Therapeutic system with energy application device and programmed power delivery

• US 20070055327A1
• Filed: 07/21/2006
• Published: 03/08/2007
• Est. Priority Date: 07/21/2005
• Status: Active Grant

• Current Assignee: Covidien LP (Medtronic Plc)
• Original Assignee: Covidien LP (Medtronic Plc)
• Inventors: Esch, Brady, Tantisira, Radit
• Granted Patent: US 8,636,729 B2
• Time in Patent Office: Days
• US Class Current: 607/96
• CPC Class Codes: A61B 18/08 by means of electrically-heated probes
• CPC Class Codes: A61B 18/082 Probes or electrodes therefor
• CPC Class Codes: A61B 18/1492 having a flexible, catheter-like structure, e.g. for heart ablation A61B18/1477 takes precedence
• CPC Class Codes: A61B 18/20 using laser
• CPC Class Codes: A61B 18/24 with a catheter A61B18/26, A61B18/28 take precedence
• CPC Class Codes: A61B 2017/00026 Conductivity or impedance, e.g. of tissue
• CPC Class Codes: A61B 2017/00084 Temperature
• CPC Class Codes: A61B 2017/00119 alarm; indicating an abnormal situation
• CPC Class Codes: A61B 2017/00123 and automatic shutdown
• CPC Class Codes: A61B 2017/00132 Setting operation time of a device A61B2017/00123 takes precedence
• CPC Class Codes: A61B 2018/00636 Sensing and controlling the application of energy
• CPC Class Codes: A61B 2018/00666 using a threshold value
• CPC Class Codes: A61B 2018/00779 Power or energy
• CPC Class Codes: A61B 2018/00791 Temperature
• CPC Class Codes: A61B 2018/00827 Current
• CPC Class Codes: A61B 2018/046 in liquid form
• CPC Class Codes: A61B 2090/0811 for the position of a particular part of an instrument with respect to the rest of the instrument, e.g. position of the anvil of a stapling instrument
• CPC Class Codes: A61B 2090/3925 ultrasonic
• CPC Class Codes: A61B 2090/3937 Visible markers
• CPC Class Codes: A61B 2090/3945 Active visible markers, e.g. light emitting diodes
• CPC Class Codes: A61B 90/39 : Markers, e.g. radio-opaque or breast lesions markers

Abstract

A working end of a catheter includes at least one therapeutic element, such as a resistive heating element, usable to deliver energy for ligating, or reducing the diameter of, a hollow anatomical structure. In certain examples, the catheter includes a lumen to accommodate a guide wire or to allow fluid delivery. In certain embodiments, a balloon is inflated to place resistive element(s) into apposition with a hollow anatomical structure and to occlude the structure. Indexing devices and methods are also disclosed for successively treating portions of the hollow anatomical structure. In certain examples, marks along the catheter shaft provide visual verification to the physician of the relative position of the therapeutic element of the catheter. Embodiments of indexing devices may include pairs of rings and/or hinged arms that move a catheter a desired indexed position between successive treatments.

Claims

1. A hollow anatomical structure therapy system comprising:

an energy application device suitable for insertion into a hollow anatomical structure;

a power source in communication with said energy application device, said power source comprising a processor and program instructions executable by said processor such that said power source is operable to;

(a) deliver power to said energy application device during a first power delivery phase;

(b) measure time elapsing during power delivery;

(c) assess performance of said therapy system during said first power delivery phase; and

(d) if said performance of said therapy system during said first power delivery phase is satisfactory, deliver power to said energy application device during a second power delivery phase.

2. A hollow anatomical structure therapy system in accordance with claim 1, wherein said energy application device is selected from the group consisting of an electrically driven heating element, an electrode, and a laser.

3. A hollow anatomical structure therapy system in accordance with claim 1, wherein said energy application device comprises an electrically driven heating element with an energy coupling surface, said surface having a distal-to-proximal length which is at least fifteen times a width of said heating element.

4. A hollow anatomical structure therapy system in accordance with claim 1, further comprising a catheter having a shaft to which said energy application device is coupled.

5. A hollow anatomical structure therapy system in accordance with claim 1, further comprising a temperature sensor configured to sense at least one of (i) a temperature of at least a portion of said energy application device, and (ii) a temperature of tissue in thermal communication with said energy application device.

6. A hollow anatomical structure therapy system in accordance with claim 5, wherein said program instructions are executable by said processor such that said power source is further operable to:

deliver power to said energy application device to reach a first treatment temperature; and

deliver power to said energy application device to reach a subsequent second treatment temperature which is lower than said first treatment temperature.

7. A hollow anatomical structure therapy system in accordance with claim 5, wherein said program instructions are executable by said processor such that said power source is further operable to determine expiration of said first power delivery phase based on temperature measurement results obtained by said temperature sensor.

8. A hollow anatomical structure therapy system in accordance with claim 1, wherein said first power delivery phase is 10 seconds or less in duration.

9. A hollow anatomical structure therapy system in accordance with claim 5, wherein satisfactory performance of said therapy system comprises reaching or exceeding a target temperature within a time limit.

10. A hollow anatomical structure therapy system in accordance with claim 9, wherein said program instructions are executable by said processor such that said power source proceeds to said second power delivery phase only when said temperature sensor senses said target temperature within said time limit.

11. A hollow anatomical structure therapy system in accordance with claim 5, wherein said program instructions are executable by said processor such that said power source is further operable to determine expiration of said first power delivery phase when said temperature sensor senses a target temperature within a time limit.

12. A hollow anatomical structure therapy system in accordance with claim 11, wherein said time limit is six seconds or less.

13. A hollow anatomical structure therapy system in accordance with claim 11, wherein said target temperature is approximately 120 degrees Celsius.

14. A hollow anatomical structure therapy system in accordance with claim 1, wherein the combined duration of said first power delivery phase and said second power delivery phase is 60 seconds or less.

15. A hollow anatomical structure therapy system comprising:

a heat delivery device suitable for insertion into a hollow anatomical structure;

a power source in communication with said heat delivery device, said power source being programmed to;

(a) deliver power to said heat delivery device during a temperature ramp-up phase;

(b) measure time elapsing during power delivery;

(c) monitor operation of said heat delivery device; and

(d) if said operation of said heat delivery device either during or shortly after said temperature ramp-up phase is acceptable, deliver power to said heat delivery device after said temperature ramp-up phase.

16. A hollow anatomical structure therapy system in accordance with claim 15, wherein said heat delivery device is selected from the group consisting of an electrically driven heating element, an electrode, and a laser.

17. A hollow anatomical structure therapy system in accordance with claim 15, wherein said heat delivery device comprises an electrically driven heating element with an energy coupling surface, said surface having a distal-to-proximal length which is at least fifteen times a width of said heating element.

18. A hollow anatomical structure therapy system in accordance with claim 15, further comprising a catheter having a shaft to which said heat delivery device is coupled.

19. A hollow anatomical structure therapy system in accordance with claim 15, further comprising a temperature sensor configured to sense at least one of (i) a temperature of a portion of said heat delivery device, and (ii) a temperature of tissue in thermal communication with said heat delivery device.

20. A hollow anatomical structure therapy system in accordance with claim 15, wherein acceptable operation of said heat delivery device during or shortly after said temperature ramp-up phase comprises reaching or exceeding a target temperature within a time limit.

21. A hollow anatomical structure therapy system in accordance with claim 15, wherein acceptable operation of said heat delivery device during or shortly after said temperature ramp-up phase comprises falling below a target temperature within a time limit.

22. A hollow anatomical structure therapy system in accordance with claim 15, wherein the combined duration of said temperature ramp-up phase and a subsequent power delivery phase is 60 seconds or less.

23. A hollow anatomical structure therapy system in accordance with claim 15, wherein said power source is further programmed to:

deliver power to said heat delivery device to reach a first treatment temperature; and

deliver power to said heat delivery device to reach a subsequent second treatment temperature which is lower than said first treatment temperature.

24. A method of treating a hollow anatomical structure, said method comprising:

inserting a heat delivery device into a hollow anatomical structure;

delivering power to said heat delivery device during a temperature ramp-up phase;

measuring time elapsing during power delivery;

monitoring operation of said heat delivery device; and

if said operation of said heat delivery device during or shortly after said temperature ramp-up phase is acceptable, delivering power to said heat delivery device after said temperature ramp-up phase.

25. A method of treating a hollow anatomical structure in accordance with claim 24, further comprising:

delivering power to said heat delivery device to reach a first treatment temperature; and

delivering power to said heat delivery device to reach a subsequent second treatment temperature which is lower than said first treatment temperature.

26. A method of treating a hollow anatomical structure in accordance with claim 24, wherein said heat delivery device is selected from the group consisting of an electrically driven heating element, an electrode, and a laser.

27. A method of treating a hollow anatomical structure in accordance with claim 24, wherein said heat delivery device comprises an electrically driven heating element with an energy coupling surface, said surface having a distal-to-proximal length which is at least fifteen times a width of said heating element.

28. A method of treating a hollow anatomical structure in accordance with claim 24, additionally comprising measuring a temperature of at least one of (i) at least a portion of said heat delivery device, and (ii) a portion of said hollow anatomical structure being treated.

29. A method of treating a hollow anatomical structure in accordance with claim 28, wherein monitoring operation of said heat delivery device comprises determining whether said measured temperature reaches or exceeds a target temperature within a time limit.

30. A method of treating a hollow anatomical structure in accordance with claim 28, wherein monitoring operation of said heat delivery device comprises determining whether said measured temperature falls below a target temperature within a time limit.

31. A method of treating a hollow anatomical structure in accordance with claim 29, additionally comprising proceeding to deliver power to said heat delivery device after said temperature ramp-up phase only when said target temperature is reached or exceeded within said time limit.

32. A method of treating a hollow anatomical structure in accordance with claim 30, additionally comprising proceeding to deliver power to said heat delivery device after said temperature ramp-up phase only when said target temperature falls below said target temperature within said time limit.

33. A method of treating a hollow anatomical structure in accordance with claim 24, wherein monitoring operation of said heat delivery device comprises comparing a measurement of electrical impedance with a reference waveform.

34. A method of treating a hollow anatomical structure in accordance with claim 24, additionally comprising:

if said operation of said heat delivery device during said temperature ramp-up phase is not acceptable, displaying an instruction to adjust treatment of said hollow anatomical structure.

35. A method of treating a hollow anatomical structure in accordance with claim 32, wherein displaying an instruction to adjust treatment of said hollow anatomical structure comprises displaying an instruction to adjust compression of said hollow anatomical structure.

36. A method of treating a hollow anatomical structure in accordance with claim 24, wherein said hollow anatomical structure comprises a vein.