Methods and devices for inducing collapse in lung regions fed by collateral pathways

• US 20030228344A1
• Filed: 03/06/2003
• Published: 12/11/2003
• Est. Priority Date: 03/08/2002
• Status: Active Grant

• Current Assignee: Pulmonx Corp.
• Original Assignee: Emphasys Medical, Inc. (Pulmonx Corp.)
• Inventors: Fields, Antony J., Hundertmark, Ronald, McCutcheon, John
• Granted Patent: US 7,412,977 B2
• Time in Patent Office: Days
• US Class Current: 424/423
• CPC Class Codes: A61B 17/00491 Surgical glue applicators surgical adhesives A61L24/00; two-component delivery syringes A61M5/19
• CPC Class Codes: A61F 2/04 Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts A61F2/18, A61F2/20 take precedence; devices, other than stent-grafts, providing patency to, or preventing collapsing of, tubular structures of the body other than stent-grafts, e.g. stents A61F2/82; instruments specially adapted for placement or removal of stents or stent-grafts A61F2/95
• CPC Class Codes: A61F 2/06 Blood vessels
• CPC Class Codes: A61F 2/2412 with soft flexible valve members, e.g. tissue valves shaped like natural valves check valves with flexible valve members in general F16K15/14
• CPC Class Codes: A61F 2/2418 Scaffolds therefor, e.g. support stents
• CPC Class Codes: A61F 2/2427 Devices for manipulating or deploying heart valves during implantation
• CPC Class Codes: A61F 2/91 made from perforated sheet material or tubes, e.g. perforated by laser cuts or etched holes
• CPC Class Codes: A61F 2002/043 Bronchi
• CPC Class Codes: F16K 15/147 the closure elements having specially formed slits or being of an elongated easily collapsible form

Abstract

Disclosed are methods and devices for regulating fluid flow in one or more lung regions that are supplied fluid through one or more collateral pathways. An identified region of the lung is targeted for volume reduction or collapse. The targeted lung region is then bronchially isolated to inhibit air from flowing into the targeted lung region through bronchial pathways that directly feed air to the targeted lung region. If the targeted lung region does not collapse after bronchially isolating the targeted lung region, then it is possible that a collateral pathway is feeding air to the targeted lung region, thereby preventing the targeted lung region from collapsing. In such a case, the collateral pathway is identified and air flow into the targeted lung region via the collateral pathway is reduced or eliminated.

Claims

1. A method of regulating fluid flow for a targeted lung region, comprising:

identifying at least one collateral pathway that provides collateral fluid flow into the targeted lung region; and

performing an intervention within the lung to reduce the amount of collateral fluid flow provided to the targeted lung region through the collateral pathway.

2. A method as defined in claim 1, additionally comprising:

identifying at least one direct pathway that provides direct fluid flow into the targeted lung region;

deploying a bronchial isolation device in the direct pathway to regulate fluid flow to the targeted lung region through the direct pathway.

3. A method as defined in claim 1, wherein the targeted lung region is a portion of a lung comprised of a lung lobe, and wherein the collateral pathway comprises an incomplete interlobar fissure that is located adjacent to the lung lobe.

4. A method as defined in claim 1, wherein the targeted lung region is a portion of a lung comprised of a lung segment.

5. A method as defined in claim 1, wherein reducing the amount of collateral fluid flow provided to the targeted lung region through the collateral pathway includes:

injecting a flowable therapeutic agent into the targeted lung region or collateral pathway, wherein the flowable therapeutic agent induces a reaction in lung tissue of the targeted lung region or in the collateral pathway to reduce collateral fluid flow into the targeted lung region.

6. A method as defined in claim 5, wherein the therapeutic agent induces a reaction that glues at least a portion of the lung tissue to at least partially seal a collateral pathway into the targeted lung region.

7. A method as defined in claim 5, wherein the therapeutic agent induces a reaction that causes sclerosis in the lung tissue.

8. A method as defined in claim 5, wherein the therapeutic agent induces a reaction that promotes fibrosis in the lung tissue.

9. A method as defined in claim 5, wherein the therapeutic agent induces a reaction that inflames the lung tissue.

10. A method as defined in claim 5, wherein the therapeutic agent is a foam that expands within the targeted lung region or collateral pathway to thereby at least partially fill-up a volume contained in the targeted lung region or collateral pathway.

11. A method as defined in claim 5, wherein the therapeutic agent is a bulking agent that fills the targeted lung region or collateral pathway to thereby at least partially fill-up a volume contained in the targeted lung region or collateral pathway.

12. A method as defined in claim 5, wherein the therapeutic agent is an infective agent that induces a local infection that scars the lung tissue in the targeted lung region or collateral pathway.

13. A method as defined in claim 5, wherein injecting a flowable therapeutic agent comprises:

deploying a delivery catheter through a bronchial tree into the targeted lung region or collateral pathway such that a distal end of the delivery catheter is positioned at the targeted lung region;

flowing the flowable therapeutic agent through the delivery catheter so that the flowable therapeutic agent exits the distal end of the delivery catheter into the targeted lung region or collateral pathway.

14. A method as defined in claim 13, additionally comprising:

using the distal end of the delivery catheter to puncture a bronchial wall of a bronchial passageway located at the targeted lung region;

passing the distal end of the delivery catheter through the bronchial wall into the target lung region.

15. A method as defined in claim 13, additionally comprising:

using RF energy applied at the distal end of the delivery catheter to puncture a bronchial wall of a bronchial passageway located at the targeted lung region;

passing the distal end of the delivery catheter through the bronchial wall into the target lung region.

16. A method as defined in claim 5, wherein injecting a flowable therapeutic agent into the targeted lung region comprises percutaneously injecting the therapeutic agent into the targeted lung region.

17. A method as defined in claim 5, additionally comprising dispersing the flowable therapeutic agent through the target lung region in a controlled manner such that the flowable therapeutic agent flows toward a collateral pathway that provides collateral flow into the targeted lung region.

18. A method as defined in claim 5, additionally comprising dispersing the flowable therapeutic agent through the target lung region in a controlled manner such that the flowable therapeutic agent flows toward and into a collateral pathway that provides collateral flow into the targeted lung region.

19. A method as defined in claim 17, wherein dispersing the flowable therapeutic agent through the target lung region in a controlled manner comprises creating a pressure differential between the targeted lung region and an adjacent lung region, wherein the pressure differential encourages the flowable therapeutic agent to flow in a desired direction.

20. A method as defined in claim 19, wherein creating a pressure differential comprises:

injecting the flowable therapeutic agent into the targeted lung region at a injection pressure;

deploying a catheter into the adjacent lung region such that a distal end of the catheter is located in the adjacent lung region;

applying a suction to the distal end of the catheter to create a back pressure in the adjacent lung region, wherein the back pressure differs from the injection pressure.

21. A method as defined in claim 5, additionally comprising removing excess therapeutic agent from the targeted lung region.

22. A method as defined in claim 5, additionally comprising leaving the flowable therapeutic agent in the lung region so that the flowable therapeutic agent is absorbed into lung tissue.

23. A method as defined in claim 1, wherein reducing the amount of collateral fluid flow provided to the targeted lung region through the collateral pathway includes:

applying energy to lung tissue of the targeted lung region or collateral pathway, wherein the energy induces a reaction in lung tissue that reduces collateral flow into the targeted lung region.

24. A method as defined in claim 20, wherein the energy is emitted from a beta-radiation emitting source.

25. A method as defined in claim 1, wherein reducing the amount of collateral fluid flow provided to the targeted lung region through the collateral pathway includes:

implanting a first flow-limiting element into a direct pathway that provides direct flow into the targeted lung region, wherein the first flow limiting element regulates fluid flow into the targeted lung region through the direct pathway;

identifying a second lung region that acts as a source of collateral flow into the targeted lung region;

implanting a second flow-limiting element into a bronchial pathway that provides fluid flow into the second lung region, wherein the second flow limiting element allows fluid flow in an exhalation direction and restricts fluid flow in an inhalation direction.

26. A method as defined in claim 1, wherein reducing the amount of collateral fluid flow provided to the targeted lung region through the collateral pathway includes using a clip to at least partially clamp shut the identified collateral pathway.

27. A method as defined in claim 1, wherein reducing the amount of collateral fluid flow provided to the targeted lung region through the collateral pathway includes percutaneously sucking fluid from the targeted lung region for a time period sufficient to adhere the lung tissue in the targeted lung region in a collapsed state such that the targeted lung region will not re-inflate through collateral pathways after the suction is stopped.

28. A method as defined in claim 1, wherein reducing the amount of collateral fluid flow provided to the targeted lung region through the collateral pathway includes:

applying a first component of an adhesive into the lung;

applying a second portion of the adhesive into the lung;

causing the first and second component to contact one another at the collateral pathway, wherein the first and second components of the adhesive collectively solidify when they contact one another.

29. A method as defined in claim 1, wherein reducing the amount of collateral fluid flow provided to the targeted lung region through the collateral pathway comprises preventing the identified collateral pathway from providing collateral fluid flow into the targeted lung region.

30. A method of regulating fluid flow for a targeted lung region, comprising:

reducing direct fluid flow in a direct pathway that provides direct fluid flow to the targeted lung region; and

reducing collateral fluid flow that flows through a collateral pathway to the targeted lung region.

31. A method as defined in claim 30, wherein reducing the amount of collateral fluid flow comprises:

injecting a therapeutic agent into the targeted lung region, wherein the flowable therapeutic agent induces a reaction in lung tissue of the targeted lung region to reduce collateral fluid flow into the targeted lung region.

32. A method as defined in claim 30, additionally comprising causing the targeted lung region to collapse.

33. A method as defined in claim 32, wherein the targeted lung region collapses as a result of the therapeutic agent being absorbed by a patient'"'"'s body.

34. A method as defined in claim 33, wherein the targeted lung region collapses as a result of the targeted lung region absorbing gas that is trapped within the targeted lung region.

35. A method as defined in claim 32, wherein the targeted lung region collapses as a result of the fluid being exhaled through the flow control element implanted in the direct pathway.

36. A method as defined in claim 31, wherein the therapeutic agent is injected into the targeted lung region after reducing direct fluid flow in the direct pathway.

37. A method as defined in claim 30, additionally comprising removing the therapeutic agent from the targeted lung region.

38. A method as defined in claim 37, wherein the therapeutic agent is removed using suction.

39. A method as defined in claim 37, wherein the therapeutic agent is removed by aspirating the therapeutic agent with a needle.

40. A method as defined in claim 30, wherein the therapeutic agent is injected into the targeted lung region prior to implanting the flow control element in the direct pathway.

41. A method as defined in claim 30, wherein the therapeutic agent is injected into parenchyma of the targeted lung region.

42. A method as defined in claim 41, additionally comprising removing the therapeutic agent from the targeted lung region.

43. A method as defined in claim 41, additionally comprising removing the therapeutic agent from the targeted lung region, wherein the flow control element is implanted after the therapeutic agent is removed.

44. A method as defined in claim 30, wherein the step of reducing direct fluid flow comprises implanting a flow control element in the direct pathway.

45. A method as defined in claim 44, wherein the flow control element allows fluid flow in an exhalation direction and restricts fluid flow in an inspiration direction.