Method and apparatus for advancing catheters through occluded body lumens

• US 5,366,443 A
• Filed: 10/09/1992
• Issued: 11/22/1994
• Est. Priority Date: 01/07/1992
• Status: Expired due to Term

• Current Assignee: ArthroCare Corporation (Smith & Nephew PLC)
• Original Assignee: Thapliyal and Eggers Partners
• Inventors: Eggers, Philip E., Thapliyal, Hira V.
• Primary Examiner(s): Yasko, John D.
• Assistant Examiner(s): MENDEZ, MANUEL A
• Application Number:
  US07/958,977
• Time in Patent Office: 774 Days
• Field of Search: 604/113, 604/114, 604/22, 604/41, 606/27-32, 606/35, 606/38, 606/41, 128/401, 128/402
• US Class Current: 604/114
• CPC Class Codes: A61B 18/1402 Probes for open surgery
• CPC Class Codes: A61B 18/149 bow shaped or with rotatable body at cantilever end, e.g. for resectoscopes, or coagulating rollers
• 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 2017/00026 Conductivity or impedance, e.g. of tissue
• CPC Class Codes: A61B 2017/00084 Temperature
• CPC Class Codes: A61B 2017/00097 one of the thermometric elements being an electrode or the heating element
• CPC Class Codes: A61B 2017/00101 using an array of thermosensors
• CPC Class Codes: A61B 2017/00247 Making holes in the wall of the heart, e.g. laser Myocardial revascularization
• CPC Class Codes: A61B 2017/00292 mounted on or guided by flexible, e.g. catheter-like, means
• CPC Class Codes: A61B 2017/003 Steerable
• CPC Class Codes: A61B 2017/22001 Angioplasty, e.g. PCTA
• CPC Class Codes: A61B 2017/22038 with a guide wire
• CPC Class Codes: A61B 2018/00029 open
• CPC Class Codes: A61B 2018/0016 Energy applicators arranged in a two- or three dimensional array
• CPC Class Codes: A61B 2018/00196 reciprocating lengthwise
• CPC Class Codes: A61B 2018/00392 Transmyocardial revascularisation
• CPC Class Codes: A61B 2018/00642 with feedback, i.e. closed loop control
• CPC Class Codes: A61B 2018/00678 upper
• CPC Class Codes: A61B 2018/00726 Duty cycle
• CPC Class Codes: A61B 2018/00761 Duration
• CPC Class Codes: A61B 2018/00791 : Temperature
• CPC Class Codes: A61B 2018/00797 : measured by multiple temperature sensors
• CPC Class Codes: A61B 2018/00821 : measured by a thermocouple
• CPC Class Codes: A61B 2018/00886 : Duration
• CPC Class Codes: A61B 2018/1213 : creating an arc
• CPC Class Codes: A61B 2018/126 : bipolar
• CPC Class Codes: A61B 2018/1497 : Electrodes covering only part of the probe circumference
• CPC Class Codes: A61B 2018/162 : located on the probe body
• CPC Class Codes: A61B 2090/378 : using ultrasound
• CPC Class Codes: A61B 2218/002 : Irrigation
• CPC Class Codes: A61F 2/2493 : Transmyocardial revascularisation [TMR] devices
• CPC Class Codes: A61M 25/0133 : Tip steering devices

Abstract

A catheter comprises a catheter body having a proximal end, a distal end, and an electrode array disposed near the distal end. The electrode array includes a plurality of isolated electrode terminals. The electrode array and a common electrode are connected to a high frequency power supply, and the common electrode may be located on the catheter, may be secured separately to a patient'"'"'s skin, or may be formed as part of a movable guidewire. By contacting the electrode array against a target location in the patient'"'"'s body, the target location may be selectively heated, with current density being contacted at the points of contact between the electrode terminals and the tissue or stenotic material. For example, by positioning the common electrode within a stenotic region and contacting a leading surface of the stenotic region with the electrode array, the stenotic material can be heated by applying a high frequency voltage between the electrode array and the common electrode. The stenotic region can thus be recanalized by advancing the distal end of the catheter body through the heated stenotic material.

Claims

1. A catheter system comprising:

a catheter body having a proximal end and a distal end;

an electrode array disposed near the distal end of the catheter body, said array including a plurality of electrically isolated electrode terminals disposed over a contact surface which is forwardly disposed to contact an occluding surface in a body lumen as the catheter is advanced through the lumen;

a common electrode; and

means for supplying high frequency power to said electrode array, wherein current flow to each individual electrode terminal is selectively limited or disrupted when a low resistance path exists between said electrode terminal and the common electrode.

2. A catheter system as in claim 1, wherein the common electrode is disposed on the catheter body proximally of the electrode array.

3. A catheter system as in claim 1, wherein the common electrode comprises a wire extending distally from the catheter body.

4. A catheter system as in claim 1, wherein the common electrode comprises means for external attachment to a patient'"'"'s body.

5. A catheter system as in claim 1, further comprising an interventional element disposed proximally of the electrode array on the catheter body.

6. A catheter system as in claim 5, wherein the interventional element comprises a dilatation balloon.

7. A catheter system as in claim 1, further comprising means for measuring temperature disposed near the distal end of the catheter body.

8. A catheter system as in claim 7, wherein the means for measuring temperature comprises a plurality of temperature sensing elements disposed within the electrode array.

9. A catheter system as in claim 7, whereby the means for applying the high frequency voltage comprises means for controlling the voltage based on the temperature sensed by the temperature sensing means.

10. A catheter system as in claim 1, further comprising means for individually limiting current flow through each electrode terminal in order to control current flow.

11. A catheter system as in claim 10, wherein the means for limiting current flow comprises a plurality of current limiting resistors located within the catheter body, with at least one resistor connected to each electrode terminal.

12. A catheter system as in claim 10, wherein the means for limiting current flow comprises a plurality of current limiting resistors located within the voltage applying means, with at least one resistor connected to each electrode terminal.

13. A catheter system as in claim 1, wherein the contact surface is a tapered surface at the distal end of the catheter body.

14. A catheter system as in claim 13, wherein the tapered surface is of nosecone configuration.

15. A catheter comprising:

a catheter body having a proximal end, a distal end, and a guidewire lumen;

an electrode array disposed near the distal end of the catheter body, said array including a plurality of isolated electrode terminals disposed over a tapered distal contact surface; and

means at the proximal end of the catheter body for simultaneous connecting each individual isolated electrode terminal to a high frequency power supply.

16. A catheter as in claim 15, further comprising a plurality of current limiting resistors disposed in the catheter body, with at least one resistor connected in series between each electrode terminal and the power supply.

17. A catheter as in claim 15, wherein the means for connecting comprises a plurality of conductors disposed in the catheter body for connecting the resistors to the power supply.

18. A catheter as in claim 15, further comprising an interventional element disposed proximally of the electrode array on the catheter body.

19. A catheter as in claim 18, wherein the interventional element comprises a dilatation balloon.

20. A catheter as in claim 18, further comprising means for measuring temperature disposed near the distal end of the catheter body.

21. A catheter as in claim 20, wherein the means for measuring temperature comprises a plurality of temperature sensing elements distributed within the electrode array.

22. A catheter as in claim 15, further comprising a movable guidewire slidable disposed within the guidewire lumen, wherein said guidewire is electrically isolated from the electrode array and includes a common electrode and means for connecting the common electrode to a high frequency power supply.

23. A catheter as in claim 15, further comprising a common electrode disposed on the catheter body proximally of the electrode array.

24. A catheter as in claim 15, wherein the current limiting resistors have a resistance in the range from 500Ω

to 50,000Ω

.

25. A catheter as in claim 15, wherein the electrode array includes at least 20 electrode terminals disposed over the tapered surface at the distal end of the catheter body.

26. A catheter as in claim 25, wherein the tapered surface is of nosecone configuration.

27. A catheter system comprising:

a catheter guide having a proximal end, a distal end, a lumen therethrough, and a common electrode disposed on an exterior distal surface;

a catheter body disposed within the lumen of the catheter guide, said catheter body having a proximal end, a distal end, and an electrode array disposed substantially uniformly over a contact surface at the distal end, said electrode array including a plurality of electrically isolated electrode terminals, wherein the contact surface is forwardly disposed to contact an occluding surface in a body lumen as the catheter is advanced through the body lumen; and

means for individually connecting the electrode terminals to a high frequency power supply along isolated high impedance conductive paths;

whereby the common electrode and the electrode array may be connected to a high frequency power supply to efficiently deliver energy to a patient surface contacted by the electrode array and electrically exposed to the common electrode.

28. A catheter system as in claim 27, wherein the catheter guide comprises an inflatable balloon disposed near its distal end.

29. A catheter system as in claim 27, further comprising a guidewire received in a guidewire lumen in the catheter body, wherein the guidewire is electrically coupled to the electrode array.

30. A catheter system as in claim 27, wherein the means for connecting comprises a plurality of current limiting resistors connected in parallel between the individual electrode terminals and a common pole of the power supply.

31. A catheter systems as in claim 30, wherein the current limiting resistors are disposed in the distal end of the catheter body.

32. A catheter system as in claim 28, wherein the contact surface is tapered.

33. A catheter system as in claim 32, wherein the tapered surface is of nosecone configuration.

34. A method for applying energy to an occluding surface in a body lumen, said method comprising:

positioning a catheter within the body lumen so that an electrode array including a plurality of forwardly disposed isolated electrode terminals contacts the surface; and

supplying high frequency power to said each of the electrode terminals in the electrode array, wherein current flow through each electrode terminal is individually controlled, wherein the surface is heated by the flow of current from individual electrode terminals which contact the surface and current flow from the terminals which do not contact the surface is limited or disrupted.

35. A method as in claim 34, wherein a common electrode is contacted against the patient as part of a guidewire.

36. A method as in claim 35, wherein the catheter is positioned over the guidewire.

37. A method as in claim 34, wherein a common electrode is contacted against the patient'"'"'s skin.

38. A method as in claim 34, wherein a common electrode is disposed within the body lumen to form a conductive path through a fluid within the body lumen.

39. A method as in claim 34, wherein the high frequency voltage is in the range from 50 kHz to 2 MHz and the voltage is in the range from two volts to 100 volts.

40. A method as in claim 34, further comprising measuring temperature at an interface between the electrodes and the stenotic material.

41. A method as in claim 40, further comprising controlling the applied power based on the measured interface temperature.

42. A method as in claim 34, further comprising advancing an interventional element into the opening and treating the occluded region with the interventional element.

43. A method as in claim 42, wherein the interventional element is an expandable balloon on the catheter body and treating comprises expanding the balloon within the opening.

44. A catheter comprising:

a catheter body having a proximal end, a distal end, and a guidewire lumen;

an electrode array disposed near the distal end of the catheter body, said array including at least 20 isolated electrode terminals disposed over a distal contact surface;

means at the proximal end of the catheter body for simultaneously connecting each individual isolated electrode terminal to a high frequency power supply.