Method and apparatus for recurrent demand injury in stimulating angiogenesis

• US 6,676,679 B1
• Filed: 11/03/2000
• Issued: 01/13/2004
• Est. Priority Date: 11/05/1999
• Status: Active Grant

• Current Assignee: Boston Scientific Scimed (Boston Scientific Corporation)
• Original Assignee: Boston Scientific Corporation
• Inventors: Mueller, Richard L., Chee, U. Hiram
• Primary Examiner(s): Hale, Gloria M.
• Application Number:
  US09/706,343
• Time in Patent Office: 1,166 Days
• Field of Search: 606/185, 606/213, 606/119, 606/220, 606/7, 606/15, 623/3.11, 623/3.26, 623/11, 128/898
• US Class Current: 606/185
• CPC Class Codes: A61B 17/3203 Fluid jet cutting instruments
• 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 17/320783 through side-hole, e.g. sliding or rotating cutter inside catheter
• CPC Class Codes: A61B 17/3478 Endoscopic needles, e.g. for infusion biopsy needles A61B10/0233; catheters with injection needles A61M25/0067
• CPC Class Codes: A61B 2017/00247 Making holes in the wall of the heart, e.g. laser Myocardial revascularization
• CPC Class Codes: A61B 2017/22077 with a part piercing the tissue A61B2017/22044 takes precedence
• CPC Class Codes: A61B 2018/00392 Transmyocardial revascularisation
• CPC Class Codes: A61B 2090/374 NMR or MRI
• CPC Class Codes: A61B 90/37 Surgical systems with images on a monitor during operation

Abstract

Various methods and devices for treating a patient who has lost, or is at risk of losing cardiac function by cardiac ischemia are disclosed. Treatment includes first imaging a patient'"'"'s heart, or a portion thereof, to identify underperfused regions of cardiac muscle, and a source of oxygenated blood that is proximate to the underperfused region. Between the underperfused regions and the oxygenated blood source, a target area is selected where thermal or mechanical injury is introduced, and optionally reintroduced, to convert initial capillary blush, resulting from the injury.

Claims

1. A method of treating a patient at risk of loss of cardiac function by cardiac ischemia, comprising:

(a) imaging the patient'"'"'s heart, or a portion thereof, to identify (i) an underperfused region of cardiac muscle, (ii) a source of oxygenated blood that is proximate a boundary of the underperfused region, and (iii) a target area that includes the underperfused-region boundary and a tissue expanse lying between the oxygenated blood supply and the boundary;

(b) at each of a plurality of sites throughout the target area, implanting a device that can be remotely activated to produce mechanical or thermal injury at its site of implantation; and

(c) at periodic intervals of between several hours and 5 days, remotely activating the device sufficiently to produce recurrent injury at the implantation sites, over a total period sufficient to convert initial capillary blush induced at the implantation sites into arterioles.

2. The method of claim 1, wherein the device is an elongate wire with barbs along its length.

3. The method of claim 2, wherein the wire has an external hook for engaging a flexible thread, the implanting includes extending the thread from the site of implantation to an external surface site of the patient, and the remotely activating includes pulling on the thread in a direction which dislodges a segment of the wire from its implantation site.

4. The method of claim 3, wherein the wire is formed of a bioerodable material.

5. The method of claim 4, wherein the wire is formed of a ferromagnetic material, and step (c) is carried out by exposing the patient to a time-varying magnetic field effective to cause recurrent injury at the implantation sites.

6. A wire device for producing recurrent injury in heart tissue, comprising:

an elongate segment having a distal end, a proximal end, and at least one barbed element along its length, said segment being adapted for implantation in a myocardial region of the heart; and

a flexible thread having a first end and a second end, the first end of the thread being attached to the proximal end of the segment, to allow repeated, remote movement of the elongate barbed segment by pulling the thread in a direction tending to dislodge the barbed segment from the heart.

7. The device of claim 6, wherein the second end of the thread is attached to a hook, the hook being adapted for engagement with a device for pulling the thread.

8. The device of claim 6, wherein the device for pulling the thread further comprises a crank mechanism.