Methods and devices for cutting tissue at a vascular location

• US 8,961,546 B2
• Filed: 07/17/2012
• Issued: 02/24/2015
• Est. Priority Date: 04/22/2003
• Status: Expired due to Fees

• Current Assignee: Covidien LP (Medtronic Plc)
• Original Assignee: Covidien LP (Medtronic Plc)
• Inventors: Rosenthal, Mike, Patel, Himanshu
• Primary Examiner(s): NGUYEN, TUAN VAN
• Application Number:
  US13/551,123
• Publication Number:
  US 20120283761A1
• Time in Patent Office: 952 Days
• Field of Search: 606/159, 604/22
• 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 device for re-entering a lumen during an endovascular procedure when in a subintimal space includes a rotating cutter extending within a first lumen used for cutting tissue, and an energy emitter which emits energy through a window to locate a lumen when in a subintimal space adjacent to the lumen. The cutter is movable to a cutting position which exposes part of the cutter through a first opening so that the cutter may create a path from the subintimal space to the lumen. The cutter is movable distally relative to the elongate body to move the cutter to the cutting position and deflect the distal body portion relative to the main body portion.

Claims

1. A device for re-entering a lumen during an endovascular procedure when in a subintimal space, comprising:

an elongate body including a main body portion and a distal body portion at a distal end of the main portion, the elongate body having first and second lumens, a distal end of the first lumen opening from the body at a first opening, a distal end of the second lumen opening from the body at a second opening, the second lumen being sized to receive a guidewire;

a window in the body between the first lumen and an exterior of the body, the window being spaced from the first opening;

a rotating cutter extending within the first lumen used for cutting tissue; and

an energy emitter which emits energy through the window to locate a lumen when in a subintimal space adjacent to the lumen;

the rotating cutter being movable to a cutting position which exposes part of the rotating cutter through the first opening so that the rotating cutter may create a path from the subintimal space to the lumen,

wherein the rotating cutter is movable distally relative to the elongate body to move the rotating cutter to the cutting position and deflect the distal body portion relative to the main body portion.

2. The device of claim 1, wherein:

the energy emitter is coupled to the rotating cutter, the rotating cutter and energy emitter being coupled to a torque transmitting element which rotates the rotating cutter and the energy emitter together.

3. The device of claim 1, wherein:

the rotating cutter is gradually exposable through the first opening so that the amount of exposure may be varied in the cutting position.

4. The device of claim 1, wherein:

the rotating cutter is exposed over 180 degrees relative to an axis of rotation when in the cutting position.

5. The device of claim 1, wherein:

the rotating cutter is exposed over 270 degrees relative to the axis of rotation when in the cutting position.

6. The device of claim 1, wherein:

the distal body portion is bendable relative to the main body portion when the rotating cutter is moved distally relative to the elongate body.

7. The device of claim 1, wherein:

the energy emitter is an ultrasound emitting element.

8. The device of claim 1, wherein:

the elongate body is wider along a portion adjacent to the rotating cutter to urge tissue toward the cutting element.

9. The device of claim 1, wherein:

the elongate body is configured to move within the subintimal space to move the rotating cutter when the rotating cutter creates the path back into the lumen.

10. The device of claim 1 wherein:

the window comprises a third opening in a sidewall of the elongate body.

11. The device of claim 1 wherein:

the first opening is at a distal end of the elongate body.

12. The device of claim 1 wherein:

the first opening is distal of the window.

13. The device of claim 1, further comprising a lip on the distal body portion, wherein the rotating cutter has a surface engaging the lip and configured to cause the distal body portion to deflect when the rotating cutter is moved distally relative to the elongate body.