Endarterectomy method and apparatus

• US 4,621,636 A
• Filed: 12/08/1980
• Issued: 11/11/1986
• Est. Priority Date: 07/23/1979
• Status: Expired due to Term

• Current Assignee: Thomas J. Fogarty
• Original Assignee: Thomas J. Fogarty
• Inventors: Fogarty, Thomas J.
• Primary Examiner(s): Thaler, Michael H.
• Application Number:
  US06/214,015
• Time in Patent Office: 2,164 Days
• Field of Search: 128/303 R, 128/304, 128/305, 128/347, 128/348, 128/330, 128/772, 128/DIG. 9, 128/753, 128/754, 128/757
• US Class Current: 606/159
• CPC Class Codes: A61B 17/32075 Pullback cutting; combined forward and pullback cutting, e.g. with cutters at both sides of the plaque
• CPC Class Codes: A61B 2017/320741 for stripping the intima or the internal plaque from a blood vessel, e.g. for endarterectomy

Abstract

An annular knife is pulled through an occluded artery. The knife is attached to a tangential wire which extends through a guidance catheter emplaced along the boundary line of occlusion and undiseased artery.

Claims

1. An endarterectomy instrument comprising a catheter and a guide wire, said catheter being split along its length into a distal portion having a closed distal end and a proximal portion, said portions being adapted to be disposed in end to end abutting but disconnected relation, said guide wire freely extending through both portions for substantially the full length thereof, said guide wire having affixed to its proximal end a handle member which is adapted to be engaged with the proximal end of the proximal portion of said catheter, an annular knife, and a wire carrier for said knife having a generally tangential relation therewith, whereby, after emplacement of said catheter along the interface of artery and atheromatous occlusion with said guide wire and removal of the distal portion of said catheter from said guide wire and removal of said guide wire from the proximal portion of said catheter, said wire carrier is adapted to be inserted in the emplaced proximal portion of said catheter up to said knife to thereby interconnect said wire carrier and said proximal portion of said catheter for one-way movement together.

2. For use with an artery occluded with an extensive length of arteriosclerotic material and having catheter emplacement incisions proximally and distally adjacent said material, a catheter emplaced in off-center relation within said artery along the interface of said material and the wall of said artery and extending for the full length of said material and out of said distally adjacent incision, a carrier wire extending through said catheter, and a cutting loop, having a diameter substantially corresponding to the diameter of the normal lumen of said artery, attached to said carrier wire so that said wire is generally tangentially related to said loop, said loop having a cutting edge at the side thereof which is proximal to said carrier wire, said cutting edge being disposed in a plane which defines with said carrier wire an obtuse included angle, said loop being adapted upon the conjoint pulling movement of said catheter and carrier wire through said distally adjacent incision to excise said material from said artery.

3. A method for removing arteriosclerotic occlusions from arteries comprising forming proximal and distal incisions in an artery adjacent an occlusion, introducing a catheter through the proximal incision and feeding it longitudinally of said artery in off-center relation thereto along the interface of said occlusion and said artery to so emplace the same and to extend the distal end of said catheter out of the distal incision while at the same time the proximal end of said catheter extends out of said proximal incision, providing a cutting loop attached generally tangentially to a carrier wire, said loop having a cutting edge at the side thereof which is proximal to said carrier wire, said cutting edge being disposed in a plane which defines with said carrier wire an obtuse included angle, threading said wire into and through said catheter and threading said catheter and wire along said artery so as to position said loop adjacent the proximal end of said occlusion, thereafter moving said catheter and carrier wire by pulling the same along said artery and through said distal incision to excise said occlusion with said loop, and removing the excised occlusion through said distal incision.

4. A method for excising arteriosclerotic occlusions from arteries comprising longitudinally positioning a catheter in off-center relation along the interface of occlusion and artery, placing a cutting loop having a cutting edge within said artery adjacent said occlusion in position to excise said occlusion as said positioned loop is pulled along said artery, said loop having a carrier wire attached thereto generally tangentially thereof, said carrier wire extending through said catheter, said cutting edge being disposed in a plane which defines with said carrier wire an obtuse included angle, and pulling said carrier wire and catheter along said artery to traverse said occlusion with said loop.

5. A method for excising arteriosclerotic occlusions from arteries comprising longitudinally positioning a flexible wire in off-center relation within an artery along the interface of occlusion and artery, said wire having a cutting loop, provided with a cutting edge, attached thereto in a position to excise said occlusion as said wire is pulled along said artery, said cutting edge being disposed in a plane which defines with said carrier wire an obtuse included angle, and pulling said wire along said artery to excisingly traverse said occlusion with said loop.