Methods and devices for cutting tissue at a vascular location

• US 8,246,640 B2
• Filed: 05/18/2006
• Issued: 08/21/2012
• Est. Priority Date: 04/22/2003
• Status: Active Grant

• Current Assignee: Covidien LP (Medtronic Plc)
• Original Assignee: Tyco Healthcare Group LP (Medtronic Plc)
• Inventors: Rosenthal, Mike, Patel, Himanshu
• Primary Examiner(s): NGUYEN, TUAN VAN
• Application Number:
  US11/437,849
• Publication Number:
  US 20070010840A1
• Time in Patent Office: 2,287 Days
• Field of Search: 606/106, 606/155, 606/159, 606/170, 606/167, 606/171, 606/180, 606/198, 600/459, 600/564, 600/164.01, 600/508, 600/568
• US Class Current: 606/159
• CPC Class Codes: A61B 17/00234 for minimally invasive surgery A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/22 Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for dilators A61M29/00
• 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 17/320758 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 17/320783 through side-hole, e.g. sliding or rotating cutter inside catheter
• CPC Class Codes: A61B 2017/00292 mounted on or guided by flexible, e.g. catheter-like, means
• CPC Class Codes: A61B 2017/00296 mounted on an endoscope
• CPC Class Codes: A61B 2017/00309 Cut-outs or slits
• CPC Class Codes: A61B 2017/0034 adapted to be inserted through a working channel of an endoscope
• CPC Class Codes: A61B 2017/00778 Operations on blood vessels A61B2017/22097, A61B2017/320741 take precedence
• CPC Class Codes: A61B 2017/22039 eccentric
• CPC Class Codes: A61B 2017/22077 with a part piercing the tissue A61B2017/22044 takes precedence
• CPC Class Codes: A61B 2017/22095 accessing a blood vessel true lumen from the sub-intimal space
• CPC Class Codes: A61B 2017/2927 the angular position of the head being adjustable with respect to the shaft
• CPC Class Codes: A61B 2017/320052 Guides for cutting instruments by marking A61B2090/395
• CPC Class Codes: A61B 2017/320766 eccentric
• CPC Class Codes: A61B 2017/320791 with cutter extending outside the cutting window

Abstract

A tissue cutting device includes a sizing element which detects the diameter of the vessel in which the cutting device is positioned. The sizing element is coupled to the cutting element so that the amount of the cutting element that is exposed varies in response to movement of the sizing element.

Claims

1. A method of cutting tissue at a vascular location, comprising the steps of:

providing a tissue cutting device having an elongate body with an outer surface and a lumen, a tissue cutting element, and a sizer, at least a portion of the sizer being contained within the lumen of the elongate body, the tissue cutting element being coupled to the elongate body and being movable relative to the body to a plurality of different operating positions relative to the body, the sizer also being movable relative to the body in response to a size of a vascular location in which the tissue cutting device is positioned, the sizer being operatively coupled within the lumen of the elongate body to the tissue cutting element so that the tissue cutting element is in one of the plurality of different operating positions in response to a position of the sizer;

advancing the tissue cutting device through a blood vessel;

positioning the tissue cutting device at a vascular location, the sizer automatically moving in response to a change in the size of the vascular location in which the tissue cutting device is positioned and the tissue cutting element moving relative to the body at the vascular location in response to movement of the sizer; and

cutting tissue with the tissue cutting element.

2. The method of claim 1, wherein:

the providing step is carried out with the tissue cutting element being movable relative to the body so that a cutting height of the tissue cutting element changes in each of the plurality of operating positions, the cutting height being a maximum distance from a cutting surface of the tissue cutting element to the outer surface of the body.

3. The method of claim 2, wherein:

the providing step is carried out with the cutting height of the tissue cutting element increasing when the sizer moves inward in response to a decrease in size of the vascular location.

4. The method of claim 2, wherein:

the providing step is carried out with the cutting height of the tissue cutting element decreasing when the sizer moves outward in response to an increase in size of the vascular location.

5. The method of claim 1, wherein:

the providing step is carried out with the body having an opening, the tissue cutting element being movable relative to the opening so that an amount of the tissue cutting element exposed through the opening is dependent upon a position of the sizer.

6. The method of claim 1, wherein:

the providing step is carried out with the elongate body having an opening;

the cutting step being carried out with the tissue cutting element directing the tissue through the opening.

7. The method of claim 1, wherein:

the cutting step is carried out by moving the tissue cutting element and the opening together, the tissue cutting element being rotated during cutting.

8. The method of claim 7, wherein:

the providing step is carried out with the tissue cutting device having a tissue collection element, the tissue collection element being positioned distal to the tissue cutting element;

the cutting step is carried out with the tissue cutting element being moved distally, the tissue cutting element directing the tissue distally into the tissue collection element as the tissue cutting element moves distally.

9. The method of claim 1, wherein:

the providing step is carried out with the sizer being biased outward to an outermost position, the outermost position defining a maximum width of the device defined along the sizer;

the cutting step being carried out with the sizer being moved inward by contact with the vascular location when the size of the vascular location is smaller than the maximum width of the device.

10. A method of cutting tissue at a vascular location, comprising the steps of:

providing a tissue cutting device including an elongate body having a lumen and an outer surface, a tissue cutting element having a cutting surface, and a sizer, the tissue cutting element being coupled to the elongate body and being movable relative to the body between a stored position where the tissue cutting element is contained within the lumen of the elongate body and an operating position where the tissue cutting element extends radially outwardly such that the cutting surface extends through a side opening in the elongate body beyond the outer surface of the elongate body;

the sizer also being coupled to the body and being movable relative to the body, the sizer moving relative to the body in response to a size of vascular location in which the tissue cutting device is positioned, the sizer being coupled to the tissue cutting element so that an outward force is applied to the tissue cutting element when the sizer is moved inward, the outward force on the tissue cutting element being directed away from the body and causing the tissue cutting element to move radially outwardly in relation to the body;

advancing the tissue cutting device through a blood vessel;

positioning the tissue cutting device at a vascular location, the sizer moving relative to the body in response to the lateral size of the vascular location, the outward force on the tissue cutting element being applied to the tissue cutting element to move the tissue cutting element to the operating position when the sizer moves inward relative to the body; and

cutting tissue with the tissue cutting element.

11. The method of claim 10, wherein:

the positioning step is carried out with the sizer automatically moving in response to a change in the lateral size of the vascular location in which the tissue cutting device is positioned.