APPARATUS FOR PROVIDING ELECTROMAGNETIC BIOSTIMULATION OF TISSUE USING OPTICS AND ECHO IMAGING

• US 20020183809A1
• Filed: 07/16/2002
• Published: 12/05/2002
• Est. Priority Date: 07/28/1996
• Status: Active Grant

• Current Assignee: Avraham Matcovitch, Uri Oron
• Original Assignee: Avraham Matcovitch, Uri Oron
• Inventors: Matcovitch, Avraham, Oron, Uri
• Granted Patent: US 7,051,738 B2
• Time in Patent Office: Days
• US Class Current: 607/88
• CPC Class Codes: A61B 1/0051 with controlled bending of insertion part
• CPC Class Codes: A61B 1/0056 the insertion parts being asymmetric, e.g. for unilateral bending mechanisms
• CPC Class Codes: A61B 10/02 Instruments for taking cell samples or for biopsy A61B10/0038 and A61B10/0045 take precedence; needle locating or guiding means A61B17/3403; samplers for enzymology or microbiology C12M1/26; sampling or preparing biological specimens G01N33/48
• CPC Class Codes: A61B 17/22012 in direct contact with, or very close to, the obstruction or concrement for removing obstructions in blood vessels by laser A61B18/245
• CPC Class Codes: A61B 17/3403 Needle locating or guiding means guides for suture needles A61B17/0482; guiding or tracking by nuclear magnetic resonance G01R33/285
• CPC Class Codes: A61B 18/24 with a catheter A61B18/26, A61B18/28 take precedence
• CPC Class Codes: A61B 18/245 for removing obstructions in blood vessels or calculi
• CPC Class Codes: A61B 2017/00039 Electric or electromagnetic phenomena other than conductivity, e.g. capacity, inductivity, Hall effect
• CPC Class Codes: A61B 2017/00106 ultrasonic
• CPC Class Codes: A61B 2017/00243 cardiac
• CPC Class Codes: A61B 2017/00247 Making holes in the wall of the heart, e.g. laser Myocardial revascularization
• CPC Class Codes: A61B 2017/003 Steerable
• CPC Class Codes: A61B 2017/00867 shape memory effect for prostheses A61F2210/0014
• CPC Class Codes: A61B 2017/22002 preventing restenosis
• CPC Class Codes: A61B 2017/22008 used or promoted
• CPC Class Codes: A61B 2018/00392 Transmyocardial revascularisation
• CPC Class Codes: A61B 2018/2211 Plurality of fibres
• CPC Class Codes: A61B 2018/2272 with reflective or refractive surfaces for deflecting the beam A61B2018/2261, A61B2018/2266 take precedence
• CPC Class Codes: A61B 2034/2051 Electromagnetic tracking systems
• CPC Class Codes: A61B 2090/363 Use of fiducial points
• CPC Class Codes: A61B 2090/374 : NMR or MRI
• CPC Class Codes: A61B 2090/378 : using ultrasound
• CPC Class Codes: A61B 2090/3954 : magnetic, e.g. NMR or MRI
• CPC Class Codes: A61B 34/20 : Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
• CPC Class Codes: A61B 5/06 : Devices, other than using radiation, for detecting or locating foreign bodies for removing same A61B17/50 ; determining position of probes within or on the body of the patient
• CPC Class Codes: A61B 5/061 : Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body A61B1/00158 takes precedence
• CPC Class Codes: A61B 5/287 : Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
• CPC Class Codes: A61B 5/6885 : Monitoring or controlling sensor contact pressure
• CPC Class Codes: A61B 8/0833 : involving detecting or locating foreign bodies or organic structures
• CPC Class Codes: A61B 8/0841 : for locating instruments
• CPC Class Codes: A61B 8/12 : in body cavities or body tracts, e.g. by using catheters catheters per se A61M25/00
• CPC Class Codes: A61M 2025/0166 : Sensors, electrodes or the like for guiding the catheter to a target zone, e.g. image guided or magnetically guided
• CPC Class Codes: A61M 25/01 : Introducing, guiding, advancing, emplacing or holding catheters A61M25/10 takes precedence
• CPC Class Codes: A61M 25/0105 : Steering means as part of the catheter or advancing means; Markers for positioning systems for detection of markers A61B
• CPC Class Codes: A61M 25/104 : used for angioplasty
• CPC Class Codes: A61N 1/05 : for implantation or insertion into the body, e.g. heart electrode A61N1/06 takes precedence
• CPC Class Codes: A61N 2005/0659 : infrared
• CPC Class Codes: A61N 5/0601 : Apparatus for use inside the body
• CPC Class Codes: A61N 5/062 : Photodynamic therapy, i.e. excitation of an agent

Abstract

An apparatus for providing electromagnetic biostimulation of tissue includes a source of electromagnetic radiation and relay optics operatively connected to the source of electromagnetic radiation for transmitting electromagnetic radiation for biostimulating tissue. An echo imaging device for producing an ultrasonic image of the tissue is also provided. And, control circuitry is used for controlling the electromagnetic radiation.

Claims

1. A method for biostimulation of a myocardial tissue comprising:

irradiating the myocardial tissue with a source of electromagnetic radiation which causes biostimulation of the myocardial tissue.

2. A method according to claim 1, wherein the electromagnetic radiation is selected from the group consisting of infrared, visible light and ultraviolet radiation.

3. A method according to claim 1, wherein irradiating the tissue comprises irradiating after the myocardial tissue develops an infarct of a given size, such that irradiating the myocardial tissue causes a reduction in the size of the infarct.

4. A method according to claim 1, wherein irradiating the tissue comprises irradiating after the myocardial tissue develops an infarct, such that irradiating the myocardial tissue causes regeneration of cardiomyocytes in the infarct.

5. A method according to claim 1, wherein irradiating the tissue comprises irradiating after the myocardial tissue develops an infarct, such that irradiating the myocardial tissue preserves structure and activity of mitochondria in cardiomyocytes in the infarct.

6. A method according to claim 1, wherein irradiating the tissue comprises irradiating after the myocardial tissue develops an infarct, such that irradiating the myocardial tissue preserves structure and activity of contractile proteins in cardiomyocytes in the infarct.

7. A method according to claim 1, wherein the source of electromagnetic radiation comprises a source of coherent light.

8. A method according to claim 7, wherein the source of coherent light comprises a diode laser.

9. A method according to any of claims 1-8, wherein the source has a power output in the range of 5 mW-5 W and a wavelength in the range of 250-940 nm.

10. A method according to any of claims 1-8, wherein irradiating the tissue comprises a plurality of irradiations of the myocardial tissue with the source of electromagnetic radiation.

11. A method according to any of claims 1-8, wherein irradiating the tissue comprises irradiating myocardial tissue with the source of electromagnetic radiation for a duration of 0.5-15 minutes.

12. A method according to any of claims 1-8, wherein irradiating the tissue comprises introducing a catheter into the heart, positioning the catheter in proximity to a heart wall, and irradiating the myocardial tissue via a waveguide introduced by the catheter into the heart, wherein the waveguide is coupled to the source of radiation.

13. A method according to claim 12, wherein the catheter is introduced through the aorta.

14. A method according to any of claims 1-8, and comprising administering a therapeutic chemical compound in conjunction with the irradiating.

15. A method according to claim 14, wherein administering the chemical compound comprises administering fructose-1,6-diphosphate (FDP).

16. A method according to claim 14, wherein administering the chemical compound comprises administering a seleno-organic free radicals scavenger.

17. A method according to claim 14, wherein irradiating the tissue and administering the chemical alleviate a post-reperfusion injury.

18. A method according to claim 12, and comprising performing a myocardial revascularization procedure in conjunction with the irradiating.

19. A method according to claim 18, wherein performing the myocardial revascularization procedure comprises performing a revascularization procedure simultaneously with the irradiating.

20. A method according to claim 12, and comprising receiving physiological signals from the tissue, wherein irradiating the tissue comprises irradiating heart tissue in response to the signals received therefrom.

21. A method according to claim 20, wherein the physiological signals comprise mechano-physiological signals.

22. A method according to claim 20, wherein the physiological signals comprise electrophysiological signals.

23. A method according to claim 12, wherein positioning the catheter comprises tracking location coordinates of the catheter using one or more position sensors.

24. A method according to claim 23, wherein positioning the catheter comprises positioning the catheter responsive to a viability map, which indicates ischemic areas in the heart tissue.

25. A method according to claim 23, wherein positioning the catheter comprises positioning the catheter relative to a grid delineating a zone to be irradiated on a geometrical map of the heart.

26. A method according to claim 25, and comprising marking irradiated locations on the grid.

27. A method according to claim 12, wherein irradiating the tissue comprises simultaneously irradiating an area of the heart wall substantially larger than a cross-sectional area of the waveguide.

28. A method according to claim 27, wherein irradiating the tissue via the waveguide comprises expanding a radial dimension of the waveguide adjacent the tissue.

29. A method according to claim 12, wherein positioning the catheter comprises pressing a flexible distal portion of the catheter against the heart wall so that the portion conforms to the wall, and wherein irradiating the tissue comprises irradiating an area radially adjacent the distal portion.

30. A method according to claim 29, wherein irradiating the tissue comprises irradiating a first elongate stripe on the heart wall adjacent the distal portion in a first position thereof, and irradiating a plurality of stripes generally parallel to the first stripe.

31. A method according to claim 12, wherein the catheter is introduced into a coronary artery.

32. A method according to claim 12, wherein irradiating the heart tissue comprises irradiating the heart epicardially, in addition to irradiating via the waveguide introduced by the catheter.

33. A method according to any of claims 1-8, and comprising at least partially exposing non-myocardial tissues in a generally perpendicular direction to a lateral wall of the myocardial tissue, and wherein irradiating the tissue comprises placing an optical element coupled to the source of electromagnetic radiation onto the at least partially exposed non-myocardial tissues.

34. A method according to claim 33, wherein the non-myocardial tissues comprise chest muscles of a chest cavity and irradiating the tissue comprises placing the optical element into the chest cavity in a vicinity of the tissue.

35. A method according to claim 33, wherein placing the optical element comprises bringing the element into proximity with the pleural membrane.

36. A method according to any of claims 1-8, and wherein the source of electromagnetic radiation comprises a source of concentrated non-coherent light.

37. A method according to claim 36, wherein the source of concentrated non-coherent light comprises a xenon lamp.

38. A method according to claim 37 wherein the xenon lamp has an radiative power flux of 30-500 mW/cm².

40. Apparatus according to claim 39, and comprising an echo transducer which communicates with an echo imaging device, the echo transducer being operative to provide positional information of the infarct;

and a fastener which fastens the relay optics together with the echo transducer and which substantially maintains the two in a fixed spatial relationship with each other.

41. Apparatus according to claim 39, wherein the electromagnetic radiation source comprises a coherent source.

42. Apparatus according to claim 41, wherein the coherent source comprises a diode laser.

43. Apparatus according to claim 42, wherein the diode laser has a power output in the range of 5 mW to 5 W and a wavelength in the range of 250 to 940 nm.

44. Apparatus according to claim 39, wherein the electromagnetic radiation source comprises a non-coherent source.

45. Apparatus according to claim 44, wherein the non-coherent source comprises a xenon lamp.

46. Apparatus according to claim 45, wherein the xenon lamp has a radiative power flux of 30 to 500 mW/cm².

49. Apparatus according to claim 48, wherein the optics comprise a filter to attenuate electromagnetic radiation power output therefrom and a lens coupled to the distal end of the fiberoptic light guide.

39. Apparatus for biostimulation of myocardial tissue comprising:

a source of electromagnetic radiation; and

relay optics, which receive the electromagnetic radiation, and convey the radiation to irradiate an ischemic area of the myocardial tissue.

47. Apparatus according to any of claims 39-46, and comprising a moving arm holding the relay optics and a servo unit for controllably moving the arm.

48. Apparatus according to any of claims 39-46, wherein the relay optics comprise a fiberoptic light guide, having a distal end for introduction into a patient'"'"'s chest, and a proximal end communicating with the electromagnetic radiation source.

50. Apparatus according to any of claims 39-46, and comprising an elongate probe for introduction into a heart chamber, wherein the relay optics include a waveguide contained within the probe.

51. Apparatus according to claim 50, wherein the probe comprises at least one position sensor, which is used to locate the probe within the chamber of the heart.

52. Apparatus according to claim 51, wherein the position sensor comprises a magnetic position sensor, which generates signals responsive to an external magnetic field.

53. Apparatus according to claim 50, wherein the probe comprises at least one physiological sensor for sensing local physiological signals from the heart indicative of myocardial viability.

54. Apparatus according to claim 50, wherein the probe comprises a radiometric sensor for sensing a local electromagnetic radiation power level reaching the myocardial tissue.

55. Apparatus according to claim 50, wherein the probe comprises a LMR waveguide, which communicates with a laser source for laser revascularization of the myocardial tissue.

56. Apparatus according to claim 55, wherein the LMR waveguide is connected at its distal end to a lens adapted to concentrate the laser beam onto the tissue.

57. Apparatus according to claim 50, wherein the waveguide comprises fiberoptics.

58. Apparatus according to claim 57, wherein the waveguide is connected at a distal end thereof to an optical element, which spreads the biostimulatory electromagnetic radiation.

59. Apparatus according to claim 58, wherein the optical element comprises a wide-angle lens.

60. Apparatus according to claim 59, wherein the lens comprises a fish-eye lens.

61. Apparatus according to claim 58, wherein the optical element emits a beam having a cross-sectional area substantially larger than a cross-section of the waveguide.

62. Apparatus for intracardiac irradiation, comprising:

an elongate probe having a proximal end and a distal end for insertion into the heart of a subject, and including;

a waveguide, which conveys electromagnetic radiation from a source at the proximal end to the distal end; and

an optical element adjacent to the distal end, which receives electromagnetic radiation through the waveguide and emits a beam having a cross-sectional area substantially larger than a cross-section of the waveguide.

63. Apparatus according to claim 62, wherein the optical element comprises an elongate, longitudinally-disposed element, which emits the beam in an outward radial direction relative to the probe.

64. Apparatus according to claim 63, wherein the optical element comprises a curved outer surface.

65. Apparatus according to claims 63 or 64, wherein the element is at least 2 cm long and between 2 and 3 mm wide.

66. Apparatus according to claim 63 or 64, wherein the probe comprises a flexible portion, which contains the optical element, and which conforms to a wall of the heart such that the optical element is in physical contact therewith.

67. Apparatus according to claim 66, wherein the probe comprises two or more proximity sensors, which sense a contact of the probe with the heart wall.

68. Apparatus according to claim 67, wherein the proximity sensors comprise pressure sensors.

69. Apparatus according to claim 62, wherein the optical element comprises a generally elliptical radiation-emitting area at the distal end of the probe, obliquely disposed with respect to the probe'"'"'s longitudinal axis .

70. Apparatus according to claim 69, wherein the element has a convex outer surface.

71. Apparatus according to claim 62, wherein the optical element comprises a widening optical tip at the distal end, having a narrow, closed configuration for insertion into the heart and a wide, expanded configuration for irradiation of the myocardial tissue inside the heart.

72. Apparatus according to claim 71, wherein the tip comprises a radiation scattering membrane.

73. Apparatus according to claim 71, wherein the tip comprises a foldable reflector encompassing a radiation emitting point source.

74. Apparatus according to claim 73, wherein the reflector comprises a multifaceted reflector.

75. Apparatus according to claim 71, wherein the tip comprises a foldable fiberoptic bundle.

76. Apparatus according to any of claims 71-75, wherein the probe comprises an external sleeve and an internal sleeve, slideable within the external sleeve, wherein the internal sleeve comprises a stretchable portion adjacent the distal end of the probe, which is held within the external sleeve in the closed configuration, and which stretches open when the internal sleeve is slid distally out of the external sleeve in the open configuration.