used to apply RF energy to raise the temperature of the treatment site.

In any of these embodiments, the

catheters

10,200 optionally include a control system capable of monitoring the temperature at the treatment site, and adjusting the operating parameters of the catheter accordingly.FIG. 10 illustrates one example of such acontrol system300, which his configured to control an embodiment in which the

heating element

40,224 comprises a thermoelectric device (for example, a resistive heater or an ultrasound element). In light of the disclosure herein, those of skill in the art will recognize how to adapt thecontrol system300 to other types of heating elements.

Thefeedback control system300 includes anenergy source370,power circuits372 and apower calculation device374 that is coupled to the

heating element

40,224. Atemperature measurement device376 is coupled to the

temperature sensor

20,236 in the

catheter

10,200. Aprocessing unit378 is coupled to thepower calculation device374, thepower circuits372 and a user interface anddisplay380.

In an exemplary method of operation, the temperature at the

temperature sensor

20,236 is determined by thetemperature measurement device376. Theprocessing unit378 receives each determined temperature from thetemperature measurement device376. The determined temperature can then be displayed to the user at the user interface anddisplay380.

In an exemplary embodiment, theprocessing unit378 includes logic for generating a temperature control signal. The temperature control signal is proportional to the difference between the measured temperature and a desired temperature. The desired temperature can be determined by the user (as set at the user interface and display380) or can be preset within theprocessing unit378.

In such embodiments, the temperature control signal is received by thepower circuits372. Thepower circuits372 are configured to adjust the power level, voltage, phase, duty cycle and/or current of the electrical energy supplied to the

heating elements

40,224 from theenergy source370. For example, when the temperature control signal is above a particular level, the power supplied to the heat element is reduced in response to that temperature control signal. Similarly, when the temperature control signal is below a particular level, the power supplied to the heating source is increased in response to that temperature control signal. After each power adjustment, theprocessing unit378 monitors the

temperature sensors

20,236 and produces another temperature control signal which is received by thepower circuits372.

Theprocessing unit378 can comprise a digital or analog controller, such as a computer with software. In embodiments wherein theprocessing unit378 is a computer, the computer can include a central processing unit (“CPU”) coupled through a system bus. In such embodiments, the user interface and display380 can include a mouse, a keyboard, a disk drive, a display monitor, a nonvolatile memory system, and/or other computer components. In an exemplary embodiment, program memory and/or data memory is also coupled to the bus.

An exemplary control routine that can be utilized by the control system to maintain the temperature of the treatment site is illustrated inFIG. 11. In this technique, a therapeutic compound and thermal energy are delivered from a catheter located at the treatment site in anoperational block302.

Once delivery of the therapeutic compound and the ultrasonic energy is established, the temperature of the treatment site is monitored in anoperational block310. Using the control system described herein, the measured temperature is compared to a specified operating range at decision points320 and330. If the measured temperature is within the specified operating range, the treatment continues unchanged. However, if the measured temperature is above the specified range, the operation of the catheter is modified to reduce the temperature of the treatment site in anoperational block340. Likewise, if the measured temperature is below the specified range, the operation of the catheter is modified to increase the temperature of the treatment site in anoperational block350.

It should be appreciated that the process of maintaining the elevated temperature of the treatment site will vary depending upon the nature of the heat heating element. For example, in one embodiment, the temperature can be controlled by increasing or decreasing the flow rate of a heating fluid or a cooling fluid. In another embodiment, the flow and/or temperature of the therapeutic compound may be used to maintain the treatment site at the elevated temperature. increasing the temperature of the therapeutic compound provided to the therapeutic compound inlet port at the catheter proximal end. In still other embodiments, the temperature is decreased by simply reducing the power supplied to the heating elements.

In one modified embodiment, the thermal energy and the therapeutic compound can be delivered to the treatment site with different components. For example, in one embodiment, the therapeutic compound is delivered through a drug delivery catheter advanced to the treatment site. The heat source may be advanced to the treatment site via a second component, such as, a second separate catheter or an element (for example, a guidewire or inner core) that is advanced through or along side the drug delivery catheter. The two components may be positioned adjacent to each other during treatment or one of the components may be removed when not in use.

In still another embodiment, the elevated temperature at treatment site can be generated from an energy source that is external to the body. For example, ultrasound energy can be provided to the treatment sight by applying an ultrasound transducer against the external surface tissue surrounding the target vessel. For example, for the neurovascular system, the external transducer may be applied against the head. The are two general external application strategies: A) low frequency (for example, 40 KHz to 200 KHz), unfocused ultrasound which has the advantage of easier penetration but must necessarily irradiate a larger area (see for example, U.S. Pat. Nos. 6,113,570, 6,575,922, 5,695,460 and 5,399,158, which are incorporated by reference in their entirety); or B) higher frequency (for example >2 MHz), focused ultrasound which can be directed towards the treatment site. With respect to the higher frequency technique, because of its less efficient transmissivity, it is common to apply the ultrasound through specific anatomic “windows” (for example, the temple, above and in front of the ears for neurovascular applications) (see for example, U.S. Pat. No. 6,733,450, which is incorporated by reference in its entirety).

In these embodiments, the therapeutic compound can be applied to the treatment site via a drug delivery catheter. The treatment site may be heated using the external ultrasound techniques described above. The ultrasound is absorbed by the biological material, thus producing a elevation of temperature at the treatment site. The drug delivery catheter may be provided with a temperature sensor to monitor the temperature at the treatment site.

As described above, the elevated temperature may be used in combination with therapeutic ultrasound therapy. See for example, U.S. Patent Application Publication 2004/0024347 (filed 3 Dec. 2002) and U.S. Patent Application Publication 2004/0049148 (filed 3 Dec. 2002), which are both hereby incorporated by reference herein. In such embodiments, the heating elements may comprise ultrasound radiating members and/or ultrasound radiating members may be integrated into the catheter described above. In such embodiments, the suitable frequencies for the ultrasound radiating members include, but are not limited to, from about 20 kHz to about 20 MHz. In one embodiment, the frequency is between about 500 kHz and about 20 MHz, and in another embodiment the frequency is between about 1 MHz and about 3 MHz. In yet another embodiment, the ultrasound radiating members are operated with a frequency of about 2 MHz.

In another embodiment, the heating element in the catheter is configured to heat the therapeutic compound as it flows through the catheter towards the treatment site. In this manner, a therapeutic compound with an elevated temperature can be delivered to the treatment site. The elevated temperature of the compound will also elevate the temperature of the treatment site.

Although this invention has been disclosed in the context of certain preferred embodiments and examples, it will be understood by those skilled in the art that the present invention extends beyond the specifically disclosed embodiments to other alternative embodiments and/or uses of the invention and obvious modifications and equivalents thereof. In addition, while a number of variations of the invention have been shown and described in detail, other modifications, which are within the scope of this invention, will be readily apparent to those of skill in the art based upon this disclosure. It is also contemplated that various combinations or sub-combinations of the specific features and aspects of the embodiments may be made and still fall within the scope of the invention. Accordingly, it should be understood that various features and aspects of the disclosed embodiments can be combine with or substituted for one another in order to form varying modes of the disclosed invention. Thus, it is intended that the scope of the present invention herein disclosed should not be limited by the particular disclosed embodiments described above.

Claims

1. A method comprising:

positioning an elongate catheter within a blood vessel having a blood carrying capacity, wherein the catheter includes a fluid delivery lumen having an exit port within a distal region of the catheter;

passing a therapeutic compound through the fluid delivery lumen, through the exit port, and into the blood vessel;

increasing the temperature of a region adjacent to the distal region of the catheter; and

increasing the blood carrying capacity of the blood vessel.

2. The method ofclaim 1, wherein increasing the temperature comprises delivering ultrasonic energy to the region adjacent to the distal region of the catheter.

3. The method ofclaim 1, wherein the therapeutic compound is passed into the blood vessel before the temperature of the region adjacent to the distal region of the catheter is increased.

4. The method ofclaim 1, wherein the therapeutic compound is passed into the blood vessel after the temperature of the region adjacent to the distal region of the catheter is increased.

5. The method ofclaim 1, wherein the therapeutic compound is passed into the blood vessel while the temperature of the region adjacent to the distal region of the catheter is increased.

6. The method ofclaim 1, wherein the therapeutic compound is selected from the group consisting of heparin, urokinase, streptokinase, tPA and rtPA.

7. The method ofclaim 1, wherein the temperature of the region adjacent to the distal region of the catheter is increased to a temperature that is less than or equal to about 43° C.

8. The method ofclaim 1, wherein the temperature of the region adjacent to the distal region of the catheter is increased to a temperature that is between about 38° C. and about 43° C.

9. The method ofclaim 1, wherein increasing the temperature is accomplished by heating the therapeutic compound before passing the therapeutic compound through the fluid delivery lumen, through the exit port and into the blood vessel.

10. A method of treating a vascular obstruction at a treatment site within a patient's vascular system, the method comprising:

positioning an elongate catheter within the patient's vascular system;

exposing the vascular obstruction to a therapeutic compound delivered from the elongate catheter; and

exposing the vascular obstruction and the therapeutic compound to ultrasonic energy in a quantity sufficient to increase a blood carrying capacity of the treatment site, wherein the ultrasonic energy is delivered from the elongate catheter.

11. The method ofclaim 10, wherein exposing the vascular obstruction and the therapeutic compound to ultrasonic energy causes the treatment site to remain at a temperature between about 38° C. and about 43° C. for at least about 5 minutes.

12. The method ofclaim 10, wherein exposing the vascular obstruction and the therapeutic compound to ultrasonic energy causes the treatment site to remain at a temperature between about 38° C. and about 43° C. for at least about 15 minutes.

13. The method ofclaim 10, wherein the elongate catheter is positioned such that a distal portion of the elongate catheter is within the vascular obstruction.

14. The method ofclaim 10, further comprising monitoring the temperature of the treatment site while exposing the vascular obstruction and the therapeutic compound to ultrasonic energy.

15. The method ofclaim 10, further comprising:

monitoring a temperature of the treatment site while exposing the vascular obstruction and the therapeutic compound to ultrasonic energy; and

displaying the monitored temperature on a user interface.

16. The method ofclaim 10, further comprising delivering a cooling fluid to the treatment site while exposing the vascular obstruction and the therapeutic compound to ultrasonic energy.

17. The method ofclaim 10, wherein:

the ultrasonic energy is delivered from an ultrasonic transducer positioned within the elongate catheter;

a voltage different is applied across the ultrasonic transducer.

18. An apparatus comprising:

a tubular body having a fluid delivery lumen that is hydraulically coupled to an exit port in a distal region of the tubular body, wherein the tubular body is configured to be positioned within a blood vessel;

a heating element positioned within the distal region of the tubular body; and

a control system configured to maintain a selected portion of the blood vessel that is adjacent to the distal region of the tubular body within a temperature range for a specified period of time, wherein maintaining the temperature range for the specified period of time is sufficient to increase a blood carrying capacity of the selected portion of the blood vessel.

19. The apparatus ofclaim 18, wherein the control system is further configured to deliver a therapeutic compound through the fluid delivery lumen and the exit port.

20. The apparatus ofclaim 18, further comprising a guidewire configured to be received in a utility lumen defined by the tubular body.

21. The apparatus ofclaim 18, wherein the fluid delivery lumen is hydraulically coupled to a plurality of exit ports in the distal region of the tubular body.

22. The apparatus ofclaim 18, wherein the exit port is located along a longitudinal axis of the tubular body.

23. The apparatus ofclaim 18, wherein the heating element is selected from the group consisting of an ultrasound transducer, a radiofrequency element and a thermoelectric device.

24. The apparatus ofclaim 18, further comprising a temperature sensor coupled to the tubular body, wherein the temperature sensor is configured to measure a temperature of the selected portion of the blood vessel.