Method and apparatus for removal of enclosed abnormal deposits

• US 4,445,509 A
• Filed: 02/04/1982
• Issued: 05/01/1984
• Est. Priority Date: 02/04/1982
• Status: Expired due to Term

• Current Assignee: Boston Scientific Corporation Northwest Technology Center Inc. (Boston Scientific Corporation)
• Original Assignee: David C. Auth
• Inventors: Auth, David C.
• Primary Examiner(s): Cohen, Lee S.
• Assistant Examiner(s): Sykes, Angela D.
• Application Number:
  US06/345,656
• Time in Patent Office: 817 Days
• Field of Search: 128/304-305, 128/749, 128/751-754, 128/757-758, 128/303 R, 604/22, 604/35, 604/93, 604/118, 604/164, 604/266
• US Class Current: 606/159
• CPC Class Codes: A61B 17/22031 Gripping instruments, e.g. forceps, for removing or smashing calculi A61B17/221 takes precedence
• CPC Class Codes: A61B 17/320758 with a rotating cutting instrument, e.g. motor driven A61B17/320725, A61B17/32075 and A61B17/320783 take precedence; for removing intra-ocular material A61F9/00763; endoscopic rotatable cutting instruments A61B17/32002
• CPC Class Codes: A61B 2017/22074 the instrument being only slidable in a channel, e.g. advancing optical fibre through a channel
• CPC Class Codes: A61B 2217/005 with suction drainage system
• CPC Class Codes: A61B 2217/007 with irrigation system

Abstract

A device for safe removal of abnormal deposits, primarily in the human body, where differential cutting properties provide for fracture of hard matter while safely preserving soft tissue. The device includes a rotating cutting tool having spirally shaped cutting flutes having hardness-differential cutting properties. The tool is driven from outside the body by means of a flexible drive shaft at greater than 2000 revolutions per minute. A channel is incorporated in the drive shaft for adding or removing chemical matter from the internal body space to provide systematic removal of cutting debris from abnormal deposits. The cutting tool has fluid ports which communicate with the drive shaft channel. The fluid ports may be at the nose of the tool as well as around its cicumference. In the latter instance, the ports extend from in front of a cutting flute into a center cavity with a circumferential component so that rotation tends to force blood into these ports. External mass transfer machines aid in injecting or withdrawing material, such as cutting debris. Auxiliary instrumentation, such as fluoroscopy and pressure measuring apparatus, are helpful in the clinical procedure. Multiple operational cycles are easily implemented to gradually dissect the deposit while periodically reestablishing physiological viability, such as blood flow in vessels.

Claims

1. A cutting tool for removing abnormal deposits, comprising a cylindrically symmetric body having a center cavity and a nose , at least one cutting flute extending along the outer surface of said body each cutting flute having a circumferentially facing cutting face formed thereon, and a radial fluid port extending from in front of a respective face of a flute into said center cavity, each port having a circumferential component extending into said cavity away from said cutting face whereby rotation of said cutting tool within a blood vessel about the major axis of said body has a tendency to force blood inwardly through said port.

2. The cutting tool of claim 1, further including a nose fluid port extending along said major axis from the nose of said body to said center cavity.

3. The cutting tool of claim 2 wherein each flute terminates before reaching said nose and said nose is polished to a smooth finish.

4. The cutting tool of claim 2 wherein each radial fluid port has a component extending along said major axis in a direction away from said nose so that fluid flows into said cavity away from said nose fluid port.

5. The cutting tool of claim 4 wherein each flute extends rearwardly and circumferentially away from said nose in a spiral configuration so that rotation of said cutting tool within a blood vessel has a tendency to force debris-entrained blood away from said nose and into said radial fluid port.

6. The cutting tool of claim 1 wherein the angle between the cutting face of each flute and the circumference around said body is between 90 and 130 degrees in order to maximize the ability of said cutting tool to remove relatively hard substances without cutting relatively soft material.

7. The cutting tool of claim 1 wherein each flute extends rearwardly and circumferentially from one end of said body to the other in a spiral configuration so that rotation of said cutting tool within a blood vessel in the forward direction has a tendency to force blood along the outer surface of said body.

8. A system for removing abnormal, relatively hard deposits from a relatively soft vessel, comprising:

a generally cylindrically symmetric cutting tool having a diameter that is smaller than the lumen of said vessel, said cutting tool having a nose and at least one cutting blade extending along an outer surface thereof, said at least one cutting blade being substantially exposed, each cutting blade having a cutting face intersecting the other surface of said tool at an angle causing fracture of said relatively hard deposits without cutting said relatively soft vessel;

a flexible drive shaft having one end connected to said cutting tool, said shaft having a length that is sufficient to reach from a point outside of a patient'"'"'s body through said vessel to said abnormal deposit;

a flexible guiding catheter surrounding said drive shaft over most of its length; and

rotary drive means connected to said drive shaft to rotate said cutting tool in the direction that said cutting face if facing.

9. The system of claim 8 wherein said drive shaft contains a hollow channel and said cutting tool includes at least one fluid port communicating with said channel, said system further including a suction device communicating with said channel to draw blood and deposit debris, forming debris entrained blood, into said fluid port and through said channel.

10. The system of claim 9 wherein said drive shaft extends through said rotary drive means and terminates in a fluid manifold that communicates with said suction device.

11. The system of claim 10, further including a fluid trap communicating with said manifold for collecting said debris-entrained blood.

12. The system of claim 10, further including means for selectively preventing said suction device from applying a vacuum to said fluid manifold and wherein said manifold further includes an injection port for inserting fluid into said vessel through said manifold, drive shaft channel, and cutting tool fluid port.

13. The system of claim 9 wherein said drive shaft extends through a fluid manifold into said rotary drive means and a portion of said drive shaft within said fluid manifold includes a fluid port allowing fluid communication between said manifold and said hollow channel.

14. The system of claim 13, further including a fluid trap communicating with said manifold for collecting said debris-entrained blood.

15. The system of claim 9, further including an auxiliary fluid manifold through which said drive shaft passes, said auxiliary fluid manifold communicating with the interior of said catheter.

16. The system of claim 15, further including a second suction device communicating with said auxiliary fluid manifold to remove blood from said catheter.

17. The system of claim 9 wherein said cutting tool has a central cavity and said fluid port extends from in front of a respective edge of a cutting blade into said center cavity, said port having a circumferential component extending into said cavity in the direction opposite the direction of rotation whereby rotation of said cutting tool within a blood vessel about the major axis of said cutting tool has a tendency to force blood inwardly through said port.

18. The system of claim 17, further including a nose fluid port extending along said major axis from the nose of said tool to said center cavity.

19. The system of claim 18 wherein each blade terminates before reaching said nose and said nose is polished to a smooth finish.

20. The system of claim 18 wherein each fluid port has a component extending along said major axis in a direction away from said nose so that fluid flows into said cavity away from said nose fluid port.

21. The system of claim 20 wherein each blade extends rearwardly and circumferentially away from said nose in a spiral configuration so that rotation of said cutting tool within a blood vessel has a tendency to force blood away from said nose and into said fluid port.

22. The system of claim 9 wherein said cutting tool has a central cavity and said fluid port extends from the nose of said cutting tool into said cavity along the major axis of said cutting tool.

23. The system of claim 8 wherein the angle between the cutting face of each flute and the circumference of said cutting tool is between 90 and 130 degrees in order to maximize the ability of said cutting tool to remove said relatively hard deposits without cutting said relatively soft vessel.

24. The system of claim 8 wherein each blade extends rearwardly and circumferentially from one end of said cutting tool toward the other in a spiral configuration so that rotation of said cutting tool within said blood vessel has a tendency to force blood along the outer surface of said cutting tool toward said drive shaft.

25. The system of claim 8 wherein said rotary drive means rotates said cutting tool at at least 2000 rpm.

26. A method of removing relatively hard, abnormal deposits from a relatively soft vessel, comprising:

inserting a guiding catheter into said vessel from a point outside the body of a patient;

inserting a cutting tool mounted on a flexible drive shaft into said guiding catheter and positioning said cutting tool adjacent said deposit, said cutting tool having at least one cutting blade extending along an outer surface thereof, each blade having a cutting face intersecting an outer surface of said tool at an angle causing said cutting face to abrade said abnormal deposits without cutting said relatively soft vessel; and

rotating said drive shaft.

27. The method of claim 26 wherein said drive shaft is rotated at a speed greater than 2000 rpm.

28. The method of claim 26, further including the steps of successively withdrawing said drive shaft and cutting tool and reinserting a drive shaft having a cutting tool of a successively larger diameter until a sufficient amount of said deposit has been removed.

29. The method of claim 26 wherein said cutting tool has a least one fluid port and said drive shaft has a hollow channel communicating with said fluid port, said method further including the step of withdrawing blood and deposit debris through said fluid port and hollow channel.

30. A cutting tool for removing relatively hard abnormal deposits positioned adjacent to relatively soft body tissues, comprising;

a generally cylindrical symmetric body having at least one cutting blade projecting therefrom, said cutting blade being substantially exposed, and attaching means at one end thereof for securing said cutting tool to a rotating drive shaft, said cutting blade having a cutting face intersecting an outer surface of said body at an angle causing fracture of said abnormal deposits without cutting said body tissues at the frequency that said tool is adapted to rotate.

31. The cutting tool of claim 30 wherein each cutting blade comprises a cutting blade extending circumferentially in a spiral configuration so that rotation of said cutting tool within a blood vessel has a tendency to force blood axially along said tool.

32. The cutting tool of claim 30 wherein the angle between the cutting face of each blade and the circumference around said body is between 90 and 130 degrees in order to maximize the ability of said cutting tool to remove said abnormal deposits without cutting said body tissues.