Sizing catheters, methods of sizing complex anatomies and methods of selecting a prosthesis for implantation

• US 10,322,000 B2
• Filed: 04/05/2018
• Issued: 06/18/2019
• Est. Priority Date: 04/05/2017
• Status: Active Grant

• Current Assignee: Medtronic Vascular, Inc. (Medtronic Plc)
• Original Assignee: Medtronic Vascular, Inc. (Medtronic Plc)
• Inventors: Orth, Geoffrey, Toloui, Mostafa, Garde, Kshitija, Krivoruchko, Michael, McHenry, Brian, Wang, Wei, Tien, Tracey, Ahlberg, Sarah, Clague, Cynthia
• Primary Examiner(s): Park, Edward
• Application Number:
  US15/946,043
• Publication Number:
  US 20180289488A1
• Time in Patent Office: 439 Days
• CPC Class Codes: A61B 5/02007 Evaluating blood vessel condition, e.g. elasticity, compliance
• CPC Class Codes: A61B 5/1076 for measuring dimensions inside body cavities, e.g. using catheters A61B3/1005 takes precedence
• CPC Class Codes: A61B 5/6852 Catheters
• CPC Class Codes: A61B 5/6853 with a balloon
• CPC Class Codes: A61F 2/2427 Devices for manipulating or deploying heart valves during implantation
• CPC Class Codes: A61F 2/2496 Devices for determining the dimensions of the prosthetic valve to be implanted, e.g. templates, sizers

Abstract

Aspects of the disclosure include sizing catheters and methods for determining the size and other physical parameters of an internal orifice or lumen. Embodiments include a sizing catheter assembly having a handle assembly and a catheter assembly including at least one catheter extending from the handle assembly. The catheter assembly also includes at least two sizers, which can be adjustably spaced from each other. Each of the sizers are configured to conform to respective portions of a lumen of a patient'"'"'s anatomy. The sizing catheter is configured such that the sizers are configured to specify or determine first and second dimensions of the lumen and also distance between the sizers. The sizers can include valve leaflets or the sizing catheter can include a temporary valve. Additional aspects include software/methods of assessing and determining an appropriate implantable device that can include assessing the biomechanical interaction between the device and the anatomy.

Claims

1. A method of selecting a prosthesis for implantation within a lumen of a patient'"'"'s anatomy comprising:

providing a lumen sizing device comprising;

a handle assembly,

a catheter extending from the handle assembly,

a distal sizer positioned on the catheter proximal a distal end of the catheter, and

a proximal sizer positioned on the catheter and spaced proximally from the distal sizer;

delivering the proximal and distal sizers to a target site within the lumen;

determining a first lumen dimension proximate the distal sizer, determining a second lumen dimension proximate the proximal sizer, and determining a distance between the distal and proximal sizers;

creating a three-dimensional model of the target site of the lumen based on a diameter of the first lumen, a diameter of the second lumen, and the distance between the first and second lumen diameters;

determining a plurality of potential prosthesis deployment positions and axis orientations relative to the three-dimensional model;

conducting a geometric fit analysis by iteratively comparing the geometry of a plurality of differently sized prostheses to the plurality of potential prosthesis deployment positions and axis orientations to identify one or more appropriately sized prostheses based on one or more geometric fit parameters; and

conducting a biomechanical interaction analysis between the one or more appropriately sized prostheses and the patient'"'"'s anatomy to select a prosthesis for implantation.

2. The method of claim 1, wherein the proximal sizer is adjustably spaced from the distal sizer.

3. The method of claim 2, wherein the distal and proximal sizers are configured to determine first and second dimensions of the lumen at a selected distance between the distal and proximal sizers.

4. The method of claim 1, wherein the distal or proximal sizer includes a hoop having an adjustable diameter.

5. The method of claim 1, wherein, in a deployed position, the distal sizer and the proximal sizer are different sizes.

6. The method of claim 1, wherein the distal sizer is spaced from the proximal sizer between about 5 and about 100 mm.

7. The method of claim 1, wherein the distal or proximal sizers are inflatable.

8. The method of claim 1, wherein the distal or proximal sizer is adjustable in diameter via the handle assembly.

9. The method of claim 8, wherein the distance between the sizers is adjustable independent of adjustment of a diameter of the proximal or distal sizer.

10. The method of claim 1, wherein the distal or proximal sizer includes a valve structure.

11. The method of claim 1, wherein the distal and proximal sizers include a lumen to allow for blood flow through the distal and proximal sizers.

12. The method of claim 1, wherein the lumen sizing device further comprises a prosthetic valve positioned on the catheter between the distal sizer and the proximal sizer.

13. The method of claim 1, wherein at least one of the proximal and distal sizers includes a sensor selected from the group consisting of a mechanical sensor and an impedance sensor.

14. The method of claim 1, wherein the proximal sizer is adjustably spaced from the distal sizer and further comprising adjusting the distance between the sizers.

15. The method of claim 1, further comprising the step of CT or MR imaging of a portion of the patient'"'"'s anatomy including the lumen.

16. The method of claim 15, wherein creating the three-dimensional model of the target site of the lumen includes the use of images from the step of imaging of the patient'"'"'s anatomy.

17. The method of claim 1, further comprises one or more data-driven machine learning techniques.

18. The method of claim 1, further comprises FEA.

19. The method of claim 1, further comprises statistical shape modeling.

20. The method of claim 1, further comprising the step of determining an optimal prosthesis deployment position and axis orientation and further comprising the step of deploying the selected prosthesis within the lumen in the optimal position and axis orientation.