Percutaneous mechanical fragmentation catheter system

• US 7,108,704 B2
• Filed: 10/07/2004
• Issued: 09/19/2006
• Est. Priority Date: 04/07/1992
• Status: Expired due to Fees

• Current Assignee: Teleflex Life Sciences Limited (Teleflex Incorporated)
• Original Assignee: Johns Hopkins University
• Inventors: Trerotola, Scott O.
• Primary Examiner(s): Dawson, Glenn K.
• Application Number:
  US10/960,773
• Publication Number:
  US 20050125016A1
• Time in Patent Office: 712 Days
• Field of Search: None
• US Class Current: 606/159
• CPC Class Codes: A61B 17/221 Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions surgical snare instruments A61B17/32056
• CPC Class Codes: A61B 17/3207 Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions A61B17/32037 takes precedence; endoscopic cutting instruments A61B17/320016
• CPC Class Codes: A61B 17/320725 with radially expandable cutting or abrading elements A61B17/32075 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 2017/22038 with a guide wire
• CPC Class Codes: A61B 2017/2212 having a closed distal end, e.g. a loop
• CPC Class Codes: A61B 2217/005 with suction drainage system

Abstract

A percutaneous thrombolytic device, also referred to herein as a percutaneous mechanical fragmentation catheter system, that includes a wire cage or basket attached to a rotational drive motor. The fragmentation basket, ensheathed in an outer catheter, is introduced into the clotted graft or vessel via an introducer sheath. When deployed, the basket will automatically conform to the inner dimensions of the vessel lumen. The rotating basket is slowly withdrawn through the clotted graft, mechanically fragmenting the clot. The fragmented, homogenized debris can be flushed into the venous system or aspirated.

Claims

1. A method for fragmenting thrombotic material in a vascular conduit comprising the steps of:

(a) introducing a fragmentation catheter in the vascular conduit, wherein the fragmentation catheter comprises an expandable distal end that automatically expands to conform to the shape and diameter of the inner lumen of the vascular conduit upon deployment of the expandable distal end;

(b) deploying the expandable distal end;

(c) rotating the expandable distal end at a speed capable of homogenizing thrombotic material; and

(d) withdrawing the rotating expandable distal end through thrombotic material in the vascular conduit.

2. The method of claim 1, wherein the expandable distal end includes a soft, flexible tip.

3. The method of claim 1, wherein the expandable distal end is made of spring tempered wire.

4. The method of claim 1, wherein the fragmentation catheter is coupled to a side arm for applying fluid or suction to the inner lumen of the vascular conduit.

5. The method of claim 1, wherein the fragmentation catheter is operably coupled at a proximal end portion thereof to a rotator unit for rotating the expandable distal end.

6. The method of claim 1, wherein the fragmentation catheter comprises a flexible drive shaft, where the expandable distal end is connected to a distal end of the flexible drive shaft.

7. The method of claim 1, wherein the fragmentation catheter comprises an outer sheath assembly slidably disposed on the flexible drive shaft for selectively receiving the expandable distal end therewithin, where the expandable distal end is deployed from the outer sheath assembly.

8. The method of claim 1, wherein the expandable distal end is rotated at a speed of 2000–

6000 rpm.

9. The method of claim 1, wherein the expandable distal end is rotated at a speed in excess of 2000 rpm.

10. The method of claim 1, wherein the expandable distal end is rotated at a speed of 3000–

4500 rpm.

11. The method of claim 1, wherein the expandable distal end is rotated at a speed of 4000 rpm.

12. The method of claim 1, wherein the speed at which the expandable distal end is rotated is controlled by a motor.

13. The method of claim 12, wherein the motor is battery operated.

14. The method of claim 1, wherein the vascular conduit is a dialysis fistulae.

15. The method of claim 1, wherein the vascular conduit is a synthetic vascular graft.

16. The method of claim 1, which further comprises checking the vascular conduit for residual thrombotic material using radiographic contrast dye under fluoroscopy.

17. The method of claim 1, wherein the fragmentation catheter comprises an outer sheath from which the expandable distal end is deployed.

18. The method of claim 17, wherein the expandable distal end is contained within the outer sheath upon introduction of the fragmentation catheter in the vascular conduit.

19. The method of claim 1, wherein a handle is attached to a proximal end of the fragmentation catheter for deploying the expandable distal end.

20. The method of claim 1, wherein the expandable distal end is advanced up to an anastomosis in step (a).

21. The method of claim 1, wherein the expandable distal end is made of memory wire, the speed at which the fragmentation member is rotated is controlled by a motor, a handle is attached to a proximal end of the fragmentation catheter for deploying the expandable distal end, the fragmentation catheter comprises an outer sheath from which the expandable distal end is deployed, the expandable distal end is contained within the outer sheath upon introduction of the fragmentation catheter in the vascular conduit, and the vascular conduit is a dialysis fistulae or a synthetic vascular graft.

22. The method of claim 1, wherein the expandable distal end is made of memory wire, the speed at which the fragmentation member is rotated is controlled by a motor, a handle is attached to a proximal end of the fragmentation catheter for deploying the expandable distal end, the fragmentation catheter comprises an outer sheath from which the expandable distal end is deployed, the expandable distal end is contained within the outer sheath upon introduction of the fragmentation catheter in the vascular conduit, the fragmentation catheter comprises a side arm for applying fluid or suction to the inner lumen of the vascular conduit, and the vascular conduit is a dialysis fistulae or a synthetic vascular graft.

23. The method of claim 1, wherein the expandable distal end is made of memory wire, the speed at which the fragmentation member is rotated is controlled by a motor, a handle is attached to a proximal end of the fragmentation catheter for deploying the expandable distal end, the fragmentation catheter comprises an outer sheath from which the expandable distal end is deployed, the expandable distal end is contained within the outer sheath upon introduction of the fragmentation catheter in the vascular conduit, the fragmentation catheter comprises a side arm for applying fluid or suction to the inner lumen of the vascular conduit, the expandable distal end comprises a soft, flexible tip at its distal end, and the vascular conduit is a dialysis fistulae or a synthetic vascular graft.

24. The method of claim 1, wherein the expandable distal end is made of memory wire, the speed at which the fragmentation member is rotated is controlled by a motor, a handle is attached to a proximal end of the fragmentation catheter for deploying the expandable distal end, the fragmentation catheter comprises an outer sheath from which the expandable distal end is deployed, the expandable distal end is contained within the outer sheath upon introduction of the fragmentation catheter in the vascular conduit, the expandable distal end is rotated at a speed in excess of 2000 rpm, and the vascular conduit is a dialysis fistulae or a synthetic vascular graft.

25. The method of claim 1, wherein the expandable distal end is made of memory wire, the speed at which the fragmentation member is rotated is controlled by a motor, a handle is attached to a proximal end of the fragmentation catheter for deploying the expandable distal end, the fragmentation catheter comprises an outer sheath from which the expandable distal end is deployed, the expandable distal end is contained within the outer sheath upon introduction of the fragmentation catheter in the vascular conduit, the expandable distal end is rotated at a speed of 3000–

4500 rpm, and the vascular conduit is a dialysis fistulae or a synthetic vascular graft.

26. The method of claim 1, wherein the expandable distal end is made of memory wire, the speed at which the fragmentation member is rotated is controlled by a motor, a handle is attached to a proximal end of the fragmentation catheter for deploying the expandable distal end, the fragmentation catheter comprises an outer sheath from which the expandable distal end is deployed, the expandable distal end is contained within the outer sheath upon introduction of the fragmentation catheter in the vascular conduit, the expandable distal end is rotated at a speed of 4000 rpm, and the vascular conduit is a dialysis fistulae or a synthetic vascular graft.

27. A method for fragmenting thrombotic material in a vascular conduit comprising the steps of:

(a) introducing a fragmentation catheter in the vascular conduit, wherein the fragmentation catheter comprises an expandable distal end that automatically expands to conform to the shape and diameter of the inner lumen of the vascular conduit upon deployment of the expandable distal end;

(b) deploying the expandable distal end;

(c) rotating the expandable distal end at a speed capable of homogenizing thrombotic material; and

(d) advancing the rotating expandable distal end through thrombotic material in the vascular conduit.

28. The method of claim 27, wherein the expandable distal end includes a soft, flexible tip.

29. The method of claim 27, wherein the expandable distal end is made of spring tempered wire.

30. The method of claim 27, wherein the fragmentation catheter is coupled to a side arm for applying fluid or suction to the inner lumen of the vascular conduit.

31. The method of claim 27, wherein the fragmentation catheter is operably coupled at a proximal end portion thereof to a rotator unit for rotating the expandable distal end.

32. The method of claim 27, wherein the fragmentation catheter comprises a flexible drive shaft, where the expandable distal end is connected to a distal end of the flexible drive shaft.

33. The method of claim 27, wherein the fragmentation catheter comprises an outer sheath assembly slidably disposed on the flexible drive shaft for selectively receiving the expandable distal end therewithin, where the expandable distal end is deployed from the outer sheath assembly.

34. The method of claim 27, wherein the expandable distal end is rotated at a speed of 2000–

6000 rpm.

35. The method of claim 27, wherein the expandable distal end is rotated at a speed in excess of 2000 rpm.

36. The method of claim 27, wherein the expandable distal end is rotated at a speed of 3000–

4500 rpm.

37. The method of claim 27, wherein the expandable distal end is rotated at a speed of 4000 rpm.

38. The method of claim 27, wherein the speed at which the expandable distal end is rotated is controlled by a motor.

39. The method of claim 38, wherein the motor is battery operated.

40. The method of claim 27, wherein the vascular conduit is a dialysis fistulae.

41. The method of claim 27, wherein the vascular conduit is a synthetic vascular graft.

42. The method of claim 27, which further comprises checking the vascular conduit for residual thrombotic material using radiographic contrast dye under fluoroscopy.

43. The method of claim 27, wherein the fragmentation catheter comprises an outer sheath from which the expandable distal end is deployed.

44. The method of claim 43, wherein the expandable distal end is contained within the outer sheath upon introduction of the fragmentation catheter in the vascular conduit.

45. The method of claim 27, wherein a handle is attached to a proximal end of the fragmentation catheter for deploying the expandable distal end.

46. The method of claim 27, wherein the expandable distal end is advanced up to an anastomosis.

47. The method of claim 27, wherein the expandable distal end is made of memory wire, the speed at which the fragmentation member is rotated is controlled by a motor, a handle is attached to a proximal end of the fragmentation catheter for deploying the expandable distal end, the fragmentation catheter comprises an outer sheath from which the expandable distal end is deployed, the expandable distal end is contained within the outer sheath upon introduction of the fragmentation catheter in the vascular conduit, and the vascular conduit is a dialysis fistulae or a synthetic vascular graft.

48. The method of claim 27, wherein the expandable distal end is made of memory wire, the speed at which the fragmentation member is rotated is controlled by a motor, a handle is attached to a proximal end of the fragmentation catheter for deploying the expandable distal end, the fragmentation catheter comprises an outer sheath from which the expandable distal end is deployed, the expandable distal end is contained within the outer sheath upon introduction of the fragmentation catheter in the vascular conduit, the fragmentation catheter comprises a side arm for applying fluid or suction to the inner lumen of the vascular conduit, and the vascular conduit is a dialysis fistulae or a synthetic vascular graft.

49. The method of claim 27, wherein the expandable distal end is made of memory wire, the speed at which the fragmentation member is rotated is controlled by a motor, a handle is attached to a proximal end of the fragmentation catheter for deploying the expandable distal end, the fragmentation catheter comprises an outer sheath from which the expandable distal end is deployed, the expandable distal end is contained within the outer sheath upon introduction of the fragmentation catheter in the vascular conduit, the fragmentation catheter comprises a side arm for applying fluid or suction to the inner lumen of the vascular conduit, the expandable distal end comprises a soft, flexible tip at its distal end, and the vascular conduit is a dialysis fistulae or a synthetic vascular graft.

50. The method of claim 27, wherein the expandable distal end is made of memory wire, the speed at which the fragmentation member is rotated is controlled by a motor, a handle is attached to a proximal end of the fragmentation catheter for deploying the expandable distal end, the fragmentation catheter comprises an outer sheath from which the expandable distal end is deployed, the expandable distal end is contained within the outer sheath upon introduction of the fragmentation catheter in the vascular conduit, the expandable distal end is rotated at a speed in excess of 2000 rpm, and the vascular conduit is a dialysis fistulae or a synthetic vascular graft.

51. The method of claim 27, wherein the expandable distal end is made of memory wire, the speed at which the fragmentation member is rotated is controlled by a motor, a handle is attached to a proximal end of the fragmentation catheter for deploying the expandable distal end, the fragmentation catheter comprises an outer sheath from which the expandable distal end is deployed, the expandable distal end is contained within the outer sheath upon introduction of the fragmentation catheter in the vascular conduit, the expandable distal end is rotated at a speed of 3000–

4500 rpm, and the vascular conduit is a dialysis fistulae or a synthetic vascular graft.

52. The method of claim 27, wherein the expandable distal end is made of memory wire, the speed at which the fragmentation member is rotated is controlled by a motor, a handle is attached to a proximal end of the fragmentation catheter for deploying the expandable distal end, the fragmentation catheter comprises an outer sheath from which the expandable distal end is deployed, the expandable distal end is contained within the outer sheath upon introduction of the fragmentation catheter in the vascular conduit, the expandable distal end is rotated at a speed of 4000 rpm, and the vascular conduit is a dialysis fistulae or a synthetic vascular graft.