US20110130834A1 - Bronchial flow control devices and methods of use - Google Patents

Abstract

Methods and systems for lung volume reduction of a patient are described. The methods include implanting a flow control device in a bronchial passageway of the lung. The flow control device regulates fluid flow through the bronchial passageway and includes a valve protector that at least partially surrounds a valve member. The valve protector has sufficient rigidity to maintain the shape of the valve member against compression.

Description

CROSS-REFERENCES TO RELATED APPLICATIONS
• This application is a continuation of U.S. patent application Ser. No. 11/092,123, filed Mar. 28, 2005, which is a continuation of U.S. patent application Ser. No. 10/270,792, filed Oct. 10, 2002, which claims priority of the following co-pending U.S. provisional patent applications: (1) U.S. Provisional Patent Application Ser. No. 60/329,249, filed Oct. 11, 2001; (2) U.S. Provisional Patent Application Ser. No. 60/350,106, filed Oct. 19, 2001; (3) U.S. Provisional Patent Application Ser. No. 60/338,508, filed Nov. 5, 2001; (4) U.S. Provisional Patent Application Ser. No. 60/351,084, filed Jan. 22, 2002; (5) U.S. Provisional Patent Application Ser. No. 60/371,634, filed Apr. 9, 2002; (6) U.S. Provisional Patent Application Ser. No. 60/384,247. Priority of the aforementioned filing dates is hereby claimed, and the disclosures of the aforementioned patent applications are hereby incorporated by reference in their entirety.
BACKGROUND OF THE INVENTION
• This disclosure relates generally to methods and devices for use in performing pulmonary procedures and, more particularly, to procedures for treating lung diseases.
• Pulmonary diseases, such as chronic obstructive pulmonary disease, (COPD), reduce the ability of one or both lungs to fully expel air during the exhalation phase of the breathing cycle. The term “Chronic Obstructive Pulmonary Disease” (COPD) refers to a group of diseases that share a major symptom, dyspnea. Such diseases are accompanied by chronic or recurrent obstruction to air flow within the lung. Because of the increase in environmental pollutants, cigarette smoking, and other noxious exposures, the incidence of COPD has increased dramatically in the last few decades and now ranks as a major cause of activity-restricting or bed-confining disability in the United States. COPD can include such disorders as chronic bronchitis, bronchiectasis, asthma, and emphysema. While each has distinct anatomic and clinical considerations, many patients may have overlapping characteristics of damage at both the acinar (as seen in emphysema) and the bronchial (as seen in bronchitis) levels.
• Emphysema is a condition of the lung characterized by the abnormal permanent enlargement of the airspaces distal to the terminal bronchiole, accompanied by the destruction of their walls, and without obvious fibrosis. (Snider, G. L. et al: The Definition of Emphysema: Report of the National Heart Lung And Blood Institute, Division of lung Diseases Workshop. (Am Rev. Respir. Dis. 132:182, 1985). It is known that emphysema and other pulmonary diseases reduce the ability of one or both lungs to fully expel air during the exhalation phase of the breathing cycle. One of the effects of such diseases is that the diseased lung tissue is less elastic than healthy lung tissue, which is one factor that prevents full exhalation of air. During breathing, the diseased portion of the lung does not fully recoil due to the diseased (e.g., emphysematic) lung tissue being less elastic than healthy tissue. Consequently, the diseased lung tissue exerts a relatively low driving force, which results in the diseased lung expelling less air volume than a healthy lung. The reduced air volume exerts less force on the airway, which allows the airway to close before all air has been expelled, another factor that prevents full exhalation.
• The problem is further compounded by the diseased, less elastic tissue that surrounds the very narrow airways that lead to the alveoli, which are the air sacs where oxygen-carbon dioxide exchange occurs. The diseased tissue has less tone than healthy tissue and is typically unable to maintain the narrow airways open until the end of the exhalation cycle. This traps air in the lungs and exacerbates the already-inefficient breathing cycle. The trapped air causes the tissue to become hyper-expanded and no longer able to effect efficient oxygen-carbon dioxide exchange.
• In addition, hyper-expanded, diseased lung tissue occupies more of the pleural space than healthy lung tissue. In most cases, a portion of the lung is diseased while the remaining part is relatively healthy and, therefore, still able to efficiently carry out oxygen exchange. By taking up more of the pleural space, the hyper-expanded lung tissue reduces the amount of space available to accommodate the healthy, functioning lung tissue. As a result, the hyper-expanded lung tissue causes inefficient breathing due to its own reduced functionality and because it adversely affects the functionality of adjacent healthy tissue.
• Lung reduction surgery is a conventional method of treating emphysema. According to the lung reduction procedure, a diseased portion of the lung is surgically removed, which makes more of the pleural space available to accommodate the functioning, healthy portions of the lung. The lung is typically accessed through a median sternotomy or small lateral thoracotomy. A portion of the lung, typically the periphery of the upper lobe, is freed from the chest wall and then resected, e.g., by a stapler lined with bovine pericardium to reinforce the lung tissue adjacent the cut line and also to prevent air or blood leakage. The chest is then closed and tubes are inserted to remove air and fluid from the pleural cavity. The conventional surgical approach is relatively traumatic and invasive, and, like most surgical procedures, is not a viable option for all patients.
• Some recently proposed treatments include the use of devices that isolate a diseased region of the lung in order to reduce the volume of the diseased region, such as by collapsing the diseased lung region. According to such treatments, isolation devices are implanted in airways feeding the targeted region of the lung to regulate fluid flow to the diseased lung region in order to fluidly isolate the region of the lung. These implanted isolation devices can be, for example, one-way valves that allow flow in the exhalation direction only, occluders or plugs that prevent flow in either direction, or two-way valves that control flow in both directions. However, such devices are still in the development stages. Thus, there is much need for improvement in the design and functionality of such isolation devices, as well as in the methods of deploying and using such devices.
• In view of the foregoing, there is a need for improved methods and devices for regulating fluid flow to a diseased lung region.
BRIEF SUMMARY OF THE INVENTION
• Disclosed are methods and devices for regulating fluid flow to and from a region of a patient's lung, such as to achieve a desired fluid flow dynamic to a lung region during respiration and/or to induce collapse in one or more lung regions. In one aspect of the invention, a flow control device can be implanted into a bronchial passageway. The flow control device includes a valve member that regulates fluid flow through the flow control device, and a seal member that at least partially surrounds the valve member. The seal member extends radially outward and forms a seal with the interior wall of a bronchial passageway when the flow control device is implanted in the bronchial passageway. The flow control device also includes an anchor member that is secured to the seal member. The anchor member exerts a radial force against an interior wall of the bronchial passageway when the flow control device is implanted in the bronchial passageway, to retain the flow control device in a fixed location in the bronchial passageway.
• When implanted in the bronchial passageway, the flow control device can eliminate air flow into the targeted lung region and result in collapse of the targeted lung region. As an alternative to eliminating air flow and collapsing the targeted lung region, the flow control device can permit a regulated airflow to and from the targeted lung region to achieve an improved air flow dynamic that does not result in collapse of the targeted lung region.
• Also disclosed is a system for delivering a flow control device into a bronchial lumen. The delivery system includes a catheter having a proximal end and a distal end. The catheter is sized to be inserted into a patient's respiratory tract and deployed to a target location of a bronchial passageway through a trachea. A housing is located at or near the distal end of the catheter. The housing defines an interior cavity that is sized to at least partially receive the flow control device. An ejection member is movably positioned in the housing, wherein the ejection member is positioned so that it can eject the flow control device out of the housing when the flow control device is located in the housing. An actuation member is attached to the catheter. The actuation member is mechanically coupled to the ejection member such that the actuation member can be actuated to cause the ejection member to move within the housing and eject a flow control device from the housing.
• Also disclosed is a system for loading a flow control device onto a delivery catheter. The loading system comprises a loader device having a loading tunnel sized to receive the flow control device. The loader device can provide a compressing force to the flow control device when the flow control device is positioned in the loading tunnel that compresses the flow control device to a size that fits within the delivery catheter. The loading system further includes a first piston that slidably fits within the loading tunnel of the loader device. The first piston can be inserted into the loading tunnel to eject a compressed flow control device from the loading tunnel into the delivery catheter.
• Also disclosed is a method of deploying a flow control device in a bronchial passageway. The method comprises identifying a target location in a bronchial passageway to which the flow control device will be deployed; providing a delivery catheter having a flow control device loaded therein, wherein the flow control device is loaded into a housing located at a distal end of the delivery catheter, and wherein the delivery catheter includes an ejector member that is positioned in the housing so that the ejection member can eject the flow control device out of the housing; positioning the delivery catheter within the bronchial passageway so that the housing is positioned at the target location in the bronchial passageway; and ejecting the flow control device from the housing to deploy the flow control device in the bronchial passageway.
• Also disclosed is a method for lung volume reduction of a patient, comprising applying suction to a lung region, wherein the suction is applied in synchronization with the patient's inhalation.
• Also disclosed is a method for lung volume reduction of a patient, comprising implanting a flow control device in a bronchial passageway of the lung, wherein the flow control device regulates fluid flow through the bronchial passageway; and aspirating a region of the lung distal of the flow control device while the patient is inhaling.
• Other features and advantages of the present invention should be apparent from the following description of various embodiments, which illustrate, by way of example, the principles of the invention.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1 shows an anterior view of a pair of human lungs and a bronchial tree with a flow control device implanted in a bronchial passageway to bronchially isolate a region of the lung.
• FIG. 2 shows an anterior view of a pair of human lungs and a bronchial tree.
• FIG. 3A shows a lateral view of the right lung.
• FIG. 3B shows a lateral view of the left lung.
• FIG. 4 shows an anterior view of the trachea and a portion of the bronchial tree.
• FIG. 5A shows a perspective view of a first embodiment of a flow control device that can be implanted in a body passageway.
• FIG. 5B shows a perspective, cross-sectional view of the flow control device ofFIG. 5A.
• FIG. 6A shows a side view of the flow control device ofFIG. 5A.
• FIG. 6B shows a cross-sectional, side view of the flow control device ofFIG. 5A.
• FIG. 7A shows a side, cross-sectional view of a duckbill valve in a closed state.
• FIG. 7B shows a side, cross-sectional view of a duckbill valve in an open state.
• FIG. 8 shows the flow control device ofFIGS. 5-6 implanted in a bronchial passageway.
• FIG. 9 shows a perspective, cross-sectional view of another embodiment of the flow control device.
• FIG. 10 shows a side, cross-sectional view of the flow control device ofFIG. 9.
• FIG. 11 shows a front, plan view of the flow control device ofFIG. 9.
• FIG. 12 shows the flow control device ofFIG. 9 implanted in a bronchial passageway.
• FIG. 13 shows the flow control device ofFIG. 9 implanted in a bronchial passageway and dilated by a dilation device comprised of a tube.
• FIG. 14 shows the flow control device ofFIG. 9 implanted in a bronchial passageway and dilated by a dilation device comprised of a tube with a one-way valve.
• FIG. 15 shows the flow control device ofFIG. 9 implanted in a bronchial passageway and dilated by a dilation device comprised of a tube with a one way valve, wherein the tube is attached to a removal tether.
• FIG. 16 shows the flow control device ofFIG. 9 implanted in a bronchial passageway and dilated by a dilation device comprised of a tube, which is fluidly coupled to a catheter.
• FIG. 17 shows the flow control device ofFIG. 9 implanted in a bronchial passageway and dilated by a dilation device comprised of a catheter.
• FIG. 18 shows another embodiment of a flow control device implanted in a bronchial passageway.
• FIG. 19 shows a perspective view of another embodiment of a flow control device.
• FIG. 20 shows a side view of the flow control device ofFIG. 19.
• FIG. 21 shows a cross-sectional view of the flow control device ofFIG. 20 cut along the line21-21 ofFIG. 20.
• FIG. 22 shows another embodiment of a flow control device.
• FIG. 23 shows a cross-sectional view of the flow control device ofFIG. 22.
• FIG. 24 shows a perspective view of another embodiment of a flow control device.
• FIG. 25 shows another embodiment of a flow control device implanted in a bronchial passageway.
• FIG. 26 shows another embodiment of a flow control device implanted in a bronchial passageway.
• FIG. 27 shows the flow control device ofFIG. 26 implanted in a bronchial passageway and dilated by a dilation device.
• FIG. 28 shows another embodiment of a flow control device implanted in a bronchial passageway.
• FIG. 29 shows another embodiment of a flow control device implanted in a bronchial passageway that has an internal, sealed chamber.
• FIG. 30 shows another embodiment of a flow control device implanted in a bronchial passageway, the flow control device having a pair of internal lumens for allowing controlled, two-way fluid flow.
• FIG. 31 shows another embodiment of a flow control device implanted in a bronchial passageway, the flow control device having a pair of flap valves for allowing controlled, two-way fluid flow.
• FIG. 32 shows a delivery system for delivering a flow control device to a target location in a body passageway.
• FIG. 33 shows a perspective view of a distal region of a delivery catheter of the delivery system.
• FIG. 34 shows a plan, side view of the distal region of the delivery catheter.
• FIG. 35A shows a cross-sectional view of a housing of the delivery catheter, the housing containing a flow control device.
• FIG. 35B shows a cross-sectional view of the housing containing a flow control device that has a distal end that protrudes from the housing.
• FIG. 36A shows the delivery catheter housing containing a flow control device and implanted at a location L of a bronchial passageway.
• FIG. 36B shows the delivery catheter deploying the flow control device at the location L of the bronchial passageway.
• FIG. 37 shows the delivery catheter deploying the flow control device distally of the location L of the bronchial passageway.
• FIG. 38 is a perspective view of a loader system for loading the flow control device onto a delivery catheter.
• FIG. 39 shows a cross-sectional side view of a loader device of the loader system.
• FIG. 40 shows a perspective view of a pusher device of the loader system.
• FIG. 41 shows the loader system readied for loading the flow control device into the housing of the delivery catheter.
• FIG. 42 shows the loader system being used to compress the flow control device during loading of the flow control device into the housing of the delivery catheter.
• FIG. 43 shows the loader system being used to compress the flow control device during insertion of the flow control device into the housing of the delivery catheter.
• FIG. 44 shows the loader system with the flow control device fully loaded into the housing of the delivery catheter.
• FIG. 45 shows an exploded, perspective rear view of the loader device of the loader system.
• FIG. 46 shows a plan, rear view of the loader device of the loader system with a delivery door in a closed position.
• FIG. 47 shows a plan, rear view of the loader device of the loader system with a delivery door in an open position.
• FIG. 48A shows a perspective, rear view of the loader device of the loader system with the delivery door in an open position and the catheter housing inserted into the loader device.
• FIG. 48B shows a perspective, rear view of the loader device of the loader system with the delivery door in a closed position and the catheter housing mated with the loader device.
• FIG. 49 shows a perspective view of a loading tube of the loader system.
• FIG. 50A shows the loading tube being used to initially insert the flow control device into the loader device.
• FIG. 50B shows the loading tube being used to initially insert the flow control device into the loader device.
• FIG. 51 shows another embodiment of a pusher device.
• FIG. 52A shows the pusher device ofFIG. 51 initially inserted into the loader device.
• FIG. 52B shows the pusher device ofFIG. 51 fully inserted into the loader device.
• FIG. 53 shows an exploded, perspective another embodiment of the loader system.
• FIG. 54 shows an exploded, perspective another embodiment of the loader system with the pusher device inserted into the loader device.
• FIG. 55 shows a front, plan view of another embodiment of a loader device.
• FIG. 56 shows a side, plan view of the loader device ofFIG. 55.
• FIG. 57 shows a front, plan view of the loader device ofFIG. 55 in a closed state.
• FIG. 58 shows a side, plan view of the loader device ofFIG. 55.
• FIG. 59 shows a bronchoscope deployed within a bronchial tree of a patient.
• FIG. 60 shows a guidewire deployed within a bronchial tree of a patient.
• FIG. 61 shows a delivery catheter deployed within a bronchial tree of a patient over a guidewire.
• FIG. 62 shows a perspective view of a delivery catheter having an asymmetric, distal tip.
• FIG. 63 shows a perspective view of another embodiment of a delivery catheter having an asymmetric, distal tip.
• FIG. 64 shows a delivery catheter having a distal curve and an asymmetric distal tip.
DETAILED DESCRIPTION OF THE INVENTION
• Unless defined otherwise, all technical and scientific terms used herein have the same meaning as is commonly understood by one of skill in the art to which the invention(s) belong.
• Disclosed are methods and devices for regulating fluid flow to and from a region of a patient's lung, such as to achieve a desired fluid flow dynamic to a lung region during respiration and/or to induce collapse in one or more lung regions. An identified region of the lung (referred to herein as the “targeted lung region”) is targeted for treatment, such as to modify the air flow to the targeted lung region or to achieve volume reduction or collapse of the targeted lung region. The targeted lung region is then bronchially isolated to regulate airflow into and/or out of the targeted lung region through one or more bronchial passageways that feed air to the targeted lung region. As shown inFIG. 1, the bronchial isolation of the targeted lung region is accomplished by implanting aflow control device110 into abronchial passageway115 that feeds air to a targetedlung region120. Theflow control device110 regulates airflow through thebronchial passageway115 in which theflow control device110 is implanted, as described in more detail below. Theflow control device110 can be implanted into the bronchial passageway using a delivery system, such as the delivery system catheter described herein.
• Exemplary Lung Regions
• Throughout this disclosure, reference is made to the term “lung region”. As used herein, the term “lung region” refers to a defined division or portion of a lung. For purposes of example, lung regions are described herein with reference to human lungs, wherein some exemplary lung regions include lung lobes and lung segments. Thus, the term “lung region” as used herein can refer to a lung lobe or a lung segment. Such lung regions conform to portions of the lungs that are known to those skilled in the art. However, it should be appreciated that the term lung region does necessarily refer to a lung lobe or a lung segment, but can also refer to some other defined division or portion of a human or non-human lung.
• FIG. 2 shows an anterior view of a pair ofhuman lungs210,215 and abronchial tree220 that provides a fluid pathway into and out of thelungs210,215 from atrachea225, as will be known to those skilled in the art. As used herein, the term “fluid” can refer to a gas, a liquid, or a combination of gas(es) and liquid(s). For clarity of illustration,FIG. 2 shows only a portion of thebronchial tree220, which is described in more detail below with reference toFIG. 4.
• Throughout this description, certain terms are used that refer to relative directions or locations along a path defined from an entryway into the patient's body (e.g., the mouth or nose) to the patient's lungs. The path generally begins at the patient's mouth or nose, travels through the trachea into one or more bronchial passageways, and terminates at some point in the patient's lungs. For example,FIG. 2 shows apath202 that travels through thetrachea225 and through a bronchial passageway into a location in theright lung210. The term “proximal direction” refers to the direction along such apath202 that points toward the patient's mouth or nose and away from the patient's lungs. In other words, the proximal direction is generally the same as the expiration direction when the patient breathes. Thearrow204 inFIG. 2 points in the proximal direction. The term “distal direction” refers to the direction along such apath202 that points toward the patient's lung and away from the mouth or nose. The distal direction is generally the same as the inhalation direction when the patient breathes. Thearrow206 inFIG. 2 points in the distal direction.
• With reference toFIG. 2, the lungs include aright lung210 and aleft lung215. Theright lung210 includes lung regions comprised of three lobes, including a rightupper lobe230, a rightmiddle lobe235, and a rightlower lobe240. Thelobes230,235,240 are separated by two interlobar fissures, including aright oblique fissure226 and a righttransverse fissure228. Theright oblique fissure226 separates the rightlower lobe240 from the rightupper lobe230 and from the right middle lobe135. The righttransverse fissure228 separates the rightupper lobe230 from the right middle lobe135.
• As shown inFIG. 2, theleft lung215 includes lung regions comprised of two lobes, including the leftupper lobe250 and the leftlower lobe255. An interlobar fissure comprised of aleft oblique fissure245 of theleft lung215 separates the leftupper lobe250 from the leftlower lobe255. Thelobes230,135,240,250,255 are directly supplied air via respective lobar bronchi, as described in detail below.
• FIG. 3A is a lateral view of theright lung210. Theright lung210 is subdivided into lung regions comprised of a plurality of bronchopulmonary segments. Each bronchopulmonary segment is directly supplied air by a corresponding segmental tertiary bronchus, as described below. The bronchopulmonary segments of theright lung210 include a rightapical segment310, aright posterior segment320, and a rightanterior segment330, all of which are disposed in the rightupper lobe230. The right lung bronchopulmonary segments further include a rightlateral segment340 and a rightmedial segment350, which are disposed in the right middle lobe135. The rightlower lobe240 includes bronchopulmonary segments comprised of a rightsuperior segment360, a right medial basal segment (which cannot be seen from the lateral view and is not shown inFIG. 3A), a right anteriorbasal segment380, a right lateralbasal segment390, and a right posteriorbasal segment395.
• FIG. 3B shows a lateral view of theleft lung215, which is subdivided into lung regions comprised of a plurality of bronchopulmonary segments. The bronchopulmonary segments include a leftapical segment410, aleft posterior segment420, a leftanterior segment430, a leftsuperior segment440, and a leftinferior segment450, which are disposed in the left lungupper lobe250. Thelower lobe255 of theleft lung215 includes bronchopulmonary segments comprised of a leftsuperior segment460, a left medial basal segment (which cannot be seen from the lateral view and is not shown inFIG. 3B), a left anteriorbasal segment480, a left lateralbasal segment490, and a left posteriorbasal segment495.
• FIG. 4 shows an anterior view of thetrachea225 and a portion of thebronchial tree220, which includes a network of bronchial passageways, as described below. Thetrachea225 divides at a distal end into two bronchial passageways comprised of primary bronchi, including a rightprimary bronchus510 that provides direct air flow to theright lung210, and a leftprimary bronchus515 that provides direct air flow to theleft lung215. Eachprimary bronchus510,515 divides into a next generation of bronchial passageways comprised of a plurality of lobar bronchi. The rightprimary bronchus510 divides into a right upperlobar bronchus517, a right middlelobar bronchus520, and a right lowerlobar bronchus522. The leftprimary bronchus515 divides into a left upperlobar bronchus525 and a left lowerlobar bronchus530. Each lobar bronchus,517,520,522,525,530 directly feeds fluid to a respective lung lobe, as indicated by the respective names of the lobar bronchi. The lobar bronchi each divide into yet another generation of bronchial passageways comprised of segmental bronchi, which provide air flow to the bronchopulmonary segments discussed above.
• As is known to those skilled in the art, a bronchial passageway defines an internal lumen through which fluid can flow to and from a lung. The diameter of the internal lumen for a specific bronchial passageway can vary based on the bronchial passageway's location in the bronchial tree (such as whether the bronchial passageway is a lobar bronchus or a segmental bronchus) and can also vary from patient to patient. However, the internal diameter of a bronchial passageway is generally in the range of 3 millimeters (mm) to 10 mm, although the internal diameter of a bronchial passageway can be outside of this range. For example, a bronchial passageway can have an internal diameter of well below1 mm at locations deep within the lung.
• Flow Control Devices
• As discussed, theflow control device110 can be implanted in a bronchial passageway to regulate the flow of fluid through the bronchial passageway. When implanted in a bronchial passageway, theflow control device110 anchors within the bronchial passageway in a sealing fashion such that fluid in the bronchial passageway must pass through the flow control device in order to travel past the location where the flow control device is located. Theflow control device110 has fluid flow regulation characteristics that can be varied based upon the design of the flow control device. For example, theflow control device110 can be configured to either permit fluid flow in two directions (i.e., proximal and distal directions), permit fluid flow in only one direction (proximal or distal direction), completely restrict fluid flow in any direction through the flow control device, or any combination of the above. The flow control device can be configured such that when fluid flow is permitted, it is only permitted above a certain pressure, referred to as the cracking pressure. As described in detail below, theflow control device110 can also be configured such that a dilation device can be manually inserted into theflow control device110 to vary the flow properties of theflow control device110.
• FIGS. 5-6 show a first embodiment of aflow control device110.FIG. 5A shows a perspective view of thedevice110,FIG. 5B shows a perspective, cross-sectional view of thedevice110,FIG. 6A shows a plan, side view of thedevice110, andFIG. 6B shows a cross-sectional, plan, side view of thedevice110. Theflow control device110 extends generally along a central axis605 (shown inFIGS. 5B and 6B) and has aproximal end602 and adistal end604. Theflow control device110 includes a main body that defines aninterior lumen610 through which fluid can flow along a flow path that generally conforms to thecentral axis605.
• The flow of fluid through theinterior lumen610 is controlled by avalve member612 that is disposed at a location along the interior lumen such that fluid must flow through thevalve member612 in order to flow through theinterior lumen610, as described more fully below. It should be appreciated that thevalve member612 could be positioned at various locations along theinterior lumen610. Thevalve member612 can be made of a biocompatible material, such as a biocompatible polymer, such as silicone. The size of thevalve member612 can vary based on a variety of factors, such as the desired cracking pressure of thevalve member612.
• Theflow control device110 has a general outer shape and contour that permits theflow control device110 to fit entirely within a body passageway, such as within a bronchial passageway. Thus, as best shown inFIGS. 5A and 5B, theflow control device110 has a generally circular shape (when viewed longitudinally along the axis605) that will facilitate insertion of the flow control device into a bronchial passageway. A circular shape generally provides a good fit with a bronchial passageway, although it should be appreciated that theflow control device110 can have other cross-sectional shapes that enable thedevice110 to be inserted into a bronchial passageway.
• With reference toFIGS. 5-6, theflow control device110 includes anouter seal member615 that provides a seal with the internal walls of a body passageway when the flow control device is implanted into the body passageway. Theseal member615 is manufactured of a deformable material, such as silicone or a deformable elastomer. Theflow control device110 also includes ananchor member618 that functions to anchor theflow control device110 within a body passageway. The configurations of theseal member615 and theanchor member618 can vary, as described below.
• As shown inFIGS. 5-6, theseal member615 is generally located on an outer periphery of theflow control device110. In the embodiment shown inFIGS. 5-6, the seal member includes a series of radially-extending,circular flanges620 that surround the outer circumference of theflow control device110. Theflanges620 can be manufactured of silicone or other deformable elastomer. As best shown inFIG. 6B, the radial length of eachflange620 varies moving along the longitudinal length (as defined by thelongitudinal axis605 inFIG. 6B) of theflow control device110. It should be appreciated that the radial length could be equal for all of theflanges620 or that the radial length of each flange could vary in some other manner. For example, theflanges620 can alternate between larger and shorter radial lengths moving along the longitudinal length of the flow control device, or the flanges can vary in a random fashion. In addition, theflanges620 could be oriented at a variety of angles relative to thelongitudinal axis605 of the flow control device. In another embodiment, the radial length of a single flange could vary so that the circumference of the flange is sinusoidal about the center of the flange.
• In the embodiment shown inFIGS. 5-6, theseal member615 includes acuff622. As can be seen in the cross-sectional views ofFIGS. 5B and 6B, thecuff622 comprises a region of theseal member615 that overlaps on itself so as to form acavity623 within thecuff622. As described below, thecavity623 can be used to retain theanchor member618 to theseal member615 of theflow control device110. Thecuff622 can function in combination with theflanges620 to seal the flow control device to the internal walls of a bronchial lumen when the flow control device is implanted in a bronchial lumen, as described below. Thecuff622 can be formed in a variety of manners, such as by folding a portion of theseal member615 over itself, or by molding theseal member615 to form thecuff622.
• As mentioned, theanchor member618 functions to anchor theflow control device110 in place when the flow control device is implanted within a body passageway, such as within a bronchial passageway. Theanchor member618 has a structure that can contract and expand in size (in a radial direction and/or in a longitudinal direction) so that the anchor member can expand to grip the interior walls of a body passageway in which the flow control device is positioned. In one embodiment, as shown inFIGS. 5 and 6, theanchor member618 comprises anannular frame625 that surrounds theflow control device110. Theframe625 is formed by a plurality of struts that define an interior envelope sized to surround theinterior lumen610.
• As shown inFIGS. 5-6, the struts of theframe625 form curved, proximal ends629 that can be slightly flared outward with respect to thelongitudinal axis605. When theflow control device110 is placed in a bronchial lumen, the curved, proximal ends629 can anchor into the bronchial walls and prevent migration of the flow control device in a proximal direction. Theframe625 can also have flared,distal prongs627 that can anchor into the bronchial walls and to prevent thedevice110 from migrating in a distal direction when theflow control device110 is placed in a bronchial lumen. Theframe625 can be formed from a super-elastic material, such as Nickel Titanium (also known as Nitinol), such as by cutting the frame out of a tube of Nitinol or by forming the frame out of Nitinol wire. The super-elastic properties of Nitinol can result in the frame exerting a radial force against the interior walls of a bronchial passageway sufficient to anchor theflow control device110 in place.
• The struts are arranged so that theframe625 can expand and contract in a manner that is entirely or substantially independent of the rest of theflow control device110, including thevalve member612, as described more fully below. In the embodiment shown inFIGS. 5-6, theframe625 is attached to theflow control device110 inside thecavity623 of thecuff622. That is, at least a portion of theframe625 is positioned inside thecavity623. Theframe625 is not necessarily fixedly attached to the cavity. Rather, a portion of theframe625 is positioned within thecavity623 so that theframe625 can freely move within the cavity, but cannot be released from the cavity. An attachment means can be used to attach the opposing pieces of thecuff622 to one another so that theframe625 cannot fall out of thecavity623. In one embodiment, the attachment means comprises an adhesive, such as silicone adhesive, that is placed inside thecavity623 and that adheres the opposing pieces of thecuff622 to one another. In an alternative embodiment, described below, rivets are used to attach the opposing pieces of the cuff. It should be appreciated, however, that different attachment means could be used to secure theframe625 to theseal member615. Furthermore, it should be appreciated that theframe625 is not necessarily bonded to theseal member615. In yet another embodiment, theframe625 can be integrally formed with thevalve protector member637, described below.
• As mentioned, thevalve member612 regulates the flow of fluid through theinterior lumen610 of theflow control device110. In this regard, thevalve member612 can be configured to permit fluid to flow in only one-direction through theinterior lumen610, to permit regulated flow in two-directions through theinterior lumen610, or to prevent fluid flow in either direction. Thevalve member612 is positioned at a location along theinterior lumen610 so that fluid must travel through thevalve member612 in order to flow through theinterior lumen610.
• Thevalve member612 can be any type of fluid valve, and preferably is a valve that enables the cracking pressures described herein. Thevalve member612 can have a smaller diameter than theframe625 so that compression or deformation of theframe625 in both a radial and axial direction will have little or no impact on the structure of thevalve member612. In the embodiment shown inFIGS. 5-6, thevalve member612 comprises a duckbill valve that includes two flaps631 (shown inFIGS. 5B and 6B) that are oriented at an angle with respect to one another and that can open and close with respect to one another so as to form an opening at a lip801 (FIG. 6B) where theflaps631 touch one another. The duckbill valve operates according to a conventional duckbill valve in that it allows fluid flow in a first direction and prevents fluid flow in a second direction that is opposed to the first direction. For example,FIG. 7A shows a schematic side-view of the duckbill valve in a closed state, wherein theflaps631 touch one another at thelip801. In the closed state, the duckbill valve prevents fluid flow in a first direction, which is represented by the arrow A inFIG. 7A. However, when exposed to fluid flow in a second direction (represented by arrow B inFIG. 7B) that is opposed to the first direction, theflaps631 separate from one another to form an opening between theflaps631 that permits flow in the second direction, as shown inFIG. 7B.
• With reference again toFIG. 6B, thevalve member612 is concentrically contained within theseal member615. In addition, at least a portion of thevalve member612 is optionally surrounded by a rigid or semi-rigid valve protector member637 (shown inFIGS. 5B and 6B), which is a tubular member or annular wall that is contained inside theseal member622. In another embodiment, the valve protector can comprise a coil of wire or a ring of wire that provides some level of structural support to the flow control device. Thevalve protector637 can be concentrically located within theseal member615. Alternately, thevalve member612 can be completely molded within theseal member615 such that the material of theseal member615 completely surrounds the valve protector.
• Thevalve protector member637 is optional, although when present, thevalve protector member637 protects thevalve member612 from damage and can maintain the shape of theflow control device110 against compression and constriction to a certain extent. Thevalve protection member637 can also support and stiffen theflanges620. Thevalve protector member637 can be manufactured of a rigid, biocompatible material, such as, for example, nickel titanium, steel, plastic resin, and the like. In one embodiment, thevalve protector member637 has two ormore windows639 comprising holes that extend through the valve protector member, as shown inFIG. 6B. Thewindows639 can provide a location where a removal device, such as graspers or forceps, can be inserted in order to facilitate removal of theflow control device110 from a bronchial passageway.
• Thevalve protector member637 can be formed out of a solid tube of a super-elastic material such as Nitinol. In one embodiment, thevalve protector member637 is compressible to a smaller diameter for loading into a delivery catheter. The compressibility can be achieved by forming thevalve protector member637 out of a series of struts or by including some open spaces in thevalve protector member637. The super-elastic characteristics of Nitinol would allow thevalve protector member637 to be compressed during deployment, yet still allow it to expand once deployed.
• Theseal615 and/or theframe625 can contract or expand in size, particularly in a radial direction. The default state is an expanded size, such that theflow control device110 will have a maximum diameter (which is defined by either theseal615 or the frame625) when theflow control device110 is in the default state. Theflow control device110 can be radially contracted in size during insertion into a bronchial passageway, so that once theflow control device110 is inserted into the passageway, it expands within the passageway.
• In one embodiment, thevalve member612 andframe625 are independently enlargeable and contractible. Alternately, theframe625 can be enlargeable and contractible, while thevalve member612 is not enlargeable and contractible. The independent collapsibility of thevalve member612 andframe625 facilitate deployment and operation of theflow control device110. Theflow control device110 can be compressed from a default, enlarged state and implanted in a desired location within a bronchial passageway. Once implanted, theflow control device110 automatically re-expands to anchor within the location of the bronchial passageway. The independent compression of the frame and valve member reduces the likelihood of damage to theflow control device110 during deployment. Furthermore, the valve can be substantially immune to the effects of compression of theframe625. In one embodiment, the diameter of theframe625 may collapse as much as 80% without affecting thevalve member612 so that thevalve member612 will still operate normally. Theflow control device110 does not have to be precisely sized for the lumen it is to be placed within. This affords medical providers with the option of buying smaller volumes of theflow control device110 and being able to provide the same level and scope of coverage for all patients.
• The dimensions of theflow control device110 can vary based upon the bronchial passageway in which theflow control device110 is configured to be implanted. As mentioned, the valve member does not have to be precisely sized for the bronchial passageway it is to be placed within. Generally, the diameter D (shown inFIG. 6A) of theflow control device110 in the uncompressed state is larger than the inner diameter of the bronchial passageway in which theflow control device110 will be placed. This will permit theflow control device110 to be compressed prior to insertion in the bronchial passageway and then expand upon insertion in the bronchial passageway, which will provide for a secure fit between theflow control device110 and the bronchial passageway.
• FIG. 8 shows theflow control device110 ofFIGS. 5-6 implanted within abronchial passageway910 havinginterior walls915 that define a lumen of thebronchial passageway910. As is known to those skilled in the art, fluids (such as air) can travel to a region of the lung through the lumen of thebronchial passageway910.
• As shown inFIG. 8, theflow control device110 is implanted such that one or more of theflanges620 contact theinterior walls915 to provide a seal that prevents fluid from flowing between theinterior walls915 and theflanges620. Thecuff622 can also provide a seal with the bronchial passageway. At least a portion of the outermost surface of thecuff622 sealingly engages the surface of theinterior walls915. Thus, theflanges620 and thecuff622 both provide a seal between theinterior walls915 of thebronchial passageway910 and theflow control device110.
• Thus, fluid must flow through theinterior lumen610 of theflow control device110 in order to flow from aproximal side1301 of theflow control device110 to adistal side1302 or vice-versa. That is, theflanges620 andcuff620 form a seal with theinterior wall915 to prevent fluid from flowing around the periphery of theflow control device110, thereby forcing fluid flow to occur through the internal lumen of theflow control device110, and specifically through thevalve member612.
• As shown inFIG. 8, thevalve member612 is oriented such that it will permit regulated fluid flow in theproximal direction204, but prevent fluid in adistal direction206 through theflow control device110. Thevalve member612 will only permit fluid flow therethrough when the fluid reaches a predetermined cracking pressure, as described below. Other types of valve members, or additional valve members, could be used to permit fluid flow in both directions or to prevent fluid flow in either direction.
• As shown inFIG. 8, theframe625 grips theinterior wall915 and presses against thewall915 with a pressure sufficient to retain theflow control device110 in a fixed position relative to the bronchial passageway. Theprongs627 are positioned such that they lodge against theinterior walls915 and prevent theflow control device110 from migrating in adistal direction206. The curved, distal ends629 of theframe625 can lodge against theinterior walls915 and prevent migration of theflow control device110 in aproximal direction204.
• When theflow control device110 is properly implanted, theframe625 does not necessarily return to its original expanded state after being implanted, but may be deformed and inserted such that one side is collapsed, or deformed relative to its pre-insertion shape. Theframe625 preferably has sufficient outward radial force to maintain the flow control device's position in the bronchial passageway. Due to the substantially independent deformation of theframe625, even if theframe625 is implanted in a deformed state, theseal member615 can still maintain a true and complete contact with the walls of the bronchial passageway.
• Theframe625 expands to grip the bronchial wall when theflow control device110 is implanted in the bronchial passageway. Thus, theframe625 can be in at least two states, including an insertion (compressed) state and an anchoring (expanded or uncompressed) state. In the insertion state, theframe625 has a smaller diameter than in the anchoring state. Various mechanisms can be employed to achieve the two states. In one embodiment, theframe625 is manufactured of a malleable material. Theframe625 can be manually expanded to the anchoring state, such as by inserting an inflatable balloon inside the frame once theflow control device110 is implanted in the bronchial passageway, and then inflating the balloon to expand the frame beyond the material's yield point into an interfering engagement with the wall of the bronchial passageway.
• Another mechanism that can be employed to achieve the two-state frame625 size is spring resilience. The insertion state can be achieved through a preconstraint of theframe625 within the elastic range of the frame material. Once positioned in the bronchial passageway, theframe625 can be released to expand into an anchoring state. Constraining tubes or pull wires may achieve the initial insertion state.
• Another mechanism that can be used to achieve both the insertion and the anchor states of theframe625 is the heat recovery of materials available with alloys, such as certain nickel titanium alloys, including Nitinol. The transition temperature of theframe625 could be below body temperature. Under such a circumstance, acool frame625 can be positioned and allowed to attain ambient temperature. The unrecovered state of theframe625 would be in an insertion position with theframe625 having a smaller diameter. Upon recovery of the frame material, theframe625 would expand, such as when the frame achieves a temperature within the bronchial passageway. Another use of this material may be through a heating of the device above body temperature with a recovery temperature zone above that of normal body temperature but below a temperature which may cause burning. The device might be heated electrically or through the modulation of a field.
• In one embodiment, the outer diameter of theseal member615 of the flow control device110 (in an uncompressed state) is in the range of approximately 0.20 inches to 0.42 inches at theflanges620 or at thecuff622. In one embodiment, theframe625 has an outer diameter (in an uncompressed state) in the range of approximately 0.24 to 0.48 inches. In one embodiment, theflow control device110 has an overall length from theproximal end602 to thedistal end604 of approximately 0.35 inches to 0.52 inches. It should be appreciated that the aforementioned dimensions are merely exemplary and that the dimensions of theflow control device110 can vary based upon the bronchial passageway in which it will be implanted.
• FIGS. 9-11 show another embodiment of theflow control device110.FIG. 9 shows a perspective, cross-sectional view,FIG. 10 shows a side, cross-sectional view, andFIG. 11 shows a front, plan view of the other embodiment of theflow control device110. Unless noted otherwise, like reference numerals and like names refer to like parts as the previous embodiment. This embodiment of the flow control device has ananchor member618 comprising aframe625 that is disposed in a spaced relationship from the rest of theflow control device110. That is, theframe625 is distally-spaced from theseal member615 and theinternal lumen610. As in the previous embodiment, theflow control device110 extends generally along a central axis605 (shown inFIGS. 9 and 10) and has a main body that defines aninterior lumen610 through which fluid can flow along a flow path that generally conforms to thecentral axis605. Theinterior lumen610 is surrounded by anannular wall608. The flow of fluid through the interior lumen is controlled by avalve member612.FIG. 9 shows thevalve member612 located at an end of theinterior lumen610, although it should be appreciated that thevalve member612 could be positioned at various locations along theinterior lumen610.
• As best shown inFIG. 11, theflow control device110 has a generally circular shape (when viewed longitudinally) that will facilitate insertion of the flow control device into a bronchial passageway, although it should be appreciated that theflow control device110 can have other cross-sectional shapes that enable the device to be inserted into a bronchial passageway.
• As best shown inFIGS. 9 and 10, theseal member615 is located on an outer periphery of theflow control device110. In the embodiment shown inFIGS. 9-11, the seal member includes a series of radially-extending,circular flanges620 that surround the entire outer circumference of theflow control device110.
• With reference toFIGS. 9 and 10, theanchor member618 is shown located on a distal end of theflow control device110, although theanchor member618 can be located at various locations along theflow control device110. In the embodiment shown inFIGS. 9-11, theframe625 is attached to theflow control device110 by one or more attachment struts626 although theframe625 could also be attached in other manners.
• In the embodiment shown inFIGS. 9-11, thevalve member612 comprises aseptum630 located at a proximal end of theinterior lumen610. In a default state, theseptum630 occludes fluid from flowing through theinterior lumen610 so that theflow control device110 shown inFIGS. 9-11 can function as an occluder that prevents flow in either direction. However, theseptum630 can be pierced by a dilator device (described below) via aslit635 in theseptum630, in order to permit fluid to flow through theinterior lumen610. Theseptum630 is made from a deformable elastic material.
• The dilator device could comprise a wide variety of devices that function to dilate theslit635 in theseptum630 and thereby provide a passageway across theflow device110 through which fluid can flow in one or two directions, depending on the design of the dilator device. The dilator devices could comprise, for example:
• (1) A suction catheter for aspirating air or fluid distal to the flow control device.
• (2) A long, thin suction catheter that could be snaked into very distal portions of the isolated lung region for aspirating fluid or air in the distal portions of the isolated lung regions.
• (3) A short tube to allow free fluid communication between the occluded region of a bronchial passageway distal of an implanted flow control device and the region of the bronchial passageway proximal of the implanted flow control device.
• (4) A tube or other short structure with a one-way valve mounted inside to allow fluid to be expelled from the isolated distal lung region (either during normal exhalation or during a procedure that forces fluid from the isolated, distal lung region) and to prevent fluid from entering the isolated lung region.
• (5) A catheter with a one-way valve mounted at the tip to allow fluid to be expelled from the isolated, distal lung region (either during normal exhalation or during a procedure that forces fluid from the distal lung segment) and to prevent fluid from entering the lung segment.
• (6) A catheter for instilling a therapeutic agent, such as antibiotics or other medication, into the region of the bronchial passageway or lung distal to the flow control device that has been implanted in the bronchial passageway.
• (7) A catheter for passing brachytherapy sources into the bronchial passageway distal to the implanted flow control device for therapeutic reasons, such as to stop mucus production, kill a pneumonia infection, etc. The brachytherapy source can be configured to emit either Gamma or Beta radiation.
• (8) A catheter with a semi-permeable distal aspect that circulates a nitrogen-solvent fluid, which absorbs through osmosis nitrogen trapped in the lung region distal to the flow control device.
• Thus, the dilator devices described above generally fall into two categories, including catheter-type dilation devices and dilation devices comprised of short, tube-like structures. However, it should be appreciated thatflow control device110 can be used with various dilation devices that are not limited to those mentioned above.
• The deployment of theflow control device110 and use of a dilator device therewith is described in more detail with reference toFIGS. 12 and 13. The use of a dilator device is described in the context of being used with one of theflow control device110 described herein, although it should be appreciated that the dilator device can be used with other types of flow control devices and is not limited to being used with those described herein.FIGS. 12 and 13 show theflow control device110 ofFIGS. 9-11 implanted within abronchial passageway910 havinginterior walls915 that define a lumen of thebronchial passageway910.
• As shown inFIG. 12, theflow control device110 is implanted such that one or more of theflanges620 contact theinterior walls915 to provide a seal that prevents fluid from flowing between theinterior walls915 and theflanges620. Thus, fluid must flow through theinterior lumen610 of theflow control device110 in order to flow from aproximal side1301 of theflow control device110 to adistal side1302 or vice-versa.
• It should be appreciated that the relative locations of theflanges620 and theframe625 along the longitudinal axis of the flow control device can be changed. For example, theflanges620 could be located on the distal side of theflow control device110 rather than on the proximal side, and theframe625 can be located on the proximal side rather than the distal side. Theflow control device110 could also be positioned in a reverse orientation in the bronchial passageway than that shown inFIG. 12. In such a case, the orientation of thevalve member612 could be arranged to permit flow in a desired direction, such as in a proximal direction204 (to allow air flow out of a lung region), a distal direction206 (to allow air flow into a lung region), or in both directions. The orientation of theflanges620 can also be changed based upon how theflow control device110 is to be implanted in the bronchial passageway.
• As discussed, theframe625 grips theinterior wall915 and presses against thewall915 with a pressure sufficient to retain theflow control device110 in a fixed position. When in the state shown inFIG. 12, theflow control device110 obstructs thebronchial passageway910 to prevent fluid from flowing in either direction through thebronchial passageway910. In this regard, theseptum630 can be sufficiently rigid so that theslit635 does not open when subjected to expiration and inhalation pressures. As described further below, other embodiments of theflow control device110 can be used to provide regulated fluid flow through thebronchial passageway910 in a distal direction, a proximal direction, or in both the distal and proximal directions.
• With reference now toFIG. 13, theseptum630 can be mechanically pierced through theslit635, such as by using a dilator device comprised of atube1010 that dilates theslit635. Alternately, theseptum630 can have noslit635 and thetube1010 can be used to pierce through theseptum630. In either case, theseptum630 preferably seals around the outer surface of thetube1010 in order to prevent fluid flow in the space between theseptum630 and thetube1010. Thetube1010 is hollow and has an internal lumen such that thetube1010 provides an unobstructed fluid flow passageway between a region of thebronchial passageway910 distal of theflow control device110 and a region of the bronchial passageway proximal of theflow control device110.
• Various dilator devices can be inserted through theflow control device110 to provide various flow characteristics to the flow control device, as well as to provide access to the region of the bronchial passageway located distal of theflow control device110. In any of the embodiments of the dilation devices and flow control devices described herein, it should be appreciated that the dilation device can be pre-loaded into theflow control device110 prior to deploying theflow control device110 to the bronchial passageway. Alternately, theflow control device110 can be implanted into the bronchial passageway without the dilation device and the dilation device inserted into theflow control device110 after implant of theflow control device110.
• FIG. 14 shows another embodiment wherein the dilator device comprises atube section1110 that includes a one-way valve1120 mounted thereon. The one-way valve1120 can be any type of valve that permits fluid flow in a first direction but prevents fluid flow in a second direction opposite to the first direction. For example, as shown inFIG. 14, the one-way valve1120 can comprise a duckbill valve of the type known to those skilled in the art. The one-way valve1120 can be positioned such that it allows fluid flow in an exhalation direction (i.e., proximal direction)204 but prohibits fluid flow in an inhalation direction (i.e., distal direction)206.
• FIG. 15 shows theflow control device110 with theseptum630 dilated by atube section1110 that includes a one-way valve1120 mounted thereon. Thetube section1110 has an attachment structure, such as aflange1210. A remote actuator, such as atether1215, is attached at a proximal end to theattachment structure1210 of thetube section1110. Thetether1215 can be formed of a variety of bio-compatible materials, such as any well-known suture material. Thetether1215 extends in a proximal direction through thebronchial passageway910 and through the trachea (shown inFIG. 2) so that a proximal end of thetether1215 protrudes through the mouth or nose of the patient. The tether can be pulled outwardly, which will also cause the attachedtube structure1110 to be pulled outwardly from theseptum630 by virtue of the tether's attachment to thetube attachment structure1210. The absence of thetube structure110 would then cause theseptum630 to re-seal so that theflow control device110 again occludes fluid flow through thebronchial lumen910.
• FIG. 16 shows theflow control device110 implanted in thebronchial lumen910, with theseptum630 dilated by atube section1110 that includes a one-way valve1120 mounted thereon. The one-way valve1120 fluidly communicates with the internal lumen of acatheter1310 at a distal end of thecatheter1310. Thecatheter1310 extends in a proximal direction through thebronchial passageway910 and through the trachea (shown inFIG. 2) so that a proximal end of thecatheter1310 protrudes through the mouth or nose of the patient. Thecatheter1310 thereby provides an airflow passageway for fluid flowing through the one-way valve1120. Thus, thecatheter1310 in combination with the one-way valve1120 and theflow control device110 provide a regulated fluid access to thebronchial passageway910 at a location distal of theflow control device110. Thecatheter1310 can thus be used to aspirate fluid from a location distal of theflow control device110 by applying a suction to the proximal end of thecatheter1310, which suction is transferred to the distal region of the bronchial passageway through the internal lumen of thecatheter1310, thetube section1110, and theflow control device110. The catheter optionally has one ormore vent holes1320 at a location proximal of the one-way valve1120. The vent holes1320 permit fluid to flow from the internal lumen of thecatheter1310 into the bronchial passageway proximal of theflow control device110.
• FIG. 17 shows theflow control device110 mounted within thebronchial passageway910, with the slit of theseptum630 dilated by acatheter1310. A distal end of thecatheter1310 is located distally of theseptum630. Thecatheter1310 extends in a proximal direction through thebronchial passageway910 and through the trachea (shown inFIG. 2) so that a proximal end of thecatheter1310 protrudes through the mouth or nose of the patient. Thecatheter1310 provides an airflow passageway across theflow control device110. Thus, thecatheter1310 provides unobstructed fluid access to thebronchial passageway910 at a location distal of theflow control device110. Thecatheter1310 can thus be used to aspirate fluid from a location distal of theflow control device110 by applying a suction to the proximal end of thecatheter1310, which suction is transferred to the distal region of the bronchial passageway through the internal lumen of thecatheter1310. Thecatheter1310 also enables the instillation of therapeutic agents into the distal side of the flow control device, the passing of brachytherapy sources to the distal side of the flow control device, etc, all via the internal lumen of thecatheter1310.
• FIG. 18 shows an alternate embodiment of theflow control device110 mounted in a bronchial passageway. This embodiment of theflow control device110 is identical to that described above with reference toFIGS. 9-11, with the exception of the configuration of theseptum630 and theslit635. A distal face of the septum has ataper1510 located at theslit635. Thetaper1510 functions to reduce the cracking pressure required to open slit635 so that the cracking pressure of theseptum630 will be lower for flow moving from thedistal side1302 toward theproximal side1301 of theflow control device110, and higher for flow from theproximal side1510 to the distal side1520. The cracking pressure can be made the same in both directions by eliminating thetaper1510. The cracking pressure can be varied by changing the durometer of the elastomer, by changing the diameter of the valve, by changing the length of theslit635, by changing the angle, depth or shape of thetaper feature1510, or by changing the thickness of the valve feature.
• FIGS. 19-21 show another embodiment of theflow control device110, which permits fluid flow in a first direction but prevents fluid flow in a second direction opposite the first direction. As in the previous embodiments, theflow control device110 includes aseal member615, avalve member612, and ananchor member618, as well as aninterior lumen610 formed by an annular wall608 (shown inFIG. 21). Theannular wall608 can be made from Nitinol, injection molded plastic such as polyetheretherketone (PEEK), or other rigid biocompatible materials. As in the previous embodiments, theanchor member618 comprises aframe625 that is formed by a plurality of struts that define an interior envelope. Theframe625 can contract and expand in a radial and longitudinal direction (relative to thelongitudinal axis1805 shown inFIG. 21). The struts of theframe625 are arranged so that one or more of the struts formprongs1605 having edges that can wedge against the interior wall of a body passageway to secure an implanted flow control device against movement within the body passageway. Theanchor member618 can be manufactured of a shape-memory material, such as nickel titanium or Nitinol.
• In the embodiment of theflow control device110 shown inFIGS. 19-21, thevalve member612 comprises a one-way flap valve that permits fluid flow in a first flow direction. The flap valve includes aflap1610, which can move between a closed position and an open position (theflap1610 is shown in an open position inFIGS. 19-21). In the closed position, theflap1610 sits within a seat to block fluid flow through theinterior lumen610. In the open position, the flap provides an opening into theinterior lumen610 so that fluid can flow through the interior lumen in the first flow direction.
• As in the previous embodiment, theseal member615 includes one ormore flanges620 that can seal against the interior wall of a body passageway in which theflow control device110 is implanted. As shown inFIGS. 21, theflanges625 of theseal member615 surround theannular wall608 that forms theinterior lumen610. Theflap1610 and theseal member615 can be manufactured of an elastomeric material such as silicone, thermoplastic elastomer, urethane, etc. Theflap1610 can also be a rigid member that seals against an elastomer surface of thedevice110, or it could be rigid and lined with an elastomer material. If a rigid flap is used, then hinges can be used to attach the flap to thedevice110.
• At adistal end1607 of theflow control device110, theseal member615 folds over itself to form anannular cuff1625. At least a portion of theframe625 is positioned within the cuff and retained therein using retaining members, such asrivets1630 that extend through holes in thecuff1625. Therivets1630 can be manufactured of a bio-compatible material, such as silicone adhesive. Therivets1630 secure thecuff1625 to theframe625 so as to allow theframe625 to expand and contract, but to still firmly capture theframe625 to thecuff1625. As best shown in the section view ofFIG. 21, therivets1630 extend between opposed sides of thecuff1625 to capture but not totally restrain theframe625 against expansion or contraction. It should be appreciated that other attachment means can be used to attach theframe625 to thecuff1625. For example, adhesive can be used as in the previously-described embodiments.
• Multiple rivets1630 may be used in any variety of patterns around the circumference of thecuff1625. While therivets1630 may be short in length such that there is little play between the folded over region of thecuff1625 and the portion of thecuff1625 located within the frame envelope, therivets1630 may be lengthened so that there is substantial play between the folded-over portion of thecuff1625 and the interior region of thecuff1625. In this manner, theframe625 can be crumpled or deformed during deployment, while still allowing sufficient space for the folded-over region of thecuff1625 to remain in contact with the lumen wall, helping to form a seal about theflow control device110. Preferably, the frame envelope will conform to the lumen internal diameter where theflow control device110 is implanted. However if there are gaps between the frame envelope and the lumen interior wall, then thecuff1625 is capable of providing the fluid seal.
• In one embodiment, the rivets are installed onto theflow control device110 by first sliding theflow control device110 over a dimpled mandrel. A hole is then drilled through the two walls of thecuff1625, and the hole is filled with a glue, such as silicone adhesive, which will dry within the hole to form the rivets. The hole in the mandrel can have a dimpled shape that forms the inside rivet heads, while the outer heads can be formed by applying excessive adhesive on the outside. The assembly is then cured in an oven and slid off the mandrel.
• In an alternative embodiment, thecuff1625 may have a length such that thecuff1625 folds over the entire length of theframe625. Thecuff1625 is re-attached to the proximal end of the polymer valve, such that theframe625 is completely enclosed by thecuff1625, so as theframe625 is implanted within the bronchial passageway, the loose folds of the polymer skirt can provide a sealing feature.
• FIGS. 22-24 show yet another embodiment of aflow control device110. Theflow control device110 shown inFIGS. 22-24 is structurally similar to theflow control device110 described above with reference toFIGS. 19-21 in that it includes aseal member615 with acuff1625 andflanges620. Thecuff1625 retains ananchor member618 comprised of aframe625. Theflow control device110 ofFIGS. 22-24 also includes avalve member612 comprised of a one-way duckbill valve1910. Theduckbill valve1910 is configured to prevent flow fluid from a proximal side to the distal side of theflow control device110, and to allow flow at a controlled cracking pressure from the distal side to the proximal side through a slit1920 (shown inFIG. 24) in thevalve1910. The cracking pressure of theduckbill valve1910 can be adjusted by changing the thickness of the material used to manufactured thevalve1910, the durometer of the material, the angle of the duckbill valve, etc. The duckbill valve can be manufactured a deformable elastomer material, such as silicone.
• As shown inFIGS. 22-24, the flow control device hasvalve dilation member1930 that facilitates the passage of a dilation device (such as any of the dilation devices described above) through theflow control device110. As was previously described, the presence of the dilation device in theflow control device110 can allow the passage of fluid or other treatment devices to or from the isolated distal lung region when theflow control device110 is implanted in a bronchial passageway. As best shown inFIGS. 22 and 24, thevalve dilation member1930 defines aninterior region1935 that has a cone shape having an apex that is adjacent to an apex of theduckbill valve1910. The outer surfaces of thevalve dilation member1920 are not sealed from the surrounding environment, but are rather exposed. Thus, air pressure of the surrounding environment is equally distributed on all sides of thevalve dilation member1930 so that thedilation member1930 will not open to fluid flow moving in a distal direction (such as during normal inspiration), but can be mechanically opened by a dilation device such as a catheter.
• Theflow control device110 is shown inFIG. 24 with an optional feature comprised of avalve protector sleeve1938 that at least partially surrounds thevalve dilation member1935. Thevalve protector sleeve1938 can be attached to theseal member615 and can made of a biocompatible materials such as stainless steel, Nitinol, etc. In order to ensure that the cracking pressure in the distal direction is not affected by the addition of thevalve dilation member1930, theprotector sleeve1938 preferably has one ormore vent holes1940, which ensure that the pressure is the same on interior and exterior surfaces of thevalve dilation member1930, as well as on the proximal surface of theduckbill valve1910. In this way, the cracking pressure in the proximal direction is also unaffected.
• FIG. 25 shows another embodiment of theflow control device110 implanted within abronchial passageway910. This embodiment is structurally similar to the embodiment shown inFIGS. 22-24, except that theanchor member618 comprises aframe625 that is distally disposed on theflow control device110 in the manner described above with respect to the embodiments shown inFIGS. 9-18. That is, theflow control device110 shown inFIG. 25 does not have a cuff that attaches the frame to the flow control member. Rather, theframe625 is distally separated from theflow control device110. As shown inFIG. 25, theflow control device110 includes avalve protector sleeve1938 that is attached to a proximal end of thevalve dilation member1930. As discussed, theprotector sleeve1938 can have one or more vent holes, which ensure that the pressure is the same on interior and exterior surfaces of thevalve dilation member1930
• FIG. 26 illustrates another embodiment of theflow control device110 that is similar to the embodiment shown inFIG. 25. However, thevalve dilation member1930 has no external support other than its attachment to theduckbill valve1910. In addition, theduckbill valve1910 is integrally attached to theseal member615, although it should be appreciated that the duckbill valve and seal member could also be molded as two separate components and bonded together.FIG. 27 shows theflow control device110 ofFIG. 26 with a dilator device comprised of adilation catheter2415 dilating theflow control device110 through thevalve dilation member1930. Thedilation catheter2415 was inserted from the proximal side of theflow control device110 for use in passing fluid to or from the distal side, or for performing other therapeutic procedures, as described below.
• FIG. 28 shows yet another embodiment of theflow control device110. In this embodiment, theduckbill valve1910 and thevalve dilation member1930 are surrounded entirely by theannular wall608.
• FIG. 29 shows yet another embodiment of theflow control device110. Theflow control device110 ofFIG. 29 includes a sealedchamber2610 that is defined by a space between theduckbill valve1910, thevalve dilation member1930, and theannular wall608. This structure results in a controlled cracking pressure for flow from theproximal side602 to thedistal side604 of theflow control device110 in addition to a controlled cracking pressure for flow from thedistal side604 to theproximal side602. The cracking pressure in either direction is a function of the pressure in the sealedchamber2610, the durometer of the material used to fabricate the duckbill valve and the valve dilation member, the thickness of the material, the included angle of the cone portion of thevalve member1910/valve dilation member1930, etc. In addition, this device allows the passage of dilation devices in the distal direction.
• FIG. 30 shows yet another embodiment of theflow control device110. In this embodiment, theflow control device110 defines twointerior lumens2710,2720. Theflow control device110 ofFIG. 30 provides for two-way fluid flow, with theinterior lumen2710 providing for fluid flow in a first direction and theinterior lumen2720 providing for fluid flow in a second direction. There is a first one-way duckbill valve2725amounted in theinterior lumen2710 that allows fluid flow in a proximal direction and asecond duckbill valve2725bmounted in theinterior lumen2720 that allows fluid flow in a distal direction. This allows for different cracking pressures for fluid flow in either direction.
• FIG. 31 shows another embodiment of aflow control device110 that permits controlled fluid flow in either a proximal direction or a distal direction. Theflow control device110 has asingle interior lumen2810. Theflow control device110 includes a first valve member comprised of aflap valve2815 that is configured to permit fluid flow through thelumen2810 in a first direction when the valve is exposed to a first cracking pressure. Asecond valve2820 permits fluid flow in a second direction through the lumen at a second cracking pressure.
• Cracking Pressure
• The cracking pressure is defined as the minimum fluid pressure necessary to open the one-way valve member in a certain direction, such as in the distal-to-proximal direction. Given that the valve member of theflow control device110 will be implanted in a bronchial lumen of the human lung, theflow control device110 will likely be coated with mucus and fluid at all times. For this reason, the cracking pressure of the valve is desirably tested in a wet condition that simulates the conditions of a bronchial lumen. A representative way of testing the valve member is to use a small amount of a water based lubricant to coat the valve mouth. The testing procedure for a duckbill valve is as follows:
• 1. Manually open the mouth of the valve member, such as by pinching the sides of the valve together, and place a drop of a dilute water based lubricant (such as Liquid K-Y Lubricant, manufactured by Johnson & Johnson Medical, Inc.) between the lips of the valve.
• 2. Wipe excess lubricant off of the valve, and force 1 cubic centimeter of air through the valve in the forward direction to push out any excess lubricant from the inside of the valve.
• 3. Connect the distal side of the valve to an air pressure source, and slowly raise the pressure. The pressure is increased from a starting pressure of 0 inches H2O up to a maximum of 10 inches H2O over a period of time (such as 3 seconds), and the peak pressure is recorded. This peak pressure represents the cracking pressure of the valve.
• The smaller the duckbill valve, the higher the cracking pressure that is generally required to open the valve. The cracking pressure of small valves generally cannot be reduced below a certain point as the valve will have insufficient structural integrity, as the wall thickness of the molded elastomer is reduced, and the durometer is decreased. For theflow control device110, the lower the cracking pressure is the better the performance of the implant.
• In one embodiment, the cracking pressure of the valve member is in the range of approximately 2.6-4.7 inches H2O. In another embodiment, wherein the valve is larger than the previously-mentioned embodiment, the cracking pressure of the valve is in the range of 1.7-4.5 inches H2O. In yet another embodiment, wherein the valve is larger than the previously-mentioned embodiment, the cracking pressure of the valve is in the range of 2.0-4.1 inches H2O. In yet another embodiment, wherein the valve is larger than the previously-mentioned embodiment, the cracking pressure of the valve is in the range of 1.0-2.7 inches H2O. The cracking pressure of the valve member can vary based on various physiological conditions. For example, the cracking pressure could be set relative to a coughing pressure or a normal respiration pressure. For example, the cracking pressure could be set so that it is higher (or lower) than a coughing pressure or normal respiration pressure. In this regard, the coughing or normal respiration pressure can be determined based on a particular patient, or it could be determined based on average coughing or normal respiration pressures.
• Delivery System
• FIG. 32 shows adelivery system2910 for delivering and deploying aflow control device110 to a target location in a bronchial passageway. Thedelivery system2910 includes acatheter2915 having aproximal end2916, and adistal end2917 that can be deployed to a target location in a patient's bronchial passageway, such as through the trachea. Thecatheter2915 has anouter member2918 and aninner member2920 that is slidably positioned within theouter member2918 such that theinner member2920 can slidably move relative to theouter member2918 along the length of thecatheter2915.
• In this regard, an actuation member, such as a two-piece handle2925, is located at theproximal end2916 of thecatheter2915. Thehandle2925 can be actuated to move theinner member2920 relative to the outer member2918 (and vice-versa). In the illustrated embodiment, thehandle2925 includes afirst piece2928 and asecond piece2930, which is slidably moveable with respect to thefirst piece2928. Theinner member2920 of thecatheter2915 can be moved relative to theouter member2918 by slidably moving thefirst piece2928 of thehandle2925 relative to thesecond piece2930. This can be accomplished, for example, by attaching the proximal end of the catheterinner member2920 to thefirst piece2928 of thehandle2925 and attaching the proximal end of the catheterouter member2918 to thesecond piece2930. The actuation member could also take on other structural forms that use other motions to move theinner member2920 relative to theouter member2918. For example, the actuation member could have scissor-like handles or could require a twisting motion to move theinner member2920 relative to theouter member2918.
• As shown inFIG. 32, thehandle2925 also includes alocking mechanism2935 for locking the position of thefirst piece2928 relative to thesecond piece2930 to thereby lock the position of theinner member2920 of thecatheter2915 relative to theouter member2918. Thelocking mechanism2935 can comprise, for example, a screw or some other type of locking mechanism that can be used to lock the position of thefirst piece2928 of thehandle2925 relative to thesecond piece2930.
• Theouter member2918, and possibly theinner member2920, can include portions of differing stiffness to allow discrete portions of the members to bend and deflect more easily than other portions. In one embodiment, the distal portion of thecatheter2915, for example, the last 10 cm or so just proximal to a distally-locatedhousing2940, can be made to have a reduced bending stiffness. This would allow thedistal end2917 of thecatheter2915 to bend easily around angles created by branches in the bronchial tree, and could make placement of flow control devices easier in more distal locations of the bronchial tree.
• Theouter member2918 of thecatheter2915 could also include wire reinforcing to improve certain desired characteristics. Theouter member2918 could be manufactured to include wire winding or braiding to resist kinking, wire braiding to improve the ability of thecatheter2915 to transmit torque, and longitudinal wire or wires to improve tensile strength while maintaining flexibility, which can improve device deployment by reducing recoil or “springiness” in theouter member2918. Theinner member2920 could also include wire reinforcing, such as wire winding, wire braiding, or longitudinal wire(s) to resist kinking and add compressive strength to theinner member2920.
• With reference still toFIG. 32, ahousing2940 is located at or near a distal end of thecatheter2915. Thehousing2940 is attached to a distal end of theouter member2918 of thecatheter2915 but not attached to theinner member2920. As described in more detail below, thehousing2940 defines an inner cavity that is sized to receive theflow control device110 therein.FIG. 33 shows an enlarged, perspective view of the portion of the distal portion of thecatheter2915 where thehousing2940 is located.FIG. 34 shows a plan, side view of the distal portion of thecatheter2915 where thehousing2940 is located. As shown inFIGS. 33 and 34, thehousing2940 is cylindrically-shaped and is open at a distal end and closed at a proximal end. Theinner member2920 of the catheter2015 protrudes through the housing and can be slidably moved relative to thehousing2940. An ejection member, such as aflange3015, is located at a distal end of theinner member2920. As described below, the ejection member can be used to eject theflow control device110 from thehousing2940. Theflange3015 is sized such that it can be received into thehousing2940. The housing can be manufactured of a rigid material, such as steel.
• In one embodiment, atip region3020 is located on the distal end of theinner member2920, as shown inFIGS. 33 and 34. Thetip region3020 can be atraumatic in that it can have a rounded or cone-shaped tip that facilitates steering of thecatheter2915 to a desired bronchial passageway location. Theatraumatic tip region3020 preferably includes a soft material that facilitates movement of theatraumatic tip region3020 through the trachea and bronchial passageway(s). In this regard, theatraumatic tip region3020 can be manufactured of a soft material, such as polyether block amide resin (Pebax), silicone, urethrane, and the like. Alternately, thetip region3020 can be coated with a soft material, such as any of the aforementioned materials.
• Theinner member2920 of thecatheter2915 can include a central guide wire lumen that extends through the entire length of thecatheter2915, including theatraumatic tip region3020, if present. The central guide wire lumen of theinner member2920 is sized to receive a guide wire, which can be used during deployment of thecatheter2915 to guide thecatheter2915 to a location in a bronchial passageway, as described more fully below.
• In an alternative embodiment of thecatheter2915, thecatheter2915 could be fitted with a short length of flexible, bendable guide wire on the distal end of thecatheter2915. The bendable guide wire could be used to ease the passage of thecatheter2915 through the bronchial anatomy during deployment of thecatheter2915. The fixed guide wire could include a soft, flexible atraumatic tip. The wire portion could be deformed into various shapes to aid in guiding thecatheter2915 to the target location. For example, the wire could be bent in a soft “J” shape, or a “hockey stick” shape, and thus the tip of the guide wire could be directed to one side or another by rotating thecatheter2915, thereby allowing thecatheter2915 to be guided into a branch of the bronchial tree that diverts at an angle away from the main passage.
• In another embodiment similar to that detailed above, the distal portion of thedelivery catheter2915, proximal to thehousing2940, could be made deformable. This would allow the distal end of thecatheter2915 to be shaped, thus allowing thecatheter2915 to be guided into a bronchial side branch by rotating the catheter shaft.
• Thedelivery catheter2915 could be modified to add a steerable distal tip function, such as by adding a “pull” wire located inside a new lumen in theouter member2918 of thedelivery catheter2915. The proximal end of the pull wire would be attached to a movable control that allows tension to be applied to the wire. The distal end of the wire would be terminated at a retainer attached to the distal end of theouter member2918 of the catheter1915. The distal portion of the catheter1915 could be manufactured to be much more flexible than the rest of thecatheter2915, thus allowing the distal end of thecatheter2915 to bend more easily than the rest of thecatheter2915. This distal portion could also have some elastic restoring force so that it will return on its own to a straight configuration after the tip is deflected or the shape of the tip is disturbed. When the moveable control is actuated, thus applying tension to the pull wire, the distal tip or distal portion of thecatheter2915 will deflect. In addition, other ways of constructing steering tips for this delivery catheter could be used.
• An alternate embodiment of thesteerable delivery catheter2915 is one where the distal tip or distal region of thedelivery catheter2915 is permanently deformed into a bent shape, with the bent shape corresponding with the greatest desired deflection of the distal tip. Theouter member2918 of the delivery catheter can have an additional lumen running along one side, allowing a rigid or semi-rigid mandrel or stylet to be inserted in the lumen. If the mandrel is straight, as it is inserted into the side lumen of thecatheter2915, the deformed tip of thecatheter2915 will progressively straighten as the mandrel is advanced. When the mandrel is fully inserted, the outer shaft of thecatheter2915 also becomes straight. Thecatheter2915 can be inserted into the patient in this straight configuration, and the mandrel can be withdrawn as needed to allow the tip to deflect. In addition, the mandrel or stylet could be formed into different shapes, and thecatheter2915 would conform to this shape when the mandrel is inserted into the side lumen.
• As mentioned, thehousing2940 defines an interior cavity that is sized to receive theflow control device110. This is described in more detail with reference toFIG. 35A, which shows a cross-sectional view of thehousing2940 with aflow control device110 positioned within thehousing2940. For clarity of illustration, theflow control device110 is represented as a dashed box inFIG. 35A. Thehousing2940 can be sufficiently large to receive the entireflow control device110 without any portion of the flow control device protruding from thehousing2940, as shown inFIG. 35A.
• Alternately, thehousing2940 can be sized to receive just a portion of theflow control device110. For example, thedistal end604 of theflow control device110 can be shaped as shown inFIG. 35B, but can protrude out of thehousing2940 when theflow control device110 is positioned within thehousing2940. In such a case, thedistal end604 of theflow control device110 can be made of an atraumatic material to reduce the likelihood of thedistal end604 damaging a body passageway during deployment.
• Alternately, or in combination with the soft material, the distal end can be tapered so that it gradually reduces in diameter moving distally away from the housing, such as is shown inFIG. 35B. The tapered configuration can be formed by a taper in the shape of the distal edge of the cuff, if theflow control device110 has a cuff. Or, if the distal edge of theflow control device110 is a frame, then the frame can be shaped to provide the taper. As shown inFIG. 35B, the tapered configuration of thedistal end604 of theflow control device110 can provide a smooth transition between the outer diameter of thedistal end3020 of the catheterinner member2920 and the outer diameter of the distal edge of thehousing2940. This would eliminate sharp transitions in the delivery system profile and provide for smoother movement of the delivery system through the bronchial passageway during deployment of theflow control device110. Thehousing2940 preferably has an interior dimension such that theflow control device110 is in a compressed state when theflow control device110 is positioned in thehousing2940.
• As shown in FIGS.35A,B, theflow control device110 abuts or is adjacent to theflange3015 of the catheterinner member2920 when the flow control device is positioned within thehousing2940. As mentioned, the catheterinner member2920 is moveable relative to thehousing2940 and the catheterouter member2918. In this regard, theflange3015 can be positioned to abut abase portion3215 of thehousing2940 so that theflange3015 can act as a detent for the range of movement of the catheterinner member2920 relative to the catheterouter member2918.
• As described in more detail below, thecatheter2915 can be used to deliver aflow control device110 to a desired bronchial passageway location. This is accomplished by first loading the flow control device into thehousing2940 of thecatheter2915. The distal end of thecatheter2915 is then deployed to the desired bronchial passageway location such that the housing (and the loaded flow control device110) are located at the desired bronchial passageway location. Theflow control device110 is then ejected from thehousing2940.
• The ejection of theflow control device110 from thehousing2940 can be accomplished in a variety of ways. For example, as shown inFIG. 36A, thecatheter2915 is deployed to a target location L of abronchial passageway3310. Thecatheter handle2925 is then actuated to move theouter catheter member2918 in a proximal direction relative to the location L, while maintaining the location of theflow control device110,inner member2920, andflange3015 fixed with respect to the location L. The proximal movement of theouter member2918 will cause the attachedhousing2940 to also move in a proximal direction, while theflange3015 will act as a detent that prevents theflow control device110 from moving in the proximal direction. This will result in thehousing2940 sliding away from engagement with theflow control device110 so that theflow control device110 is eventually entirely released from thehousing2940 and implanted in the bronchial passageway, as shown inFIG. 36B. In this manner, theflow control device110 can be implanted at the location L where it was originally positioned while still in thehousing2940.
• According to another procedure for ejecting theflow control device110 from the housing, thecatheter2915 is implanted to a location L of abronchial passageway3310, as shown inFIG. 36A. Thecatheter handle2925 is then actuated to move the inner catheter member2920 (and the attached flange3015) in a distal direction relative to the location L, while maintaining the location of theouter member2918 and thehousing2940 fixed with respect to the location L. The distal movement of theflange3015 will cause theflange3015 to push theflow control device110 in a distal direction relative to the location L, while the location of thehousing2940 will remain fixed. This will result in theflow control device110 being ejected from engagement with thehousing2940 so that theflow control device110 is eventually entirely released from thehousing2940 and implanted in the bronchial passageway distally of the original location L, as shown inFIG. 37.
• Loader System
• As discussed above, theflow control device110 is in a compressed state when it is mounted in thehousing2940 of thedelivery catheter2915. Thus, theflow control device110 should be compressed to a smaller diameter prior to loading theflow control device110 into thehousing2940 so that theflow control device110 can fit in the housing.FIG. 38 shows a perspective view of one embodiment of aloader system3510 for compressing theflow control device110 to a smaller diameter and for inserting theflow control device110 into thedelivery catheter housing2940. Theloader system3510 can be used to securely hold thecatheter housing2940 in place and to properly align thehousing2940 relative to theflow control device110 during insertion of theflow control device110 into thehousing2940. This facilitates a quick and easy loading of theflow control device110 into thehousing2940 and reduces the likelihood of damaging theflow control device110 during loading.
• Theloader system3510 includes aloader device3515 and apusher device3520. As described in detail below, theloader device3515 is used to compress theflow control device110 to a size that can fit into thehousing2940 and to properly align theflow control device110 with thehousing2940 during insertion of theflow control device110 into thehousing2940. Thepusher device3520 is configured to mate with theloader device3515 during loading, as described more fully below. Thepusher device3520 is used to push theflow control device110 into theloader device3515 and into thehousing2940 during loading, as described in more detail below.
• FIG. 39 is a schematic, cross-sectional view of theloader device3515. Aloading tunnel3610 extends entirely through a main body of theloader device3515 so as to form afront opening3615 and an opposedrear opening3620. Theloading tunnel3610 can have a circular cross-sectional shape, although it should be appreciated that theloading tunnel3610 could have other cross-sectional shapes. Theloading tunnel3610 has three regions, including a funnel-shapedloading region3622, ahousing region3630, and acatheter region3635. Theloading region3622 of theloading tunnel3610 gradually reduces in diameter moving in a rearward direction (from thefront opening3615 toward the rear opening3620) so as to provide theloading region3622 with a funnel shape. Thehousing region3630 has a shape that substantially conforms to the outer shape of thecatheter housing2940 so that thecatheter housing2940 can be inserted into thehousing region3630, as described below. Thecatheter region3635 is shaped to receive theouter member2918 of thecatheter2915.
• Theloader device3515 can also include acatheter locking mechanism3640 comprised of adoor3645 that can be opened to provide thecatheter2915 with access to thehousing region3630 of theloading tunnel3610. Thedoor3645 can be manipulated to vary the size of therear opening3620 to allow thehousing2940 to be inserted into thehousing region3630, as described in more detail below.
• FIG. 40 shows a perspective view of a first embodiment of thepusher device3520. Additional embodiments of thepusher device3520 are described below. Thepusher device3520 has an elongate shape and includes at least onepiston3710 that is sized to be axially-inserted into at least a portion of theloading region3622 of the loaderdevice loading tunnel3610. Thepiston3710 can have a cross-sectional shape that substantially conforms to the cross-sectional shape of theloading region3622 in order to facilitate insertion of thepiston3710 into theloading region3622. In one embodiment, the piston has one ormore registration grooves3715 that conform to the shape of corresponding registration grooves3530 (shown inFIG. 38) in theloading tunnel3610. When thegrooves3715,3530 are used, thepiston3710 can be inserted into theloading tunnel3610 of theloader device3515 by aligning and mating the grooves to one another prior to insertion. Theregistration grooves3715,3530 can be used to ensure that thepiston3710 can only be inserted into the tunnel in a predetermined manner.
• With reference toFIGS. 41-44, theloader device3515 is used in combination with thepusher device3520 to compress theflow control device110 and insert theflow control device110 into thehousing2940 of thecatheter2915. As shown inFIG. 41, thedelivery catheter2915 is mated to theloader device3515 such that thehousing2940 is positioned within thehousing region3630 of the loaderdevice loading tunnel3610 and thecatheter2915 is positioned within thecatheter region3635 of theloading tunnel3610. When properly mated, thecatheter housing2940 is fixed in position relative to theloading region3622 of theloading tunnel3610. (A process and mechanism for mating thedelivery catheter2915 to theloader device3515 is described below.) Furthermore, when thehousing2940 is positioned within thehousing region3630, the housing interior cavity is open to theloading region3622 of theloader device3515, such that the open end of thehousing2940 is registered with a rear edge of theloading region3622.
• With reference still toFIG. 41, after thecatheter2915 is mated with theloader device3615, theflow control device110 is positioned adjacent thefront opening3615 of theloading region3622 of theloader device3515. As shown inFIG. 41, thefront opening3615 is sufficiently large to receive theflow control device110 therein without having to compress the size of theflow control device110. Alternately, a slight compression of theflow control device110 can be required to insert theflow control device110 into theopening3615. Thepusher device3520 is then positioned such that anend3810 of thepiston3710 is located adjacent to theflow control device110. Thehousing2940,flow control device110 and thepiston3710 are preferably all axially aligned to a common longitudinal axis3711 prior to loading theflow control device110 into thehousing2940. However, even if these components are not all axially aligned, the structure of theloader device3515 will ensure that the components properly align during the loading process.
• With reference now toFIG. 42, thepiston3710 of thepusher device3520 is then used to push the flow control device into theloading region3622 of theloading tunnel3610 through thefront opening3615 in the tunnel. In this manner, theflow control device110 moves through theloading tunnel3610 toward thehousing2940. As this happens, the funnel-shape of theloading region3622 will cause theflow control device110 to be gradually compressed such that the diameter of the flow control device is gradually reduced as theflow control device110 moves toward thehousing2940. The walls of theloading tunnel3610 provide an equally balanced compressive force around the entire circumference of theflow control device110 as the flow control device is pushed through theloading tunnel3610. This reduces the likelihood of deforming the flow control device during compression.
• As shown inFIG. 43, as the flow control device is pushed toward thehousing2940, theflow control device110 will eventually be compressed to a size that permits the flow control device to be pushed into thehousing2940. In one embodiment, theloading region3622 of theloading tunnel3610 reduces to a size that is smaller than the opening of thehousing2940 so that theflow control device110 can slide easily into thehousing2940 without any snags. Alternately, the opening in thehousing2940 can be substantially equal to the smallest size of the loading region3625.
• As shown inFIG. 44, thepusher device3520 continues to push theflow control device110 into theloader device3515 until the entireflow control device110 is located inside thehousing2940. Thepusher device3520 can then be removed from theloader device3515. Thecatheter2915 and the housing2940 (which now contains the loaded flow control device110) can then also be removed from theloader device3515.
• As mentioned above, theloader device3515 includes alocking mechanism3640 that is used to lock and position thecatheter2915 andcatheter housing2940 relative toloader device3515 during loading of theflow control device110 into thehousing2940. Anexemplary locking mechanism3640 is now described with reference toFIGS. 45-48, although it should be appreciated that other types of locking mechanisms and other locking procedures could be used to lock and position thecatheter2915 andcatheter housing2940 relative toloader device3515 during loading.
• As mentioned, the locking mechanism can comprise adoor3645 that can be moved to facilitate insertion of thecatheter housing2940 into theloader device3515. Such alocking mechanism3640 is described in more detail with reference toFIG. 45, which shows an exploded, rear, perspective view of theloading member3515. Thelocking mechanism3640 comprises adoor3645 that is pivotably-attached to a rear surface of theloader device3515 by afirst pin4210. Asecond pin4215 also attaches thedoor3645 to theloader device3515. The second pin extends through an arc-shapedopening4220 in thedoor3645 to provide a range of pivotable movement for thedoor3645 relative to theloader device3515, as described more fully below. The rear surface of theloader device3515 has anopening4230 that opens into thehousing region3630 of theloading tunnel3610 in theloader device3515. When mounted on theloader device3515, thedoor3645 can partially block theopening4230 or can leave the opening unblocked, depending on the position of thedoor3645. Thedoor3645 includes an irregular shapedentry port4235 through which thecatheter2915 andcatheter housing2940 can be inserted into theopening4230.
• FIG. 46 shows a rear view of theloader device3515 with thedoor3645 in a default, closed state. When in the closed state, the door partially occludes theopening4235. Theentry port4230 includes acatheter region4310 that is sized to receive theouter member2918 of thecatheter2915. Thecatheter region4310 is aligned with a central axis A of theopening4230 in theloader device3515 when thedoor3645 is closed. As shown inFIG. 47, thedoor3645 can be moved to an open position by rotating thedoor3645 about an axis defined by thefirst pin4210. When the door is in the open position, theentry port4230 is positioned such that a large portion of theentry port4230 is aligned with theopening4235 in theloader device3515 so that theopening4230 is unblocked. This allows thehousing2940 of thecatheter2915 to be inserted into thehousing region3630 through the alignedentry port4230 andopening4235 while thedoor3645 is in the open position, as shown inFIG. 48A. Thedoor3645 can then be released and returned to the closed position, such that thedoor3645 partially blocks theopening4230 and thereby retains thehousing2940 within thehousing region3630, as shown inFIG. 48B. Thedoor3645 can be spring-loaded so that it is biased toward the closed position.
• As discussed above, during loading of theflow control device110, theflow control device110 is initially positioned within theloading tunnel3610 of theloader device3515. The initial positioning of theflow control device110 can be facilitated through the use of aloading tube4610, shown inFIG. 49, which is comprised of ahandle4615 and anelongate tube region4620 having a diameter that can fit within the internal lumen of theflow control device110. Theelongate tube region4620 can be hollow so as to define an interior lumen that can fit over the front nose region3020 (shown inFIGS. 33 and 50A) of thecatheter2915. Theloading tube4610 is used as follows: theflow control device110 is first mounted on thetube region4620 by inserting thetube region4620 into the interior lumen of theflow control device110, such as is shown inFIG. 50A. Thetube region4620 can optionally have an outer diameter that is dimensioned such that the tube region fits somewhat snug within the interior lumen of theflow control device110 so that theflow control device110 is retained on thetube region4620 through a press-fit.
• As shown inFIG. 50B, theloading tube4610 is then used to insert theflow control device110 over thetip region3020 and into the tunnel of theloader device3515. Thehandle4615 can be grasped by a user to easily manipulate the positioning of theflow control device110 relative to theloader device3515. Theloading tube4610 can then be removed from theflow control device110 while keeping theflow control device110 mounted in theloader device3515 in an initial position. Thepusher device3715 is then used to push theflow control device110 entirely into theloader device3515, as was described above with reference toFIGS. 41-44.
• FIG. 51 shows another embodiment of thepusher device3520, which is referred to using thereference numeral3520a.Thepusher device3520aincludes threeseparate pistons3715a,3715b,3715cthat each extend radially outward from a center of thepusher device3520 in a pinwheel fashion. Each of thepistons3715a,3715b,3715chas a different length L. In particular, the piston3710ahas a length L1, the piston3615bhas a length L2, and the piston3710chas a length L3. Thepistons3715a,b,ccan be used in series to successively push theflow control device110 to increasingly greater depths into the tunnel of theloader device110. For example, the piston3710acan be used first to push theflow control device110 to a first depth L1, as shown inFIGS. 52A and 52B. The piston3710bcan be used next to push theflow control device110 to a second depth deeper than the first depth. The third piston3710ccan finally be used to push theflow control device110 entirely into the housing. The pistons3710a,b,ccan also have different diameters from one another. The varying diameters of the pistons can correspond to the varying diameter of the loading tunnel in which the piston will be inserted. For example, the piston with the shortest length can have a larger diameter, as such as piston will be inserted into the region of the loading tunnel that has a relatively large diameter. A large diameter will prevent the piston from being inserted to a location of smaller diameter in the tunnel. The piston with the longest length can have a smaller diameter, as such a piston will be inserted deeper into the loading tunnel, where the diameter is smaller. In this way, the piston length and diameter can be optimized for insertion into a particular location of the loading tunnel. In addition, the use of apusher device3520 with pistons of varying length can reduce the likelihood of pushing the flow control device into theloader device3515 at too fast of a rate.
• FIG. 53 shows another embodiment of a loader device, which is referred to asloader device3515a,as well as another embodiment of acorresponding pusher device3520, which is referred to using thereference numeral3520a.Theloader device3515ahas plurality ofprongs5015 that are arranged in an annular fashion so as to define a funnel-shapedloading region5010. Thus, theloading region5010 is defined by a series of prongs, rather than an internal tunnel, as in the embodiment of the loader device shown inFIG. 38. As shown inFIG. 54, thepusher device3520acan be inserted into theloading region5010 of theloader device3515ato load theflow control device110 into the housing of thecatheter2915 when thecatheter2915 is mated with theloader device3515a.It should be appreciated that other structures could be used to define the loading region of the loader device. Thepusher device3520ahas a piston with ridges that are dimensioned to mate with theprongs5015.
• FIGS. 55-58 show another embodiment of a loader device, which is referred to asloader device5510.FIG. 55 shows a front, plan view of theloader device5510 in an open state andFIG. 56 shows a side, plan view of the20loader device5510 in an open state. Theloader device5510 includes afirst handle5515 and asecond handle5520. Thehandles5515,5520 can be moved with respect to one another in a scissor fashion. Thehandles5515,5520 are attached to aloader head5525. Acompression mechanism5530 is contained in theloader head5525. Thecompression mechanism5530 comprises a series ofcams5549 that are mechanically-coupled to thehandles5515,5520, as described in more detail below.
• Thecompression mechanism5530 defines aloading tunnel5540 that extends through theloader head5525. Thecams5549 have opposed surfaces that define the shape of theloading tunnel5540. In the illustrated embodiment, there are four cams550 that define a rectangular-shaped tunnel looking through the tunnel when the device in the open state. As described below, when thehandles5515,5520 are closed, thecams5549 reposition so that the loading tunnel takes on a circular or cylindrical shape, as shown inFIG. 58. In the open state, theloading tunnel5540 can accept an uncompressedflow control device110 that has a diameter D. In alternative embodiments, thecompression mechanism5530 may contain three, five ormore cams5549.
• With reference toFIG. 56, theloader device5510 has apiston mechanism5545 that includes apiston5547 that is slidably positioned in theloading tunnel5540. Thepiston5547 is attached at an upper end to alever5550 that can be used to slide thepiston5547 through theloading tunnel5540. In an alternative embodiment, thepiston5547 is advanced manually, without the use of thelever5550, by pushing thepiston5547 into theloading tunnel5540.
• As mentioned, thefirst handle5515 and thesecond handle5520 are movable with respect to one another in a scissor fashion. In this regard,FIG. 55 shows thehandles5515,5520 in an open state.FIG. 57 shows thehandles5515,5520 in a closed state. The movement of thehandles5515,5520 with respect to one another actuates thecompression mechanism5530 by causing thecams5549 of thecompression mechanism5530 to change position and thereby change the size of theloading tunnel5540. More specifically, the diameter D of aflow control device110 inserted into theloading tunnel5540 is larger when thehandles5515,5520 are open (as shown inFIG. 55) and smaller when thehandles5515,5520 are closed (as shown inFIG. 57). When thehandles5515,5520 are open, the size of theloading tunnel5540 is sufficiently large to receive aflow control device110 of diameter D in the uncompressed state.
• Thus, as shown inFIG. 56, the flow control device110 (represented schematically by a box110) can be inserted into theloading tunnel5540. Once theflow control device110 is inserted into theloading tunnel5540, thehandles5515,5520 can be closed, which will cause the size of theloading tunnel5540 to decrease. The decrease in the size of theloading tunnel5540 will then compress the diameter of theflow control device110, which is contained in theloading tunnel5540. Theflow control device110 is compressed to a size that will permit theflow control device110 to fit within thehousing2940 of the catheter delivery system2910 (shown inFIG. 32). When thehandles5515,5520 are closed, theloading tunnel5540 is at its minimum size. Thecams5549 have a shape such that when theloading tunnel5540 is at its minimum size, theloading tunnel5540 preferably forms a cylinder. Theloading tunnel5540 may also form other shapes when the device is in the closed state, however a cylindrical shape is preferable.
• With reference toFIGS. 56 and 58, thepiston5547 can then be used to push theflow control device110 into thehousing2940. As mentioned, thelever5550 can be used to slidably move thepiston5547 through theloading tunnel5540. As shown inFIG. 56, when thelever5550 is in a raised position, the 10piston5547 is only partially inserted into theloading tunnel5540. As shown inFIG. 58, thelever5550 can be moved toward theloader head5525 to cause thepiston5547 to slide deeper into theloading tunnel5540 to a depth such that thepiston5547 will push theflow control device110 out of theloading tunnel5540. Thecatheter housing2940 can be placed adjacent to theloading tunnel5540 so that thehousing2940 can receive theflow control device110 as it is pushed out of theloading tunnel5540 by thepiston5547. AlthoughFIGS. 55-58 show thepiston mechanism5545 attached to theloader5510, it should be appreciated that thepiston mechanism5545 could be removably attached or a separate device altogether.
• Both thesecond handle5520 and thelever5550 for operating thepiston5547 are capable of being attached to one or more stops that allow the user to limit the amount of compression of theloading tunnel5540 or to limit the distance thepiston5547 moves into theloading tunnel5540. In this manner, theloader5510 can be set to compress aflow control device110 to a particular size (where the stop corresponds to a desired diameter) and insertion to a particular length (where the stop corresponds to a movement of the piston5547). It should be appreciated that theloader5510 can also be configured such that thesecond handle5520 can actuate both the compression mechanics as well as the piston5547 (or a piston substitute), such that when thesecond handle5520 is closed to a certain point, theflow control device110 will be fully compressed. Continuing to actuate thehandle5520 will cause theflow control device110 to be loaded into thehousing2940 of thecatheter2915.
• Theloader5510 advantageously allows a user to compress and load the 10 flow control device into thehousing2940 using a single hand. The user can load theflow control device110 into theloading tunnel5540 of theloader5510 and then use one hand to close thehandles5515,5520, which will cause theloader5510 to compress theflow control device110 to a size that will fit within thehousing2940. The user can then actuate thepiston mechanism5545 to eject15 theflow control device110 out of theloading tunnel5540 and into thehousing2940.
• Methods of Use
• Disclosed is a method of deploying aflow control device110 to a bronchial passageway in order to regulate or eliminate airflow to or from a targeted lung region. The deployedflow control device110 can eliminate air flow into the targeted lung region and result in collapse of the targeted lung region. However, the deployedflow control device110 need not result in the collapse of the targeted lung region in order to gain a beneficial effect. Rather, theflow control device110 can regulate airflow to and from the targeted lung region to achieve an improved air flow dynamic, such as by eliminating airflow into the targeted lung region during inhalation, but not resulting in collapse. The deployment of theflow control device110 can channel or redirect the inhaled air to a non-isolated, healthier region of the lung, thus improving ventilation to the healthier lung tissue, and improving ventilation-perfusion matching in the healthier lung region. The exhaled air of the targeted lung region can still be vented through the implanted one-wayflow control device110, and thus the exhalation dynamics of the targeted lung region need not be affected by the presence of the flow control device. This can result in an increase in the efficiency of oxygen uptake in the lungs.
• The method of deployment and treatment can be summarized according to the following steps, which are described in more detail below. It should be appreciated that some of the steps are optional and that the steps are not necessarily performed in the order listed below. The steps include:
• (a) identifying a targeted lung region and determining a target location in bronchial passageway(s) to which the flow control device will be deployed;
• (b) determining the diameter of the target location in the bronchial passageway(s) and selecting an appropriately sized flow control device for deploying in the lumen of the bronchial passageway; as described below, this step is optional, as a flow control device can be manufactured to span a wide range of bronchial diameters so that lumen measurement would not be necessary;
• (c) loading the selected flow control device into a delivery device, such as the delivery catheter described above, for delivering and deploying the flow control device to the bronchial passageway; this step is optional, as the flow control device can be manufactured or obtained pre-loaded in a delivery device;
• (d) positioning the delivery catheter within the bronchial passageway so that the flow control device is positioned at the target location in the bronchial passageway;
• (e) deploying the flow control device at the target location in the bronchial passageway;
• (f) removing the delivery device;
• (g) performing one or more procedures on the targeted lung region and/or allowing reactions to occur in the targeted lung region as a result of the presence of the flow control device.
• According to step (a), a physician or technician evaluates the diseased area of a patient's lung to determine the targeted lung region and then determines the bronchial passageway(s) that provide airflow to the targeted lung region. Based on this, one or more target locations of bronchial passageways can be determined to which one or more flow control devices can be deployed.
• In step (b), the proper size of a flow control device for insertion into the bronchial passageway is determined. As mentioned, this step is optional, as a flow control device can be manufactured to span a wide range of bronchial diameters so that lumen measurement would not be necessary. It should be appreciated that a precise match between the size of theflow control device110 and the lumen of the bronchial passageway is not required, as the compressibility and expandability of theflow control device110 provides a variation in size. In one embodiment, the flow control device is selected so that its size is slightly larger than the size of the bronchial passageway.
• Various methods of measuring a bronchial passageway diameter are known and understood in the art. For example, a balloon having a known ratio of inflation to diameter can be used, thus allowing an accurate way of determining a bronchial passageway diameter. A loop or measuring device such as a marked linear probe may also used. The diameter could also be measured using a high resolution computerized tomography (CT) scan. Even an “eye-ball” estimate could also be sufficient, wherein the sizing is done visually without using a measuring tool, depending on the skill of the physician.
• In step (c), the flow control device is loaded onto a delivery system, such as thedelivery system2910 comprised of thecatheter2915 that was described above with reference toFIG. 31. If thedelivery system2910 is used, theflow control device110 is loaded into thehousing2940 at the distal end of thecatheter2915, such as by using theloader system3510, described above. Alternately, theflow control device110 can be loaded into thehousing2940 by hand. As mentioned, the loading step can be optional, as theflow control device110 can be manufactured or obtained with the flow control device pre-loaded. It should be appreciated that other delivery systems could also be used to deliver the flow control device to the bronchial passageway.
• In step (d), the delivery catheter is inserted into the bronchial passageway so that theflow control device110 is positioned at a desired location in the bronchial passageway. This can be accomplished by inserting the distal end of thedelivery catheter2915 into the patient's mouth or nose, through the trachea, and down to the target location in the bronchial passageway. The delivery of thedelivery catheter2915 to the bronchial passageway can be accomplished in a variety of manners. In one embodiment, a bronchoscope is used to deliver thedelivery catheter2915. For example, with reference toFIG. 59, thedelivery catheter2915 can be deployed using abronchoscope5210, which in an exemplary embodiment has asteering mechanism5215, ashaft5220, a workingchannel entry port5225, and avisualization eyepiece5230. Thebronchoscope5210 has been passed into a patient'strachea225 and guided into the rightprimary bronchus510 according to well-known methods.
• It is important to note that the distal end of the bronchoscope is preferably deployed to a location that is at least one bronchial branch proximal to the target bronchial lumen where the flow control device will be implanted. If the distal end of the bronchoscope is inserted into the target bronchial lumen, it is impossible to properly visualize and control the deployment of the flow control device in the target bronchial lumen. For example, if the bronchoscope is advance into the rightprimary bronchus510 as shown inFIG. 59, the right upperlobar bronchi517 can be visualized through the visualization eyepiece of the bronchoscope. The right upperlobar bronchi517 is selected as the target location for placement of aflow control device110 and the distal end of the bronchoscope is positioned one bronchial generation proximal of the bronchial passageway for the target location. Thus, the distal end of the bronchoscope is deployed in the rightprimary bronchus510. Thedelivery catheter2915 is then deployed down a working channel (not shown) of thebronchoscope shaft5220 and thedistal end5222 of thecatheter2915 is guided out of the distal tip of the bronchoscope and advanced distally until the delivery system housing containing the compressed flow control device is located inside thelobar bronchi517.
• Thesteering mechanism5215 can be used to alter the position of the distal tip of the bronchoscope to assist in positioning the distal tip of thedelivery catheter5222 such that the delivery catheter housing can be advanced into the desired bronchi (in this case the lobar bronchi517). It should be appreciated that this technique can be applied to any desired delivery target bronchi in the lungs such as segmental bronchi, and not just the lobar bronchi.
• Alternately, thedelivery catheter2915 can be fed into the bronchoscope working channel prior to deploying the bronchoscope to the bronchial passageway. Thedelivery catheter2915 and thebronchoscope5210 can then both be delivered to the bronchial passageway that is one generation proximal to the target passageway as a single unit. The delivery catheter can then be advanced into the target bronchi as before, and theflow control device110 delivered.
• In another embodiment, theinner member2920 of thedelivery catheter2915 has a central guidewire lumen, so that thecatheter2915 is deployed using a guidewire that guides thecatheter2915 to the delivery site. In this regard, thedelivery catheter2915 could have a well-known steering function, which would allow thecatheter2915 to be delivered with or without use of a guidewire.FIGS. 60-61 illustrate how thecatheter2915 can be used to deliver theflow control device110 using a guidewire.
• FIG. 60 illustrates a first step in the process of deploying adelivery catheter2915 to a target location using a guidewire. Aguidewire5310 is shown passed down thetrachea225 so that the distal end of theguidewire5310 is at or near thetarget location5315 of the bronchial passageway. Theguidewire5310 can be deployed into the trachea and bronchial passageway through free wiring, wherein theguidewire5310 with a steerable tip is alternately rotated and advanced toward the desired location. Exchange wiring can also be used, wherein theguidewire5310 is advanced down the working channel of a bronchoscope that has been previously deployed. The bronchoscope can then be removed once the guidewire is at the desired location.
• In any event, after theguidewire5310 is deployed, the distal end of thedelivery catheter2915 is back loaded over the proximal end of theguidewire5310. Thedelivery catheter2915 is advanced along theguidewire5310 until thehousing2940 on the distal end of thedelivery catheter2915 is located at thetarget location5315 of the bronchial passageway. Theguidewire5310 serves to control the path of thecatheter2915, which tracks over theguidewire5310, and insures that thedelivery catheter2915 properly negotiates the path to the target site. Fluoroscopy can be helpful in visualizing and insuring that theguidewire5310 is not dislodged while the delivery catheter is advanced. As shown inFIG. 61, thedelivery catheter2915 has been advanced distally over theguidewire5310 such that thehousing2940 at the distal end of thedelivery catheter5310 has been located at thetarget location5315 of the bronchial passageway. Theflow control device110 is now ready for deployment.
• Visualization of the progress of the distal tip of thedelivery catheter2915 can be provided by a bronchoscope that is manually advanced in parallel and behind thedelivery catheter2915. Visualization or imaging can also be provided by a fiberoptic bundle that is inside theinner member2920 of thedelivery catheter2915. The fiberoptic bundle could be either a permanent part of theinner member2920, or could be removable so that it is left in place while thehousing2940 is maneuvered into position at the bronchial target location, and then removed prior to deployment of theflow control device110. The removable fiberoptic bundle could be a commercial angioscope which has fiberoptic lighting and visualization bundles, but unlike a bronchoscope, it is not steerable.
• Passage of the delivery catheter through tortuous bronchial anatomy can be accomplished or facilitated by providing thedelivery catheter2915 with a steerable distal end that can be controlled remotely. For example, if the distal end of thecatheter2915 could be bent in one direction, in an angle up to 180 degrees, by the actuation of a control on thehandle2925, thecatheter2915 could be advanced through the bronchial anatomy through a combination of adjusting the angle of the distal tip deflection, rotating thedelivery catheter2915, and advancing thedelivery catheter2915. This can be similar to the way in which many bronchoscopes are controlled.
• It can be advantageous to use a specific design of a guidewire that configured to allow thedelivery catheter2915 to navigate the tortuous bronchial anatomy with minimal pushing force, and minimal hang-ups on bronchial carinas.
• A guidewire can be constructed of a stainless steel core which is wrapped with a stainless steel coil. The coil is coated with a lubricous coating, such as a Polytetrafluoroethylene (PTFE) coating, a hydrophilic coating, or other lubricious coating. The guidewire can be in the range of, for example, around 180 cm in length and 0.035″ inch in overall diameter, though other lengths and diameters are possible. A proximal portion of the wire core can be constructed so that after winding the outer coil onto the core, it is as stiff as possible but still allows for easy placement in the lungs using an exchange technique with a bronchoscope. The distal portion, such as the distal-most 2-5 cm, of the wire core may be made with a more flexible construction in order to create an atraumatic tip to the wire. This atraumatic nature of the distal tip can be enhanced by adding a “modified j” tip. A portion of the wire (such as about 3 cm) between the distal and proximal sections could provide a gradual stiffness transition so that the guidewire does not buckle when placed in the lung anatomy.
• By having a relatively short atraumatic section, the clinician can place the guidewire in the target location of the bronchial passageway with only a small length of guidewire extending distally of the target passageway. This will minimize the probability of punctured lungs and other similar complications. The clinician can then utilize the stiff nature of the proximal portion of the guidewire to facilitate placing the delivery catheter all the way to the target bronchial passageway.
• With reference again to the method of use, in step (e), theflow control device110 is deployed at the target location of the bronchial passageway. Theflow control device110 is deployed in the bronchial lumen such that theflow control device110 will provide a desired fluid flow regulation through the bronchial lumen, such as to permit one-way fluid flow in a desired direction, to permit two-way fluid flow, or to occlude fluid flow.
• The deployment of theflow control device110 can be accomplished by manipulating the two-piece handle2925 of thecatheter2915 in order to cause thehousing2940 to disengage from theflow control device110, as was described above with reference toFIGS. 36 and 37. For example, the handle can be actuated to withdraw the outer member of the catheter relative to the inner member, which will cause thehousing2940 to move in a proximal direction while the flange on the inner member retains theflow control device110 against movement within the bronchial passageway. By withdrawing the housing instead of advancing the flange, theflow control device110 can be deployed in the bronchial passageway at the target location, rather than being pushed to a more distal location. After theflow control device110 has been deployed at the target site in the bronchial passageway, the delivery devices, such as thecatheter2915 and/or guidewire, is removed in step (f).
• Either all or a portion of theflow control device110 can be coated with a drug that will achieve a desired effect or reaction in the bronchial passageway where theflow control device110 is mounted. For example, theflow control device110 can be coated with any of the following exemplary drugs or compounds:
• (1) Antibiotic agents to inhibit growth of microorganisms (sirolimus, doxycycline, minocycline, bleomycin, tetracycline, etc.)
• (2) Antimicrobial agents to prevent the multiplication or growth of microbes, or to prevent their pathogenic action.
• (3) Antiinflammatory agents to reduce inflammation.
• (4) Anti-proliferative agents to treat cancer.
• (5) Mucolytic agents to reduce or eliminate mucus production.
• (6) Analgesics or pain killers, such as Lidocane, to suppress early cough reflex due to irritation.
• (7) Coagulation enhancing agents to stop bleeding.
• (8) Vasoconstrictive agents, such as epinephrine, to stop bleeding.
• (9) Agents to regenerate lung tissue such as all-trans-retinoic acid.
• (10) Steroids to reduce inflammation.
• (11) Gene therapy for parenchymal regeneration.
• (12) Tissue growth inhibitors (paclitaxel, rapamycin, etc.).
• (13) Sclerosing agents, such as doxycycline, minocycline, tetracycline, bleomycin, cisplatin, doxorubicin, fluorouracil, interferon-beta, mitomycin-c,Corynebacterium parvum,methylprednisolone, and talc.
• (14) Agents for inducing a localized infection and scar, such as a weak strain ofPneumococcus.
• (15) Fibrosis promoting agents, such as a polypeptide growth factor (fibroblast growth factor (FGF), basic fibroblast growth factor (bFGF), transforming growth factor-beta (TGF-.beta.)).
• (16) Pro-apoptopic agents such as sphingomyelin, Bax, Bid, Bik, Bad, caspase-3, caspase-8, caspase-9, or annexin V.
• (17) PTFE, parylene, or other lubricous coatings.
• (18) In addition, the retainer and other metal components could be irradiated to kill mucus production or to create scar tissue.
• It should be appreciated that the aforementioned list is exemplary and that theflow control device110 can be coated with other types of drugs or compounds.
• After theflow control device110 is implanted, the targeted lung region can be allowed to collapse over time due to absorption of trapped gas, through exhalation of trapped gas through the implantedflow control device110, or both. As mentioned, collapse of the targeted lung region is not necessary, as theflow control device110 can be used to simply modify the flow of air to the targeted lung region. Alternately, or in addition to, allowing the targeted lung region to collapse over time, one or more methods of actively collapsing the lung segment or segments distal to the implanted flow control device or devices can be performed. One example of an active collapse method is to instill an absorbable gas through a dilation catheter placed through the flow control device and very distally in the targeted lung region, while at the same time aspirating at a location proximal to theflow control device110 with a balloon catheter inflated in the proximal region of theflow control device110. In another example, oxygen is instilled into the distal isolated lung region through a catheter that dilates theflow control device110. When this is complete, a method of actively collapsing the isolated lung region could be performed (such as insuflating the pleural space of the lung) to drive the gas present in the isolated lung region out through the implantedflow control device110. One example of performing active collapse without a dilation device present would be to insert a balloon into the pleural space and inflate it to force gas or liquid out of the isolated lung region and collapse the lung.
• The following is a list of methods that can be used to actively collapse a targeted lung region that has been bronchially isolated using a flow control device implanted in a patient's bronchial passageway:
• (1) The patient is allowed to breath normally until air is expelled from the lung segment or segments distal to the device.
• (2) The targeted lung region is aspirated using a continuous vacuum source that can be coupled to a proximal end of the delivery catheter, to a dilator device that crosses the flow control device, or to a balloon catheter placed proximally to the implanted flow control device.
• (3) Fluid is aspirated from the targeted lung region using a pulsed (rather than continuous) vacuum source.
• (4) Fluid is aspirated from the targeted lung region using a very low vacuum source over a long period of time, such as one hour or more. In this case, the catheter may be inserted nasally and a water seal may control the vacuum source.
• (5) The targeted lung region can be filled with fluid, which is then aspirated.
• (6) Insuflate pleural space of the lung with gas through a percutaneously placed needle, or an endobronchially placed needle, to compress the lung.
• (7) Insert a balloon into the pleural space and inflate the balloon next to targeted lung region.
• (8) Insert a percutaneously placed probe and compress the lung directly.
• (9) Insert a balloon catheter into the bronchial passageway leading to adjacent lobe(s) of the targeted lung region and over-inflate the adjacent lung segment or segments in order to collapse the targeted lung region.
• (10) Fill the pleural space with sterile fluid to compress the targeted lung region.
• (11) Perform external chest compression in the region of the target segment.
• (12) Puncture the targeted lung region percutaneously and aspirate trapped air.
• (13) Temporarily occlude the bronchus leading to the lower lobe and/or middle lobe as the patient inhales and fills the lungs, thus increasing compression on the target lung segment or segments during exhalation.
• (14) Induce coughing.
• (15) Encourage the patient to exhale actively with pursed lip breathing.
• (16) Use an agent to clear or dilate the airways including mucolytics, bronchodilators, surfactants, desiccants, solvents, necrosing agents, sclerosing agents, perflourocarbons, or absorbents, then aspirate through the flow control device using a vacuum source.
• (17) Fill the isolated lung region with 100% oxygen (O2) or other easily absorbed gas. This could be accomplished using a dilation device, such as a catheter, that is passed through an implanted flow control device.
• The oxygen would dilute the gas that is in the isolated lung region to thereby raise the oxygen concentration, causing any excess gas to flow out of the isolated lung region through the flow control device or dilation device. The remaining gas in the isolated lung region would have a high concentration of oxygen and would be more readily absorbed into the blood stream. This could possibly lead to absorption atelectasis in the isolated lung region. The remaining gas in the isolated lung region could also be aspirated back through the dilation device to aid in collapse of the isolated lung region.
• Optionally, a therapeutic agent could be instilled through a dilator device (such as was described above) that has been passed through the flow control device deployed at a target site in the patient's bronchial lumen. The therapeutic agent is instilled into the bronchial lumen or lumens distal to the implanted flow control device. Alternately, brachytherapy source or sources could be inserted through the dilator device and into the lumen or lumens distal to the flow control device to reduce or eliminate mucus production, to cause scarring, or for other therapeutic purposes.
• The patient's blood can be de-nitrogenated in order to promote absorption of nitrogen in trapped airways. Utilizing any of the devices or methods above, the patient would either breath through a mask or be ventilated with heliox (helium-oxygen mixture) or oxygen combined with some other inert gas. This would reduce the partial pressure of nitrogen in the patient's blood, thereby increasing the absorption of nitrogen trapping in the lung spaces distal to the implanted flow control device.
• As mentioned, one method of deflating the distal lung volume involves the use of pulsed vacuum instead of continuous vacuum. Pulsatile suction is defined as a vacuum source that varies in vacuum pressure from atmospheric pressure down to −10 cm H.sub.2O. The frequency of the pulse can be adjusted so that the collapsed bronchus has time to re-open at the trough of the suction wave prior to the next cycle. The frequency of the pulse could be fast enough such that the bronchus does not have time to collapse at the peak of the suction wave prior to the next cycle. The suction force could be regulated such that even at the peak suction, the negative pressure is not low enough to collapse the distal airways. The frequency of the pulsatile suction could be set to the patient's respiratory cycle such that negative pressure is applied only during inspiration so that the lung's tethering forces are exerted keeping the distal airways open.
• One possible method of implementing this described form of pulsatile suction would be to utilize a water manometer attached to a vacuum source. The vacuum regulator pipe in the water manometer could be manually or mechanically moved up and down at the desired frequency to the desired vacuum break point (0 to −10 cm). This describes only one of many methods of creating a pulsatile vacuum source.
• At any point, the dilator device (if used) can be removed from the flow control device. This can be accomplished by pulling on a tether attached to the dilator device (such as was shown inFIG. 15), pulling on a catheter that is attached to the dilator device, or grasping the dilator device with a tool, such as forceps. After removal of the dilator device, another dilator device could be used to re-dilate the flow control device at a later time.
• Asymmetric Delivery Catheter
• During deployment of theflow control device110 using an over-the-wire delivery catheter, navigating thedelivery catheter2915 past the lungs' carinae can frequently present difficulties, as thehousing2940 can often get stuck against the sharp edge of a carina or will not properly align with the ostium of a target bronchus. If thehousing2940 gets stuck, it can be very difficult to advance thecatheter2915 any further or to achieve a more distal placement.
• In order to ease the navigation of the housing past carinae and into the ostium of a target bronchus, thetip region3020 of the catheterinner member2920 can have a rib orelongate protrusion5810 extending in one direction radially so as to provide thetip region3020 with an asymmetric shape, such as is shown inFIGS. 62 and 63. Thetip region3020 is asymmetric with respect to a centrallongitudinal axis6210 of thecatheter2915. Theprotrusion5810 can extend radially, for example, as far as the outer diameter of thehousing2940. Theprotrusion5810 extends only in one direction in order to minimize the perimeter of thetip region3020, which facilitates passing thetip region3020 through the central lumen of theflow control device110. Theprotrusion5810 can be made of a solid material (such as shown inFIG. 62) or, alternately, theprotrusion5810 can be hollow (such as shown byreference numeral6310 inFIG. 63) in order to allow some compressive compliance. The compliance would be such that theprotrusion5810 does not compress when pushed against lung tissue but would compress when it is pulled through theflow control device110 or pushed into the lumen of a loading device.
• By having theprotrusion5810 be compliant, theprotrusion5810 could be tall enough to extend to the outside diameter of the housing but then compress to a smaller size that would fit through the flow control device lumen or the loading device. Alternatively, two or more radially spaced protrusions could be added to thetip region3020 of thecatheter2915 to provide a smooth transition between thetip region3020 and thehousing2940. Theprotrusions5810 could be made hollow or very soft so that they would easily collapse when inserted through theflow control device110.
• As mentioned, theouter shaft2918 of thedelivery catheter2915 could be shaped to contain a curve, biasing the whole catheter in one direction. In one embodiment, shown inFIG. 64, thecurve6010, if present, is contained within a single plane and is limited to a portion, such as 3 inches, of catheter length just proximal to thehousing2940. The plane of the outer shaft curve could be coincident with the plane containing theprotrusion5810 on thetip region3020. In this manner, the curve in the outer shaft could be used to align thedelivery catheter2915 so that as thecatheter2915 is traveling over a curved guidewire it will have theprotrusion5810 always facing outward relative to the curve. Due to the three dimensional nature of the bronchial tree in the lungs, a useful geometry of the shaped end of the catheter may be a complex curve that bends in three dimension to match the lung anatomy, rather than being a simple curve in single plane (two dimensions). In addition, the proximal end of thecatheter2915 might be shaped to conform to the curve commonly found in endotracheal tubes to ease delivery if the patient is under general anesthesia and is being ventilated.
• Although embodiments of various methods and devices are described herein in detail with reference to certain versions, it should be appreciated that other versions, embodiments, methods of use, and combinations thereof are also possible. Therefore the spirit and scope of the appended claims should not be limited to the description of the embodiments contained herein.

Claims (12)

1. (canceled)

2. A method for deploying a flow control device in a bronchial passageway to regulate airflow to a targeted lung region, the method comprising:

identifying the targeted lung region;

determining a target location for deploying the flow control device in a bronchial passageway leading to the targeted lung region;

approximating an inner diameter of the bronchial passageway at the target location;

selecting an appropriately sized flow control device for deploying in the bronchial passageway, based on the approximated inner diameter;

loading the selected flow control device into a delivery catheter;

advancing the delivery catheter into the bronchial passageway to position the flow control device at the target location;

deploying the flow control device out of the delivery catheter at the target location, wherein upon deployment the flow control device expands to form a seal with an inner wall of the bronchial passageway; and

removing the delivery catheter.

3. A method as inclaim 2, wherein the identifying and determining steps are performed by evaluating a CT scan.

4. A method as inclaim 2, wherein approximating the inner diameter is performed using a bronchial passageway measurement device.

5. A method as inclaim 2, wherein approximating the inner diameter comprises evaluating a CT scan including the bronchial passageway.

6. A method as inclaim 2, wherein approximating the inner diameter comprises viewing the bronchial passageway using a bronchoscope.

7. A method as inclaim 2, wherein advancing the delivery catheter comprises advancing the catheter through a bronchoscope.

8. A method as inclaim 2, further comprising repeating at least some of the steps to deploy at least one additional flow control device in at least one additional bronchial passageway.

9. A method as inclaim 8, wherein the at least one additional bronchial passageway leads to the targeted lung region.

10. A method as inclaim 8, wherein the at least one additional bronchial passageway leads to an additional targeted lung region.

11. A method as inclaim 2, wherein the targeted lung region comprises a lobe of a lung.

12. A method as inclaim 2, wherein the targeted lung region comprises a segment of a lung.

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