Apparatus for percutaneously performing myocardial revascularization having means for sensing tissue parameters and method of use
First Claim
1. Apparatus for percutaneously performing myocardial revascularization comprising.a first catheter adapted for insertion into the left ventricle, the first catheter having a lumen and a distal endface movable to a plurality of sites on an endocardial surface;
- a stabilizer element disposed on the first catheter, the stabilizer element contacting the endocardial surface to stabilize the first catheter against the endocardial surface;
a cutting head disposed movable from a retracted position within the lumen of the first catheter to an extended position wherein the cutting head extends beyond the distal endface of the first catheter to form a channel in cardiac tissue; and
means for sensing a physiologic state of cardiac tissue in a region adjacent to the distal endface of the first catheter.
1 Assignment
0 Petitions
Accused Products
Abstract
Apparatus and methods for percutaneously performing myocardial revascularization are provided using a catheter having an end region that is directable to contact a patient'"'"'s endocardium at a plurality of positions. A cutting head is disposed within a lumen of the catheter and coupled to a drive tube that rotates and reciprocates the drive shaft. One or more stabilizing elements are disposed on the distal end to retain the catheter in position when the cutting head is actuated. The cutting head and drive tube include a lumen through which severed tissue is aspirated. Mechanisms and methods are provided for providing the operator with information to assess the desirability of treating a proposed site. Mechanisms also are provided for controlling the maximum extension of the cutting head beyond a distal endface of the catheter, independent of the degree of tortuosity imposed on the catheter.
-
Citations
57 Claims
-
1. Apparatus for percutaneously performing myocardial revascularization comprising.
a first catheter adapted for insertion into the left ventricle, the first catheter having a lumen and a distal endface movable to a plurality of sites on an endocardial surface; -
a stabilizer element disposed on the first catheter, the stabilizer element contacting the endocardial surface to stabilize the first catheter against the endocardial surface; a cutting head disposed movable from a retracted position within the lumen of the first catheter to an extended position wherein the cutting head extends beyond the distal endface of the first catheter to form a channel in cardiac tissue; and means for sensing a physiologic state of cardiac tissue in a region adjacent to the distal endface of the first catheter. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19)
-
-
20. Apparatus for percutaneously performing myocardial revascularization comprising.
a first catheter adapted for insertion into the left ventricle, the first catheter having a cutting head lumen, a needle lumen, and a distal endface movable to a plurality of sites on an endocardial surface; -
a first needle disposed on the first catheter movable from a retracted position within the needle lumen to an extended position extending beyond a distal endface of the first catheter, the first needle contacting and penetrating the endocardial surface to stabilize the first catheter against the endocardial surface; and a cutting head disposed movable from a retracted position within the lumen of the first catheter to an extended position wherein the cutting head extends beyond the distal endface of the first catheter to form a channel in cardiac tissue. - View Dependent Claims (21, 22, 23, 24, 25, 26, 27, 28, 29)
-
-
30. A method of percutaneously performing revascularization of a patient'"'"'s cardiac tissue, the method comprising:
-
providing a first catheter adapted for insertion into the left ventricle comprising a stabilizer element and a cutting head movable from a retracted position to an extended position; advancing a distal region of the first catheter transluminally to a position within a patient'"'"'s left ventricle; deploying the stabilizer element to stabilize the distal region of the first catheter in contact with an endocardial surface; sensing a physiologic state of cardiac tissue in a portion of the cardiac tissue adjacent to the distal endface of the first catheter; and if it is determined that myocardial revascularization in the portion of cardiac tissue adjacent to the distal endface would have a beneficial effect, advancing the cutting head from the retracted to the extended position to bore a channel into the patient'"'"'s cardiac tissue. - View Dependent Claims (31, 32, 33, 34, 35, 36, 37, 38, 39)
-
-
40. A method of percutaneously performing revascularization of a patient'"'"'s cardiac tissue, the method comprising:
-
providing a first catheter adapted for insertion into the left ventricle comprising a first needle movable from a retracted position to an extended position and a cutting head movable from a retracted position to an extended position; advancing a distal region of the first catheter transluminally to a position within a patient'"'"'s left ventricle; advancing the first needle to the extended position to penetrate and stabilize the distal region of the first catheter in contact with an endocardial surface; rotating the cutting head; and advancing the cutting head from the retracted to the extended position to bore a channel into the patient'"'"'s cardiac tissue. - View Dependent Claims (41, 42, 43, 44, 45)
-
-
46. An apparatus comprising:
-
a first catheter adapted for percutaneous insertion into a cardiac tissue, the first catheter having a needle lumen with a longitudinal axis, a stabilizer lumen radially offset from the needle lumen, and a distal endface steerable to a plurality of sites on the cardiac tissue relative to another portion of the first catheter proximal to the distal endface; a needle disposed within the needle lumen while in a retracted position, the needle moveable from the retracted position, through the distal endface, to an external position beyond the distal endface in which the needle extends in alignment with the longitudinal axis of the needle lumen from the distal endface to a distal tip of the needle, the needle having at least one lumen to inject a therapeutic agent into the cardiac tissue; a stabilizer element to stabilize the first catheter against the cardiac tissue, the stabilizer element moveable through the stabilizer lumen from an unextended position to an extended position, wherein the stabilizer element is disposed within the stabilizer lumen while in the unextended position, and wherein the stabilizer element angles in a distal direction while in the extended position; and a second catheter adapted for insertion into a left ventricle, the second catheter having a preformed bend and an inner lumen for receiving movement of the first catheter therethrough. - View Dependent Claims (47, 48, 49, 50, 51, 52, 53)
-
-
54. An apparatus comprising:
-
a first catheter adapted for percutaneous insertion into a cardiac tissue, the first catheter having a preformed bend, a needle lumen with a longitudinal axis, a stabilizer lumen radially offset from the needle lumen, and a distal endface steerable to a plurality of sites on the cardiac tissue relative to another portion of the first catheter proximal to the distal endface; a needle disposed within the needle lumen while in a retracted position, the needle moveable from the retracted position, through the distal endface, to an external position beyond the distal endface in which the needle extends in alignment with the longitudinal axis of the needle lumen from the distal endface to a distal tip of the needle, the needle having at least one lumen to inject a therapeutic agent into the cardiac tissue; a stabilizer element to stabilize the first catheter against the cardiac tissue, the stabilizer element moveable through the stabilizer lumen from an unextended position to an extended position, wherein the stabilizer element is disposed within the stabilizer lumen while in the unextended position, and wherein the stabilizer element angles in a distal direction while in the extended position; and a second catheter adapted for insertion into a left ventricle, the second catheter having a preformed bend and an inner lumen for receiving movement of the first catheter therethrough. - View Dependent Claims (55)
-
-
56. An apparatus comprising:
-
a first catheter adapted for percutaneous insertion into a cardiac tissue, the first catheter having a needle lumen with a longitudinal axis, a stabilizer lumen radially offset from the needle lumen, and a distal endface steerable to a plurality of sites on the cardiac tissue relative to another portion of the first catheter proximal to the distal endface; a needle disposed within the needle lumen while in a retracted position, the needle moveable from the retracted position, through the distal endface, to an external position beyond the distal endface in which the needle extends in alignment with the longitudinal axis of the needle lumen from the distal endface to a distal tip of the needle, the needle having at least one lumen to inject a therapeutic agent into the cardiac tissue; and a stabilizer element to stabilize the first catheter against the cardiac tissue, the stabilizer element moveable through the stabilizer lumen from an unextended position to an extended position, wherein the stabilizer element is disposed within the stabilizer lumen while in the unextended position, and wherein the stabilizer element angles in a distal direction while in the extended position. - View Dependent Claims (57)
-
Specification